Test 1 Flashcards by Patrick Burns

Meningitis

Contagious= viral/airborne, bacterial/droplet

S/S= photo/phono-phobia, stiff neck, patechiae on chest

Treatment= viral/antiviral, bacterial/antibiotic, fungal/antifungal, IV fluids, phenytoin for seizures

Inflammation of the meniges, occurs from injuries to facial bones

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Brudzinki sign

Lift head while supine if pt flexes knees = positive

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Kermigs sign

While supine flex knee at 90degrees and extend knee, if patient feels pain in back = positive

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Encephalitis

Inflammation of brain via virus(most common), bacteria, or parasite

S/S = confusion, stiff neck

Treat = acyclovir(monitor kidney function)

Avoid opioids(mask neuro symptoms)

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Myasthenia gravis

Autoimmune disorder that effects neuromuscular junction via acetylcholine receptors

S/S = ocular/facial/throat muscle weakness and if not treated can progress to diaphragm and cause breathing issues

Treatment = initial/pyridostigmine, bromide, mestinon Next/immunosuppressive therapy plasmapheresis IV with thymectomy

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Cholenergic crisis

Over medication of acetylcholinesterase inhibitors

S/S = may develop decreased swallow/gag reflex, and inadequate cough

may have to intubate

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Myasthenic crisis

Sudden and temporary onset of MG symptoms

S/S = ptosis, diplopia, respiratory issues, impaired speech/swallowing

may have to initiate tube feeding

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Guillain-Barré syndrome (GBS)

Autoimmune attack of nerve myelin but spare Schwann cells , commonly caused by a virus

S/S = symptoms ascending diminished muscle/reflexes in lower extremities that can progress to tetraplegia

Treatment = plasmapheresis and IVIG

Interventions = may need to intubate, DVT/PE prevention, Q2 turns, relieve pressure of bony province assit w/ ROM and communication

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Parkinson’s disease

Results from decrease in dopamine causing increase in excitatory(acetylcholine) neurotransmitters

S/S - TRAP T-tremors R-rigidity A-akinesia P-postural disturbances

Treatment- levodopa, deep brain stimulation, medical marijuana

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Alzheimer’s disease

Deterioration of the brain

S/S- progressive starting with subtle memory loss escalating to further memory loss w/ decreased ability to understands concepts and consequences of actions and may even cause difficulty speaking/ambulating

Treatment- pharmacological, promoting independence

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Multiple sclerosis

Autoimmune disorder that does no spare Schwann cells

S/S- unilateral vision loss, orbital pain, diplopia, pain, ataxia, muscle spasticity

Treatment- Disease modifying therapy(requires injections), methylprednisolone, Baclofen(spasticity), encourage walking

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Bell’s palsy

Unilateral inflammation of the 7th cranial nerve

S/S- facial distortion, possible speech/eating difficulties

Treatment- corticosteroid for inflammation, analgesic/heat and cold for pain

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Amyotrophic lateral sclerosis

S/S- inc. or dec. muscle tone/spasticity, exaggerated deep tendon reflexes

Treatment- interventions to improve/maintain function= rehab, enteral feedings, Resp. Therapy

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Increased intracranial pressure (ICP)

Cerebral edema swells, intracellular, extracellular or both

S/S- slows HR, RR is irregular, decreased blood flow(cushings response)

Normal value-15to15mmhg if >20mmhg treatment required

Treatment- fluid restriction, mannitol or hypertonic solution(.3% NS)

cushings response can progress to cushings triad

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SIADH

Causes fluid overload due to decreased fluid/urine output

S/S- increased urine specific gravity(normal 1.005-1.015), decreased serum osmolality(normal 278-300), low sodium(normal 135-145)

Treatments- fluid restriction or if pt has TBI .3% NS is administered possibly with lasix

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Neurogenic shock

Bradycardia, hypotension, slow RR, warm/dry skin

Spinal cord injury

> th1 tetraplegia, <th1 paraplegia

Cause autonomic dysreflexia (onset of excessively high BP

Treatment- laminectomy

Brain tumors

Glioma- most common and aggressive malignant tumor

Meningioma- most common brain tumor and benign/slow growing

Acoustic neuroma- benign tumor of 8th cranial nerve(hearing and balance)

Primary tumors- nonfunctioning(does not secrete), functioning(secretes hormones)

Brain angioma- abnormal blood vessels

Cerebral metastasis- breast/lung cancer

Signs of brain tumor

Increased ICP, seizures, headaches, personality changes, papilledema, hemepharesis, Cushing triad(late symptom)

Headaches more common in morning and may not respond to pharmacological treatment

Assessment of brain tumors

MRI IS GOLD STANDARD

Treatment of brain tumors

Primary- surgery, radiation,chemo, drugs

Metastatic(secondary)- palliative care

Spinal cord tumors

Can be primary or metastatic(secondary)

S/S- pain, loss of reflexes above tumor level, loss of sensation or motor function

Treatment- surgery

Normal labs

PTT- 21 to 35
PT- 11 to 12.5
INR-1
Na-135 to 145
K- 3 to 5
WBC- 4 to 10
RBC- 4 to 6
Hb- 13 to 18
Hct- 36 to 50
Platelet- 150 to 400

Musculoskeletal trauma

Contusion- soft tissue injury via blunt force
Strain- injury to musculotendinous unit via over-use/stretching/stressed
sprain- injury to ligament or supporting muscle that surrounds joint

Fracture

A break in the continuity of bone S/S- deformity, shortening, crepitus, swelling, discoloration Priorities- stability, immobilization, assessment, infection Treatment- reduction(restoration of fracture fragments to anatomic alignment and rotation **if wound is sticking out cover with sterile gauze**

Hypovolemic shock

S/S- thready pulse, decreased urine output and pulse pressure, MAP below 65, RR shallow and rapid

Potential complication of fracture

-Fat embolism syndrome(FES) -Delayed Union, malunion, nonunion -venous thromboemboli - necrosis -reaction to internal or external fixation devices

Hip fracture

Very high incidence in older adults Treatment- hemiarthroplasty(hip replacement)

Casts

Made of fiberglass or plaster Major complication is compartment syndrome Other complications include pressure ulcers and disuse syndrome

Traction

Bucks traction is when weight is applied via cast to pull and keep bones in alignment Skeletal require pins be placed into leg and then weight is applied to pull and keep bones in alignment Priorities- ensures traction is aligned properly, maintaining patient in correct position, prevent skin breakdown, provide pin site care(skeletal only)

Joint replacement

Surgical replacement of joint with prosthetic Management- prevent dislocation, monitor complications and wound drainage, prevent DVT and infection

Amputation

Performed at most distal point that will heal properly Complications- hemorrhage, infection, skin breakdown, phantom limb, join contracture Priorities- promote rehab, minimize altered perception, promote mobility

Lupus

Autoimmune inflammatory disease Look for butterfly/coin shape rash, inflammation especially pericarditis/pleuritis, Abnormal labs include ANA, CSR, CBC, Treatment= corticosteroids, NSAIDS, DMARDS, reduce sum exposure

Scleroderma

Hardening/stiffness of the skin May require echo,ANA, skin biopsy to diagnose but has poor prognosis Management includes meticulous skin care, treat pain, and limit disability **can possibly impair respiratory function**

Osteoporosis

Reduction in bone density or change in bone structure, due to resorption being greater than osteogenesis Diagnosed via dexascan Treatment includes diet high in vitamin c, calcium, increase sunshine, and educating on weight loss Pharm. treatment includes calcitonin, biophosphates, or or SERMS if post menopause

Osteomyelitis

Infection of the bone aka staphylococcus aureus Can result from tissue infection, direct bone contamination, or blood borne infection Signs include tachycardia tachypnea, fever, abnormal, WBC, guarding, purulent drainage Treatment is antibiotic therapy depending on culture

Bone tumors

More often benign than malignant Malignant can come from connective tissue (sarcoma) or bone marrow (multiple myeloma) and are classified as primary Secondary tumors come from anywhere else Dishes include weakness, gait abnormalities, brittle bone, loss of control or rententiin of urine Management includes elimination or surgical removal **SPINAL METASTASIS IS A MEDICAL EMERGENCY**