TEST #4 C. 37 Flashcards Preview

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Flashcards in TEST #4 C. 37 Deck (131):
1

rosing sign

palpate on the left side and makes right side hurt

2

mcburneys point

appendicitis starts periumbilical and goes down to RLQ

3

rebound tenderness

press down and let go hurts; appendicits

4

autonomic nervous system signs of g. barre

postural hypotension, arrhythmia, sweating, flushed face, urinary retention

5

damaged myelin causes scar tissue and the scar tissue is called

sclerosis; multiple sclerosis

6

wheres the phrenic nerve

c3-c5

7

No problem with blood getting there but blood isn’t oxygenated

hypoxia

8

A situation of greatly reduced or interrupted blood flow; Oxygen and glucose in that blood

ischemia

9

Glutamate, the brain’s most prevalent excitatory amino acid neurotransmitter, is released in excessive quantities when blood vessels are blocked.

Excitatory amino acid injury

10

Occurs with conditions that impair the function of the blood–brain barrier and allow transfer of water and proteins from the vascular into the interstitial space.

vasogenic edema

11

an increase in intracellular fluid.

cytotoxic edema

12

normal intracranial pressure

5-15 mm hg

13

signs of intracranial pressure ; LATE SYMPTOMS

cushings triad
widening pulse pressure/hypertension
bradycardia-heart rate less than 60
irregular breathing

14

Systolic going up and diastolic is going down

widening pulse pressure

15

differentiate between cushings and shock state

SHOCK
decrease bp
increase pulse
increase respirations

CUSHINGS
increase bp
decrease pulse
decrease respirations

16

cerebral perfusion pressure in the brain is normally

70-100

17

the most common herniation syndrome.

uncal syndrome / transtentorial

18

upward herniation; less frequent

infratentorial herination

19

downward herniation

posturing

20

bruising on the brain surface or a lacerations or tearing of brain tissue.

contusions

21

basilar skull fractures 2 signs

raccoons eyes-indicative of brain injury
battle sign-bruising behind ear

22

tear in the artery

epidural hematoma

23

develops between the inner side of the skull and the dura.

epidural hematoma

24

a history of head injury and a brief period of unconsciousness followed by a lucid period in which consciousness is regained.

epidural hematoma

25

whats worse epidural or subdural

epidural because its a tear in the artery and veins bleed slower so youd want that

26

develops in the area between the dura and the arachnoid (sub-dural space)

subdural hematoma

27

subdural they can stay away from the hospital. why

slower bleed because its a vein, and in elderly the brain shrinks so more room for blood

28

a&o x4

alert and oriented to person place time and date

29

level of consciousness LOOK UP

confusion
delirium-restlessness, illusions, and incoherence of thought and speech.
obtundation-the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states
stupor-only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state
coma-state of unarousable unresponsiveness.

30

measures of loss of consciousness

glasglow coma scale measures motor response, verbal response, and eyes (pupil)

31

total score of glasglow coma

15- best response
8 or less- comatose
3-dead

32

doll eyes

when you turn their head the eyes will stay midline -not good (comatose patient)

33

they will have period of aspirations

cheyne stokes breathing

34

respiratory response in brain injury early and late

yawning is early
cheynes stokes breathing is late

35

when somebody is having a stroke its usually

in circle of willis

36

syndrome of acute focal neurologic deficit resulting from a vascular induced disorder that injures brain tissue

stroke; cva; brain attack

37

most common
Interruption of blood flow; blockage; no bleeding

ischemic stroke

38

less common
More fatal ; have a bleed; must stop bleeding

hemorrhagic

39

2 types of ischemic strokes

embolic - clot that moves
thrombotic -clot that was formed there

40

Hypertension
Smoking
Diabetes
Diet
Physical inactivity
Obesity
High blood cholesterol
Carotid Artery Disease
Peripheral Artery Disease
Atrial Fibrillation
Sickle cell disease

risk factors you can control

41

Age
Family history
Race
Gender
Prior Stroke, TIA or Heart Attack

risk factors you cannot control

42

“ministroke” is equivalent to “brain angina” and reflects a temporary disturbance in cerebral blood flow, which reverses before infarction occurs, analogous to angina in relation to heart attack.

Transient ischemic attack-

43

common predisposition for a embolic stroke

deep vein thrombosis

44

common predisposition for a hemorrhagic stroke

advancing age and hypertension

45

Most frequently fatal stroke is caused by the spontaneous rupture of an intracerebral vessel

hem stroke

46

post stroke fast

facial drooping
arm drift
speech difficulties
time

47

headache, fever, and stiffness of the neck (nuchal rigidity).

bacterial meningitis

48

what causes bacterial meningitis

pneumococcal and meningococcal.

49

infection of the brain that looks the same as meningitis but they will get more neuro signs; confusion

encephalitis

50

stages of a seizure

aura- alterations in smell, taste, visual perception, hearing, and emotional state
ictus- actual seizure
postictal - alert but very sleepy because of the increased energy, oxygen, a seizure utilizes.

51

unconsciousness along with both tonic and clonic muscle contractions.

tonic clonic seizures

52

see Neurofibrillary tangles Neuritic plaques on the scans

alzheimers

53

previously called picks disease but there are changes in behavior and problem with language

Frontotemporal Dementia (FTD)

54

Is an acute state of brain dysfunction.
Onset is usually abrupt.
Autonomic nervous system is overactive.
Is common in critical care units, postsurgically, or during withdrawal from CNS depressants (e.g., alcohol, narcotics).

delirium

55

the progressive failure of many cerebral functions.
Onset is usually gradual.
Progressive dementias produce nerve cell degeneration and brain atrophy.
Age is the greatest risk factor.

dementia

56

type of brain disorder caused by a lack of vitamin B-12, or thiamine.

Wernicke-Korsakoff syndrome

57

Rare, autosomal dominant hereditary-degenerative disorder; short arm on chromosome 4

hunington disease

58

what is another name for huntingtons disease and where does it affect

chorea; basal ganglia

59

originate in the target gland responsible for producing the hormone.

primary disorders of endocrine

60

the target gland is essentially normal, but its function is altered by defective levels of stimulating hormones or releasing hormones from the pituitary gland.

secondary disorders of endocrine

61

results from hypothalamic dysfunction… both the pituitary and target glands are under stimulated.

tertiary disorders of endocrine

62

most common cause of hyperpituitarism

pituitary adenoma, or a benign tumor arising from the anterior pituitary*

63

Exaggerated growth of the ends of extremities (fingers, hands, toes, and feet)

acromegaly

64

most common cause of acromegaly

Growth hormone secreting adenomas

65

Exaggerated growth of the ends of the extremities (fingers, hands, and toes)
Broad and bulbous nose
Protruding jaw
Slanting forehead
difficulty swallowing
Kyphosis (hunchback)
sleep apnea

acromegaly

66

Acromegaly is commonly caused by: (select all that apply)

adenomas -tumor
excessive secretion of growth hormones

67

A child’s body begins changing into that of an adult (puberty) too soon.
Early activation of hypothalamic-pituitary-gonadal gland

precocious puberty

68

How do we diagnose precocious puberty?

Physical exam
Blood test
Ultrasound

69

function of the thyroid gland

take in iodine and convert it into t3 and t4; Combine iodine and the amino acid tyrosine to make T3 and T4.

70

when thyroid hormones t3 and t4 drop too low..

pituitary gland responds to make thyroid stimulating hormone - product the hormones

71

p. 778

32.1

72

two tests to do for meningitis

Kernig and Brudzinski

73

abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest. herniation in brain

decorticate posture

74

abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward.

decerebate posture

75

inability to synthesize the thyroid hormone, or the deficiency of the thyroid stimulating hormone (TSH) secretion.

congenital hypothyroidism

76

why does congenital hypothyroidism happen

defect in thyroid anatomy
iodine deficient-not permanent
error in mechanism

77

manifestations of congenital hypothyroidism

prolonged jaundice
Respiratory and feeding difficulties
somonlence

78

manifestations of congenital hypothyroidism if it is left untreated.

creatinism -teeth delayed, mental retardation, impaired physical growth

79

regulates metabolism

t4

80

Health condition where the thyroid is not producing enough hormones, resulting in a slowed metabolic rate

acquired hypothyroidism

81

common cause of acquired hypothyroidism

Hashimoto thyroiditis: autoimmune disorder where the thyroid gland is destroyed by the immune system

82

Onset of Hashimoto

will see goiter before hypothyroidism is evident

83

Extreme fatigue *
Cold intolerance*
Weight gain despite appetite loss*
Puffy face*
dry skin
constipation
hoarse voice

acquired hypothyroidism

84

Life-threatening condition caused by Hypothyroidism

Myxedematous Coma

85

Myxedematous Coma triad

hypothermia
fluid and electrolyte imbalance
co2 retention and hypoxemia

86

A 20-year-old woman presents to the clinic with signs of peripheral edema, short stature, cold intolerance, weight gain, and her mother notices she is having trouble concentrating on her school work. She reports having heavier than normal menstrual cycles over the last few months. What diagnosis would the nurse suspect?
A: Precocious Puberty
B: Congenital Hypothyroidism
C: Hyperthyroidism
D: Acquired Hypothyroidism

acquired hypothyroidism

87

most common cause of hyperthyroidism

graves disease and diffuse goiter

88

normal sinus rhythm

1. is it regular?
2. identify the rate-count the r waves X by 10 to get the heart rate
3. is there a p for every QRS
4. QRS wide or narrow?
5. PR interval is less than .20

89

irregularly irregular
no P waves

atrial fib

90

drug to put patient on in atrial fib

anticoagulant so that can't form clots

91

racing heart
shortness of breath
light headed

symptoms of atrial fib

92

protruding eyes

Ophthalmopathy

93

manifestations of graves disease

hyperthyroidism, ophthalmopathy, goiter

94

most common type of hyperthyroidism

graves disease

95

Extremely rare form of thyrotoxicosis (excess thyroid hormone in the body)

thyroid storm

96

Tachycardia
Fever (105-106 F)
Persistent sweating
Nausea & Vomiting
Confusion
Agitation
Restlessness
Diarrhea
Unconsciousness

thyroid storm- fever is #1

97

PaCO2

35-45 respiratory

98

HCO3

22-26 metabolic

99

which one is flipped from the rest on ABGs

PaCO2 lower numbers are alk and higher are acid

100

A disease characterized by an insufficiency of all hormones produced by the adrenal cortex

addison disease

101

Hyperpigmentation
Hypoglycemia
Weight loss
Hyponatremia
Hyperkalemia
Results in dehydration, weakness, and fatigue

addison disease

102

Mrs. Jones presents to the ER with dehydration, weakness, and fatigue. She was diagnosed with Addson Disease. The nurse knows to watch for which lab values? (Select all that apply)

hyperkalemia
hyponatremia

103

hypercortisolism from any cause

cushings syndrome

104

buffalo hump
osteoporosis
weight gain
high blood pressure
pink and purple stretch marks
round face
copper tone

cushing syndrome

105

Mrs. Jones arrives at the clinic presenting with muscle weakness, thinning of the extremities, and purple striae over her abdomen. Based on these clinical manifestations, you suspect her body may be producing excess amounts of cortisol. As a good clinician, which test would you perform to support this diagnosis? Select all that apply.
A. Saliva test
B. Tensilon test
C. 24-hour urine test
D. BUN test

AC

106

Addison's disease, a condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs.

addisons

107

A life-threatening condition that occurs when there is not enough cortisol being produced

acute adrenal crisis

108

causes the adrenal gland to release cortisol

ACTH

109

if the pituitary gland is injured then what could happen

the reduction of ACTH and therefore reduction of cortisol

110

hypotension
shock
abnormal craving of salt
are the hallmark signs

acute adrenal crisis

111

A patient with known Addison disease presents to the ER after an MVA with nausea, vomiting, hypotension, abdominal pain, and shock. As a nurse, you suspect:
Cushing syndrome
Acute adrenal crisis
Thyroid storm
Myxedematous coma

acute adrenal crisis

112

all shocks has signs of

hypoeperfusion on cellular level

113

Used to diagnose hyperthyroidism or determine severity of hyperthyroidism

t3; elevated levels indicate hyperthyroidism

114

determines how thyroid is functioning

thyroid stimulating hormone

115

when TSH levels are elevated

t3 and t4 are decreased ; hypothyroidism. low levels of tsh and high levels of t3 t4 is hyperthyroidism

116

thyroid absorbs iodine from the blood to product

t3 and t4

117

radioactive iodine uptake test

measures how much iodine is in the thyroid

118

Blood levels
24-Hour Urine Cortisol Test
ACTH Stimulation Test
Insulin-Induced Hypoglycemia Test

adrenal function tests

119

An increase in ACTH from the pituitary will cause in increase in which hormone?

Cortisol
-example of a glucocorticoid released from the adrenal CORTEX

120

people with metabolic syndrome are usually what shape

apple

121

metabolic syndrome

waist >35 in women >40 in men
triglycerides >150
high density lipoproteins <50 women or <40 men
bp >130/85
fasting plasma >100

122

A state of continuous seizures lasting more than 5 minutes, or second seizure is experienced before the person has fully regained consciousness from the preceding seizure, or a single seizure lasts longer than 30 minutes.

status epileptics

123

potential complication of status epileptics

respiratory status is compromised so they are concerned about air maintenance

124

hallmark signs of intracranial pressure

headache and papillary edema

125

Rare group involve neurons-control VOLUNTARY muscle movement

Amyotrophic Lateral Sclerosis

126

who had als

lou gehrig and steven hawkings

127

what signs can be elicited by bacterial meningitis

kernigs
brudzinski

128

Normal activity of the spinal cord ceases at and below the level of injury; sites lack continuous nervous discharges from the brain

spinal shock

129

5 a's of alzheimers

amnesia- memory loss
aphasia- loss of speech
agnosia- can't recognize things
apraxia- misuse of objects; using shoe for pen
anomia- inability to remember names of things

130

whats the problem in myasthenic crisis

bulbar muscles -respiratory muscles -become weak which can lead to artifical airway

131

cause of acromegaly

Growth hormone secreting adenomas