Flashcards in TEST #4 C. 37 Deck (131):
palpate on the left side and makes right side hurt
appendicitis starts periumbilical and goes down to RLQ
press down and let go hurts; appendicits
autonomic nervous system signs of g. barre
postural hypotension, arrhythmia, sweating, flushed face, urinary retention
damaged myelin causes scar tissue and the scar tissue is called
sclerosis; multiple sclerosis
wheres the phrenic nerve
No problem with blood getting there but blood isn’t oxygenated
A situation of greatly reduced or interrupted blood flow; Oxygen and glucose in that blood
Glutamate, the brain’s most prevalent excitatory amino acid neurotransmitter, is released in excessive quantities when blood vessels are blocked.
Excitatory amino acid injury
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.
an increase in intracellular fluid.
normal intracranial pressure
5-15 mm hg
signs of intracranial pressure ; LATE SYMPTOMS
widening pulse pressure/hypertension
bradycardia-heart rate less than 60
Systolic going up and diastolic is going down
widening pulse pressure
differentiate between cushings and shock state
cerebral perfusion pressure in the brain is normally
the most common herniation syndrome.
uncal syndrome / transtentorial
upward herniation; less frequent
bruising on the brain surface or a lacerations or tearing of brain tissue.
basilar skull fractures 2 signs
raccoons eyes-indicative of brain injury
battle sign-bruising behind ear
tear in the artery
develops between the inner side of the skull and the dura.
a history of head injury and a brief period of unconsciousness followed by a lucid period in which consciousness is regained.
whats worse epidural or subdural
epidural because its a tear in the artery and veins bleed slower so youd want that
develops in the area between the dura and the arachnoid (sub-dural space)
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
alert and oriented to person place time and date
level of consciousness LOOK UP
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.
measures of loss of consciousness
glasglow coma scale measures motor response, verbal response, and eyes (pupil)
total score of glasglow coma
15- best response
8 or less- comatose
when you turn their head the eyes will stay midline -not good (comatose patient)
they will have period of aspirations
cheyne stokes breathing
respiratory response in brain injury early and late
yawning is early
cheynes stokes breathing is late
when somebody is having a stroke its usually
in circle of willis
syndrome of acute focal neurologic deficit resulting from a vascular induced disorder that injures brain tissue
stroke; cva; brain attack
Interruption of blood flow; blockage; no bleeding
More fatal ; have a bleed; must stop bleeding
2 types of ischemic strokes
embolic - clot that moves
thrombotic -clot that was formed there
High blood cholesterol
Carotid Artery Disease
Peripheral Artery Disease
Sickle cell disease
risk factors you can control
Prior Stroke, TIA or Heart Attack
risk factors you cannot control
“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-
common predisposition for a embolic stroke
deep vein thrombosis
common predisposition for a hemorrhagic stroke
advancing age and hypertension
Most frequently fatal stroke is caused by the spontaneous rupture of an intracerebral vessel
post stroke fast
headache, fever, and stiffness of the neck (nuchal rigidity).
what causes bacterial meningitis
pneumococcal and meningococcal.
infection of the brain that looks the same as meningitis but they will get more neuro signs; confusion
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.
unconsciousness along with both tonic and clonic muscle contractions.
tonic clonic seizures
see Neurofibrillary tangles Neuritic plaques on the scans
previously called picks disease but there are changes in behavior and problem with language
Frontotemporal Dementia (FTD)
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).
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.
type of brain disorder caused by a lack of vitamin B-12, or thiamine.
Rare, autosomal dominant hereditary-degenerative disorder; short arm on chromosome 4
what is another name for huntingtons disease and where does it affect
chorea; basal ganglia
originate in the target gland responsible for producing the hormone.
primary disorders of endocrine
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
results from hypothalamic dysfunction… both the pituitary and target glands are under stimulated.
tertiary disorders of endocrine
most common cause of hyperpituitarism
pituitary adenoma, or a benign tumor arising from the anterior pituitary*
Exaggerated growth of the ends of extremities (fingers, hands, toes, and feet)
most common cause of acromegaly
Growth hormone secreting adenomas
Exaggerated growth of the ends of the extremities (fingers, hands, and toes)
Broad and bulbous nose
Acromegaly is commonly caused by: (select all that apply)
excessive secretion of growth hormones
A child’s body begins changing into that of an adult (puberty) too soon.
Early activation of hypothalamic-pituitary-gonadal gland
How do we diagnose precocious puberty?
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.
when thyroid hormones t3 and t4 drop too low..
pituitary gland responds to make thyroid stimulating hormone - product the hormones
two tests to do for meningitis
Kernig and Brudzinski
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
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.
inability to synthesize the thyroid hormone, or the deficiency of the thyroid stimulating hormone (TSH) secretion.
why does congenital hypothyroidism happen
defect in thyroid anatomy
iodine deficient-not permanent
error in mechanism
manifestations of congenital hypothyroidism
Respiratory and feeding difficulties
manifestations of congenital hypothyroidism if it is left untreated.
creatinism -teeth delayed, mental retardation, impaired physical growth
Health condition where the thyroid is not producing enough hormones, resulting in a slowed metabolic rate
common cause of acquired hypothyroidism
Hashimoto thyroiditis: autoimmune disorder where the thyroid gland is destroyed by the immune system
Onset of Hashimoto
will see goiter before hypothyroidism is evident
Extreme fatigue *
Weight gain despite appetite loss*
Life-threatening condition caused by Hypothyroidism
Myxedematous Coma triad
fluid and electrolyte imbalance
co2 retention and hypoxemia
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
D: Acquired Hypothyroidism
most common cause of hyperthyroidism
graves disease and diffuse goiter
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
no P waves
drug to put patient on in atrial fib
anticoagulant so that can't form clots
shortness of breath
symptoms of atrial fib
manifestations of graves disease
hyperthyroidism, ophthalmopathy, goiter
most common type of hyperthyroidism
Extremely rare form of thyrotoxicosis (excess thyroid hormone in the body)
Fever (105-106 F)
Nausea & Vomiting
thyroid storm- fever is #1
which one is flipped from the rest on ABGs
PaCO2 lower numbers are alk and higher are acid
A disease characterized by an insufficiency of all hormones produced by the adrenal cortex
Results in dehydration, weakness, and fatigue
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)
hypercortisolism from any cause
high blood pressure
pink and purple stretch marks
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
Addison's disease, a condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs.
A life-threatening condition that occurs when there is not enough cortisol being produced
acute adrenal crisis
causes the adrenal gland to release cortisol
if the pituitary gland is injured then what could happen
the reduction of ACTH and therefore reduction of cortisol
abnormal craving of salt
are the hallmark signs
acute adrenal crisis
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:
Acute adrenal crisis
acute adrenal crisis
all shocks has signs of
hypoeperfusion on cellular level
Used to diagnose hyperthyroidism or determine severity of hyperthyroidism
t3; elevated levels indicate hyperthyroidism
determines how thyroid is functioning
thyroid stimulating hormone
when TSH levels are elevated
t3 and t4 are decreased ; hypothyroidism. low levels of tsh and high levels of t3 t4 is hyperthyroidism
thyroid absorbs iodine from the blood to product
t3 and t4
radioactive iodine uptake test
measures how much iodine is in the thyroid
24-Hour Urine Cortisol Test
ACTH Stimulation Test
Insulin-Induced Hypoglycemia Test
adrenal function tests
An increase in ACTH from the pituitary will cause in increase in which hormone?
-example of a glucocorticoid released from the adrenal CORTEX
people with metabolic syndrome are usually what shape
waist >35 in women >40 in men
high density lipoproteins <50 women or <40 men
fasting plasma >100
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.
potential complication of status epileptics
respiratory status is compromised so they are concerned about air maintenance
hallmark signs of intracranial pressure
headache and papillary edema
Rare group involve neurons-control VOLUNTARY muscle movement
Amyotrophic Lateral Sclerosis
who had als
lou gehrig and steven hawkings
what signs can be elicited by bacterial meningitis
Normal activity of the spinal cord ceases at and below the level of injury; sites lack continuous nervous discharges from the brain
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
whats the problem in myasthenic crisis
bulbar muscles -respiratory muscles -become weak which can lead to artifical airway