Test 4 Content

Question 1

What is the pathology behind Guillan-Barre?

Answer 1

Immune system attacks parts of the peripheral NS that involves ascending paralysis. This presents as progressive motor weakness

Question 2

Which vaccinations should you hold if a patient has had Guillian-Barre in the past 6 weeks?

Answer 2

Flu
Tdap
DTAP

Question 3

What are the complications of Guillian-Barre?

Answer 3

Acute Respiratory Failure that requires mechanical ventilation
Respiratory Acidosis

Question 4

What is the pathology behind Myasthenia Gravis?

Answer 4

Acquired autoimmune disease in which antibodies attach to Ach Receptors (primary are at neuromuscular junction and at motor end plate). This decreases the amount of nerve impulses at NMJ and therefor skeletal muscle is unable to be stimulated)

Question 5

What are the hallmark characteristics of Myasthenia Gravis?

Answer 5

Progressive muscle weakness that improves with rest
Generalized ocular palsies
Weak or incompetent eye closures
Drooping eyelid
Diplopia

Question 6

What are the symptoms of an undermedicated Myathenia Gravis Crisis?

Answer 6

Respiratory Distress
Increased HR/BP
Poor/weak cough
Dysphagia/aspiration
Bowel/Bladder control

Question 7

What are the examples of a cholinergic crisis?

Answer 7

Abdominal cramps
N/V/D
Excessive secretions
Miosis/blurred vision
Hypotension
Fasciculations
Weakness

Question 8

What is the pathology of Multiple Sclerosis?

Answer 8

Autoimmune chronic disease that involves demyelination of axons that impairs nerve impulses leading to lesions and axonal injury

Question 9

What are the 4 cardinal signs of Parkinsons?

Answer 9

Tremor (one sided on hand or leg)
Rigidity (resistance/rigidity to passive movement)
Akinesia/Bradykinesia
Postural instability

Question 10

What are the main complications of PD and Alzheimers?

Answer 10

Falls
Aspiration pneumonia
Impaired coping
Impaired cognition

Question 11

What is a tonic seizure?

Answer 11

Stiffening, rigidity of muscles, loss of consiousnes

Question 12

What is a clonic seizure?

Answer 12

Rythmic jerking of extremities, breathing irregularities, airway compromise, incontinence, postictal confusion, decreased LOC
Repetitive widespread movements

Question 13

What is an Absence seizure?

Answer 13

Periods of staring and loss of awareness

Question 14

What is a myoclonic seizure?

Answer 14

Sudden, uncontrolled jerking movements of one or more muscle groups and will not have LOC

NOT widespread

Question 15

What is an Atonic Seizure?

Answer 15

Sudden loss of msucle tone/strength but usually remains conscious and can be called drop attacks (sudden loss of muscle tone and strength)

Question 16

What is a focal/local seizure?

Answer 16

No LOC
+ Aura
Unusual unilateral sensation/movement
ANS sx

Question 17

What is a complex/partial seizure?

Answer 17

Altered level of consiousness with unsual repetitive movements that can become a tonic clonic seizure

Question 18

What is the nursing priority in the seizure postictal period?

Answer 18

Roll to side and and ensure airway is open

Question 19

What should be recorded by the nurse during a seizure?

Answer 19

Record the onset, duration, LOC, apnea, cyanosis, motor activity, incontinence

Question 20

What is the prediabetic and diabetic HA1C levels?

Answer 20

Prediabetes: 5.4-6.4%
Diabetes: >6.5

Question 21

What is the oral glucose tolerance test?

Answer 21

When they take 75 g of glucose and then recheck after 2 hours

Positive if >200 after 2 hr

Question 22

What is the somogyi phenomenon?

Answer 22

Morning hyperglycemia from the counter regulatory response to nightime hypoglycemia

Question 23

What is the intervention to the somogyi phenomenon?

Answer 23

Adequate evening and nighttime intake of food, evaluation of insulin dosage
(A protein rich snack can prevent this)

Question 24

What is the dawn phenomenon?

Answer 24

Nightime release of growth hormone
Elevation of BG between 0300 & 0600

Question 25

What is the intervention to the dawn phenomenon?

Answer 25

Increase insulin at night

Question 26

What is the pathology behind hyperglycemic hyperosmolar syndrome?

Answer 26

More common in type 2, insulin deficiency=profound hyperglycemia, dehydration and electrolyte imbalance

Question 27

How do you treat mild hypoglycemia?

Answer 27

10 to 15g of rapidly absorbed carbohydrates/glucose tabs , check BG in 15 then eat a small meal with protien

Question 28

How do you treat moderate hypoglycemia?

Answer 28

15 to 30g of rapidly absorbed carbohydrates (D50 ampule IVP), small meal in 15 to 30 minutes with protein, BG in 15 and continue to monitor

Question 29

How do you treat severe hypoglycemia?

Answer 29

Glucagon 1mg IM or SQ 2nd dose if patient remains unconscious Once resolved eat a small meal with protein Unresolved-transport to ED/Call RT

Question 30

What type of fluids should be administered for DKA?

Answer 30

hypotonic fluids 0.9NS

Question 31

Which electrolyte is used to stablize the cell membrane in DKA?

Answer 31

Calcium

Question 32

What are the insulin administration guidelines in DKA?

Answer 32

0.1unit/kg/hr Infusion 0.1unit/kg/hr with a goal of decreasing glucose by 75 mg/dL.hr

Question 33

What are the insuloin administration guidelines for HHS?

Answer 33

Insulin AFTER fluid rescuitation Bolus 0.1 unit/kg Infusion 01.unit.kg.hr with a decrease in glucose by 50-75mg/dL/hr

Question 34

What are the fluid rescutation guidelines for HHS?

Answer 34

Replace wwith NA @ 1L/hr until BP and UO are stabilized and then switch to 1/2NS

Question 35

What is the testing for diabetic neuropathy?

Answer 35

Monofilament testing q6 months-1yr in very specific places on foot where monofilaments are placed. 8-10 locations felt=normal <8=impaired

Question 36

What are the SSAs for cataracts?

Answer 36

-Blurred vision -Cloudiness -Decreased color perception -Reduced night vision -Diplopia with present opacities on inspection -Absent red reflex on exam

Question 37

What are the pre and post operative medications for catarcts?

Answer 37

Pre: Atropine Post: Antibiotics and steroids

Question 38

What are the SSAs for open angle glaucoma?

Answer 38

Foggy Vision HA Halos Decreased peripheral vision with increased IOP Cupping/atrophy of optic disc

Question 39

What are the SSAs for closed angle glaucoma?

Answer 39

Severe pain radiating to face N/V HA Halos Blurred vision Photophobia Decreased light perception w/reddened sclera Non reactive pupil Decreased visual acuity on Snellen Chart Decreased peripheral vision Rapid increase on IOP Cloudy aqueous humor Shallow anterior chamber

Question 40

What are the SSAs for macular degeneration?

Answer 40

Blurring Distortion Loss of central vision Loss of depth perception Decreased vision on Snellen

Question 41

What are the dietary treatment options for dry macular degeneration?

Answer 41

High antioxidants Carotene Vitamin E B12

Question 42

What are the treatment options for wet macular degeneration?

Answer 42

Laser to seal leaking vessels or injections to inhibit blood vessel growth

Question 43

What are the SSAs for a detached retina?

Answer 43

Painless Bright flashes of light Floaters with gray bulges/folds on retina

Question 44

What are the Interventions for a retinal tear?

Answer 44

Cryotherapy Photocoagulation Diathermy

Question 45

Which medications should be avoided when a patient is experiencing prebycusis?

Answer 45

Gentamycin/Vancomycin Furosemide NSAIDS (ibuprofen) Cisplatin (Chemo agent)

Question 46

What is the pathology behind Meniere's Disease?

Answer 46

Swelling distorts the semicircular canals, cochlea and causes a backup of fluid in the end-lymphatic sac

Question 47

What are the SSAs for Meniere's Disease?

Answer 47

Episodic tinnitus N/V Vertigo with 1 sided sensorineural loss Impaired balance

Question 48

What are the interventions for Meniere's Disease?

Answer 48

Nutrition Vestibular rehab therapy Surgery (to decompress the end lymphatic sac) Meds (duiretics, antivertiginous, antimeticsm benzos)

Question 49

What is Labrythitis?

Answer 49

Inflammation of the inner ear

Question 50

What are the SSAs of Guillian Barre?

Answer 50

Acute illness (URI, GI, flu, strep) HIV Surgery Virus (CMV, Epstein Barr, Varicella Zoster) Lupus medications Vaccines

Question 51

How is Guillian Barre Diagnosed?

Answer 51

CBC (for increased WBC) Lumbar puncture (looking for increased protein in CFS) Electromyogram (muscle response to electrical stimuli) MRI CT

Question 52

What are the diagnostic criteria for Myasthenia Gravis?

Answer 52

Thyroid Function Test Serum protein electrophoresis ACH receptor antibodies Repetitive nerve stimulation Electromyography Single fiber EMG