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4739 Final Exam
n/a
185
Nursing
Undergraduate 4
04/03/2015

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Term
Describe increased ICP stage 1
Definition
compensatory; asymptomatic; displacement of CSF from skull to spine and vasoconstriction in attempt to decrease ICP
Term
Describe increased ICP stage 2
Definition
compensatory; altered LOC, may have slight pupil changes, everything else is normal
Term
How do you quantify changes in LOC?
Definition
Glasgow coma scale; 3 is lowest score possible, 15 is highest
Term
Describe increased ICP stage 3
Definition
ICP approaches MAP, brain is hypoxic and hypercapneic; decreased LOC, widened pulse pressure
Term
Describe cerebral perfusion pressure
Definition
CPP, MAP-ICP; determines cerebral blood flow. Should be 60-70
Term
Describe increased ICP stage 4
Definition
brain tissue herniates from high pressure to low pressure areas; increased ICP, coma, anisicoria, abnormal breathing and VS
Term
Define aniscoria
Definition
uneven pupils; CN3 compressed
Term
Which is worse: decerebrate or decorticate?
Definition
Decerebrate (thumbs are behind)
Term
Describe treatment for someone with increased ICP
Definition
induce respiratory alkalosis (PaCO2), minimize csf (drain, diuretics), decrease brain tissue (surgery)
Term
how do you treat cerebral edema
Definition
osmotic diuretics and corticosteroids
Term
What is the treatment plan focus for those with head injuries?
Definition
optimize perfusion, minimize ICP, maximize CPP
Term
Describe the use of mannitol in patients with increased ICP
Definition
lowers ICP and improves CBF
Term
What is another name for propofol?
Definition
diprivan/milk of amnesia
Term
What are the advantages of propofol use?
Definition
short duration of action and rapid elimination; can turn it off and effects disappear in minutes
Term
What 2 things should be avoided to maintain CPP?
Definition
HTN and hypotension
Term
What types of fluids should never be used on neuro patients and why? what is preferred?
Definition
hypotonic; increases edema; Ns.9
Term
What is the most common diuretic used for increased ICP and how is it prepared?
Definition
mannitol/somitrol; use filter needle to draw it up; osmotic diuretic, monitor electrolytes
Term
What happens when mannitol is used with lasix?
Definition
synergistic effects; electrolyte disturbances
Term
What are two alternate osmotic diuretics and why are they used less often?
Definition
urea and glycerol; shorter duration time
Term
What are some anticonvulsants and what levels should be checked on the patient?
Definition
phenobarbitol and dilantin; therapeutic levels
Term
What are 3 ways of treating refractory increased ICP?
Definition
mechanical hyperventilation (bag them down), hypothermia, coma
Term
Describe the use of hyperventilation to reduce ICP
Definition
used for acute episodes; use ambu bag, then ventilator to get PaCO2 in mid 30s
Term
How does hypothermia reduce ICP?
Definition
decreases cerebral metabolism; demerol is used to treat shivering b/c it increases metabolic rate
Term
How is insulin administered to critically ill patients?
Definition
IV
Term
Describe the use of a ventroculostomy
Definition
briefly drains CSF when ICP exceeds parameters
Term
Ventriculostomy stopcocks or transducers need to be placed at what level?
Definition
level of foramen monro (corner of eye and ear)
Term
What are the criteria of brain death?
Definition
coma, absence of brainstem reflexes(blink, corneal, gag), apnea
Term
___ is to a stroke as ___ is to an MI
Definition
TIA; Angina
Term
What are the clinical manifestations of a cerebrovascular disorder?
Definition
severe headache (back of the head), bloody CSF, nucchal rigidity, kernig's sign, Brudzinski’s sign, Opisthotonus
Term
Describe the use of thrombolytic therapy in treating ischemic stroke
Definition
can only be used if within 3 hrs of stroke; example is TPA
Term
What are the signs of a left hemisphere stroke?
Definition
aphasia, reading issues, quick anger
Term
What are the signs of a right hemisphere stroke?
Definition
disorientation, euphoria, loss of ability to hear tone variations
Term
Describe multiple sclerosis
Definition
progressive degenerative disorder of CNS; disseminated demyelination of nerves in brain and spinal cord; person eventually can't move at all
Term
Neuro changes from MS lead to ___ formation in the CNS
Definition
plaque
Term
What are the common S&S for ppl with MS?
Definition
motor problems (weakness/prarlysis), sensory issues (numbness), cerebellar (ataxia) and emotional issues
Term
Define ataxia
Definition
lack of control of voluntary movements
Term
Describe the use and results of a CSF analysis for someone with MS
Definition
used to diagnose the condition; increased oligoclonal IgG, higher lymphs and monos
Term
Describe the purpose of MS treatment?
Definition
treat dysfunctional immune system to prevent damage to myelin
Term
What is the most common drug used to treat MS?
Definition
interferon beta 1b (betaseron); given QOD SQ
Term
What does Avonex treat and how is it given?
Definition
MS; IM
Term
What are the most common side effects of betaseron?
Definition
flu like symptoms, weakness and headache; depression
Term
What are the 5 types of meds used to treat MS?
Definition
corticosteroids, antispasmodics, CNS stimulanst, anticholinergics (vesicare), antidepressants
Term
Describe PD
Definition
disease of basal ganglia; slows initiation and execution of movement, increased muscle tone with tremor at rest
Term
Describe the patho of PD
Definition
dopamine deficiency (inhibits)
Term
What is the nature of acetylcholine?
Definition
excitatory?
Term
What is the classic triad of PD?
Definition
tremor, rigidity, and bradykinesia
Term
Define festination
Definition
shuffling gait
Term
Describe retropulsion
Definition
when you try to walk but end up walking backwards
Term
The tremor in PD is more active when?
Definition
at rest; resting, non-intention, pill rolling
Term
Describe the rigidity in PD
Definition
increased resistance to passive motion; cogwheel rigidity
Term
list the complications of PD
Definition
dementia, dysphagia, orthostatic hypotension, sleep disorders
Term
What is the diagnostic criteria for PD?
Definition
2/3 of classic triad (tremor, rigidity, bradykinesia); positive response to PD drugs
Term
Describe levodopa
Definition
converted to dopamine to treat PD, causes n/v and is often given with carbidopa, long term use causes dyskinesias, may spontaneously stop working
Term
What are the dopamine agonists?
Definition
mirapex, requip, parlodel
Term
Describe the use of anticholinergics to treat PD
Definition
help with tremor and ease dystonia, may cause blurred vision and constipation, artane, cogentin
Term
Describe cause of ALS
Definition
neurons die causing muscles to weaken, twitch and eventually stop moving
Term
Where does ALS effect the body first?
Definition
upper body
Term
What are the symptoms of ALS?
Definition
muscle weakness, difficulty swallowing, twitching (fasciculation) and impaired use of extremeties
Term
Describe riluzole
Definition
treats ALS; slows progression by reducing glutamate levels
Term
What are the meds to treat excess salivation?
Definition
robinul, probanthine, elavil, pamelor, scopolamine
Term
Describe huntington's disease
Definition
autosomal dominant; movement disorders, impaired cognition, psychiatric disorders; targets basal ganglia and cortex of the brain
Term
What is the long term prognossi for someone with huntington's?
Definition
eventually will no longer be able to move or speak; awareness of surroundings remains intact; COD pneumonia or fall injuries
Term
What are the early symptoms of huntington's?
Definition
slight uncontrollable movements, clumsiness, mood swings, lack of concentration
Term
What are the signs of late huntington's?
Definition
involuntary movements, weight loss, difficulty with speech and swallowing
Term
What med treats the movement disorders associated with Huntington's?
Definition
xenazine
Term
Describe haldol
Definition
antipsychotic drug for huntington's that may cause respiratory issues
Term
Describe guillain-barre syndrome
Definition
acute inflammatory demyelinating polyneuropathy of the peripheral nerves causing progressive weakness; T2&4 hypersensitivity (humoral and cell mediated)
Term
Guillain-barre syndrome follows what procedures?
Definition
vaccinations, epidural anesthesia, thrombolytic agents, infection with CMV and campylobacter
Term
What is the most common trait of guillian barre?
Definition
ascending paralysis
Term
What are the initial signs of GB?
Definition
tingling in toes, lower extremity weakness; weakens withing 2-4 weeks and improves over weeks/months
Term
What are the signs of autonomic dysfunction in GB?
Definition
cardiac dysrhythmias, orthostatis hypotension, paralytic ileus,
Term
Primary treatment of GB should be focused on what?
Definition
stabilize VS and supportive care
Term
Describe the treatment for GB
Definition
corticosteroids, plasmaphoresis (removal of damaged antibodies and re-transfusion of blood cells), infusion of healthy immunoglobulin antibodies to block unhealthy ones
Term
Describe MG
Definition
autoimmune disease where autoantibodies attach acetylcholine receptors in muscles so they can't contract
Term
What other autoimmune diseases co-exist wiht MG?
Definition
hyperthyroidism, RA, lupus, scleroderma
Term
What is a classic sign of extraocular weakness in MG?
Definition
ptosis; involves CN 3,4,6
Term
Describe bulbar complaints in MG
Definition
speech difficulty, dysphagia or a combo of both; CN9-12
Term
Describe MG progression
Definition
top to bottom
Term
Describe the x ray results for someone with MG
Definition
thyoma; anterior mediastinal mass
Term
Describe the tensilon test for MG
Definition
short acting acetylcholinesterase inhibitor; improves muscle wekaness by allowing acetyl to accumulate; if condition improves, myasthenic crisis and need to increase meds, if opposite (cholinergic crissi), hold meds
Term
Describe the treatment for MG
Definition
mestinon (cholinesterase inhibitor, first line), corticosteroids, immunosuppressants, plasmaphoresis, thymectomy (thyoma present)
Term
What are some important things to remember about pyridostigmine?
Definition
administration should be timed that max effect= strenuous physical activity; causes sweating, miosis, increased salivation
Term
Describe nursing care for MG
Definition
activitis after meds, E saving, eye protection; slow small meals frequently
Term
Describe trigeminal neuralgia
Definition
causes facial pain, classic=sharp, atypical= burning; more frequent with age
Term
What are the meds used to treat trigeminal neuralgia?
Definition
antiseizure meds (tegretol, neurontin), baclofen, gamma knife radiosurgery
Term
What are some nursing interventions for post trigeminal nerve surgeries?
Definition
ice pack, no rubbing eye, teach regular dental visits, monitor for headache and bleeding
Term
Describe Bell's Palsy
Definition
acute paralysis of CN7(often occurs over nigtht). Sometimes 5/8. Deemed Bell's when no particular cause can be found
Term
Describe the nursing care for Bell's Palsy
Definition
protect eye, sip fluids through straw, facial sling, emotional support
Term
Describe DLB
Definition
dementia with lewy bodies; progressive dementia that leads to decline in thinking and independent function
Term
Describe vascular dementia
Definition
brain lesions from CDV disease cause loss of function; decreased blood supply from narrowing of arteries
Term
What are the risks for vascular dementia?
Definition
DM, obesity, smoking HTN, coronary artery disease
Term
Describe the patho of alzheimer's
Definition
gradual loss of connections between neurons and neuron death; plaques and tangles in the brain
Term
What is the most common cause of dementia?
Definition
alzheimer's
Term
What are the cholinesterase inhibitors? (used to treat alzheimer's)
Definition
aricept, exelon, galantamine, memantine
Term
Describe Celexa
Definition
antidepressants (SSRI); boost serotonin signaling in the brain; use with caution w/ dementia; increases risk of stroke and death
Term
Define parasuicide
Definition
act of self harm that lacked lethality to cause death
Term
What are the risk factors for suicide?
Definition
depression, bipolar, substance abuse, previous attempt, victim of sexual abuse
Term
Describe the nursing assessment for suicidal references
Definition
mental illness, stressors, support system; does patient have thoughts? plan? taken steps to suicide? access?
Term
What is the safety net nursing assessment for suicide prevention?
Definition
suicide contract; informs pt to take alternative actions when ideation is present
Term
When a patient makes a death related statement, when should the physician be notified?
Definition
AFTER the safety implementation
Term
Describe suicide precautions level 1
Definition
observation q30; verbal contact qh; therapeutic activities limited to the unit unless supervised by staff
Term
Describe suicide precautions level 2
Definition
Obervation q14; verbal qh; all activities limited to the unit
Term
Describe suicide precautions level 3
Definition
one to one continuous observation; verbal contact q30; body searches as ordered
Term
What are the 5 A's?
Definition
ask, advise, assess, assist, arrange
Term
What are the 5 R's?
Definition
for those unwilling to quit smoking; relevance, risks, rewards, roadblocks, repetition
Term
Describe the use of Wellbutrin and side effects
Definition
nicotine antagonist; increases extracellular amounts of norepi and dopamine; may cause insomnia and dry mouth
Term
What is an important side effect of chantix?
Definition
thoughts of suicide
Term
What are the adverse effects for the difference NRTs?
Definition
Patch: headache, dizziness, skin reaction
Lozenge and Gum: mouth soreness, upset stomach, jaw ache
Term
What is the preferred category of drugs to treat alcohol withdrawal. Specific example?
Definition
benzodiazepines; lorazepam/ativan
Term
Describe the alcohol withdrawal timeline
Definition
minor symptoms within 6 hrs; hallucinosis within 12-24 hrs. with normal VS; Withdrawal seizures within 12-48 hrs; Delirium tremens (tachycardia) 48-96 hrs.
Term
What meds will treat withdrawal seizures?
Definition
ativan/lorazepam and valium/diazepam
Term
Describe Delirium Tremens
Definition
shaking frenzy-> hyperventilation and respiratory alkalosis-> decreased cerebral blood flow
Term
Describe treatment for delirium tremens
Definition
thiamine and glucose; folate; NPO to prevent aspiration, parenteral glucose
Term
What are the meds used to treat psychomotor agitation r/t alcohol withdrawal
Definition
benzos (librium, serax), phenobarb
Term
Librium prophilactically treats what?
Definition
seizures, delirium tremens
Term
Describe wernicke-korsakoff syndrome
Definition
acute wenicke-encephalopathy -> chronic korsakoff's syndrome
Term
Describe wernicke encephalopathy
Definition
changes in mental state (dementia), ocular disturbances (nystagmus) and unsteady stance/gait (ataxia); causes stupor, low BP and seizures
Term
Describe Korsakoff syndrome
Definition
acute onset of memory impairment without cognitive deficit
Term
What are the diagnostic criteria for Korsakoff Syndrome?
Definition
amnesia, aphasia (language), apraxia (motor issues), agnosia (sensory issues), deficit in executive functions
Term
Describe executive function deficit
Definition
behavior becomes poorly controlled
Term
What are the nursing interventions for alcoholism?
Definition
don't allow patient to blame others-> acceptance; don't blame, educate
Term
Describe Antabuse (disulfiram) and its use
Definition
inhibits acetaldehyde dehydrogenase in the liver; causes acute sensitity to alcohol (immediate hangover)
Term
How does cocaine effect the brain?
Definition
increases dopamine levels; prevents it from being recycled allowing it to build up
Term
What are the effects of cocaine on the body?
Definition
pupil dilation, increased temp, BP and HR
Term
What are the serious effects of cocaine?
Definition
heart attack, stroke, sudden death; cardiac arrest -> apnea
Term
Describe withdrawal from cocaine
Definition
crash -> strong craving for more; no visible physical symptoms; irritability and delayed depression; worse than other drugs
Term
How do amphetamines work and what are their effects on the body?
Definition
release of dopamine and norepi throughout the body; dilated pupils; induced psychosis
Term
Describe coming down from Amphetamine use
Definition
begins hrs after last use; restless use and exhaustion, headaches, dizziness and hallucinations
Term
Describe amphetamine induced psychosis
Definition
paranoid delusions w/ overly aggressive behavior
Term
What are the effects of amphetamines and antidepressant use?
Definition
HTN, dysrhythmia, heart failure, stroke
Term
Describe the effects of amphetamines with alcohol/cannabis/benzos
Definition
can lead to overdose
Term
Describe the illicit use of benzos
Definition
date rape drugs, tranquilizers, withdrawal is hard to distinguish from anxiety
Term
Describe the effect of heroin use on the body
Definition
rush followed by "on the nod"; converts to morphine and binds to opioid receptors; constricted pupils
Term
Describe withdrawal from heroin
Definition
begins hrs after last use; restlessness, bone pain, diarrhea, vomiting, kicking movements
Term
What are the treatment options for heroin withdrawal?
Definition
methadone (helps with weaning), naltrexone (block drug effect), narcan (emergency treatment for OD)
Term
What effect does oxy have on the eyes?
Definition
constriction
Term
What are the addiction treatment options for oxy?
Definition
subtex and suboxone; can be prescribed outpaient
Term
Describe the effect of cannabis on the eyes?
Definition
dilate pupils; blood shot eyes
Term
Describe the effects of cannabis on users
Definition
affects brain development in use; increases risk of neurobehavioral problems in babies
Term
Describe BBT for infertility
Definition
basal body temperature; tests for ovulation, should be done every day at the same time before any activity
Term
Describe ferning
Definition
crystalization of the cervical mucous that happens during ovulation
Term
Describe normal results for a semen analysis
Definition
>2ml, 80 mill sperm, pH 7.2-7.8; >60% motility
Term
Describe Hysterosalpingogram (HSG)
Definition
tests for tubal infertility by inserting contrast dye and then x-ray; force of dye can open fallopian tube and allow conception
Term
Describe the popst-coital (sims huhner) test
Definition
assess ability of sperm to survive cervical barrier; done 1-2 days before ovulation 1-2 hrs post coitus
Term
What is the purpose of pergonal?
Definition
stimulates egg growth
Term
What is the purpose of clomid?
Definition
stimulates ovulation
Term
What value is used to measure fetal wellbeing?
Definition
HR
Term
What is normal size and glucose for an infant?
Definition
7lbs; >40
Term
How long do babies usually stay in the NICU?
Definition
until their due date
Term
What is the risk of missed abortions?
Definition
if not treated in 4-6 wks. DIC can occur
Term
Describe chronic HTN in pregnancy and the risks
Definition
previous history of HTN prior to pregnancy; no ace inhibitors, monitor BP so its not too low with meds; procardia
Term
Describe gestational HTN
Definition
occurs with pregnancy, resolved by delivery, HTN can occur within 24 hrs of delivery
Term
Describe pre-eclampsia and its risk factors
Definition
HTN with proteinuria and swelling; DTR may ; cured by delivery; AA, 1st baby, DM
Term
What is the typical treatment for pre=eclampsi and why?
Definition
Mag sulfate; prevents seizure (eclampsia), relaxes uterus and lowers BP
Term
Describe elampsia
Definition
pre-eclampsia with seizure and elevated BP; CNS irritability, at risk for meconium stained fluid from stress
Term
Describe HELLP
Definition
hemolysis, elevated liver enzymes, low platelets; n/v, persistent pain in RUQ, increasing BP
Term
Describe shoulder dystocia
Definition
shoulder is stuck under mom's pelvis in delivery; turlte sign
Term
What are the treatment options for shoulder dystocia?
Definition
stop pushing, put mom on all 4's, suprapubic pressure, extend episiotomy, woods maneuver, put baby back in and do c section
Term
Describe the management of preterm labor
Definition
labor before 37 wks.; glucocorticoids, tocolytics to decrease uterine activity (check pulse and BP), hydration and activity restrictions, procardia
Term
Describe umbilical cord prolapse
Definition
when cord lies beside or below presenting part; variable decels with increasing FHR; elevate fetus off cord and c section
Term
Describe a threatened abortion
Definition
cervix closed, uterus soft, non-tender equal to dates; can resolve or progress
Term
Describe placenta previa
Definition
bright red painless bleeding with normal uterine tone; diagnosed via ulrasound
Term
What is the management for placenta previa?
Definition
pelvic rest, NO vaginal exams and monitor blood loss; risk for post partum bleed and infection
Term
Describe placental abruption
Definition
premature separation of placenta from uterine wall; dark red vaginal bleeding with rigid board like abdomen and intense pain
Term
Why do postpartum women have higher risk of DVT/PE?
Definition
increase in clotting factors to prevent hemorrhage
Term
What is the most common cause of postpartum hemmorrhage?
Definition
boggy uterus
Term
Temps over what can indicate infection? (pregnancy)
Definition
100.4 F
Term
What is the best treatment for UTI in pregnant woman?
Definition
macrobid
Term
Describe chorioamnionitis
Definition
infection from multiple exams during prolonged labor; foul smelling lochia and high temp
Term
What are the risk factors for ectopic pregnancy?
Definition
PID, IUD use, hx of untreated STDs
Term
What are the symptoms/diagnostics of ectopic pregnancy?
Definition
unilateral sharp pelvic pain, ROM-> shock, vaginal bleeding; low quantitative HCG
Term
Describe molar pregnancy
Definition
development of benign, edematous, cystic grape like clusters; high risk for >45; uterus larger than dates, no fetal skeleton
Term
How long does a woman have to wait to get pregnant after a molar pregnancy?1
Definition
1 yr. should be on BC until then
Term
What is the purpose of an aneurysm clip?
Definition
prevents blood to get to weak area and reduce chance of rupture
Term
Describe AVM
Definition
arteriovenous malformations; arteries->veinoles causing a huge jump in pressure in small vessels
Term
What are the 3 conditions caused by CVA in the frontal lobe?
Definition
broca's aphasia, wenicke's aphasia and global aphasia
Term
Describe broca's aphasia
Definition
can understand speech but cannot speak correctly
Term
Describe wenicke's aphasia
Definition
cannot understand speech
Term
Describe global aphasia
Definition
combo of broca's and wenicke;s aphasia
Term
What are the 3 issues of a parietal lobe CVA?
Definition
contralateral neglect, gerstmann's syndrome and balint's syndrome
Term
Describe gerstmann's syndrome
Definition
L parietal damage, L/R confusion, agraphia and acalcula
Term
Describe baint's syndrome
Definition
bilateral ocular apraxia (can't control eyes, hard to focus) and optic ataxia (can't line up objects with vision)
Term
Describe scotoma
Definition
visual field defect of the occipital lobe; dots in vision, periphery gone
Term
Damage to which side of the brain is likely to lead to someone cheerful, euphoric and unaccepting of their deficit?
Definition
right hemisphere
Term
Damage to which side of the brain is likely to lead to field cuts, language deficits, confuse left and right
Definition
left hemisphere; more aware of deficits and don't want to move
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