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 |
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|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
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
|
Definition
disease of basal ganglia; slows initiation and execution of movement, increased muscle tone with tremor at rest |
|
|
Term
|
Definition
dopamine deficiency (inhibits) |
|
|
Term
What is the nature of acetylcholine? |
|
Definition
|
|
Term
What is the classic triad of PD? |
|
Definition
tremor, rigidity, and bradykinesia |
|
|
Term
|
Definition
|
|
Term
|
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
|
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
|
Definition
neurons die causing muscles to weaken, twitch and eventually stop moving |
|
|
Term
Where does ALS effect the body first? |
|
Definition
|
|
Term
What are the symptoms of ALS? |
|
Definition
muscle weakness, difficulty swallowing, twitching (fasciculation) and impaired use of extremeties |
|
|
Term
|
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
|
|
Term
|
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
|
|
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
|
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
|
Definition
|
|
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
|
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
|
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
|
|
Term
What are the cholinesterase inhibitors? (used to treat alzheimer's) |
|
Definition
aricept, exelon, galantamine, memantine |
|
|
Term
|
Definition
antidepressants (SSRI); boost serotonin signaling in the brain; use with caution w/ dementia; increases risk of stroke and death |
|
|
Term
|
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
|
Definition
ask, advise, assess, assist, arrange |
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
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
|
|
Term
What is the purpose of clomid? |
|
Definition
|
|
Term
What value is used to measure fetal wellbeing? |
|
Definition
|
|
Term
What is normal size and glucose for an infant? |
|
Definition
|
|
Term
How long do babies usually stay in the NICU? |
|
Definition
|
|
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
|
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
|
Definition
pre-eclampsia with seizure and elevated BP; CNS irritability, at risk for meconium stained fluid from stress |
|
|
Term
|
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
|
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
|
|
Term
Temps over what can indicate infection? (pregnancy) |
|
Definition
|
|
Term
What is the best treatment for UTI in pregnant woman? |
|
Definition
|
|
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
|
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
|
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
|
Definition
can understand speech but cannot speak correctly |
|
|
Term
Describe wenicke's aphasia |
|
Definition
|
|
Term
|
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
|
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
|
|
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 |
|
|