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N-202 Exam III
Cerebral Vascular Attack, Prostate, Seizure
108
Nursing
Not Applicable
06/11/2011

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Cards

Term
Venous Blood Flow
Definition
Draining sinuses throughout the brain. Drain into jugular vein. NO VALVES 
Term
Cerebral Vascular Accident
Definition
A neurological deficit caused by disruption of blood flow to the brain
Term
Decrease in Mortality of CVA
Definition
Control of hypertension, improved tx of TIA's, improved intervention of the acute phase(TPa) and awareness of better diet and exercise & smoking cessation has led to?
Term
Risk Factors for Stroke
Definition
HYPERTENSION, Heart Disease, DM, Sleep Apnea, Elevated Cholestorol, SMOKING,SUBSTANCE ABUSE and living in the stroke belt are all?
Term
Why does A Fib put you at risk of CVA?
Definition
Blood pools in the ventricles, clots form and can be pushed out on the next efficient stroke.
Term
Uncontrollable Risk Factors of CVA
Definition
Gender, Race, Previous TIA or Stroke and Family Hx
Term
Risk factors of CVA
Definition
Socioeconomic (low income-inexpensive high-carb diet), excessive ETOH, Oral Contraceptive use, Pregnancy, Childbirth, Menopause, Migraine's w/Aura 
Term
Classifications of Stroke
Definition

Ischemic 80%

Thrombotic & Embolic

 

Hemorrhagic 10%

Term
Characteristics of Thrombotic Stroke
Definition
Develop during sleep or within 1 hr of awakening, gradual development of ischemia, block the artery where they are formed, No LOC but Confusion. TIA often a warning sign, Hypertension increases risk 
Term
Characteristics of Embolic Stroke
Definition
Onset not r/t activity, consist of fibrin platelet clots that travel to the brain, Cardiac is the main source (A Fib), No LOC
Term
Clinical Manifestations of Ischemic Stroke
Definition
Variety of Neurological Deficits; Numbness or weakness, confusion, change in mental status, trouble speaking or understanding speech, difficulty walking, loss of balance
Term
Hemorrhagic Stroke
Definition
Caused by bleeding into the brain tissue, the ventricles or the subarachnoid space. The pathophysiology depends on the cause and type
Term
Causes of Hemorrhagic Stroke
Definition
Advancing age-vessels wear out, Hypertension, Aneurysm, Trauma, Erosion of vessels by Tumors, AV Malformations, Coagulation Disorders, Vasculitis,Drugs
Term
Aneurysm
Definition
Caused by a dilation of the walls of a cerebral artery that develop as a result of weakness in the wall
Term
Arterial Venous Malformation
Definition
Caused by a abnormality in embryonic development that leads to a tangle of arteries and veins in the brain.  
Term
Clinical Manifestations of Hemorrhagic Stroke
Definition
Sudden Severe Headache, Neuro deficits, CHANGE IN LOC, Pain, Stiff Neck, Nuchal Rigidity, Visual Disturbances, Tinitis & Diziness
Term
TIA
Definition
Temporary clog of artery. Most damaging strokes are not preceded by TIA's however of those who have had >1 a 1/3 will have a stroke. OCCUR RAPIDLY-GO AWAY QUICLY, LASTS<1HR (CT SCAN) 
Term
RIND
Definition
Recovery is Total. Considered minor ischemic stroke, caused by thrombus or emboli in artery, subsequent infarction greater than TIA, S/S Last >1hr to few days, PT NEEDS TREATMENT
Term
Evolving Stroke
Definition
 Continues until it is Complete. Progressive deterioration or pattern of inceasing neuro deficits occurring over time. Worsening within 7 days of onset. Develops over minutes or hours
Term
Completed Stroke
Definition
Patient is left with deficits--->rehab needed. Neuro deficits remain unchanged. Occurs over2/3days. 
Term
T/F: Rule in ischemic stroke by ruling out hemorrhagic via CT Scan
Definition
TRUE
Term
T/F: Patient with confirmed Hemorrhagic Stroke should be placed in SIM's position?
Definition
FALSE, due to intercranial pressure pt should remain in semi-fowler's 
Term
S/S OF Increased Intercranial Pressure IICP
Definition
LOC, Headache, Abnormal RR, Increased BP w/widening pulse pressure, Bradycardia, Increase T, N/V projectile, Vision Problems, Pupil Changes, Blown Dilated, Pinpoint Pupils, Change in VS
Term
Care of IICP Patient
Definition
Elevate head of bed 30 to 40 degrees, prevent flexion of neck, AVOID TRENDELENBERG, monitor respiratory status to prevent hypoxia, prevent shivering, instruct patient to avoid straining, AVOID VALSALVA'S MANEUVER, Medications, IMPROVED LOC & DIURESIS mean RX is working
Term
What is tPA?
Definition
Tissue Plasminogen Activase for Ischemic Strokes ONLY. Reestablished flow to blocked arteries. Clot specific to be administered w/in 3hrs of CVA  onset.
Term
Right Side CVA
Definition
Safety  Issues, Impulsivity, Weakness on Left Sde
Term
Left Side CVA
Definition
Cautious, Emotionally Unstable, Aware of Deficits
Term
What do Early Stages of CVA resemble? Examples?
Definition

Rag Doll-Flaccid Paralysis

Hypotonia, Hyporefelxia, Hip rotated externally & facial weakness. See changes from face downward.

Term
Nursing care Early Stages
Definition
Support the affected limbs side. Elevate the affected limb (distal to proximal), ROM exercises,Assist w/balance, work on weight bearing. Help pt feel secure and stable
Term
Late Stages-Hemiplegia
Definition
Paralysis on one side. Think Rigor Mortis. Adductors and Flexors are stronger, hypertonia resistance. Increased resistance to motion, increased tone, spasticity. Deep tendon refelxes exagerated, limbs drawn to midline. Prop in extension position. Use Splints
Term
T/F When Rehab of CVA pt, advance to sitting up Before ROM exercises
Definition

FALSE:

Begin w/ROM then advance to sitting up. Monitor for orthostatic hypotension

Term
Place CVA pt in prone positon for _ to _min daily to_________________?
Definition
15 to 30 min daily to promote hyperextension of the hip joint. This prevents contractual deformaties of shoulders and knees. CHANGE POSITIONS Q2HRS
Term
Speech vs. Language
Definition

Speech: sounds, utterances

Language: symbols connected with concrete objects

Term
Expressive Aphasia
Definition
Broca's Aphasia-Difficulty speaking and writing. (Tom Brokaw)
Term
Receptive Aphasia
Definition
Wernicke's Aphasia- Difficulty understanding spoken/written word. Speech is Meaningless (Sam Witwicky TRNSFRM II college breakdown)
Term
Global Aphasia
Definition
Expressive & Receptive combined
Term
Dysarthria
Definition
Disturbance in muscular control, not meaning of language, simply the mechanics do not work (lips)
Term
Homonymous Hemianopsia
Definition
Loss of field vision on the same side in both eyes.
Term
 Acute Care of H. Hemianopsia patient rehab
Definition
Place obects on the patients unaffected side. Place pt so that unaffected side is toward the door-so you won't startle them
Term
Care of H. Hemianopsia Pt during active rehab.
Definition
Place objects necessary for  ADL's on pt's affected side. This promotes scanning of the rooms to work at seeing
Term
Unilateral neglect
Definition

Rare but Serious; failure to perceive stimuli coming from one side of the brain. The stimuli may be auditory, visual or tactile.

CORPUS COLLUSUM DAMAGE

Term
Strokes Impair?
Definition
Memory & Judgement. 
Term
Elimination during Acute Phase
Definition
Pt is flaccid needs catheter, monitor I & O's & Bowel. Begin stool softener, laxatives. No enemas to patient @risk for IICP.
Term
Elimination during Late Phase
Definition
Remove catheter, bedside commode. Check for abdominal distention, bladder scan. Bladder training may be necessary 2 Q hrs
Term
What is # 1 leading cause of death after a CVA
Definition
Aspiration Pneumonia
Term
How to Prevent CVA
Definition
CONTROL HYPERTENSION, Smoking cessatio, Rx for hyperlipidemia, diet & weight loss, Anti platelet Rx for chronic A Fib, routine health exams
Term
Carotid Endartercetomy
Definition
Carotic Angioplasty and stenting for pt's at poor surgical risk. > 70% occlusion. PREVENTS STROKES IN PT'S WITH CAROTID STENOSIS
Term
Prostate
Definition
Makes and stores seminal fluid. Located b/t bladder and anterior to rectum. Encirlces upper part of urethra. REQUIRES MALE HORMONES TO FUNCTION PROPERLY
Term
Parts of body with androgen receptors will respond to?
Definition
Testostorone, converts to dihydrotestosterone; androgen responsible for stimulating prostate growth.
Term

Causes of BPH are?

1-5

Definition

1.Age >50

2.Race-African American develop a decade earlier

3.Environment

4.Family Hx

5.Hx of Prostatitis

Term
Possible BPH Risk Factors 
Definition

Obesity- poor diet, avoid excessive fats, alcohol,caffeine. 

OTC Medications: Decongestants, Antihistamines, Anticholinergics

Term
Symptoms r/t Urination
Definition
Weak Stream, Nocturia, frequency >2 Q hrs while awake, Anuria, Hematuria
Term
American Cancer Society Recommendations
Definition

DRE annually ---> 50 &over      

    African American Men ---> 45      

Family Hx of BPH ---> 40          

Term
Urodynamic Testing
Definition
In MD's office. Measures the volume and pressure of urine in the bladder, how quickly bladder can be emptied, pressure in bladder during urination. EXAMINES THE PROCESS OF VOIDING
Term
Emergency TX device for BPH
Definition
Coude Catheter, firmer curved tip. Warn pt of discomfort.
Term
IPSS Scores
Definition

7<:watchful waiting

8-19:moderate, depends on man's ability to tolerate

>20:man almost always chooses tx

 

OFTEN A MAN'S PROFESSION THAT DICTATES HOW QUICKLY HE SEEKS TREATMENT(TX)

Term
Watchful Waiting
Definition
Annual Exams, Avoid aggravating meds, avoid alcohol and coffee-ANY CAFFEINE. PRACTICE KEGEL'S
Term
Medication's to treat BPH
Definition

Alpha Reductase Inhibitor: size reduction by ANDROGEN SUPPRESSION- lower the levels of Testosterone. Finasteride/Proscar and Dutasteride/Avodart.

 

Term
Contraindication's of Proscar
Definition
Pregnant woment should not handle Rx. Male should not donate blood for 6months post tx. Decreased libido, breast enlargement(gynecomastia)
Term
Alpha Blocker
Definition

Flomax-Alpha Adrenergic Blocker that decreases pressure in smooth muscle.

Hyrtin, Cardura, Minipress-Alpha Adrenergic Receptor Blocker Drugs: Blood Pressure Meds--->relaxes prostate smooth muscle

 

Term
Alpha Blocker Considerations
Definition

Orthostatic hypotension

Cautious when changing positions, teach pt to report weakness and lighheadedness, NO VIAGRA (also lowers BP)

Term
TURP-Gold Standard
Definition
Resect the overgrowth only, damges the urethra, leaves a prosthetic fossa
Term
TURP PRE-OP CARE
Definition
EDUCATE, go home w/catheter, irrigation 24-48hrs post op, symptoms to report, post-op dribbling, pain mngt, signs of infection, exercise-NO SITTING, fluids 2-3L day, follow up with MD, sperm bank
Term
Symptoms pt to Report post-op
Definition
Bright red bleeding, Pain, Bladder Spasms, Chills, Fever
Term
Post-Op Assessment for  _, _, _?
Definition

Hemorrhage, Pain, Infection.

Observe VS and maintenance of urinary drainage. 

Term
Post-op Irrigation
Definition

Closed continuous maintains asceptic system. Prevents clots forming in bladder. Q 1hr I & O documentation

 

Term
Bladder Irrigation
Definition
0.9 NS (3000cc) post op 1hr still bloody, increase drip rate, check hour later if no improvement call MD. 
Term
PRN IRRIGATION
Definition
Piston Syringe 60cc, open catheter irrigate vigorously to reestablish flow, if still blocked call MD.
Term
Dark Red vs Bright Red BLOOD
Definition

Dark=Venous Blood (balloon traction)

Bright=Arterial Blood (back to OR) can be indicative of hemorrhage

 

CLOTS NORMAL POST-OP FIRST 24-36HOURS

Term
Transurethral Resection Syndrome
Definition
Rare, Caused by absorption of irrigation solution. Causes electrolyte imbalance due to overhydration. S/S lethargy, hypertension, tachycardia, N/V, collaspe, headache, muscle spasms, seizures 
Term
Foley & BPH
Definition

Pain-large cath

Leakage-blocked cath

Removal-document time and tell next shift

Term
Post TURP Complications
Definition
Bleeding,Obstruction, Retention, Infection, Temp Intolerance, Bladder Retraining, Retrograde Ejaculation
Term
Discharge Instructions
Definition
Cautious with catheter. Delay sexual activity until cleared by MD. Do not return to work until cleared by MD. KEGELS!!!!!!!
Term
Prostate Cancer
Definition
occurs on outer lobes, often undetected due to lack of symptoms, contrasted by multiple symptoms in BPH.
Term
T/F:Race and AGE are factors in prostate cancer?
Definition

TRUE:

72 and older high risk

&

African American Males are 2x as likely to develop prostate cancer

Term
T/F: BPH puts you at higher risk for developing Prostate Cancer
Definition
FALSE
Term
Testing for Prostate Cancer
Definition

Serum PSA & DRE

Normal PSA=0-4ng

 

Term
EPCA-2
Definition
New Screening Test Developed by Johns Hopkins, more accurate that the PSA
Term
Treatment Options of Prostate Cancer
Definition

None-Watchful Waiting:older or seriously ill pt

TOTAL PROSTATECTOMY

-younger healthier man w/advanced cancer, surgery would be tx of choice

Term
Supra vs Retro Pubic Prostatectomy
Definition

S=pt will have bladder spasms, abdominal wound, incontinence and erectile dysfunction risk,monitor for leakage into the ab wound around supra pub cath assess pain, hemorrhage, infection

 

R=external wound, post op dribbling, hemorrhage, 24HR IRRIGATION, SIDE TO SIDE POSITIONING

Term
Perineal Prostatectomy
Definition
Pt require rectal prep, will have perineal tissue drain, Foley, external wound, maintain fluid balance, prevent constipation, prevent pulmonary complication, Monitor for HEMORRHAGE, INFECTION. Turn, cough& deep breathe *URISPAS*
Term
Treatment of Prostate cancer
Definition

Orchiectomy, anti-androgen therapy deprivation,estrogen hormonal therapy

&

Radiotherapy(w/surgery)

external beam & brachytherapy{permanent implantation/HDR temporary implantation}

--->provide local control, used alone for palliation

 

Term
Precautions after Brachtherapy
Definition
wear condom during sexual intercourse for 2months, children should not sit on lap >5min daily 6months post implant, 3ft away from pregnant women
Term
SEIZURE
Definition

Abnormal sudden excessive uncontrolled electrical discharge of neurons within the brain. May occur for no known reason. CAN BE MOTOR, SENSORY, AUTONOMIC, PYSCHIC OR COMBINATION 

 

SEIZURES CEASE WHEN THE UNDERLYING PROBLEM IS CORRECTED

Term
EPILEPSY
Definition

Recurrent seizure activity or chronic disorder or recurrent seizures >2 is SEIZURE DISORDER (preferred term). 

Epilepsy is at least 2 seizures without and identifiable cause

Term
CAUSES OF SEIZURES
Definition
birth trauma, neonatal asphyxia, acid/base imbalance, head injuries, FEVER >104 peds, D & ETOH intoxication, congenital malformations. ANY PROCESS THAT DISRUPTS THE STABILITY OF THE NEURONAL CELL MEMBRANE CAUSING HYPERACTIVITY. 
Term
T/F Seizures often accompany stroke?
Definition
TRUE, due to cerebral vascular disease & polypharmacy
Term
WOMEN & Seizure's
Definition
Increased frequency during menses, caution during pregnancy, increased risk  of osteoporosis due to AED's
Term
Seizure Classification
Definition

-Generalized(Tonic/Clonic, Absence, Myoclonic, Atonic)

-Partial

-Unclassified

Term
Tonic/Clonic
Definition

Tonic-Initial Phase, Rigid/Stiff, Immediate LOC

Clonic-Second Phase, rhythmic jerking of all extremities, incontinence, tongue biting

Term
Atonic Seizure
Definition
Formerly known as Drop Attacks. Repetitive, characterized by loss of muscle tone, lasts for seconds, patients fall in most cases
Term
Unclassified
Definition
Idiopathic, account for >50%. Occur for no known reason, don't fit generalized or partial classification.
Term
Phases of Seizures
Definition

Prodomal-before, precedes, may last minutes-hours. Vague change in emotion or affect reponses

 

Aura/Pre-Ictal- brief sensory exp, feeling of weaknesss, dizziness, numbness, odor)@onset of seizure

 

Ictal-Tonic/Clonic Activity, Synonymous w/seizure stage

 

Post-Ictal-phase of Recovery after seizure. May include memory lapse, headache lethargy, LOC, sonorous breathing, confusion, disorientation. Pt may sleep for hours

Term
T/FMedications Cure Seizure disorder?
Definition
FALSE: Medication therapy controls
Term
Meds given during seizure
Definition
IV: Valium, Ativan, Dilantin also as rectal suppository
Term
Nursing the patient w/Seizure disorder
Definition

Assessment!!!!!

GOOD HX, What precipitates it?, Is there an Aura (pre-ictal), what is the effect on your lifestyle?, how much does the patient know about his/her seizing?

Term
Nursing Management during seizure
Definition

SAFETY FIRST!!!!!

provide privacy, ease pt to floor if possible, protect heat frm inj, loosen constrictive clothing, move furniture, raise side rails, do not restrain, place in sidelying position with head flexed forward, clear secretions if necessary, may need IV access administer prescribed tx

Term
Nursing Post Seizure
Definition
Side lying one side w/head flexed forward, bed in low position, monitor disorientation, Monitor for apnea, reorient to environment upon awakening, Monitor for agigtation use calm persuasion
Term
Status Epilepticus
Definition

Acute prolonged seizure activity, without full recovery of conciousness between attacks. Produces cumulative effects. May cause irreversible brain damage

MEDICAL EMERGENCY= seiz > 10min may cause death 

Term

Causes & Tx of Status Epilepticus

 

Definition

sudden stop of AED, Acute D & ETOH w/drawal, headtrauma (IICP), Metabolic Disturbances.

&

Stop ASAP, establish and maintain oxgenation and airway, IV meds, Iv hydration, Labs&ABG's, transfer to ICU

Term
Tegretol/Carbamazepine
Definition

Check CBC & Liver enzymes, Photobia & administer with food

 

Term
Valium/diazepam
Definition
Used for Status Epilepticus, Monitor BP(hypo), Bradycardia
Term
Dilantin/Phenytoin
Definition
Gingival Hypeplasia. Meticulous Oral Hygiene,Monitor liver enzymes & Administer w/Food 
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