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Nursing 128 Test #3


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measures level of consciousness.
is the most sensitive indicator of change in neuro status
Glasgow Coma Scale
Glasgow Coma Scale measure what three areas?
1. eyes open
2. best verbal response
3. best motor response
with the glasgow coma scale you can score between 3-15.
a score of 8 or better means what?
High score of 8 or better you have a good prognosis
score of 3-4 = high mortality
score of 3-7 = coma
____________= an increase in intracranial bulk due to blood, CSF, or swelling of brain tissue or tumors.
increased intracranial pressure
Increased pressure impedes cerebral circulation, absorption of _____, and function of nerve cells
With ICP there is increasing pressure that is transmitted downward toward the brainstem with eventual tentorial herniation, brainstem compression which affects ____________and ___________ function and eventually death.
respiratory and cardiac
With ICP- ___________________ is the ability of the brain to alter the diameter of its blood vessels to maintain a constant blood flow of oxygen and glucose to its tissue. In ICP this is lost.
Factors that increase ICP- make it worse:
decrease in PO2
valsalva maneuver
body position (prone flextion of the neck, hip)
isometric muscle contractions
coughing, vomiting, sneezing
emotional upset
Assessment of ICP- evaluate level of consciousness (most sensitive indication of increasing ICP) changes from restlessness to _________ to declining level of consciousness and coma.
With assessment of ICP- Evaluate vital signs- watch for ___________ pulse pressure, reflex slowing of pulse, abnormalities in respiration, especially periods of apnea (cushings triad) and temperature elevation.
Widening pulse pressure
Goal with ICP is to decrease intercranial pressure and prevent damage to brain cells by maintaining adequate blood flow with adequate oxygenation and glucose and reduction of the buildup of _________________.
carbon dioxide
___________- decadron (dexamethasone) decrease cerebral edema by their antiinflammotory effect; decrease capillary permeability in inflammatory process, thus decreasing leakage of fluid into tissue.
___________- Lasix, Mannitol- decrease cerebral edema; action by carrying out large volume of water through the nephron; complication of therapy are fluid and electrolyte imbalance.
In treating ICP you need to:
-normalize body temperature
-fluid balance, IV fluids, daily weights, I&O
-prevent seizures
-Elevate head of bed 30 degrees and avoid the ___________, keep head in neutral position.
-increase oxyg
Trendelenburg position
Pavolon, and Norcuran are _____________
Paralyzing agents
Interventions for the confused client:
- written memory aids
- appeal to several senses directed at the same activity
-small steps- simple to complex
Decreased memory
Interventions for the confused client:
-place by window, day and night
-clock, calendar, photographs, television, room with other people
-structure environment, use consistency
-face to face contact
- short sen
Lack of orientation
Interventions for the confused client:
-maintain calm, firm attitude
- use 2 to 3 people to give care, rotate care among staff
-avoid overstimulation- regulate visitor, tv, quiet environment
-provide stuctural, sa
Aggressive behavior
Nursing care of the aphasic client- alterations in _______________.
Nursing care of the dysphagic client- alteration in _______________
Nursing care of the incontinent client- alteration in ___________.
Medication used for flaccid bladder?
Medication used for spastic bladder?
Ditropan, Pro-Banthine
__________- physical manifestations of paroxysmal and abnormal electrical firing of neurons.
_____________ is a chronic disorder characterized by recurrent unprovoked seizure activity.
Highest incidence in older adults and children.
May be inherited
type of seizure that is bilaterally symmetrical, throughout entire brain.
Generalized seizure
type of grand mal seizure that is characterized by stiffening and relaxing of the body.
tonic- clonic
Tonic-clonic seizure lasts _________.
-cry out, jaws clamp shut
-body stiffens
-body jerks
-loss of consciousness
-respirations may stop
-ends with a sigh
1-5 minutes
during the ________ stage of a tonic-clonic seizure the patient will be:
-sleep, confused
-don't touch
-decrease stimuli
-quiet environment
- calm gentle reassurance
Postictal stage
_______- petit mal. common in children.
brief period of loss of consciousness, staring
__________- abrupt increase in muscle tone, loss of consciousness
_________________- muscle contraction and relaxation.
__________- brief jerking, stiffening
________-(drop) sudden loss of muscle tone.
seen with cerebral palsy and brain tumors
-no warning
__________seizures- focal area of brain, one part of the brain.
consists of both complex and simple seizures.
________ partial seizure-
-loss of consciousness
- automatisms (lip smacking, picking)
-post seizure amnesia
_______partial seizure-
-no loss of consciousness
-unilateral movements
-sensory, autonomi symptoms
____________- seizure activity lasting 30 minutes or more without regaining consciousness (potential complication with all types)
-medical emergency (may cause irreversible brain damage and death)
-IV Valium (activan or Depacon) followed by Dil
Status Epilepticus
Post seizure care:
- Vital signs with ____________
-keep on side
-allow to rest
-document (onset, duration, type of motor movements, incontinence, pupil changes, respiratory status, skin color and moisture, and precital and postictal
neuro checks
Type of infection that has inflammation of the arachnoid and pia mater of brain and spinal cord and cerebrospinal fluid
-can be bacterial or viral
Assessment for ____________includes:
-nuchal rigidty
-positive Kernigs, brudsinski (bacterial)
-signs of ICP
-Vascular dysfunction
-CSF analysis
_________- inflammation of brain tissue, mostly viral cause (arbovirus, HSVI, amebas)
Assessment of ____________includes:
-fever, N&V, stiff neck
-LOC changes
-Motor weakness, tremors, seizures
-focal deficits
-with severe causes- s & sx increased ICP
use ____________ for HSV I infection
With ______________-
-client usually over age 50
-no gender preference
-rare in blacks
-not genetic
-no acute exacerbations
-no cure
3 possible causes of _______________-
1. degeneration of substantia nigra causing a decrease in dopamine and excess acetylcholine- loss in ability to refine and control voluntary movement
2. some cases associated with encephalitis and exposure
clinical manifestation of _________-
-begins insidiously(usually unilateral)
with a mild tremor, slight limp and progresses over a gradual declining course. The triad of symptoms include:
Parkinsons Disease
Symptom of Parkinson include:_________-
-hand, small handwriting, pill rolling
-head, neck, face, jaw, feet
Symptom of Parkinsons include:__________
-increase in muscle tone
-movement is jerky, like a cog wheel
-results in muscle soreness and aching
Symptom of Parkinsons include_________-
-delay in starting movement, slowness while moving and inability to stop movement.
-results in stooped posture, masked face, drooling, difficulty in balance, dysphagia, blinking, dysarthia
Symptom of Parkinsons include__________-
-increased perspiration flushing or orthostatic hypotension.
ANS symptoms
Drug therapy for Parkinson's - aim is to increase __________ and decrease acetychonline (use individually or combination tolerance and toxicity problematic)
-sinemet (effective 3-5 years)
-artane, cogentin
-COMT inhibitors-
Management for Parkinsons-
__________- probe into pallidum destroys hyperactive neurons- 5% effective 2 years later
Management for Parkinson's-
____________- thermocoagulation of brain cells to decrease tremors. Implanted electrical stimulators, brain pacemaker- delivers electrical impulses
Amantadine (symmetrel) and Levodopa- carbidopa (sinemet) are in what drug classification?
________- release dopamine from storage sites; permits peripheral and central accumulation of dopamine.
-helps movement but not tremors; mild to moderate disease
Bromocriptine (parlodel) and Pergolide (permax) are in what drug class?
Dopamine Receptor agents
__________-stimulates dopamine production
-used with sinemet to lower dosage
-used with patient who experience end of dose failure using levodopa alone.
Dopamine Receptor agents
Trihexyphenidyl (artane) and Benztropine (cogentin) are in what drug class?
-blocks or inhibits effects of acetycholine
-most effective against tremors
-use with caution in the elderly
Diphenhydramine (benadryl) is in what drug class?
Deprenyl(eldepryl) is in what drug class?
Monoamine Oxidose inhibitor
-enhances and prolongs effect of dopamine
-used frequently as first drug of treatment
Monoamine Oxidose inhibitor
Generic name- clonazepam
Trade name___________
Type of seizure drug is most commonly used to control:
-absence (petit mal), atonic, myoclonic
Generic name- Valproic acid
Trade name-__________________
Type of seizure the drug is most commonly used to control:
absence (petit mal), generalized tonic-clonic (grand mal)
Trade Name_______________
Generic name- divalproex sodium
seizure the drug is most commonly used to control:
-absence (Petit mal), generalized, tonic-clonic (grand mal)
Trade Name________________
Generic name- phenytoin
seizure the drug is most commonly used for:
any seizure except absence (petit mal)
Trade Name_______________
Generic Name- primidoine
seizure the drug is most commonly used to control:
complex partial (psychomotor, temporal lobe), generalized tonic-clonic (grand mal), simple partial
Trade Name_________________
Generic Name- phenobarbital
seizure the drug is most commonly used to control:
most types of seizures
no trade name commonly used
Trade Name_____________________
Generic Name- carbamazepine
seizure the drug is most commonly used to control:
complex partial (psychomotor, temporal lobe) generalized tonic- clonic (grand mal), simple partial
Trade Name______________________
Generic Name- clorazepate dipotassium
seizure the drug is most commonly used to control:
complex partial (psychomotor, temporal lobe)
Trade Name______________________
Generic Name- ethosuximide
seizure the drug is most commonly used to control:
absence (petit mal)
_____________- progressive, debilitation, fatal neurological disease
-occurs as early as mid-life; however, most are over 65
-fourth leading cause of death, after heart, cancer and stroke
Alzheimers Disease
Warning signs of _____________________:
-recent memory loss that affects job skills
-difficulty performing familiar tasks
-problems with language
-disorientation of time and place
-poor or impaired judgement, abstract thinking
Alzheimers disease
_______________- deficit in the brains cholinergic system of neurotransmitters ( a decrease in acetycholine)
-cause unknown
-structural changes in the brain:
1. neurofibrillary tangles
2. neuritic plaques
3. excessive loss of neu
Alzheimers disease
This disease has a genetic disposition- a defect of chromosone 21, which is the genetic marker that produces the chemical found in neurofibrin tangles and plaque.
-also will have selective cell death provoked by a slow virus or autoimmune response.<
Alzheimers disease
3 stages of alzheimers disease are
1. early
2. progressive cognitive, physical, emotional decline
3. total dependence
medications used to treat alzheimers disease are called_______________
ex: Reminyl, aricept, exelon, cognex
also can use tranquilezers to lessen agitation such as valium
antipsychotics such as haldol for behavioral disturbances
type of back pain that is caused by:
-trauma, degenerative disc, obesity, smoking, congenital conditions, poor posture and body mechanics
assessment of:
-posture/ gait
-presence of paresthesia non surgical
Type of injury most common in areas of maximum mobility result of sudden violent external trauma
level of dysfunction depends on location of injury and degree (quadriplegia, paraplegia)
spinal cord injury
________-- the entire cord below the level of the injury falls to function; temporary; symptoms appear 30-60 minutes after injury; can last several months. Will see:
-flaccid paralysis
-loss of reflexes
-hypotension, bradycardia
-as c
Spinal shock
_______________- loss of autoregulatory control of B/P; usually seen in injuries above T6 after spinal shock subsides. Triggered by stimuli below level of injury- Medical emergency.
Symptoms seen are:
Autonomic dysreflexia
With Spinal cord injury, the goal is
Treated with medications such as solumedrol, dextran, atropine
Spinal cord injury above ______, respiratory difficulty, and paralysis of all four extremities
Injury to C_____- usually rapidly fatal
injury to C___- involves shoulder (partial) and elbow (partial)
-needs adaptive devices
Injury to C____- shoulder, elbow, wrist (partial)
Propel wheelchair equipped with knobs on wheel rims
Injury to C____- shoulder, elbow, wrist, hand (partial)
Propel wheelchair outside transfer. drive car with special adaptations.
Injury to C_____- Normal arm, hand weakness.
transfer wheelchair into car. Vocational and recreational goals can be achieved.
Injury to T________- wheelchair ambulation; walk with braces
Injury to T________- wheelchair not essential
T11 and below
The _______ the injury, the more serious, more debilating
The _________the injury- the quicker to resume ADL's
____________- chronic, progressive, degenerative disorder of the CNS. prevalence in females 20-40 yrs, familial tendency, cold climate, frequent remissions and exacerbations.
-damage to myelin sheath causing inflammation, scarring, and dimished nerv
multiple sclerosis (MS)
Clinical manifestations of ___________ are gradual and vague:
motor- weakness of limbs, stiffnessm spasticity, intention tremor, unsteady gait, increased reflexes.
sensory- tingling, paresthesia, diplopia, vision changes, tinnitus, vertigo, inc
MS- multiple sclerosis
Factors that aggravate symptoms of ___________ are:
temperature fluctuations
MS- multiple sclerosis
Medications used for MS:
Exacerbations Methylpredinosolone (______) - ACTH, immunosuppressant (cytoxan, Immuran)
Medications used for MS to stabilize disease process include:
___________, Immuran plus solu-medrol
Medications used for MS to decrease number and severity of relapses include:
Betaseron, ____________, Capaxone
Medications used for MS to lessen spasticity include:
Medications used for MS for spastic bladder to correct urinary frequency include:
Medications used for MS for flaccid bladder include:
__________ to correct urinary retention
____________- 3rd leading cause of death, increased frequency in males, those over 65 years.
Heredity, gender, age and race are risk factors that can or cannot be controlled?
No control
HTN, CAD, DM, hyperlipidemia, lifestyle factors, obesity, smoking, and alcohol are risk factors that can or cannot be controlled?
Can control
Causes of decreased blood flow to the brain:
__________- 85% of all strokes
either thrombosis or embolism.
Type of Ischemic that has narrowing of the blood vessel due to plaque build up with eventual occlusion- HTN, and DM accelerate this process.
Type of stroke that is bleeding into the brain tissue from rupture of blood vessels due to HTN, aneurysm, and congenital abnormalities (berry aneurysm, AV malformation)
Type of Ischemic stroke where you have occlusion of the blood vessel by a clot
Type of Ischemic stroke where it has the following characteristics:
-oldest median age
-men more than women
-TIA 30-50% of time
-often during sleep
-stepwise progression
-usually some improvement; recurence in 20-25% of surv
Type of Ischemic stroke that has the following characteristics:
-men more than women
-TIA 30-50% of time
-unrelated to activity
-usually some improvement; recurrence common unless underlying pathology treated afres
Type of Hemorrhagic stroke that has the following characteristics:
-slightly higher in women
-Headache about 25% of time
-often during activity
-progressive over 24 hours
-poor, if accompanied by coma, fatality more likely
Intracerebral (ICH)
Type of hemorrhagic stroke that has the following characteristics:
-youngest median age
-slightly higher in women
-headache common
-often during activity (very sudden onset)
-Usually single sudden attack
-coma and fatality m
Subarachnoid (SAH)
Warning signs of ___________-
-brief episode of neurologic deficit without residual effects
-lasts a few minutes to 24 hours; brain tissue is damaged; multiple episodes increase risk of major stroke
Common sign- loss of vision, hemiparesis
Transient Ischemic Attack (TIA)
-deficit remains after 24 hours but less than a week
-leaves no residual signs and symptoms after days to weeks but brain tissue is damaged.
Reversible Ischemic Neurologica Deficit
Drug therapy for Stroke:
_______________ agents (recombinant tissue plasminogen activator)- rtPA
thrombolytic agents
Drug therapy for stroke patients:
______________- such as aspirin, heparin, lovenox, coumadin
Drug therapy for stroke patients:
____________- ticlid, plavix, persantine
also can use:
-calcium channel blockers

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