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?: semicomatose
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.: ICP
increased intracranial pressure
Increased pressure impedes cerebral circulation, absorption of _____, and function of nerve cells: CSF
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.: autoregulation
Factors that increase ICP- make it worse: _____PCO2 decrease in PO2 valsalva maneuver body position (prone flextion of the neck, hip) isometric muscle contractions coughing, vomiting, sneezing emotional upset: increase
Assessment of ICP- evaluate level of consciousness (most sensitive indication of increasing ICP) changes from restlessness to _________ to declining level of consciousness and coma.: confusion
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.: Steriods
___________- Lasix, Mannitol- decrease cerebral edema; action by carrying out large volume of water through the nephron; complication of therapy are fluid and electrolyte imbalance.: diuretics
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: ____________- -repetition - 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 _______________.: communication
Nursing care of the dysphagic client- alteration in _______________: nutrition
Nursing care of the incontinent client- alteration in ___________.: elimination
Medication used for flaccid bladder?: Urecholine
Medication used for spastic bladder?: Ditropan, Pro-Banthine
__________- physical manifestations of paroxysmal and abnormal electrical firing of neurons.: Seizures
_____________ is a chronic disorder characterized by recurrent unprovoked seizure activity. Highest incidence in older adults and children. May be inherited: epilepsy
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 -incontinent: 1-5 minutes
during the ________ stage of a tonic-clonic seizure the patient will be: -sleep, confused -irritable -don't touch -decrease stimuli -quiet environment - calm gentle reassurance: Postictal stage
_______- petit mal. common in children. brief period of loss of consciousness, staring: absence
__________- abrupt increase in muscle tone, loss of consciousness: Tonic
_________________- muscle contraction and relaxation.: Clonic
__________- brief jerking, stiffening: Myoclonic
________-(drop) sudden loss of muscle tone. seen with cerebral palsy and brain tumors -no warning: atonic
__________seizures- focal area of brain, one part of the brain. consists of both complex and simple seizures.: Partial
________ partial seizure- -loss of consciousness - automatisms (lip smacking, picking) -post seizure amnesia: Complex
_______partial seizure- -no loss of consciousness -aura -unilateral movements -sensory, autonomi symptoms: simple
____________- 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: Meningitis
Assessment for ____________includes: -nuchal rigidty -positive Kernigs, brudsinski (bacterial) -signs of ICP -Vascular dysfunction -CSF analysis: Meningitis
_________- inflammation of brain tissue, mostly viral cause (arbovirus, HSVI, amebas): Encephalitis
Assessment of ____________includes: -fever, N&V, stiff neck -LOC changes -Motor weakness, tremors, seizures -focal deficits -with severe causes- s & sx increased ICP: Encephalitis
use ____________ for HSV I infection: cyclovir
With ______________- -client usually over age 50 -no gender preference -rare in blacks -not genetic -no acute exacerbations -no cure: Parkinsons
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: Parkinsons
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: Tremor Rigidty Bradykinesia: Parkinsons Disease
Symptom of Parkinson include:_________- -hand, small handwriting, pill rolling -head, neck, face, jaw, feet: Tremor
Symptom of Parkinsons include:__________ -increase in muscle tone -movement is jerky, like a cog wheel -results in muscle soreness and aching: Rigidty
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 -shuffling: Bradykinesia
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 -parlodel -COMT inhibitors-: Dopamine
Management for Parkinsons- __________- probe into pallidum destroys hyperactive neurons- 5% effective 2 years later: Pallidotomy
Management for Parkinson's- ____________- thermocoagulation of brain cells to decrease tremors. Implanted electrical stimulators, brain pacemaker- delivers electrical impulses: Thalamotomy
Amantadine (symmetrel) and Levodopa- carbidopa (sinemet) are in what drug classification?: Dopaminergics
________- release dopamine from storage sites; permits peripheral and central accumulation of dopamine. -helps movement but not tremors; mild to moderate disease: Dopaminergics
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?: Anticholinergics
__________- -blocks or inhibits effects of acetycholine -most effective against tremors -use with caution in the elderly: Anticholinergics
Diphenhydramine (benadryl) is in what drug class?: Antihistamine
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: Clonopin
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): Depakene
Trade Name_______________ Generic name- divalproex sodium seizure the drug is most commonly used to control: -absence (Petit mal), generalized, tonic-clonic (grand mal): Depakote
Trade Name________________ Generic name- phenytoin seizure the drug is most commonly used for: any seizure except absence (petit mal): Dilantin
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: Mysoline
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: Tegretol
Trade Name______________________ Generic Name- clorazepate dipotassium seizure the drug is most commonly used to control: complex partial (psychomotor, temporal lobe): Tranxene
Trade Name______________________ Generic Name- ethosuximide seizure the drug is most commonly used to control: absence (petit mal): Zarontin
_____________- 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. 2. 3.: 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: acetylcholinesterase
type of back pain that is caused by: -trauma, degenerative disc, obesity, smoking, congenital conditions, poor posture and body mechanics assessment of: -pain -posture/ gait -presence of paresthesia non surgical -mobility: Lumbosacral
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: -hypertension -bradycardia -flush: Autonomic dysreflexia
With Spinal cord injury, the goal is ________________. Treated with medications such as solumedrol, dextran, atropine: Prevention
Spinal cord injury above ______, respiratory difficulty, and paralysis of all four extremities: C-4
Injury to C_____- usually rapidly fatal: C2-3
injury to C___- involves shoulder (partial) and elbow (partial) -needs adaptive devices: C-5
Injury to C____- shoulder, elbow, wrist (partial) Propel wheelchair equipped with knobs on wheel rims: C-6
Injury to C____- shoulder, elbow, wrist, hand (partial) Propel wheelchair outside transfer. drive car with special adaptations.: C-7
Injury to C_____- Normal arm, hand weakness. transfer wheelchair into car. Vocational and recreational goals can be achieved.: C-8
Injury to T________- wheelchair ambulation; walk with braces: T1-T10
Injury to T________- wheelchair not essential: T11 and below
The _______ the injury, the more serious, more debilating: Higher
The _________the injury- the quicker to resume ADL's: Lower
____________- 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: fatigue stress overactivity temperature fluctuations: MS- multiple sclerosis
Medications used for MS: Exacerbations Methylpredinosolone (______) - ACTH, immunosuppressant (cytoxan, Immuran): solumedrol
Medications used for MS to stabilize disease process include: ___________, Immuran plus solu-medrol: Cytoxan
Medications used for MS to decrease number and severity of relapses include: Betaseron, ____________, Capaxone: Avonex
Medications used for MS to lessen spasticity include: _______ Lioresal Valium: Dantrium
Medications used for MS for spastic bladder to correct urinary frequency include: ____________ Pro-Banthine: Ditropan
Medications used for MS for flaccid bladder include: __________ to correct urinary retention: Urecholine
____________- 3rd leading cause of death, increased frequency in males, those over 65 years.: Stroke
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.: Ischemic
Type of Ischemic that has narrowing of the blood vessel due to plaque build up with eventual occlusion- HTN, and DM accelerate this process.: Thrombosis
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): Hemorrhagic
Type of Ischemic stroke where you have occlusion of the blood vessel by a clot: Embolism
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: Thrombotic
Type of Ischemic stroke that has the following characteristics: -men more than women -TIA 30-50% of time -unrelated to activity -SINGLE ATTACK -usually some improvement; recurrence common unless underlying pathology treated afres: Embolic
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)
RIND_________________- -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: anticoagulants
Drug therapy for stroke patients: ____________- ticlid, plavix, persantine also can use: -antipeleptics -calcium channel blockers: antiplatelet

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