FINAL EXAM Study Guide Version Part 2 Flashcards

Question

STATUS EPILEPTICUS MEDICAL MANAGEMENT

Answer 1

* Monitor V.S., I/O, and neurovital signs; Activity: bedrest; seizure precautions; Diet: General * **IV therapy:** fluids as needed * **Labs:** Glucose, electrolytes, anticonvulsant drug levels **Meds:** Anticonvulsants: Depakote,Tegretol, Dilantin, Zarontin, Luminal, Neurontin, Lamictal, Topomax * If a patient has hx of seizures- need to find out what meds he/she is taking; all seizure meds have therapeutic blood level * Ativan (Lorazepam) or Valium (Diazepam) for status epilepticus. Must be given IV push !!!

Answer 2

* Maintain patient's diet, Maintain seizure precautions; protect patient from injury during seizure, Assess post-ictal state: record time of sleep period, Maintain a patent airway, Monitor ABC’s * **First thing to do when patient seizes in front of you: check time & mentally record it/write it down!!** To have duration of seizure activity → review in mind what happened preceding the seizure (resp pattern, pupils, weakness,.. Etc. && also check these post seizure) * When you see signs of hypoxia/cyanosis: try to give blow by oxygen

Answer 3

**DEFINITION: Inflammation of the brain and spinal cord meninges. Most commonly caused by a bacterial infection, but can be viral.** **TYPES:** **Septic:** due to bacteria (Streptococcus pneumoniae, Neisseria meningitidis) **Aseptic:** due to viral infection, lymphoma, leukemia, or brain abscess Most commonly in adults: Bacterial infection: Neisseria meningitidis and Streptococcus pneumoniae Neisseria meningitidis is transmitted by secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses. **Manifestations include SEVERE** headache, fever, chills, systemic infection, petechial rash (seen with an infection; little red dots on hands/arms), changes in LOC, behavioral changes, nuchal rigidity (stiff neck→ chin to chest hard to do-one of the hallmark signs), positive **Kernig's sign, positive Brudzinski’s sign,** and photophobia, tachycardia **Neuro Assessment findings:** decreased level of consciousness; cranial nerve palsies: most commonly ptosis (eyes drooping), diplopia, facial weakness, tinnitus (ringing in ears), vertigo, and deafness; focal motor weakness, ataxia, seizures

Answer 4

* Cultures: identify source of infection in blood, urine, nose, throat secretions, sputum * CT scan or X-rays: assess for fractures, abscesses, or signs of infection in the chest, skull, and sinuses. * Lumbar puncture (diagnostic gold standard): elevated CSF pressure; cloudy, turbid, or clear in appearance with WBC elevation, increased protein; decreased glucose → all positive for meningitis. Culture and sensitivity will identify bacteria unless cause is viral.

Answer 5

* IV therapy; electrolyte replacement→ keep pt hydrated * Oxygen therapy, Monitor VS, ECG, ICP, Neurovitals, Oxygen saturation, I/O, Activity: Bedrest, quiet, darkened room * Ondansetron: when patients can’t hold down food/are nauseous this is given * Early, High dose Antibiotics: Penicillin, Ampicillin, or Chloramphenicol, or one of the Cephalosporins; Vancomycin alone or in combination with Rifampin for resistant strains. * Dexamethasone, (Decadron): given rather than prednisone because it is stronger and needed to decrease inflammation in the brain * Treat dehydration, shock, and seizures → to determine shock watch for urine output and bp * Antipyretics/ Analgesics: Tylenol, Advil * Glucocorticoid: Decadron * Osmotic Diuretic: Mannitol→ stronger than lasix, bumex; decreases cerebral edema * Isolation precautions, Seizure precautions: pads around bed rails and patient to remain on bedrest. * Anticonvulsants: Dilantin, Phenobarbital

Answer 6

* Maintain dimly lit, quiet environment (limit amount of visitors), asses for headache, semi-fowler’s position, Use cooling blanket or tepid bath to control temp, Provide nutrition as appropriate, Provide skin care, Report meningococcal meningitis to local health authorities, Assess for rehab and refer if appropriate, Provide home care instruction, Assess for infection spread to family members and friends or personal contacts. **Possible complications:** * Visual impairment, optic neuritis, deafness, personality changes, headache, seizures, paresis, and death

Answer 7

**DEFINITION: An interruption of normal bladder innervation** Three types of neurogenic bladder may occur: **1. Spastic:** upper motor neuron problem, Involuntary or frequent scanty urination without a feeling of bladder fullness, Possible spontaneous spasms of the arms and legs, Increased anal sphincter tone **2. Flaccid:** lower motor neuron lesion, Overflow incontinence, Diminished anal sphincter tone, Greatly distended bladder with an accompanying feeling of bladder fullness (most at risk for UTI) **3. Mixed:** cortical damage from some disorder or trauma, Dulled perception of bladder fullness, Diminished ability to empty the bladder, Urgency that can’t be controlled * All are at risk for UTI, urolithiasis, renal failure * Bladder program: patient goes to bathroom every hour/ 2 hrs/etc.; encourage patient to go on regular basis and drink fluids **Causes:** Cerebral disorders (stroke, brain tumor, Parkinson’s disease, multiple sclerosis, dementia), Chronic alcoholism, Herpes zoster, Collagen diseases such as SLE, Disorders of peripheral innervation, Heavy metal toxicity, Spinal cord disease or trauma, Atherosclerosis, Acute infectious diseases such as transverse myelitis

Answer 8

Maintain patient’s diet and fluid intake, Assess renal status, Monitor VS and intake and output, Administer medications as prescribed, Indwelling catheter- strict aseptic technique, Assess for signs and symptoms of infection, Provide patient teaching if required for aseptic technique in self-catheterization, Patient teaching for intermittent self-catheterization, follow dietary measures to prevent renal calculi

Answer 9

* Encourage fluids, monitor VS and I&O, asses renal status * Tx: Valsalva’s maneuver, indwelling urinary catheter, intermittent self-catheterization * Antispasmodics: if there are many bladder spasms; Pro-Banthine, Urispas, Dicyclomine * Alpha-adrenergic blockers: Hytrin, Cardura

Answer 10

**Spinal Cord Injury: traumatic injury to the spinal cord that results in sensory & motor deficits** Two types: * **Paraplegia: paralysis of the legs** * **Quadriplegia: paralysis of all four extremities** **Causes:** car accidents, falls, gun shots, stab wounds, shallow water dive, infection, tumor, congenital **Patho:** injury may result in complete transection of the spinal cord; associated edema & hemorrhage from the injury cause ischemia; necrosis & scar tissue form in area of the traumatized cord **Assessment findings:** * Paralysis below the level of the injury, Paresthesia below the level of the injury, Neck pain, Loss of bowel and bladder control, Respiratory distress, Numbness and tingling, Flaccid muscle, Absence of reflexes below the level of the injury, Loss of perspiration below the level of the injury **Diagnostic findings:** * Spinal x-rays: vertebral fracture * CT and MRI scan: spinal cord edema, vertebral fracture, spinal cord compression

Answer 11

**Respiratory System:** Cervical injury or fracture above C4-total loss of resp muscle function. Mechanical ventilation required to keep patient alive **Cardiovascular system:** Cord injury above T6 decreases SNS effects. Bradycardia occurs as a result of unopposed PNS on the heart and peripheral vasodilation causes hypotension. **Urinary system:** Retention is common as is spinal shock. The bladder is atonic and becomes overdistended. Foley catheter is needed to drain bladder. **Integumentary system:** Tremendous potential for skin breakdown. Pressure ulcers occur quickly and lead to major sepsis and infection. **GI system:** Cord injury above T5 creates primary problems of hypomotility. Contributes to paralytic ileus and gastric distension. NG tube may be needed for relief of distension. **Peripheral problems:** DVT is common problem especially in first 3 months. PE is leading cause of death.

Answer 12

**Massive uncompensated cardiovascular reaction mediated by the SNS. Occurs in response to visceral stimulation in spinal cord lesions above T7.** * Life threatening situation- if not resolved can lead to status epilepticus, stroke, and death * Most common precipitating cause is overdistended bladder or rectum. * Manifestations include hypertension (up to 300 mmHg), blurred vision, throbbing headache, marked diaphoresis above level of lesion, bradycardia (30-40 bpm), piloerection, nasal congestion, and nausea. ******Treatment is relief of cause- empty bladder or rectum!!--\> suppository, foley catheter & then treat hypertension slowly**

Answer 13

* Maintenance of vertebral alignment: Stryker turning frame, Crutchfield tongs, Halo brace, Cervical collar → keep alignment ! * Specialized bed: rotation (Rotorest, Tilt and Turn, Paragon) * Position: flat, neck immobilized * Endotracheal intubation and mechanical ventilation, NG tube with GI decompression * IV therapy as needed; saline lock; replacement of electrolytes * Diet: High protein * Foley catheter * Labs: CBC, Electrolytes, Glucose, ABG’s, urine osmolality, urine specific gravity * Meds: * Glucocorticoids: Decadron, Solumedrol, * Anticonvulsants: Dilantin, * Histamine antagonists: Tagamet, Zantac * Antacids: Maalox, Mucosal barrier: Carafate * Antianxiety agents: Valium * Antihypertensive agents: Hyperstat, Apresoline * Muscle Relaxants: Dantrium → for preventing muscle spasms * Laxative: Bisacodyl

Answer 14

* Monitor the patient’s resp status, provide suctioning as needed. Monitor neuro status and neurovitals, Monitor vital signs, ECG, I/O, labs, arterial BP, O2, Keep patient flat, maintain body alignment, Turn patient using logrolling technique * Administer fluids and electrolyte replacements, Administer meds as prescribed * Initiate bowel and bladder retraining, Assess for spinal shock and autonomic dysreflexia * S/S of autonomic dysreflexia: UTI and URI * Provide skin care: Provide heel and elbow protectors and sheepskin; maintain skin integrity * Apply antiembolism stockings, Provide Passive ROM exercises; use assistive devices, Encourage patient to express his feelings about changes in his body image, altered mobility, changes in sexual expression and function, Provide sexual counseling, Provide for rehabilitation; reinforce independence, Access resources to begin home care provisions and set-up for patient needs. * Complications: * Spinal shock, autonomic dysreflexia, resp. distress, osteomyelitis, pressure ulcers * Possible surgical interventions: laminectomy, spinal fusion

Answer 15

**Because the skull can’t expand, an increase in brain tissue, CSF, or blood, results in increased ICP** * Increased ICP results in decreased cerebral circulation and anoxia, which can lead to permanent brain damage. * Early sign if increased ICP: * confusion, changes in patients level of consciousness, changes in condition: restlessness, confusion, drowsiness, increased respiratory effort, & purposeless movements; pupillary changes and impaired ocular movements, weakness in one extremity or one side, headache that is constant, increasing in intensity, or aggravated by movement or straining * Late sign of increased ICP: * Respiratory and vasomotor changes; Projectile vomiting * VS: increase in systolic blood pressure, widening of pulse pressure, and slowing of the heart rate; pulse may fluctuate rapidly from tachycardia to bradycardia and temperature increase * Cushing’s triad: bradycardia, hypertension, and bradypnea * Further deterioration of LOC; stupor to coma * Hemiplegia, decortication, decerebration, or flaccidity * Respiratory pattern alterations including Cheyne-Stokes breathing & arrest * Loss of brain stem reflexes: pupil, gag, corneal, and swallowing

Answer 16

* CCP (cerebral perfusion pressure) is closely linked to ICP * CCP = MAP (mean arterial pressure) – ICP * Normal CCP is 70 to 100 * A CCP of less than 50 results in permanent neurologic damage

Answer 17

**Glaucoma is increased intraocular pressure with peripheral vision loss** **Open Angle Glaucoma** * Develops slow with NO symptoms of pain or pressure * Nothing noticed until suddenly vision is compromised * Tx: B-adrenergic receptor blocker (Timoptic), alpha-adrenergic agent (Epifrin), cholinergic agent (miotics), carbonic anhydrase inhibitors (hyperosmotic agents)

Answer 18

**ACUTE** * Sudden excruciating pain, n/v * colored halos around lights * frosted cornea * **OCULAR EMERGENCY; immediate care topical cholinergic, hyperosmotic agents with LASER peripheral iridotomy** **SUB-ACUTE / CHRONIC** * Appear gradually * Colored halos * Eye or brow pain * **Tx** for chronic same as open angle

Answer 19

**Meniere’s Disease** - Increased endolymph causes rupture, mixes high-K endolymph with low-K periplymph, leads to damaged cochlear hair cells * Vertigo with n/v, tinnitus, ear fullness, hearing loss, sudden drop attack **Tx: treating symptoms not disease** * stabilize self during attack, antihistamines, anticholinergics, benzodiazepines (valium/diazepam), antiemetic (Zofran), antivert

Answer 20

**Palliative care:** * comfort, can still receive treatments * possible to graduate from palliative care * ex: after ARF if kidneys start functioning again **Hospice:** * end of life comfort; * 6 months or less left to live, * tx: analgesics

Answer 21

Because older patients think that because they are old, they are not likely to get pregnant or get someone pregnant, so they do not use protection.

Answer 22

* Pre-op will be centered on the checklist, consent, and patient understanding of the surgery they are to have. * Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed * Checklist: know that one exists (page 423) Has the procedure been explained to the pt? Have they consented to receive blood? Are they an organ donor? DO the have DNR? Is there an H&P? Are they NPO, are they on heparin? * Consent: Freely given without coercion, must be 18, staff must witness signature * Understanding of surgery: Discuss advance directives, patient education on benefits of controlling pain, time with patient/family and give therapeutic touch.

Answer 23

* Begins when the patient is transferred onto the OR bed and ends with admission to the PACU (post anesthesia care unit) * The intra-op will focus on the "time-out" to ensure the right part of the patient is being operated on **“Time out” is when you stop and make sure you're** * **Operating on the right person** * **Right place and** * **Right area of body** * **Everyone knows their roles**

Answer 24

**Post-op will be focused on the safe awakening of the patient from anesthesia and what to do if the patient is not breathing well or if they are bleeding from their incision, or if their vital signs are not stable.** * Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home * Safe Awakening: Maintain ventilation and prevent hypoxemia and hypercapnia. (page 457) * Patient not breathing: (page 457) Hypopharyngeal obstruction. Tilt head back with neck supportive and open the jaws to open airway. Use a tongue suppressor. Use a endotracheal tube, when can they be extubated? Patient bleeding from incision: (page 459) If bleeding is evident. 1. Sterile gauze pad and a pressure dressing are applied. 2. Site of the bleeding is elevated to heart level if possible. 3. Patient is placed in the shock position. 4. If hemorrhage is suspected but cannot be visualized, the patient is taken back to the OR for emergency exploration * Vital signs not stable: shock might ensue, give IV fluids, specifically lactated Ringer solution, 0.9% sodium chloride. Give O2

Answer 25

* Need to reduce doses * Treat the patient, not the numbers (Well focus on that, but not primarily)

Answer 26

* We over prescribe them * Be aware of cost, as many cannot afford, so they don't fill or take them. * Will resort to pill rationing (cutting pills in half)

Answer 27

**Advance health care directives** * instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity. * A living will is one form of advance directive, leaving instructions for treatment. * Another form of authorization is the power of attorney for health care. People may have one or the other or a combination of both. **Power of Attorney** * A durable power of attorney allows a competent person - (the “principal”) to appoint an agent to make decisions for the principal when the principal is incapacitated and unable to make decisions.

Answer 28

* Alcohol and opioids

Answer 29

**Multiple Sclerosis (MS)** * SS: **INTENTION** **tremors** **Parkinson’s triad** * S/S: **RESTING** tremors, shuffling gait, bradykinesia (slow movements) * Tx: L-dopa

FINAL EXAM Study Guide Version Part 2 Flashcards

(54 cards)