Endo Final review

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Endo Final review
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2012-01-25 22:31:22
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BMC Endo final
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  1. Neurological System
    • system that originates, transmits and causes nerve impulses
    • CND & PNS
    • somatic- voluntary control of skeletal muscles
  2. Neurological System Structure
    • Nerve Cells (neurons)- cell body, dendrites, axons
    • Supportive tissue (neuralgia)- supports nerve paths, protects, neutrilze
    • Neurotransmitters- chemical substance that conducts an impulse- acetylcholine, epinephrine, norepinephrine, dopamine, sarotonin
  3. Neurons
    • Cell Body
    • Dendrites
    • Axon types
    • afferent- ascending to CNS
    • efferent- descending to body (organ)
    • association- join A and E pathways
    • Neurotransmitters
  4. Brain Protection
    • 3 Layers
    • Dura Mater- fiberous, tough, leathery
    • Arachnoid Mater- web like
    • Pia Mater- soft, tender, vascular
  5. Brain Hemispheres
    • Right- Controls left side of body, art, creativity, nonverbal communication, spiritual, perception of physical environment, music
    • Left- Controls right side of body, analysis, verbal communication, problem solving, interpretation of hearing, seeing and language, calculations
  6. Gyri/Gyrus
    elevations
  7. Sulci/Sulcus
    Valleys
  8. Cerebrum Frontal
    Behavior, decision making, higher intelligences, concentration

    Prefrontal- morals, emotions, judgement

    Broca's Area- Speech
  9. Cerebrum Parietal
    Language, sensory information, interpretation of pain, temp and pressure
  10. Cerebrum Temporal
    Hearing, memory, speech perception

    Wernicke's Area- speech comprehension
  11. Cerebrum Occipital
    Visual interpretation, vision, reading and understanding
  12. Cerebral Spinal Fluid (CSF)
    • Produced in Choroid Plexus (500ml daily)
    • Reabsorbs in Arachnoid Villa
    • Shock absorption, bathes the brain and spinal cord, lubricates
  13. CSF characteristics
    • WBC- 0
    • RBC- 0
    • Protein- 15-45mg
    • Glucose- 60-80mg
    • Pressure- 50-175mmH2O (normal)
  14. Cranial Nerves
    • 12 Pairs
    • Emerge from brain stem and other parts of the brain
    • Sensory- sight, hearing, smell, taste, equilibrium
    • Motor
  15. Autonomic Nervous System (ANS)
    • Involuntary control of viscera
    • Sympathetic- receptors located in cervical and lumbar levels
    • Parasympathetic- receptors located in cranial and sacral levels
  16. Sympathetic/Parasympathetic
    • Heart- Vasoconstriction/vasodilation
    • BP & P- Increases/back to normal
    • Bronchi- Dilate/constrict
    • Skin- Sweats/Dry
    • Intestine- Slows motility/back to normal
    • Bladder- Decrease U. O., less renal blood flow/back to normal
    • Pupils- Dilate/back to normal
  17. Neuro Data Collection
    • Baseline data collection
    • History of neuro problems
    • Level of consciousness (LOC)
    • Cranial Nerves
    • Muscle Strength- 0-5 scale, push and pull
    • Movement-smooth
    • Gait- smooth coordination
  18. Glasglow Coma Scale
    • Objective tool to score LOC
    • Eye opening- 4
    • Verbal response- 5
    • Motor response- 6
    • Highest- 15, 7 and lower- coma, lowest 3- deep coma
  19. Brain Cerebrum
    • Right and Left Hemispheres
    • Governs sensory and motor activity, thought and learning
  20. Thalmus
    • Relays sensory impulses to the cortex
    • Provides pain gate
    • Part of the reticular activation system
  21. Hypothalamus
    • Regulates autonomic responses
    • Regulates stress response, sleep, appetite, body temp, fluid balance, emotions
    • Responsible for the production of hormones secreted by the pituitary gland and hypothalamus
  22. Brain Stem
    • Midbrain
    • Pons
    • Medulla Oblongata
  23. Midbrain
    • Motor Coordination
    • Contains visual reflex and auditory relay centers
  24. Pons
    Contains respiratory centers and regulates breathing
  25. Medulla Oblongata
    • Contains all afferent and efferent tracts
    • Contains cardiac, resp, vomiting and vasomotor centers
    • Controls HR, respirations, blood vessel diameter, sneezing, swallowing, vomiting and coughing
  26. Cerebellum
    Coordinates smooth muscle movement, posture, equilibrium, muscle tone
  27. Neuro Data Collection Cerebral Function
    • LOC- Glasgow Coma Scale
    • Orientation
    • Mental Status
    • Intellectual Functioning
    • Emotional Status
    • PERRLA
    • Communication
  28. Neuro Data Collection Motor Function
    • Muscle Size/symmetry
    • Muscle Tone/strength
    • Coordination
    • Romberg Test
    • Posturing
    • -decorticate- flexion
    • -decerebrate- extension
  29. Neuro Data Collection Sensory Function
    • Tactile
    • Pain and Temp
    • Vibration
    • Proprioception- sense of joint in space
    • Stereognosis- ability to recognize a familiar object by touch
    • Graphesthesia- identify letters or number drawn on skin
    • 2 point discrimination
  30. Neuro Data Collection
    • Reflexes
    • Deep Tendon- nurses don't do
    • Superficial- cornial reflex, abd reflex, plantar reflex
  31. Neuro Diagnostics
    • Lumbar Puncture
    • EEG (electroencephalogram)
    • EMG (electromyogram)
    • X-Ray
    • CT Scan
    • MRI
    • Cerebral Angiogram
    • Brain Scan
    • Myelogram
  32. Head Injury Scalp
    • Watch for infection
    • Clean wound before sutures
    • Closed injury- dura mater is intact
    • Open injury- damage to dura mater
    • Pain, headache, neuro defict,
  33. Head Injury Skull
    • Linear- non placed cracks in skull
    • Comminuted- broken into fragments
    • Depressed- fragment is pressing down into cranial cavity
    • Basilar- fracture at base of skull, battle sign, echimosis
  34. Traumatic Brain Injury
    • Acceleration- moving object strikes the skull
    • Deceleration- head is moving strikes a solid object
    • Acceleration-Deceleration
    • Rotational- bouncing around
    • Coup- impact of the head against the object
    • Contracoup- movement of the brain based on the original impact
  35. Concussion
    • Transient neuro deficit caused by shaking the brain
    • Loss of conciseness- seconds to hours
  36. Concussion Data Collection
    headache, dizziness, N, V, amnesia before or after trauma, no skull or dura injury noted, momentary loss of reflexes, agitation, confusion, unsteady gait, visual disturbances, loss of mentation, resp arrest
  37. Concussion
    • Spontaneous improvement
    • Post Concussion Syndrome- can last a few weeks to years, lingering headache, emotional ability, insomnia
  38. Contusion
    • Brusing of the brain
    • 7-8 GCS
    • Prognosis full recovery to death
    • Can have permanent brain damage
  39. Contusion Data Collection
    Unconsciousness, come in and out, skin cool and pale, P, BP and Resp below normal, high risk for ICP, dizziness, doll's eyes
  40. Epidural Hematoma
    • collection of blood between dura mater adn skull
    • arterial bleed, Menigeal Artery
    • Medical Emergency
    • Data Collection- neuro status decline, headache, paralyzed extraocular movement, seizures, fixed dilated pupils, increased ICP
  41. Subdural Hematoma
    • Collection of blood between dura and arachnoid
    • Vein bleed
    • Acute- 24-48hrs Subacute- 2-4 days chronic- 2 weeks to months
    • small treated with meds, large surgery to remove
    • Data Collection- altered LOC, undilated, paralysis, forgetfulness, lethergy, headache, pupil changes
  42. Subarachnoid Hemorrhage
    • Bleeding occurs below arachnoid or in the ventricles
    • Surgery to repair, on lots of meds
    • In hospital to head injury
    • Data Collection- noctual rigidity, all data for others, increased ICP
    • Never suction through nose with head injury
  43. Intracerebral Hemorrhage
    • bleeding in the brain tissue
    • surgery to repair
    • Data collection same as others
    • Interventions same as others
  44. Interventions for head injury
    • Control ICP
    • Airway/lung sounds
    • Pain
    • Mobility
    • Safety
  45. Increased Intracranial Pressure
    • Anything in the brain that doesn't belong
    • Monroe-Kellie Hypothesis
    • Causes to much volume, edema, tumor, increased CSF or not being reabsorbed
  46. Increased Intracranial Pressure Data Collection
    decreased LOC, confussion, difficulty arousing, restlessness, change in pupil size, responses get slower, vision changes, pulmonary edema, increased temp Systolic BP, decreased P, and resp, hemipalesia, mentation, loss of conciousness, hearing problems, seizures, posturing
  47. Increased Intracranial Pressure Interventions
    Never suction through nose, O2, ABG's, limit activity, HOB 30-40 degrees, shivering, straining, surgery to decompress, resp status
  48. Decadron dexamethasone
    • Corticosteroid, decrease cerebral edema
    • PO, IM, IV, Rectal
    • SE- depression, euroharia, increased ICP, hypertension, anorexia, N, V, adrenal gland supression, edema, wt gain, decreased wound healing, increase BS
    • Interventions- big dose in morning, small in evening, give with food, I&O, daily wt, check BS, wounds that dont heal, report (swelling, tenderness, brusing, wt gain)
  49. Tagamet cimetidine
    • Antiulcer, inhibits action od H2 receptors
    • PO, IM, IV
    • SE- confusion, dizziness, headache, constipation, drug induced hepitis, N, V
    • Interventions- pain status, avoid antacids 30 mins before and after, give with meals, take as prescribed, no smoking, safety, avoid alcohol, irritating foods, report (diarrhea, dizziness, confusion, rash)
  50. Osmitrol mannitol
    • Osmotic diuretic, decrease kidney ability to reabsorb fluids
    • IV Only
    • SE- confussion, headache, blurried vision, pulmonary edema, N, V, thirst, dehydration, dizziness,
    • Interventions- lung sounds, vitals, I&O, daily wt, monitor dehydration, increased ICP, renal function, hypovolemia
  51. Tylenol acetaminophen
    • antipyretic, decreases pain and fever
    • PO, Rectal
    • SE- hepatoxicity, renal failure, rash,
    • Interventions- vitals, BS changes, decreased metabolism, decreased cerebral blood flow, decreased ICP, increased O2 to tissue
  52. Dilantin phenytoin
    • Anticonvulsant, slows electrical conduction to stop seizures
    • PO, IM, IV
    • SE- gingival hyperplasia, N, V, anorexia, constipation, altered sense of taste, redish urine, wt loss, back pain, drowsiness
    • Interventions- around the clock as prescribed, seizure data, dental exams, give with meals, safety, avoid alcohol, dont switch between trade and generic, will interfere with birth control, frequent oral care, if on G tube stop feed for 2 hrs, theraputic range 10-20mg
  53. Brain Tumors
    • primarly develop in brain
    • can start somewhere else and travel to brain
    • tumor grows ICP increases
    • find out what blood flow is effected
  54. Brain Tumors Diagnostics
    • CT Scan
    • MRI
    • EEG
    • PET
    • Needle biopsy
  55. Brain Tumors Data Collection
    altered consiousness, decreased mental function, headache, seizures, vomiting, fatigue, inability to preform ADL's, signs of neuro changes (first drowsiness)
  56. Brain Tumors Complications
    Seizures, memory impairment, cognative changes, ataxia, increased ICP
  57. Brain Tumors Interventions
    Control symptoms, radiation, meds to control ICP, chriotherapy, prepare for surgery, may be in ICU after surgery
  58. Paveral codeine
    • Opioid agonist
    • PO, IM, IV, SubQ
    • SE- confussion, sedation, hallucinations, N, V, constipation, dry mouth, urinary retention
    • Interventions- vitals, resp delow 10 call dr do not give, bowel function, change position slowly, safety, avoid alcohol, oral hygein, stool softener, sometimes given with amtiemtics
  59. Brain Tumors Nursing Problems
    • Self Care
    • Reorient
    • Pain
    • Injury risk, Sensory perceptual alterations
  60. Epilepsy/Seizure Disorders
    • Sudden attack
    • Electrical disturbances
    • infection, decreased O2 levels in blood
    • Trama during birth, drugs, alcohol, arua, hypoxia, infection, hypoglycemia
  61. Epilepsy/Seizure Disorders Diagnostics
    • EEG
    • CT Scan
  62. Epilepsy/Seizure Disorders Types
    • Generalized- tonic clonic, absent, atonic
    • Partial- simple, complex
  63. Epilepsy/Seizure Disorders Data Collection
    decreased muscle tone, mood changes, perceptation changes
  64. Epilepsy/Seizure Disorders Interventions
    Safety, airway, loosen tight clothes, privacy, never leave alone, don't put anything in mouth, head to side, record length, origin of seizure
  65. Seizure Meds Goals
    • Goal minimize side effects, stop or decrease seizures
    • Do not stop taking med abruptly- needs tapered
    • Status Epilepticus- emergency condition- acute prolonged seizure last 30 mins or more, can go in and out of consciousness, can have irreversible brain damage
  66. Seizure Meds
    • Anticonvulsants
    • Therapeutic levels
    • - Dilantin- 10 - 20mg
    • - Phenobarbitol- 10 - 40mg
    • - Tegretol- 6-12mcg
    • - Depakene
    • - Mysoline
  67. Luminal phenobarbitol
    • Anticonvulsant, Sedative, Hypnotic
    • PO, IM, IV
    • SE- drowsiness, vertigo, resp depression, bronchiospasm, N, V, photo sensitivity, dependency, diarrhea, constipation
    • Interventions- drug levels, toxic, resp rate before admin, document seizure activity, LOC, safety, can crush, deep IM, no alcohol, sunscreen, no driving
  68. Tegretol carbamazepine
    • Anticonvulsant, Sedative, Hypnotic
    • PO Only
    • SE- drowsiness, ataxia, dry mouth, blurred vision, photo sensitivity, urine retention, increase or decrease BP
    • Interventions- document seizures, give with food, can not crush, around the clock, safety, sunscreen, frequent fluids, avoid alcohol, messes with birth control
  69. Depakene valproic acid
    • Anticonvulsant, Sedative, Hypnotic
    • PO, IV
    • SE- N, V, anorexia, constipation, diarrhea, confusion, dizziness, headache, increased bleeding time
    • Interventions- single dose at bedtime, can help sleep, give with meals or right after, sprinkle on food, safety, no alcohol
  70. Herniated Intervertebral Disc
    lower back pain down siatic nerve
  71. Herniated Intervertebral Disc Predispoed
    • Chronic back pain
    • Repetitive lifting
    • Trauma
    • Twisting
    • Falls
    • Accidents
    • Aging Process
    • Sometimes slow progression
  72. Herniated Intervertebral Disc Types
    • Lumbar- L4-L6 most common 90-95%
    • Cervical- C5-C7
  73. Herniated Intervertebral Disc Data Collection
    Lesegue's sign, Kernig's sign, pain, numbness, tingling, loss of reflex above or below, muscle spasm
  74. Managing Herniated Intervertebral Disc
    • Conservative- provide rest, stress reduction, immobility of spine, pain relief
    • Surgical
    • Medications- narcotic analgesics, muscle relaxants
  75. Lioresal baclofen
    • Skeletal muscle relaxer, inhibits reflexes at spinal level
    • PO, Intrathecal
    • SE- dizziness, drowsiness, fatigue, wt gain
    • Interventions- monitor spactisity, give with food, dont stop abruptly, change positions slowly, avoid alcohol
  76. Spinal Cord Injury
    • Injury to the spinal cord
    • MVA, violence, falls, sporting accidents
    • Cervical and lumbar most common
  77. Spinal Cord Injury Data Collection
    • Flexion- bends forward
    • Hyperextension- bends back
    • Rotational- twisting
    • Compression- crushed together between vertebrae
  78. Spinal Shock
    • Neurogenic shock
    • Hypotensive event
    • Loss of motor, sensory, autonomic and reflexes
    • Areflexia- absence of reflexes
    • Occurs immediatly upon injury
    • C5 and above- Resp involvement
    • Cervical injury- Quadriplegia
    • Thoracic and below- Paraplegia
    • Under S1- leg movement
    • Under S4- bladder and bowel function
  79. Autonomic Dysreflexia
    • Hypertensive Crisis
    • 1. Elevated systolic BP (260-300)
    • 2. Bradycardia
    • 3. Throbbing headache
    • decreased resp
    • diaphoresis
    • Data- decreased resp rate, BP, CO, HR
    • Loss ability to sweat, poikilothermia
    • Tx- notify DR., remove stimuli, elevate HOB
  80. Spinal Cord Injury Interventions
    • Immoblize head
    • antiembolism stockings
    • Diet- high protein, calcium, vita D
    • May be on TPN or feeding tube
    • Airway kit and suction by bedside
    • Skull tong/Halo- pin care, body straight in bed, weights hang free
  81. Nipride nitroprusside
    • Antihypertensive, relaxes venous smooth muscles
    • IV Only
    • SE- N, V, abd pain, dizziness, headache, bradycardia, flushing, decreased reflexes
    • Interventions- vitals, change position slowly, I&O, daily wt, lung sounds
  82. Care of the Unconscious Client
    • Resp Status
    • Circulation
    • Neruo checks
    • Gastrointestinal
    • Renal Function
    • Skin/Oral Care/Positioning
    • Safety
    • Always assume they can hear you
  83. Craniotomy
    Incision into the cranium to remove a blood clot, tumor, or anything that doesn't belong
  84. Craniotomy Interventions
    Vitals every 30 mins, head in midline, quiet enviornment, drainage (30-50ml), I&O every hour, fluid restriction 1500ml, electrolyte balance, ROM every 8hrs, monitor for dysrythmias, cold packs for periorbital edema
  85. Craniotomy Data Collection
    Decreased LOC, motor weakness, personality changes, vision problems
  86. Craniotomy Complications
    Increased ICP, swelling, shock, pulmonary edema, Diabetes Insipidus, hemmatoma
  87. Bell's Palsy (facial paralysis)
    causes- infection, trauma, hemmorage, menningitis, tumor
  88. Bell's Palsy Interventions
    • Facial exercises, use eye drops, food in small pieces, protect eye from injury
    • Will eventually come out once cause is treated
  89. Bell's Palsy Data Collection
    problem with taste and swallowing, paralyzed facial movement
  90. Multiple Sclerosis
    • Abnormal response to bodies immune system or viral infection
    • Slow peogressive degenerative disease which leads to permanent neuro dysfunction
    • No Cure
    • Demyelination of the brain and spinal nerve cells and replacement occurs with sclerotic patches, interfering with transmission of nerve impulses
    • Onset 20-40 yrs
    • Periods of remission and exacerbation
    • Women effected 2-3 times more then men
  91. Multiple Sclerosis Data Collection
    Motor- decreased muscle strength, spasitity of lower extremited, paralysis, incontinence of bowel and bladder

    Sensory- Diplopia (double vision), blurred vision, transient blindness, numbness, paresthesia, decreased temp sensation

    Other- ataxia, mystagmus, tremors, speech disturbances, vertigo, dysphasia, CSF will have increased protein, IgG, WBC
  92. Multiple Sclerosis Interventions
    • Bed rest during exacerbation
    • daily exercise, physical therapy, ROM, occupational therapy, change positions frequently, use of assistive devices, safety
    • Diet- well balanced, high roughage and fiber, aadiquet fluids, wt reduction
    • Meds- Corticosteroids, muscle relaxers, immunosuppressive agents, urinary meds
  93. Multiple Sclerosis Complications
    UTI, pneumonia, pressure ulcers, contractures, depression
  94. Avonex Rebif interferon beta 1a
    Betaseron interferon beta 1b
    • Anti multiple sclerosis agent, slows progression of disease\
    • IM, SubQ
    • SE- headache, weakness, drowsiness, N, V, diarrhea, dyspnea, UPI, tachycardia, depression, photosensitivity, alopecia, decreased WBC, flu like symptoms
    • Interventions- monitor for exacerbation, check for depression, teach correct injection technique, tylonel for relief of flu like symptoms, sunscreen, infection, avoid crowds and ill people
  95. Amyotropic Lateral Sclerosis (ALS)
    Lou Gehrig's Disease
    • slow progressive degenerative disease
    • caused by viral immune response or genetic
    • onset to death 3 years
    • men 2-3 times more likely to get
    • Body falls apart, mind is intact
  96. Amyotropic Lateral Sclerosis (ALS)
    Lou Gehrig's Disease Data Collection
    drooling, chewing and swallowing difficulties, muscle weakness, atrophy, spasticity of upper extremities, flaccid paralysis, decreased resp status,
  97. Amyotropic Lateral Sclerosis (ALS)
    Lou Gehrig's Disease Intervention
    • continue activities as long as they can do them, physical therapy, occupational therapy, speech therapy, regular soft foods, may progress to feeding tube
    • meds- muscle relaxers
    • ask about living wills, POA, and advanced directives before they get bad
  98. Guillian Barre
    • acute inflammatory PNS
    • Demyelination of distal nerves, remyelination of the proximal to distal
    • immune system overreactsto infectionand destroys the myelin sheath
    • Stages acute- 1-3 weeks, plateau- several days to 2 weeks, recovery- up to 2 years
    • nonspecific infection, viral, autoimmune
  99. Guillian Barre Data Collection
    Motor- weakness begins in legs and works up the body, absence of reflexes, resp failure

    Sensory- paresthesia, pain

    Autonomic- BP regulation, GI mobility, urinary elimination
  100. Guillian Barre Interventions
    • Physical therapy, occupational therapy, loc, ABG's, turn frequently, cough and deep breath, skin care, position to prevent contracture, TED hose, Homan's sign, I&O, prune juice, pool therapy, balanced diet to prevent muscle breakdown, vitals
    • Meds- steroids, imuran, heparin
  101. Imuran azathioprine
    • Immunosuppressant, blocks purine metabolism
    • PO, IV
    • SE- anorexia, N, V, diarrhea, mucositis, leukopenia, chills, fever, pulmonary edema, retinopathy
    • Interventions- monitor for infection, life long therapy, avoid crowds and ill people, I&O, daily wt, watch for blood in stool, report tiredness, weakness, cough, hoarseness, fever, chills, lower back or side pain, black tarry stool
  102. Calcilean heparin
    • Anticoagulant, prevents conversion of prothrombin to thrombin
    • IV, SubQ
    • SE- drug enduced hepatitis, alopecia, anemia, injection site pain, fever
    • Interventions- monitor for bleeding, teach admin technique, 2 nurses must check, safety, soft toothbrush, electric razor
    • antidote- protamine sulfate
  103. Headache
    • Primary- not caused by an underlying condition
    • Tension- most common, steady, occurs frequently
    • Migraine- more often in women, irritable, anorexia, N, V, photophobic
    • silent migraine- may have aura
    • Cluster- severe pain, one side behind the eyes, goes away for years then can come back at any time, alcohol is trigger
    • Secondary- result from another condition

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