Med Surg II Test 2

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Med Surg II Test 2
2012-08-02 19:48:19

Med Surg II Test 2
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  1. Tension headaches
    • Bilateral, band-like pressure at base of skull
    • Constant squeezing tightness
    • Cycles for years
    • 30min-7 days
    • palpable neck and shoulder muscles, stiff neck, tenderness
  2. Migraine headaches
    • Unilateral, may switch sides, commonly anterior
    • Throbbing, with pulse
    • Periodic, cycles of months to years
    • 4-72 hours
  3. Cluster headaches
    • Unilateral radiating up or down from one eye
    • Severe, bone crushing pain
    • Months or years inbetween
    • Occur during 2-12 week period, last 5min-3hr
    • Nocturnal, facial flushign or pallor, unilateral lacrimation, ptosis and rhinitis
  4. Tegretol
    • Generalized tonic-clonic and partial seizures
    • Do not take with grapefruit juice
    • Pt report visual abnormalities
    • Abrupt withdrawal may precipitate seizures
    • Can cause bone marrow suppression, anemia, leukopenia
    • Also used for bipolar, trygeminal neuralgia
  5. Depakote
    • Treats all major seizure types
    • GI effects - N/V
    • Can cause pancratitis or hepatomegaly
    • Used for migraines also
  6. Phenobarbital
    • Oldest seizure drug, barbiturate, treats all seizures
    • Lethargy, depression, learning impairment
    • Physical dependence, pregnancy and withdrawal are concerns
    • Can intefere with Vitamin D and K
  7. Dilantin
    • Tonic clonic and partial
    • Metabolized by liver
    • Can be given IV, used to treat dysrhythmias
    • Therapeutic level of 10-20
    • Adverse: nystagmus, ataxia, diplopia, cognitive impairment
    • Gingival hyperplasia, rash
  8. Neurontin
    • Also used for postherpatic neuralgia
    • Can cause peripheral edema, ataxia
  9. Multiple Sclerosis
    • Viral/infectious, autoimmmune - affects myelin sheath
    • Fatigue, weakness, numbness, difficulty with coordination, diploplia in early stages.
    • Remission while pregnant.
    • Interferon, Avonex, Copaxone
    • Methotrexate - also used in RA
    • Symmetrel, tegretol, BACLOFEN
  10. Parkinson's
    • Dopamine deficiency, destruction and degeneration of nerve cells at basal ganglia.
    • Drug induced sx from  Haldon, lithium, aldomet
    • Infections, chemical/environmental exposure
    • Bradykinesia, tremors, rigiditiy, head forward/shuffling gait.
    • Levodopa/Carbodopa, symmetrel (dopamine agonist, given with sinemet for dyskinesia), Parlodel - orthostatic hypoTN, headache. Anticholinergics.
  11. Myasthenia Gravis
    • Autoimmune - affects myoneural juncion.
    • Skeletal muscle fatigue, diplopia, ptosis
    • Precipitated by stress, pregnancy,menses, hypokalemia
    • Tensilon test
  12. Myasthenic crisis
    • Acute exacerbation of symptoms resulting in major muscular weakness and inability to maintain respiratory function.
    • Can be caused by infection, surgery, emotional stress.
    • S/sx- sweating, excess salivation, constricted pupils, difficulty chewing and swallowin, abd pain.
    • Pt should be intubated, resp status monitored
    • Tensilon improves condition but will worsen if pt in CHOLINERGIC CRISIS
  13. Amyotrophic Lateral Sclerosis, ALS, Lou Gehrig's
    • Degeneration of motor neurons, primarily in brainstem and spinal cord.
    • Upper extremity weakness, dysarthria, dysphagia, trapped in body. 
    • Treated with Riluzole
  14. Huntington's Disease
    • Progessive, hereditary, autosomal dominant genetic disorder.
    • Excess abnormal movements, decreased intellect, emotional problems, progression leads to constant twisting and uncontrollable movements and facial movements, grimacing.
    • Treat symptoms, Haldol blocks dopamine receptors.
  15. Cholinergic crisis
    Abd cramps, blurred vision, bowel or bladder incontinence, increased pulse and decrease urine output, restlessenss, increased salivation, dyspnea.
  16. Central cord syndrome
    • Damage to central cord areas
    • Motor and sensory loss to UE and LE
  17. Functional levels with various spinal cord injuries, cervical
    • C1-3- often fatal, movement in neck and above
    • C4-  sensation and movement in neck and above, may be able to breath without respirator
    • C5- full neck, partial shoulder, back,biceps, gross elbow, unalbe to roll over or use hands, decreased respiratory reserves
    • C6- shoulder and upper back abduction and rotation at shoulder  full biceps to elbow flexion, wrist extansion weak grasp of thumb, decreased respiratory reserve
    • C7-8- triceps to elbow extension, finger extensors and flexors, good grasp with decreased strength, decreased respiratory reserve
  18. Functional level of spinal cord injuries, thoracic and lumbar
    • T1-6- full innervation of upper extremities, back, essential intrinsic muclse of hands, full strength and dexterity of grasp, decreased trunk stability, decreased resp reserve
    • T6-12 - Full, stablethoracic muscles and upper back, functional intercostals, resultin in increased resp reserve
    • L1-2 - varying control of legs and pelvis, instability of lower back.
    • L3-4 - quardriceps and hip flexors, absence of hamstring function, flail ankles.
  19. Spinal cord shock
    • Can happen immediately after or up to 72 hours post injury.
    • Temporary loss or dysfunction of spinal reflex.
    • Loss of control with higher centers.
    • Loss of sensation, absence of reflexes
    • Bowel and bladder dysfunction.
    • Occurs primarly in cord lesions.
    • Hypotension and bradycardia.
  20. Neurogenic shock
    • Loss of vasomotor tone caused by injury.
    • SNS causes vadoilation, venous pooling, decreaed CO
    • hypotension, bradycardia.
    • Hyperreflexia as recovery porgreses.
  21. Autonomic dysreflexia
    • Can occur with injuries at T6 or higher, occurs after spinal shock resolves.
    • Severe HTN, pounding headache, bradycardia (30-40 bpm)
    • Elevate HOB 45 degrees, treat with dopamine, porcardia, beta blockers, methylprednisolone (not in penetrating injuries, cautions in elderly due to renal impact), Anticholinergics - ditropan, detrol, Alpha-Adrenergic blockers- hytrin, cardura, Antispasmodic- Baclofen
  22. Guillane Barre syndrome
    Ascending - most severe, weakness and paresthesias begin in lower extremities and progress upward to include legs, trunk, arms and cranial nerves.

    Descending- weakness starts in face, jaw, SCM and tongue, larynx and pharynx and progressess down limbs, affects respiratory system, shallow resp, breathless with speech.
  23. Acute pyelonephritis
    • inflammation or renal parenchma, most often caused by bacterial infection, also caused by obsruction, rerograde, frequent eps of pyelonephritis, also fungi/protozoa or viruses.
    • S/sx of fever, chills, blood in urine, mild fatigue, n/v, dysuria, flank pain.
    • Treat with IV abx, urinary analgesics (pyridium, orange piss)
  24. Glomerulonephritis
    • Caused by strep, viral inf, bronchitis, pneumonia, mumps, varicella.
    • S/sx of HTN, elevated BUN and Cr, edema in hands and fingers, periorbital edema, protein/RBC and RBC casts in urine. Fluid in lungs, decreased output, azotemia, increased specific gravity. GFR below 50.
    • Tx with rest, sodium and fluid restriction, diuretics, antiHTN, limit protein, broad spectrum ABX.
  25. Acute renal failure
    • Sudden and almost complete loss of kidney function, can be hours do days. Failure to excrete nitrogenous waste products.
    • S/sx- azotemia, uremia, oliguria.
  26. Contributin factors of ARF
    • tubular necrosis- most common cause
    • Infection - most common cause of death
    • Hpovolemaia, hypotension, heart failure, kidney/renal obstruction.
  27. Prerenal stage
    • Decreased blood flow/ischemia.
    • S/sx- hypotension, tachycardia, decreased urine output, lethargic, slighlty elevated Bun and Cr.
    • Caused by hemorrhage, dehydration, CHF
  28. Intrarenal stage
    • Actual kidne damage caused by imflammatory or innumologic processes.
    • S/sx- anemia, edema, hypertension, JVD, crackles in lungs
    • Caused by tubular necrosis, injury
  29. Postrenal stage
    • Obstruction of urine collecting system.
    • Caused by cancer, BPH, sotnes, strictures, renal calculi.
  30. Chronic renal failure.
    Progressive, irreversible loss of kidney function, GFR or less than 60 for 3 months. Inability to concentrate urine.
  31. CRF Stage 1
    • Normal BUN and Cr.
    • GFR over 90, healthy tissue compensating for damaged tissue
  32. CRF Stage 2
    • kidney damage with GFR 25% of normal, 60-89.
    • BUN and Cr increased, azotemia, polyuria, nocturia, increased specific gravity.
  33. CRF Stage 3
    Moderate decrease in GFR, 30-59
  34. CRF Stage 4
    Severe GFR decreased, 15-29
  35. CRF Stage 5
    • Renal failure, uremia
    • GFR less than 15
    • Severe azotemia, uremia, hyperkaliemia, hyponatremia, hperphosphatemia, anemia can occur, metabolic acidosis, decreased erythropoetien, 1.010 specific gravity.
  36. S/sx of CRF
    • Decreased GFR, retendion of fluids
    • Disrupted creatinine, excreion, BUN elevated
    • Sodium elevated
    • hyperkalemia - K of 7-8 before dialysis, causes dysrhythmias
    • Kussmaul, low calcium, HTN, hyperlipidemia, LOC, uremic encephalopathy, pururites, uremic frost (deosits of urine crystals on skin. RAAS activated.
  37. CRF treatment
    • ACE inhibitors- can cause hyperkalemia
    • digoxin for heart
    • restricted phosphate and protein  (to pt tolerance)
    • Restrict fluids
    • dialyisis