Card Set Information

2013-09-03 01:21:11

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  1. tx spinal cord injurie-s
    • patent airway
    • immobilize (traction, special beds)
    • administer drugs
    • preserve cord function (surgery)
  2. autonomic dysreflexia
    sudden htn, pounding ha, anxiety, flushed face, diaphoresis, bradycardia, nasal congestion, vasoconstriction below lesion w cold skin and goose flesh, vasodilation above lesion with warm moist skin
  3. spinal shock
    relex activity below level of injury is temporarily stopped. starts 30-60 mins after, paralysis is flaccid (no muscle tone)
  4. types of seizures
    • absence
    • tonic-clonic
    • myoclonic
    • atonic
  5. ansence seizures
    dont include motor signs; may last less than one min; seen in children; thought as daydreaming; no post
  6. tonic-clonic
    • tonic phase- muscles are rigid
    • clonic phase - rythmic muscle jerking
    • hear "cry" from rigid trunk and diaphragm air coming thru vocal cord
  7. myoclonic
    • muscles to jerk
    • person may fall
    • no post
  8. atonic
    • brief loss of tone in muscle
    • person may drop things/fall
    • no post
  9. postictal phase
    • time immediately after as pt recovers
    • clear secretions, open airway, o2, assess for injuries (abrasions, bruises, tongue biten)
  10. interictal phase
    • time between seizure activity
    • siderails up and padded
    • suction at beside
    • disable locks
    • no glass thermometers
    • helmets for walkers
  11. intracranial surgery baseline assessment
    to have something to compare to during surgery
  12. management of seizures
    • remove objects
    • turn on side
    • note time began and how progresses
    • assess/document postictal status
    • allow quiet rest
    • call emergency for t-c lasting longer than 4 mins or seizes rapidly succession
    • dont restrain
    • dont put anything in mouth
  13. meningitis s/s
    • ha
    • nachal rigidity
    • irritability
    • decr loc
    • photophobia
    • hypersensitivity
    • seizures
    • + kernigs and brudzinskis
  14. parkinsons s/s
    • dont occur until 70% neurons destroyed
    • TRAP - tremors, rigidity, akinesia/bradykinesia, and postural instability.
    • wkness, fatigue, diff w fine motor movement, loss facial expression, diff chew/swallow, voice changes, memory loss, prob-solving diff, visual spatial deficits
  15. myasthenia gravis
    6 s/s
    muscle wkness, fatigue, ptosis & diplopia, cant keep mouth shut/chew/swallow long periods, emotionless face, wk neck causing head to fall forward
  16. myasthenia gravis testing
    • tensilon test
    • given iv - pt have brief incr in muscle strength
  17. primary/closed spinal cord injury
    • skin and meningeal covering remain in tact:
    • compression, flexion, hyperextension, rotation, blunt trauma, hematomas, degeneration, tumor, fx
  18. secondary/open spinal cord injury
    • damage to skin/meninges
    • gun shot wound
    • stab wound
  19. neuro checks
    • pt hx while gathering:
    • speech pattern
    • mental status
    • intellectual function
    • reasoning ability
    • movement/lack of
  20. agnosia
    failure to recognize/identify objects despite intact sensory function
  21. assessing pain
    • broken wooden applicator as "sharp"
    • cotton side as dull
    • ask pt whether sharp/dull sensation felt
    • recognition of sharp indicates perception of painful stimuli
  22. deep pain sensation
    may indicate pressure on a sensory nerve
  23. rombergs sign
    motion and position
    • pt stand w feet together eyes close
    • if loses balance = presence of pathologic condition
  24. kernigs sign
    inability to extend legs when knee flexed at hip
  25. brudzinskis sign
    hip and knee flexed when neck is flexed
  26. assessment of pupils
    size, shape, response to light, equality
  27. 12 cranial nerves
    • olfactory
    • optic
    • oculomotor
    • trochlear
    • trigeminal
    • abducens
    • facial
    • acoustic
    • glossopharyngeal
    • vagus
    • spinal accessory
    • hypoglossal
  28. test olfactory
    common odors to one nostril at a time
  29. test optic
    visual acuity, field, optic disk
  30. occulomotor
    EOMs, dolls eyes, accomodation
  31. trochlear
    eoms, dolls eyes
  32. abducens
    • eoms
    • dolls eyes
  33. facial
    smile, frown, show teeth, puff cheeks, taste (ant 2/3), close eyes
  34. acoustic
    vestibular not tested
  35. glossopharyngeal
    • swallow on command
    • gage reflex
    • taste post 1/3
  36. vagus
    gag reflex, midline elevation uvula
  37. spinal accessory
    shrug shoulders, turn head against resistance
  38. hypoglossal
    protrude tongue (deviates to affected side)
  39. eoms
    extraocular movements
  40. dolls eyes
    when head is moved, eyes move opposite direction
  41. 4 functions nervous system
    • receives info from internal and external environments
    • communicates info bw bd and cns
    • processes info recieved to determine response situations
    • transmits info for bd action, control, or modification (touch something hot)
  42. speech areas of brain
    • cerebrum dominant side
    • brocas and wernickes
  43. brocas
    controls verbal, expressive speech
  44. wernickes
    reception and understanding language
  45. age related changes
    • loss of cells and wt
    • nerve cell loss diffuse and gradual
    • decr bld flow
    • labile and unpredictable
    • decr nerve impulse velocity
    • decr sensory and motor conduction
  46. nsg role lumbar puncture
    monitor insertion site for swelling, redness, or drainage
  47. signs of decreased LOC
    • minimal agitation/drowsiness
    • restless or suddenly quiet - alert dr
    • somnolence
    • lethargy
    • stupor
    • semi/coma
  48. somnolence
  49. lethargy
    excessive drowsiness
  50. stupor
    decr responsiveness c lack of spontaneous motor activity
  51. semicomatose
    in stupor but can be aroused
  52. coma
    cannot be aroused
  53. IICP early signs
    • decr loc
    • ha increased w cough/strain
    • pupillary changes (dilation, slowed constict)
    • contrlateral motor/sensory losses
  54. IICP late signs
    • change in vitals
    • incr systolic
    • decr diastolic
    • widened pulse pressure
    • slow pulse
    • resp dysrythmias
    • hiccups
    • incr pupil size
    • fever wo infection
    • vomiting
    • decerebrate/decorticate posturing
  55. IICP meds
    osmotic diuretics
    • Mannitol
    • promotes fluid removal from edematous brn tis
  56. IICP meds
    • Decadron
    • used to reduce edema associated w tumors/abcesses
  57. IICP meds
    • Dilantin
    • prevent seizures
  58. IICP meds
    opiods and sedatives
    • use cautiously bc of resp depressant effect
    • may alter pts ability to cooperate for accurate neuro exam
  59. IICP meds
    • phenobarb
    • given to slow cerebral metabolic rate
    • and minimize damage caused by IICP induced ischemia
  60. significant changes in LOC that need reported
    pts who are restless and agitated or suddenly quiet

    • report to dr
    • monitor
  61. primary ha
    • no pathologic cause
    • migraine, tension, cluster
  62. secondary ha
    • pathologic cause
    • meningitis, tumor, subarachnoid hemorrhage
  63. migraines
    cerebral bld ves narrow and bld flow reduced (vasoconstriction) followed by vasodilation and inflammation cause release of serotonin

    vary in freq, duration, and intensity
  64. cluster ha
    • similar to migraines
    • but brief (45 mins of less)
  65. tension ha
    stress-induced muscle tension over neck, scalp, face
  66. tx ha
    • common meds
    • quiet dark room
    • relax tech
  67. signs of a stroke
    • sudden numbness/wkness of face, arm, or leg, esp on one side of bd
    • sudden confusion, trouble speaking or understanding
    • sudden trouble seeing in one/both eyes
    • sudden trouble walking, dizziness, loss of balance or coordination
    • sudden severe ha w no known cause
  68. modifiable risk factors stroke
    can be controlled reducing risk for cva
  69. nonmodifiable risk factors
    • cant be changed
    • age, race, gender, hereditary
  70. causes of stroke in younger ppl
    drug abuse, bc pills with smoking, congenital hrt conditions, mitral valve prolapse, a fib, infectious endocardititis, sickle cell anemia, rheumatic fever, leukemia
  71. htn
    • antihypertensive drugs
    • wt control
    • stress management
    • smoking cessation
    • limited etoh
    • low fat diet
    • reduced na
  72. cardia disease
    • drug therapy to improve bld flow and prevent clots
    • treatment of a fib
  73. dm
    balanced drug therapy, diet, wt control, exercise, bld glucose monitoring
  74. hypotension
    • good hydration, esp elderly
    • monitor effects of diuretic and antihypertensive drugs
  75. migraine ha
    drug therapy to abort impending ha or prophylaxis
  76. incr risk for bld clot
    • good hydration
    • drug tx
  77. excessive etoh
    limit etoh to one oz pure etoh: 2 cans beer, 2 sml glass wine, 2 cocktails

    no binge drinking
  78. smoking
    • advise of risks
    • explain risks falls w cessation
    • self help programs
    • md for drugs
  79. obesity
    • maintain bd normal bd wt
    • proper diet instriction
    • wt control prgrams
    • exercise programs
  80. high fat diet
    • instruction in meal planning and prep
    • reduce sat-fats
  81. drug abuse
    drug abuse tx programs