front 1 What causes Increased intercranial pressure? | back 1 _ Traumatic Brain injuries from concussion ruptured cerebral aneurysm stroke obstructions in the circulation of CSF infectious disorders of the nervous system such as a meningitis and encephalitis |
front 2 Client present w/ Drowsiness, Difficult to awaken restlessness confusion irritability Glasgow Coma Scale>13 Personality changes sluggish or unequal pupil response weakness in arms or legs slow or slurred speech Dull headache, especially upon awakening vomiting without nausea | back 2 Early signs of Increased Intracranial Pressure |
front 3 What are some Late signs of Increased Intracranial Pressure | back 3 Unresponsive Glasgow Coma Scale<12 Decreased response to painful stimuli Decorticated or Decerebrated posturing Increased weakness or Hemiparesis Dilated Pupil(s) Seizures Cushing triad: Bradycardia, elevated systolic blood pressure w/wide pressure, irregular breathing loss of gag or corneal reflexes period of apnea |
front 4 What is the First sign of ICP before any other? | back 4 Decreased Level of Consciousness (LOC) Can be accompany by lethargic, stupors, semi-comatose, to comatose. Confusion restlessness and periodic disorientation accompany decreased LOC |
front 5 What is Papilledema? | back 5 Swelling of the optic nerve |
front 6 Client present w/ Pulse rate that increase initially but then decrease Systolic BP rise w/a widening pulse pressuse | back 6 Cushing Triad |
front 7 What is done to DX's underlying causes of ICP? | back 7 Skull radiography CT, MRI Lumbar Puncture Cerebral angiography |
front 8 Medical TX's for ICP | back 8 Decreasing ICP by relieving the cause Maintain BP, Prevent Hypoxia Mechanical Ventilator Client head maintain at midline of 30 |
front 9 True or False Shivering and seizures can cause increase ICP? | back 9 True |
front 10 What can be given when ICP can't be reduce? | back 10 Sedation w/ Barbiturates and propofol (helps with seizure) |
front 11 Nursing MNGT's for ICP client? | back 11 Gather history of leading up to injury for client of witness, or technician, Medical History LOC/VS assist with head -to toe exam neurologic assessment q 30-60 min obtain current and daily WT, I's and O's, monitor electrolytes and ABG's evaluate bowel sound and elimination note evidence of seizures |
front 12 Nursing care plan 37-1 610-612 | back 12 Nursing care plan 37-1 610-612 |
front 13 What is meningitis? | back 13 Inflammation of the meninges caused by various infections microorganism Bacteria, Viruses, fungi, or Parasites |
front 14 What are the pathogens that causes Meninges? | back 14 Bacteria (meningococci and streptococci) Viruses (HSV, Mumps, Enteroviruses) |
front 15 What space so the microorganism travel through? | back 15 Subarachnoid |
front 16 Client present w/ Headache Fever nuchal rigidity (stiff neck not able to place chin on chest) N/V Photophobia (aversion or sensitivity to light) Restlessness irritability seizure small to large petechiae( rug burn appearance) Maculopapular rash (viral) | back 16 Meningitis |
front 17 Severe irritation of Meninges causes hyperextension of head and arching of the back? | back 17 Opisthotonos |
front 18
| back 18 Positive Kernig sign |
front 19 Positive Brudzinski Sign | back 19 flexion of the neck produces flexion of the knee and hips |
front 20
| back 20 Lumbar Puncture (on CSF) Cloudy (Bacterial) Elevated CSF, Decrease Glucose concentration, Elevated Protein level WBC and RBC are elevated C&S to determine Bacterial causative Viral C&S negative CT, Blood culture, CBC rule out other poss. disorders |
front 21 What medical management are done to treat Meningitis? | back 21 Hand Hygiene Local Health department is notified of all cases IV fluids antimicrobial therapy (bacterial) Penicillin, Cephalosporin, Rifampin (turn secretion orange) Ciprofloxacin, azithromycin or a IM dose of cefriaxone |
front 22 What vaccine is recc for all college and universities ? | back 22 Meningococcal meningitis Haemophilus influenzae type b reduce the acquistion of bacterial meningitis |
front 23 What is encephalitis | back 23 Inflammatory process affecting the CNS |
front 24 What is the most common cause of Encephalitis? | back 24 Vector-borne viral infections (St. Louis, western equine, eastern equine, West Nile) Transmit by Ticks and Mosquitoes |
front 25 Client present w/ Sudden fever severe headache stiff neck vomiting drowsiness Insect bite on physical exam Worsen infection tremors, seizures, Spastic or Flaccid paralysis, Irritability and Muscle Weakness, Lethargy, delirium or coma, incontinence and visual disturbances involuntary eye movement, double or blurred vision | back 25 Viral encephalitis |
front 26 What diagnostic procedure is done to Dx's encephalitis | back 26 Lumbar puncture CSF elevated Fluid is Clear West Nile blood or CSF show rise in IGM antibodies EEG Slow waveforms MRI, CT to rule out other etiologies |
front 27 What medical Management is use to treat encephalitis? | back 27 antipyretics anticonvulsants anti-inflammatory drugs and analgesics |
front 28 what are nursing intervention for encephalitis? | back 28 Monitor VS and LOC frequently Consult PCP if Indwelling catheter for urinary incontinence or urinary retention Measure I's and O's (sign Fluid volume deficit) electrolyte imbalance assess Bowel elimination to deter if stool softener or enema is needed |
front 29
| back 29 Measures to Control Exposure to Mosquitoes |
front 30 What is Guillain-Barré syndrome? | back 30 acute postinfectious polyneuropathy, polyradiculoneuritis) affects the peripheral nerves and the spinal nerve roots. |
front 31 What is the cause of GBS Guillain–Barré syndrome? | back 31 exact cause of the disorder is unknown, Is believed to be an autoimmune reaction History of recent surgery recent vaccination for viral disease(FLU) |
front 32 What are the different types of Guillaun-Barre syndrome GBS? | back 32
|
front 33 Client present w/ Weakness, numbness and tingling in the arm and leg(painful the 1st symptoms) Paralysis, weaken Muscle If Cranial nerve involve (Chewing talking and swallowing difficult) | back 33 Guillaun-Barre syndrome |
front 34 What procedures are us to Dx's Guillaun-Barre syndrome | back 34 Lumbar puncture reveal Elevated CSF, Protein level and Pressure Electrophysiological test marked slow conduction of nerve impulses |
front 35 What are some Medical Management for Guillaun-Barre syndrome | back 35
|
front 36 Nursing intervention for client with Guillaun-Barre syndrome | back 36 observe the client for respiratory distress spirometer to evaluate the clients ventilation capacity assess for pneumonia check VS and lung sound frequently provide meticulous skin care position change q2hours help client perform active and passive exercises to prevent muscle atrophy |
front 37 What is a Brain abscess? | back 37 Collection of purulent material in the brain |
front 38 What causes a brain abscess? | back 38 Infection in the middle ear, sinuses or teeth or infection or organs After intracranial surgery or head trauma secondary to such disorders Bacterial endocarditis, bacteremia, Pulmonary or abdominal infection |
front 39 The client is present with/ Increased ICP, Fever, headaches, neurologic changes ( paralysis seizures, muscle weakness, lethargy) | back 39 Brain Abscess |
front 40 What is done to DX's Brain Abscess? | back 40 Elevated WBC CSF by lumbar confirms DX( risk for herniation of brain stem) CT, MRI and Skull radiography are safer techniques for diagnosing and locating the abscess |
front 41 What medical management for Brain Abscess? | back 41 Antimicrobial therapy once dx confirmed. Craniotomy done to drain abscess Cerebral edema and seizure treated with drug therapy Control fever, mechanical ventilation, IV fluids and nutritional support |
front 42 Nursing management for brain abscess | back 42 Assess frequently for altered LOC change in sensory and motor functions Sign of ICP monitors VS frequently measures fluids I's and O's for overhydration that can leaded to Cerebral edema |
front 43 What is Multiple Sclerosis? | back 43 Chronic progressive dx of the Peripheral nerves |
front 44 What cause a client to have MS? | back 44 Trigger by a defective genes |
front 45 Why is MS characterized by demyelinating dx | back 45 Cause permanent degeneration and destruction of myelin |
front 46 Client present w/ Pressure ulcers, cachexia, deformities, and contractures develop Pneumonia by limited activity Shallow breathing and general Debility cause death 1st is fatigue and strain blurred vision, diplopia( double vision) Nystagmus weakness, clumsiness and numbness and weakness and tingling of an arm or leg . intention tremor and slurred, hesitant speech, mood swings are commonParaplegis Bowel or bladder incontinence | back 46 Multiple Sclerosis |
front 47 What Dx's are done to confirm multiple Sclerosis? | back 47 Lumbar puncture for CSF reveal increased WBC count Electrophoresis of CSF reveal abnormal immunoglobulin G bsnd CT MRI my or may not be discolsed lesion in the brains white matter |
front 48 True or false There is a cure for MS? | back 48 False there is no cure for MS, nor a single treatment that relieves all symptoms |
front 49 What are medical management for MS? | back 49 Keep client functional as long as possible Current research for promoting nerve regeneration Medication use 1st dx's modifying drug Interferon beta-1a(avonex) Interferon beta-1b(betaseron), fingolimod(Gilenya) Newer Drugs Immunosuppressive Alemtuzumab, Natalizunba, teriflunomide inhibit neurodegeneration baclofen and dantrolene for muscle spasticity and rigidity antibiotic for infection tranquilizer alleviate mood swings Oxybutynin and Botulinum toxin manage urinary incontienence bethanechol use to relieve urinary retention anti-inflammatory action of corticosteroids relieve symptoms and hastens remissions |
front 50 What are some nursing management for clients with MS? | back 50 Assess the client current physical and emotional status new developments or changes to previously assess identifies the client visual problem emphasize that these may diminish when a remission occurs listen to clients speech (rec. language board or assistive devices) assess weight regularly blenderization of food in swallowing is impaired Manage constipation with high fiber food and fluids provide instruction concerning drug therapy |
front 51 What is Myasthenia Gravis? | back 51 Neuromuscular disorder characterized by severe weakness of on or more groups of skeletal muscles Most common in women |
front 52 What are some causes of Myasthenia Gravis? | back 52 Cause is unknow believed to be autoimmune in nature |
front 53 The client is present w/ is what? Muscle weakness Ptosis(drooping of eyelids) most common difficulty chewing, swallowing, diplopia, voice weakness, Masklike facial expression, Weakness of the extremities Respiratory system is affected | back 53 Myasthenia Gravis |
front 54 The client present w/ is what? Increase muscle weakness respiratory distress decreased tidal volume difficulty talking, swallowing and chewing | back 54 Myasthenic Crisis |
front 55 How do you Dx's Myasthenia Gravis? | back 55 IV administration of edrophonium (tensilon) relieve muscle weakness in a few seconds then dissipate in about 5 min elevated acetylcholine receptor antibody titer Chest radiography show enlargement of thymus(thymoma) Electromyography measures the electrical potential of muscles |
front 56 What are some medical and surgical management for client with Myasthenia Gravis? | back 56 Administer Anticholinesterase (Pyridostigmine bromide) mestinon, (neostigmine) prostigmin or (ambenonium Chloride) mytelase facilitate normal neurotransmission surgical removal of thymus gland for client who don't response to therapy Prednisone or other immunosuppressant (azathioprine) Imuran TID a week Myasthenic Crisis w/severe respiratory distress requires intubation and mechanical ventilation |
front 57 What are some nursing management for client with Myasthenia Gravis? | back 57 Provide periods of rest support ventilation by elevating the head of the bed and suction secretion w/difficulty in swallowing make effort to understand the client when speech is compromises demonstrates patience and empathy administer medication at exact times to maintain therapeutic blood level observe for signs of drug overdose (abd cramps, clenched jaws, muscle rigidity) |
front 58 What is Amyotrophic Lateral Sclerosis (Lou Gehrig disease)? | back 58 Progressive and fatal neurologic disorder Common in men than women |
front 59 What cause of Amyotrophic lateral sclerosis? | back 59 Cause is unknown |
front 60 Client Present w/ is what ? Progressive muscle weakness and wasting of arms, legs and truck Muscle Fasciculations (twitching) If brain stem is affected (speaking and swallowing becomes difficult) Inappropriate laughing and crying Respiratory failure and total Paralysis (Terminal stages) | back 60 Amyotrophic Lateral Sclerosis (Lou Gehring Disease) |
front 61 How is ALS DX's ? | back 61 Difficult to diagnose in the early stage No specific diagnostic test Electromyography validated weakness in the affected muscles |
front 62 What are some medical management for ALS? | back 62 no specific treatment, death occurs several years after Dx encourage remain active as long as possible Mechanical ventilation when ALS affect muscles of respiration treated with riluzole slow progression and delay need for Trachestomy |
front 63 What are some nursing management for client with Amyotrophic lateral Sclerosis? | back 63 Comprehensive assessment and plan of care on client basis problems Provide assist with walking, bathing, shaving and dressing teach family required skills ( suctioning, how to administer feeding tubes and catheter care |
front 64 Client and family teaching for client with ALS | back 64 Medication schedule, adverse effects of medications |
front 65 Nursing process for client with chronic neuromuscular disorder 621-622 | back 65 Nursing process for client with chronic neuromuscular disorder 621-622 |
front 66 What is Trigeminal Neuralgia (Tic Douloureux)? | back 66 Painful condition that involves the 5th cranial nerve 3 major branches ( Mandibular maxillary and ophthalmic) for Chewing facial movement and sensation |
front 67 What is the cause of Trigeminal Neuralgia Nerve pain? | back 67 Unknown Suggested it could be related to compression of the trigeminal nerve root |
front 68 Client present w/ is what? sudden pain, severe and burning Pain ends as quick as it begins repeat many time a day face twitches and eye tear during spasm | back 68 Trigeminal Neuralgia |
front 69 What is done to DX's Trigeminal Neuralgia? | back 69 Skull radiography, MRI or CT are preformed to rule out other pathologies DX's is base on symptoms |
front 70 What medical treatment for Trigeminal Neuralgia? | back 70 Supportive and symptomatic opioids Anticonvulsants (phenytoin) Dilantin and (Carbamazepine) Tegretol reduce pain Check toxicity level Dentist referral correction of dental Malocclusion (relieve some cases) |
front 71 What are surgical management for trigeminal Neuralgia? | back 71 Surgical division of sensory root of trigeminal nerve provides permanent relief |
front 72 Nursing process for client with Trigeminal Neuralgia 623-624 | back 72 Nursing process for client with Trigeminal Neuralgia 623-624 |
front 73 Client and Family Teaching for Trigeminal Neuralgia | back 73 Inspect the mouth daily for breaks in the mucous membrane. |
front 74 What is Bell Palsy? | back 74 involves the 7 cranial nerve that originates in the pons |
front 75 What causes Bell Palsy? | back 75 Unknown, But viral link it suspected |
front 76 Client is present w/is what? Symptoms develop in few hour to over 1-2 days Facial pain, pain behind the ear numbness, diminished blink reflex Ptosis of eyelid ,Tearing on the effected side Speaking and chewing become difficult | back 76 Bell Palsy |
front 77 What is done to DX's Bell Palsy? | back 77 No specific diagnostic tests Based on symptoms and visual examination to the face. Electromyography (EMG) Determine if any residual nerve and muscle activity MRI or CT scan rule out other etiologies |
front 78 What medical treatment is use for Clients w/ Bell palsy? | back 78 Short-term high dose Corticosteroid therapy w/ prednisone Reduce nerve inflammation and edema Antiviral acyclovir, Famciclovir or valacyclovir inhibit viral replication and shorten symptoms B complex vitamin Facial reanimation Improve facial movement and appearance |
front 79 Nursing process for client with Bell palsy 625 Chew on unaffected side, protect eye with eye patch | back 79 Nursing process for client with Bell palsy 625 Chew on unaffected side, protect eye with eye patch |
front 80 What is the cause of Parkinson Disease? | back 80 Deficiency of Dopamine The imbalance between dopamine and acetylcholine result in movement disorder |
front 81 Client present w/ is what? Stiffness, pill-rolling tremor fine tremor, hand tremor Bardykinesia Slowness preforming spontaneous movement Masklike expression, stooped posture Hypophonia (low volume of speech) difficulty swallowing saliva and food, Weight loss occurs Shuffling gait Arms are rigid While Walking Foward lean | back 81 Parkinson Disease |
front 82 Nutrition notes for client with Parkinson Disease? | back 82 High fiber crushed bran added to hot cereal and fiber-fortified supplement prevent constipation w/fluids prunes and prune juice stimulate peristalsis Taking levodopa should avoid high intake of protein decreasses it effectiveness High protein diet for client with weight loss |
front 83 Client present w/ affect the jaw tongue and larynx, speech is slurred and chewing and swallowing become difficult Rigidity can lead to contractures Salivation increases accompanied by drooling Cogwheel rigidity muscles ( stop and go motion) | back 83 Late stage Parkinson Diseases |
front 84 What diagnosis is use for Parkinson Disease? | back 84 Typical symptoms and neurologic examination |
front 85 Medical treatment for Parkinson Disease? | back 85 Aim to prolong independence Drug Selegiline( Eldepryl) Levodopa (larodopa) levodopa-carbidopa (sinemet) Amantadine (symmetrel) Bromocriptine (parlodel) Apomorphinr (apokyn) Benztropine (cogentin) Rehabilitation measures physical therapy occupational therapy client family education and counseling |
front 86 Surgical management for clients with Parkinson Disease | back 86 Deep Brain Stimulation implantation of the neurostimulation Pacemaker for the brain Gene therapy Transplant of fetal dopamine neurons |
front 87 Nursing Management for client with Parkinson Disease are | back 87 Managing Client drug Therapy Levodopa associated with periods of break through or end of dose wearing off apomorphine help relieving the above Help with walking OT and PT small meals, difficult swallowing 37-2 and 37-1 some meds look at safety B6 |
front 88 What is Huntington disease? | back 88 Hereditary disorder of the CNS |
front 89 The client present with mental apathy and emotional disturbance Choreiform movements, grimacing difficulty chewing and swallowing, speech difficult, intellectual decline and loss of bowel and bladder control Severe depression | back 89 Huntington disease |
front 90 How is Huntington disease diagnostic? | back 90 Base on the symptoms and family history PET scan shows CNS changes Genetic testing can predict which member will develop the disease |
front 91 What are some medical management for Huntington's | back 91 Treatment is supportive , No cure Tranquilizers and antiparkinson drug relieve choreiform, movements in some clients No drug available TO HALT THE MENTAL DETERIORATION Genetic counseling before a pregnancy is advised |
front 92 nursing management for client with Huntington's disease | back 92 Help with ADL's were the client can do. encourage client to lead a normal life, Demonstrates how to use both hands to hold drink, use a straw to drink and wear slip on shoes Increase risk for acquired infections especially if the client is catheterized |
front 93 What is a seizure? Safety for client on meds 37-2 and 37-3 | back 93 brief episode abnormal electrical activity in the brain Convulsion symptom of a seizure (spasmodic) contractions of muscles Epilepsy chronic recurrent pattent of seizure |
front 94 What causes seizure in a client? | back 94 Idiopathic High fever electrolyte imbalances uremia Hypoglycemia hypoxia brain tumor drug abuse and Alcohol withdrawal |
front 95 Client present with/ Motor symptoms No LOC seizure last less than 1 minute uncontrolled jerking of body part (finger, mouth, hand or foot) Sensory Symptoms Hallucinatory Sight, sounds and odors, mumbling, and use of nonsense word | back 95 Partial Seizures |
front 96 True or False Generalized seizure involves the entire brain? | back 96 True |
front 97 Client present after a seizure that last for several second to several minutes and lose of consciousness is ? | back 97 Generalized Seizure |
front 98 What are Absence seizure | back 98 Brief loss of Consciousness or Cognition during which physical activity ceases |
front 99 Client present in the with Stares blankly the eyelids flutter the lips move and slight movement of the head and leg occurs lasting on for a few seconds | back 99 Absence Seizures Misidentified as a learning disability |
front 100 Client present with brief activity of sudden excessive jerking of the arms leg or entire body and fall to the ground | back 100 Myoclonic seizures |
front 101 Tonic-clonic seizure are also called | back 101 Grand Mal seizures |
front 102 What is Preictal Phase? | back 102 happen before a seizure that could be vague emotional changes, depression, anxiety and nervousness. Lasting for minutes of hours before a seizure |
front 103 What is a Aura? | back 103 Sensation that occurs immediately before the seizure. Sensory( Hallucinatory or odor or sound) or weakness or numbness always the same |
front 104 When and what is the epileptics cry? | back 104 Epileptics Cry after the aura and it is the spasm of the respiratory muscles of the throat and glottis after Cry the client will have LOC (tonic-Clonic phase) Muscles contract rigidly in Clonic phase Contraction and relaxation of muscle, jerking movement and thrashing of the arms and legs, skin cyanotic and breathing spasmodic Saliva mixed with air (Frothing at the mouth Jaws tight clenched, biting of the tongue and inner cheek my occur, urinary and fecal incontinence is common Clonic phase last for 1 min or more |
front 105 What is Postical phase? | back 105 Period following the seizure client has Headache, Fatigue, Deep, sleep Confusion, Muscle soreness |
front 106 What is status epilepticus? | back 106 After a tonic-Clonic a client does not regain consciousness between seizure. If not treated Death can occur Can be brought in by anticonvulsant abrupt stopping. Must be withdrawn gradually |
front 107 What is Atonic seizure and Akinetic ? | back 107 LOC briefly and falls to the ground, recovery rapid (atonic) Similar client may or may not fall and recovery rapid |
front 108 What is done to DX's a Atonic Seizure? | back 108 Neurologic exam EEG performed CT, MRI, Serology and serum Electrolyte levels Confirm DX and determining cause of seizure If EEG required if 1st on normal if epilepsy is suspected |
front 109 What are medical management for client with seizure disorders? Client need to have a current and updated medical list | back 109
|
front 110 Drug Therapy 37-2 633-634 | back 110 Drug Therapy 37-2 633-634 |
front 111 What are some surgical Management for clients with seizures? | back 111 Surgery only if client does not response to drug or the seizures are severe Surgeon must consider if part of brain will cause neurologic dysfunction( paralysis) or loss of speech |
front 112 What are nursing interventions for clients with seizures? See nursing process for client p636 | back 112 Medical history and if they have seizures and treatment regimen identifies client who may be prone to seizure Promote safety (suction, oral airway, and oxygen equipment at the bedside, padded siderails and head board bed lowest position administered and reinforces drug compliance event of seizure position client on side loosen restrictive clothing airway keep patient, suction and oxygen if need inspected for injuries to tongue, teeth, and buccal cavity If incontinent clean the client and change linen Document situation that lead up to seizure duration of seizure and parts of body involved, VS, Oxygen |
front 113 Anticonvulsants impair vitamin D metabolism | back 113 Leads to calcium imbalance, rickets or osteomalacia if supplemental vitamin D is not given |
front 114 Childrens who seizures are not well control need | back 114 High Fat diet |
front 115 What is a brain tumor? | back 115 Growth of abnormal cells within the cranium |
front 116 What causes a brain tumor? | back 116 Congenital Genetic factors Viral infection exposure to radiation head trauma immunosuppression |
front 117 Client present with Headache (most common in the Morning), vomiting, papilledema Vomiting without Nausea or warning seizure develop, behavior and mood changes speech difficulty, paralysis and double vision | back 117 Brain tumor |
front 118 What is done to diagnosis Brain tumor in a client? | back 118 CT scan, MRI, Brain scan, and Cerebral angiography show Tumor's size and location |
front 119 What are medical management for client that has a brain tumor? | back 119 Brain tumor Treat by surgery, radiation therapy, Chemotherapy, Metastatic tumors some are inoperable, radiation therapy and Chemotherapy the only treatment choices if cant do surgery are keep comfortable and free from pain as possible to destroy or slow down tumor growth (intra-arterial or intrathecal) symptomatic drug includes Corticosteroids and osmotic diuretics reduces cerebral edema, analgesics, anticonvulsants and antibiotics |
front 120 What are surgical interventions for clients with Brain tumors? | back 120 Craniotomy incision through skull Craniectomy excision of part of the skull |
front 121 What is a Gamma-Knife radiosurgery? | back 121 Noninvasive procedure for treating deep brain tumor or that conventional surgery can only partially remove Laser procedure Outpatient basis or 24 hour inpatient stay involves more than one procedure Headaches, minor nausea after treatment , Temporary hair loss my occur if tumor is close to surface |
front 122 What are some nursing interventions for client with brain tumor? | back 122 Medication regimen |