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95 Cards in this Set
- Front
- Back
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What is Parkinson's disease?
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Chronic, slowly progressive degenration of brains dopamine neuronal systems
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What are the symptoms of Parkinson's disease?
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Mask-like face
Trunk forward flexion Muscle weakness/rigidity Shuffling gait Resting tremors Pill-rolling Bradykinesia |
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Complications of Levodopa therapy (SINEMET) for Parkinson's
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Involuntary mvmts. (increase w/ higher doses, longer term therapy)
On-off phenomenon (mobility/immobility - unrelated to time of admin.) Wearing-off phenomenon (before next dose due) *Use of adjuncts may be necessary (Parlodel, Premax) |
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Assessment of client with Parkinson's
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Tremors (lips, face, limbs, "temulous writing")
Posture (shuffling gait) Equilibrium (festination - leaning trunk w/ each step) Face (mask, no blink) Speech (repetition) Gradual dementia Skin, urination, hypotsn. Drooling, weight loss |
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Nsg. diagnoses & interventions for client with Parkinson's
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Imp. physical mobility (assess rigidity/tremors, gait, bradykin. Q4H - give meds - acyive/passive ROM)
Nutrition (diet prefs., tremors/rigid. mouth/neckmeds should peak at meals, small, freq., hi-cal. semi-soft meals) Injury r/t Gait dist. (armrests, handrails, clutter-free, wide-based stance, rails up) Coping (express fear, encg. self-care/social activ.) |
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What's Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)?
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Rapidly progressive degeneration of upper and lower motor neurons (atrophy of hands, forearms, legs, rest of body)
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ALS nursing care
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Impaired verbal (anticipate, use non-verbal, don't interrupt)
Impaired swallow (HOB 45-90, preferences, soft diet, mouth care, suction ready) Impaired mobility (passive ROM, rest periods, mobility aids, musc. relaxants, reposit. Q2, relax. techniques) |
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Plasmapheresis is used for which conditions?
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Myesthenia Gravis
Multiple sclerosis Guillian-Barre Syndrome *Diseases w/ a probable immunologic component |
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What's plasmapheresis?
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Removal of plasma from the blood and replacemrnt with donor plasma/colliodial product
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What are some potential complications with plasmapheresis?
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HYPOCALCEMIA
HYPOKALEMIA Vascular access Bleeding Anemia Infection Hypothermia Air emboli |
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Nursing diagnosis and interventions for plasmapheresis
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HYPOCALCEMIA/CITRATE TOX. (see: numbness, tingling, twitching, pos. Chvostek's & Trousseau's)
Give calcium gluconate HYPOKALEMIA (see: leg cramps, confusion, malaise, dysrhythmias) BLEEDING (anticoagulants, platelet count drop) Monitor: CBC, PT, PTT, fibrinogen, platelets Pressure Dressings Observe sites Q30min. FLUID VOL. DEFICIT Monitor: HR, BP Urine output Administer replacement fluids |
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What's multiple sclerosis?
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Demylenation of nerve fibers (in brainstem, cerebellum, spinal cord, optic nerve, and cerebrum)
Decrease in nerve conduction velocity and impulse transmission (symptom remission when areas heal by sclerotic tissue) |
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In multiple sclerosis, some clinical manifestations of brainstem syndrome are:
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Diplopia
Eye pain, Nystagmus * Cranial nerves III - XII |
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In multiple sclerosis, some clinical manifestations of cerebral syndrome are:
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Emotional lability - depression/euphoria
* Also optic neuritis (clouding, loss of field, pain), seizures, hemiparesis, hemi-sensory loss, dysphasia |
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In multiple sclerosis, some clinical manifestations of cerebellar syndrome are:
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Charcot triad (dysarthria, intention tremor, nystagmus)
* Also ataxia, hypotonia, weakness |
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Nursing care of a client with MS
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ALTERATION IN URINARY ELIMINATION
Assess pattern, palpate, offer bathroom Q2H, Kegel's, decrease eve. fluids, avoid caffeine, catheterize PRN, antispasmodics * Also muscle fatigue (avoid increased body temp.), impaired mobility (teds, anticoags., T&P, splints/braces), impaired vision (alt. eye patch Q2H), impaired communication |
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What's myesthenia gravis?
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Systemic autoimmune disease. Abnormal weakness of voluntary muscles that improve with rest and anticholinesterase drugs
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Nursing assessment for myesthenia gravis
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Facial Muscles: Mask-like, Drooping, Dysphagia, Choking, Drooling
Neck Muscles: Difficulty maintaining head position Resp. Muscles: SOB, Weak cough, resp. failure |
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Differential diagnosis for myesthenia gravis
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Recent history of anticholinesterase use and the Tensilon test
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How is the edrophonium chloride (Tensilon) test done?
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2 mg injected IV
No Symptoms? Another 8mg Observe for muscle tone improvement for 30 sec. - 1 min. Tone improvement = positive for myesthenia gravis Tone weakens = negative for MG (positive for cholinergic crisis) |
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Drug teaching & side effects of drugs for myesthenia gravis (increase acetylcholine concentration and inhibit acetylcholinesterase)
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**Take drug exactly as prescibed and on time
**Schedule routine care activities one hr. after administration Side effects: Blurred vision, difficulty with dark adaptation & far vision; urinary frequency, abdominal cramps, sweating |
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Nursing care of client with myesthenia gravis
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Ineffective Breathing (severe musc. weakness) - administer anticholinesterase drugs, HOB 30-45, suction, O2, ABG's
Activity Intolerance - Schedule ADL's after rest or in AM Altered nutrition (weak mastication/swallow) - antichol. meds 1 hr. before eating Ocular weakness - alt. eye patch 1/2 hr. |
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What's Guillain-Barre syndrome?
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Rapidly progressive, symmetrical, ascending, flaccid paralysis usually following a viral infection
**Hx of URI, gastric flu, mono or hepatitis common |
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Major worry with Guillain-Barre syndrome
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When nerves innervating intercostal muscles and the diaphragm are compressed and demylenated - FATAL RESP. IMPAIRMENT
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Nursing care of client with with Guillain-Barre syndrome
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Impaired Mobility (assess cranial nerves QH, thrombo, teds, passive ROM, splints 2H on 2H off)
Ineffective Breathing (monitor rate, airway, ABG's, suction) Autonomic Instability (BP, dysrhythmias, flushing, LOC) |
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Nursing assessment for spinal cord abscess
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Hx. of boil on back (spread to CNS)
Local pain (radiates to legs) Back spasms Leg weakness Numb/tingle (paraplegia 24-72 hrs) Decreased urination/incont. GI upset Fever Positive Kerning's or Brudzinski CBC - Inc. neutrophils CSF - yellow/cloudy, inc. protein |
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An infection in the paranasal sinuses may lead to an abscess where?
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Frontal lobe
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An ear infection may lead to an abscess where?
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Temporal lobe
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An infection in the middle ear or mastoid may lead to an abscess where?
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Cerebellum
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An staphylococcal skin infection may lead to an abscess where?
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Epidural (Thorassic most common)
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An systemic infection from lungs or GU system may lead to an abscess where?
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Intramedullary
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How to care for someone with AIDS dementia complex (ADC)
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Provide orientation
Structured activity Same provider Verbal cues Memory board |
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Nursing diagnoses and interventions for client with AIDS
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Infection (r/t immunosupression) - assess: CBC /w differential, T4/T8 count, skin integ. invasive lines, gloves, gown, mask goggles w/ fluids, LOW MICROBIAL DIET, no plants, keep fever down
Alt. in thought - Neuro checks Q2H, nuchal rigidity, Self care defecit Altered nutrition |
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What's meningitis?
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Inflamation of the brain and meninges covering spinal cord (via bacteria, fungi, viruses, parasites)
*Bacterial = greater severity |
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What do you see with bacterial meningitis?
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Cloudy, turbid, yellow CSF
Headache Elevated temp. (101-104) Meningial Irritation (Nuchal rig., Pos. Kernig/Brudzinski, photophobia) Rash w/ petechial hemorrhage Cranial nerve defecits (ocular palsies, pupils, ptosis, diplopia, facial paresis, deafness, vertigo) Progression = may see s/s of ICP Seizures |
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What do you see with viral meningitis?
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Headache
Nuchal rigidity Photoohobia General malaise |
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What can you expect to do for a client with bacterial meningitis?
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Review lumbar puncture results - administer antinfectives for bacterial meningitis
(Spinal tap, ID organism, give antibiotics) |
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What's encephalitis?
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Inflamation of brain parenchyma due to viral or bacterial infective agents
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How do you get bacterial encephalitis?
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Depressed skull fractures
Septic penetrating instruments |
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How do you get viral encephalitis?
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Bite or sting
Secondary to viral infections |
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How do you get equine encephalitis? Area of concentration? Incidence? Symptoms?
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Horse mosquito
Cerebrum/Brainstem Adults >50, Horse workers Sudden drowsiness -> coma Convulsive seizures Meningeal signs Cranial nerve palsies Hemiplegia, N/V |
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How do you get St. Louis encephalitis? Area of concentration? Incidence? Symptoms?
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Mosquito
Blood vessels in thalamus and midbrain Late summer Recent "flu" Meningeal signs INTENTION TREMORS (fingers, lips, tongue) Constricted pupils ABSENT ABDOMINAL REFLEX |
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How do you get Rocky Mountain encephalitis? Area of concentration? Incidence? Symptoms?
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Tick (resevoir in squirrels/rodents)
Diffuse CNS - localized in skin Rural, mountainous terrain, late spring/early fall Fever Decreased consiousness Measles like rash on 3rd or 4th day Rash fades, replaces by MACULOPAPULAR RASH ON WRISTS AND ANKLES (spreading to legs, arms, trunk) Tremors, Convulsions, Muscle rigidity |
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What's Subacute Sclerosing Panencephalitis (Dawson's Encephalitis) preceeded by
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Rubeola (2-10 yrs. prior)
*Fatal Prognosis |
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What's Reye's syndrome?
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Acute brain edema secondary to infiltration of liver
*3-7 days after URI, flu, chix pox, measels - Uses of ASA during infection implicated |
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What do you see with Reye's syndrome?
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Vomiting (no nausea/diarrhea)
Behavior change Staring Alt. drowsiness/screaming Musc. weakness Light/sound/touch sensitivity Seizures ICP |
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Reye's syndrome Diagnostic tests
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Increased:
SGOT SGPT BUN Blood Ammonia Decreased: Blood Glucose |
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Whats Myelitis? What do we see with it?
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Inflammation of the spinal cord secondary to an infectious process (viral/bacterial) elsewhere
**See: Rapid, flaccid paralysis, loss of urinary/fecal control, NO back pain |
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How do you get poliomyelitis?
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Through oropharynx (droplet inhalation) or GI (fecally contaminated foods)
*Assess for recent resp./GI infection & subsequent rise in temp. |
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What do we see with poliomyelitis?
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Weakness/malaise
Headache/stiff neck Neck/back/leg musc. ache Alt. irritability/drowsiness Difficulty swallowing/breathing/speaking (hiccups) Pos. Kernig's/Brudzinski's Convulsions/seizures Difficulty walking Cerebellar ataxia |
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What's Herpes Zoster? Who's at risk?
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Shingles (adults who haven't had chix pox)
*Viral infection of posterior root gamglion (spinal nerves) 40-50% have neuralgia for 1-2 yrs. |
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Interventions for herpes zoster
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Quiet environment
Analgesics, topical antiinflammatory, antipruritics Maintain skin/eye hygene Eye patch for corneal abrasions |
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How do you get neurosyphilis?
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CNS invasion of the spirochete Treponema pallidum (3-18 mos. after primary inoculation)
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How is neurosyphilis diagnosed?
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Positive flourescent treponemal antibody test (FTA) and VDRI
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What's Bell's palsy?
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Facial nerve paralysis (unilateral or bilateral) most recover within 4 wks.
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Nursing care for Bell's palsy
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Pain?
Electro. stim. Facial sling Facial exercises 4x daily Inability to close eyes? Nutrition? |
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Natalizumab (Tysabri) use
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Relapsing MS, Reduces frequency of exacerbations
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Natalizumab (Tysabri) general side effects
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HYPERSENSITIVITY/anaphylaxis
Hives/rash/puritis Dizziness/nausea Fever/flushing Hypotension Dyspnea/chest pain |
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Natalizumab (Tysabri) GI side effects
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Cholelithiasis
Gastroenteritis |
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Natalizumab (Tysabri) CNS side effects
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Depression
Suicidal Ideation Headache Tremor |
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Natalizumab (Tysabri) respiratory side effects
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Lower resp. infection
Tonsilitis |
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Natalizumab (Tysabri) GU side effects
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UTI
Vaginitis Urinary freq./urgency Irregular mentstruation (amen., dysmen.) |
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Natalizumab (Tysabri) administration instructions
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No IV push
Don't shake bag Assess for hypersensitivity 300mg Q4wks. |
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Natalizumab (Tysabri) client/family teaching
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Report s/s of allergic reaction
Depression, infections, gall stones possible Assess for suicide |
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Glatiramer acetate (Copaxone) life threatening side effect
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Vaginal hemorrhage
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Glatiramer acetate (Copaxone) immediate post injection reaction
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Flushing
CP Palpitations Anxiety Dyspnea Laryngeal constriction Uticaria (Hives) |
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Mitoxanthrone (Novantrone) life time dose
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140 mg
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Mitoxanthrone (Novantrone) CV side effects
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CHF
CP Arrhythmias Tachycardia Hypotension (Cardiotoxicity) |
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Mitoxanthrone (Novantrone) patient/family teaching
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Assess for cardiotoxicity
*Evaluate left ventricular ejection fraction on ECG |
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Pyrostigmine bromide (Mestinon) contraindications
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Hypersensitivity
Intestinal or urogenital tract obstruction Peritonitis Pregnancy/Lactation |
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Use Pyrostigmine bromide (Mestinon) with caution in...
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Asthma
Peptic Ulcer Bradycardia Arrhythmias Coronary occlusion Vagotonia Hyperthyroidism Epilepsy |
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Pyridostigmine bromide (Mestinon) administration
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Slowly (.5mg over 1 min. IV push)
ATROPINE SULFATE on standby DC & call MD for: Excessive salivation, emesis, urination, diarrhea Decrease dose for excessive sweating/nausea *Take exactly as pres. and ontime *Schedule routine care 1hr. after admin. |
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Serious side effects of Sumatriptan (Imitrex)
(for migraines) |
Acute MI
Dysrhythmias Death w/in a few hrs. of use Cerebral/subarach. hemorrhage Stroke Myocardial ischemia Hypertensive crisis Anaphylaxis |
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Nursing considerations when giving Sumatriptan (Imitrex)
(for migraines) |
Single dose PO w/ fluids as soon as symptoms appear
NO second dose sooner than 2-4 hrs, Must consult provider before 2nd dose. *NO MAOI's, ergotamine, IV's (vasospasm), Hx of MI, stroke, TIA, CAD, angina |
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Onset and signs of fat emboli
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Several hours to 3 days:
Temp elevated Tachycardia PO2 and PCO2 decrease Serum lipase elevated Petechial rash of neck shoulders, thorax, eyelids |
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Signs of respiratory fat emboli
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Cough
CP Cyanosis Dyspnea Rales |
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Signs of cerebral fat emboli
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Confusion
Lethargy Stupor Coma Seizures Aphasia Hemiplegia More profound on second day |
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Challenges of a cervical spinal cord injury
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Flaccid quadriplegia
Autonomic dysfunction: Decreased BP Absence of perspiration Priapism Gastric/Urinary/Fecal retention **Respiratory distress/failure above C4 (nerves to diaphragm) |
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Challenges of a thoracic spinal cord injury
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High paraplegia
(legs, trunk, urinary and rectal sphincters) *after 3-4 wks. jerking reflex mvmts. |
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Challenges of a lumbar spinal cord injury
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Persistant flaccid paraplegia of legs bladder and rectum
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Does Horner's syndrome occur with complete or incomplete spinal transection?
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Both
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Signs of Horner's syndrome
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Ipsilateral ptosis of eyelid and downward rotation of eyeball
Miotic pupil Ipsilateral facial anhidrosis |
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What do we see with an incomplete transection?
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Variable loss of motor and/or sensory function on the same side as the sectioning
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What do we see with a complete transection?
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Permanent loss of motor and sensory functionbelow the transection
SPINAL SHOCK |
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Initial signs of spinal shock
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Decreased BP (syst <80)
Decreased pulse rate Decreased resp. rate Decreased temp. Skin: pink warm dry Areflexia, flaccid paralysis, loss of sensation below lesion |
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Signs of spinal shock 24-48 hrs after trauma
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Paralytic ileus
Urinary retention |
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Signs of spinal shock 7-10 days after trauma
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Stress ulcers (occult stool)
Decreased musc. tone/strength Pulmonary/urinary infections |
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Some nursing challanges of spinal cord injury
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Fecal impaction (glycerine suppositories)
Bladder distention/urine retention (intermittent catheterization) UTI's, avoid colds/flus, promote independence |
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What's Brown-Sequard Syndrome? Signs?
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Spinal cord injury where only one side of the cord is damaged
Signs: Ipsilateral motor loss Contralateral temp./sensation loss |
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What's autonomic Hyperreflexia? Signs? Interventions?
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Increased autonomic nervous system activity due to noxious stimuli below the injury
S/s: Pounding headache, elevated BP, bradycardia, profuse sweating above injury, anxiety, visual disturbances Intervention: Remove noxious cause, Raise HOB, Monitor BP, Give anti HTN med |
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Frequently, type of memory affected in Alzheimer's
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Short term (long term largely intact)
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Some features of Alzheimer's
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Agitation
Wandering Muscle rigidity over time ** Consistency/same HCP importent in care of these patients |
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Most significant factor in the development of CP
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Anoxia (prenatal, perinatal & postnatal)
**Wide variety of impairmants r/t muscle and cognition |
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S/s of CP in an infant
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Poor sucing
Persistent tongue thrust Poor head control & failure to smile after 3mos. Arching back Extreme irritability/crying Feeding difficulties (gagging/choking; tongue pushes out food) |
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Most common type of muscular dystrophy
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Duchenne - regeneration and replacement of muscle tissue by connective tissue
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