Med Surge - Test 4 #26

Front 1

cervical injuries
-involvement above C4 causes what problems

Back 1

respiratory difficulty and paralysis of all 4 extremities

Front 2

Thoracic injury can cause problems with what?

Back 2

stomach emptying, peristalsis, muscles of abd.

Front 3

Mechanism of injury terms:

hyperflexion- occurs when?

Back 3

when the head is suddenly and forcefully accelerated (moved) forward, causing extreme flexion of the neck

Front 4

Mechanism of injury terms:

-this type of injury occurs in head on vehicle collisions and driving accidents

Back 4

hyperflexion

Front 5

Mechanism of injury terms:

-neck flinging forward / whiplash

Back 5

hyperflexion

Front 6

Mechanism of injury terms:

these injuries occur most often in vehicle collisions in which the car is struck from behind or during falls when the patient’s chin is struck.

Back 6

hyperextension

Front 7

Mechanism of injury terms:


-the head is suddenly accelerated and then decelerated. this stretches or tears the anterior longitudinal ligament, fractures, or subluxates the vertebrae and possibly ruptures an intervertebral disk

Back 7

hyperextension

Front 8

Mechanism of injury terms:

-neck flinging back / whiplash

Back 8

hyperextension

Front 9

Mechanism of injury terms:

diving accidents, falls on the buttocks, or a jump in which a person lands on the feet

Back 9

vertical compression (axial loading)

Front 10

Mechanism of injury terms:

-a blow to the top of the head can cause the vertebrae to shatter. pieces of bone enter the spinal canal and damage the cord (jumped off a building)

Back 10

vertical compression (axial loading)

Front 11

Mechanism of injury terms:

hanging (you are pulling C1 against C2)

Back 11

vertical compression-

Front 12

Mechanism of injury terms:

these are classified by the speed of the object (knife, bullet) causing the injury

Back 12

penetrating –

Front 13

Mechanism of injury terms:

-low speed or low impact injuries cause damage directly at the site or local damage to the spinal cord or spinal nerves.

Back 13

penetrating –

Front 14

Mechanism of injury terms:

-high speed injuries that occur from gunshot wounds cause both direct and indirect damage

Back 14

penetrating –

Front 15

paraplegia – (paralysis) and paraparesis (weakness) involve only the lower extremities, as seen in lower what vertebrae?

Back 15

thoracic and lumbosacral injuries or lesions

Front 16

quadriplegia - (weakness) involves all four extremities, as seen with what vertebrae?

Back 16

cervical cord and upper thoracic injury

Front 17

cervical injury (neck)
-what C_ injury to be considered a quadriplegia

Back 17

C4 and C6

Front 18

thoracic injury (upper back)
-what T__ injury to be considered a paraplegia?

Back 18

T6

Front 19

lumbar injury (lower back)
-what L__ injury to be considered a paraplegia?

Back 19

L1

Front 20

Assessment of spinal cord injury

what is the #1 assessment

Back 20

respiratory status

•Motor and Sensory Changes –numbness and tingling sensory changes
•Reflexes
•Bowel & Bladder Function –every pt with a spinal cord injury

Front 21

Assessment of spinal cord injury

tell me about the presence of sweat

Back 21

not usually present on paralyzed areas (if you paralyzed you won’t sweat below the level of injury)

Front 22

What is “spinal shock?”

-occur immediately as a concussion response to the injury.

what 2 s/s does the patient experience?

Back 22

The patient has flaccid paralysis and loss of reflex activity below the level of the lesion.

Front 23

What is “spinal shock?”

tell me about reflexes

Back 23

they are absent

Front 24

What is “spinal shock?”

how long does this last?

Back 24

Often lasts less than 48 hr. muscle spasticity begins in patients with cervical or high thoracic injuries when spinal shock is resolved

reflexes come back

Front 25

What is “spinal shock?”

-also called:
S/S of this injury:

Back 25

- Neurogenic shock

hypotension,
bradycardia,
peripheral vasodilation (flushing, dry warm)

hypothermia

Front 26

What is “spinal shock?”

results from the disruption in what?

Back 26

A result of disruption in the communication pathways between the upper motor neurons and the lower motor neurons.

Front 27

What is “spinal shock?”

-what should you do to prevent them from going into cold shock?

Back 27

when they come in, put warm blankets on pt so they don’t go into cold shock

Front 28

S/S of a spinal cord injury

what vertebrae usually result in fetal injuries

Back 28

C2 & C3

Front 29

S/S of a spinal cord injury

Involvement above _____ causes respiratory difficulties and paralysis of all 4 extremities –over time function may return

Back 29

C4

Front 30

S/S of a spinal cord injury

Injury at C5 or below may afford the patient partial movement of

Back 30

shoulder, elbow, & wrist

Front 31

•Injury at C7 may afford partial movement of

Back 31

shoulder, elbow, wrist & hand

Front 32

•Injury at C8 may afford normal

Back 32

arm/hand, but weak

Front 33

Thoracic Injuries
-results in

Back 33

leg paralysis

Front 34

Autonomic Dysreflexia results from an injury above?

Back 34

T6

Front 35

Lumbar and Sacral Injuries

causes loss of sensation and movement where

Back 35

Loss of sensation and movement in the lower extremities (bowel and bladder)

Front 36

Injury below ____, the bladder will contract, but not completely empty (called: “Neurogenic Bladder”) caudia equina can cause this

Back 36

S2

• Document that the pt denies difficulty urinating and denies difficulty of defecating, also say the last BM

Front 37

Injury above ___ allows male erection, but the patient may not be able to ejaculate

Back 37

S2

Front 38

Injury between _______ damages sympathetic & parasympathetic responses, therefore no erection or ejaculation.

Back 38

S2-S4

Front 39

What is the name of the medication that is given in pts with spinal cord shock?

Back 39

methylpredisone (this drug decreases inflammation, such as that caused by injury to spinal cord and nerve tissue)

preserves core tissue

Front 40

Spinal Shock
-put in what position?

-give what for bradycardia?

-prevent what?

Back 40

•Trendelenburg positon

•Atropine for Bradycardia

•Prevent hypothermia

Front 41

What is autonomic dysreflexia?

it is excessive, uncontrolled _________output.

Back 41

sympathetic

Front 42

What is autonomic dysreflexia?

what is it characterized by

Back 42

severe hypertension,

bradycardia,

severe headache,

nasal stuffiness,

flushing

Front 43

What is autonomic dysreflexia?

what is the cause of this?

Back 43

when there is an irritation, pain, or stimulus to the nervous system below the level of injury. (Can often be a full bladder/bowel, skin stimulation, even a cold breeze on the skin).
– usually a distended bladder or constipation.

Front 44

autonomic dysreflexia

-this is a neurologic emergency and must be promptly treated to prevent a hypertensive stroke

Back 44

Neurologic emergency occurs in persons with SCI at or above the T6 level. Irritated area sends a signal to the brain but not able to reach the brain, reflex action takes place, tightening blood vessels, causing BP to rise which could lead to stroke seizure or death

Front 45

autonomic dysreflexia

The irritated area sends a signal to the brain, but it’s not able to reach the brain.
-what happens?

Back 45

A reflex action takes place, tightening blood vessels, causing the BP to rise. If the high BP is not controlled, it may cause a stroke, seizure, or death.

Front 46

When would autonomic dysreflexia be observed?

Back 46

in a patient with upper spinal cord injury above the level of T6
when there is an irritation, pain or stimulus to the nervous system below the level of injury (often full bladder/bowel, skin stimulation, even a cold breeze)

Front 47

S/S associated with autonomic dysreflexia

Back 47

-sudden onset of severe, throbbing headache
-severe, rapidly occurring hypertension
-bradycardia
-flushing above level of lesion (face and chest)
-pale extremities below level of lesion
-nasal stuffiness
-sweating
-nausea
-blurred vision
-piloerection
-restlessness and feeling of apprehension

Front 48

autonomic dysreflexia

constriction of some sort below the level of injury

Back 48

-start low and move up the level of injury

Front 49

Treatment of autonomic dysreflexia

what is the first priority?

Back 49

-place patient in sitting position (1st priority) --high Fowlers position

Front 50

Treatment of autonomic dysreflexia

Back 50

-page/notify health care provider
-loosen tight clothing on the patient
-assess for and treat the cause
-check the urinary catheter tubing if present for kinks or obstruction
-if urinary catheter is not present, check for bladder distention and catheterize immediately if indicated
-place anesthetic ointment on top of catheter before insertion
-check the patient for fecal impaction, if present, disimpact immediately using anesthetic ointment
-check the room temperature to ensure that it is not too cool or drafty
-monitor BP every 10-15 minutes
-give nitrates or hydralazine
(anti-hypertensive)

Front 51

Medications given for autonomic dysreflexia

-what is given for bradycardia?

-what is given for hypotension?


what is given for muscle spasticity?

Back 51

Atropine Sulfate is used for bradycardia,

Dopamine is used for hypotension.


Dantrium = control muscle spasticity.

Front 52

Spinal cord injury - interventions during hospitalization

Respiratory system
-assess what?

Back 52

respiratory status because paralysis of the intercostal and abdominal muscles occurs with C4 injuries

Front 53

Spinal cord injury - interventions during hospitalization

Respiratory system
-encourage deep breathing and monitor for signs of

Back 53

infection, like pneumonia

Front 54

Cervical injury at C3-C5 with cord compression

•physiologic response if a cord injury occurred in those areas:

Back 54

: patient would have difficulty with respiration. The diaphragm is a muscle and it would not have function. The heart would be affected as well. If above T6 the pt will have bradycardia, hypotension, and hypothermia because of loss of sympathetic input and could lead to dysrhythmias The patient would be a quadriplegiac may be able to have partial movement of the shoulder and elbow if c5. Patient would be totally incontinent

Front 55

Cervical injury at C3-C5 with cord compression

what would be most important assessment to perform:

Back 55

respiratory status

Front 56

Thoracic injury at T7-T9 with cord compression

•physiologic response if a cord injury occurred in those areas:

Back 56

patient would be able to breathe but would be a paraplegic and would not have control over bowel and bladder function

Front 57

Thoracic injury at T7-T9 with cord compression

what would be most important assessment to perform:

Back 57

Bowel and bladder function

Front 58

Lumbar injury at L3-L5 with cord compression

physiologic response if a cord injury occurred in those areas

Back 58

patient would be a paraplegic but probably wouldn’t have control over bowel and bladder function. May have some sensation in legs

Front 59

Lumbar injury at L3-L5 with cord compression

what would be the most important assessment to perform:

Back 59

need to assess motor and sensory changes

Front 60

Respiratory System
- interventions during hospitalization

monitor what blood levels

Back 60

arterial bood gas

Front 61

Respiratory System
- interventions during hospitalization

- Patient may need mechanical ventilation!

Back 61

bag valve mask

Front 62

Cardiovascular System- interventions during hospitalization

- Bradycardia, hypotension & hypothermia may result from a loss of sympathetic input & may lead to dysrhythmias

Back 62

monitor for cardiac dysrhythmias

Front 63

Cardiovascular System- interventions during hospitalization


- b/c of the cooling of blood can that occurs below the level of injury they are at risk for clots in legs and arms...assess for?

Back 63

Assess for possible DVT formation

Front 64

G.I. System- interventions during hospitalization

assess abdomen for?

Back 64

distention and hemorrhage

Front 65

G.I. System- interventions during hospitalization

monitor bowel sounds and assess for

Back 65

paralytic ileus

Front 66

G.I. System- interventions during hospitalization

prevent bowel retention by doing what 2 things

Back 66

initiate a bowel control program and maintain adequate nutrition and a high-fiber diet

Front 67

Renal System- interventions during hospitalization

prevent urinary retention
-how?

Back 67

initiate a bladder control program

maintain fluid and electrolyte balance

fluid intake to be 2000 mL/day

Front 68

Renal System- interventions during hospitalization


monitor for what

Back 68

UTI and calculi

Front 69

Spinal Cord Rehab

what are the 2 main goals as a nurse?

Back 69

Maximize recovery & independence**test**

Front 70

Why do we need bowel and bladder programs for SCI patient?

what do you lose control of first?

Back 70

patients have reflex or neurogenic loss of bowel and bladder control but many can become continent if they rigorously adhere to an established program. Goal is to prevent accidents and keep adequate fluid balance


(loss of bladder control often occurs before a loss of bowel control)

Front 71

Bacterial Meningitis

what time of the year is it common

Back 71

occurs most often in fall and winter when upper respiratory tract infections commonly occur

Front 72

Bacterial Meningitis

-the 3 most frequently involved organisms responsible for bacterial meningitis include

Back 72

streptococcus pneumonia

neisseria meningitidis

Haemophila Influenzae

Front 73

Bacterial Meningitis

-usually, the pt has a predisposing condition such as:

Back 73

otitis media, pneumonia, acute or chronic sinusitis, or sickle cell anemia, brain or spinal surgery, pts who are immune suppressed or have infections elsewhere in the body and older adults with debilitating diseases and tongue piercing

Front 74

Treatment of Bacterial Meningitis

VS and nuero checks how often

Back 74

Q2-4 hrs (monitor for early neurologic changes that may indicate increased ICP, such as decreased LOC)

Front 75

Treatment of Bacterial Meningitis

pay attention to CN 3,4,6,7,8


what cranial nerve tells you about hydrocephalus?

Back 75

-(cranial nerve 6 defect, inability to move the eyes laterally) may indicate the development of hydrocephalus, excessive accumulation of CSF within the brains ventricles)

Front 76

Treatment of Bacterial Meningitis

provide what precautions?

Back 76

-provide seizure precautions (from increased ICP)
- pain management

Front 77

Treatment of Bacterial Meningitis

vascular assessment every __ hours.

assess what?

Back 77

4

asses the patient’s temperature, color, pulses, and capillary refill in the fingernails. also identify any indicators of abnormal bleeding)

Front 78

Treatment of Bacterial Meningitis

-isolation procedures (standard precautions are appropriate for all patients with meningitis unless that pt has a bacterial type that is transmitted by _______

Back 78

droplets

Front 79

Treatment of Bacterial Meningitis

what medication is prescribed until they find out the pathogen

Back 79

-medical management of broad spectrum antibiotics depending on pathogen

-drugs used to treat complications include hyperosmolar agents and antiepileptic drugs

Front 80

Treatment of Bacterial Meningitis

Are large fluid volumes given? Why?

Back 80

no, because each ml changed in the blood volume changes ICP

Front 81

What kind of illness is Gillian-Barre syndrome?

Back 81

demyelination (destruction of the myelin sheath) of the peripheral nerves with ascending paralysis

Front 82

What kind of illness is Gillian-Barre syndrome?

-progressive motor weakness and sensory abnormalities occur.
-what is ascending paralysis mean?

Back 82

symptoms typically begin in the legs and spread to the arms and upper body.

paralysis can increase in intensity until the muscles cannot be used at all and the patient is almost totally immobile

Front 83

a disorder in which the body's immune system attacks part of the peripheral nervous system

Back 83

Gillian-Barre syndrome

Front 84

Gillian-Barre syndrome

DEMYELINATION-meaning?

Back 84

Demyelination (it’s going after the myelin sheath around your nerves and these nerves lose the ability to perform their function. Because of the impaired ability to transmit is how they become paralyzed. The coding of the neurons is gone)of the peripheral nerves, progressive motor weakness and sensory abnormalities

Front 85

How does G-B Syndrome usually manifest itself in the pt?

Back 85

sudden onset of muscle weakness and pain

paresthesias

weakness of lower extremities

Front 86

How does G-B Syndrome usually manifest itself in the pt

late manifestations are?

Back 86

-Late manifestations are cranial nerve involvement and autonomic dysfunction. Weakness and paresthesia begin in the lower extremities and progress upward toward the trunk, arms and cranial nerves ascending

Front 87

Guillain-Barré syndrome

Motor Manifestations

Back 87

-ascending symmetric muscle weakness -->flaccid paralysis without muscle atrophy
-decreased or absent deep tendon reflexes
-respiratory compromise (dyspnea, diminished breath sounds, and respiratory failure)
-loss of bowel and bladder control
-ataxia (loss of muscle coordination)

Front 88

Guillain-Barré syndrome

Sensory Manifestations

Back 88

-paresthesias
-pain (cramping)

Front 89

Guillain-Barré syndrome

Cranial nerve manifestations

Back 89

-facial weakness
-dysphagia
-diplopia (double vision)
-difficulty speaking

Front 90

Guillain-Barré syndrome

Autonomic manifestations

Back 90

-labile BP (changing from hypertensive to hypotensive)
-cardiac dysrhythmias
-tachycardia

Front 91

-Guillain-Barré syndrome

what will be in the cerebrospinal fluid

Back 91

increased protein level

Front 92

Treatment for Guillain-Barré syndrome

There is no known cure for Guillain-Barré syndrome, but therapies can lessen the severity of the illness and accelerate the recovery in most patients.

2:

Back 92

drug therapy (cant stop virus but give DMARDs and Predisone)

Plasmapheresis (clean out blood) by removing the circulating antibodies thought to be responsible for the disease.

Front 93

Treatment for Guillain-Barré syndrome

plasmapheresis and high-dose immunoglobulin therapy are used. Plasmapheresis seems to reduce the severity and duration of the Guillain-Barré episode

Back 93

--

Front 94

Myasthenia Gravis

What is this disease process characterized by

Back 94

fatigue and weakness primarily in muscles innervated by the cranial nerves, as well as in skeletal and respiratory muscles.

Front 95

Myasthenia Gravis

-MG is caused by an autoantibody attack on the acetylcholine receptors in the muscle end plate membranes. as a result, nerve impulses are not transmitted to the skeletal muscle at the neuromuscular junction, and the muscles cannot contract

Back 95

causes include insufficient secretion of acetylcholine and excessive secretion of cholinesterase

Front 96

Myasthenia Gravis

S/S

Back 96

weakness and fatigue

difficulty chewing

difficulty breathing

Front 97

Myasthenia Gravis

-therapeutic efforts for inducing remission, such as the administration of what kind of drugs?

Back 97

immunosuppressive drugs or corticosteroids, plasmapheresis, and thymectomy (removal of thyroid gland)

Front 98

Myasthenia Gravis

-what are the drugs that are the first line treatment

Back 98

-cholinesterase inhibitor drugs / anticholinesterase meds

Neostigmine bromide (pyridostigmine, Mestinon, Tensilon )

Front 99

Myasthenia Gravis

cholinesterase inhibitor drugs / anticholinesterase meds, what do they do?

Back 99

-they enhance neuromuscular impulse transmission by preventing the decrease of Ach by the enzyme ChE. This increases the response of the muscles to nerve impulses and improves muscle strength

Front 100

Myasthenia Gravis
--What is a cholinergic crisis?

Back 100

a potential adverse effect of ChE inhibitors is a cholinergic crisis

Front 101

Myasthenia Gravis
--what indicates that the patient is experiencing a cholinergic crisis?

Back 101

sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately

Front 102

Myasthenia Gravis
-- cholinergic crisis

-it is an acute exacerbation of muscle weakness caused by too many anticholinesterase drugs
S/S:

Back 102

n/v, diarrhea, abd cramps, blurred vision, pallor, facial muscle twitching, hypotension

Front 103

Myasthenia Gravis
--cholinergic crisis

What medication is administered is reduce symptoms?

Back 103

Treated with atropine sulfate (antidote)

Front 104

Parkinsons Disease

-degeneration of what?

Back 104

of the basal ganglia in the cerebrum specifically the substantia nigra (grey matter) leading to a decrease in dopamine

Front 105

Parkinsons Disease

-progressive neurodegenerative disease

Back 105

degenerative disease caused by depletion of dopamine, which interferes with the inhibition of excitatory impulses, resulting in dysfunction of the extrapyramidal system

Front 106

Parkinsons Disease

-debilitating disease affecting motor ability and is characterized by four cardinal symptoms:

Back 106

tremor,

rigidity,

bradykinesia or akinesia (slow movement/no movement)

postural instability

Front 107

Parkinsons Disease

-PD also reduces the sympathetic nervous system influence on the heart and blood vessels

True or false

Back 107

true

dopamine mimics adrenalin (you have a decrease of dopamine in PD)

Front 108

Parkinsons Disease

S/S
-posture:
-gait:

Back 108

-posture (stooped, flexed trunk)

-gait (slow and shuffling, short hesitant steps, difficulty stopping quickly)

Front 109

Parkinson's Disease

S/S
Motor:

Back 109

bradykinesia (slow movement),

muscular rigidity,

tremors,

maslike facies (wide-open, fixed staring eyes)

difficulty chewing and swallowing,

uncontrolled drooling, esp at night

Front 110

Parkinson's Disease

S/S
Speech

Back 110

soft, low pitched voice,
dysarthria-slurred speech
echolalia- autonomic repetition of what another person says and repetition of sentences)

Front 111

Parkinson's Disease

S/S
-autonomic dysfunction

Back 111

(orthostatic hypotension, excessive perspiration, poly skin, flushing

Front 112

Parkinson's Disease
Interventions

Back 112

-allow pt extra time to respond to questions
-administer meds promptly on schedule to maintain continuous therapeutic drug levels
-provide medication for pain
-monitor for SE of meds: hallucinations, orthostatic hypotension, hallucinations, delirium
-keep pt as mobile and as independent as possible in ADLs
-implement interventions to prevent complications from immobility such as constipation, pressure ulcers, and contractures

Front 113

Parkinson's Disease
Interventions

Back 113

-schedule appointments and activities late in the morning to prevent rushing the pt
-teach pt to speak slowly and clearly (use communication board)
-monitor the pts ability to eat and swallow. monitor actual food and fluid intake
-provide high-protein, high-calorie foods or supplements to maintain weight
-recognize that PD affects the pts body image. focus on the pts strengths

Front 114

Alzheimers Disease: Chemical changes in the brain related to this disease

Back 114

abnormalities in the neurotransmitters (acetylcholine, norepinephrine, dopamine, serotonin
-high levels of beta amyloid are associated with reduced Ach which leads to a decrease in the amount of acetyltransferase in the hippocampus..this loss is major because the decrease in acetyltransferase interferes with cholinergic innervations to the cerebral cortex. this results in impaired cognition, recent memory, and the ability to acquire new memories.

Front 115

Alzheimers Disease:
Medications`

Back 115

Acetylcholinesterase inhibitors, such as Reminyl, Aricept, & Exelon;

these meds Block the enzyme that breaks down ACH, by doing that ACH stays out of the synapse longer and elicit chemicals that help with memory

Front 116

Alzheimers Disease:
Medications`

Antidepressants, why?

Back 116

• antidepressants: Zoloft & Desyrel (for the mood swings)

Front 117

When you hear the word Alzheimerz , think memory change (does short or long term memory go first)

Back 117

short term goes first, and then long term

Front 118

Alzheimers Disease:

-complications of: most patients die within ________years after onset of their symptoms death results from complications of immobility and physiologic changes

Back 118

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