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178 Cards in this Set
- Front
- Back
abnormal episodes of motor, sensroy, autonomic, or psychic activity
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seizures
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what causes Szs
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abnormal uncontrolled electrical discharge from cerebral neurons
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being in one part of the brain
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partial seizures
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can often progress to complex szs
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simple szs
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affect the whole brain
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generalized szs
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recurring seizures
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epilepsy
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unknown cause
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idiopathic
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what causes epilepsy
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unknown
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causes of secondary seizures (4)
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- brain tumor
- acute ETOH w/d - electrolyte imbalance - drugs |
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what are the risk factors for seizures (12)
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- genetic predisposition
- acute febrile state - head trauma - cerebral edema - abrupt cessation of drugs - infection - metabolic disorder - exposure to toxins - hypoxia - acute drug/etoh w/d - F&E imbalances |
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neuro connected
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sodium
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trigerring factors for seizures (8)
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- increased Px activity
- hormonal shifts (adolesants) - stress - fatigue - alcohol - caffeine - some chemicals - medication |
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Dx procedures used to rule out cerebral mass (3)
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- CT
-MRI _EEG |
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can induce Szs during EEG
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flashes of stobe light
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what does sedation with Dx procedures do
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alters brainwaves
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should be done before and after procedure of EEG
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washing of hair to remove oils,sprays, and glue
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can be given with MRI/CT/EEG for Dx of Szs
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precedex
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restricted part or one hemisphere of brain
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partial
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bilateral involvement
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generalized
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simple partial szs charac (5)
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- no impairment of conciousness
- may have aura - Sx depend on area of brain - alter. in finger/hand/mouth - sensory alteration- smell/taste/sound/visual |
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beings in one area and spreads sequentially to adjacent muscles
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jacksonian szs
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some can often tell when they are going to have one by taste,sound,smell
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aura
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impaired consciousness and repetitive activities during event
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complex partial
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what are automatisms (4)
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lip smacking
chewing mumbling fumbling with hands |
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what do complex partials have a postictial state of (2)
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confusion
amnesia |
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what can complex partials evolve into
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generalized tonic clonic
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outcomes of complex partials
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interfere with life
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szs that can progress to complex
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simple
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typical tx for complex partials
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more than one anticonvulsant
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deep brain structures on both hemispheres
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generalized szs
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what are the types of generalized szs (5)
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- absence (non convulsive)
- tonic -clonic -atonic -tonic-clonic (convulsive) |
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have no loss of motor function
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absence szs
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very important with generalized szs
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airway
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character. of tonic-clonic szs (grande mal) (3)
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- aura/no aura
- unconcious - falls to ground |
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what happens in the tonic phase (6)
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- sharp rhythmic muscle contractions
- rigid muscles include (diaphragm/chest) - neck hyperextended - all extremities extended - breathing may cease/apnea -postictial state |
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what are the rigid muscles in the tonic phase
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diapragh and chest
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generalized szs that never stop
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status eptilipticus
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charac. of tonic szs (3)
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- sudden onset
- tonic extension/flexion of head/trunk and/or extremities - other neuro abnormalities |
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what do tonic szs occur in relation to (3)
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- drowsiness
- right after falling asleep - right after awakening |
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tonic Sz have extenison/flexion of what (3)
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- head
-trunk -extremities |
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clonic szs charac (4)
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- rhythmic motor jerking movements
- unilateral/ bilateral - any age - unusual |
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what happens in postictal state (4)
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-may sleep
-confusion -amnesia - some incontinence |
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when are absence sxs dx
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childhood
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charac of absence szs (4)
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- blank stare
- facial automatisms (blinking) - impaired conciousness - brief cessation of movement - |
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what are the trigers for absence szs (2)
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-hyperventilation
-photic stimuli |
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needed for emergencies with szs
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oral airway are HOB
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Sz care (10)
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- observe aura
- observe beginning behavior/motor activity/eyes/ pupils - dont force anything to PO - note incontinence - time Sz - suction/02 available - ordered meds - loosen clothing/bedrails up - document all - note postural state |
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what should be noted with the postitical state in sz care (4)
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- difficult to arouse
- confusion - speech -sleeps |
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Sz precautions to have in place (5)
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- standby 02
- suction - IV access - side rails up - bed in lowest position |
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what are the IV anticonvulsants (3)
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- benzos (ativan)
- hydantoins ( dilantin/cerebyx) - barbs (phenobarbital) |
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what is the 1st choice IV anticonvulsant
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ativan ---lorazepam
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longer acting IV anticonvulsant
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barbituate (phenobarbital)
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what are the PO anticonvul meds (8)
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- clonazepam (klonopin)
- phenytoin (dilantin) - lamotrigine (lamictal) - valproic acid (depakene) - carbamazepine (tregretol) - ethosuximide (zarontin) |
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should be checked with PO anticonvul
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liver function
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when are hydantoins given
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partial and generalized szs
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effects of hydantoins (4)
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- dilantin ( cardiac effects/ decreases effectiveness of birth control/ teratogenic)
- gingival hyperplasia - decrease in plts and WBC - Tfeeding decrease blood levels (10-20mcg/ml) |
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effects of dilantin (3)
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- cardiac effects
- decreases effects of birth control - teratogenic |
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important with hydantoins (4)
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- difficult to give
-irritating -give slowly - oral care |
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charac of barbituates (3)
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- tonic clonic and acute szs
- resp depression - no antidote |
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charac of benzos (4)
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- status epilepticus/absence/ maintenance
- consider 1/2 life of drug used - resp depression -antidote (flumenazol) |
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what type of szs are benzos used for (3)
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-status epilepticus
-absence -maintenance |
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what is drug of choice for status Epil.
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ativan
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SE of valproates (3)
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- blood dyscrasias
- pancreatitis -liver toxicity |
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valproates used for maintenance of what szs (3)
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- tonic clonic
- partial - psychomotor |
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needs to be done with valproates (2)
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-cbc
-lab mtr |
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Sz mgnt (3)
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-ketogenic diet
- surgery - vagal nerve stimulators |
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what is a ketogenic diet
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- high fat, low carbs, low protein to induce ketosis
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why are ketogenic diets used
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to induce ketosis
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what does surgical mgnt involve with Szs
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sepating brain hemispheres or removin epileptic foci
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implant of an electirc stimulator above left collarbone with a 3 coil lead that wraps around left vagus nerve
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VNS
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where VNS generator pack implanted
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chest or axilla
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programming for VNS
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two tiered
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what are the types of programming for VNS (2)
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- conti stimulation- 30 sec on 5 min off 24/7
- demand for szs- activated by pt or caregiver |
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how is demand for sz activated
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by the pt or caregiver swiping a wand across the generator to activate the stimulus
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complications of VNS (5)
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coughing/swallowing/hoarseness
- infection - bedding - tingling - hoarseness |
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when having an MRI what must one know
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if VNS is present
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nsg intervention for pt education (4)
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- mtr antiepileptic drug levels
- maintain therapeutic levels - possible drug interactions - med alert bracelet |
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what is status epilepticus
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cont' series of szs
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what does status E result in (3)
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- metabolic demands
-cerebral hypoxia - resp arrest |
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what does status E occur from
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- abrupt cessation of pharm tx
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meds for tx of status E (3)
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- diazepam (valium)
- lorazepam (ativan) - fosphenytoin (cerebyx) |
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has a loading dose and cont/ infusion
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cerebyx (fosphenytoin)
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inflammation of the membranes and the fluid space surrounding the brain and spinal cord
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meninigitis
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types of meningitis (2)
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- septic
-aseptic |
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cause of aseptic meningitis (4)
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- viral infection
- lymphoma - leukemia - brain abscess |
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cause of spetic meningitis
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- bacteria (step pneum, neisseria, meningitidis)
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infectious process of the CNS (bacterial, viral, Tb)
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infectious neuro disorders
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common in young adults (dorm rooms, etc)
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neisseria
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what are the meningitis organisms in the imunosuppresed (5)
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- strep pneu
- neisseria meninigitidis -fungal-candida - crytoccous - mycobacterium TB |
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what is the easiet to tx (PCN)
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neisseria
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how does one transmit meningitis
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catch the organism and then it crosses BBB in blood stream
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clinical presentation of meningitis (8)
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- fever
-nuchal rigidity (early) - + Kernigs and Brudzinski - photophobia - rash (petechial/purpuric) - Szs (pneumococcal) - HA -irritability |
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important with nuchal rigidity
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dont move the head
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involuntary raising of the knee
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brudzinski
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pain in mennigis
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kernigs
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complication of meningitis (7)
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- brainstem herniation
- DIC - meningococcemia - septic shock - SIADH (increased ICP) -cerebral palsy (aftermath) -hearing deficits) |
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cause of brainstem herniation
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increased ICP
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cause of meningococcemia
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nieserria in blood stream
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cause of septic shock
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strep
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help tp break up clots
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fibrin split products
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what is polymerase chain reaction (PCR)
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a virus that should be pretx with antibiotics
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dx of meningitis (8)
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- LP
- CBC with diff - CSF - culture blood/urine - rapid antigen testing - PCR - rectal swab - if DIC- coag panel |
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what does rectal swab culture show
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viral men
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decrease fast with coag panel due to DIC
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fibrinogen
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done with CSF (4)
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- cell count/diff
- protein -glucose -antigen testing |
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increased in CBC with diff with menig
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WBC and neutros
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present in CSF if bacterial
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neutros
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precautions for meningitis
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contact airbourne and droplet
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medical mgnt for meningitis (5)
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- vaccincation HFLu, Spneu, and meninigococcal
- early IV abx - Cipro for those exposed - desamethasone - tx for dehydration/ shock/sz |
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used to decrease hearing deficits
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dexamethasone
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who should be tx with nieserria
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anyone in contact
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nsg mgnt for meningitis (9)
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- IV abx
- Sz precautions - VS/neuro assess - Daily wt/I&O - Elec/ urine spec/ osmolarity - isolation precaut. - Tx those in contact - hemodynamic mtr - tx complicatons (HA, Sz) |
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what happens when dexamethasone is given prior to abx
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inhibit cytokine cascade
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scary with tx of menin
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they look worse before they look better d/t breakdown
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process of abx tx (3)
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- rapid bacterial lysis
- release of bacterial cell wall membrane fragments - increased inflam and ICP |
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viral with severe HA
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aseptic menin
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used for contacts with menin
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cipro (chemoprophylaxis)
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decreases with bacterial d/t what
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glucose d/t bacterial eating it up
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collection of infectious material within brain tissue
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brain abscess
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at increased with for brain abscess (2)
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-immunocompromised
- otitis media/mastoiditis/sinusitis/dental infections |
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S&S of brain abscess (5)
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- HA
-fever - vomitting - neurologica deficits - ICP S&S |
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Dx of brain abscess
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- MRI
-CT |
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how is CT performed for Dx of Menin
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guided aspiration used to identify the causative organisms
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medical mgnt for brain abscess (3)
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-control ICP
- drain abscess -abx/corticosteroids( edema) |
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nsg mgnt for brain abscess (3)
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- neuro assess and responses to tx
- ensure pt safety - provide supportive care |
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acute inflammation process of the brain tissues
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encephalitis
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causes of encephalitis (3)
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- viral (herpes simplex)
-vector borne viral infec ( west nile) - fungal infec |
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Dx of encephl (4)
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- EEg
-LP -cultures - PCR |
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medical mgnt for encepal
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- acyclovir for HSV
- amphotericin/antifungals |
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acyclovir charac (3)
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- no bacteriostatic H2O
- 1 hr infusion - mtr renal function |
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amphotericin charach (3)
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- mix with D5W
- must use large filter (5mcron) - start slow (hypotension/shock |
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what should be done with amphotericin
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mtr Bp q 15 min,,, stay in room
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encephalopathy with hepatic, metabolic, neurologic failure
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reyes syndrom
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what is reyes preceded by
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viral infection
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increased risk for reyes with what
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ASA use
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results of reyes (3)
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- undetected metabolic disorder/toxins
- neuro deterioration -liver failure |
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contains ASA
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pepto
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complications with reyes (3)
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- blood sugar declines
- ammonia levels rise - rise in cerebral edema (decrease LOC/szs) - |
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dx for reyes (3)
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- liver bx/scan
- ammonia level -liver enzymes (ALT/SGPT) |
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tx for reyes (3)
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- glucose
- anticonvulsants - mtr coags |
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toxic to brain and causes encephalopathy
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ammonia
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issues with liver biopsy
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bleeding
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% of cancers that result in brain mets
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20
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tx for brain mets (7)
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-palliative
- corticosteroids -hyperosmotic diuretics - chemo - thrombosis (LMWH) - pain control - nutritional support |
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has little effect with mets
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chemo
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how are spinal cord tumors classified
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by anatomic relation to spinal cord
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intramedullary
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within the cord
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extramedullary/extradural
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outside the dural membrane
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presentation of spinal cord tumors (3)
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- pain
-weakness - loss of motor function/reflexes/sensation |
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used with spinal cord tumors to decrease CSF buildup
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lumbar drains
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what does tx of spinal cord tumor depend on
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tumor and location
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used with SC tumors to decrease compression
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dexamethasone
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classification of brain tumors based on what
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- location
-characteristics |
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types of primary tumors (6)
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- gliomas
- meningiomas (encapsulated) - acoustic neruromas - pituitary adenmoas -angiomas -metastatic |
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masses of abnormal blood vessels
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angiomas
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what is plasmaphoresis
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removing of plasma containing antibodies, then returning cells
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what are the blood therapies
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-IVIG
-plasmaphoresis |
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should be done with IVIG (5)
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-record lot #
- baseline VS - epi/benadryl - start slow and then increase - know dose |
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complications of neuro oncologic disorders (4)
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- increased ICP
- Szs - hydrocephalus - altered pituitary function |
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tx of hydrocephalis
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shunts
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what do manisfestations of neuro oncologic disorders depend on
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- tissue infiltrated and compressed by the neoplasm
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what tissues can become infiltrated with neuro oncologic disorders (3)
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- dura
-around cranial nerves -brain tissue |
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dx for GB
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electromyelogram
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important to watch with GB
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resp involvement
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what does GB often follow
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resp or GI infection
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breaks down with GB
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myelin sheath
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where does GB start
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feet but may begin in hands
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progression of GB
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hours to weeks
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length of GB
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plateaus for 2-3wks and then recovery in 6-12mths
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Dx of brain tumors (5)
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- neuro exam
- CT - MRI - CSF study - biopsy |
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done if mass is present with brain tumor
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MRI
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manifestations of brain tumors (4)
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- sx of increased ICP
- HA in am - vomitting - visual disturbances |
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SE of acoustic neuroma (3)
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- hearing
-tinnitus - vertigo |
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Se of pituitary adenoma
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hormonal effects
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radiation therapy (2)
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- external beam
- brachytherapy |
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tx for childrean
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infratentorial
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tx with adults
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supratentorial
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tx for guillain barre (3)
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- supportive
- plasmaphoresis -IVIG |