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111 Cards in this Set
- Front
- Back
Aterial
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Epidural
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Veins
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subdural
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Synapse
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travelling from one cell to another,
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UMN - Upper Motor Neurons
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Brain to spinal cord - unable to leave the spinal cord.
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LMN - Lower Motor Neurons
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Spinal cord and rest of the body except cranial nerves 1, II, VIII
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Reglan
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Used for decreased nausea and vomiting. Decreased symptoms of gastric stasis . Side effects are: drowiness, extrapyramidal reactions, restlessness tachycardia, bradycardia hypertension, hypotension and dry mouth.
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Assessment - History of medication
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OTC, Herbal meds everything that the patient is taking
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Assessment -Growth and Development
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injuries, where they were and where they have been
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Assessment -Head Injury
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loss of conscousness - Very Important - epidural - arterial bleed.
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Assessment -Headaches
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Use scale 0-10, Where is it?
Where is it located? When did it start? Associated symptoms? Always start with the worst scenerio and go down. |
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Assessment -Dizziness
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Not able to hold onto the world
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Assessment -Vertigo
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"room is spinning"
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Assessment -Syncope
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Passing out
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What concerns are there with a Seizure?
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The duration, safety and maintaining airway.
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What concerns are there with Dysphagia
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Dysphagia is difficulty swallowing - Obstruction airway - altered nutrition - and NPO
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What concerns are there with Parasthesias?
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Parasthesias is numbness and tingling - think numb foot - always check if the same on both sides - symmetry and trends.
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What are the Five point Neuro check?
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1-Behavior - restless, irriable
2-Speech - slurring3 3-Content - person place & time 4-Arouseabilty - voice, tactile 5-Systolic BP - triad - three symptoms that occur as you watch : Systolic will go up and diastolic go down, heart rate goes down, what is baseline? what is it now? where is it going? |
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What concerns are there with Cerebellar>
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gait - walk a straight line - arm swing and unequal steps
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What is myelin?
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think of a paved street - makes an easy transition- a sheath that covers the axon of a neuron.
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What are Glial cells?
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It is the glue that holds everything together - Glia means glue in Greek
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Synapse
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traveling from one cell to another
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Neurons
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–Motor
–Sensory Receive and transmit information |
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Glial Cells(major cellular component)
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commonly called neuroglia or glia, (GLUE)
non-neuronal cells –Provide support –Nutrition –Maintain homeostasis- clean up waste/breakdown dead neurons –Form myelin, –Key to blood/brain barrier –participate in signal transmission in the nervous system, |
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Synapse (cont)
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–Neuron to neuron
–Neuron muscle/gland |
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Neurotransmitters
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–Excite
–Inhibit |
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THE BRAIN
The Meninges |
Are the coverings:
–Dura (outer layer) –Arachnoid (middle layer) –Pia mater (inner layer) |
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THE BRAIN
The Spaces |
–Epidural
–Subdural –Subarachnoid |
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THE BRAIN
Diencephalon |
–Thalamus
–Hypothalamus –Pituitary gland |
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THE BRAIN
Brain Stem |
Midbrain
Pons Medulla |
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THE BRAIN
Cerebellum |
–Muscle tone/balance
–coordinated muscle movement |
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Spinal Cord
“conduction pathway” |
Foramen magnum to L1-L2
H - shaped mass –Grey matter (cell body) –2 horns |
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Spinal cord -
Posterior |
(Dorsal) sensory- afferent
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Spinal cord -
Anterior |
(Ventral)-motor-efferent
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Spinal cord -White matter
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White matter surrounds horns
–Myelinated nerve fibers –Arranged in “tracts” |
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Nerve Transmission
“The Tracts” |
The motor cortex
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Upper motor neurons (UMN)
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starts in motor cortex
–Crown to internal capsule unable to leave the spinal cord |
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lower motor neurons (LMN)
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cranial and spinal nerves
–Except cranial nerves I, II, VIII –cell bodies in the brain stem –axons leave to the body –Messages sent to the target organ |
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Pyramidal Tracts
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Pyramidal tracts-(descending motor tracts)
Group of nerve fibers that carry –VOLUNTARY MOTOR MOVEMENT to LMN –Fine/skilled movements in skeletal muscle –Long = rapid transmission –Cross at the pyramids of the medulla 85% CONTRALATERAL (lateral) 15% IPSILATERAL(direct) cross in lower cord area |
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–Corticospinal tract
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fibers synapse with spinal nerves
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–Corticobulbar tract
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exit brain stem and synapse with the cranial nerves
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Extrapyramidal Tracts
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Automatic motor movement
Gross rather than fine Indirect rather than direct (multiple synapse) Works with the autonomic nervous system |
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Basal ganglia
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3 clusters of neurons
–caudate nucleus, –putamen, –globus pallidus) located at the base of the brain responsible for involuntary movements such as –tremors –athetosis –chorea. The basal ganglia are abnormal in a number of important neurological conditions including Parkinson disease . The term "basal ganglia" refers to the fact that this region is in the "basement" of the brain |
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Basal ganglia
what it does- |
Inhibit
“rapid firing of neurons” |
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Basal ganglia
–Most affect |
Head
Hands Fingers |
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Extrapyramidal Tracts
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Automatic motor movement
Gross rather than fine Indirect rather than direct (multiple synapse) Works with the autonomic nervous system |
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Extrapyramidal Tracts
–Responsible for |
Posture
Muscle tone Facial expression |
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Extrapyramidal Tracts
Components |
–Basal ganglia
–Red nucleus –Substantia nigra –Reticular formation –cerebellum |
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Extrapyramidal Tracts
(problem solver) |
Complex system-tracts & ganglia
–Basal ganglia, red nucleus, substantia nigra and reticular formation and cerebellum –Function is unconscious Act: automatically/involuntary Gross rather than fine –Origin is diffuse within the CNS |
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VOLUNTARY MUSCLE EXCITATION
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Culprit:
–Gravity- posture/balance Skeletal muscle “resting tension” or TONUS –Prior learning – bike riding –Compensating Movements – anticipatory postural reflexes –Merging voluntary and involuntary |
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BASAL GANGLIA
–Neurotransmitters involved |
Acetylcholine
Dopamine – substantia nigra GABA ( gamma amino butric acid) |
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Ascending Tracts
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From spinal cord to brain
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The Peripheral Nervous System
Somatic |
31 pairs spinal and 12 pairs cranial
****Voluntary control***** Spinal nerves – Arranged in segments –Attached to the spinal cord –Numbered by vertebral location |
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–Anterior root – motor
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From cord to muscle or gland
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–Posterior root – sensory
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–Dorsal route ganglion
–Relay sensor input to the cord |
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Cranial Nerves
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12 pairs of cranial nerves
Sensory Motor Sensory motor |
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The Autonomic Nervous System
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not voluntary
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The Autonomic Nervous System
Sympathetic |
“fight or flight”
–adrenergic |
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The Autonomic Nervous System
Parasympathetic |
“rest and digest”
–cholinergic |
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Focused Neurological
History |
Present illness/ Review of systems
Current medications Growth and development Head injury? –Loss of consciousness –Details- when , where, how often aggravating/alleviating factors Headaches? Dizziness/Vertigo/Syncope Seizure Swallowing difficulty/ Dysphagia Speech / Disarthria Coordination Sensation – numbness of tingling / Parasthesias Environmental/occupational hazards (insecticide/ ETOH) Significant neurologicl history (CVA, infection) ASSESSING THE PATIENT THINK TRENDS and SYMMETRY |
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QUICK 5 POINT
NEURO CHECK 1. Behavior |
Affect
Irritability Restlessness |
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QUICK 5 POINT
NEURO CHECK 2 Speech |
Appropriateness
Slurring |
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QUICK 5 POINT
NEURO CHECK 3. Content |
Person
Place time |
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QUICK 5 POINT
NEURO CHECK 4. Arousability |
Spontaneous
voice tactile |
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QUICK 5 POINT
NEURO CHECK 5.Systolic BP |
Triad
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NEUROLOGICAL ASSESSMENT
THE SINGLE MOST IMPORTANT ASSESSMENT |
Level Of Consciousness
Full consciousness Lethargy –awakens, follows commands, slow , inattentive Obtunded –difficult to arouse, constant stimulation, few words, asleep Stupor –Deep stimulation ,moan, does not follow commands , may remove painful stimuli Coma –No verbal response, reflex action |
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Cranial Nerve assessment
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Inspect and palpate the motor system
–Muscle size/ symmetry –Muscle strength-use resistance method –Muscle tone – limited ROM /pain/ flaccid/ spastic or rigid. –Involuntary Movement- TICS /Tremors/ fasciculations |
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Cerebellar Function
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Balance
Coordination Skilled movements |
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Cerebellar Function
Check- |
–Gait- walk a straight line
Stiff posture/ staggering/wide base of support/ arm swing/ unequal steps/foot slapping or ataxia –Romberg Test –Rapid alternating movement –Finger to finger test –Finger to nose –Heel to shin |
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Assess the sensory system
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Presence
–Pain –Temperature Light touch –Discrimination Light touch – sharp or dull Hot and cold Other sensory evaluation Vibration – tuning fork Position (kinesthesia) Tactile discrimination –Stereognosis –Graphesthesia Two point discrimination |
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CHECK REFLEXES
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Involuntary actions in response to stimulus sent to the CNS
First sign of neurological dysfunction –UMN LESION –PYRAMIDAL TRACTS SPINAL CORD INJURY 2 TYPES –STRETCH OR DEEP TENDON (0-5+ NORMAL +2) –SUPERFICIAL Ex: Babinski |
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The CAT or CT Scan
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–Computerized axial tomography
–X ray in segments –Can be made into 3D pictures –Specialized scanners (ex) Dynamic CT – contrast is injected into an artery Helical or Spiral CT |
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The CAT or CT Scan
CONTRAINDICATIONS |
–Patient status?
–Pregnancy –Obesity –Allergy –Residual barium –Cooperation/claustrophobia - Can not give meds for two days after procedure. -Radiation **Can not give Glucophage** it is a medicine given fordiabetic patients |
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Patient Prep for CT Scan
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NPO – time?
Remove anything that may obstruct scan Educate patient / address concerns Contrast –Confirm order –Assess allergies Pre treatment –Assess renal function BUN/Creatinine –Check medications –metformin (glucophage) Stop 48 hours after test –Initiate IV access –Hydration –48 hours between exams with contrast |
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MRI
Magnetic Resonance Imaging |
Its a huge magnet.
Stimulates the body to produce different signals that correspond to different tissue characteristics Maps changes in soft tissue Reduce the risk associated with more invasive tests Contrast |
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MRI
Magnetic Resonance Imaging Benefits |
Non-Radioactive contrast agent
Rare allergic reactions Cleared by kidney Enters where cell wall is compromised |
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MRI
Magnetic Resonance Imaging –contraindications |
Metal
Claustrophobia Patient status Pregnancy Previous allergy –Check list –Sedative |
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PET SCAN
POSITRON EMISION TOMOGRAPHY |
Inhalation or injection with a radioactive substance
Brain scan – pt asked to perform cognitive activities i.e. Pledge of Allegiance – measure of brain activity during reasoning or remembering Determines level of functioning of an organ –A/P: glucose metabolism, blood flow, tissue perfusion on specific areas –Pathology : alteration in normal metabolic process Exposure to radiation minimal Radioactive tracer (RA isotope to pharm agent) Waiting period of few minutes to few hours Isotope releases energy (gamma rays) PET scanner measures energy Computer converts it to an image of metabolic activity |
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PET SCAN
Use |
cancers/ CV/ Neurological problems
Staging disease Metastatic spread Effectiveness of therapy |
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PET SCAN
Preparation/Education |
Check for pregnancy/ breast feeding
Fluids Time |
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LUMBAR PUNCTURE \ LP
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LP/ Spinal tap
Needle inserted into subarachnoid space at L2 – L3 |
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LUMBAR PUNCTURE \ LP
Purpose |
–ICP measurement
–Specimen collection –Inject medication Chemo Antibiotics Anesthesia |
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LUMBAR PUNCTURE \ LP
Purpose |
–ICP measurement
–Specimen collection –Inject medication Chemo Antibiotics Anesthesia |
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LUMBAR PUNCTURE \ LP
Contraindications |
Increased ICP
Infection Coagulation defects Degenerative joint disease Patient cooperation |
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LUMBAR PUNCTURE \ LP
Procedure |
Consent
Vital signs Empty bladder Educate – position/ sensation |
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LUMBAR PUNCTURE \ LP
Post procedure |
Flat in bed
Headache/ nuchal rigidity Neuro assessment Site leakage Fluids |
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LUMBAR PUNCTURE \ LP
Complications |
Infection
Brain herniation Blood patch |
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EMG- ELECTROMYOGRAPHY
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CEREBRAL ANGIOGRAPHY
ARTERIOGRAPHY measures electrical activity in nerves and muscles. provides clues about nerve and muscle disorders. determine the cause of problems such as – muscle weakness –spasms, –paralysis –pain in arms, hands, legs, feet, face. |
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EMG- ELECTROMYOGRAPHY
How to Prepare : |
Eat regular meal
Take any medication normally taken shower or bath to remove any body oils. Do NOT use any bath oils, lotions, or creams where symptoms are present. Deodorant may be used |
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EMG- ELECTROMYOGRAPHY
What to Expect |
What to Expect :
two parts lasts from 1-3 hours. first part nerve conduction studies. –lying down, electrodes taped to the skin. nerves will be stimulated on the skin and the response will be measured. sensation compared to a tingle. physician administers second part of the test. a small, thin, sterile disposable needle is inserted into the muscles to be tested. measures muscle's electrical activity. patient asked to relax and contract the muscle during assessment. After the test minor soreness for several days. – mild analgesic. |
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Ultrasound Prep
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Really not too much prep - Jelly - cold
you can also use a veinous doppler to check for clots very invasive procedure |
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Parkinson’s Disease
TRAP |
tremor, rigidity ,akinesia, difficult maintaining posture.
Side bar -Akinesia (from the prefix a-, "without", and the Greek κίνηση, kinisi, "motion") is the inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system. Common in severe cases of Parkinson's disease, akinesia is a result of severely diminished dopaminergic cell activity in the direct pathway of movement. |
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Parkinson’s Disease
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One of most crippling diseases in US
1 in every 40-50 people over 60 affected Symptoms begin around age 60 men more than women 60,000 new case diagnosed annually in US Increase predicted as population ages |
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Parkinson’s Disease
Classification: Determine Progression |
Stage I: Unilateral involvement
'asymmetric rest tremor' is considered a hallmark symptom of early Parkinson's disease. It can also affect the legs, chin, or jaw (as in a chewing motion). Stage II: Bilateral involvement Stage III: Impaired posture/ reflexes Mild to moderate disability Stage IV: Fully developed severe disease Marked disability Stage V: Confinement to bed or wheelchair Cause |
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Parkinson’s Disease
Cause |
Unknown or unclear
Genetic/environmental factors |
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Parkinson’s Disease
Research |
Genetics – less than 50 yrs
Exogenous toxins Manganese dust- welders disease/ early onset Carbon monoxide Viral agents Clinical symptoms do not appear until 80% of the basal ganglia are destroyed |
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Parkinson’s Disease
The Disease Process |
Basal Ganglia (sturcture deep in brain)
Connects cerebral cortex and thalamus “ease of movement” SUBSTANTIA NIGRA Located in midbrain Produces dopamine Smooth, voluntary movement |
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Parkinson’s Disease
A SECOND NEUROTRANSMITTER |
Acetylcholine (Ach)
Excitatory message thru basal ganglia Determines brain speed Dopamine inhibits and allows CONTROL OVER VOLUNTRY MOVEMENT PATHOPHYSIOLOGY degeneration of dopaminergic neurons in the basal ganglia fine motor movement Controls posture Coordination of voluntary motor movement Symptoms caused by the imbalance between dopamine (inhibits) and acetylcholine (excites) Too much Acetylcholine = Rigidity Tremors Bradykinesia Or too little dopamine |
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Parkinson’s Disease
4 Cardianl signs and Symptoms (Think Trap) |
Tremor
Begins in fingers (pill-roll) Resting tremor Increases during stress Start unilateral Rigidity Resistance to muscle stretching Cog Wheeling Akinesia(bradykinesis) Causes difficulty walking Starting Parallel Short shuffling gait Postural changes |
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Parkinson’s Disease
Other Signs And Symptoms |
Tremor at rest
Rigidity- Resistance to passive movement Cogwheel- rhythmic interruption muscle movement Plastic- mildly restrictive Lead Pipe- Total resistance Bradykinesia (slowness of movement) Hypokinesia (reduced motor reaction) Flexed posture Loss of postural reflexes Freezing phenomenon Other Signs And Symptoms soft monotone voice Drooling Mask like facial expression Facial muscle Dysarthria Slow monotonous slurred speech Dysphagia Loss of posture control Excessive sweating Autonomic Decreased GI/GU function Autonomic Orthostatic hypotension |
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The PET SCAN
Positron Emission Tomography Additonal info |
Looks at dynamic process
Blood flow Cell metabolism Radioactive Isotopes Short half life Minimal radiation Vascular Access Decay of Isotope = release of radiation Gamma camera takes images Visualize concentration |
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Tensilon Test used for the diagnosis of MG
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The Tensilon test is done by injecting the drug Tensilon into a vein and watching for rapid improvement of strength, usually of eye muscles. Improvement in strength of speech may also be considered a positive test.
A patient feeling better after Tensilon does NOT necessarily mean that the patient has MG. Blood pressure and pulse need to be monitored during the test. A patient may have MG and a negative Tensilon test (no improvement with the administration of the medication), but then the diagnosis should be supported by other tests, such as the acetylcholine receptor antibodies in the blood, or by a positive EMG test. *Blockds the acetycholine. |
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Steroids - Prednisone
(MG) |
used for the management of MG – It must be taken with food as the steroids tend to upset the stomach.
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Immunosuppressant
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Immunosuppressants
Azathioprine (Imuran), Mycophenolate (MFM or CellCept), Cyclosporine (Sandimmune) and Mercaptopurine (6-MP) The immunosuppressants are a class of drugs capable of inhibiting the body's immune system. Many of the agents included in this category are also cytotoxic (cell poisons) and are used in the treatment of cancer. Cytotoxic agents used as immunosuppressants include antimetabolites (azathioprine), alkylating agents (cyclophosphamide), and folic-acid antagonists (methotrexate or 6-MP). Other immunosuppressants include mycophenolate (CellCept) and cyclosporin. |
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Immunosuppressant
side effects |
These include stomach upset, nausea, vomiting, abdominal pain, mouth ulcers, darkened urine, pale stools, jaundice (yellowing of the skin or white portion of the eyes), unusual bleeding or bruising.
A serious (and life threatening) side effect is reduced activity of bone marrow, but this can be monitored with regular blood tests. Occasionally, patients taking immunosuppressants will develop pancreatitis (inflammation of the pancreas) some months after starting these drugs. |
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Anticholinesterase Drugs
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several drugs that prevent destruction of the neurotransmitter acetylcholine by the enzyme acetylcholinesterase within the nervous system. Acetylcholine acts to transmit nerve impulses within the parasympathetic nervous system—i.e., that part of the autonomic nervous system that tends to induce secretion, to contract smooth muscles, and to dilate blood vessels. In preventing the destruction of acetylcholine, anticholinesterase permits high levels of this neurotransmitter to build up at the sites of its action, thus stimulating the parasympathetic nervous system and in turn slowing the heart action, lowering blood pressure, increasing secretion, and inducing contraction of the smooth muscles.
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Riluzole Generic name
Rilutek Brand name ALS Medication |
Riluzole
(Rilutek, United States and Canada) More drugs used for ALS. Use: Riluzole or Rilutek is used in the treatment of amyotrophic lateral sclerosis (ALS) or Lou Gherig's disease. How It Works: Riluzole or Rilutek inhibits glutamate release possibly by blocking sodium channels. The accumulation of glutamate seems to be involved in ALS, and Riluzole or Rilutek's action prevents the accumulation. Side Effects: Riluzole or Rilutek can cause nausea, vomiting, increased asthenia, and increased spasticity. Cautions for People: People need to know, before they use Riluzole or Rilutek, that it is not clear whether Riluzole or Rilutek is useful or not. At most, it is considered to offer a modest benefit. Drug Interactions: Riluzole or Rilutek, at this time, does not appear to have any significant drug interactions. |
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DOPAMINERGIC!!!'
Parkinsons Disease |
Dopamine can be supplied as a medication that acts on the sympathetic nervous system, producing effects such as increased heart rate and blood pressure. However, because dopamine cannot cross the blood-brain barrier, dopamine given as a drug does not directly affect the central nervous system. To increase the amount of dopamine in the brains of patients with diseases such as Parkinson's disease and dopa-responsive dystonia, L-DOPA, which is the precursor of dopamine, can be given because it can cross the blood-brain barrier.
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Sinemet - Parkinsons Disease
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Sinemet is made up of levodopa and another drug called carbidopa. Levodopa enters the brain and is converted to dopamine while carbidopa increases its effectiveness and prevents or lessens many of the side effects of levodopa, such as nausea, vomiting, and occasional heart rhythm disturbances. It is generally recommended that patients take Sinemet on an empty stomach, at least ½ hour before, or 1 hour after meals.
****While Sinemet is the most effective medication and has the least short-term side effects, it is associated with high risks of long-term side effects, such as involuntary movements (dyskinesia). Used on a long-term basis, levodopa may also cause restlessness, confusion, or abnormal movements |
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PET Precautions
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Nursing Responsibility
Radiation exposure risk low Hematoma or infection at site Preparation NPO Varies(2-12 hours) Medications Caffeine / alcohol / tobacco held Special Considerations Diabetics Takes several hours Increase water intake after scan |
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Angiogram
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An angiogram is an imaging test that uses x-rays to view your body’s blood vessels. Physicians often use this test to study narrow, blocked, enlarged, or malformed arteries or veins in many parts of your body, including your brain, heart, abdomen, and legs. When the arteries are studied, the test is also called an arteriogram. If the veins are studied, it is called a venogram.
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Angiogram Precautions
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Usually your physician will ask you not to eat or drink anything within 6 hours of your angiogram. Depending on your particular situation, however, you may be encouraged to take extra fluid before an angiogram. Sometimes this fluid will be given to you by intravenous administration. Also, if you have problems with your kidney functions, you may benefit from medication given to you before the test as well as the extra fluid administration. If you have allergies to the contrast material or to iodine or shellfish, you may require medication before the test to lessen your risk for an allergic reaction. Your vascular surgeon will advise you regarding the best treatment options for your particular situation.
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