Scc Third Sem Final

Front 1

Hd

Back 1

Most commonly used form of dialysis

· Used in both the acutely ill and end stage renal disease. For rapid exchange of toxins and fluid removal. Done three times a week for 3- 5 hours per day.

· Not a cure for renal disease

· Removes toxins, water, electrolytes, corrects acidosis

· Processes used are diffusion, osmosis, ultra filtration.

· Heparin is flushed through system to prevent clotting

Front 2

hd pre

Back 2

Check physician orders

o Weight patient, hold Antihypertensives, antibiotics on dialysis days – administered after dialysis

o Draw BMP, CBC, PT/PTT – if patient needs transfusion best to administer during dialysis.

o Assess vital signs, breath sounds, assess cardiac status – overload assessment.

o Check access – bruit and thrill

o BUN > 150 or if ARF – patient may complain of Headache, nausea, vomiting, restlessness, lethargy, decreased LOC, seizures.

Front 3

hd during

Back 3

Access is secured, check for leaks or bleeding.

o Patient encouraged to limit movement /activity. Assess peripheral pulses, temperature, capillary refill, warmth.

o Monitor all vital signs – watch for hypotension, cramping, vomiting. VS every 15 – 30 minutes.

o Watch flow of dialysate – venous arterial thrombus.

o Disequilibrium syndrome – headache, muscle twitching, backache, N/V, seizures. Common in patient when first started on dialysis.

o No eating encouraged during dialysis.

Front 4

hd post

Back 4

Check access site

o Vital signs

o Weight patient

o Post dialysis – BMP, CBC,
ABG’s not done immediately.

o Treat pruritis with benedryl.

o Goal weight gain maximum-

o 1.5 kg/ day

o Teaching should be no longer

o than 10 – 15 minute intervals.

o Dietary consult

Front 5

complications

Back 5

Hypotension – Albumin and saline, dopamine.

o Muscle cramping, dizziness, tachycardia

o Exsanguination

o Dysrhythmias

o Air embolus

o Anemia

o Access complication – pericarditis, sepsis

o Hep. B, C

Front 6

pt hd teaching

Back 6

Eat balanced portions of foods high in protein such as meat, chicken, fish and beans.

o Watch the amount of potassium you eat. Potassium is a mineral found in salt substitutes, some fruits, vegetables, milk, chocolate and nuts.

o Limit how much you drink. Fluids build up quickly in your body when your kidneys aren't working.

o Avoid salt.

o Limit foods such as milk, cheese, nuts, dried beans, and soft drinks. These foods contain the mineral phosphorus. Too much phosphorus in your blood causes calcium to be pulled from your bones. Calcium helps

Front 7

pd

Back 7

Remove toxins and metabolic waste using the peritoneal cavity as semipermeable membrane.

· For those who are not candidates for hemodialysis or those who prefer peritoneal method.

· Diabetics, cardiovascularly impaired patients more likely to have PD

· Patient has more freedom

· Fewer dietary restrictions- increased protein loss.

· Allowed more fluids

· Needs increased fiber in diet.

· Increases serum triglycerides and lipid levels

· Acute intermittent

· Continuous ambulatory

· Continuous cyclical

· Procedure

· Sterile dialysate instilled into peritoneal cavity

· Dialysate is dextrose based, provides osmotic gradient.

· Slower process than hemodialysis

· Tenckoff catheter – long term therapy

· Dialysate exchanges are every 1- 4 hours.

· Exchanges:

o Usually 2 liter bags of dialysate are used. Initially use 1 or 1.5 to prevent leaking.

o Solution concentration 1.5,2.5 or 4.25%.

o Solution must be warmed to 98.6 o F.

o Additives – heparin, potassium, insulin, antibiotics

o During infusion – keep HOB at least semi fowlers position. Assess for SOB, complaints of abdominal pain.

o Assess vital signs, assess breath sounds.

o Infusion time approx, 10 minutes.

o Patients usually have chronic back pain

o Anorexia common

Front 8

drainage

Back 8

Dialysate removed by gravity.

o Approximately 10 – 30 minutes time

o Normal drainage – clear, straw colored

o Blood in first few exchanges only.

o Assess for brown drainage, fibrin clots

o Higher dialysate concentration, more pull, increased returns. Check BP.

Front 9

pd complications

Back 9

Peritonitis – Staph – cloudy dialysate, abdominal pain, rebound tenderness, increased protein loss.

o Bleeding – catheter displacement, patient menstruating, post enema administration.

o Protein loss – increases if patient develops peritonitis.

o Abdominal hernias

o Hemorrhoids

o Anorexia

o Constipation

o Adhesions

o Diverticulitis

o Pulmonary – atelectasis, pneumonia, bronchitis ( increased dwell time)

Front 10

Acute poststreptococcal glomerulonephritis:

Back 10

This disease is a bilateral inflammation of the glomeruli (the kidney’s blood vessels). It occurs after a streptococcal infection.

Causes:

· Antigen-antibody complex: this produces an immunologic mechanism in response to streptococci.

· Untreated pharyngitis

Front 11

clinic findings

Back 11

Azotemia

· Fatigue

· Oliguria

· Edema

· Hematuria

· Proteinuria

Front 12

dx test findings

Back 12

Creatinine levels- elevated

· 24-hour urine- low creatinine

· Urinalysis:

o Proteinuria

o Hematuria

o RBCs

o WBCs

o Mixed cell casts

· KUB-X-ray- enlarged kidneys

Front 13

tx

Back 13

Fluid restriction

· Bed rest- in acute period

· High calories; low sodium, potassium and protein diet

· Dialysis- occasional necessary

· Drug therapy:

o Diuretics:

§ Metolazone (Zaroxolyn)

§ Furosemide (Lasix)

o Antihypertensive:

§ Hydralazin

Front 14

monitor

Back 14

Vital signs

o Cardiovascular status

o Respiratory status

o I&O

o Daily weights

o Renal function

o S/S of acute renal failure

§ Oliguria

§ Azotemia

§ Acidosis

· Good nutrition

· Good hygiene

· Gradually resume activities as symptoms subside

· Allow patient to express emotions

Front 15

arf

Back 15

This is the sudden interruption of renal function.

Types:

· Prerenal – hypoperfusion to kidney.

· Intrarenal – damage to kidney tissue.

· Postrenal – obstruction to urine flow.

Front 16

arf causes

Back 16

Acute glomerulonephritis

· Acute tubular necrosis

· Anaphylaxis

· BPH

· Blood transfusion reaction

· Burns

· Cardiopulmonary bypass

· Collagen disease

· Dehydration

· Diabetes mellitus

· Heart failure

· Hemorrhage

· Hypotension

· Nephrotoxins

· Renal calculi

· Septicemia

· Trauma

· Tumor

Front 17

arf clinical findings

Back 17

Oliguria

· Anuria or adequate urine output.

· BUN and Creatinine increased

· Azotemia

· Persistent nausea and vomiting

· Lethargy, drowsiness, headache

· Skin and mucus membranes dry

· Uremic fetor

· Muscle twitching

· Seizures

· Anemia

Front 18

arf dx test

Back 18

Increased BUN, serum creatinine, decrease in creatinine clearance ( determines GFR)

· Hyperkalemia – tall peaked T waves, widened QRS, loss of P waves

· Metabolic Acidosis

· Decreased HCT and HGB

· Casts in urine

· Decreased specific gravity

· Urine Sodium < 20 (prerenal) > 40 (intrarenal)

· Ultrasound abdominal films Retrograde pyelography, KUB, renal scan, CT scan

Front 19

arf tx

Back 19

Low protein diet, low K diet, low Na diet

· Maintain fluid balance – I&O

· Monitor electrolytes (K, Mg, Ca, P)

· Assess for uremia, HTN, fluid overload (periorbital edema, sacral edema)

· Fluid retention treated – limit PO and IVF

· Diuretic therapy (Oliguric phase)

· Prevent infection

· Monitor Metabolic acidosis – administer NaHCO3.

Front 20

Chronic glomerulonephritis

Back 20

This is the slow, progressive inflammation of the glomeruli. It results in sclerosis, scaring and possible renal failure.

Front 21

causes

Back 21

Hemolytic transfusion reactions

· Burns

· Renal disorders

· Nephrotoxic drugs

· Septicemia

· Systemic disorders:

o Lupus erythematosus

o Goodpasture’s syndrome

o Diabetes mellitus

Front 22

clinical findings

Back 22

Hematuria

· Hypertension

· Edema

· Uremic symptoms

Front 23

dx test

Back 23

Urinalysis:

o Proteinuria

o Hematuria

o Cylindruria

o RBC casts

· Elevated:

o BUN

o Creatinine

· Kidney biopsy

· Ultrasound and X-rays- small kidneys

Front 24

tx

Back 24

Dialysis

· Kidney transplant

· High calorie; low sodium

· Drug therapy:

o Antihypertensive:

§ Metoprolol (Lopressor)

o Diuretics

§ Furosemide (Lasix)

o Antibiotics- as needed to treat UTI

Front 25

monitor

Back 25

Vital signs

o I&O

o Daily weight

o Fluid and electrolyte balance

o Acid-base balance

· Supportive care

· Good oral hygiene

Front 26

chronic renal failure

Back 26

This is the irreversible loss of renal function. It may be a rapid or slowly progressive.

Front 27

crf causes

Back 27

Congenital abnormalities

· Diabetes mellitus

· Hypertension

· Nephrotoxins

· Systemic lupus erythematosus

· Dehydration

· Recurrent UTI

· Urinary tract obstruction

· Exacerbation of nephritis

Front 28

clinical findings

Back 28

Azotemia

· Decrease urine output

· Heart failure

· Lethargy

· Pruritus

· Weight gain

· Bone pain

· Brittle nails

· Ecchymosis

· Muscle twitching

· Paresthesia

· Seizures

· Stomatitis

Front 29

dx test

Back 29

24 hour urine for Creatinine clearance

· ABG’s

· H&H

· BMP

Front 30

meds

Back 30

Fluid restriction

· Low protein, sodium, potassium and phosphorus; high calorie and carbohydrate diet

· Dialysis

· Possible transfusion of packed RBCs

· Drug therapy:

o Diuretics:

§ Furosemide (Lasix)

o Calcium supplements:

§ Calcium carbonate (Os-Cal)

o Antiemetics:

§ Prochlorperazine (Compazine)

o Antacids:

§ Aluminum hydroxide gel (Al-ternaGel)

Front 31

monitor

Back 31

Cardiovascular status

o Renal status

o Respiratory status

o Fluid and electrolyte status

o Vital signs

o I&O

o Daily weight

o Stools for occult blood

o Ecchymosis

· Tepid baths- to relieve itching

· Provide skin and mouth care

· Provide a cool and quiet environment

· Avoid IM injections

· Allow patient to express feelings

Front 32

renal calculi

Back 32

his condition is associated with the formation of crystalline substances in varying sizes. They are also known as kidney stones.

Front 33

causes

Back 33

ehydration

· Diet high in:

o Calcium

o Vitamin D

o Milk

o Protein

o Oxalate

o Alkali

o Vitamin C

· Genetics

· Gout

· Hypercalcemia

· Hyperparathyroidism

· Immobility

· Leukemia

· UTI

· Urinary obstruction

· Urinary stasis

Front 34

clinical findings

Back 34

Flank pain

· Chills fever

· Nausea and vomiting

· Diaphoresis; cool moist skin

· Pallor

· Dysuria

· Frequent urination

· Renal colic

· Urgency of urination

· Costovertebral tenderness

· Syncope

Front 35

dx test

Back 35

KUB X-ray

· Excretory urography reveals stones

Front 36

tx

Back 36

Extracorporeal shock wave lithotripsy

· Percutaneous nephrostolithotomy

· Increase PO fluid intake (3 liters per day)

· Dietary changes based on components of stones

· Moist heat to flank

· Drug therapy:

o Antibiotics:

§ Cefazolin (Ancef)

§ Cefoxitin (Mefoxin)

o Analgesic:

§ Meperidine (Demerol)

§ Morphine

o Antiemetic:

§ Prochlorperazine (Compazine

Front 37

monitor

Back 37

Renal status

o Pain level

o Vital signs

o I&O

o Daily weights

· Strain all urine

Front 38

cns

Back 38

brain and spinal cord

Front 39

pns

Back 39

cranial nerves and spinal nerves

Front 40

ans

Back 40

Sympathetic
-“Fight or Flight”
-Causes and increase in heart rate and blood
pressure.
-Causes an increase in respiratory rate
-Decreases peristalsis (movement through the bowels)
-Secretes epinephrine and norepinephrine
-Dilates pulmonary bronchioles
-Parasympathetic
-Maintains normal body function
-Maintains normal heart rate and blood pressure
-Maintains normal respiratory rate
-Increases peristalsis
-Secretes acetylcholine
-Constricts pulmonary bronchioles

Front 41

cerebrum includes

Back 41

frontal lobe, parietal, occipital, temporal lobes

Front 42

cerebrum

Back 42

This area of the brain is responsible for the synergic control of skeletal muscle. It receives afferent impulses (information from the periphery of the body) and discharges efferent impulses (the information that is sent to the muscles and glands), but does not act as a reflex center in the usual sense.

Front 43

Brain Stem:

Back 43

his area includes the midbrain, pons and medulla. These areas contain the cardiac, respiratory and vasomotor centers and are the pathways connecting the brain and spinal cord.

Front 44

Corticospinal Tract

Back 44

Corticospinal Tract: Motor impulses are conducted from the motor cortex to anterior horn cells.

Front 45

Spinocerebellar Tract

Back 45

muscle tension

Front 46

Spinothalamic Tract:

Back 46

spinothalamic Tract: The pain and temperature sensations are transported by the lateral area, while crude touch and pressure are carried by the anterior tract

Front 47

Anterior Horn

Back 47

Anterior Horn: This area contains the cell bodies that produce efferent or motor fibers.

Front 48

lateral horn

Back 48

Lateral Horn: This area contains the cells that produce autonomic fibers of the sympathetic nervous system.

Front 49

posterior horn

Back 49

Posterior Horn: This area contains cell bodies that connect with the afferent or sensory fibers.

Front 50

reflex arc

Back 50

Reflex Arc: When an impulse is received by the sensory receptor, such as pain, it is carried along the afferent pathway, to the posterior horn of the spinal cord. The interneuron creates a synapse (the junction across which a nerve impulse passes from axon terminal to neuron) between the posterior horn and the anterior horn. The impulse is then carried by the efferent pathway to the periphery, where the effector responds to the stimulus. Example, the hand pulls away from the hot surface.

Front 51

gcs

Back 51

This is a test used to assess a patient’s progress over time. It tests three areas, eye opening, best motor response and best verbal response. It is scored as follows:

Front 52

gsw

Back 52

eye opening, motor responce, and verbal responce

Front 53

Decorticate posturing:

Back 53

hands in and out

Front 54

Decerebrate Posturing

Back 54

The abnormal body posture indicated by rigid extension of the arms and legs, the downward pointing of the toes and backward arching of the head. It is indicative of sever brain injury at the level of the brainstem.

Front 55

icp

Back 55

Being the in an adult’s skull is a fixed space, any increase in one component will cause an increase in pressure. This increase in pressure could be caused by tumors, abscesses, edema, hemorrhage and/or inflammation.

Front 56

signs of icp

Back 56

Altered level of consciousness
* Bradycardia
* Alterations respirations
* Projectile vomiting

Front 57

the following interventions are the nurse’s priority, designed to minimized stimulation and promote venous return:

Back 57

Maintain airway; limit the suctioning to 15 seconds or less
* Elevate the head of the bed to about 30 degrees
* Maintain the patient’s neck in neutral position to promote venous drainage
* Create a quiet environment
* Ensure proper bowel routine to prevent the Valsalva maneuver
* Diuretics are usually ordered to decrease fluid volume

Front 58

seizure disorders

Back 58

Seizures are the recurrent disturbances of the skeletal motor function, consciousness, autonomic function or behavior

Front 59

types of seizures

Back 59

Tonic-clonic or Grand mal
* Absence or Petit mal
* Myoclonic
* Atonic
Partial:
* Simple
* Complex

Front 60

sz interventions

Back 60

* Maintain safety
-move harmful objects
-protect the patients head
* Do not put anything into the patients mouth
* Allow free movement
* Educate the client and their family about the importance of safety and drug therapy

Front 61

Medical Management of Seizure and Key points

Back 61

Dilantin: administered in Normal Saline and monitor blood levels (10-20mcg/ml)
* Phenobarbital: Side effects related to CNS disturbances.
* Tegretol: Used to treat seizures that are unresponsive to other medication.

Front 62

cva

Back 62

This is damage to the brain caused by a decrease cerebral blood flow and oxygen deprivation. This is a result of:
* Thrombus
* Embolism
* Hemorrhage
Signs and Symptoms:
* Facial drop
* Lateral weakness
* Flaccidity
* Change in mental status

Front 63

Nursing Concerns:

Back 63

Monitor for aspiration
* Assess possible nutrition imbalances
* Assess for elimination problems
* Possible problems with communication and vision

Front 64

aneuryism

Back 64

an Aneurysm is an outpouching of an artery. This can lead to a rupture and possible subarachnoid bleed.

Front 65

rn interventions

Back 65

Calm and dark environment
* Head of bed 30-45 degrees
* Decrease stimulation
* Avoid Valsalva’s maneuver
* No rectal temperatures
* Suction only if absolutely necessary

Front 66

meningitis

Back 66

his is the inflammation of the meninges of brain and spinal cord. The causes include: bacteria, viruses or other microorganisms that cause an infection.

Front 67

s/s

Back 67

* Fever
* Lethargy
* Confusion
* Nuchal rigidity (Stiff nick)
* Kernig’s sign (see below)
* Brudzinski’s sig

Front 68

kernig's sign

Back 68

It is positive if the lower leg cannot extend due to pain and spasm when the patient is lying on their back with one leg bent over the abdomen

Front 69

Brudzinski’s sign

Back 69

This is considered positive if the patient’s hips and knees flex when they are lying supine and lifting their head toward their chest.

Front 70

rn concerns

Back 70

Isolation
* Client safety
* Monitor vital signs and neurological test
* Administer antibiotics as prescribed

Front 71

parkinsons disease

Back 71

This is a progressive degenerative disorder of the neurological system. It is caused by a depletion of dopamine. Dopamine is a neurotransmitter. This depletion results with generalized weakness and these cardinal symptoms:

Front 72

s/s

Back 72

* Tremors at rest
* Rigidity
* Shuffling gait
* Slow movement
* Mask-like face
* Emotional liability
* Autonomic symptoms:
o Drooling
o Sweating
o Constipation

Front 73

rn concerns

Back 73

Maintain a safe environment
* Optimism patients independence
* Monitor for side effect of medications
* High caloric diet

Front 74

ms

Back 74

This is a disorder caused by demyelination in the brain and spinal cord. The signs and symptoms of this disorder depend on the area of demyelination, however they usually include visual deficits, decrease in sensation, weakness and paralysis.

Front 75

rn concerns

Back 75

* Major concern is safety
* Maximize independence
* Encourage a low saturated fat diet

Front 76

mg

Back 76

This is an autoimmune disorder. This results in disturbances in the transmission of nerve impulses to muscles. This results in extreme muscle weakness.

Front 77

fyi

Back 77

This is the test that distinguishes this disorder form cholinergic crisis. If the patients muscle strength improves with the administration of Tensilon (edrophonium chloride) a diagnosis of myasthenia gravis is confirmed. Often used on NCLEX.

Front 78

mg crisis

Back 78

A patient that is experiencing a myasthenic crisis will suffer from:
* Double vision
* Difficulty swallowing
* Ptosis (eye droop)
* Restlessness
* Sweating

Front 79

rn concern 4 mg

Back 79

Nursing Concerns:
* Maintain airway if necessary
* Safety
* High caloric diet; tube feeding might be indicated
* Treat with anticholinesterase drugs
* Encourage rest
* Observe for signs and symptoms of cholinergic crisis:
o Hypotension
o Bradycardia

Front 80

In relation to the Glasgow coma scale a patient that opens his eyes in reponse to painful stimuli, and is moving without any purpose and making little sense with his words, would receive a score of :

Back 80

9

Front 81

If a patient were experiencing difficulties in cranal nerve number IX, a nurse could expect:

Back 81

problem w/ swollowing

Front 82

The sign that is associated with meningitis is:

Back 82

kernigs

Front 83

For the patient with a diagnosis of myasthenia gravis the nurse's primary concern would be

Back 83

encourage rest

Front 84

For the patient with Parkinson's disease, the nurse would expect to find which of the following clinical manifestations?

Back 84

mask like face

Front 85

For the patient with the diagnosis of myasthenia gravis, the administration of tensilon will result in

Back 85

increased muscle strength

Front 86

for the patient with cerebral aneurysm, the nurse should avoid which of the following intervention?

Back 86

rectal temp

Front 87

our patient begins to have rigidity with repetitive movements of his arms and legs with lossof consciousness, you would say the patient was experiencing:

Back 87

tonic clonic

Front 88

For the patient having a Clonic-Tonic seizure the nurses primary action would be to :

Back 88

saftey

Front 89

alpha waves

Back 89

relaxed w/ eyes closed

Front 90

beta

Back 90

alert awake eyes open

Front 91

viral meningitis

Back 91

Viral meningitis (also called aseptic meningitis) is relatively common and far less serious. It often remains undiagnosed because its symptoms can be similar to those of the common flu.

Front 92

bacterial meningitis

Back 92

rare serious life threating

Front 93

meningitis s/s

Back 93

* fever
* lethargy (decreased consciousness)
* irritability
* headache
* photophobia (eye sensitivity to light)
* stiff neck
* skin rashes
* seizures

Front 94

brain abscess

Back 94

A brain abscess can cause many different symptoms, depending on its location, its size, and the extent of inflammation and swelling around the abscess. Symptoms include headache, nausea, vomiting, sleepiness, seizures, personality changes, and other signs of brain dysfunction. These symptoms can develop over days or weeks. A fever and chills may occur at first but then disappear as the body fights

Front 95

tx

Back 95

abx and maybe surg

Front 96

subarchaniod bleed

Back 96

outside of brain and in blood vessels

Front 97

intraveticular hemmorage

Back 97

in the cavites and the middle brain

Front 98

causes

Back 98

htn, trauma rupture of a berrys anurism, av malform, bleeding from tumor or infx

Front 99

bleed investigations

Back 99

ct, mri, angiogram,

Front 100

head injuries

Back 100

* A concussion is a jarring injury to the brain. A person who has a concussion usually, but not always, passes out for a short while. The person may feel dazed and may lose vision or balance for a while after the injury.
* A brain contusion is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.
* A skull fracture is when the skull cracks. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.
* A hematoma is bleeding in the brain that collects and clots, forming a bump. A hematoma may not be apparent for a day or even as long as several weeks. So it's important to tell your doctor if someone with a head injury feels or acts oddly. Watch out for headaches, listlessness, balance problems or throwing up.

Front 101

teach pts get help w/ head injury when;

Back 101

* Any symptom that is getting worse, such as headaches, nausea or sleepiness
* Nausea that doesn't go away
* Changes in behavior, such as irritability or confusion
* Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
* Trouble walking or speaking
* Drainage of bloody or clear fluids from ears or nose
* Vomiting
* Seizures
* Weakness or numbness in the arms or legs

Front 102

stroke

Back 102

A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cells damaged.

Front 103

tia

Back 103

Transient ischaemic attack (TIA) or 'mini-stroke' is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke.

Front 104

cerebral thrombosis

Back 104

Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen.

Front 105

cerebral embolism

Back 105

Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots.

Front 106

Cerebral haemorrhage

Back 106

s when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra damage.

Front 107

stroke s/s

Back 107

# weakness down one side of the body, ranging from numbness to paralysis that can affect the arm and leg

# weakness down one side of the face, causing the mouth to droop

# speech may be difficult or become difficult to understand

# swallowing may be affected

# loss of muscle coordination or balance

# brief loss of vision

# severe headache

# confusion.

Front 108

stroke r/f

Back 108

etoh, smoke, htn, a fib, dm,

Front 109

seizure

Back 109

Seizures are sudden, abnormal, and excessive electrical discharges from the brain that can change motor or autonomie function, consciousness, or sensation

Front 110

sz types

Back 110

two basic types of seizures are partial and generalized. Partial seizures start in a specific part of the brain and have focal discharges that can be monitored. Partial seizures fall into two types: simple, in which the patient doesn't lose consciousness, and complex, in which the patient loses consciousness.

Front 111

sz nursing care

Back 111

f you witness the beginning of the patient's seizure, first check his airway, breathing, and circulation, and ensure that the cause isn't asystole or an obstructed airway. Stay with the patient and ensure a patent airway. Focus your care on observing the seizure and protecting the patient. Place a towel under his head to prevent injury, loosen his clothing, and move any sharp or hard objects out of his way. Never try to restrain the patient or force a hard object into his mouth; you might chip his teeth or fracture his jaw. Only at the start of the ictal phase can you safely insert a soft object into his mouth.

If possible, turn the patient to one side during the seizure to allow secretions to drain and to prevent aspiration. Otherwise, do this at the end of the clonic phase when respirations return. (If they fail to return, check for airway obstruction and suction the patient if necessary. Cardiopulmonary resuscitation, endotracheal intubation, and mechanical ventilation may be needed.)

Protect the patient after the seizure by providing a safe area in which he can rest. As he awakens, reassure and reorient him. Check his vital signs and neurologic status. Be sure to carefully record these data and your observations during the seizure.

If the seizure lasts longer than 4 minutes or if a second seizure occurs before full recovery from the first, suspect status epilepticus. Establish an airway, insert an I.V. catheter, give supplemental oxygen, and begin cardiac monitoring. Draw blood for appropriate studies. Turn the patient on his side, with his head in a semi-dependent position, to drain secretions and prevent aspiration. Periodically turn him to the opposite side, check his arterial blood gas levels for hypoxemia, and administer oxygen by mask, increasing the flow rate if necessary. Administer diazepam or lorazepam by slow I.V. push, repeated two or three times at 10- to 20-minute intervals, to stop the seizures. If the patient isn't known to have epilepsy, an I.V. bolus of dextrose 50% (50 ml) with thiamine (100 mg) may be ordered. Dextrose may stop the seizures if the patient has hypoglycemia.

Front 112

sz patient teaching

Back 112

Patient teaching

▪ Explain the disorder and treatment plan.

▪ Teach the family how to observe and record seizure activity.

▪ Emphasize the importance of compliance with drug therapy and follow-up appointments.

▪ Tell the patient to carry medical identification.

Front 113

most reliable indicator of icp

Back 113

lathragy

Front 114

increased icp affects

Back 114

occipital lobe= blurred
frontal= changes in behavior
temporal= hearing
cerebellum= dizzy, ataxic
motor speech= apashia

Front 115

decorticate

Back 115

in

Front 116

hob 30 degrees

Back 116

aids w/ venous drainage decrease aspiration

Front 117

no coughing

Back 117

may cause hem

Front 118

no valsalva

Back 118

it increases icp

Front 119

corticosteriods

Back 119

dexamethasone reduce cerebral edema may increase bg

Front 120

administer manitol or lasix

Back 120

decrease swelling/edema

Front 121

Lp

Back 121

explain, on side, legs flexed, head down BECAREFUL dont occlude airway!! after lie flat 4-24 hrs fource fluids to promote cerebral spinal fluid production. monitir for
HA

Front 122

addisons disease

Back 122

his disease is a result of adrenocortical insufficiency. It can be a result of autoimmune response or a pituitary insufficiency.

Front 123

causes

Back 123

Autoimmune

· Histoplasmosis

· Metastatic lesion from lung cancer

· Pituitary dysfunction

· Surgical removal of adrenal gland

· Trauma

· Tuberculosis

Front 124

clinical findings

Back 124

Progressive weakness

· Fatigue

· Weight lose

· Anorexia

· Skin hyperpigmentation

· Hypoglycemia

· Hypotension; orthostatic hypotension

· Hyponatremia

· Hyperkalemia

· Nausea, vomiting and diarrhea

Front 125

labs

Back 125

ACTH stimulation test: cortisol levels fail to raise (primary adrenal disease)

o An increase in levels indicates a possible pituitary problem

· Other abnormal values:

o Hyperkalemia

o Hypochloremia

o Hyponatremia

o Hypoglycemia

o Anemia

o Increase in BUN

Front 126

meds

Back 126

# IV fluid
# High protein, carbohydrate, and sodium; low potassium diet
# Drug therapy:

* IV corticosteroids (Solu-Cortef)
* Vasopressin
* Antacids:
o Magnesium and aluminum hydroxide (Maalox

Front 127

monitor

Back 127

* :
o Vital signs
o Fluid and Electrolyte status
o I&O
o Daily weight

· Safety

· Assistance with ADL’s

· Maintain a quiet environment

· Encourage PO fluids

Front 128

pt ed

Back 128

Lifelong replacement therapy

o Medical identification bracelet

o S/S of overdosage or underdosage:

§ Profound weakness’

§ Fatigue nausea and vomiting

§ Hypotension

§ High fever followed by hypothermia

o Stress reduction

o Emergency Kit at all times: 100mg of hydrocortisone IM

o Prevent infection or receive prompt treatment for infections

· Avoid strenuous activity

Front 129

cushings syndrome

Back 129

This disease is a result of excess corticosteroid especially glucocorticoids

Front 130

cushings causes;

Back 130

Prolonged high-dose corticosteroids

· ACTH-secreting pituitary tumor

· Cortisol-secreting neoplasm

· Excess secretion of ACTH from carcinoma of the lung

Front 131

sx

Back 131

Weight gain

· Muscle wasting

· HTN/CHF

· Hirsutism and menstrual disorders

· Unexplained hypokalemia

· Skin changes

· Metabolic alkalosis

· Visual disturbances

· Acne

· Decreased libido

· Fragile skin

· Mood swings

· Purple striae on abdomen

Front 132

dx tests

Back 132

Dexamethasone suppression test

o 24r-urine collection for free cortisol

· Abnormal lab values:

o High sodium

o High glucose

o Low potassium

Front 133

tx

Back 133

Surgical options

o Pituitary adenoma

§ Transsphenoidal surgery

o Adrenal tumor

§ Adrenalectomy

o Ectopic tumor

§ Removal of tumor

· Drug therapy:

o Mitotane (Lysodren): suppresses cortisol production

§ Side effects:

· Anorexia, nausea and vomiting

· GI bleeds

· Depression

· Vertigo

· Skin rashes

Front 134

prolonged therapy

Back 134

Gradual decrease dose

o Reduce dose

o Conversion to alternating day regimen

Front 135

monitor

Back 135

Vital signs

o Daily weights

o Glucose levels

o Signs and Symptoms of infections

o Fluid and electrolyte balance

Front 136

post op monitor

Back 136

Do to hormone fluctuations the patient will have unstable:

§ Blood pressure

§ Fluid balances

§ Electrolytes

o High-dose corticosteroids

o Rapid changes in blood pressure, respirations or heart rate should be reported to MD

o Critical period ranges from 24-48hrs

o Pt at risk for:

§ HTN

§ Hemorrhage

§ Infection

Front 137

pt ed

Back 137

Medical identification bracelet

o Extremes should be avoided:

o Temperature

o Infections

o Stress

o Do to patients potential adrenal insufficiency

Front 138

hyperthyroid

Back 138

This disorder is an increase in the synthesis and release of thyroid hormone

Front 139

causes

Back 139

Infection

· Autoimmune disease

· Genetic

· Pituitary tumor

· Stress

· Thyroid adenomas

Front 140

hyperthyroid findings

Back 140

Palpitation of the thyroid gland, can reveal a goiter

· Bruits may be noted on auscultation

· Atrial fibrillation

· Exophthalmos

· Diaphoresis

· Palpitations

· Tachycardia

· Tachypnea

· Weight loss

· Weakness

· Heat intolerance

· Fine hand tremors

· Increased blood pressure

· Older adults symptoms may be different:

o Anorexia

o Apathy

o Lassitude

o Depression

o Confusion

Front 141

dx test

Back 141

T3 and T4; possilbey TSH

o RAIU

Front 142

therapy

Back 142

Radiation therapy

· Thyroidectomy

· High protein, carbohydrate, and calorie diet

· Drug therapy:

o Iodine preparations: potassium iodide (SSKI)

o Adrenergic-blocking agents:

§ Propranolol (Inderal)

§ Reserpine (Serpasil)

Front 143

monitor

Back 143

Cardiovascular status

o Vital signs

o I&O

o Fluid and electrolyte balance

o Daily weights

· IV fluids

· Provide a quiet, cool environment

· Provide frequent rest periods

· Skin and eye care

· Avoid stimulants: caffeine

· Allow patient to express feeling

Monidor for S/S of Thyrotoxic Crisis

o Severe tachycardéa

o Heart failure

o Shock

o Hyperthermia (up to 105.3F)

o Restlessness

o Agitation
Seizures

o Abäominal pain

o Nausea/vomiting/diarrhea

o Delirium

o Coma

Front 144

hypothyroid

Back 144

This is a disease of thyroid insufficient T3 & T4

Front 145

causes

Back 145

Hashimoto’s

· Malfunction of pituitary gland

· Over use of antithyroid drugs

· Thyroidectomy

· Radioactive iodine

Front 146

findings

Back 146

Fatigue

· Lethargic

· Personality and mental changes

· Anemia

· Elevated cholesterol and triglycerides

· Decreased GI motility

· Cold intolerance

· Hair loss

· Dry and course skin

· Brittle nails

· Muscle weakness

· Weight gain

· Menorrhagia

· Edema

· Constipation

· Hypersensitivity to sedatives

· Menstrual changes

· Swollen lips and thick tongue

Front 147

dx tests

Back 147

T3 and T4: Low

· TSH: may be high or low

Front 148

tx

Back 148

Goal is to restore the patient to a euthyroid state as safely and quickly as possible.

· High fiber, protein, low calorie diet

· Drug therapy:

o Levothyroxine (Synthroid)

§ Initial dosage for typical adult 0.05 mg

§ Smaller initial dosage for those with compromised cardiac status

§ It also enhances the affects of warfarin (Coumadin)

Front 149

monitor

Back 149

Vital signs

o I&O

o Fluid and electrolyte balance

o Bowel functions

· Encourage PO fluids

· Provide warm environment

· Skin care

· Encourage activity

· Provide mental stimulation

Front 150

pt teaching

Back 150

S/S of hyperthyroidism

o Explain the need for life long therapy

o Emphasize need to avoid cold

o Proper skin care

o Avoid sedatives

o Methods to avoid constipation

o

Front 151

monitor

Back 151

Allow patient to express feelings

· Assess for S/S of Myxedema coma:

o Subnormal temperature

o Hypotension

o Hypoventilation

Front 152

myxedcoma monitoring

Back 152

Support:

§ Mechanical respiratory support

§ Cardiac monitoring

§ Hormone replacement therapy IV

Front 153

monitor

Back 153

Temperature

§ Electrolyte levels

§ Cardiac status

§ Mental alertness

Front 154

thyroidectomy

Back 154

Mediation administration

§ Patient Education

· Coughing and deep breathing

· Leg exercises and ROM for neck

· How to support the head manually post-op

§ Inform patient that talking may be difficult post-op

§ Tracheostomy should be at pt’s bed side

Front 155

post op

Back 155

Assess a minimum of q2hrs for 24hrs:

§ Hemorrhage or Tracheal compression

· Irregular breathing

· Neck swelling

· Frequent swallowing

· Sensation of fullness

· Choking

· Blood on anterior or posterior dressing

§ Semi-fowler position, avoid neck flexion

§ Evaluate hoarseness

§ Tetany secondary to hypoparathyroid

§ Assess for Trousseau’s sign and Chvostek sign for 72 hrs

§ Have calcium gluconate at bed side

§ Pain medications as needed

Front 156

complications

Back 156

Hypothyroidism

§ Removal of parathyroid

§ Hypoparathyroidism

§ Hypocalcemia

§ Hemorrhage

§ Injury to laryngeal nerve

§ Thyrotoxic crisis

§ Infection

Front 157

pt teaching

Back 157

May experience a period of relative hypothyroidism.

§ Reduce caloric intake

§ Avoid goitrogens food

§ Regular exercise

§ Signs and symptoms of hypothyroidism

· Encourage patient to express their feelings

Front 158

a potential complication of hyperthyroidism

Back 158

Thyrotoxic Crisis

Front 159

manifestation of hyperthyroid

Back 159

Adrenergic stimulation

Front 160

clinical manifestation of hypo thyriod

Back 160

Hypothermia

Front 161

While caring for the patient post-thyroidectomy, the nurse is aware that symptoms of peripheral numbness and tingling as well as muscle spasm should be treated with which of the medications?

Back 161

iv calcuim

Front 162

overuse of predinsone =

Back 162

cushings syndrome

Front 163

with addisons crisis administer`

Back 163

ns

Front 164

eleminate joint pain in chronic renal failure

Back 164

low purine diet (high protein food and organ meat)

Front 165

pt returning from tyroidectom has chocking feeling!! what to do!

Back 165

assess surgical site, exam under dressing, loosen dressing,elevate HOB

Front 166

ms

Back 166

This is a disorder caused by demyelination in the brain and spinal cord. The signs and symptoms of this disorder depend on the area of demyelination, however they usually include visual deficits, decrease in sensation, weakness and paralysis.

Front 167

rn concerns

Back 167

* Major concern is safety
* Maximize independence
* Encourage a low saturated fat diet

Front 168

parkinsons disease

Back 168

This is a progressive degenerative disorder of the neurological system. It is caused by a depletion of dopamine. Dopamine is a neurotransmitter. This depletion results with generalized weakness and these cardinal symptoms:

Front 169

sx

Back 169

Tremors at rest
* Rigidity
* Shuffling gait
* Slow movement
* Mask-like face
* Emotional liability
* Autonomic symptoms:
o Drooling
o Sweating
o Constipation

Front 170

nursing concerns

Back 170

Maintain a safe environment
* Optimism patients independence
* Monitor for side effect of medications
* High caloric diet

Front 171

You are developing a care plan for a patient with injury to the frontal lobe of the brain. Which of the following interventions should be part of the care plan?

Back 171

(1). Keep instructions simple and brief because the patient will have difficulty concentrating.
Orient the patient to person, place and time as needed because of memory problems.
Damage to the frontal lobe affects personality, memory, reasoning, concentration, and motor control of speech. Damage to the temporal lobe, not the frontal lobe, causes hearing and speech problems. Damage to the occipital lobe causes vision disturbances. Damage to the brain stem affects vital functions

Front 172

You are planning care for a patient with hyperthyroidism.

Back 172

wt pt, isotonic eyedrops,small well balanced meals and rest

Front 173

A 35-year-old patient with chronic renal failure plans to receive a kidney transplant. Recently, the patient was told that he is a poor candidate for transplant because of chronic uncontrolled hypertension and diabetes mellitus. Now the patient tells you "I want to stop dialysis.I'd rather die than be on this machine for the rest of my life".

Back 173

take a seat, your feeling upset about the news of your transplant

Front 174

When is seizure activity most likely to occur out of the following periods of time?

Back 174

falling asleep and waking

Front 175

: Muscular dystrophy is a result of

Back 175

gene mutation

Front 176

levadopa

Back 176

relives muscle rigidity and reduces tremors

Front 177

anticholenergics

Back 177

relive muscle rigidity and tremors by decreasing effects of acth

Front 178

levadopa s/e

Back 178

postural hypotension, a/n/v gi bleed dizziness...

Front 179

hyper thyriod tx I 131

Back 179

sx subside several weeks p tx . flush toilet several times p use, no kissing, no sex, no physical contact, seperate sheets, glasses. dont come in contact with secretions.

Front 180

hyperthyroid nursing

Back 180

observe for heat intolerance , hoarness from goiter, BMR increases, assess for nervousness and excitiblity r/t catecholamines.

Front 181

exophthalos

Back 181

sunglasses, methylcellulose eye drops

Front 182

diet

Back 182

4-5 k cals mostly protein and carbs watch for persperation fluid loss

Front 183

hypothyroid sx

Back 183

fatigue, alopecia, brittle hair nails cold intolerance

Front 184

betablocker for hyperthyroid

Back 184

controls palp and nervous tremors

Front 185

post op thyriodectomy

Back 185

support neck, limit talking r/t hemmorage. observe for airway obstruction. keep trach at bedside. listen for hoarsness r/t damaged laryngeal nerve. monitor for tetany chvostek and trousseau. ca gluconate combats hypocalcemia

Front 186

hypotyroid

Back 186

assess for lathargy and slowness increased wt decreased appetite

Front 187

hypotyroid meds

Back 187

levothyroxine/synthroid cytomel. decrease fatigue and edema reduce wt and minimize cold intolerance

Front 188

increased p over 100

Back 188

can indicate drug tox

Front 189

cushings

Back 189

hypercrotisol. causes increaed production of acth by pit gland

Front 190

swollen and puffy

Back 190

increased aldosterone leads to na retention and k secretion. increased fluid retention = htn

Front 191

muscle wasting

Back 191

r/t glucocorticosteriods

Front 192

hyperglycema

Back 192

glucogenesis increases

Front 193

emotional liablity and stress

Back 193

r/t glucocorticosteriod s/e

Front 194

hirsutism and decreased menses

Back 194

r/t adrogen secretion from sx

Front 195

dx tests

Back 195

increase urine cortisol
increased blood cortisol

Front 196

labs for kidney failure

Back 196

BUN < 100
Creatinine < 10

Front 197

tx for oliguric

Back 197

Normal saline, then high dose diuretic such as Mannitol or Lasix. Small dose of Dopamine 2.5-5 mic/kg/min to increase renal perfusi

Front 198

disequalibrium syndrom

Back 198

urea is removed from blood but not brain or CSF, causes fluid shift and edema,N/V, low BP,HA, confusion. Start dialysis slowly at first to prevent.

Front 199

cfr breathing

Back 199

kussmal and acidosis

Front 200

nl creatinine

Back 200

0.6 - 1.2 mg/dl

Front 201

nl ca

Back 201

8.5- 10.5

Front 202

renal pt lab results

Back 202

ncreased BUN
increased creatine
increased triglycerides because of high lipids

Front 203

atn

Back 203

caused by ischemia of kidneys or
exposure to nephrotoxic agents

Front 204

complication of icp

Back 204

herniation syndrome

Front 205

sah

Back 205

bleeding into subarracnoid space, most often from trauma and anerysm. May lose concious immediately or become confused and lethargic and gradually comatose.

Front 206

icp interventions

Back 206

head at midline
HOB 15-30 degrees
pressure off neckfor adequate flow
maintain normothermia
treat pain
NGT w/ IVPB Zantac

Front 207

post renal

Back 207

obstruction any were in urinary tract

Front 208

crf diet

Back 208

fluid restriction (1000cc day)
low sodium
low potassium
low protein
beware of sodium substitutes because they are high in potassium

Front 209

drugs for renal faliure

Back 209

ace inhibitors (Dopamine)
diuretics (mannitol, lasix)

Front 210

nl bun

Back 210

8-23

Front 211

doners may not

Back 211

COPD,liver disease, active infection, extensivevascular disease, must be histocompatible (family best fit).

Front 212

arf pre renal

Back 212

decreased blood flow to kidneys leads to ischemia.
Increasing blood flow reverses it usually.

Front 213

nl albumin

Back 213

3.4 - 5.4 g / dl

Front 214

ARF Renal (intrarenal) phase

Back 214

Damage to kidneys or neurons of the kidney itself. May be from immune or inflammatory process.

Front 215

hy does dialysate solution have glucose?

Back 215

Glucose is lost during dialysis, the levels in bag are prescribed by physician. Different percentage means amount of glucose.

Front 216

nl icp

Back 216

10-15

Front 217

adverse synthroid effectd

Back 217

-hypertension
-tachycardia (to much given)
-hyperreflexia
-anxiety
-increased sweating

Front 218

thyroid storm

Back 218

life threatening, rarely seen.
precipitated by stress, diabetic ketoacidosis, physical/emotional traum

Front 219

thyriod strom tx

Back 219

peripheral cooling
replace fluids, glucos, electrolytes
antithyroid drug
avoid asa

Front 220

synthroid administerd when

Back 220

First thing in the morning
Or two hours BEFORE meals.

Front 221

thyroid storm manifestations

Back 221

High Fever
Extreme Cardiovascular Effect
Extreme CNS effects

Front 222

What is myxedematous coma?

Back 222

life threatening disorder characterized by:coma, hypothermia, cardiovascular collapse, hypoventalation, hyponatremia, hypoglycemia, lactic acidosis

Front 223

hyperthyroid tx

Back 223

Propylthiouracil (PTU)

Front 224

ptu

Back 224

-hyperthyroidism
-adjunct therapy in prep for surgery or radioactive iodine therapy
-control thyrotoxic crisis

Front 225

Management of myxedematous coma?

Back 225

hyroid replacement therapy
slow rewarming of hypothermia

Front 226

What are manifestations of Graves Disease?

Back 226

onset 20-40 years old
severe eye problems (tissue behind eyes) bulging

Front 227

What should you suspect in surgery pt after thyroidectomy that spikes a fever of 103 of higher?

Back 227

thyroid storm

Front 228

nurses should monitor what with Synthroid?

Back 228

Thyroid Function Test
ECG
Serum lab analysis
skin color, temp, and texture
muscle tone
weight
VS

Front 229

symptoms of a goiter

Back 229

-dysphagia
-stridor (crowing sound)
-distention of neck veins
-edema of eyelids and conjunctiva
-syncope with coughing

Front 230

purines

Back 230

nuts, organ meat, tea, milk

Front 231

oxalate avoid

Back 231

spinich, cabbage, tomatoes

Front 232

map

Back 232

60mm/hg

Front 233

gfr

Back 233

125 hr

Front 234

azotemia

Back 234

increase bun increased crt

Front 235

dopamine dilates

Back 235

renal artries

Front 236

anasarca

Back 236

generalized edema

Front 237

nh3 causes

Back 237

twitching hands

Front 238

24 hr urine

Back 238

void first then start collecting void before turning in

Front 239

arf death r/t

Back 239

hyperkalemia and infx

Front 240

fluid restriction calc

Back 240

total days urine output plus 600

Front 241

geri complications with renal

Back 241

renal reseve comprimised, bph can cause hydronephrosis

Front 242

chronic renal failure

Back 242

progressive nephron destruction, irreversible, gfr less then or equal to 60 for more then 3 months is chronic

Front 243

crd stage one

Back 243

gfr >90 no sx

Front 244

stage 5

Back 244

gfr<15 needs dialysis or transplant

Front 245

arf

little pee then lots
gfr nl in 1 yr
rapid onset
anemia inproves
temorary sx

Back 245

ckd
gfr wrose and wrose
gfr<15
gradual anemia continues
perm sx
increase r/f carcinoma sensory nerve changes
encephalopathy

Front 246

protein

Back 246

40 grams q day

Front 247

RN role

Back 247

hx, comorbidity, diet, wt, vs , labs, i/o
wt check for 2-3 pounds over night
or 5lbs q week

Front 248

goal

Back 248

education, compliance, coping, adl's

Front 249

PD dialysis nursing care

Back 249

site careinspect antiseptic, clean dressing qd, document dressing, instruct pt, check md infusion order f/u care

Front 250

PD 3 phases

Back 250

inflow like 2 L in 10 minutes
dwell 30 min-8hrs
drain 15-30 min

Front 251

PD problems

Back 251

pain (slow rate)
air in tubing (shoulder pain)
cath tip touches organs =pain so try repositioning. back pain from fluid wt. can result in hernia, atalectasis, pnu, bronchitis, so pulmonary toileete!

Front 252

outflow problems

Back 252

if not draing well turn , move if inserted 2000ml and 1600ml come out=problem. Constipation can block output

Front 253

steal syndrome

Back 253

avg steals proxymal blood supply

Front 254

cerebral angiogram

Back 254

use femerol artery

Front 255

map less then 50

Back 255

vessels dilate to increase blood flow

Front 256

brain

Back 256

regs csf

Front 257

icp causes

Back 257

emergency- puss,blood, bleed, decrease o2, htn, cva

Front 258

tpa

Back 258

tissue plasminogen activator clot buster

Front 259

rn stroke care

Back 259

1-10 days rest, turn off tv, shut door, 6m-1yr full recovery

Front 260

sz disorder

Back 260

epilepsy is reccurent sz and is on meds

Front 261

sz causes

Back 261

imbalance, drugs, etoh, dehydrated, h2o intox, fevers, idiosycratic, caffine w/hx of sz

Front 262

status epilticus

Back 262

tonic clonic hypoxemia arrythmia acidosis death increased cpk

Front 263

sz stages

Back 263

prodromal
aura
sz ( ictal)
post ictal

Front 264

postictal

Back 264

sommolence assess v/s neuro check mouth

Front 265

sz manifestation

Back 265

rep movment, salivation, tonic clonic movement, resp irreg, snoring, apnea, cyanosis

Front 266

sz dx

Back 266

see it- eeg, mri, ct, cpk

Front 267

tx for patial sz

Back 267

klonopin/depakot/ phenobarb

Front 268

tx for gen sz

Back 268

dilantin/tegratol/topamax/lomictal

Front 269

keppra s/e

Back 269

altered thoughts anxiety weakness

Front 270

sz assesmet

Back 270

subjective/pmh/hos/sur/sz
objective=note time of onset
check mouth abcs continece ns gcs vs w/02 sat

Front 271

sz interventions

Back 271

dont leave, protect injury, insitute sz percautions, pad rails, iv, suction ativan or valiume anti sz med, d50, dont restrain loosed tight clothes

Front 272

dilantin tox

Back 272

flu sx

Front 273

ms chronic progressve

Back 273

or remession with exacerbation

Front 274

fnx lost

Back 274

sx varies weakness, parathesia, neuropathic pain, life expec. 25 yrs, scotomas, urinary issues

Front 275

dx

Back 275

hx csi, evoked responce test, ct mri

Front 276

ms med tx

Back 276

corticosteriod, immunosupressors-interferon. cholenergics-urine retention
urine dribbling- anticholenergics
muscle relaxers

Front 277

increase fiber

Back 277

and PT

Front 278

parkinsons

Back 278

slow progression, slow initiaton and execution of movments men over 50. degeneration of dopamine. caused by genes trauma drugs pscy meds

Front 279

manifestations

Back 279

tremmor, dhuffle gait, bradykenesis, cogwheel rigdity, diff swallow, monotone speech, dysphagia

Front 280

tx

Back 280

sinemnt, eldopa/levadopa= s/e freezing
benadryl and b blockers

Front 281

rn assess

Back 281

trauma, drugs, carbon mon, antipsy, constipation,contence, falls

Front 282

parkinson objective

Back 282

lack of face expressions, monotone, no blink, orthostatic changes, drooling, pillrolling, dementia, cogwheel, bradykenesis, poor posture

Front 283

exopthalmos

Back 283

t3