2Nd Exam In Nursing 2Nd Term

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Encephalitis

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is an acute inflammation of the brain, commonly caused by a viral infection. Sometimes, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like rabies (viral) or syphilis (bacterial). Certain parasitic or protozoal infestations, such as toxoplasmosis, malaria, or primary amoebic meningoencephalitis, can also cause encephalitis in people with compromised immune systems. Brain damage occurs as the inflamed brain pushes against the skull, and can lead to death.

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signs of increased intracranial pressure

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alterted level of consciousness, headache, vomitting, papilledema (back of the retrna swelling), change in V/S, unequal pupils and adnormal response to light, posturing.

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LOC

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level of consciousness, is one of the earliest signs of increased intracranial pressure (IICP), or intracranial pressure (ICP).

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A Grave sign

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A constant headache

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Papilledema

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swelling of the optic nerve is caused by interference with venous drainage from the eyeball and is observed through examination with ophthalmoscope.

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Light response

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Normal pupil resonse to strong light is rapid and constritction; in IICP it is sluggish or nonexistent (fixed).

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Crushing triad

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the pulse increases initially but then decreases, systolic BP rises, and pulse pressure (the difference between the systolic and sialstolic measurement) widens, these three signs are Cushings Triad.

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Cheyne Stokes Respirations

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occur consisting of shallow, rapid breathing followed by a period of apena.

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Diagnostic findings that determine the underlying cause of IICP include:

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skull radiography, computed tomography (CT), magnetic resonance imaging (MRI), lumbar puncture, and cerbral angiography.

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Normal ICP in the ventricles is:

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1 to 15 mm HG, although ICP varies, a rise of 2 mm HG from a previous measurement is cause for concern.

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Medical and surgical measurements:

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Immediate treatment aims at relieving the cause of IICP. Osmotic diurectics such as mannitol (Osmitrol), glycerin (Osmoglyn), or urea (Ureaphil and corticosteroids such as dexamethasone (Decadron) are given to reduce cerbral edema.

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Infectious and Inflammatory disorders of the nervous system:

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There are 4 neurologic conditions that have an infectious or inflammatory cause, (meningitis, encephalitis, Guillian Barre syndrome, and brain abscess).

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TPN

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Total parenteral nutrition.

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Cerebral edema and seizures are treated with?

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Drug therapy, additional treatment includes control of fever, mechanical ventilation, IV fluids and nutritional support.

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Demyleinating disease

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The disease MS, the cause is unknown, so it is considered an autoimmune and charterized as Demylelinating disease becuase it causes permanent degenerationa dn destruction of myelin in the brain and spinal cord.

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Pathophysiology and etilogy of MS

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Many clients experience gradual and continous worsening of symptomes, a few have the disease in a mild form and do not experiance increased severity of sytoms, for some the sytoms subside during the early stages, the client seems healthy for serveral month, sometimes years, however when they symptoms do come back, they come back harder, lasting longer, most people with MS do not die from the disease MS, they die from the complications leading from MS.

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Aura

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sensation that occurs immediately before a seizure

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bradykinesia

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Brady = slow, Kinsia = movement. Slowness in performing spontaneous movements.

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cheyne strokes respirations

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shallow, rapid breathing followed by a period of apnea

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Choreiform Movemements

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Uncontrollable writhing and twisting movements of the body.

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Convolsion

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Manifestation of a seizure, characterized by spasmodic contractions of muscles.

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Dipopia

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Double Vision

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Epilepsy

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Chronic recurrent pattern of seizures

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Neuralgia

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Nerve pain

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Nystagmus

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Involuntary movement of the eyeball

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Ptosis

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Another term for drooping.

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What drugs would be used in treatment of tonic clonic seizures?

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Dilantin and Phenobarbital

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Encephalitis

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When a client presents having a severe headache a few days after being bitten by a mosquito.

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Gullain Barre Syndrome

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acute posinfectious polyneuropathy, polyradiculoneuritis, affects the peripheral nevers and spinal never roots. Most clients begin to recover about 1 month after progression of symptoms ceases. The care would be primarily supportive.

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Amyotrophic lateral sclerosis (ALS)

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also known as lou Gdhrigs disease, is a progressive, fatal neurologic disorder. The disease in more in men than in women.

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Fasciculations

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In ALS patients they experiance muscle weakness, and wasting of arms, legs and trunk. The clients experiances (fasciculations) twitching.

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Trigeminal Neuralgia (Tic Doulouruex)

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Is very painful, this condition affects the 5th cranial (trigeminal) nerve. Which has 3 major branches, mandibular, maxillary, and ophthalmic, this sensory and motor nerve is important to chewing, facial movement, and sensation.

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Bells Palsy

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Involves the 7th cranial nerve, which is reponsible for movement of the facial muscles. Cause is unknown, but a viral link is suspected. Inflammation occurs around the nerve, blocking motor inpulses to facial muscles. Most clients who recover show improvement in a few weeks, those whose paralysis is permanent fail to show improvement after 3 months or more.

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Symptoms of Bells Palsy

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Develop in a few hours or over 1 to 2 days. Facial pain, pain behind the ear, numbness, dimished blink reflex, ptosis of the eyelid, and tearing on the affected side occur. Speaking and chewing become difficult.

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Parkinsons Disease

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Usually begins after 50yrs of age. It primarily affects basal ganglia and connections in the substantia nigra and corpus striatum. The term Parkinsonism describes the cluster of Pakinsons like syptoms that develop from serveral etioligies.

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Pathophysiology and Etiology of Parkinsons

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Parkinsons Disease and Parkinsonism occur from the depletion of the neurotransmitter dopamine in affected areas of the brain. This upsets the balance between dopamine and acetylcholine, resulting in movement disorders.

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Sytoms of Parkinsons Disease

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In most cases no cause is found for dopamine depletion. Syptoms are associated with exposure of enviromental toxins such as insecticides and herbicides and self administration of illegal synthectic form of heroin known as MPTP, and can occur as a sequela of head injuries and encephalitis.

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Tonic Clonic Seizure

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The seizures are divided into two phases, the tonic phase and the clonic phase. In the tonic phase, the person will fall unconscious, and the person's muscles will suddenly tense up, often causing the extremities to either be pulled towards the body or rigidly pushed away from it, which will cause the person to fall to the ground if they are standing. The tonic phase is usually the shortest part of the seizure, usually lasting only a few seconds. The person may also express vocalisations sounding like a loud moan during the tonic stage, though this is not always the case. In the clonic phase, the person's muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the arms and legs to violent shaking or vibrating of the stiffened extremities. The person may roll and stretch as the seizure spreads. The eyes typically roll back, the tongue is often bitten, and incontinence is seen in some cases. Post-ictal sleep invariably follows a tonic-clonic seizure. Confusion and amnesia upon awakening is usually experienced.

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What syptoms should a nurse anticpate during an assessment of a client wih Parkinson Disease?

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A slow shuffling gait, difficulty swallowing, and pill rolling tremor.

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A client is incontent during a seizure and sleeps for several hours afterward, what kind of seizure would this be?

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Tonic Clonic Seizure

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When a client takes Phenytonin Sodium (Dilantant), what hygeine measures are especially important?

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Brushing their teeth. Phenytonin Sodium causes gingiva (Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone and are designed to resist the friction of food passing over them. Healthy gingiva is usually coral pink, but may contain physiologic pigmentation. Changes in color, particularly increased redness, together with edema and an increased tendency to bleed, suggest an inflammation that is possibly due to the accumulation of bacterial plaque).

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ALS clients usually die from?

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Most deaths occur because of respiratory failure.

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The most prominent symptom of Tic Douloureux would be?

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Facial Neuralgia

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What is the difference between Bells Palsy and Tic Douloureux (TD)?

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Bells Palsy disturbs the motor function and TD disturbs the sensory function.

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Neuron

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Nerve cell

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The nervous system has 2 anatomic divisions what are they callled?

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The central nervous system, (CNS) and the Peripheral nervous system (PNS). The basic structure is the nerve cell of (neuron).

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Central Nervous system (CNS)

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Sensory neurons transmit impulses in the CNS.

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Peripheral Nervous System (PNS)

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Motor Neurons transmit impulses PNS. CNS?

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Neurons

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are either sensory or motor impulses.

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Dendrites

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A Neuron is composed of a cell body, a nucleus, and threadlike projections of fibers called denrites.

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Axon

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Nerve fiber that projects and conducts imnpulses away from the cell body. It is therefore called an efferent (away from) nerve fiber.

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Synapses

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Neurons are separate units and not directly connected to one another. Impulses travel along neurons, moving from one neuron to the next by means of synapes, junctions between the axon of one neuron to the dendrite of another.

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Neurotransmitters

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are substances or neurohormones, accomplish transmission of an impulse from one neuron to the next.

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Mylelin

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A fatty substance that covers some axons in the CNS and PNS. Such axons are called mylinated, or white, nerve fibers.

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Neruilemma

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A shealth that covers the mylelin.

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Unmyelinated

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Axons without myelin are called unmyelinated or gray, nerve fibers.

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CNS consists

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of the brain and the spinal cord.

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Brain

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Divided into 3 parts, cerebrum, cerebellum, and the brain stem

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Cerebellum

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a part of the brain that consists of 2 hemispheres connected to the corpus callosum (a band of white fibers that acts as a bridge for transmitting impulses between the left and right hemispheres.

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Hemispheres of the brain

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Each hemisphere has 4 lobes, frontal, temporal, parietal, and occipital.

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Cerebellum of the brain

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located behind and below the cerebrum controls and coordinates muscle movements.

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Brain Stem

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Consists of the midbrain, pons, and medulla oblongata.

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midbrain

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forms the forward part of the brain stem and connects the pons and cerebellum with the 2 cerbral hemisheres.

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Pons of the brain

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is located between the midbrain and the medulla and connects the 2 hemisheres of the cerebulla with the brain stem, spinal cord and cerebrum.

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Medulla Oblongata

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Lies below the pons and transmits motor impulses from the brain to the spinal cord and sensory impulses from peripheral sensory neurons of the brain., the medulla contains vital centers concerned with respiration, heartbeat, and vasomotor activity (the control of smooth muscle activiity in the blood vessel walls).

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Meninges of the brain

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The brain in protected by rigid bones of the skull and covered by 3 membranes of meninges: the Dura Mater, (the tough outermost covering, Arachnoid (or middle membrane lying directly below the Dura, and the Pia Mater, (a delicate layer that ahheres to the brain and the spinal cord).

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Caua Equina

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Is where the spinal cord ends between the first and second lumbar verebrae, where it divides into smaller sections.

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PNS consists of?

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All nerves outside the CNS. There are 12 pairs of cranial nerves: Olfactory nerve, Optic nerve, Oculmotor never, Trochlear nerve (eye movement), Trigeminal nerve (sensory), abducens (eye movement), facial nerve (facial expressions), Vestibulocochlear (or auditory), Glossopharyngeal (taste, swallowing), Vagus nerve (heart rate, muscle of speech), Accessory (or spinal accessory), Hypoglossal nerve (movement of tongue).

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Automatic Nervous System

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consists of the Sympathetic nervous system, and the Parasympathetic nervous system. It has functions essential to survive.

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Sympathetic Nervous System

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Regulates expenditure of energy. The neurotransmitters of this system are known as: catecholamines (epinephrine, norepinephrine, and dopamine.

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Catecholamines

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Stressful situations such as danger, intense emotion, and severe illness result in the release of Catecholamines.

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Acetycholine

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is a neurotransmitter released at the nerve endings of parasympathetic nerve fibers, at some never endings in the sympathetic nervous system and at nerve endings in the skeletal muscles.

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Acetylcholinesterase

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Release of Achylcholine allows passage of a nerve impulse from the nerve fiber to the effector organ or structure, where the enzyme Acetycholinesterase inactivates aceylcholine

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Glasgow Coma Scale

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is a tool for assessing a clients response to stimuli. A score of 10 or less indicates a need for emergency attention: a score of 7 or less is generally interpreted as coma. It consists of 3 parts, eye opening, best verbal response, and best motor response. A normal response for Glasgow Coma Scale is 15, a score of 7 or less is a coma

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concussion

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results to a blow to the head and jars the brain.

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Contusion

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is more serious than a concussion and leads to gross structural injury to the brain, they may result in bruising and hemorrhage.

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Coup injury

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when the head is struck directly the injury to the brain is called coup injury

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contrecoup injury

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this is Dual bruising it is caused from a force strong enough to send the brain riocheting to the opposite side of the skull.

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Cerebral Hematoma

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is Bleeding within the skull which forms expanding lesion.

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Epidural Hematoma

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Stems from arterial bleeding usually from the middle menigeal atery, and blood accumulation above the dura.

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Subdural Hematomas

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results from venous bleeding with blood gradually accumulating in the space below the dura.They are classified as acute, subacute, and chonic according to the rate of neurologic changes.

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Intracerebral Hematoma

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is bleeding within the brain that results from an open or closed head injury or from a cerebravascular condition such as a ruptured cerebral aneurysm.

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Heparin

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highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule.[1] It can also be used to form an inner anticoagulant surface on various experimental and medical devices such as test tubes and renal dialysis machines. Pharmaceutical grade heparin is commonly derived from mucosal tissues of slaughtered meat animals such as porcine intestine or bovine lung