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205 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which meningitis is worse, bacterial or viral?
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bacterial
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What's another name for viral meningitis?
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aseptic mening.
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Since both are CNS inflammation, what's the diff between mening. and encheph.?
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mening. = meninges (surrounding brain/spinal cord);
enceph = brain tissue itself |
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Nursing assessment criteria for bacterial mening.:
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Acknowledged Kernig/Brudzinski signs
Vertigo Ocular palsies Increased temp Diplopia, deafness Brain pain (h/a) Rash Abnormal pupils IICP Nuchal rigidity Photophobia Angled-down eyelid (ptosis) Involuntary jerking (seizures) Numbness of face (paresis) |
"AVOID BRAIN PAIN"
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What do the following set of sym occur b/c of?:
nuchal rigidity, pos Kernig/Brudzinski signs, photophobia |
meningeal irritation
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With bact. mening. what's a specific characteristic of the skin rash?
With what type of bacteria do you expect it? |
petechial hemorrhage,
meningococcal |
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IICP is a late or early sign of bact. mening.?
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late
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What are four symptoms of aseptic mening.?
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h/a,
nuchal rigidity, photophobia, general malaise |
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What are the four NI in order for meningitis?
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1. isolate pt (resp. precaut.)
2. spinal tap 3. C&S 4. admin anti-b |
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What are two potential secondary infections with meningitis?
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pneumonia, and
endocarditis |
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What are two ways to contract bact. enceph.?
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depressed skull fx,
septic penetrating instruments |
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What are two ways to contract viral enceph?
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bite/sting of infected anthropoid,
secondary to viral infection |
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What are three examples of viruses when viral enceph secondary to one of them?
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measles, mumps, herpes
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If client comes in with bact. enceph, what could you look for in their recent history, for example?
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trauma from car accident
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What is one of the main sym to look for if suspecting enceph?
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alteration in neuro function
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If client has suspected equine enceph., what do you ask them about?
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exposure to horses
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absent abdominal reflex,
assoc w/? |
St. Louis enceph
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St. Louis enceph,
assoc w/ what sym? |
absent abdominal reflex
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Rocky Mtn, enceph,
assoic w/ what sym? |
maculopapular rash on wrists and ankles
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maculopapular rash on wrists and ankles,
assoc w/ what enceph? |
Rocky Mtn
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During earliest stage of Lyme disease, what does Lyme test show?
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negative
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Early sym of Lym?
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bull's eye rash, fatigue, h/a, joint pain, swollen glands, low grade fever
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What's the Lyme disease rash called?
How long does it show up after bite? |
erythema migrans,
2 days to 5 weeks |
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Later sym of Lyme's, what are three things that occur with joints?
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joint pain, swelling, knee most commonly affected
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With Lyme's, when two systems can be affected in later stages?
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Cardiac,
CNS |
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With Lyme's, when can Cardiac signs show up?
What are they? |
1-3 weeks,
dizziness, irregular pulse |
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With Lyme's, when can CNS signs show up?
What are they? |
4 weeks,
Poor motor coordination Impaired concentration Nuchal rigidity Kicked ass Irritability Shittiness Headache |
PINKISH
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What drug do you use for adults and kids over 8 with Lyme's?
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doxycycline
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What two drugs could you use for kids under 8 with Lyme's?
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Penicillin,
Erythromycin |
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What's in the PHx of pt w/ Dawson's encephaolitis?
How long ago? What's the prognosis? |
rubeola,
2-10 years, fatal |
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What does the following describe?
acute brain edema secondary to infiltration of the liver, occurring 3 to 7 days after an upper respiratory infection, flu, chicken pox, or measles. |
Reye's syndrome
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What is short definition of Reye's Syndrome?
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acute brain edema secondary to infiltration of the liver
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(a) When did it occur and
(b) what happened prior to pt getting Reye's Syndrome? (x5) (c) What is implicated with its occurrence? |
(a) 3 to 7 days after,
(b) URI, flu, chicken pox, measles; (c) ASA as antipyretic during these infections |
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What's the four steps to the pathophysiology of Reye's Syndrome?
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1. liver dysfunction
2. can't convert protein to urea 3. systemic circulation of ammonia (NH3) 4. interference of cerebral function |
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Who's at risk for Reye's Syn?
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adolescents and younger
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What's the NI for Reye's Syndrome
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Staring into space
Change in behavior Alternating drowsiness & screaming Muscle weakness Protracted vomiting w/o nausea or diarrhea Extreme sensitivity to light, sounds, touch R Increased ICP N Generalized edema |
"SCAMPERING" without the "RN" causes problems (like brain swelling)
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What results of what diagnostic tests may indicate Reye's Synd?
x5 |
Liver:
SGOT ^ SBPT ^ Ammonia ^ Other: BUN ^ Blood Glucose v |
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What is the definition and basic pathophysiology of MYELITIS?
(2 elements) |
spinal cord inflam,
secondary to infection elsewhere |
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What are three sym of myelitis?
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Rapid flaccid paraysis,
loss of urinary & fecal control, w/o back pain |
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Poliomyelitis, how do you get it?
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enters thru oropharynx (droplet) or GI from fecal matter
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What are two general causes of myelitis?
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bacteria and viruses
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What's polio, bact or virus?
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virus
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What's the nsg ass. for polio?
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Pos. Kernig/Brudzinski, progessing paralysis
Onset of cerebellar ataxia (trouble walking) Labored neck (nuchal rigidity) Irritability and drowsiness alternating Ouch! my head hurts (h/a) Malaise w/ weakness Yammering, swallowing, breathing, hiccuping difficult Extra cold (chills) Leg, back, neck ache Infection of resp or GI and subsequent... Temp elevation Inadequate immunizations Seizures, convulsion |
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What disease is a:
viral infection of the posterior post ganglion primarily of spinal nerves |
Herpes Zoster
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Who is at risk for Herpes Zoster (shingles)?
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debilitated adult with previous chicken pox infection
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Herpes Zoster:
what's the Nursing Assessment? |
- painful unilateral vesicular skin eruption along sensory tracts
- muscle weakness in the ares of and distal to blisters - h/a - drowsiness - impaired concentration - facial muscle weakness - eye pain and itchiness - visual disturbances - regional lymph node enlargement - nuchal rigidity if meninges are infiltrated - ophthalmic - v visual acuity, v motor eye movement, corneal scarring |
thought for studying: write all of the symptoms in a list from the entire unit. Maybe group by system. Make an ordinal list with letters (A thru Z for ex). Put that list in the hint column of each disease-symptom question. Just select the appropriate letters and check the answer that way
p.s. could do the same for ND and NI |
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How much time could it take for neurosyphilis present after primary inoculation?
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3 to 18 months
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What are the initial s/s of neurosyphilis? x2
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asymptomatic meningitis
discovered only by CSF exam |
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What's a unique sym of neurosyphilis?
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Argyll Robertson pupils
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Describe Argyll Roberston pupils
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small, irregular, unequal pupils that do not dilate to mydriatics and have v response to light, but normal reaction to accomodation
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If there is a small, irregular pupil that constricts poorly to light, but normally to accommodation, this is...
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an Argyll Roberston pupil
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For Neurosyphilis, what are the two blood tests?
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FTA &
VDRL |
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What's FTA?
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fluorescent treponemal antibody test
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w/ Bell's Palsey, what are the 5 areas of nurse ass.?
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Pain,
Paralysis, Taste, Eating/Drinking difficulty, Psychosocial |
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w/ Bell's Palsey, where does the pain begin?
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behind ear
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w/ Bell's Palsey what are three NDx?
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- Pain r/t nerve damage (VII)
- Potential for injury r/t inability to close eyes - Potential for altered nutrition, < body req r/t inability to chew, sip, taste |
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What can paranasal sinus infection cause?
Where specifically? |
brain abscess,
frontal lobe |
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What are two sources abscess in brain?
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sinus infection,
ear infection |
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What is the most common site of spinal cord abscess?
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thoracic area
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What can ear infection cause?
Where specifically? |
brain abscess,
temporal lobe |
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What can middle ear or mastoid infection cause?
Where specifically? |
brain abscess,
cerebellum |
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What could pt w/ AIDS present with even if they seem physically well?
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AIDS-related dementia
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What are four NDx for client with AIDS?
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1. Potential for infection
2. Alteration in though 3. Self-care deficit 4. Altered nutrition: < body req |
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Client w/ AIDS, potential for infection r/t...?
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immunosuppression
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Client w/ AIDS, alteration in thought r/t . . . ?
x3 |
opportunistic infection of CNS, neoplasms, and med s/e
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Client w/ AIDS, self-care deficit r/t...?
x3 |
impaired mental status, motor/sensory loss, fatigue
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With client w/ AIDS, altered nutrition: < body req r/t...?
x7 |
diarrhea, oral/esophageal lesions, anorexia, vomiting, diarrhea, depression, and med s/e
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Re: client w/ AIDS, potential for infection:
what 2 blood tests to you monitor? |
CBC w/ differential,
T4/T8 count |
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Re: client w/ AIDS, altered nutrition:
what do you assess in clients nutritional status? x4 |
weight, serum proteins, electrolytes, and fatigue
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Re: client w/ AIDS, altered nutrition,
what do you want to check before they try to eat? x3 |
LOC,
ability to chew, gag reflex |
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What is the first sign of Guillain-Barre Syndrome?
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numbness & tingling
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Is Bell's Palsy bilateral or unilateral?
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either
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Is Guillain-Barre symmetrical or unilateral?
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symmetrical
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What is the biggest danger re: Guillain-Barre?
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fatal resp impairment
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What disease has the danger of fatal resp impairment?
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Guillain-Barre
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What disease is described by the following:
rapidly progressing symmetrical ascending flaccid paralysis usu. following viral infection |
Guillain-Barre
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What's the def of Guillain-Barre?
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rapidly progressing symmetrical ascending flaccid paralysis usu. following a viral infection
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With Gullain-Barre, what might you see in the recent medicas hx? x2
What are two specific organisms that are common to see? x2 |
URI, GI flu;
mono or hepatitis |
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Where does the paralysis of Guillain-Barre and what does it head towards?
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feet to intercostals
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What are three potential NDx r/t Guillain-Barre with related conditions?
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1. impaired px mobility r/t progressive paralysis
2. ineffective breathing pattern r/t resp muscle weakness 3. potential for injury r/t autonomic instability |
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Guillain-Barre, what are 3 things to assess r/t impaired px mobility? (other than skin)
x3 |
motor-sensory status,
cranial nerves, for thrombophlebitis |
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Guillain-Barre, how often do you assess neural status (motor-sensory, and cranial nerves)?
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q h
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What do you apply to affected limbs in Guillain-Barre?
How often are they on and off? |
splints,
2 h on 2 h off |
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How often do you check resp rate r/t Guillain-Barre?
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q h
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How fast can paralysis occur r/t Guillain-Barre?
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48 hours
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What's imp to assess for r/t potential for injury in Guillain-Barre?
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autonomic instability
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Guillain-Barre, what do you assess for r/t autonomic instability? x5
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BP change, profuse diaphoresis, cardiac dysrhythmias, facial flushing, v LOC
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What may be in the med hx of client w/ spinal cord abscess?
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boil on back
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What's the follow describe:?
abnormal weakness of voluntary muscles that improve with rest and from anticholinesterase drugs |
Myasthenia Gravis
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If you see someone that has to hold their own head up, what might they have?
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Myasthenia Gravis
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What are five areas of nsg ass r/t MG?
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eye muscles,
facial muscles, neck muscles, respiratory muscles, skeletal muscles |
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Define MG:
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abnormal weakness of voluntary muscles that improve with rest and the admin of anticholinesterase meds
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What are 3 nsg ass r/t eye muscles in MG?
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diplopia,
ptosis, ocular palsy |
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What are 4 nsg ass r/t facial muscles in MG?
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mask-like,
dysphagia, choking, drooling |
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What is a nsg ass r/t neck muscles in MG?
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difficulty keeping head up
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Whare are 3 nsg ass r/t resp muscles in MG?
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SOB,
weak cough, resp failure |
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What are 2 types of crises r/t MG?
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1. myasthenic crisis
2. Cholinergic crisis |
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What's a myasthenic crisis?
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insufficiency of acetylcholine
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What's a cholinergic crisis?
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excess of acetylcholine d/t drug overdose
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What can cause myasthenic crisis?
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stress or
med withdrawal |
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What are 4 common sym of myasthenic and cholinergic crises?
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acute weakness of resp muscles,
generalized muscle weakness, apprehension, restlessness |
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What two things help differentiate myasthenic and cholinergic crises?
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recent hx of med use (part. anticholinesterases),
Tensilon Test |
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What's another name for Tensilon Test?
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Edrophonium Chloride Test
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How do you interpret results of Tensilon Test?
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- if client improves = (+) test = myasthenia crisis
- if sym worsen = (-) test = cholinergic crisis |
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When taking anticholinesterase meds for MG, when do you schedule routine care?
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1 hour after admin
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What's important teaching for client on anticholinesterase meds?
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schedule routine care 1 hour after admin
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What is an important colaborative ass for MG pt.?
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regulating of meds
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anticholinesterase meds,
contraindications: x5 |
hypersensitivity,
intestinal or urogenital obstruction, peritonitis, pregnancy, lactation |
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anticholinesterase meds,
use cautiously in: x8 |
asthma, peptic ulcer, bradycardia, cardiac arrhythmias, coronary occlusion, vagotonia, hyperthyroidism, epilepsy
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anticholinesterase meds,
what do you keep nearby? |
atropine sulfate
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anticholinesterase meds,
what do you do if excessive salivation? |
d/c drug,
contact LIP |
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anticholinesterase meds,
what do you do if emesis? |
d/c drug,
contact LIP |
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anticholinesterase meds,
what do you do if freq urination? |
d/c drug,
contact LIP |
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anticholinesterase meds,
what do you do if diarrhea? |
d/c drug,
contact LIP |
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anticholinesterase meds,
what do you do if excessive sweating? |
v dosage
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anticholinesterase meds,
what do you do if nausea? |
v dosage
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What's the HOB for MG?
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30-45 deg
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With MG, when do you assess motor status?
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1/2 hour before, 1 hour after med admin
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When do you admin anticholinesterase meds?
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1 hour before meal
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MS, what is an emotional symptom?
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labile mood
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With what disease might you Charcot Triad?
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MS
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When unique set of sym might you see in MS?
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Charcot Triad
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Charcot Triad, define:
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dysarthria,
intention tremor, nystagmus |
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What is the combination called:
dysarthria, intention tremor, nystagmus |
Charcot Triad
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How often to you rotate eye patch for:
MG? MS? |
MG = q 1/2 hour
MS = q 2 hour |
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What are 5 NDx of MS?
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1. Activity intolerance
2. Impaired px mobility 3. Impaired vision 4. Impaired communication 5. Impaired urinary elimination |
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What are 3 indications for Plasmapheresis?
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Guillain-Barre,
MS MG |
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With what disease does plasmapheresis produce great results?
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Guillain-Barre
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What are 3 potential complications of plasmapheresis?
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hypokalemia,
hypocalcemia, bleeding (d/t v platelets & clotting factors) |
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What are 5-ish s/s of hypocalcemia?
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numbness,
tingling, twitching, pos Chvostek's and Trousseau's signs, cardiac dysrhythmias |
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Why is hypocalcemia a factor during plasmapheresis?
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Ca binds with acid citrate dextrose,
an anticoagulant use in the tx |
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What are four s/s of hypokalemia?
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leg cramps,
mental confusion, malaise, cardiac dysrhythmias |
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What's the main dx tool for ALS?
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atrophy of precentral gyrus
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What's ALS stand for?
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Amyotrophic Lateral Sclerosis
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What is unique about the motor-sensory system in ALS?
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sensation stays intact,
even though motor function v |
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What's the HOB for client w/ ALS?
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45-90 deg
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What are 3 NDx for ALS?
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1. Impaired verbal communication
2. Impaired swallowing 3. Impaired px mobility |
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With what neuro disease might you teach relaxation techniques?
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ALS
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What 2 things NI address spasticity in ALS?
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- admin muscle relaxants,
- teach relaxation |
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What are 7 classic sym of Parkinson's?
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mask-like face, trunk-forward flexion, muscle weakness/rigidity, shuffling gait, resting tremors, finger pill-rolling, bradykinesia
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What disease presents w/ resting tremors?
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Parkinson's
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What disease do the following sym indicate:?
mask-like face, trunk-forward flexion, muscle weakness/rigidity, shuffling gait, resting tremors, finger pill-rolling, bradykinesia |
Parkinson's
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What's the most significant factor leading to development of CP?
When? Example? |
anoxia;
prenatal, perinatal, postnatal; eg. Premature delivery |
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In CP, What are the two main areas of impairment?
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muscle,
cognitive |
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What's a primary early s/s of CP?
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feeding difficulties
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What's a unique s/s of CP?
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very early unilateral hand use
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What's a reflex abnormality of CP?
3 examples? |
persistent or hyperactive reflexes:
Moro, plantar, palmar |
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In CP, what are two elements of feeding difficulties?
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- persistent gagging or choking when fed
- extrusion w/ tongue (p 6 mo) |
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What's the most common form of muscular dystrophy?
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duchenne
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WHat is the most imp part to remember for pathophys of MD?
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replacement of muscle tissue by connective tissue
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What's the nsg goal r/t MD?
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promote activity and minimize functional deterioration
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Prone to what 4 things with MD r/t muscles?
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muscle tightness,
contractures, atrophy, spinal deformity |
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What's imp with alteration in O2 exchange in MD?
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tx URI
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What are two etiologies of embolism?
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fat from bones, and
plasma protein |
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Complications of cerebral trauma, when do signs appear?
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hours to 3 days later
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Complications of cerebral trauma, what are the 5 general s/s?
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temp ^, tachycardia, pO2 / pCO2 v, serum lipase ^, rash
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Complications of cerebral trauma, what kind of rash appears?
Where? |
petechial rash,
on neck, shoulders, thorax, and eyelids |
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What are 5 s/s of RESPIRATORY FAT EMBOLI?
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cough, chest pain, cyanosis, dyspnea, rales
"DR. CCC" "Dr. Columbia-Greene Community College got a piece of fat in his lung" |
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What are 7 s/s of CEREBRAL FAT EMBOLI?
What about their timing? |
confusion, lethargy, stupor, coma, seizures, aphasia, and hemiplegia
*sym worse 2nd day |
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What is the danger r/t cervical spinal cord injury?
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respiratory distress or failure
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What are the s/s of Horner's syndrome?
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ipsilateral,
ptosis, downward rotation of eye ball, miotic pupil, facial anhidrosis |
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What are the three big risks r/t Spinal Cord Injury, in part. HYPERREFLEXIA?
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resp,
skin, kidney failure |
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6 sym of AUTONOMIC HYPERREFLEXIA?
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pounding h/a,
^ BP, bradycardia, profuse sweating above level of injury, anxiety, visual distrubances |
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NI for autonomic hyperreflexia?
x4 |
remove noxious cause, raise HOB, monitor BP, admin anti-HTN meds
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Spinal Shock, initial s/s? x8
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v BP (sys <80), v P, v RR, skin pink warm dry, v temp, areflexia, flaccid paralysis, loss of skin sensation below lesion
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Spinal Shock, what happens w/in several weeks?
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affected muscles may become spastic
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What's the diff between neurogenic shock and hypovolemic shock?
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neuro: v P, skin warm & dry
hypovolemic: ^ P, cool and clammy |
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What condition do you assume if pt BP v, P v, temp v, areflexia dev?
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spinal shock
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Spinal shock, what happens 24-48 hours after trauma?
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paralytic ileus,
urinary retention |
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Spinal shock, what happens 7-10 days after trauma?
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stress ulcers,
v muscle tone/strength, pulmonary/urinary infections |
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What's it called when only one side of spinal cord damaged?
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Brown-Sequard Syndrome
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In Brown-Sequard Syndrome, describe location of motor loss & sensory loss?
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ipsilateral motor loss,
contralateral sensory loss |
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In Brown-Sequard Syndrome, what kind of sensory loss happens on contralateral side?
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pain and temp loss
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Imitrex - generic name?
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sumatriptan
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Imitrex, what do you teach?
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1. single dose
2. call dr if want 2nd dose |
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Imitrex: life-threatening s/e?
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acute MI, dysrhythmias, myocard ischemia, HTN crisis, prompt death, severe anaphylactic reaction, stroke, brain hemorrhage
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adihdasb
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Levodopa, complications?
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involuntary movements,
on-off phenomenon, wearing-off phenomenon, |
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Who is more prone to involuntary muscle movements when taking Levodopa?
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patients you take high doses over an extended period
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Describe on-off phenomenon
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patient on Levodopa alternates rapidly between mobility and immobility
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Describe wearing-off phenomenon
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pt on Levodopa has sym return before next dose due
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Tysabri, what labs are unique?
Is it reversible? |
WBCs & nucleated RBCs,
increases are reversible and return to baseline w/in 16 wks of last dose |
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Tysabri is for what condition?
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MS
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Tysabri, teach what? x3
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1. report signs of allergic reaction
2. May experience infection or GB stones 3. May experience depression, assess for suicide |
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Copaxone, don't give with what?
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echinacea
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Copaxone, when can the following reactions occur?:
flushing, CP, palpitations, anxiety, dyspnea, laryngeal constriction, urticaria |
immediately post injection
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If MS pt has the following reaction, what do you check in recent PMHx?:
flushing, CP, palpitations, anxiety, dyspnea, laryngeal constriction, urticaria |
use of Copaxone
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What drug (& for what condition) increases the following?:
^ lymphocytes, monocytes, eosinophils, basophils, nucleated RBCs |
Tysabri (for MS)
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What is a GU complication of Copaxone?
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vaginal hemorrhage
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What do you teach with Copaxone?
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1. Rotate sites
2. CP, SOB, flushing, anxiety may occur 3. practice reliable birth control |
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With Copaxone, what's the time after admin for CP, SOB, flushing, anxiety?
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occurs w/in min,
for 30 min |
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With Copaxone, why teach to rotate sites?
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may experience pain, itching, swelling, hardening of skin at injection site
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natalizumab - brand name?
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Tysabri
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Tysabri - generic name?
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natalizumab
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glatiramer - brand name?
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Copaxone
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Copaxone - generic name?
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glatiramer acetate
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mitoxantrone - brand name?
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Novantrone
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Novantrone - generic name?
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mitoxantrone
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What's antineoplastic med used for MS?
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Novantrone
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What's important to assess for with Novantrone?
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cardiotoxicity
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What drug might turn urine and whites of eyes greenish blue?
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Novantrone
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What's a weird s/e of Novantrone?
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may turn pee and eyes greenish blue for 24 hr
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Why drink 2-3 L / day of fluid with Novantrone?
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prevent ^ uric acid levels
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In what category of meds is pyridostigmine bromide?
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anticholinesterase meds
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In what category of meds is Mestinan?
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anticholinesterase meds
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What is the anticholinesterase med Cindy wants us to know?
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pyridostigmine bromide (Mestinan)
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