hello quizlet
Home
Subjects
Expert solutions
Create
Study sets, textbooks, questions
Log in
Sign up
Upgrade to remove ads
Only $35.99/year
2455 - Medsurg3 - Neuro (Exam 2)
Flashcards
Learn
Test
Match
Flashcards
Learn
Test
Match
Terms in this set (77)
Cranial Nerve 1
- Smell
- Assess with soap or coffee
- Head trauma or tumor
Cranial Nerve 2
- Behind the eyes
- Central & Peripheral Vision
- Stroke, Homonymous Hemianopsia, Pituitary tumors
Cranial Nerve 3
- Pupillary restriction
- PERRL
- Raise eyebrows, Eyelid droop
- Stroke, Trauma, Tumor
Cranial Nerve 4
- Cardinal gazes
- Look at nose
- Stroke, Trauma, Tumor
Cranial Nerve 5
- Trigeminal nerve
- Optic, Maxillary, Mandibular branch
- Use dull object to test sensation
- Trigeminal Neuralgia, Tumor, Trauma, Facial pain
Cranial Nerve 6
- Extra Occular movements (sideways)
- Observe for Nystagmus & Twitching
- Stroke, Trauma, Tumor
Cranial Nerve 7
- Facial Movement / Facial drooping
- Smile, blow out candle, wrinkle forehead, check nasal-labial fold, check for symmetry
- Bells palsy, Shingles
Cranial Nerve 8
- Acoustic nerve / Hearing
- Rub fingers together by each ear
- Meniere's
Cranial Nerve 9 & 10
- Swallowing & Gag reflex
- Stick out tongue & say AH
- Stroke, ALS, MS, Gullian barre
Cranial Nerve 11
- Spinal accessory
- Shrug shoulders, check resistance
- Keep stroke pt body in alignment
- ALS, Guillian Barre
Cranial Nerve 12
- Tongue movements
- Ask pt to stick out tongue. It should be midline. Look for problems eating, swallowing or speaking
- Stroke, ALS, MS, Polio
Multiple Sclerosis (MS)
- Myelin Sheath is damaged and can not regenerate causing a inflammatory response
- Autoimmune or Genetic
Multiple Sclerosis - Early Manifestations
- Eye problems: Blurred, Double, Nystagmus, Drooping eyelids
- Stumbling gait
- Trigeminal Neuralgia: Pain in face, prob swallowing
Multiple Sclerosis - Later Manifestations
- Fatigue / stiff muscles
- Muscle spasms / Hyperactive DTR
- Intention tremor, Vertigo
- Hearing loss, slow speech, 1/2 field vision loss
- ↓ Bladder/Bowel, Paresthsia
- ↓ concentration & short term memory
- Depression / Euphoria, Anxiety
MS - Remission Drugs
- Steroid or Immunosupressive therapy
- Methotrexate (Chemo)
- Cyclosporine, T-cell peptides, IVIg
- Mitoxantrone (Novantrone)
- Azathiopirine (Imuran)
- Natalizumab/Tysabri (BRMs)
Mitoxantrone (Novatrone) S/E
- Last resort / End stage
- Dysrhythmias, CHF, Crackles
- 2° Cancers
Natalizumab / Tysabri (BRMs) S/E
- Liver problems
- ↓ CBC
- Cardiovascular effects
MS - ↓ Flair up Drugs
Interferon Beta (BRM):
- Betaseron / Avonex / Rebif
S/E: ↑ BS, Flu like sx,
Glatiramer Acetate:
- Copaxone
S/E: Chest tightness, MI sx
FAST - Stroke
F: Facial drooping (Nasal folds)
A: Arm weakness
S: Slurred speech
T: Time-call 911 asap (3-4hrs)
Stroke - Pathophysiology
- Ischemia in brain tissue = hypoxia/hypogycemia = brain dysfunction (death of neurons)
- Opposite side of hemisphere affected (either motor or sensory)
Thrombolic Stroke
- Ischemic (Occlusive) Clot
- More than 1/2 off strokes
- Associated with atherosclerosis
- Slow onset
Embolic Stroke
- Ischemic (Occlusive) Dislodged Clot
-Emboli travels to cerebral arteries via carotid artery
- Sources of emboli are cardiac (AFib)
- Sudden onset
Hemorrhagic Stroke
- Aneurysm in the brain
- Usually younger pts
- Can be caused by HTN or Cocaine
Stroke Risk Factors
- HTN, DM, Heart Disease, AFib
- Smoking, Substance Abuse
- Obesity, Sedentary lifestyle
- Sleep apnea, ↑ Lipids, ↑ Homocystein
- Hereditary hypercoagulation
Neglect Syndrome
- Treating affected side like it is not there
- Usually with right cerebral hemorrhage
Assessment Findings - Right Cerebral Hemisphere Stroke
- Unaware of deficits
- Impaired proprioception
- Disoriented to time/place
- Impulsivity/poor judgement
Assessment Findings - Left Cerebral Hemisphere Stroke
- Aphasia (Can't speak)
- Alexia (Can't read words)
- Agraphia (Can't write)
- Difficulty with math
- Slow & Cautious
- Quick anger & frustration
Assessment Findings - Temporal Lobe Stroke
- Wernicke's or Sensory (Receptive Aphasia)
- Unable to understand spoken & written words
- Neologisms (learn what made up words mean)
- Use swear words when didn't before
- Memory loss
Assessment Findings - Frontal Lobe Stroke
- Broca's or Motor (Expressive Aphasia)
- Motor speech problems (Point to pictures)
- Understands but unable to communicate
- Difficulty with writing
- Frustration & anger / Personality changes
TIA
- Transient Ischemic Attack (Silent Stroke)
- Last minutes - 24hrs
- Sx resolve in 30-60min / No deficits
- Pt on Plavix after
RIND
- Reversible Ischemic Neurologic Deficit
- Warning sign for stroke
- Lasts 24hrs - 1 week
Homonymous Hemianopsia
- Left side of vision on each eye not there
Meds for Stroke Pt
- Thrombolytic Therapy (3-4hrs)
- Revasculization
- Anticoagulants or Antiplatelets
- Antiseizure meds
- Calcium channel blockers
- Antidepressants / Antianxiety / Analgesics
- Intracranial Pressure Monitoring
Nursing Care for Pt with a Stroke
- Turn Q2hrs, Proper body alignment
- Lay flat or Semi-Fowlers, SCDs
- Get out of bed on unaffected side
- Swallow eval, Speech eval, PT, OT
- Straight cath, Stool softners
- Don't get frustrated
Parkinson's Disease
- Neurodegenerative disease of the midbrain nerves
- ↓ Dopamine
Parkinson's 3 Cardinal Symptoms
- Bradykinesia (Slowing of movement)
- Tremor (Pill rolling)
- Muscle rigidity (Not flexible)
Cogwheel (rhythmic), Plastic (move but resistance), Lead pipe (No movement)
Parkinson's Assessment Findings
- Fatigue, Masklike facial expressions
- ↑ sweating, fixed eyes, drooling
- prob speaking, echolalia
- small handwriting, prob picking up objects
- GI rigidity, prob swallowing
- Easily upset, mood swings, paranoia
Post Encephalitic Parkinsonism
Drug induced Parkinson's or caused by toxins
Anticholinergics - Parkinson's Med
- ↓ Stimulation / Improve balance between excitatory & inhibitory
- Helps rigidity & tremors
S/E: Confusion, Dry mouth, Constipation, Urinary retention
Cogentin / Artane
Antihistamines - Parkinson's Med
- For slight tremors
S/E: ↑ BP & ↑ BS
Benedryl
Dopaminergics - Parkinson's Med
- For marked rigidity & tremors
- Better balance of dopamine & acetocholine
S/E: OH, Dyskinesia, Hallucinations
Levodopa-Carbidopa (Carbidopa blocks conversion of Levodopa)
Dopamine Agonists - Parkinson's Med
- Bind to dopamine & stimulate extra pyramidal tracks
S/E: Nausea, Hypotension, Fatigue
Mirapex, Requip
COMT Inhibitors - Parkinson's Med
- ↑ availability of Levodopa
- Give w/ Dopaminergics
S/E: Vivid dreams, Dyskinesias, Quick liver failure
Entacapone
MAO Inhibitors - Parkinson's Med
- Prevents cell death of substania nigra
- Used in begining
S/E: No Tyramine, No wine, beer, cheese, aged meats, chocolates
Teaching Interventions for Parkinson's Pts
- Speak slow & clear / No buttons
- Lay on stomach w/ head to side
- Soft foods, weighted spoons
- Avoid concentrating on feet when walking
- Use a rocking motion to get up
- Take a drug holiday
ALS - Lou Gehrig's Disease
- ↑ & ↓ motor neuron disease
- Cognitive but frozen
- No cure / Quick time frame
- Usually ↑ extremities 1st
ALS - Lou Gehrig's Disease S/S
- Progressive weakness
- Muscle wasting
- Spasticity then paralysis
- Dysphagia / Nasal quality to speech
- Fatigue while talking, facial twitching
- Eventually lose respiratory control
ALS - Lou Gehrig's Disease Teaching
- Rilutek (Riluzole)- Not cure but extends survival time
- Soft foods pt can swallow / May need tube feedings
- May need BiPAP or mechanical vent
- Pt needs advance directive / Emotional support
Myasthenia Gravis (MG)
- Chronic neuromuscular autoimmune disease
- Weakness in cranial nerves & respiratory
- Can't excite muscles so it can't contract
Myasthenia Gravis (MG) S/S
- Rapid onset of fatigue
- Muscle weakness
- Incomplete eye closure, ↓ extraocular movement
- Droopy eyelid, Double vision
- Prob swallowing / chewing
- Respiratory difficulty
- Weakness of voice
Myasthenia Gravis (MG) Interventions
- Cholinesterase Inhibitors / Anticholinesterases
- Give meds when pt wakes up w/ food
- Respiratory support, Assist ADLs
- Eye protection, Nutritional support
- Communicate when pt at peak level
- Family needs to know CPR
Myasthenia Gravis Crisis
- Exacerbation of sx
- ↑ BP, ↑HR, ↑Resp, Anoxia, Cyanosis
- Incontinence, ↓ UO, Absent cough & swallow reflex
- Pt didn't take meds or dose to ↓
Tx: Give meds
Cholinergic Crisis
- Exacerbation of muscle weakness
- ↓ BP, NVD, Abd cramps, Pallor, Facial twitching, Constricted pupils, Blurred vision
- Pt over medicated, infection, dehydrated (Mestinon / Regonaol / Cold meds)
Tx: Atropine, Enemas, Laxatives
Mixed Crisis
- Apprehension, Restlessness, Dyspnea, Dysphagia, Dysarthria, ↑ tears & saliva, Diaphoresis, Weakness
- Watch Respiratory
- Can happen when trying to fix a crisis
Tx: Explain what's going on, ↓ anxiety, ↑ or ↓ meds see what works
Guillain-Barre Syndrome (GBS)
- Acute inflammatory process
- Affects peripheral nervous system myelin: Can regenerate
- Motor weakness & paralysis
- Hx of Illness, Trauma, Surgery, Vaccines, EBV, ↑ Resp infection, Stomach bacteria (1-3wks prior)
Guillain-Barre Syndrome S/S
- Abrupt muscle weakness & pain
- Know what's going on but can't move
- Ascending or Descending
- Cranial nerves involved
Ascending GBS
- Weakness/Paralysis begins in ↓ extremities and moves ↑
- 50% pts have Respiratory compromise
- Intubate if you see creeping up (O2 won't work)
- Most common
Descending GBS
- Weakness progresses & affects Respiratory Function & ↓
- Visual disturbances, Eye muscle paralysis, DTR ↓
- CN 7,9,10,11
- Can't eat, dysrthymias, ↓HR
- NG Tube, TPN, Intubate
Priorities for GBS pt
- Respiratory function
- Proper body alignment / ROM
- Pain management (Opiates)
- ↓ Anxiety, talk to pt, they will recover
- Manage cardiac dysfunction
- IVIg therapy / Plasmapheresis
- 6mo - 2yrs myelin regenerated
Assessment after Back Surgery
- Neuro checks, VS, Numbness & tingling
- Able to void, Bladder/Bowel control
- Pain Control (PCA 24hr then Oral 24hr)
- Wound care (MD removes 1st dressing)
- Swallowing ability
- CSF check
- Log roll, no bending or twisting, Use assistive devices
Spinal Shock
- Immediately after injury
- Cord is bleeding & compressing
- Flaccid paralysis
- Loss of activity ↓ lesion
- ↓HR, ↓BP, paralytic ileus
What indicates Spinal Shock is Resolving?
- Return of reflex activities
- Lasts few days to several months
Autonomic Dysreflexia
- Injuries ↑ T6, after spinal shock
- Cerebral cortex no longer controls SNS because of blocked impulse transmission (Epinephrine d/c)
- ↑BP, ↓HR, Flushing above lesion, Severe HA, Nasal stuffiness, Sweating, Nausea, Blurred vision
Priority Interventions for Autonomic Dysreflexia
- Sit them upright to ↓ BP
- Give meds (antihypertensives, Catepres)
- Caused by full bladder, BM, pants to tight, wrong position, sitting to long
- Life Threatening
Anterior Cord Syndrome
- Damage to anterior of gray & white matter (Chest down / not arms)
- Motor, pain & temperature sensation lost ↓ injury
- Touch, position & vibration intact
- Small % recover some functional motor control
Posterior Cord Lesion
- Damage to posterior gray & white matter (Waist ↓)
- Motor function intact
- Loss of vibratory sense, crude touch, position sense
Brown-Sequard Syndrome
- Penetrating injury that hemisection of spinal cord or 1/2 spinal cord
- Loss of pain, temp, & light touch on opposite side
- Loss of motor function & vibration, position, & deep touch sensation on same side as cord injury
Central Cord Syndrome
- Lesions of the central portion (waist ↑)
- Loss of motor function is more severe in ↑ extremities than ↓
- Varying degrees & patterns of sensation remain intact
Lumbosacral Injuries
- Damage to Cauda Equina or Conus Medullaris
- Variable pattern of motor or sensory loss
- Peripheral nerves have potential for recovery & regrowth
- Neurogenic bowel & bladder
Assessment findings of Proprioception (Position sense) of the lower extremities
- Move toes ↑ & ↓ & pt identify position of toes, have pt wiggle toes, flex & extend feet & knees & move 1 or both hips
- L2-4: Apply resistance w/ pt lifting legs
- L5: Apply resistance w/ pt dorsiflexing feet
- S1: Apply resistance w/ pt plantar flexing feet
Spinal Cord Injury Meds
- Solu-Medrol: ↓ inflammation, monitor infection, ↑BS, stress ulcers
- Fluids: ↑ blood flow to spinal cord & prevent/tx ↓BP
- Atropine: Tx ↓HR
- Dopamine: ↑BP & HR, helps kidneys
- Baclofen: to relax muscles
Spinal Cord Tumors
- Sxs depend on location
- Pain r/t compression, infiltration of spinal tracts or irrigation of spinal roots
- Assess weakness, spasticity, ↑ DTR, Ataxia, + babinski
- Surgery to remove tumor, decompression, cordectomy
Spinal Cord Injury Complications
C2: Intubated w/ vent
C3-5: ↓ diaphragm control, ↑ risk of arrest
C6-8: Sensory changes in hands & fingers
T7-9: ↑ Abdomen
T10: ↓ Abdomen, Umbilicus
L3-5: Sensation on top of foot & calf
S3: urinary sphincter control, foot drop
Trigeminal Neuralgia
- Chronic irritation of CN5
- Sudden, intense facial pain & spasms
- Unilateral, usually 2nd & 3rd branch
- Bouts of pain for weeks-months then spontaneous remission for days-years
Treatments of Trigeminal Neuralgia - Meds & S/E
Pain management w/
- Antiepileptics: Tegretol & Neurontin Ataxia (NV, dizziness, Fatigue, No ETOH)
- Muscle Relaxants: Baclofen (Dizziness, drowsiness, Confusion, Nausea)
- Lidocaine spray
Treatments of Trigeminal Neuralgia - Surgery & Complications
- Percutaneous stereotactic rhizotomy (puncturing the carotid artery)
- Microvascular decompression (Meningitis, CSF leak, Ataxia, Hearing loss, CN7 damage)
- Both: Facial numbness, weakness, reoccurrence of pain
Bell's Palsy
- Peripheral facial paralysis
- Motor aspects of CN7 (Unilateral)
- Upward movement of eyeball
- Drooping of mouth
- Flattening of nasolabial fold
- Cannot close eye
- Caused by inflammatory process triggered by HSV-1
Sets found in the same folder
NURS 2455 Oncology (Kim)
163 terms
NURS 2455 Neuro Exam 2 (part 1)
63 terms
NURS 2455 Neuro Exam 2 (part 2)
135 terms
NURS 2455 Musculoskeletal Disorders
108 terms
Other sets by this creator
Nutrition ch1
15 terms
NURS 2455 Musculoskeletal Trauma
51 terms
2356 Cardiovascular (julie)
61 terms
2356 Oncology Disorders (julie)
102 terms
Verified questions
earth science
What is the source of oxygen in the epipelagic zone?
chemistry
A sample of HI $\left(9.30 \times 10^{-3} \mathrm{~mol}\right)$ was placed in an empty $2.00 \mathrm{~L}$ container at $1000 \mathrm{~K}$. After equilibrium was reached, the concentration of $I_2$ was $6.29 \times 10^{-4} \mathrm{M}$. Calculate the value of $K_c$ at $1000 \mathrm{~K}$ for the reaction $\mathrm{H}_2(\mathrm{~g})+\mathrm{I}_2(\mathrm{~g}) \rightleftharpoons 2 \mathrm{HI}(\mathrm{g})$.
physics
A satellite is in a $91.5$-min-period circular orbit $350 \mathrm{~km}$ above Earth's surface. Find (b) its centripetal acceleration.
chemistry
Which energy transfer occurs when ice cubes are placed in water that has a temperature of $45^{\circ} \mathrm{C}$? (1) Chemical energy is transferred from the ice to the water. (2) Chemical energy is transferred from the water to the ice. (3) Thermal energy Is transferred from the ice to the water. (4) Thermal energy is transferred from the water to the ice.
Recommended textbook solutions
Pharmacology and the Nursing Process
7th Edition
•
ISBN: 9780323087896
(1 more)
Julie S Snyder, Linda Lilley, Shelly Collins
388 solutions
The Human Body in Health and Disease
7th Edition
•
ISBN: 9780323402118
Gary A. Thibodeau, Kevin T. Patton
1,505 solutions
Clinical Reasoning Cases in Nursing
7th Edition
•
ISBN: 9780323527361
Julie S Snyder, Mariann M Harding
2,512 solutions
Gordis Epidemiology
6th Edition
•
ISBN: 9780323552295
(1 more)
David D Celentano, Moyses Szklo
123 solutions