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COTAC II Exam 5 - Sensory and Neurologic Disorders

Terms in this set (71)

What are symptoms of retinal detachment?
-Flashing lights

-Sensation of shade/curtain coming across vision

-Floatersn
What are symptoms of primary angle-closure glaucoma?
-Sudden severe eye pain

-Red eyes, headache

-NV

-Colored haloes

-Hazy cornea

-Photophobia

-Blurring vision

-Nonreactive pupils
What type of vision loss happens with primary open-angle glaucoma?
Peripheral vision (outer part of the vision is blurry)
What's known as the "Silent thief of sight"
Glaucoma

This happens slowly over time and "steals" the vision.
Type of vision loss with macular degeneration
Central vision
What are the 3 main pharmacologic treatments for Glaucoma?
Timolol
Apraclonidine
Pilocarpine


Remember that a TAP fixes glaucoma!
How does glaucoma damage the optic nerve leading to blindness?
Increases ocular pressure
What is it important to education patients on after ocular surgery?
-Wear sunglasses
-Report symptoms of infection
-Avoid and limit activities that increase IOP
-Don't lie on operated side.
What are activities that increase IOP?
-Bending at the waist

-Sneezing

-Coughing

-Straining

-Lead hyperflexion

-Restrictive clothing

-Sexual Intercourse

-Lifting more than 15 pounds

-Housekeeping activities
Symptoms of cataracts
-Opacity of the leans
-Blurry vision
-Light scattering
-Diplopia
-Colors become dimmer and brown
-"It is like they are looking through a dirty window"
What eye drops will dilating the eyes?
Anticholinergics
What are the 3 main treatments for retinal detachment?
-Scleral buckle
-Vitrectom
-Pneumonic retinopathy
Eye patch use after cataract surgery
Continuous wear for 24 hours, then nightly for one week.
What are the 4 main treatments for acute otitis media?
-Antibiotics

-Analgesics

-Heat

-Decongestants
What are the '3 Triad Symptoms' of Ménière's disease?
-Vertigo
-Tinnitus
-Hearing loss
What are the 6 things for the treatment of Ménière's disease?
-Limit sodium to 1000-1500 mg a day

-Meclizine

-Diuretics

-Tranquilizers

-Antiemetics

-Surgery
What are the 5 Ototoxic medications you need to know about?
-Gentamycin
-Vancomycin
-Erythromycin
-Furosemide (Lasix)
-NSAIDS (ASA)

Remember! -Mycin drugs, Lasix, and NSAIDS!
What are Normal ICP levels?
10-15 mmHg
What's the formula to calculate CPP (cerebral perfusion pressure)?
MAP - ICP = CPP
What's normal CPP range?
70-100 mmHg

Less than 50 the brain will (most likely). suffer from permanent brain damage
What decreases CPP (Cerebral Perfusion Pressure)?
Low MAP or high ICP (Intracranial pressure)
Early manifestations of increased ICP?
Changes in LOC- restlessness, agitation, confusion, increasing drowsiness. Weakness in one extremity or one side. Headache: constant, increasing in intensity, or aggravated by movement or straining
What are late manifestations of increased ICP?
Respiratory and vasomotor changes​
Projectile vomiting​
Fixed dilated pupils (loss of brain stem reflexes)​
Seizures, coma, posturing​
Changes in vital signs​
What are nursing actions that decrease ICP?
-Proper positioning (neutral neck position, no extreme flexion or extension, HOB at 30 to 45 degrees)
-Hyperventilation/mechanical ventilation
-Calm quiet environment
Pharmacological management for increased ICP
Mannitol and phenytoin
Patient positioning after a infratentorial craniotomy
Flat on either side
Patient positioning after a lumbar puncture
Flat strict bedrest
Patient position after a gas bubble is placed to tamponade a retinal break
Prone
Patient positioning after a seizure
Side lying
Common causes of status epilepticus
ETOH withdrawal, abrupt discontinuation of antiepileptics, head injury, cerebral edema, infection, metabolic disturbances
Right-sided hemisphere stroke symptoms
Spatial-perceptual deficits, impulsive behavior, increased distractibility, decreased facial recognition, and altered creative or music perception
Left-sided hemisphere stroke symptoms
Difficulty with language (expressive, receptive or global), impaired logic, slow cautious behavior
What's the treatment for status epilepticus?
IV benzodiazepine followed by IV phenytoin/fosphenytoin
Nursing actions post cerebral angiogram
Assess for bleeding/hematoma, activity restrictions, and increase fluids to flush out contrast
What are contraindications of an MRI?
Metal implants: Pacemaker, orthopedic joints, artificial heart valves, IUD, aneurysm clips
Triggers for seizures for EEG (seizure mapping)
-Sleep Deprivation (fatigue)
-Flashing lights
-Hyperventilation
What are the DONT'S of seizure precautions?
Restrain
Attempt to open the jaw
Insert airway
Use padded tongue blades
What is the GCS scale?
3 to 15

Anything less than 8 you need to intubate!

8 or less = severe head injury (likely a coma)
What are the 3 areas we check with the Glasgow Coma Scale?
-Eye Opening
-Verbal Response
-Motor Response
When you're assessing pupils in a neuro patient, what are you assessing for?
Function of cranial nerve 3

This can be effected due to an elevation in ICP
What is the treatment of choice for an ischemic stroke, if the patient was last seen normal within 4.5 hours
Tissue plasminogen activator (tPA)
Treatment of migraines
NSAIDs, acetaminophen, sumatriptan, ergotamine, beta blockers, botox
What's a contusion?
Brain bruise with a period of unconsciousness associated with stupor or confusion
What is a Diffuse axonal injury (DAI)?
Shearing injury that results in a coma
What's an epidural hematoma?
Arterial bleed- EMERGENCY!
Brief loss of consciousness with return of lucid state; then, will often suddenly reduce LOC
What's the treatment for cataracts?
Surgery
What's a Subdural hematoma?
Venous bleed between the dura and brain. Acute symptoms develop over 24-48 hours. Subacute symptoms develop over 48 hours to 2 weeks. Chronic symptoms develop over weeks to months.
SCI level that impairs ventilation
C3, C4, and C5
What is spinal shock?
Temporary loss of all reflexes and autonomic function below the level of spinal injury
Neurogenic shock
Sudden loss of communication within the sympathetic nervous system . BP and HR decreases.
Autonomic dysreflexia
Stimulation of the sympathetic nervous system and an inadequate compensatory response by the parasympathetic nervous system.
Nursing actions for autonomic dysreflexia
Place client in sitting position immediately​. Notify provider. Determine and treat the cause. Administer antihypertensives.
Meningitis vaccines
-Hemophilus influenzae type b (Hib)

-Pneumococcal polysaccharide vaccine (PPSV)
​
-Meningococcal vaccine (MCV4)​
What are symptoms of meningitis?
-Excruciating, constant headache​

-Nuchal rigidity​ (neck stiffness)

-Altered level of consciousness
​
-Positive Kernig's sign (can't extend the leg when the hips are flexed)

-Positive Brudzinski's sign (raising the neck will raise the knees)
What kind of precautions is someone with Meningitis under?
Droplet
How will CSF analysis appear in bacterial meningitis? What will be decreased in this fluid?
-Cloudy CSF
-Decreased glucose
Multiple sclerosis
A chronic progressive immune-related demyelination disease of the CNS​.
What medications are used to treat Multiple Sclerosis (MS)?
-Interferons beta-1a and beta-1b​
-corticosteroids
-antispasmodics
-anticonvulsants
-anticholinergic
What will a Tensilon test cause?
Will cause a temporary improvement of muscle weakness in a client with Myasthenia Gravis
What is Gullain-Barre syndrome?
Autoimmune disorder with acute attack of peripheral nerve myelin.
What is nursing care for Guillain-Barre Syndrome?
-Assist with intubation
-Mechanical ventilation
-Continuous monitoring
-DVT prophylaxis
-Prevent pressure ulcers
-Nutritional support.
What are parts of medical / nursing management for a patient with Bell's Palsy?
-Corticosteroid therapy
-Eye care
-Facial exercises
-Facial Massage
Parkinson's disease is a result of decreased levels of ____________.
Decreased levels of dopamine which allows acetylcholine to dominate​.

Remember! There's NO DOPE in the PARK
What are the "4 primary symptoms" of Parkinson's Disease?
-Tremor​ "pill rolling" (at rest)

-Muscle rigidity (mask like appearance from losing facial expressions)
​
-Bradykinesia​ (slow movements, and slow to initiate movements)

-Postural instability (they'll start to lean forward, start shuffling, and become a huge fall risk)
What's the action of Levodopa/carbidopa?
Carbidopa protects levodopa from being metabolized before it reaches the brain​.
What are signs + symptoms of Levodopa/carbidopa toxicity?
-Muscle twitching​
-Facial grimacing​
-Spasmodic eye winking
What are the differences between Guillain-Barre and Multiple Sclerosis?
Guillain-Barre - PNS
Multiple Sclerosis - CNS

Remember:
Guillain-BARAWAY WILL GO AWAY but Multiple Sclerosis is here to stay
What can damage to the cranial nerve 3 cause?
-Diplopia (Double Vision)
-Pupil Mydriasis (Dilated pupils)
-Upper Eyelid Ptosis (drooping eyes)

The 3rd cranial nerve is an oculomotor nerve
What are immobilized patients at risk of?
-Skin breakdown (We move patients EVERY 2 HOURS)
How often do we move patients in wheelchairs to prevent skin breakdown?
EVERY HOUR (NOT EVERY 2 HOURS LIKE WITH EVERYTHING ELSE)
What is autonomic dysreflexia?
a life-threatening emergency in spinal cord injury patients that causes a hypertensive emergency; it occurs AFTER spinal shock has resolved; the symptoms are severe headache, diaphoresis, nausea, nasal congestion, and bradycardia.

Resulting blood pressure is DANGEROUSLY HIGH that can lead to a HEMMORHAGIC STROKE

SIT THE PATIENT UP AND REMOVE STIMULUS (TOP 3 - FULL BLADDER, CONSTIPATION, TIGHT CLOTHING AND ANYTHING ELSE UNCOMFORTABLE)
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