Term
| Normal pH, pCO2, pO2, HCO3 |
|
Definition
pH 7.25-7.35
pCO2 35-45
pO2 75-100
HCO3 24-28 |
|
|
Term
| This condition is highly contagious through aerosol or direct contact and is characterized by nasal swelling, redness, congestion, sneezing and cough. It lasts 1-2 wks. |
|
Definition
|
|
Term
| Type of rhinitis that is seasonal |
|
Definition
|
|
Term
| Rx Rhinitis (mild sympathomimetics alpha1-adrenergic stimulators) |
|
Definition
| pseudoephedrine, oxymetazoline (spray) |
|
|
Term
| Side effects (local and systemic) of pseudoephedrine. |
|
Definition
Local - rebound vasodilation after 3 days of usage
Systemic - HTN, CNS stimulant, vasoconstriction |
|
|
Term
| Non-sedating anti-histamines Rxd for rhinitis |
|
Definition
| fexofenadine, Calritin, Zyrtec |
|
|
Term
| Sedating anti-histamine for rhinitis |
|
Definition
|
|
Term
Glucocorticoid nasal sprays Rxd for rhinitis
What other drugs can you use for symptom relief? |
|
Definition
Fluticasone
Mometasone
Can also use throat lozenges or NSAIDs for symptomatic relief. |
|
|
Term
| As pO2 decreases, ____ increases. |
|
Definition
|
|
Term
| How often do Type A flu pandemics occur? |
|
Definition
|
|
Term
| This type of flu is mild endemic. |
|
Definition
|
|
Term
| This illness is characterized by abrupt chills & fever, HA, malaise, muscle ache, clear nasal discharge, dry cough and sore throat |
|
Definition
|
|
Term
| How effective is flu vaccine as prevention? |
|
Definition
|
|
Term
| Name two risks associated with getting vaccinations |
|
Definition
Anaphylaxis
Guillian-Barre syndrome |
|
|
Term
| What question should you ask people prior to vaccination regarding allergies? |
|
Definition
| Are you allergic to eggs? |
|
|
Term
| If exposed and unvaccinated to the flu what should you get within 48 hours? |
|
Definition
| Symmetrel or Flumadine + vaccine |
|
|
Term
| These drugs decrease duration and intensity of the flu |
|
Definition
| zanamivir, oseltamivir (Tamiflu) |
|
|
Term
| Antitussive used to treat flu |
|
Definition
|
|
Term
| This is r/t obstruction of sinus drainage and increased bacteria. If you have a cold for >3-4 wks it could be this condition. It manifests as pain, HA, fever and malaise. |
|
Definition
|
|
Term
| Polyps, deviated septum, rhinitis, tooth abscess and trauma can all be causes of what? |
|
Definition
|
|
Term
|
Definition
| Abx if infection, decongestant nasal sprays (eg phenylephrine), anti-histamines |
|
|
Term
| Name 3 types of sinus surgery done for sinusitis. |
|
Definition
Irrigation
Endoscopic obstruction removal
Caldwell-Luc for maxillary sinus (2nd opening into lateral nasal wall) |
|
|
Term
| Post-op Caldwell-Luc care |
|
Definition
Packing 24-48 hrs
Liquids x 24 hrs
No coughing or nose blowing |
|
|
Term
| Methods to treat pain in patients with sinusitis (3) |
|
Definition
Ice packs
Inc. HOB
Mild analgesics |
|
|
Term
| Diet post-Caldwell-Luc surgery |
|
Definition
Clear diet -> Solids as tolerated
Liquid supplements PRN |
|
|
Term
| These conditions are contagious for 2-3 days and have symptoms for 3-10 days. |
|
Definition
| Pharyngitis & Tonsillitis (Acute or Viral) |
|
|
Term
| Sore throat, fever, dysphagia, malaise and swollen lymph nodes characterize ______ pharyngitis. |
|
Definition
|
|
Term
| Low fever, sore throat, mild hoarseness, HA and rhinorrhea characterize ________ pharyngitis. |
|
Definition
|
|
Term
| This condition has the same symptoms as acute/viral pharyngitis but with pain to the ears. |
|
Definition
|
|
Term
| Complications of strep throat (2) |
|
Definition
Acute glomerulonephritis
Rheumatic fever |
|
|
Term
| Labs drawn for pharyngitis or tonsillitis |
|
Definition
|
|
Term
| Meds given for pharyngitis or tonsillitis |
|
Definition
| Antipyretics, mild analgesics |
|
|
Term
| Surgeries for severe tonsillitis or pharyngitis |
|
Definition
| Tonsillectomy, I&D abscess (incision and drainage) |
|
|
Term
| How long post-op must an airway be kept in? |
|
Definition
| Until gag & swallowing reflexes return. |
|
|
Term
| Home palliation for post-op tonsillectomy |
|
Definition
| Soft diet, saline gargles, fluids, ice collar PRN |
|
|
Term
| Picking nose, trauma, dry mucosa, infection, substance abuse, arteriosclerosis, HTN, decreased platelets, liver disease and anti-coagulants can all be causes of this. |
|
Definition
|
|
Term
| Preliminary measures for epistaxis |
|
Definition
| ID source & stop bleeding |
|
|
Term
| Rx epistaxis (topical vasoconstrictors) |
|
Definition
| neo-synephrine, epinephrine, prophylactic Abx. |
|
|
Term
| Nasal packing time frames for anterior and posterior epistaxis. |
|
Definition
Anterior - 24-72 hrs
Posterior - 2-5 days |
|
|
Term
| Respiratory complications, nasal & ear infections and toxic shock syndrome can be complications of what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 4 steps to decrease the anxiety of someone with epistaxis |
|
Definition
Be calm
Pinch nares
Breathe slowly orally
Have emesis basin. |
|
|
Term
| 2 steps to decrease aspiration risk in patient with epistaxis. |
|
Definition
Upright, forward sitting
Ice compresses |
|
|
Term
| A patient with a severe nosebleed states, "I'm just swallowing the blood, I don't want to get it everywhere." What is your response? |
|
Definition
| Spit it out. Blood irritates the stomach and can cause you to throw up and increase your risk for aspiration. |
|
|
Term
| Absence of airflow through upper airways for >10 s. |
|
Definition
| Sleep apnea/Hypopnea Syndrom (SAHS) |
|
|
Term
| Who does SAHS affect most (name 4 factors)? |
|
Definition
Men > Women
Obese
Inc. Age
Large neck circumference |
|
|
Term
| Obese people with SAHS have __________ syndrome. |
|
Definition
|
|
Term
| Obese people with SAHS have __________ syndrome. |
|
Definition
|
|
Term
| Name 3 contributing factors to sleep apnea |
|
Definition
Increased tonsil size
ETOH use
Sedatives |
|
|
Term
| Why do ETOH and sedative use contribute to sleep apnea? |
|
Definition
| When your body is sedated you have a decreased response to discomfort. Your tongue can become "lazy" and block your airway. |
|
|
Term
| Why does Pickwickian syndrome cause sleep apnea? |
|
Definition
| Weight of torso/abdomen can bear down on the diaphragm and stop diaphragmatic expansion |
|
|
Term
| Dysrhythmias, fragmented sleep, HTN, morning HA, impotence and decreased ventilatory drive are complications of what? |
|
Definition
| SAHS (Sleep apnea/Hypopnea syndrome) |
|
|
Term
| Name 4 diagnostic tests done at a sleep lab when sleep apnea is suspected. |
|
Definition
EEG (electroencephalogram) for sleep stages.
EKG (dysrhythmias)
Airflow monitoring under nares
Continous pulse ox & pulse |
|
|
Term
| Lifestyle changes to manage SAHS |
|
Definition
Wt. loss
No ETOH (esp HS)
No sleeping supine |
|
|
Term
| Machine that continuously flows air into the lungs during sleep, for home use. |
|
Definition
| CPAP (Continuous Positive Airway Pressure) |
|
|
Term
| Machine that pushes air in and forces expansion used only in hospital. |
|
Definition
|
|
Term
| Two surgical managements of SAHS. |
|
Definition
T&A (tonsils & adenectomy)
(UPPP) Uvulopalatopharyngoplasty |
|
|
Term
1-3% of all cancers 60-70 year olds. Risk factors: ETOH and smoking.
Precursors: Leukoplakia & erythroplakia (don't come off)
Early Sxs: Painful swallowing, voice change, sore throat, lump feeling. |
|
Definition
|
|
Term
| Name 4 late symptoms of Laryngeal carcinoma. |
|
Definition
| SOB, foul breath, palpable lump & nodes, pain radiating to ear |
|
|
Term
| First choice treatment for early Laryngeal CA. What does it use? |
|
Definition
| Radiation (iridium seeds) |
|
|
Term
| What is surgery for laryngeal CA based on? |
|
Definition
|
|
Term
| Surgical tx for laryngeal cancer can range from cordotomy to partial to total laryngectomy with ________ (speech lost) or a radical ______ dissection. |
|
Definition
|
|
Term
| Chemotherapy is used in tx for laryngeal CA as an ________ only. |
|
Definition
|
|
Term
| When is the best time to seek Speech Therapy consult for a patient with Laryngeal cancer with a surgical treatment plan? |
|
Definition
| Before surgery. Get them used to using the equipment while they can still communicate the way they are used to. |
|
|
Term
| Three methods for vocal communication after permanent tracheostomy is done on a patient with laryngeal cancer. |
|
Definition
Esophageal speech (burp/talk, very hard to do and very rare)
TracheoEsophageal Puncture (TEP) (implanted)
Speech generators |
|
|
Term
| Where are speech generators held (2)? Name an example of a speech generator |
|
Definition
Against cheek or throat.
Copper-Rand electronic speech aid. |
|
|
Term
| Which surgical treatment of laryngeal cancer has a risk for aspiration? |
|
Definition
|
|
Term
| What is the priority nursing diagnosis for all patients undergoing surgical treatment for laryngeal cancer? |
|
Definition
| Altered nutrition: Less than body requirements r/t dysphagia |
|
|
Term
| Food experimentation, supplements, dietician consult, tube feeding PRN, swallowing exercises (ST/PT), mouth care and topical anesthetics are all strategies for what? |
|
Definition
| Increasing nutritional intake of patients who have undergone surgical treatment for laryngeal cancer |
|
|
Term
| Why can't most patients who have been surgically treated for laryngeal cancer aspirate? |
|
Definition
| There is no connection between their oral cavity and their trachea. |
|
|
Term
| In order to care for a stoma at home you should ______ the stoma, use a humidifier, increase ________ and avoid _____ sports. |
|
Definition
|
|
Term
| Aerosol spray and showers are a hazard for people with stomas because they can cause them to ______. |
|
Definition
|
|
Term
| The most susceptible population to this condition are smokers and those with impaired defense mechanisms. It typically follows upper respiratory infection. |
|
Definition
|
|
Term
| _____ bronchitis is a component to COPD. |
|
Definition
|
|
Term
| ______ bronchitis is common in adults. |
|
Definition
|
|
Term
| Name two early symptoms of bronchitis. |
|
Definition
| Mucosal irritation, non-productive cough |
|
|
Term
| Productive cough, chest pain, malaise and fever are characteristic of what? |
|
Definition
| Later symptoms of bronchitis |
|
|
Term
| How do providers R/O pneumonia in a client with suspected bronchitis? |
|
Definition
|
|
Term
| Rx bronchitis (3 classes) |
|
Definition
| antipyretics, antibiotics, expectorants |
|
|
Term
| What should patients with bronchitis absolutely avoid? |
|
Definition
|
|
Term
| Inflammation of the lung parenchyma (bronchioles & alveoli) |
|
Definition
|
|
Term
| Noninfectious causes of pneumonia include what? |
|
Definition
|
|
Term
| Pneumonia accounts for ____% of all hospital admissions and is the ____ leading cause of death in the US. |
|
Definition
|
|
Term
Pneumonia process:
Inflammation -> antibodies & endotoxins damage _________ -> edema & exudate fill ________ -> decrease ____ exchange -> consolidation. |
|
Definition
|
|
Term
| How is non-infectious pneumonia resolved? |
|
Definition
| WBC phagocytosis of debris. |
|
|
Term
| 70-75% of acute bacterial pneumonia is caused by _____ (__________) |
|
Definition
|
|
Term
Sx of acute bacterial pneumonia:
_______ onset,
Chest pain,
Fever (high 101-102) & chills
Cough
______ or _______ sputum,
Hypoxemia & cyanosis. |
|
Definition
| Sudden; Rusty or purulent |
|
|
Term
| A characteristic of acute bacterial pneumonia seen on CXR is what? |
|
Definition
| Consolidation : lobar (usually in 1 lobe) |
|
|
Term
| Pleuritis, empyema, lung abcess, pleural effusion and septicemia are potential complications of _________. |
|
Definition
| Acute Bacterial Pneumonia |
|
|
Term
| This disease is caused by weak gram- bacteria found in standing water. People get very sick. It has up to 31% mortality rate and 80% if immunocompromised. |
|
Definition
|
|
Term
| This is what is seen on CXR in a Legionnaire's patient. |
|
Definition
|
|
Term
| This illness is seen in kids and young adults, is contagious, has a severe, non-productive cough, low fever, crackles, clear CXR and normal WBCs |
|
Definition
| Mycoplama pneumoniae bacteria "Walking Pneumonia" Primary atypical pneumonia |
|
|
Term
| Influenza, adenovirus and cytomegalovirus (in immunocompromised) are common causes of ____ ________. |
|
Definition
|
|
Term
| Viral pneumonia is often mild, a "walking pneumonia". It is characterized by a low grade fever, croupy cough, malaise, ________ and ______/______ sputum. |
|
Definition
| arthralgias (joint pain); yellow/green |
|
|
Term
| THis disease is caused by a fungus and is usually the first sign of AIDS/Immunosuppression. |
|
Definition
| Pneumocytis carinii Pneumonia (PCP) (P Jiroveci new name) |
|
|
Term
| IN PCP pneumonia the sputum is _____ and _______. |
|
Definition
|
|
Term
| S/sx of PCP include dry cough, ___ RR, sudden fever and a unique CXR. |
|
Definition
|
|
Term
| This type of pneumonia is caused by chemicals and bacteria from gut. |
|
Definition
| Aspiration pneumonia (gastric aspiration) |
|
|
Term
| Why are patients NPO for at least 6-8 hrs prior to surgery? |
|
Definition
| High risk of aspiration & aspiration pneumonia with anesthesia; |
|
|
Term
| High risk persons and people 65 years of age can get the _______ vaccine which provides lifetime immunity. |
|
Definition
|
|
Term
| What should be obtained prior to the first antibiotic given for pneumonia? |
|
Definition
|
|
Term
| Common WBC range for pneumonia |
|
Definition
|
|
Term
| _______ is the most commonly prescribed antibiotic for pneumonia. |
|
Definition
|
|
Term
| Bronchodilators including _______ and _______ and Expectorants including _________ are given to patients with pneumonia. |
|
Definition
| Proventil/Theophylline; guaifenesin |
|
|
Term
| Desired O2 sat for someone with pneumonia |
|
Definition
| >95% not ever less than 90% |
|
|
Term
| How can you give a patient 100% O2? |
|
Definition
|
|
Term
| Room air is ____% O2 with ___% increase for every liter per NC. |
|
Definition
|
|
Term
| RNS can perform these actions to decrease lung sectretions. |
|
Definition
| Chest physiothearpy, C&DB, IS, fluids, Inc. HOB |
|
|
Term
| localized area of lung destruction or necrosis & pus formation. Usually seen about 2 wks after aspiration pneumonia. |
|
Definition
|
|
Term
| Lung abscess patients have the same symptoms of pneumonia but with ____ fevers and greater complicaitons of septicemia and ARDS. |
|
Definition
|
|
Term
| CXR, bronchoscopy or thoracotomy are used to ______ lung abscess. |
|
Definition
|
|
Term
| Treatment for lung abscess patients can include what? |
|
Definition
Abx
I&D abscess via bronchoscopy
Chest tube if in pleural space |
|
|
Term
| This disease's risk factors include HIV, homelessness, poverty, immigration and multi-drug resistance. It is spread by droplets and can be suspended for hours. Overcrowding increases incidence. |
|
Definition
|
|
Term
| What does TB do in the lungs? |
|
Definition
| Gets walled off but can come back with immune suppression. |
|
|
Term
| If TB is progressive it spreads via the ______. |
|
Definition
|
|
Term
| The classic signs of TB are what? |
|
Definition
|
|
Term
| If a TB patient is hospitalized they are kept on _______ isolation. |
|
Definition
|
|
Term
| What does non-compliance with TB meds cause? |
|
Definition
|
|
Term
TB tests
_______ mm =negative
______-______ mm = if Hx or Risk factors
____ mm = always positive. |
|
Definition
|
|
Term
Inflamed pleura > nerves irritated -> Usually secondary to other disorger eg viral resp. infection, pneumonia or rib injury.
Sx include:
Abrupt onset,
Unilateral, localized pain c movement
Shallow, rapid breaths
Pleural friction rub |
|
Definition
|
|
Term
|
Definition
| Analgesics & NSAIDS, codeine |
|
|
Term
|
Definition
| Positioning & splinting c cough; elastic bandage wrapping |
|
|
Term
| Collection of excess fluid in pleural space that causes lung to collapse from outside of thelungs |
|
Definition
|
|
Term
Pus PE
Blood PE
Boold & Serum PE |
|
Definition
Empyema;
Hemothorax;
Hemorrhagic |
|
|
Term
| Sx of pleural effusions depend on amount of _____. |
|
Definition
|
|
Term
| Common Sx of Pleural effusion are: |
|
Definition
| Dyspnea, decreased or no breath sounds |
|
|
Term
|
Definition
| Thoracentesis c fluid analysis |
|
|
Term
| Reoccurence of pleural effusion Tx |
|
Definition
| Chest tube; irritant instillation |
|
|
Term
| Tx Malignant pleural effusion |
|
Definition
| Pleurex catheter & drainage system |
|
|
Term
| Leading cause of cancer deaths; most patients die within one year of diagnosis. |
|
Definition
|
|
Term
| 80% of lung cancer is caused by _________. |
|
Definition
|
|
Term
| Carcinoma from airway epithelium damage |
|
Definition
|
|
Term
| 25% of lung cancers with rapid growth & spread. Hormonally active (ACTH, ADH) Low Na+ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Lung cancer with early metastasis and is aggressive |
|
Definition
|
|
Term
| Locally invasive lung cancer |
|
Definition
|
|
Term
| Early metastasis lung cancer |
|
Definition
|
|
Term
| Common manifestations of lung cancer (3) |
|
Definition
| Chronic cough, hemoptysis, SOB (may be none) |
|
|
Term
| What symptoms do patients with lung cancer experience as it spreads? |
|
Definition
Dull, aching chest pain
Pleuritis pain
Hoarseness, dysphagia
Pleural effusions |
|
|
Term
| This syndrome is an endocrine syndrome characterized by hypercalcemia, hyperphosphatemia, Cushings syndrome and SIADH and is seen in patient's with lung cancer. |
|
Definition
|
|
Term
| This syndrome is seen in people with lung cancer as a complication. It is back up flow that leads to edema in the arm. |
|
Definition
| Superior vena cava syndrome |
|
|
Term
| What is the most common cause of brain cancer? |
|
Definition
|
|
Term
| What is common sputum color post-bronchoscopy? |
|
Definition
|
|
Term
| Chemotherapy can be done for _____ lung cancer and has ___% chance of remission if done early. |
|
Definition
|
|
Term
| What is the best treatment for NSCLCA (squamous)? |
|
Definition
|
|
Term
| _____ is the only chance of cure for patients with NSCLCA and 30% live for >5 years with this. |
|
Definition
|
|
Term
| ___% of patient's with lung cancer have ______ at diagnosis. |
|
Definition
|
|
Term
| Chronic inflammation of airways c recurrent episodes of wheezing, SOB, chest tightness & coughing. |
|
Definition
| Reactive Airways Disease "RAD" Asthma |
|
|
Term
| Bronchial muscles contract and lead to wheezing. |
|
Definition
|
|
Term
| _________ of the bronchiole lining and ________ of airways are characteristic of asthma. |
|
Definition
| Inflammation; Hyper-reactivity |
|
|
Term
| If the patient hyperventilates they will become ______. If they have an airway obstruction they will become _______. |
|
Definition
|
|
Term
| Intercostal retractions and accessory muscle use are seen during what? |
|
Definition
|
|
Term
| Severe bronchospasm and swelling unresponsive to initial Tx. LIFE THREATENING! |
|
Definition
|
|
Term
| How can asthma attacks be prevented? |
|
Definition
| Take Rx'd medication; avoid triggers |
|
|
Term
| This is a home monitoring system for asthma attacks that allows for adjustable medication doses based on severity. |
|
Definition
|
|
Term
| This drug for asthma has a high toxicity potential. Must check blood levels often. |
|
Definition
|
|
Term
| This class of drugs blocks parasympthatic NS to decrease bronchoconstriciton. |
|
Definition
| Anticholinergic (ipratropium, atropine) |
|
|
Term
| This class of medications for asthma has a risk of thrush (need good oral care) |
|
Definition
| Corticosteroids eg. prednisone, beclamethasone |
|
|
Term
| This drug class decreases hyper-reactivity in asthma. |
|
Definition
| NSAIDS (cromolyn, nedocromil) |
|
|
Term
| These are the newest drugs for asthma and decrease inflammation, mucus production and bronchoconstriction |
|
Definition
| Leukotriene modifiers (zafirlukast, zileuton) |
|
|
Term
| Which asthma medications are for acute attacks? |
|
Definition
| B agonists, IV corticosteroids, IV aminophylline, Whicanticholinergic drugs |
|
|
Term
| Which drugs are long-term maintenance asthma medications? |
|
Definition
| PO methylxanthines, po Corticosteroids, NSAIDs and leukotriene modifiers |
|
|
Term
| What tool makes MDIs more effective? |
|
Definition
|
|
Term
| What type of breathing can asthma patients use if they have an obstruction? |
|
Definition
| Pursed-lip breathing (PLB), abdominal breathing |
|
|
Term
| Chronic air flow obstruction |
|
Definition
| Chronic Obstructive Pulmonary Disease (COPD) |
|
|
Term
| Which two diseases are characterized as COPD? |
|
Definition
| Chronic bronchitis and/or emphysema |
|
|
Term
| Copious sputum & productive cough >3 months in 2 years. |
|
Definition
|
|
Term
| Primary cause of chronic bronchitis is ______. |
|
Definition
|
|
Term
| Chronic bronchitis is after age ___ and emphysema is after age ____. |
|
Definition
|
|
Term
| Loss of elastin in alveoli= wall destruction. Exhaling is work. Air trapping. |
|
Definition
|
|
Term
| What contributes to emphysema? |
|
Definition
| Loss of ciliary action -> increase debris -> increase layer of fibrous tissues and decrease gas exchange |
|
|
Term
| This type of COPD has exacerbations. |
|
Definition
|
|
Term
| This type of COPD is permanent. |
|
Definition
|
|
Term
| Barrel-chest, wt. loss, muscle wasting, hypoxia and severe SOB are symptoms of what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What does increased CO2 retention lead to? |
|
Definition
|
|
Term
| In early emphysema patients are _____. In late emphysema they are _______. |
|
Definition
|
|
Term
| What classes of drugs given to asthma patients are also given to COPD patients? |
|
Definition
| B2 agonists, corticosteroids, anti-cholinergics, methylxanthines |
|
|
Term
| What classes of drugs are given to COPDers but not asthma patients? |
|
Definition
| Muscarinic antagonists (Alupent), Abx if purulent sputum & dyspnea, O2 |
|
|
Term
| Giving a COPD patient too much _____ can kill them because their respiratory drive is no longer based on CO2 because of the chronically increased levels. |
|
Definition
|
|
Term
| What meds are COPD patients not allowed to have? |
|
Definition
| Cough suppressants & sedatives (decrease respiratory drive) |
|
|
Term
| What are two surgeries done for COPDers? |
|
Definition
| Lung reduction surgery; lung transplant |
|
|
Term
| Condition of partial or total lung collapse & airlessness. |
|
Definition
|
|
Term
| What are symptoms of atelectasis? |
|
Definition
| &Decreased breath sounds, Inc. HR RR, cyanosis, decreased chest excursion, fever (if infection) |
|
|
Term
| This is used for prevention and treatment of atelectasis |
|
Definition
|
|
Term
| This procedure is done to remove plug in atelectasis |
|
Definition
|
|
Term
| Your patient has left-sided atelectasis - what side do you place him on? |
|
Definition
| Right side - put affected lung superior |
|
|
Term
| This occupational lung disease is a malignant mesothelioma (incurable) |
|
Definition
|
|
Term
| Miners, sandblasters and granite cutters get this nodular pulmonary fibrosis. |
|
Definition
|
|
Term
| This type of lung disease destroys pulmonary vascular bed & airway. |
|
Definition
| Coal Worker's Pneumoconiosis "Black lung disease" 12% miner's get it. |
|
|
Term
| Farmers and bird-fanciers get this occupational lung disease caused by allergic response. |
|
Definition
| Hypersensitivity Pneumonitis |
|
|
Term
| Sudden occlusion of a pulmonary artery. Common cause: clot from R <3; (Less common: DVTs, tumors, trauma, amniotic fluid, IV air or precipitate, fat emboli) |
|
Definition
|
|
Term
| What increases the risk for getting a pulmonary embolism by 5x? |
|
Definition
|
|
Term
| What are Pulmonary embolisms commonly mistaken for? |
|
Definition
|
|
Term
| What is the major complication of pulmonary embolism? |
|
Definition
| Pulmonary infarction (death in 10% of patients) |
|
|
Term
| 90% of people that die from pulmonary embolisms die within _____ hrs |
|
Definition
|
|
Term
| Abprupt dyspnea & CP, anxiety, cough, inc. HR RR, crackles and low grade fever are common symptoms of what? |
|
Definition
|
|
Term
| How is pulmonary hypertension measured? |
|
Definition
|
|
Term
| You suspect your patient has a pulmonary embolism. What do you do? |
|
Definition
| Give O2 and analgesics, call provider, get transferred to ICU |
|
|
Term
| This test shows clot degradation |
|
Definition
|
|
Term
| Why do patients with pulmonary embolisms get ECGs? |
|
Definition
|
|
Term
|
Definition
| Analgesics, tpA, coumadin and/or heparin |
|
|
Term
| Two types of surgical treatment for pulmonary embolism |
|
Definition
| Vena caval filter; greenfield filter |
|
|
Term
| Your patient is in the hospital with a pulmonary embolism. His wife and kids and very worried and want to visit him. What is your priority action? |
|
Definition
|
|
Term
| This drug doubles as an opioid analgesic and improves blood circulation in the pulmonary tree |
|
Definition
|
|
Term
| How can you prevent DVTs? |
|
Definition
Ambulate on plane and car trips
Don't cross legs
Regular exercise |
|
|
Term
| These cells maintain the bone matrix |
|
Definition
|
|
Term
| What are the components of building bones? |
|
Definition
| Collagen produced, coats with protein glue, holds calcium in place, calcium in bloodstream adheres to collagen to form new bone material |
|
|
Term
| If osteoclasts are active, is it harmful? |
|
Definition
| Not unless they are overactive. Bone resotption is part of the cycle of building healthy bones |
|
|
Term
| Bone develops and remodels to resist stresses placed on it. |
|
Definition
|
|
Term
| Increases Ca2+ absorption from GI tract |
|
Definition
|
|
Term
| What is adult rickets caused by? |
|
Definition
|
|
Term
| What happens if the bone matrix is not mineralized and the person has to bear too much weight? |
|
Definition
|
|
Term
| Normal Ca2+ range in blood |
|
Definition
|
|
Term
| Two major regulators of calcium |
|
Definition
|
|
Term
| What gland secretes calcitonin? When? |
|
Definition
| Thyroid gland, in response to elevated calcium levels |
|
|
Term
| What happens when osteoclasts malfunction? |
|
Definition
|
|
Term
| This hormone stimulates osteoblast activity and is why women are likely to get osteoporosis after menopause. |
|
Definition
|
|
Term
| Outerlayer of connective tissue on bone with blood vessels and nerves |
|
Definition
|
|
Term
| This occurs when bones are deprived of blood |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Pain
Pallor
Paresthesia
Pulse
Paresis
Polar |
|
|
Term
| Most common bone break after age 65 |
|
Definition
|
|
Term
| Injury to ligament (twisting) |
|
Definition
|
|
Term
| Muscle or tendon tear due to mechanical overloading |
|
Definition
|
|
Term
| The most common site for a sprain is the ______; the most common site for strain is the _______ |
|
Definition
|
|
Term
| Nursing care for sprains & strains |
|
Definition
Rest
Ice
Compression dressing
Elevation |
|
|
Term
| 3 phases of fracture healing |
|
Definition
Inflammatory
Reparative (48 hrs with osteoblasts & clasts)
Remodeling (2-3 months to years) |
|
|
Term
| An uncomplicated fracture takes _____ wks to heal. A hip fractures takes ______ wks to heal |
|
Definition
|
|
Term
| Worst type of bone fracture |
|
Definition
|
|
Term
| Your patient is being sedated for alignment of a closed fracture. What must you do? |
|
Definition
Get meds for sedation
Monitor VS q5 min
Have emergency airway available
Observe for alertness and gait
Designated driver.
Have 2 nurses & crash cart in the room - too much Rx can lead to apnea |
|
|
Term
|
Definition
NSAIDs
Anticoagulants
Antibiotics
Narcotics |
|
|
Term
| Internal fixation is done with ___ and _____. |
|
Definition
|
|
Term
| External fixation is done with an _____ ______. |
|
Definition
|
|
Term
| Skin traction used to immobilize and decrease spasm. |
|
Definition
|
|
Term
| Pin site care goals traction |
|
Definition
|
|
Term
| More than one direction of pull traction |
|
Definition
|
|
Term
| What 5 classes of drugs will most post-op fracture patients be on? |
|
Definition
NSAIDs,
H2 blocker
Narcotics
Antibiotics
Stool softeners |
|
|
Term
| What are the most important assessment components in post-op ortho patients? |
|
Definition
| Wound, alignment, BS, pain management, status of 6 Ps |
|
|
Term
| This tool stimulates osteoblasts and osteoclasts to decrease fracture healing times. |
|
Definition
| Electrical bone stimulation |
|
|
Term
| Why is traction necessary? |
|
Definition
| Muscle spasms with fractures pull the bones out of alignment |
|
|
Term
| This type of traction is most comfortable for patients and easy to manipulate but has a wt. limit of 6 lbs |
|
Definition
| Buck's (Straight) traction |
|
|
Term
| This type of traction utilizes pins in the bone. You can have more weight on it but there is a higher risk for infection and more pain for the patient |
|
Definition
|
|
Term
| This type of traction allows for greater patient mobility but cause the patient to slide to the end of the bed and is very complicated |
|
Definition
| Balanced suspension traction |
|
|
Term
| Your patient is begging you to take him off traction because of the pain. What is your priority action? |
|
Definition
| Assess the pain and the site for infection, provide more pain medication |
|
|
Term
| This fracture has a higher than normal risk for atelectasis and can have damage to internal organs |
|
Definition
|
|
Term
| This type of fracture commonly has malunion and nerve/ligament damage |
|
Definition
|
|
Term
| This type of fracture takes up to 6 months to heal |
|
Definition
|
|
Term
| Prolonged healing of bones beyond usual time period. Poor nutrition, inadequate immobilization, prolonged reduction time, immunosuppression, severe bone trauma, necrosis, infection and age are risk factors. |
|
Definition
|
|
Term
| What may delayed union lead to? |
|
Definition
| Nonunion (persistent pain & movement of fracture site) |
|
|
Term
| Partial or total removal of body part resulting from traumatic event or chronic condition. Interruption in blood flow either acute or chronic. |
|
Definition
|
|
Term
| Preserving what during amputation allows for greatest function? |
|
Definition
|
|
Term
| What are three major causes of amputation? |
|
Definition
Peripheral Vascular Disease
Trauma
Events (frost bite, burns, electrocution) |
|
|
Term
| This occurs when excess pressure in a limited space constricts the structures within reducing circulation to muscles and nerves |
|
Definition
| Acute Compartment Syndrome |
|
|
Term
| What is the Tx for Acute Compartment Syndrome? |
|
Definition
|
|
Term
| If post-fracture pain is not eliminated with drugs and the patient doesn't have drug abuse history, what is likely? |
|
Definition
| Acute compartment syndrome |
|
|
Term
|
Definition
| Renal failure (bc myoglobin released from damaged and necrotic muscle) |
|
|
Term
| Elbow fracture w/ unTx'd compartment syndrome |
|
Definition
|
|
Term
| High pressure in the marrow or stress-induced release of catecholamines causes rapid mobilization of fat globules. |
|
Definition
| Fat Embolism Syndrome (FES) |
|
|
Term
| What fractures does FES commonly occur with? |
|
Definition
| Long bone fractures & hip replacements |
|
|
Term
| Where do fat globules lodge in FES? |
|
Definition
| Pulmonary vascular bed or peripheral circulation |
|
|
Term
| FES is more common in ________ year olds and in ______ with fx of proximal femur. |
|
Definition
|
|
Term
| What do the fat globules do? |
|
Definition
| Compine with plt and travel to lungs, brain, kidney and other organs and occlude small blood vessels causing ischemia |
|
|
Term
| What are common manifestations of FES? |
|
Definition
Neurological dysfunction
Pulmonary Insufficiency
Petechial rash on chest, axilla and upper arms (petechiae may be caused by depletion of clotting factors) |
|
|
Term
| What time frame does the petechial rash from FES occur within? |
|
Definition
| Within hours to weeks after injury |
|
|
Term
| What is the best prevention method of FES? |
|
Definition
| Early stabilization of fractures |
|
|
Term
| Your patient had surgery on the proximal end of both of her femur fractures. She is confused and irritable and keeps trying to get out of bed. What is your priority action? |
|
Definition
|
|
Term
| A blood clot that forms along the intimal lining of a large vein. |
|
Definition
|
|
Term
| 5% of DVTs dislodge and enter the ________ system to become _________. |
|
Definition
| Pulmonary; pulmonary emboli |
|
|
Term
| What are the three precursors to DVT formation? |
|
Definition
| Injury to blood vessel wall, Altered blood coagulation, venous stasis/decreased blood flow |
|
|
Term
| What two tests are used to diagnose DVTs? |
|
Definition
Venogram
Doppler Ultrasound |
|
|
Term
| Your patient was recently diagnosed with a DVT after surgery on her left tibia. You have an order to apply SCDs. What do you do? |
|
Definition
| Question the order, no compression devices on affected limbs! |
|
|
Term
|
Definition
Bed rest
Heparin
Thrombolytic
Vena Cava filter maybe |
|
|
Term
| What may post-fracture infection lead to? |
|
Definition
|
|
Term
| What are the two most likely times of infection in patients post-op ortho? |
|
Definition
| Time of injury, during surgery, infected soft tissue adjacent to bone - venous stasis |
|
|
Term
|
Definition
|
|
Term
| Most common organism causing osteomyelitis |
|
Definition
|
|
Term
| Diagnostic tests for osteomyelitis |
|
Definition
| CT, MRI, CBC, ESR, Blood & tissue cultures |
|
|
Term
| Why is osteomyelitis so hard to treat? |
|
Definition
| Infection develops in bone and interferes with vascular supply to the bone causing bone necrosis. It is difficult for abx to reach bacteria within bone |
|
|
Term
|
Definition
|
|
Term
|
Definition
Surgical debridement,
Oral Abx (Ciprofloxacin) |
|
|
Term
| Nsg actions to decrease pain in pt's with osteomyelitis |
|
Definition
| Administer analgesics, elevate, apply warm, moist packs to increase vasodilation, encourage movemnt and frequent position changes, teach relaxation, notify provider of unrelieved pain |
|
|
Term
| You are caring for a patient with osteomyelitis. What problems should you report to the physician? |
|
Definition
| Pain, loss of sensation or motor, change in VS |
|
|
Term
| Porous bones with high risk of fracture and loss of bone mass |
|
Definition
|
|
Term
| How does cigarette smoking increase osteoporosis risk? |
|
Definition
Decreases blood supply to bones,
Nicotine slows osteoblast production,
Impairs Ca2+ absorption |
|
|
Term
|
Definition
|
|
Term
| Osteoporosis medication that causes hot flashes, and increases risk for blood clots and breast cancer. |
|
Definition
|
|
Term
| These osteoporosis medications should be taken 30 min before food or meds, milk taken concurrently impairs absorption |
|
Definition
| ibandronate, risedronate (bisphophonates) |
|
|
Term
| This osteoporosis medication has the potential to cause anaphylaxis but slows osteoclast activity. |
|
Definition
|
|
Term
| This osteoporosis medication stimulates osteoblast activity in the spine. |
|
Definition
|
|
Term
| If taking sodium fluoride, what must a patient do? |
|
Definition
| Get serum fluoride levels q3months & monitor for stained teeth |
|
|
Term
| Progressive metabolic skeletal disorder in which there is excessive bone resorption and formation resulting in large, soft bones. |
|
Definition
|
|
Term
| What are the manifestations of Paget's disease? |
|
Definition
Bone pain
Arthritis
Skeletal deformities
Fractures |
|
|
Term
| What medications are prescribed to people with Paget's disease? |
|
Definition
| NSAIDs, calcitonin, bisphosphonate |
|
|
Term
| Why do patient's with Paget's have bone pain? |
|
Definition
| Because of hypermetabolic bone activity |
|
|
Term
| Inadequate or delayed mineralization of bone matrix in mature compact and spongy bone resulting in softening of bones. |
|
Definition
| Osteomalacia "Adult rickets" |
|
|
Term
|
Definition
|
|
Term
| What are some typical causes of osteomalacia? |
|
Definition
Decreased calcium intake or absorption,
Decreased Vit. D,
Inc. renal losses |
|
|
Term
| Most common site for gout |
|
Definition
|
|
Term
| Metabolic disease that occurs from an inflammatory response to the production or extretion of uric acid resulting in high levels of uric acid in the blood which deposit in joints or soft tissues or ureters as stones. |
|
Definition
|
|
Term
| Name 2 causes of hyperuricemia. |
|
Definition
1. Errors of purine metabolism resulting in overproduction of uric acid or decreased excretion (renal failure).
2. Malignancies - leukemia |
|
|
Term
| What time of day does gout typically occur at? |
|
Definition
|
|
Term
| What values are increased in gout? |
|
Definition
|
|
Term
| Deposits of uric acid in synovial fluids |
|
Definition
|
|
Term
|
Definition
1. Asymptomatic hyperuricemia
2. Acute gouty arthritis attacks
(Aysmptomatic)
3. Chronic tophaceous gout |
|
|
Term
| What drugs are used in what stages of gout? |
|
Definition
Stage I - None
Stage II - Colchicine, NSAIDs, Indomethacin for subsequent attacks.
Asymptomatic period - Small doses colchicine or allopurinol
Stage III - Allopurinol |
|
|
Term
| This gout medication interrupts cycle of urate crystal deposits and inflammation but can cause cramps and diarrhea. |
|
Definition
|
|
Term
| This drugs decreases serum uric acid levels |
|
Definition
|
|
Term
| These drugs are indicated for people who have trouble eliminating uric acid adequately |
|
Definition
| Probenecid & sulfinpyrazone |
|
|
Term
|
Definition
| Avoid ETOH, all meats, seafood, yeast, beans, oatmeal, spinach and mushrooms. Lose weight (don't fast) |
|
|
Term
| Gout acute attack treatment |
|
Definition
| Bed rest 24 hrs post attack - elevate joint pain w/hot or cold compresses, liberal fluid intake 2000 mL |
|
|
Term
| Repetitive joint overuse and obesity leads to degradation of collagen by enzymes. Cysts and cartilage becomes grey, yellow and dry with asymmetric loss of cartilage and bone exposure in joints -> osteophytes |
|
Definition
| Osteoarthritis (Degenerative Joint Disease) (Repetitive actions!) |
|
|
Term
|
Definition
| Inc. rest, dec use leads to increased stiffness, decreased ROM, synovitis (pain) |
|
|
Term
| What does osteoarthritis manifest as? |
|
Definition
| Bony overgrowth - Heberden's nodes (distal digital joints), Bouchard's nodes (middle digital joints) and osteoarthritis of the spine |
|
|
Term
| Interventions for osteoarthritis |
|
Definition
| PT, rest of joint, wt. loss |
|
|
Term
|
Definition
| ASA, Tyelenol, NSAID Cox-2's (Celebrex, Vioxx), Corticosteroid injection of joints |
|
|
Term
| Debridement of involved joints as a surgical intervention for osteoarthritis |
|
Definition
|
|
Term
| Shift of joint load toward areas of less cartilage damage |
|
Definition
|
|
Term
| Reconstruction or replacement of joint |
|
Definition
|
|
Term
| This type of arthroplasty is secured to bone, can achieve normal activity rapidly and increases inflammatory response which eventually loosens joint |
|
Definition
|
|
Term
| Porous, ceramic, tight fitting, 6 wk non wt. bearing, bony growth fixates to prosthesis, joint lasts longer |
|
Definition
|
|
Term
| New Tx for OA of the knee injected into the knee for pain relief and function, lasts approximately 1 yr, unknown long term side FX. |
|
Definition
| Hyaluronan (Viscosupplementation) |
|
|
Term
| This type of arthritis is caused by genetic factors and possibly epstein barr virus. There is an inc. in T lymphocytes in synovial membrane that cause immune responses and destroy joint tissue. Bilateral autoimmune. Hyperplasia and hypertrophy of cells in synovium |
|
Definition
|
|
Term
|
Definition
| Vasodilation, swelling, pannus (scar tissue) |
|
|
Term
| Systemic manifestations of RA |
|
Definition
| Fatigue, weakness, anorexia, low grade fever, anemia, wt loss |
|
|
Term
| Lab used to monitor effect of RA Tx |
|
Definition
|
|
Term
|
Definition
| Synovial fluid (reduced viscosity, cloudy, protein, WBC) |
|
|
Term
|
Definition
| NSAIDS (ASA), low dose steroids, Intra-articular corticosteroids for temporary relief, DMARDs |
|
|
Term
| This DMARD used for RA interferes with quickly reproducing cells. |
|
Definition
|
|
Term
| This DMARD used for RA helps stop further joint damage and is used in combination with methotrexate |
|
Definition
|
|
Term
| This drug accumulates slowly in the body and reduce inflammation and progression of RA over time |
|
Definition
|
|
Term
| This drug suppresses the immune system and reduces inflammation. It takes 2-6 months to see improvement (vision changes) |
|
Definition
| Antimalarial agents eg Plaquenil |
|
|
Term
|
Definition
|
|
Term
| ____ is progressive with remissions and exacerbations, ____ is slowly progressive. |
|
Definition
|
|
Term
| ___ cool & bony hard joints on palpation. ___ red, hot, tender, boggy joint with weakness. |
|
Definition
|
|
Term
| ____ Pain w/activity, stiffness following immobility and relief within minutes; ____ has pain first thing in the morning lasting greater than 1 hr and following prolonged inactivity. |
|
Definition
|
|
Term
| ____ has several systemic manifestations and ___ has fatigue |
|
Definition
|
|
Term
| Chronic inflammatory immune complex connective tissue disease affecting all body systems with periods of remission and exacerbation. |
|
Definition
| Systemic Lupus Erythematosus (SLE) |
|
|
Term
| Highest risk for patients with SLE. |
|
Definition
| Infection (pneumonia, septicemia) Also, renal & CNS involvement |
|
|
Term
| Skin manifestation of SLE |
|
Definition
| Butterfly rash & discoid lesions |
|
|
Term
| Mimics ___ but without deformity |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What effects does SLE have on the renal system? |
|
Definition
| Proteinuria, nephrotic syndrome |
|
|
Term
| What effects does SLE have on the nervous system? |
|
Definition
| Seizures, memory loss, disorientation, psychosis |
|
|
Term
|
Definition
CBC
ESR
Anti-DNA specific to SLE
Urinalysis
Kidney biopsy to determine severity |
|
|
Term
|
Definition
| ASA, NSAIDs, DMAR hydroxychloroquine (skin and arthritic sx), Corticosteroids topical and/or systemic, immunosuppressive therapy |
|
|
Term
| This is usually due to strains in muscles and tendons resulting from abnormal stress or overuse |
|
Definition
|
|
Term
|
Definition
| NSAIDs, analgesics, muscle relaxants (Cyclobenzaprine), epidural steroid injections |
|
|
Term
| What pt. teaching is important for cyclobenzaprine? |
|
Definition
| Don't mix with ETOH or cough meds; don't drive |
|
|
Term
| Advise lower back pain patients to use heat for no more than ___ minutes because it will cause this. |
|
Definition
| 30; rebound congestion and blood vessel constriciton |
|
|
Term
|
Definition
| Glucose, some AAs, gases, H20 and electrolytes |
|
|
Term
| What cannot cross the BBB? |
|
Definition
| Urea, creatinine, proteins, some toxins, most Abx |
|
|
Term
| Brain injury can change ________. |
|
Definition
|
|
Term
| What is the brain's sole source of energy? |
|
Definition
|
|
Term
| The brain uses __% of the body's total O2 uptake and receives ___% of CO/min |
|
Definition
|
|
Term
| HA r/t muscle contractions in neck or head. Poorly localized, achy, pressure, viselike |
|
Definition
|
|
Term
|
Definition
| Decrease stress, increase good posture, massage, NSAIDs, diazepam if v. severe to dec. muscle tension |
|
|
Term
| HA r/t disturbed cranial circulation and 5-HT/serotonin. Women>men, herditary, lasts 4-72 hrs. |
|
Definition
|
|
Term
| HA r/t disturbances of cranial circ. most common in men 20-40 yo. Intense unilateral pain often during sleep lasting 30 min to hrs. Clusters of 1-8 HA's/day |
|
Definition
|
|
Term
|
Definition
| Eliminate cause as can't abort |
|
|
Term
|
Definition
| Brain CT, MRI, Xray of skull/c-spine, EEG or spinal tap to r/o inflammation, metabolic screens. |
|
|
Term
| Serotonin selective agonists for migraine HA |
|
Definition
| rizatriptan (Maxalt), sumatriptan (Imitrex) |
|
|
Term
| Classes of Rx's used to prevent HAs esp migraines |
|
Definition
B-blockers,
TCAs (amitriptyline, imipramine),
Ergot alkaloid derivatives: Serotonin receptor antagonist (Methysergide maleate)
Anticonvulsants low dose (topiramate, valproic acid) |
|
|
Term
| Classes of Rx used to aborn HA esp migraines |
|
Definition
Ergotamine (70% effective in attacks, decrease amplitude of cranial artery pulsations)
Serotonin selective agonists (triptans)
Narcotic analgesics (demerol or codeine)
Antiemetics
NSAIDS |
|
|
Term
| Which migraine drug class increases HR and can cause palpitations? |
|
Definition
| Serotonin selective agonists (triptans) |
|
|
Term
| an episode of excessive an abnormal discharge of electrical activity involving all or part of brain |
|
Definition
| Seizure disorder (Epilepsy) |
|
|
Term
| seizures caused by acute febrile state (>39 or 103), head injury or brain pathologies, infection in brain, metabolic or endocrine disorder, exposure to toxins, drug or ETOH withdrawal |
|
Definition
| Isolated episodes = Provoked secondary seizures |
|
|
Term
| Idiopathic seizures with permanent changes secondary to birth injury, infection, vascular abnormalities, trauma, tumors. Manifestations are discontinuous minutes, days, months or yrs between episodes |
|
Definition
| Chronic seizures = Epilepsy |
|
|
Term
| When a few reactive neurons cause repetitive hypersynchronous discharge (Initiator unknown) |
|
Definition
|
|
Term
| Amt of stimulus needed to cause seizure |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Metabolic needs inc. with seizures. ____% ATP from glucose & ___% O2; cerebral blood flow inc ____ times |
|
Definition
|
|
Term
| Seizure limited to 1 cerebral hemisphere. Pt. is conscious and has motor sx |
|
Definition
|
|
Term
| motor sx starting in 1 area and spreading sequentially to adjacent parts seen in simple partial seizures |
|
Definition
|
|
Term
| Seizure with impaired consciousness, automatisms (non-purposeful repetitive activity) and amnesia |
|
Definition
|
|
Term
| Seizure that involves both hemispheres & deeper areas. LOC always impaired |
|
Definition
| Generalized-Onset Seizures |
|
|
Term
| Sudden brief cessation of all motor activity - blank stare, unresponsive. 5-10 up to 30 s |
|
Definition
| Absence seizures (petit-mal) |
|
|
Term
| Phase of seizure with aura or sudden onset, muscle contract, fall into opisthotonic posture, incontinent, no breathing, pupils fixed/dilated, 15-60 s. |
|
Definition
|
|
Term
| Phase in which alternation between contraction & relaxation, hyperventilation, eyes roll back, frothing at the mouth, 60-90 s. |
|
Definition
|
|
Term
| Phase where gradual consciousness returns, disoriented, forgets seizure, HA, muscle aches, fatigue , sleepy |
|
Definition
|
|
Term
| You seizure patient states he is having an aura. What do you help him do? |
|
Definition
|
|
Term
| Seizure activity becomes continuous with short periods of calm - LIFE THREATENING. |
|
Definition
|
|
Term
| Consequences of status epilepticus |
|
Definition
| Hypoxemia, acidosis, hypoglycemia, hyperthermia, exhaustion |
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Term
| daignostic test to detect brain waves |
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Definition
| EEG (electrical encephalogram |
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Term
|
Definition
| withold fluids, foods and meds that may inc. or dec. brain waves for 24-48 hrs eg caffeinated foods. Avoid anticonvulsants if ordered, no tranquilizers, depressants. Wash hair before and after. Don't give food before if trying to provoke seizure r/t aspiration risk |
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Term
| Meds that raise seizure threshold or limit spread |
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Definition
| Anticonvulsants or Antiepileptic drugs (AEDS) |
|
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Term
|
Definition
| Phenytoin, phenobarbital, carbamazepine, valproic acid, primidone, ethosuximide, clonazepam, gabapentin, lamotrigine |
|
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Term
|
Definition
| Sedation, blurred vision, slurred speech, nystagmus, confusion |
|
|
Term
| When may you titrate off AEDs? |
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Definition
|
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Term
| Which AED demineralizes bone and therefore should be taken with vitamin and calcium rich diet |
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Definition
|
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Term
|
Definition
| Incompatibility - monitor for respiratory depression & shock |
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Term
|
Definition
| IV D50, IV diazepam or lorazepam to stop immediately. phenytoin or phenobarbital for longer-term control. |
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Term
| Surgery Tx for status epilepticus |
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Definition
| Resection to remove epileptogenic focus. Only if control methods fail ~5% pts |
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Term
| Pacemaker to vagus. Pt. activates to block impending partial seizure via vagal impulses. |
|
Definition
| Vagal Nerve Stimulation Therapy |
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Term
| Your patient says they are feeling an aura for a grand mal seizure. What are your actions? |
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Definition
| Ease to floor if out of bed or have bed down, side rails up and padded. Folded towel or pillow under head if on floor. Loosen clothing around neck, position onto side, O2 by mask and suction PRN. STAY WITH PT and call for help |
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Term
| What do seizure precautions entail? |
|
Definition
| Oral airway at bedside, Suction & O2 at bedside, padded side rails and pillows |
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Term
| Sudden loss of brain function from disruption of blood supply |
|
Definition
| Cerebral vascular accident (CVA) |
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Term
| Brief period of localized ischemia with neuro deficits lasting <24 hrs. Warning signal of CVA. |
|
Definition
| Transient ischemic attack (TIA) |
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|
Term
| Common deficits during TIAs |
|
Definition
| Numbness or weakness of hand, forearm or face; aphasia, visual changes (blurring) |
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Term
| CVA caused by arterial occlusion by thrombus on vessel wall |
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Definition
|
|
Term
| A thrombotic stroke can take ___ days to form |
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Definition
|
|
Term
| Embolism travels to cerebral vessels and lodges in narrow vessel bifurcations |
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Definition
|
|
Term
| Where to many embolic CVAs start? |
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Definition
|
|
Term
| What needs to be done prior to a cardioversion? |
|
Definition
| TEE to see if <3 has clots. Cannot do it if it does or will cause CVA |
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|
Term
|
Definition
| Sudden loss of muscle function |
|
|
Term
| Cerebral blood vessel ruptures causing sudden sxs; often during activity and r/t HTN |
|
Definition
|
|
Term
|
Definition
| Vomiting, HA, photophobia, neck rigidity, dec LOC, flaccid hemiplegia, inc ICP, coma and death if brain stem forced through cranial opening |
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|
Term
| Medical management hemorrhagic CVA |
|
Definition
| brain rest with sedation, analgesics, DVT prevention |
|
|
Term
|
Definition
| Craniotomy and evacuation of bleed if >3cm but don't want to operate if unstable |
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|
Term
| Potential complications of hemorrhagic CVA |
|
Definition
| vasospasms, seizures, hydrocephalus, HTN ->rebleed, SIADH/hyponatremia |
|
|
Term
| Major return of function happens within __ months of CVA. After that time only minor changes are possible. |
|
Definition
|
|
Term
| Loss of half visual field |
|
Definition
|
|
Term
| Inability to recognize one or more subjects that were previously familiar |
|
Definition
|
|
Term
| The inability to carry out some motor pattern |
|
Definition
|
|
Term
| Inability to use or understand language |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Not being able to form words (muscular deficit) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Tx during clot/embolic CVA (NOT IN HEMORRHAGIC) |
|
Definition
| Anticoagulants during thrombotic stroke in evolution phase only; thrombolytics within 3 hrs onset, ASA/dipyridamole |
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|
Term
| Tx during hemorrhagic CVA |
|
Definition
dexamethasone if cerebral edema
If Inc. ICP Mannitol or furosemide
seizures phenytoin
vasospasms - verapamil
SIADH Hypertonic 3% Saline |
|
|
Term
| Procedure to remove plaque |
|
Definition
|
|
Term
| Which side should you place an endartarectomy patient on? |
|
Definition
| Un-operated side, HOB up 30, head/neck aligned, support head with moving |
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|
Term
|
Definition
|
|
Term
| Area of severe ischemia 10-25% blood flow |
|
Definition
|
|
Term
| Tx penumbra (remains viable for 8hrs) |
|
Definition
| Penumbra device: cerebral catheterization via femoral artery |
|
|
Term
| How should a new CVA pt eat? |
|
Definition
| Sit upright, pureed/soft/thickened foods, place behind front teeth on unaffected side, tuck chin, 1 bit at a time, have suction available and minimize distractions |
|
|
Term
| What Dx test does a CVA pt have to have q2wks for the first 3 month |
|
Definition
|
|
Term
| Saccular out pouching of cerebral artery due to weakness in vessel wall (causes: atherosclerosis, congenital defect, head trauma or HTN) |
|
Definition
|
|
Term
| Prodromal Sx Intracranial aneurysm |
|
Definition
| Headache, n/v, pain in neck&back, visual defects |
|
|
Term
| No sxs or slight HA aneurysm (grade __); deep coma with decerebrate posturing aneurysm (grade __) |
|
Definition
|
|
Term
| Intracranial aneurysm Dx tests |
|
Definition
| CT scan, lumbar puncture, cerebral angiography |
|
|
Term
| Rx after intracranial aneurysm and why |
|
Definition
| Ca2+ blocker eg nifedipine to decrease vasospams from blood irritation and increase collaterals. PO |
|
|
Term
| Other Rx intracranial aneurysm |
|
Definition
| Stool softeners, anticonvulsants, analgesics |
|
|
Term
| Surgical Tx intracranial aneurysm |
|
Definition
Craniotomy to prevent rupture or to isolate vessel to prevent further bleeding OR
Endovascular balloon therapy to solidify and occlude aneurysm |
|
|
Term
| Aneurysm precautions to prevent rebleeding |
|
Definition
Private, quiet, darkened room
No phone or bright lights
HOB 30-45
Dec. activity, BR w/o BRP
Limit visitors
Inc. relaxation
Stool sofener
If alert, allow self care |
|
|
Term
|
Definition
|
|
Term
| A ruptured disk, herniated nucleus, slipped disk Rupture of cartilage surrounding the intervertebral disk with protrusion of nucleus puposus. >Men 30-50 |
|
Definition
| Herniated intervertebral disk |
|
|
Term
| Where do the majority of herniated intervertebral disks occur? |
|
Definition
| Lumbar region (If thoracic degenerative disease) |
|
|
Term
| Where does pain radiate in lumbar disk herniation? |
|
Definition
| Across buttocks and down posterior leg = sciatica |
|
|
Term
| How do you elicit sciatica? |
|
Definition
| Straight leg raising while dorsiflexing foot - Can't tolerate it |
|
|
Term
|
Definition
| Myelogram c contrast medium with LP - Keep HOB up 30 to prevent contrast from entering cranium |
|
|
Term
| Measures electrical activity of skeletal muscles at rest and during voluntary contractions - ID's specific muscles affected by pressure of herniation on nerve roots |
|
Definition
|
|
Term
| Removal of part of vertebral lamina to relieve pressure on nerves |
|
Definition
|
|
Term
| Removal of nucleus pulposus of intervertebral disk |
|
Definition
|
|
Term
| Insertion of wedge shaped piece of bone between vertebrae to stabilize spinal cord |
|
Definition
|
|
Term
| When are surgical procedures used in patients with herniated disks? |
|
Definition
| If neuro deficits or conservative tx fails |
|
|
Term
|
Definition
| Inc. v. slightly with small pillow only cervical, flat for lumbar |
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