1538 Test 3

ataxia

(impaired coordination of movements)

⦁ Traumatic ⦁ Subarachnoid Hemorrhage (tSAH)

) is bleeding into the space between the arachnoid and pia mater. This space is normally filled with cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. occurs when small vessels tear during the initial injury. The blood spreads over the surface of the brain causing widespread effects

anaphlactic shock

, is a disorder that causes inadequate tissue perfusion. Systemic vasodilation leads to decreased blood flow to the brain, heart, and kidneys causing damage to vital organs

The choroid plexus

, is a plexus (latin = braid = cluster of specialized / same cells) of ependymal cells that arises in each of the ventricles of the brain. produces cerebrospinal fluid (CSF). CSF is produced and secreted by the regions in each of the ventricles.

Corticosteroids

- Block leukotrienes and prostaglandins

Albuterol

- Inhaled beta-2 agonist

Dopamine

- Non-selective adrenergic agonist (alpha & beta Vasopressor for hypotension (anaphylactic shock)

IV fluids

- Volume expander for hypotension in anaphylaxis

Pia Mater

- is the thin, translucent, mesh-like meningeal layer, spanning nearly the entire surface of the brain. A network of blood vessels to the brain and spinal cord pierce through the pia membrane and the capillaries are responsible for nourishing the brain. When becomes irritated and inflamed the result is meningitis

Basophil

- released mature from bone marrow and circulate in bloodstream. Also responds to exposure to IgE causing release of histamine contents.

Decerebate

- survival rate in patients who show this posture is ≈10%

Side effects of epinephrine

. Patients should know that they may experience sweating, tremors, anxiety, fast heart rate, weakness, dizziness, or GI upset following the use of this drug.

subarachnoid space between the arachnoid mater and the pia mater.

. ⦁ Cerebrospinal fluid is located in the

500 mL.

24 hour production is ( of CSF)

Discoid lupus

: Limited to the skin

nursing intervention of circulation for anaphalaxis

: Maintain blood pressure (>90 Systolic) and perfusion Place patient on cardiac monitoring Place recumbent and elevate legs Initiate intravenous infusion Administer intravenous epinephrine (bolus or continuous). Initiate a continuous infusion of dopamine (vasopressor) Removal of chemical mediators Administer intravenous antihistamines H1 blocker (diphenhydramine) H2 blocker (ranitidine) Administer corticosteroids (IV methylprednisolone) - thought to reduce severity of second phase reactions

systemic lupus

: can affect any body system but most commonly impacts one or more of the following: CV, CNS, hematological, kidneys, lungs, musculoskeletal, mucocutaneous

Mild TBI/Concussion

: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.

Moderate TBI

: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable

Severe TBI

: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.

interpretation of TB test

<5mm - Neg response but does not r/o infection 5-9mm - positive for people who: Close contact w/ infected persons Abnormal CXR Immunocompromised or HIV Organ transplant 10-15 mm - positive for Birth in high incidence country AA, Hispanic, or Asian American in poverty area IV drug user Homeless shelter, long term care facility, correctional facility >15 mm - positive for all people

Use a soft toothbrush.

A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication?

Positive Anti-dsDNA antibody test

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Take daily weights

A client has sustained a traumatic brain injury with involvement of the hypothalamus. The nurse is concerned about the development of diabetes insipidus. Which of the following would be an appropriate nursing intervention to monitor for early signs of diabetes insipidus?

Place the client in reverse isolation.

A client infected with human immunodeficiency virus (HIV) has a low CD4+ level. What intervention should the nurse implement?

Assess the client's neurologic status for subtle changes, administer acetaminophen, and then reassess the client in 30 minutes.

A client is admitted to the hospital after sustaining a closed head injury in a skiing accident. The physician ordered neurologic assessments to be performed every 2 hours. The client's neurologic assessments have been unchanged since admission, and the client is complaining of a headache. Which intervention by the nurse is best?

Anaphylactic reactions involve an antibody that causes the release of histamine. Histamines produce immediate reactions. Anaphylactic reactions can lead to respiratory distress and even respiratory arrest.

A client is being discharged from the emergency department (ED) after being treated for an anaphylactic reaction to shrimp the client ate for dinner. The client asks the nurse to explain food reactions. Which would be correct responses? Select all that apply.

INH

A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug?

Jaundice

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?

Oral

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route?

Oral

A client is to receive erlotinib. The nurse would expect to administer this drug by which route?

10:30 to 11:00 a.m.

A client is to receive intravenous immunoglobulin (IVIG). The infusion is started at 10 a.m. The nurse would be alert for signs and symptoms of an anaphylactic reaction during which time frame?

Paresthesia

A client presents to the emergency department stating numbness and tingling occurring down the left leg into the left foot. When documenting the experience, which medical terminology would the nurse be most correct to report?

Immune surveillance hypothesis

A client received a liver transplant and is now taking immunosuppressant medication. The client has been told that a potential side effect of the therapy is the development of cancer. Select the option that best supports this information.

acute

A client was hit in the head with a ball and knocked unconscious. Upon arrival at the emergency department and subsequent diagnostic tests, it was determined that the client suffered a subdural hematoma. The client is becoming increasingly symptomatic. How would the nurse expect this subdural hematoma to be classified?

A T-cell-mediated response to an immunologic trigger, such as a microbial agent

A client who has developed rheumatoid arthritis can experience joint inflammation that involves of immunologic mediation triggered by which physiologic response?

disappearance of signs and symptoms associated with the disease.

A client with Crohn's disease in remission is admitted to the nursing unit for follow-up care. The remission state is characterized by:

Autonomic dysreflexia

A client with a T4 level spinal cord injury (SCI) is complaining of a severe headache. The nurse notes profuse diaphoresis of the client's forehead and scalp. Which of the following does the nurse suspect?

Look for signs of increased intracranial pressure

A client with a concussion is discharged after the assessment. Which instruction should the nurse give the client's family?

C5

A client with a spinal cord injury has full head and neck control when the injury is at which level?

Chronic rejection

A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?

For their immunosuppressant effects

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

Absence of reflexes along with flaccid extremities

A client with quadriplegia is in spinal shock. What finding should the nurse expect?

Apply anti-embolic stockings prior to elevation of the head.

A client with tetraplegia has a spinal cord injury (SCI) at C4. He experiences severe orthostatic hypotension with any elevation of his head. Which of the following interventions will the nurse employ to reduce the hypotension?

Rifampin

A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?

decrease the potential for brain damage.

A gymnast sustained a head injury after falling off the balance beam at practice. The client was taken to surgery to repair an epidural hematoma. In postoperative assessments, the nurse measures the client's temperature every 15 minutes. This measurement is important to:

Alefacept

A nurse is caring for a client who has been admitted for immunosuppressant treatment of severe psoriasis. Which drug is the nurse likely to administer?

Splenomegaly Lymphadenopathy Elevated erythrocyte sedimentation rate (ESR)

A nurse is caring for a client with rheumatoid arthritis (RA). For which of these extra-articular manifestations does the nurse assess?

Inferior posterior frontal areas

A patient has expressive speaking aphasia after having a stroke. Which portion of the brain does the nurse know has been affected?

An intracerebral hematoma

A patient sustained a head trauma in a diving accident and has a cerebral hemorrhage located within the brain. What type of hematoma is this classified as?

Graves disease

Adult strabismus is almost always of the paralytic variety. What is a cause of adult strabismus?

Phenylephrine

Alpha-1 agonist for anaphalaxis

Hepatotoxicity

An 80-year-old client is diagnosed with latent tuberculosis infection. What is a risk for the elderly population when being treated with INH?

Laryngeal edema

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often follows the vascular response in anaphylaxis?

Epinephrine

Anaphylaxis is initially treated with

anaphylaxis second treatment

Antihistamines, such as diphenhydrAMINE hydrochloride IV, IM, or by mouth or cetirizine hydrochloride by mouth Histamine-2 receptor antagonists, such as raNITIdine hydrochloride or famotidine Corticosteroids, such as hydrocortisone, prednisone, and methylPREDNISolone Inhaled beta2-adrenergic agonists such as albuterol sulfate IV fluids (typically normal saline and lactated Ringer solution) for fluid resuscitation DOPamine hydrochloride as adjunctive therapy for refractory hypotension Aminophylline injection IV Oxygen therapy

Natalizumab

As monotherapy for the treatment of patients with relapsing forms of MS; to induce and maintain clinical response and remission in patients with moderately to severely active Crohn disease with evidence of inflammation who have had an inadequate response to, or are unable to tolerate, conventional therapies and inhibitors of TNF-α

Drug-induced lupus

Associated with antineoplastic drugs, INH, Apresoline - Symptoms subside when the drug is discontinued

Bradycardia Hypertension Bradypnea

At a certain point, the brain's ability to autoregulate becomes ineffective and decompensation (ischemia and infarction) begins. Which of the following are associated with Cushing's triad?

150 mL

At any given time, the normal circulating rate of CSF is

T6

Autonomic dysreflexia can occur with spinal cord injuries above which of the following levels?

Rituximab

B cell depletion with this, another monoclonal antibody, has been used successfully for rheumatoid arthritis, but studies have shown mixed results for the treatment of SLE An open study using this med showed positive results as rescue therapy for patients with active SLE who were unresponsive to standard immunosuppressant therapy. There have also been case reports of patients with severe refractory SLE in which off-label use of this drug showed benefits with tolerable safety profiles

teaching for RA

Basic pathophysiology disease No weight-bearing on affected joints / assistance when joints inflamed Avoid prolonged or deep heat during acute episodes (cold reduces inflammation) Warm bath/shower relieves morning pain and stiffness-- ROME post heat < stiffness/pain amount of fatigue directly r/t activity of disease Relief of pain can relieve fatigue Use devices (splints, canes) and methods (bed rest, relaxation techniques) to ease fatigue Develop and maintain sleep routine Conserve energy (pacing, delegating, prioritizing)

side effects of natalizumab

CNS: depression, dysesthesia, fatigue, headache, vertigo, syncope. CV: chest discomfort, peripheral edema. EENT: tonsillitis. GI: abdominal discomfort, diarrhea, gastroenteritis, nausea, dyspepsia, constipation. GU: UTI, vaginitis, amenorrhea, dysmenorrhea, irregular menstruation, urinary frequency, urinary urgency, ovarian cyst. Hepatic: cholelithiasis. Metabolic: weight increase or decrease. Musculoskeletal: arthralgia, extremity pain, muscle cramps, swollen joints, back pain. Respiratory: upper and lower respiratory tract infection, cough. Skin: rash, dermatitis, pruritus, urticaria, night sweats, thermal injury, skin laceration. Other: hypersensitivity reaction, infusion-related reaction, tooth infections, herpes infection, rigors, seasonal allergy, flulike symptoms.

≈ 20 mL per hour

CSF is produced by ependymal cells in the choroid plexus of the ventricles at a rate of

CPP = MAP - ICP

Calculating Cerebral Perfusion Pressure

MAP = SBP + 2(DBP) 3

Calculating an estimate of Mean Arterial Pressure

Venous pooling in the extremities Bradycardia Warm skin

Clinical manifestations of neurogenic shock include which of the following

Venous pooling in the extremities Bradycardia Warm skin

Clinical manifestations of neurogenic shock include which of the following?

Dexamethasone

Corticosteroid

50 or below = irreversible neurological damage

Critical low is (for CPP)

Common Meds for MS

Disease modifying agents Corticosteroid therapy Muscle relaxants / baclofen pump Immunosuppressants Vitamin D3 2000-5000 i.u. daily

Respiratory irregularities Slow bounding pulse Widened pulse pressure

Elevated ICP is most commonly associated with head injury. Which of the following are clinical signs of increased ICP that a nurse should evaluate?

Glutamate

Excessive levels of which neurotransmitter has been implicated in amyotrophic lateral sclerosis (ALS)?

Symptoms of MS

Fatigue affects almost all clients Vision problems (double vision, pain, impaired vision, blind spots, color blindness, flashing/flickering lights) Ataxia Paresthesia Dizziness/balance problems Bladder issues (bowel issues - constipation) Sexual dysfunction Cognitive problems

Non-pharmacologic therapy for MS

Get plenty of rest. Look at your sleep habits to make sure you're getting the best possible sleep. To make sure you're getting enough sleep, you may need to be evaluated — and possibly treated — for sleep disorders such as obstructive sleep apnea. Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you're bothered by heat. Other types of mild to moderate exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi. Cool down. MS symptoms often worsen when the body temperature rises in some people with MS. Avoiding exposure to heat and using devices such as cooling scarves or vests can be helpful. Eat a balanced diet. Since there's little evidence to support a particular diet, experts recommend a generally healthy diet. Some research suggests that vitamin D may have potential benefit for people with MS. Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help.

is 70 mmHg (adults)

Goal for treatment is (for CPP)

Diphenhydramine

H1 blocker

Ranitidine

H2 blocker

anaphalaxis first treatment

Immediate injection of EPINEPHrine 1:1,000 aqueous solution, 0.3 to 0.5 mL IM (preferred), or subcutaneously every 5 to 15 minutes for up to three doses, or 2 to 10 mcg/minute of a 1:10,000 solution by slow IV infusion; endotracheal or intraosseous administration if IV administration isn't possible

Eye opening Verbal response Motor response

Level of consciousness (LOC) can be assessed based on criteria in the Glasgow Coma Scale (GCS). Which of the following indicators are assessed in the GCS?

nursing intervention of airway with anaphalaxis

Maintain airway patency Administer Epinephrine (0.3-0.5 ml of 1:1000 concentration) intramuscular. Repeat every 5-15 minutes as needed Assist with intubation and mechanical ventilation

nursing intervention of breathing for anaphalaxis

Maintain oxygenation Administer nebulized albuterol Administer oxygen to maintain oxygen saturations >90

bacterial

Neck stiffness, headache, mental status changes (declining level of consciousness [LOC]) is what type of memimgitis

Epinephrine

Non-selective adrenergic agonist (alpha & beta) Alpha & beta-adrenergic agonist. Rapid production of bronchodilation and vasoconstriction

equal 70 - 100 mmHg

Normal CPP

0-10 up to 15mmHg

Normal ICP?

MS

One of the leading causes of disability between ages 20-40

Leading causes of death in SLE include:

Pneumonia and septicemia Renal and/or CNS involvement

True

Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.

SLE

Systemic symptoms include fever, malaise, weight loss, and anorexia. The mucocutaneous, musculoskeletal, renal, nervous, cardiovascular, and respiratory systems are most commonly involved. Less commonly affected are the gastrointestinal tract and liver as well as the ocular system. Joint symptoms, with arthralgias, arthritis (synovitis), or both, occur in more than 90% of patients this and are commonly the earliest manifestation of the disease process. Joint swelling, tenderness, and pain on movement are also common. Frequently, these are accompanied by morning stiffness. Osteopenia and Osteoporosis are common developments associated with the use of corticosteroids in this. In fact, osteopenia is reported in 25% to 74% and osteoporosis in 1.4% to 68% of patients with this. Also, myalgias and avascular necrosis.

swelling in the small joint, associated with pain, stiffness and fatigue

T and B cell proliferation angiogenesis in the synovial lining causes what

Most "CLASSIC" PRESENTATION of SLE

The LUPUS TRIAD: Unexplained FEVER, Painful/Swollen joints, Rash in woman of childbearing age

3 months

The client has been on a systemic corticosteroid for the last 3 weeks. How long should the client wait before receiving a live virus vaccine?

Vitamin B6 (pyridoxine)

The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy?

Basilar skull fracture

The nurse in the emergency department is caring for a patient brought in by the rescue squad after falling from a second-story window. The nurse assesses ecchymosis over the mastoid and clear fluid from the ears. What type of skull fracture is this indicative of?

Place the client in high Fowler's. Stop the antibiotic infusion. Notify the rapid response team. Monitor vital signs. Implement interventions ordered. Document interventions and client's respon

The nurse is assessing a client that is receiving the first dose of an antibiotic for a left leg staphylococcus aureus infection. Upon assessment, the nurse notes the client is experiencing dyspnea, cyanosis, and tachycardia. Place the steps that the nurse should perform in the correct order. All options must be used.

Hypertension Diaphoresis Nasal congestion

The nurse is assigned to care for clients with SCI on a rehabilitation unit. Which signs does the nurse recognize as clinical manifestations of autonomic dysreflexia?

1 to 7 days of injury

The nurse is caring for a client following a head injury. The nurse understands that the client is at risk for posttraumatic seizures. A seizure classified as early occurs within which time frame?

Reduction in ACTH

The nurse is caring for a client who is receiving exogenous corticosteroids for rheumatoid arthritis. Recognizing that hormone levels are regulated by negative feedback, which laboratory test result does the nurse anticipate uncovering when reviewing the medical record?

Extramedullary

The nurse is caring for a client who is scheduled for surgery to relieve pressure on a compressed nerve. The compression does not involve the spinal cord. What kind of spinal nerve root compression does the nurse know this is

increased fatigue

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care?

The normal protective immune response attacks the body, damaging tissues.

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which statement correctly describes the process of autoimmunity?

intradermal testing

The nurse is working with a client with allergies. What will the nurse use to confirm allergies and decrease the risk of anaphylaxis?

Dura mater

The outermost mater of the meninges, the dura is a thick, durable (tough) membrane, closest to the skull and vertebrae

rubella Explanation: The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue.

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from?

cushion the brain and spinal cord from trauma and to supply them with nutrients and remove waste.

The primary functions of the CSF are to

coma, absence of brain stem reflexes, and apnea.

The three cardinal signs of brain death on clinical examination are

an acute subdural hematoma

The usual mechanism that produces is a high-speed impact to the skull. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures, tearing blood vessels. Often, the torn blood vessel is a vein that connects the cortical surface of the brain to a dural sinus (termed a bridging vein). In elderly persons, the bridging veins may already be stretched because of brain atrophy (shrinkage that occurs with age). Alternatively, a cortical vessel, either a vein or small artery, can be damaged by direct injury or laceration.

Non-communicating and communicating

There are generally two forms of obstructive hydrocephalus

THE EPIDURAL HEMATOMA

This condition is usually caused by the rupturing of the middle meningeal artery as a consequence of the fracture of the temporal bone as a result of head trauma. As the hemorrhage rapidly expands under arterial pressure, the dura peels away from the calvarium creating a lens-shaped biconvex hematoma, as seen by a CT scan. As the hematoma compresses the underlying brain tissue, brain herniation can occur and lead to death unless treated with surgery.

Protracted Anaphylaxis

This type of anaphylaxis is relatively rare. The reaction can last for hours or even days without completely resolving. Recommendations from the Joint Task Force (JTF) on Practice Parameters advise that people who've had an anaphylactic reaction be monitored in an ER for 4 to 8 hours afterward. The task force also recommends that they be sent home with a prescription for an epinephrine auto-injector — and an action plan on how and when to administer it — due to the possibility of a recurrence.

uniphasic reaction

This type of reaction is the most common. Symptoms peak within 30 minutes to an hour after you're exposed to the allergen. Symptoms get better within an hour, with or without treatment, and they don't return.

within 24 hours;; over about 1 week.

Typically, signs and symptoms develop in patients with bacterial meningitis ??? in patients with viral meningitis, signs and symptoms develop ???

the dura mater, the arachnoid mater, and the pia mater (DAP)

What three layers make up the meninges

Body temperature

When caring for a client who is post-intracranial surgery what is the most important parameter to monitor?

IgE

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

Fever Night sweats 6-month weight loss of 8 pounds New expectoration of mucus

Which adolescent symptoms are indicative of a reactivation of a secondary tuberculosis

severe hypertension, slow heart rate, pounding headache, sweating

Which are characteristics of autonomic dysreflexia?

Protection against physical injury Protection from an invasion of microbes Synthesis of vitamin D

Which are considered functions of the skin? Select all that apply.

Young age Alcohol use Drug abuse

Which are risk factors for spinal cord injury (SCI)?

Subdural hematoma

Which condition occurs when blood collects between the dura mater and arachnoid membrane?

Group A (β-hemolytic) streptococcal antibodies

Which lab result strongly suggests an immunologic response in the client with possible rheumatic heart disease?

Administer sedation and analgesia.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

Absence of brainstem reflexes Apnea Coma

Which signs are considered cardinal signs of brain death

hives difficulty breathing panicked feeling

Which symptoms are indicators that the client is having an anaphylactic reaction? (

Epidural

Which type of hematoma is evidenced by a momentary loss of consciousness at the time of injury, followed by an interval of apparent recovery (lucid interval)?

Epidural

Which type of hematoma results from a skull fracture that causes a rupture or laceration of the middle meningeal artery?

Grade 3 concussion

While riding a bicycle in a race, a patient fell into a ditch and sustained a head injury. Another cyclist found the patient lying unconscious in the ditch and called 911. What type of concussion does the patient most likely have?

Autonomic dysreflexia

You are a neurotrauma nurse working in a neuro ICU. What would you know is an acute emergency and is seen in clients with a cervical or high thoracic spinal cord injury after the spinal shock subsides?

Children younger than 5 years old People with weakened immune systems caused by diseases, medications (such as chemotherapy), and recent organ or bone marrow transplantations. Infants younger than 1 month old and people with weakened immune systems are more likely to have severe illness.

You can get viral meningitis at any age. However, some people are more at risk of getting the disease. Who might this include?

osteophyte

a bony outgrowth or protuberance; bone spur

immunoglobulins

a family of closely related proteins capable of acting as antibodies

Leukotrienes

a group of chemical mediators that initiate the inflammatory response...cause tightening of airway muscles and the production of excess mucus and fluid. These chemicals play a key role in allergies, allergic rhinitis, and asthma, also causing a tightening of your airways, making it difficult to breathe

Anaphylaxis

a severe response to an allergen in which the symptoms develop quickly, and without help, the patient can die within a few minutes.

antibody

a substance produced by the body that destroys or inactivates an antigen that has entered the body

allergen

a substance that causes an allergic reaction

bradkinin

a substance that stimulates nerve fibers and causes pain

rheumatoid arthritis

a systemic autoimmune disease with symmetric arthritic manifestations and multiple extra-articular features

RA

a systemic disease with multiple extra-articular features. Most common are fever, weight loss, fatigue, anemia, lymph node enlargement, and Raynaud's phenomenon (cold- and stress-induced vasospasm causing episodes of digital blanching or cyanosis).

tophi

accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage

Hypersensitivity

an exaggerated response by the immune system to a particular substance

Secondary Progressive MS

begins with an initial RR course, followed by progression of variable rate, which may also include occasional relapses and minor remissions.

subchondral bone

bony plate that supports the articular cartilage

Primary progressive MS

characterized by disease showing progression of disability from onset, without plateaus and temporary minor improvements.

Serotonin

chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor

angioneurotic edema

condition marked by development of urticaria and an edematous area of skin, mucous membranes, or viscera (i.e., angioedema)

mast cells

connective tissue cells that contain heparin and histamine in their granules...- immature circulating cells in resting state. Activated by IgE exposure to release contents (histamine); exist in connective tissue (mucosa, skin, etc)

The meninges

consist of three membranes that envelop the brain and spinal cord.

TBI (traumatic brain injury)

describes an injury that is the result of an external force and is of sufficient magnitude to interfere with daily life and prompts the seeking of treatment.

Secondary injury

evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen to the cells.

ankylosis

fixation or immobility of a joint

Eosinophils

granular leukocyte

Antimalarial therapy (hydroxychloroquine)

has been shown to prevent disease flares and to decrease mortality in SLE

Motor vehicle crashes

he nurse is discussing spinal cord injury (SCI) at a health fair at a local high school. The nurse relays that the most common cause of SCI is

urticaria

hives

TB Disease (in the lungs)

in adults - cough with or without sputum production, hemoptysis, chest pain, anorexia, unexplained weight loss, night sweats, fever, fatigue

TB disease

in children - persistent cough, fatigue, weight loss or failure to gain weight, decreased appetite, low-grade fever, night sweats, chills, enlarged lymph nodes

Hapten

incomplete antigen

arthritis

inflammation of a joint

allergy

innappropriate and often harmful immune system response to substances that are normally harmless

Arachnoid Mater

involved in cerebrospinal fluid (CSF) metabolism via the subarachnoid space. It cushions the central nervous system via the CSF in the subarachnoid space. The arachnoid barrier has no extracellular collagen and is considered to represent an effective physiological meningeal barrier between the cerebrospinal fluid in the subarachnoid space and the blood circulation in the dura. In addition to the CSF, the major arteries of the brain run through the subarachnoid space.

⦁ Hematoma

is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body's natural way to stop the bleeding. may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot.

contusion

is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact.

Concussion

is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury. A

Platelet Activating Factor (PAF)

is a potent phospholipid activator and mediator of many leukocyte functions, platelet aggregation and degranulation, inflammation, and anaphylaxis. It is also involved in changes to vascular permeability, the oxidative burst, chemotaxis of leukocytes, as well as augmentation of arachidonic acid metabolism in phagocytes.

⦁ Diffuse axonal injury (DAI)

is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons. Axons connect one nerve cell to another throughout the brain, like telephone wires.

systemic lupus erythematosus (SLE)

is an inflammatory, autoimmune disorder that affects nearly every organ in the body

Belimumab (Benlysta)

is approved by the FDA for the treatment of SLE - is a monoclonal antibody that specifically recognizes and binds to BLyS -acts to stimulate B cells to produce antibodies against the body's own nuclei, which is an integral part of the disease process in SLE -acts to render BLyS inactive, preventing it from binding to B-cell surfaces and stimulating B-cell activity This action then halts the production of unnecessary antibodies and decreases disease activity in SLE

Relapsing-remitting (RR) MS

is characterized by clearly acute attacks with full recovery or with sequelae and residual deficit upon recovery. Periods between disease relapses are characterized by lack of disease progression

primary injury

is defined as the consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries (e.g., contusions, lacerations, external hematomas, and skull fractures), as well as possible focal brain injuries from sudden movement of the brain within the cranial vault (e.g., subdural hematomas (SDHs), concussion, diffuse axonal injury [DAI]). The greatest opportunity for decreasing TBI is the implementation of prevention strategies

Cerebral edema

is the most common cause of increased ICP in the patient with a head injury, with the swelling peaking approximately 48 to 72 hours after injury.

B cells

lymphocyte cells that are important in producing circulating antibodies

T cells

lymphocyte cells that can cause graft rejection, kill foreign cells, or suppress production of antibodies

TB meningitis

may present with a headache that has been either intermittent or persistent for 2-3 weeks. Subtle mental status changes may progress to coma over a period of days to weeks. Fever may be low grade or absent.

Antihistamines

medicines that reduce the production of histamines Block histamine from attaching to receptor cells

rheumatic diseases

numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints

biphasic reaction

occur when symptoms go away for an hour or more, but then return without your being reexposed to the allergen

Spasticity (muscle hypertonicity)

occurs in 90% of patients with MS, most often in the lower extremities, and can include loss of the abdominal reflexes.

Persistent post-concussive symptoms, also called post-concussion syndrome,

occurs when concussion symptoms last beyond the expected recovery period after the initial injury. The usual recovery period is weeks to months. These symptoms may include headaches, dizziness, and problems with concentration and memory.

remission

period when disease symptoms are reduced or absent

exacerbation

period when disease symptoms occur or increase

Pannus

proliferation of newly formed synovial tissue infiltrated with inflammatory cells

The primary function of the meninges

protect the central nervous system.

cytokines

proteins that can be produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

erythema

redness of the skin

arthroplasty

replacement of a joint

true

rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.

Progressive-relapsing MS

shows progression from onset but with clear acute relapses with or without recovery.

environmental risks of MS

smoking, lack of vitamin D exposure, and exposure to the Epstein-Barr virus

Histamine

substance in the body that causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle

Antigen

substance that triggers an immune response and induces the production of antibodies

Decorticate -

survival rate in patients who show this posture is ≈37%

rheumatoid arthritis

symmetric joint pain and morning joint stiffness lasting longer than 1 hour. Over the course of the disease, clinical manifestations vary, usually reflecting the stage and severity of the disease. Symmetric joint pain, swelling, warmth, erythema, and lack of function are classic symptoms. Palpation of the joints reveals spongy or boggy tissue. Often, fluid can be aspirated from the inflamed joint. Characteristically, the pattern of joint involvement begins in the small joints of the hands, wrists, and feet. As the disease progresses, the knees, shoulders, hips, elbows, ankles, cervical spine, and temporomandibular joints are affected. The onset of symptoms is usually acute. Symptoms are usually bilateral and symmetric.

Atopy

term often used to describe immunoglobulin E-mediated diseases (i.e., atopic dermatitis, asthma, and allergic rhinitis) with a genetic component

Amantadine (Gocovri, Osmolex), modafinil (Provigil) and methylphenidate (Ritalin)

these meds may be helpful in reducing MS-related fatigue. Some drugs used to treat depression, including selective serotonin reuptake inhibitors, may be recommended.

ABG

this lab may reveal hypoxemia, hypercarbia, and acidosis

Dalfampridine (Ampyra - K channel blocker, muscle strengthener)

this med may help to slightly increase walking speed in some people. People with a history of seizures or kidney dysfunction should not take this medication.

Non-communicating obstructive

this type of hydrocephalus can be caused by: A colloid cyst blocking foramen of Monro, aqueductal stenosis (congenital, post-infectious - such as meningitis, etc) and lesions in the posterior fossa.

Noncommunicating

this type of hydrocephalus implies a blockage of the normal CSF flow through the Ventricular System and the subarachnoid space.

viral

this type of meningitis usually presents as a headache, fever, photophobia, and stiff neck. There are usually no symptoms of brain involvement.

atopic dermatitis

type 1 hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions

Prostaglandins

unsaturated fatty acids that have a wide assortment of biologic activity: are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. They control processes such as inflammation, blood flow, the formation of blood clots and the induction of labor.

TB treatment

´Four drug therapy for 6-9 months

First line drugs for TB

´are isoniazid (INH), rifampin, ethambutol, & pyrazinamide

Hemoptysis

´is not common and is usually associated with advanced disease of TB

Immediate (Type I) Hypersensitivity

•Symptoms appear after a few seconds to minutes •Anaphylactic reactions: the most severe form of allergic reaction •Anaphylaxis is a medical emergency that can lead to sudden, life-threatening respiratory failure •Symptoms include difficulty breathing, swelling, low blood pressure, bluish skin, and shock IgE antibodies are produced by the immune system in response to allergens such as pollen, animal dander, insect bites, dust mites, or certain foods

Cytotoxic (Type II) Hypersensitivity

•Symptoms appear after minutes to hours •IgG and IgM antibodies damage cells by activating the complement system of the immune system such as in: •Autoimmune hemolytic anemia •Immune thrombocytopenia •Autoimmune neutropenia •Goodpasture syndrome •Graves' disease •Myasthenia gravis

•Immune complex-mediated (type III)

•Symptoms set in after several hours •IgM and IgG antibodies react with allergens to form immunocomplexes (antigen-antibody complexes) such as in: •Lupus •Serum sickness •Arthus reaction

•Delayed hypersensitivity (type IV)

•Symptoms set in hours to days later •Often in long-term infectious diseases such as: •Tuberculosis •Fungal infections

Somatosensory evoked response (SSER) test

•This test can detect problems with the spinal cord that cause numbness of the arms and legs. For this test, a healthcare professional attaches electrodes to your wrist, the back of your knee, or other locations. He or she will apply a mild electrical stimulus through the electrodes. Electrodes on your scalp then determine the amount of time it takes for the current to travel along the nerves to the brain.

Brainstem auditory evoked response (BAER) test

•This test can diagnose hearing ability and can point to possible brainstem tumors or multiple sclerosis. A healthcare professional places electrodes on your scalp and earlobes and delivers auditory stimuli, such as clicking noises and tones, to one ear.

Visual evoked response (VER) test.

•This test can diagnose problems with the optic nerves that affect sight. A healthcare professional places electrodes along your scalp to record the electrical signals as you watch a checkerboard pattern flash for several minutes on a screen.

a subdural hematoma (think more commonly venous).

⦁ A clot that forms between the brain and the dura is called a

epidural hematoma (think middle meningeal artery).

⦁ A clot that forms between the skull and the dura lining of the brain is called an

an intracerebral hematoma

⦁ A clot that forms deep within the brain tissue itself is called . Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.

Chronic Traumatic Encephalopathy

⦁ Repeated concussive incidents can lead to a syndrome known as.This syndrome has been recognized in those participating in contact sports such as football and boxing. The presentation is similar to Alzheimer disease, characterized by personality changes, memory impairment, and speech and gait disturbances. Imaging findings show gross cerebral, particularly temporal lobe, atrophy.

SUBARACHNOID HEMORRHAGE

⦁ The most common symptom is a sudden severe headache, often characterized as "the worst headache of my life." This headache occurs in up to 97 percent of cases. ⦁ Other symptoms include vomiting, fainting, temporary loss of consciousness during the headache, and blurred or double vision. ⦁ The presence of blood circulating in the subarachnoid space also may lead to neck stiffness and low back pain due to irritation of nerve roots in the lower back.

The SUBARACHNOID HEMORRHAGE

⦁ Treatment generally occurs in three phases: ⦁ Early intensive care focuses on support of vital functions of the body, preventing high blood pressure, renewed bleeding and seizures. ⦁ Surgery to stop the bleeding within 24 to 36 hours of onset of symptoms. ⦁ Late intensive care treats vasospasm by elevating blood pressure and blood volume.