Major Exam 2, 4322, Health Alterations
Cushing's test results
(Remember: *UP, UP, UP, DOWN, UP*) HYPERnatremia HYPERtension INCREASED blood volume HYPOkalemia HYPERglycemia
whole muscle parts
-fascia -epimysium -perimysium -endomysium
bone repair stages
-inflammation/hematoma formation -procallus formation -callus formation -callus replacement -remodeling
3 phases of bone remodeling
1) activation of the remodeling cycle 2) resorption 3) formation of new bone
Mg normal range adult
1.5-2 mEq/L
Normal CSF volume
125-150 mL
how many bones in the appendicular skeleton?
126
how many bones are in our body?
208
In the MMSE, a score of _____ out of 30 or above indicates a normal test.
24
In the Mini-Cog, a score of _____ or higher is considered negative for dementia.
3
how long does the process of bone remodeling take?
3-6 months
K normal range
3.5-5 mmol/L
CSF is produced at a rate of about
500 mL per day (and is absorbed at the same rate so we normally have only about 150-175 mL in circulation)
Normal ICP
7-15 mmHg
BUN normal range adult
8-21 mg/dL
how many bones in the axial skeleton?
80
compact bone makes up how much of the skeletal?
85%
Cl normal range adult
95-105 mmol/L
Non-pharmacological treatments for Alzheimer's
A team approach consisting of social workers, occupational therapists, psychologists, and speech therapists is important in prolonging independence and supporting the family
Which disorders are tested for when a cosyntropin stimulation test is used? A Cushing's B Addison's C Diabetes insipidus Pheochromocytoma D Syndrome of inappropriate antidiuretic hormone (SIADH)
A, B
Which principles should the nurse remember when caring for a client with spinal shock? Select all that apply. A It involves all skeletal muscles below the lesion. B Poor venous circulation occurs below the lesion. C It causes increased muscle tone below the lesion. D No disruption of thermal control occurs below the lesion. E It is characterized by an incomplete loss of reflex function below the lesion.
A, B
A nurse teaches the client about the meninges surrounding the brain. Which information indicates successful teaching? Select all that apply. A Arachnoid B Dura mater C Anterior horn D Anterior fossa E Choroid plexuses
A, B The meninges are the dura mater, the arachnoid, and the pia mater. The anterior or ventral horn contains nerve cell bodies for efferent pathways leaving the spinal cord. The anterior fossa is the location where the frontal lobe lies. The choroid plexuses are structures that produce the cerebrospinal fluid.)
Which disorders result in a deficiency of thyroid hormones and would require thyroid hormone replacement therapy? Select all that apply. A Cretinism B Myxedema C Graves' disease D Hashimoto's thyroiditis E Type 1 diabetes mellitus
A, B, D
Which findings on magnetic resonance imaging (MRI) would be consistent with hydrocephalus? Select all that apply. A Compression of brain tissue B Flattening of the cerebral sulci C Atrophy of brain on volumetric MRI D Enlargement of the cerebral ventricles E Characteristic white matter lesions of demyelination
A, B, D
Which is accurate regarding suppression testing for pheochromocytoma? A This is a safe test. B This test is nearly 100% accurate. C Cortisol samples will be drawn for testing. D The goal of the test is to suppress the secretion of corticotropin-releasing hormone. E Pheochromocytoma will cause no suppressive effect on catecholamines after clonidine administration.
A, B, E
Which are accurate statements regarding imaging in Alzheimer's disease? Select all that apply. A Volumetric MRI shows progressive atrophy. B CT of the brain provides no useful information. C MRI and CT are useful to rule out other conditions that may cause dementia. D MRI and CT of the brain, with or without contrast, are usually normal in Alzheimer's disease. E MRI of the brain in Alzheimer's disease shows characteristic white patches in the white matter.
A, C
On the Mini Mental State Exam, an individual is given a total of 12 points. What does this indicate? A The individual needs further testing. An abnormal MMSE screen indicates the need for further testing. B The individual does not need further testing. This individual has an abnormal MMSE score, which means that the person may have cognitive impairment and needs further testing. C The individual has normal cognitive function. A score below 24 on the MMSE indicates abnormal cognitive function. D The individual has moderate cognitive impairment. A score of 12 on the MMSE is consistent with moderate cognitive impairment. E The test was scored incorrectly, since the maximum score is only 5. The maximum score on the MMSE is 30, while the maximum score on the Mini-Cog is 5.
A, D
Which is accurate information regarding a scintiscan of the thyroid gland? A Images of the thyroid will be captured on film. B The large scintigraphy camera will pass over the chest and abdomen. C A radioactive substance is given after the imaging is performed. D The imaging will provide information about the size, shape, and position of the thyroid gland. E The uptake of radionuclear substance will provide information about the physiologic function of the thyroid gland.
A, D
Which are accurate statements regarding the Tensilon test? A Tensilon inhibits acetylcholinesterase in the myoneural junction. B The Tensilon test is useful for diagnosing early Parkinson's disease. C Elevated blood levels of Tensilon are diagnostic of myasthenia gravis. D Tensilon causes an increase in acetylcholine in the myoneural junction. E Tensilon causes rapid, but temporary, improvement in symptoms of myasthenia gravis.
A, D E
Paresis and paralysis
A. Upper motor neuron syndromes
Corticosteroid drugs
ACTH Prednisone Methylprednisolone
Corticosteroid drugs
ACTH prednisone methylprednisolone (Drugs for Managing Exacerbations)
Executive attention deficits
ADHD
spina bifida diagnostic tests
AFP elevated in maternal blood (leaked from defect, specimen obtained at 16-18 wks of gestation via amniocentesis) Prenatal ultrasound and/or amniotic fluid analysis
Parasomnias
Abnormal behaviors such as nightmares or sleepwalking that occur during sleep.
thrombotic stroke
Accounts for more than half of all strokes Commonly associated with development of atherosclerosis Gradual occlusion of arteries—slow onset
Which adrenal gland disorder frequently requires treatment with hydrocortisone? Cretinism Addison's disease Cushing's syndrome Pheochromocytoma
Addison's
3 portions of nervous system responsible for sensation and perception of pain
Afferent pathways Interpretive centers Efferent pathways
Predisposing factor for type II diabetes
Age: Obesity: Race and ethnicity: Metabolic syndrome: Prediabetes:
Acute pain
Alerts of a condition or experience that is immediately harmful and causes prompt action to relieve it
Myositis ossificans
Also called heterotopic ossification Late complication of local muscle injury Associated with burns, joint surgery, and trauma to the musculoskeletal system or central nervous system Soft tissue calcification causes stiffness or deformity of an extremity
Migraine triggers
Altered sleep patterns Skipping meals Overexertion Weather change Stress or relaxation from stress Hormonal changes (menstrual periods) Excess afferent stimulation (bright lights, strong smells) Chemicals (alcohol or nitrates)
Manifestations of Gout
An increase in serum urate concentration (hyperuricemia) Recurrent attacks of monoarticular arthritis (inflammation of a single joint) Deposits of monosodium urate monohydrate (tophi) in and around the joints Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels Formation of renal stones
Thrombotic stroke
Arterial occlusions caused by thrombi formed in arteries supplying the brain or in the intracranial vessels
Neurologic function increases as
As the inflammation subsides (The inflammation and pressure in the brain must be minimized as quickly as possible, and therapy instituted to dissolve thrombi and maintain adequate perfusion to limit the area of permanent damage.)
Dislocation and Subluxation
Associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
Hypoperfusion
Associated with systemic hypoperfusion resulting in inadequate blood supply to brain
Clinical Stages of gout
Asymptomatic hyperuricemia Acute gouty arthritis Tophaceous gout
Immunosuppressant
Avoid contact with large crowds and people who have an infection. Side effects include cardiotoxicity, leukemia, and infertility. Pregnancy should be avoided.
Immunosuppressant drugs properties
Avoid contact with large crowds and people who have an infection. Side effects include cardiotoxicity, leukemia, and infertility. Pregnancy should be avoided.
Immunosuppressant properties
Avoid contact with large crowds and people who have an infection. Side effects include cardiotoxicity, leukemia, and infertility. Pregnancy should be avoided.
Muscle relaxants properties
Avoid driving and similar activities due to sedative effects. Do not abruptly stop therapy. Avoid use with tranquilizers and alcohol.
muscle relaxant properties
Avoid driving and similar activities due to sedative effects. Do not abruptly stop therapy. Avoid use with tranquilizers and alcohol.
SAIDH treatment
Avoid or stop medications that stimulate the release of ADH. In cases of severe hyponatremia (less than 120 mEq/L), hypertonic saline solution (3%) may be slowly administered. A diuretic such a furosemide (Lasix) may be used if the serum sodium is at least 125 mEq/L because it may promote a further loss of sodium. Sodium supplements may be needed: tolvaptan (Samsca) and conivaptan (Vaprisol)
Number of exacerbations
Avoidance of excessive fatigue, stress, injury, or infection
The nurse is assessing a patient with a history of spinal shock. After assessing the patient, the nurse finds that the patient has developed dysreflexia. Which findings support the nurse's opinion? Select all that apply. A The patient's body temperature is 33.2 o C. B The patient's heart rate is 32 beats/minute. C The patient's blood pressure is 240/110 mm Hg. D The patient's respiratory rate is 15 breaths/minute. E The patient's fasting blood glucose level is 110 mg/dl.
B, C
Which are accurate statements regarding laboratory studies used for Alzheimer's disease? Select all that apply. A Presence of markers in cerebrospinal fluid is a definitive diagnostic test. B Cerebrospinal fluid analysis helps identify markers of Alzheimer's disease. C Brain biopsy showing neurofibrillary tangles is a definitive diagnostic test. D Cerebrospinal fluid analysis for tau protein and beta amyloid is a common clinical diagnostic test. E Laboratory studies are usually normal in preclinical Alzheimer's disease, but become abnormal with late dementia.
B, C
Which diagnostic tests are abnormal in myasthenia gravis? Select all that apply. A MSAFP B Tensilon test C Anti-MuSK antibodies D Complete blood count E Cerebrospinal fluid analysis for amyloid
B, C
Which tests are consistent with the causes of acquired hydrocephalus? A Blood count B CSF analysis showing cancer cells C Lumbar puncture showing red blood cells D Lumbar puncture showing evidence of infection E Elevated maternal serum alpha-fetoprotein during pregnancy
B, C D
Which diagnostic tests are anticipated for a patient with suspected neurogenic diabetes insipidus? A Kidney scan B MRI of brain tissue C CT scan of the lungs D CT scan of the pituitary gland E MRI of the adrenal gland
B, D
Which statements are accurate regarding the HbA1c laboratory test? A The goal of the HbA1c test is to achieve 10% or less. B The HbA1c test monitors long-term control of diabetes. C The HbA1c test will be repeated every three weeks until stable. D The HbA1c test will be drawn at 1 and/or 2 hours after eating. E The HbA1c test indicates excess glucose attached to red blood cell hemoglobin.
B, E
Immunomodulator drugs
B-1a interferon (Rebif, Plegridy, Avonex) B-1b interferon (Betaseron, Extavia) Glatiramer acetate (Copaxone) Teriflunomide (Aubagio)
Immunomodulator drugs
B-1a interferon (Rebif, Plegridy, Avonex) B-1b interferon (Betaseron, Extavia) Glatiramer acetate (Copaxone) Teriflunomide (Aubagio) (disease modifying)
extrapyramidal motor syndromes
Basal ganglia motor syndromes Cerebellar motor syndromes
Which symptom of Alzheimer's would warrant a prescription of olanzapine (Zyprexa)? Depression Sleep disturbances Behavioral problems Decreased memory and cognition
Behavioral problems
Treatments for elimination problems Alzheimer's
Behavioral retraining of bladder and bowel function (e.g., scheduled toileting) may help decrease episodes of incontinence. Constipation related to immobility, dietary intake (reduction in fiber), and decreased fluid intake may also occur. Patients should increase dietary fiber, fiber supplements, and use stool softeners. Use of mineral oil, stimulants, osmotic agents, and enemas may be associated with increased risk of complications due to the combination of aging, other health problems, and swallowing difficulties.
Bowing
Bending of bone
cholinergic drugs
Bethanechol (Urecholine) Neostigmine
cholinergic drugs
Bethanechol (Urecholine) Neostigmine (Drugs for symptom management)
Osteomyleitis
Bone infection often caused by bacteria, usually Staphylococcus aureus Hematogenous Pathogens carried through the bloodstream Cutaneous, sinus, ear, and dental infections Insidious onset Vague symptoms Fever, malaise, anorexia, weight loss, and pain Contiguous Infection spreads to an adjacent bone Open fractures, penetrating wounds, surgical procedures Manifested by signs and symptoms of soft tissue infection Low-grade fever, lymphadenopathy, local pain, and swelling Brodie abscesses Characterize subacute or chronic osteomyelitis Circumscribed lesions, usually in the ends of long bones Treatment Antibiotics, débridement, surgery, hyperbaric oxygen therapy
Osteomyleitis
Bone infection often caused by bacteria, usually Staphylococcus aureus Hematogenous Pathogens carried through the bloodstream Cutaneous, sinus, ear, and dental infections Insidious onset Vague symptoms Fever, malaise, anorexia, weight loss, and pain
Greenstick
Break in one cortex of bone with splintering of inner bone surface Commone in children and elderly
Torus
Buckling of cortex
A client presents with a large pupil that does not react to light. Which cranial nerve (CN) will the nurse report as altered? A CN I B CN II C CN III D CN VII
C
A patient experiences edema in the brain caused by movement of cerebrospinal fluid from the ventricles into the extracellular space. What type of edema does this describe? a. ischemic b. cytotoxic c. interstitial d. vasogenic
C
What causes the formation of lichenification? A Dry skin B Skin that has been burned C Frequent friction to the skin D Prolonged pressure to the skin
C
Which diagnostic testing is used for Addison's disease? A Metanephrine B Heel stick screening C 24-hour urine for cortisol D Glucose tolerance testing
C
Which laboratory test is useful for diagnosing spina bifida? A Abnormal white blood count B Cerebrospinal fluid analysis for tau protein C Maternal serum alpha-fetoprotein (MSAFP) D Abnormal serum protein levels, especially amyloid
C
Which statement describes the hypodermis? A It secretes sebum into the pores. B It contracts when it is cold outside. C It is made of a loose, fibrous tissue. D It is composed of heavily keratinized epidermal cells.
C
Which term should the nurse use to describe an arterial bleed from the blood vessels that lie within the grooves of the skull? A Choroid plexuses B Cerebrospinal fluid C Epidural hematoma D Subdural hematoma
C
Which test finding related to urine osmolality indicates that a patient has a nephrogenic source of diabetes insipidus? A Urine osmolality increases. B Urine osmolality decreases. C Urine osmolality remains the same. D Urine osmolality value is needed to determine a neurogenic or nephrogenic cause.
C
Which information from the staff indicates teaching by the nurse was successful for saccular aneurysms? Select all that apply. A They grow rapidly. B They occur commonly in childhood. C They may be round, broad-based, or cylindrical. D Saccular aneurysm is another name for an arteriovenous malformation. E They can be due to a combination of congenital and degenerative changes.
C, D
A person who has suspected bacterial meningitis would be prescribed which medications immediately following a lumbar puncture (LP)? Doxycycline (Doryx) Gentamicin (Gentak) Penicillin (Ampicillin) Ceftriaxone (Rocephin) Vancomycin (Vancocin)
C, D, E
Which are three protective functions of the skin? A Sensing vibrations B Producing vitamin D C Releasing waste products D Defending against pathogens E Keeping the body cool or warm
C, D, E
Age related osteoporosis
Cause unclear Reduced physical activity is likely a factor
Secondary osteoporosis
Caused by other conditions Hormonal imbalances Medications Disease
Seizures are classified by
Clinical manifestations Site of origin EEG correlates Response to therapy
Clinical Manifestations of Cerebrovascular Accident: Nervous System Dysfunction
Cognitive changes motor changes sensory changes cranial nerve dysfunction
Additional risk factors of CVSs and TIAs
Combination of severe or long-term hypertension along with atherosclerosis can increase risk in the elderly patient for an intervertebral hemorrhage Other risk factors for TIAs and CVAs include: Emboli or blood clots arising from atheromas (the fatty material that forms plaques in the arteries) Acute myocardial infarction Atrial fibrillation Endocarditis
A client experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. Which type of fracture did the client experience? Simple Dislocation Compressed Comminuted
Comminuted
Avulsion, again
Complete separation of a tendon or ligament from its bony attachment site
Manifestations of spinal cord tumors
Compressive syndrome Irritative syndrome
Lack of blood supply to middle cerebral artery
Contralateral paralysis and sensory loss primarily in upper body and arm
A nurse is asked which cells form the client's myelin sheaths in the peripheral nervous system. How should the nurse respond? A It is the neurons. B It is the microglia. C It is the astrocytes. D It is the Schwann cells.
D
The nurse teaches nursing students about the organization of the nervous system. Which instructions, if given by the nurse, are accurate? Select all that apply. A The spinal cord is part of the peripheral nervous system. B The central nervous system is composed of cranial nerves. C The somatic nervous system is part of the central nervous system. D The afferent pathways carry sensory impulses toward the central nervous system. E The autonomic nervous system is divided into the sympathetic and parasympathetic. F The efferent pathways or descending pathways innervate skeletal muscles or effector organs.
D, E, F
nerve conduction enhancers
Dalfampridine (Ampyra)
nerve conduction enhancer drugs
Dalfampridine (Ampyra) (Drugs for symptom management)
Ataxic Cerebral Palsy
Damage to the cerebellum Loss of balance and coordination
Dyskinetic disease
Damage to the extrapyramidal tract, basal nuclei, cranial nerves Manifested by athetoid or choreiform involuntary movements
A patient is prescribed rivastigmine (Exelon) for Alzheimer's disease. Which symptom of Alzheimer's does this medication target? Depression Sleep disturbances Behavioral problems Decreased memory and cognition
Decreased memory and cognition
hypokinesia
Decreased movement Akinesia Bradykinesia Loss of associated movement
Hydrocephalus causes
Decreased reabsorption Increased fluid production Obstruction within the ventricular system
Tremors (not manageable by drugs)
Deep brain stimulation Thalamotomy
Disorders of the sleep-wake schedule causes
Desynchronize circadian rhythm which can depress the degree of vigilance, performance of psychomotor tasks and arousal rapid time-zone changes (jet lag) alternating the sleep schedule (rotating work shifts)
antihistamine drugs for Parkinson's
Diphenhydramine
Antihistamines mode of action
Diphenhydramine has an anticholinergic effect.
Disorders of Awareness Pathophysiology
Direct destruction caused by ischemia Indirect destruction caused by compression Effects of toxins, chemicals, or metabolic disorders
Which is the first step performed when a human is suspected of being exposed to an animal bite? Analysis of CSF Western blot test Enzyme immunoassay Direct fluorescent antibody (DFA) test
Direct fluorescent antibody (DFA) test
cranial nerve dysfunction
Dysphagia (trouble swallowing) Facial paralysis Absent gag reflex Impaired tongue movement Nystagmus (involuntary movements of the eye) Pupil constriction or dilation Ptosis (eye lid dropping)
Cerebral palsy treatments require
Early stimulation, which encourages motor skills, coordination, and intellectual development are vital. Hearing and vision require monitoring, and some form of communication must be developed during the early stages
Opiate drugs that relieve pain by attaching to opiate receptors and enhancing the natural endogenous opioid response Have potent analgesic effects
Endomorphins (exogenous)
GI tract pain stimuli
Engorged or inflamed mucosa Distention or spasm of smooth muscle Traction on mesenteric attachment
Catechol-O-methyltransferase (COMT) inhibitors
Entacapone (Comtan) Tolcapone ( Tasmar)
contusions can cause
Epidural hematomas Subdural hematomas Intracerebral hematomas
Causes of hydrocephalus
Evidence of CNS infections such as meningitis Brain tumors (CSF showing cancer cells) Head trauma Intracranial hemorrhage
Conservative Treatment for OA
Exercise and weight loss Pharmacologic therapies Analgesics and anti-inflammatories Nutritional supplements
Sphingosine 1-phoshpate receptor modulator drugs
Fingolimod (Gilenya)
Oblique
Fracture line at an angle to long axis of bone
Menigitis
Fungal, bacterial, and viral
Nonmodifiable risk factors for CVA/TIA include:
Gender Genetics Age
antipsychotic drugs (neuroleptics)
Haloperidol (Haldol) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Abilify)
Closed brain injury
Head strikes hard surface or a rapidly moving object strikes the head The dura remains intact and brain tissues are not exposed to the environment Causes focal (local) or diffuse (general) brain injuries
Addison's treatment
Hydrocortisone therapy is most commonly used as it has glucocorticoid and mineralocorticoid properties Daily mineralocorticoid [fludrocortisone (Florinef)] replacement therapy. May require increased doses of hydrocortisone in times of stress such as hospitalization or surgery
Dynorphins are found in
Hypothalamus Medulla Periaqueductal gray Spinal dorsal horn
Damage to which cranial nerve affects the size and response time of the pupils with increased intracranial pressure (ICP)? I II III IV
III
Types of DM treatment
Insulin Oral hypoglycemics Noninsulin injectables
Causes of type II diabetes
Insulin resistance, or decreased effectiveness of the cells' insulin receptors in the body. Insulin deficit, in which the body may not be producing enough insulin.
Other common areas of dysfunction in cerebral palsy
Intellectual function communication of speech seizures visual problems
noncommunicating hydrocephalus
Internal. Intraventricular
Activation of noiceptors causes
Ion channels (Na, Ca) to open
Changes in vital signs include the three classic signs or responses to increased ICP, known as Cushing's triad:
Irregular or slowing respirations Bradycardia Widening pulse pressure (increased systolic blood pressure with unchanged diastolic)
A nurse is caring for a client with encephalitis. Which information should the nurse remember when planning care for this client? It is an afebrile illness. It is treated with chemotherapy. It is caused exclusively by herpes simplex II. It is usually a result of arthropod borne viruses.
It is usually a results of arthropod borne viruses
manifestions of cerebrovascular disorders
Kernig sign Brudzinski sign
cranial nerve neurons
LMNs that are known as the "final common pathway"
Postconcussion syndrome
Lasts for weeks or months post concussion Symptomatic relief with observation
Risk Factors for gout
Male sex Increasing age High intake of alcohol, red meat, and fructose Drugs
antithyroid drugs
Methimazole (Tapazole) propylthiouracil (PTU) (Used in young patients and pregnant women)
Stress
Microfracture
Postmenopausal osteoporosis
Middle-aged and older women Estrogen deficiency and secondary causes Remodeling imbalance between the activity of osteoclasts and osteoblasts
Immunosuppressant drugs
Mitoxantrone Dimethyl fumarate (Tecfidera)
TIA facts
More than one-third of people who have a TIA and do not get treatment have a major stroke within 1 year. As many as 10% to 15% of people will have a major stroke within 3 months of a TIA.1 In the United States, someone has a stroke every 45 seconds.2 Strokes account for 1 out of 15 deaths each year. 2 Stroke is the fifth leading cause of death in the United States and is a major cause of adult disability. About 800,000 people in the United States have a stroke each year. One American dies from a stroke every 4 minutes, on average.
An acquired chronic autoimmune disease where IgG antibody is produced against acetylcholine receptors (antiacetylcholine receptor antibodies)
Myasthenia gravis
monoclonal antibody drugs
Natalizumab (Tysabri) Alemtuzumab (Lemtrada) Daclizumab (Zinbryta)
neurophysiologic pain
Nociceptive (somatic and visceral) neuropathic
Which elevated lesion can be caused by squamous cell carcinoma? Papule Vesicle Nodule Pustule
Nodule
Improper reduction or immobilization
Nonunion, delayed union, and malunion
focal brain injury
Observable brain lesion Force of impact usually produces contusions Closed brain injury
Lacunar stroke
Occlusion of single, deep perforating artery causing ischemic lesions (Rare)
primary spinal cord injury
Occurs with initial mechanical trauma and immediate tissue destruction Inadequate mobilization following injury May occur in absence of vertebral fracture or dislocation
neurogenic shock
Occurs with injury above T5 Caused by absence of sympathetic activity and unopposed parasympathetic tone
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Pain
Skin care Alzheimer's
Patient's skin should be monitored over time. Areas of rashes, redness, and skin breakdown should be treated immediately. During later stages, the patient is at risk for skin breakdown due to incontinence along with immobility and undernutrition. Caregivers should ensure that the skin is kept dry and clean. Caregivers should ensure the patient's position is changed regularly to avoid areas of pressure over bony prominences.
cholinergic drugs properties
Patients should consult with a health care provider (HCP) before using other drugs (including over-the-counter drugs).
cholinergic properties
Patients should consult with a health care provider (HCP) before using other drugs (including over-the-counter drugs).
Maintaining mobility
Physical therapy and exercise
Ongoing treatment of Parkinson's
Physical therapy helps maintain general mobility. Exercise that encourages use of the arms and forceful movements is helpful. Improving balance, coordination, and safe use of adaptive devices with the aid of an occupational therapist is recommended. Constant monitoring for urinary and respiratory tract infections to decrease the risk of organ damage is necessary.
neurological disfunction
Physical therapy such as water therapy which gives buoyance to the body and allows the patient to have more control over the body
Monoclonal antibody properties
Pregnancy should be avoided. Side effect of natalizumab is, increased risk of progressive multifocal leukoencephalopathy. Alemtuzumab is reserved for patients with inadequate response to two or more drugs indicated for MS.
monoclonal antibody
Pregnancy should be avoided. Side effect of natalizumab is, increased risk of progressive multifocal leukoencephalopathy. Alemtuzumab is reserved for patients with inadequate response to two or more drugs indicated for MS.
monoclonal antibody drugs properties
Pregnancy should be avoided. Side effect of natalizumab is, increased risk of progressive multifocal leukoencephalopathy. Alemtuzumab is reserved for patients with inadequate response to two or more drugs indicated for MS.
Skin pain stimuli
Pricking Cutting Crushing Burning Freezing
Myasthenia Gravis (MG)
Pyridostigmine (Mestinon) and neostigmine (Prostigmin) are anticholinesterase agents which may be used to improve neuromuscular transmission temporarily. Glucocorticoids such as prednisone effectively suppress the immune system.
Hypoglycemia (Insulin Shock)
RAPID ONSET! S/S Include: -cool, sweating -hunger -weakness -tingling/numbness -cranky/aggressive -fast pounding heart -blurred vision
The different types of insulin are
Rapid-acting insulin: lispro, aspart Short-acting insulin: regular Intermediate-acting insulin: NPH Long-acting insulin: glargine, detemir Combination insulin: NPH/regular, lispro protamine/lispro
CSF analysis in traumatic brain injury and bleeding
Red blood cells
3 modes of action of oral/noninsulin injectables
Reduces insulin resistance by increasing tissue sensitivity to insulin Stimulates the beta cells of the pancreas to increase insulin release Decreases hepatic glucose production
Disuse Atrophy
Reduction in the normal size of muscle cells as a result of prolonged inactivity Bed rest Trauma (casting) Local nerve damage Prevention Isometric movements Passive lengthening exercises
survivors of cerebral death
Remain in coma Emerge into a persistent vegetative state Progress into a minimal conscious state (MCS) Locked-in syndrome
Transcortical-mixed motor and sensory, nonfluent
Repeats words and phrases spoken to them
Dietary modifications for diabetes insipidus
Replace fluid orally or IV depending upon severity in order to replace lost fluids from increased urinary output. For nephrogenic: Limit sodium intake to no more than 3 g/day as limiting sodium to aid in decreasing urine output
image processing amnesia symptoms
Reports by others of frequent misinterpretation of data failure to conceptualize or generalize information
Compartment Syndrome
Result of increased pressure within a muscle compartment Can be caused by any condition that disrupts the vascular supply to an extremity Muscle ischemia causes edema, rising compartment pressure, and tamponade that lead to muscle infarction and neural injury can do faciotomy
spastic paralysis
Results from damage to the pyramidal tracts, motor cortex, general cortical damage Characterized by hyperreflexia
Increased Ammonia
Results from impaired hepatic (liver) function
increased Bilirubin
Results from impaired hepatic function
Which are surgical treatment options for a patient with multiple sclerosis? Colectomy Rhizotomy Cordotomy Craniotomy Neurectomy
Rhizotomy Cordotomy Neurectomy
respond to deep sustained pressure, stretch, and joint position
Ruffini endings
Which common pituitary gland disorder frequently requires treatment with furosemide (Lasix)? Acromegaly Addison's disease Diabetes insipidus Syndrome of inappropriate antidiuretic hormone (SIADH)
SIADH
Transchondral
Separation of cartilaginous joint surface from main shaft of bone
inhibitory neuromodulators that stimulate peripheral nerves but inhibit central nerves
Seratonin Norepinephrine
Parkinson disease
Severe degeneration of the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway
Manifestations of acute gouty attack
Severe pain, especially at night Hot, red, tender joint Signs of systemic inflammation Increased sedimentation rate Fever Leukocytosis
heat cramps
Severe spasmodic cramps in the abdomen and extremities following prolonged sweating and associated sodium loss Common in individuals not accustomed to heat or those performing strenuous work in warm climates Fever, rapid pulse, and increased blood pressure often accompany the cramps
Hydrocephalus signs and symptoms
Signs of increasing CSF depends on age of patient; pupil response light to sluggish; scalp veins appear dilated Infant Lethargic, irritable, difficult to feed Eyes show "sunset sign"—white sclera visible above colored pupil High-pitched cry when moved or picked up Must be diagnosed and treated as soon as possible to minimize brain damage
Brain Tumor
Since tumors of the brain are generally slow-growing, the onset of signs and symptoms is gradual There may be headaches, motor weakness, difficulty with ambulation, and trouble speaking If the tumor is in the frontal lobe, patients may have personality changes and hallucinations that are first noticed by family members Brain tumors may be found incidentally as a part of staging assessment for other primary cancers Laboratory studies are generally normal, other than in cases involving the pituitary gland A lumbar puncture with cerebrospinal fluid (cytology and chemistry) analysis may show blood, elevated protein, and presence of cancer cells.
A normal cyclic process that restores the body's energy and maintains normal functioning
Sleep
Descartes theory that proposes that there are specific pain receptors in the body that project to the brain and that the intensity of pain is directly related to the amount of associated tissue injury
Specificity theory of pain
Early intervention for Parkinson's
Speech and language pathologists are used to maintain functioning for as long as possible.
visual impairment or speech disorders
Speech and language pathologists to maximize communication and aid with some feeding problems Speech therapy
Types of Spina Bifida
Spina bifida occulta meningocele myelomeningocele
degenerative disk disease
Spondylolysis Spondylolisthesis Spinal stenosis
Surgical treatment for Cushing's
Standard treatment is surgical removal of the pituitary tumor (hypophysectomy) using a transsphenoidal approach if the underlying cause is a pituitary adenoma. Radiation therapy may also be used for patients who are not good surgical candidates. Adrenalectomy is indicated for Cushing's syndrome caused by adrenal tumors or hyperplasia. Patients with ectopic ACTH-secreting tumors are best managed by locating and removing the tumor (usually lung or pancreas).
Muscle Strain
Sudden, forced motion causing the muscle to become stretched beyond its normal capacity Can also involve the tendons Healing in three phases Destruction Repair Remodeling
somatic pain
Superficial arising from the skin, typically well localized, described as sharp, dull, aching, or throbbing
Gout
Syndrome caused by either overproduction or underexcretion of uric acid Manifests high levels of uric acid in the blood and other body fluids Occurs when the uric acid concentration increases to high enough levels to crystallize Crystals deposit in connective tissues throughout the body When these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis Linked to purine metabolism
Joint pain stimuli
Synovial membrane inflammation
Endocrine Disorders
Systemic effects of hormonal imbalance overshadow muscular symptoms
CVA that lasts less than one hour and results from an ischemic event
TIA (mini stroke)
2 types of CVAs
TIA (transient ischemic attack) thrombotic stroke
Sprain
Tear or injury to a ligament
Strain
Tearing or stretching to a tendon or muscle
Which pharmacologic agents are classified as disease-modifying drugs and used for multiple sclerosis (MS)? Select all that apply. Oxybutynin (Ditropan XL) Teriflunomide (Aubagio) Bethanechol (Urecholine) Dimethyl fumarate (Tecfidera) Glatiramer acetate (Copaxone)
Teriflunomide Dimethyl fumarate Glatiramer acetate
selective attention
The ability to select certain stimuli in the environment to process, while ignoring distracting information. Sensory inattentiveness Selective attention deficit
body heat is produced by
The chemical reactions of metabolism and skeletal muscle tone and contraction
Pain transmission is modulated by a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a "gate" that regulates the pain transmission to higher centers in the CNS
The gate control theory
Analysis of Metabolites and Electrolytes
The levels of many metabolites like ammonia, bilirubin and blood urea nitrogen (BUN) are important as increased levels may toxically affect the brain, a condition known as metabolic encephalopathy.
Toxic Myopathies
The most common cause of toxic myopathy is alcohol abuse Acute attack of muscle weakness, pain, and swelling Chronic weakness in a drinker of long duration Necrosis of individual muscle fibers Other causes include lipid-lowering agents (fibrates and statins), antimalarial drugs, steroids, thiol derivatives, and narcotics
The brain produces patterns of nerve impulses drawn from various inputs, including genetic, psychologic, and cognitive experiences
The neuromatrix theory
S/S of TIAs
The patient remains conscious. Intermittent short episodes of impaired function, such as muscle weakness in an arm or leg, visual disturbances, or numbness and paresthesia in the face, may occur. Temporary aphasia or confusion may develop. The attack may last a few minutes or longer, but typically resolves within 24 hours. Repeated attacks are frequently a warning of the development of an obstruction related to atherosclerosis. Such attacks should be investigated immediately and treatment instituted, depending on the cause, to prevent progression and possible permanent brain damage.
Craniotomy procedure
The surgeon drills a set of burr holes and uses a saw to connect the holes to remove the bone flap. After surgery, the bone flap is secured with small plates or wired shut. Drains may be placed to remove fluid and blood. Patients are then cared for in the ICU until stable.
dopamine precursors mode of action
These drugs are converted to dopamine in basal ganglia. Signs of dyskinesia should be monitored. Report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands, legs; mental changes; palpitations; severe nausea and vomiting; and difficulty urinating.
Anticholergic drugs mode of action
These drugs block cholinergic receptors.
MAOIs mode of action
These drugs block the breakdown of dopamine.
Immunomodulator drugs properties
These drugs modify disease progression and prevent relapses. Flu-like symptoms should be treated with acetaminophen. These drugs are given subcutaneously. These drugs have anti-inflammatory properties. They may cause serious liver disease, and liver tests should be monitored. Pregnancy should be avoided.
Immunomodulators
These drugs modify disease progression and prevent relapses. Flu-like symptoms should be treated with acetaminophen. These drugs are given subcutaneously. These drugs have anti-inflammatory properties. They may cause serious liver disease, and liver tests should be monitored. Pregnancy should be avoided.
COMT inhibitors mode of action
These drugs slow the breakdown of levodopa and therefore prolong the action of levodopa.
dopamine receptor agonists mode of action
These drugs stimulate dopamine receptors. Side effects of Parlodel include high blood pressure, seizure, heart attack, and stroke.
convulsion
Tonic-clonic (jerky, contract-relax) movements associated with some seizures
Causes of ICP
Too much cerebrospinal fluid (the fluid around brain and spinal cord) Bleeding into the brain Swelling in the brain Aneurysm Blood pooling in some part of the brain Brain or head injury Brain tumor Infections such as encephalitis, meningitis, or abscess Hydrocephalus High blood pressure Stroke
Bilirubin normal range adult
Total bilirubin: 2-20 µmol/LDirect bilirubin: 1.7-5.1 µmol/L
Anticholinergic drugs for Parkinson's
Trihexyphenidyl Benztropine (Congentin)
Viral, bacterial, and parasitic myositis
Tuberculosis and sarcoidosis Trichinellosis Toxoplasmosis Staphylococcus aureus
sensory changes
Unaware of existence of paralyzed side Amaurosis fugax (blindness in one eye) Hemianopsia (blindness in half of the visual field)
brain cells that are the source of the "descending motor pathways"
Upper motor neurons (UMNs)
Tendon or Ligament Injuries
Usually lack sufficient strength to withstand some stress for 4 to 5 weeks after the injury Painful and are usually accompanied by soft tissue swelling, changes in tendon or ligament contour, and dislocation or subluxation of bones Rehabilitation is crucial to regaining good functional outcome
Posterior cerebral artery supplied occipital lobe
Vision loss
CSF analysis in infection due to bacteria (using glucose as the energy source)
WBCS bacteria
Which are the steps involved in a diagnosis of Lyme disease? Lipid profile Western blot test Enzyme immunoassay (EIA) Cerebrospinal fluid (CSF) analysis
Western blot enzyme immonoassay (EIA)
Treatments for Eating and Swallowing Difficulties Alzheimer's (Significant nutritional deficiencies can occur due to undernutrition, co-morbid conditions, loss of interest in food, and a decreased ability to self-feed.)
When chewing and swallowing become problematic, use pureed foods, thickened liquids, and nutritional supplements. Caregivers may need to remind patients to chew and swallow their food. Mealtime distractions such as a television should be avoided. Improve eating behaviors with the use of low lighting, music, simulated nature sounds, easy-grip eating utensils, and finger food. Liquids should be offered frequently. Nasogastric feeding or percutaneous endoscopic gastrostomy (PEG tube) may be needed when oral feeding is not possible.
A nurse is describing the part of the brain that is composed of myelinated nerve fibers. Which area of the brain is the nurse explaining? Gyri Sulci Gray matter White matter
White matter
non-REM sleep
a quiet or deep sleep state characterized by the absence of motor activity or eye movements and more regular, slow brain waves, breathing, and heart rate
iris
a ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening
Chronic pain is perceived as as meaningless and is often associated with
a sense of hopelessness as more time elapses and no cure seems possible
REM sleep
a stage of sleep characterized by rapid eye movements and a high level of brain activity occurs about every 90 minutes
Consciousness
a state of awareness both of oneself and the environment and a set of responses to that environment
regional pain
abdominal pain chest pain headache low back pain orofacial pelvic
Which are surgical treatment options for a patient with Parkinson's disease? Ablation Thymectomy Transplantation Ventriculoatrial shunt Deep brain stimulation
ablation transplantatioin deep brain stimulation
Which is the consequence of an electrolyte imbalance in the nervous system? Viral encephalitis Cerebral vascular accident Metabolic encephalopathy Abnormal brain and nerve function
abnormal brain and nerve function
parosmia
abnormal or perverted sense of smell
Paroxysmal dyskinesias
abnormal, involuntary movements that occur as spasms
sleep
active brain process that provides restorative functions and promotes memory consolidation
Temporal pain
acute (somatic, visceral) chronic
Sebum inhibits the growth of harmful?
bacteria
Physical protection:_______________ against bacteria, UV, chemicals, friction
barrier
an area of residual scar tissue and often cysts remain with a permanent loss of neurons in that area
because neurons do not regenerate
In spina bifida, sensory and motor function __________ level of herniation is impaired
below
Which signs are typical of hemorrhagic cerebrovascular accidents? Select all that apply. Aphasia Spastic paralysis Muscle weakness Blinding headache Severe neurologic deficits
binding headache severe neurologic deficits
Third degree burns
burn all the layers of the skin, burning of muscle and bone
Diabetes insipidus
caused by deficiency in ADH
central neuropathic pain
caused by lesion or dysfunction in brain or spinal cord (includes phantom pain)
The third ventricle is linked to the fourth by way of the
cerebral aqueduct (lies between the pons and medulla)
Major body trauma affects temperature regulation through
damage to CNS inflammation increased intracranial pressure intracranial bleeding accidental injuries hemorrhagic shock major surgery thermal burns
Addison's disease
deficiency in adrenocortical hormones
Infratentorial (cerebellar or tonsillar) herniation
develops when the cerebellar tonsils are pushed downward through the foramen magnum, which compresses the brain stem and vital centers, and causes death
Degenerative disk disease (DDD)
disk degeneration due to continuous vertical compression of the spine (axial loading) usually due to aging
Loss of myelin
disrupts nerve conduction with subsequent death of neurons and brain atrophy
diplopia
double vision
The nerves which carry impulses away from the brain (through the ventral root)
efferent
Fusiform muscle
elongated muscles shaped like straps and can run from one joint to another (bicep, tricep)
exogenous pyrogens
endotoxins produced by pathogens
Which are the three categories of the Glasgow Coma Scale? Eye opening Level of pain Best motor response Best verbal response Amount of seizure activity
eye opening best motor response best verbal response
Where are oil glands commonly located?
face and scalp
Migraine
familial, episodic disorder, marker is headache lasting longer than 4-72 hours, usually centralized area of pain, affects women 25-55 years
endogenous opioids
family of morphine like neuropeptides that inhibit transmission of pain impulses in the spinal cord, brain, and periphery
hyperopia
farsightedness
Alterations in movement
hyperkinesia-excessive, purposeless movement
The primary cause of hemorrhagic stroke is
hypertension
Narcolepsy is associated with
hypothalamic hypocretin (orexin) deficiency (may be related to immune-mediated destruction of hypocretin-secreting cells. There is a genetic component to the disorder)
spindles
mechanoreceptors that respond to muscle stretching
headaches
migraines cluster tension
astrocytoma
most common
neurofibroma, neurofibromatosis
nerve sheath tumors
Closed fractures
noncommunicating wound between bone and skin
Focal brain injury
observable brain lesion (tumor), force of impact typically produces contusions
Sebaceous glands are also called?
oil glands
Complications of traumatic brain injury
postconcussion syndrome posttraumatic seizures
hypoperfusion
problem with blood flow to brain
Microglia
provide phagocyte functions within the CNS
Lunule
region at base of nail that appears as a white crescent
increased BUN
results from impaired renal function
Nails are composed of a compressed layer of?
stratum corneum
neuroglia
supporting cells
Nail groove
the groove where the nail fold meets the nail plate
epilepsy
thought to be caused by genetic mutations interacting with environmental effects
Hydrocephalus treatment
- Surgery * To remove obstruction * Provides a shunt for CSF from ventricle into the peritoneal cavity or other extracranial site - Shunt will have to be replaced as child grows
The Strata of the Epidermis
-Stratum Basale -Stratum Corneum
2 Strata of the dermis include?
-Stratum papillarosum -Strata reticulosum
Stratum Basale
-deepest layer of the epidermis -located in this layer are pigment that produce melanin -in this layer cells divide and are pushed outward to the surface layer
Osteoblasts
-derived from mesenchymal stromal cells -produce type 1 collagen -respond to the parathyroid hormone -produce osteocalcin when stimulated by vitamin D -synthesize osteoid
Keratin
-epidermal cells move toward the surface of the skin that manufactures this -a protein that gives skin mechanical strength and flexibility -insoluble and serves as a diffusion barrier for the body
Haversian system parts
-haversian canal (central canal) -lamellae (concentric layers of bone matrix) -lacunae (tiny spaces between lamaellae) -osteocyte (dark spots) -canaliculi (small channels)
fibrous joint
-joins bone to bone -no joint cavity and allows little, if any movement
Stratum papillarosum
-layer located below the epidermis -papillae are projections of the dermis into the epidermis, the framework for fingerprints
articular cartilage
-layer of hyaline cartilage that covers the end of each bone -not actually in the joint, it is on the bone -microfracture injury
Dermis
-lies beneath the epidermis -composed of a dense fibrous connective tissue made up of collagen fibers -sweat glands and hair follicles are embedded -the layers of the skin are nourished by blood vessels -sensory receptors for touch, pain, and temperature -has two strata
bone remodeling
-maintenance of bone integrity--day to day wear and tear
Subcutaneous Tissue
-mammalian skin rests on a layer of this tissue -mainly composed of adipose tissue (fat tissue) -this layer helps insulate the body from enviromental temperature extremes
fascia
-not necessarily part of the muscle -three part CT framework -protect the muscle fibers, attach the muscle to bony prominences and provide a structure for a network of nerve fibers, blood vessels and lymphatic channels
Vascular supply
-nourish epidermis, hair root and dermis itself with blood supply
Epidermis
-outer layer of the skin -mature as they mature toward the surface of the skin -composed of several strata or sublayers
Stratum reticulosum
-reticular fiber layer -stretches well, but can be overstretched and can lead to stretchmarks
Arrector pill
-small muscle attached to hair root and base of epidermis -when pulled hair shaft stands up and leads to goosebumps -example of a vestigial structure in humans
2 types of glands that make up the integumentary system?
-subcutaneous -sudoriferous
osteoclasts
-the major reabsorptive cells of the bone -large, multinucleated cells -contain lysosomes filled with hydrolytic enzymes
Stratum Corneum
-the most superficial layer of the epidermis -vertebrates have no capillaries in the epidermis, the maturing cells receive less and less nourishment as they move closer to the surface of the skin
osteocytes
-transformed osteoblast that are surrounded in osteoid as it hardens as a result of minerals that enter during calcification -synthesize matrix molecules for bone calcification -give bone their tensile strength
Na normal range
135-145 mmol/L
Ammonia normal range adult
15-50 µmol/L
Ultrasound of the pregnant mother at about _____ weeks of gestation can sometimes identify spina bifida.
16
Lyme Disease testing
2 step process First step uses a testing procedure called enzyme immunoassay (EIA) or an indirect immunofluorescence assay (IFA) (if positive or indeterminate the 2nd step should be done) Second step uses a test called an immunoblot test, commonly known as a Western blot test. Results are considered positive only if the EIA/IFA and the immunoblot are both positive
A client is having problems with voluntary skeletal muscle control. Which portion of the nervous system is primarily affected? A Somatic nervous system B Autonomic nervous system C Sympathetic nervous system D Parasympathetic nervous system
A
A nurse is teaching about the structures of the nervous system. Which statement, if made by the nurse, will be appropriate to include in the teaching session? A "The spinal cord is part of the central nervous system." B "The autonomic nervous system is located in the medulla." C "The peripheral nervous system includes the cranial vault." D "The somatic nerves regulate the body's internal environment."
A
A patient with pheochromocytoma is having a suppression test done. Which drug will be administered? A Clonidine B Vasopressin C Cosyntropin D Dexamethasone
A
Which condition might explain an elevated cerebrospinal fluid level of protein, gamma globulin, and lymphocytes? A Multiple sclerosis B Parkinson's disease I C Alzheimer's disease D Congenital hydrocephalus
A
Which describes the procedure for incision and drainage? A cut is made to expel the fluid of an abscess. A small hole is made in the cranium to drain fluid to remove a hematoma. An incision is made into the bladder to place a tube that helps the person urinate. An opening is created in the artery and a stent is placed to allow for better blood flow.
A
Which diagnostic finding supports the presence of an endemic goiter? A Low T3 B High T4 C Low TSH D Thyroid antibodies
A
Which does an abnormal MMSE combined with a normal Mini-Cog mean? A Further testing is indicated. B The individual has Alzheimer's disease. C The examiner did not give the test correctly. D The individual is not oriented to time or place.
A
Which is accurate regarding CT scan and MRI tests for pheochromocytoma? A These tests will image the adrenal glands. B MRI is the examination of choice for the adrenal glands. C A CT scan will determine the functioning of the adrenal glands. D These tests will evaluate tumors in the brain that affect the adrenal glands.
A
Which neurotransmitter is involved in determining a client's mood, anxiety, and sleep induction? A Serotonin B Histamine C Substance P D Acetylcholine
A
Which person is at highest risk for traumatic brain injury? A 14-year-old boy A 55-year-old man A 22-year-old woman A 45-year-old woman
A 14 year old boy
therapeutic hyperthermia
A form of local, regional, or whole-body hyperthermia used to destroy pathologic microorganisms or tumor cells by facilitating the host's natural immune process or tumor blood flow
Which are rationales for treatment with α- and β-adrenergic receptor blockers prior to surgical removal of an adrenal medulla tumor? Select all that apply. A To reduce tachycardia B To reduce glucose levels C To reduce blood pressure D To increase corticosteroids levels E To increase thyroid hormone levels
A, C
Which tests are included in the Mini-Cog? Select all that apply. A Recall B Abstraction C Registration D Clock drawing E Mathematical ability
A, C, D
Which are accurate statements regarding imaging in multiple sclerosis? Select all that apply. A MRI of the brain or spinal cord is often definitive. B The lesions noted on MRI are fixed and unchanging. C MRI in multiple sclerosis shows areas of demyelination. D CT of the brain reveals areas of involvement in multiple sclerosis. E MRI is more sensitive for the diagnosis of multiple sclerosis than blood or cerebrospinal fluid analysis.
A, C, E
Which imaging studies are useful for the diagnosis of brain tumors? Select all that apply. A MRI B X-ray C CT scan D Ultrasound E SPECT scan F Cerebral angiography
A, C, E, F
Which conditions are most likely to show abnormalities on the magnetic resonance imaging of the brain? A Brain tumors B Cerebral palsy C Multiple sclerosis D Myasthenia gravis E Parkinson's disease F Alzheimer's disease
A, C, F
Which statements about the Mini Mental State Exam (MMSE) are correct? Select all that apply. A The MMSE is a screening test for dementia. B The MMSE consists of a series of 30 questions. C The MMSE requires specialized tools to perform. D The MMSE takes longer to do than the Mini-Cog. E The MMSE requires specialized training to perform. F The MMSE is useful for tracking the progression of dementia.
A, D, F
A person with known astrocytoma of the brain scores low on both the MMSE and the Mini-Cog. Which statements are true for this person? A Further testing is indicated. B She also has Alzheimer's disease. C Her brain tumor is causing her to have dementia. While this may be true, these two tests do not provide enough information to confirm or rule out a diagnosis. D A different version of the MMSE should have been given since she has a brain tumor. E It is difficult to interpret the results of neuropsychiatric tests in the presence of a brain tumor.
A, E
After assessing a patient with herniated intervertebral disk (HID), the nurse suspects that the primary health care provider will recommend surgery for the patient. Which findings support the nurse's conclusion? Select all that apply. A The patient has weak bowel reflexes. B The patient has strong bladder reflexes. C The patient has weak Babinski reflexes. D The patient has strong ankle jerk reflexes. E The patient has weak deep tendon reflexes.
A, E
Which are accurate statements regarding imaging studies for cerebral palsy? A Bony deformities may be seen on skeletal surveys. In children with spastic cerebral palsy, muscles can constantly pull on bony attachments, causing deformities. B CT shows typical dilation of the cerebral ventricles. Dilated cerebral ventricles are seen in hydrocephalus and not in cerebral palsy. C Imaging studies are critical to establish the diagnosis. Imaging studies in cerebral palsy are generally normal. D Prenatal ultrasound at 16 weeks can identify many cases of cerebral palsy. Prenatal ultrasound is useful for antenatal diagnosis of spina bifida, but not cerebral palsy. E MRI is useful to rule out other, potentially treatable conditions. MRI and CT of the brain are generally normal and can help rule out other conditions of the brain.
A, E
encephalitis
Acute febrile illness, usually of viral origin with nervous system involvement
Manifestations of TM
Acute muscle weakness Painless or severe pain if necrosis Most severe complication is rhabdomyolysis (acute muscle fiber necrosis with leakage of muscle protein into the bloodstream) that leads to myoglobinuria and acute renal failure
Paget Disease
Also called osteitis deformans Chronic accelerated remodeling of spongy bone and deposition of disorganized bone Enlarges and softens affected bones Mostly affects vertebrae, skull, sacrum, sternum, pelvis, and femur Often symptomless Genetic and environmental factors Evaluation based on radiographic findings
dopamine agonists
Amantadine Apomorphine (Apokyn)
dopamine agonists mode of action
Amantadine increases dopamine release and blocks dopamine reuptake. Apomorphine stimulates postsynaptic dopamine receptors.
Which client does the nurse most closely monitor for a chronic subdural hematoma? An infant who fell A teenager who fell An elderly client who fell A middle-aged client who fell
An elderly client who fell
non-pharmacologic treatments of MG
Antibodies are removed from the blood via plasmapheresis. This process may help the patient temporarily. If hyperplasia or an adenoma is present, a thymectomy (removal of the thymus) may be performed to reduce symptoms. Plenty of rest is recommended to control fatigue. An eye patch is used if double-vision is present. Chopped, mashed, or pureed foods need to be consumed to aid in difficulty chewing and swallowing. Moisten dry foods with liquid.
Pharmacologic treatments for Graves disease
Antithyroid drugs Iodine RAI (radioactive iodine therapy) B-adrenergic blockers
Dominant hemisphere of the brain
Aphasia
The (spider) web-like middle meningeal layer
Arachnoid Mater
chronic migraine
At least 50% of days with headache. At least 8 days with IHS migraine. Many have tension-type pattern on non-migraine days. This is basically the early stages of another migraine.
A client may have damage to the cranial nerve that arises from the medulla and innervates the tongue. Which test will the nurse perform to assess this cranial nerve? A Perform the caloric test. B Ask the client to stick out the tongue. C Assess the gag and swallow reflexes. D Check the sense of taste on the posterior tongue.
B
A nurse is teaching the staff about neurotransmitters in the nervous system. Which structure should the nurse include that releases norepinephrine? A Preganglionic sympathetic fibers B Postganglionic sympathetic fibers C Preganglionic parasympathetic fibers D Postganglionic parasympathetic fibers
B
A person experiences demyelination of the peripheral nerves with sparing of the axons. Of which of the following diseases is this a characteristic? A. Alzheimer B. Guillain-Barré C. Myasthenia gravis D. Amyotrophic lateral sclerosis
B
An extradural (epidural) hematoma occurs: A. Within the brain B. Between the dura mater and the skull C. In the space located between the dura mater and the brain D. By opening a communication between the cranial contents and the environment
B
Arterial blood gas results indicate metabolic acidosis. Which condition might this diabetic patient be experiencing? A Hypoglycemia B Diabetic ketoacidosis C Long-term control of diabetes D Hyperosmolar hyperglycemic state
B
How does the skin protect the body from microorganisms? A The skin produces a hormone that kills pathogens. B The skin contains microbes that defend against pathogens. C The skin is thick, so pathogens have a hard time penetrating the body. D The skin produces sweat, so pathogens are continuously being washed away from the skin.
B
The rate of production of CSF is _________ of blood pressure or intraventricular pressure A dependent B independent
B
Which describes the procedure for a craniotomy? A subdural hematoma is removed through a small hole. Bone is removed for a larger evacuation, and then the bone is replaced. The flap of the cranium is not replaced after part of the bone is removed. A tube is placed into the brain through a small incision and a lesion is drained.
B
Which is the description of a Burr hole? A procedure in which an abscess is drained A procedure in which the subdural hematoma is removed through a small hole A procedure in which a suprapubic catheter is placed in the bladder using a small hole A procedure in which a hole is made in the artery and a stent is placed to keep the artery open
B
Intracerebral hemorrhage
Bleeding into the brain tissue Can be caused by elevated blood pressure More common of the two types of hemorrhage
subarachnoid hemorrhage
Bleeding into the subarachnoid space Caused by ruptured aneurysm or arteriovenous malformation
Hemorrhagic stroke
Blinding headache and severe neurologic deficits
Sphingosine 1-Phosphate Receptor Modulator properties
Blood pressure should be monitored regularly. Pregnancy should be avoided.
Sphingosine 1-phoshpate receptor modulators
Blood pressure should be monitored regularly. Pregnancy should be avoided.
Sphingosine 1-phoshpate receptor modulators properties
Blood pressure should be monitored regularly. Pregnancy should be avoided.
A patient has a structural problem within the brain tissue that decreases the level of consciousness. Which of the following terms best describes this location? A subdural B infratentorial C intracerebral D extracerebral
C
A patient is told he has spondylolisthesis. Which of the following best describes this condition? A Spinal stenosis B Radiculopathy C Forward displacement of the vertebrae D Degenerative process of the vertebral column
C
The nurse is teaching about an organ that has both β 1- and β 2-adrenergic receptors. Which organ is the nurse describing? A Lung B Liver C Heart D Adrenal medulla
C
CSF analysis in viral infection
CSF clear
CSF analysis in bacterial meningitis
CSF cloudy
Hydrocephalus diagnostic tests
CT MRI (helps locate the obstruction or abnormal flow and determines the size of the ventricles
posttraumatic seizures
Can occur within days or up to 2-5 years post injury Hyperexcitable state related to injury and repair Seizure prevention initiated early with moderate to severe TBI
factors affecting temperature regulation in infants
Can produce sufficient body heat primarily through metabolism of brown fat cannot conserve heat because of their small body size (greater ratio of body surface to body weight) inability to shiver they have little subcutaneous fat
Expressive dysphasia-broca, nonfluent, or motor aphasia
Cannot find words, difficulty writing
Expressive (Motor): Broca's area Left frontal lobe
Cannot speak or write fluently or appropriately. Patient is aware of deficit and may become frustrated or angry. Patient understands what is said, but cannot communicate verbally.
DM dietary modifications
Carbohydrates (45 to 60 g/meal) Consume adequate protein (15%-20% of total calories) Limit saturated fats to less than 7% of total calories Minimize intake of trans fat Ingest less than 200 mg/day of cholesterol Fiber intake of 25-30 g/day
Chondrosarcoma
Cartilage-forming tumor Tumor of middle-aged and older adults Infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones The tumor expands and enlarges the bone Causes erosion of the cortex and can expand into the neighboring soft tissues
Causes of AS
Cause unknown, but there is a strong association with HLA-B27 antigen Begins with the inflammation of fibrocartilage, particularly in the vertebrae and sacroiliac joint Inflammatory cells infiltrate and erode fibrocartilage As repair begins, the scar tissue ossifies and calcifies; the joint eventually fuses
Embolic stroke (dislodged clot)
Caused by a thrombus or group of thrombi that break off Usual source of emboli is the heart Middle cerebral artery is most commonly involved Sudden development and rapid occurrence of neurologic deficits
cerebral infarction
Caused by vascular occlusion in brain Irreversible ischemia and necrosis Prompt infusion of thrombolytic agents may restore perfusion and prevent necrosis
Cognitive changes
Changes in the level of consciousness Impairment in memory, judgment or problem solving, and decision making abilities Proprioceptive (awareness of body position) Aphasia Alexia (inability to see words or to read, caused by defect of the brain) or dyslexia Agraphia Acalculia Agnosia
Characteristics of Normal Cerebrospinal Fluid
Characteristics Observations Appearance Clear and colorless Pressure 7-15 mmHg or 150 mm H2O Red blood cells None White blood cells Occasional Protein 15-45 mg/dL Glucose 45-75 mg/dL Sodium 140 mEq/L Potassium 3 mEq/L Specific gravity 1.007 pH 7.32-7.35 Volume in the system at one time 125-150 mL Volume formed in 24 hours 500-800 mL
Osteoarthritis
Characterized by Loss and damage of articular cartilage Inflammation New bone formation of joint margins Subchondral bone changes Variable degrees of mild synovitis Thickening of the joint capsule Prevalence increases with age Risk factors Increased age Joint trauma, long-term mechanical stress Obesity
Periodic paraylysis
Characterized by episodes of flaccid weakness Usually hereditary Thyrotoxic hypokalemic Hyperkalemic
The specificity theory of pain does not account for
Chronic pain Cognitive and emotional elements that contribute to more complex types of pain
Dysfunctions of the general senses include
Chronic pain Abnormal temperature regulation Tactile or proprioceptive dysfunction
Fibromyalgia
Chronic widespread diffuse joint pain, fatigue, and tender points Vague symptoms Increased sensitivity to touch Absence of inflammation Fatigue Sleep disturbances/nonrestorative sleep Anxiety and depression 80% to 90% of individuals affected are women, and the peak age is 30 to 50 years Inflammation may play a role CNS dysfunction Amplification of pain transmission and interpretation (central sensitization) Autoimmune disorders often coexist Studies of genetic factors have implicated alterations in genes affecting serotonin, catecholamines, and dopamine
Brain death criteria
Completion of all appropriate diagnostic and therapeutic procedures Unresponsive coma (absence of motor and reflex responses) No spontaneous respirations (apnea) Pupils dilated, fixed; no reflexes Flat EEG No ocular responses Isoelectric EEG Persistence 6 to 12 hours after onset
Regional osteoporosis
Confined to a segment of the appendicular skeleton Associated with disuse May be transient
vestibular nystagmus
Constant, involuntary eyeball movement caused by ear disturbances; overstimulated semicircular canal system
Subluxation
Contact between articular surfaces is only partially lost
Lack of blood supply to anterior cerebral artery
Contralateral muscle weakness or paralysis sensory loss in the leg confusion loss of problem solving skills personality changes
DM goals
Control blood glucose levels Maintain optimum body weight Decrease cardiovascular risk Slow the rate of development of chronic complications
Amyotrophic Lateral Sclerosis (ALS)
Currently, no specific treatment or cure available to slow down the degenerative process in ALS. A new drug, riluzole (Rilutek), assists with maintaining swallowing and ventilation reflexes by slowing down further damage to neurons.
A nurse has been caring for a client with a brain abscess for 11 days. The brain abscess has a decreased necrotic center with a mature collagen capsule. Which stage of brain abscess formation is the client experiencing? A Late cerebritis B Early cerebritis C Late capsule formation D Early capsule formation
D
How is riluzole (Rilutek) used in the treatment of amyotrophic lateral sclerosis (ALS)? A To slow down the generative process B To reduce symptoms of flaccid paralysis C To treat infections caused by mechanical ventilation D To help maintain swallowing and ventilation reflexes
D
The nurse describes the protective structures of the central nervous system to a group of new nurses. Which statement, by a new nurse, indicates further teaching is necessary? A "The brain and the spinal cord are protected by three membranes." B "The cranium protects the brain and is composed of eight bones." C "The structures of the brain and spinal cord float in cerebrospinal fluid." D "The vertebral column protects the spinal cord and is composed of 24 vertebrae."
D
Which component is a part of the dexamethasone suppression test? A Urine collection for osmolality testing B Plasma cortisol sample drawn at 3 A.M. C Cosyntropin for IV administration D Synthetic glucocorticoid administration at 11 P.M.
D
Which information should be given to a patient with suspected syndrome of inappropriate antidiuretic hormone (SIADH) who has questions about diagnostic testing for the condition? A In the absence of head injury, brain imaging can be cancelled. B Only testing of the central nervous system will need to be completed. C A CT scan of the head is the best test to determine abnormalities in brain tissue. D There are many causes for SIADH, necessitating the investigation of multiple areas of the body.
D
Which is accurate regarding the rationale for performing a lung scan in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A Imaging the lungs reveals bleeding as a source of SIADH. B SIADH is always associated with tumor growth in the lung. C Benign lung disease needs to be ruled out as a cause for ADH secretion. D Malignant tumor in the lungs is the most common source of ADH secretion.
D
Which is an appropriate purpose of carotid endarterectomy? Draining spinal abscesses Relieving pressure from the cranium Keeping the artery open with a stent Removing plaque from the lumen of the artery
D
Which of the following is TRUE regarding multiple sclerosis? A. Uncommon disease B. Affects gray matter C. Involves the central nervous system only D. Is a demyelinating disorder
D
Which sign or symptom should the nurse assess as the most critical clinical index of a client's nervous system function? A Pupillary changes B Patterns of breathing C Oculomotor responses D Level of consciousness
D
Why is the use of chemotherapeutic agents limited in the treatment of brain tumors? A Due to the myelosuppression caused by chemotherapeutic agents B Due to the extremely short half-life of chemotherapeutic agents C Due to the difficulty of the drugs not being easily digestible D Due to the difficulty of getting drugs to cross the blood-brain barrier
D
efferent pathway
Descends from CNS back to the dorsal horn of the spinal cord
Rhabdo diagnosis
Diagnosed when CK level five to ten times upper limit of normal (about 1000 units/L) Renal failure likely when CK reaches 15,000 units/L Preventing kidney failure and maintaining adequate urinary output are goals of treatment
spina bifida
Diagnosis is initially based on a complete H&P A sac may be noticed over the lower back A tuft of hair in the center of the lower back is a classic finding Lower extremity weakness is seen when the spinal cord is involved Blood and urine tests are generally normal Before birth, elevated maternal blood and amniotic fluid levels of alpha-fetoprotein (AFP) alert clinicians to perform an ultrasound to look for spinal deformities before birth Elevated blood levels of maternal serum AFP (MSAFP) along with other markers suggest the need for amniocentesis and a detailed ultrasound.
muscle relaxants
Diazepam (Valium) Baclofen (Lioresal) Dantrolene (Dantrium) Tizanidine (Zanaflex)
muscle relaxants
Diazepam (Valium) Baclofen (Lioresal) Dantrolene (Dantrium) Tizanidine (Zanaflex) (Drugs for symptom management)
Modifiable risk factors for CVA/TIA include:
Disease processes, such as heart disease, hypertension, and diabetes Use of oral contraceptives Tobacco abuse Sedentary lifestyle
Dislocation
Displacement of one or more bones in a joint Loss of contact between articular cartilage
Cholinesterase inhibitors (treats decreased memory and cognition)
Donepezil Rivastigmine Galantamine
drugs for decreased memory and cognition
Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) Memantine (Namenda)
Diagnostic Tests for osteoporosis
Dual x-ray absorptiometry (DXA) Gold standard for detecting and monitoring osteoporosis Trabecular bone score (TBS) Evaluates pixel variations in the gray-level areas of lumbar spine images from DXA scans Enhanced predictions of fracture risk
Infection Prevention Alzheimer's (Urinary tract infection and pneumonia are common infections. Some infections may ultimately be the cause of death in many patients.)
Due to feeding and swallowing problems, aspiration pneumonia may occur. Immobility is a predisposition to pneumonia. Reduced fluid intake, prostate enlargement in men, poor hygiene, and urinary drainage devices such as catheters may predispose a patient to bladder infections. Patients with a change in behavior, fever, cough (pneumonia), or pain on urination (bladder) should have prompt evaluation and treatment.
hydrocephalus
Dx based on a complete H&P, and varies with age and chronicity. Onset in infants is usually recognized by enlargement of head circumference above the normal growth curve and a "sunset" appearance of eyes (upper lid retraction) Routine blood tests (e.g., blood count) are usually normal in congenital hydrocephalus Diagnosis after closure of the anterior fontanelle is more difficult: Rely on symptoms (lethargy, confusion, headaches, visual problems) and signs (ataxic gait, urinary incontinence) Diagnostic tests (lumbar punctures showing red blood cells or evidence of infections) are generally used to search for causes of acquired hydrocephalus
Manifestations of AS
Early symptoms Low back pain that begins in early 20s and progresses over time Stiffness Pain Restricted motion Loss of normal lumbar curvature (lordosis) Increased concavity of upper spine (kyphosis) Sacroiliitis present on imaging Physical therapy to maintain skeletal mobility and prevent the natural progression of contractures NSAIDs for pain
Clinical manifestations of brain abscess
Early: low-grade fever, headache (most common symptom), neck pain and stiffness, confusion, drowsiness, sensory deficits, and communication deficits Later: inattentiveness (distractibility), memory deficits, decreased visual acuity and narrowed visual fields, papilledema, ocular palsy, ataxia, seizures, and dementia
Potential causes of osteoporosis
Endocrine dysfunction Parathyroid hormone, cortisol, thyroid hormone, and growth hormone Medications Vitamin D deficiency Underlying diseases Low physical activity Abnormal BMI Fractures are the major complication
hydrocephalus
Excess CSF accumulates in the skull (compresses brain tissue and blood vessels)
Sphingosine 1-Phosphate Receptor Modulator drugs
Fingolimod (Gilenya) (disease modifying)
Fibrosarcoma
Firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast-like giant cells Usually affects metaphyses of the femur or tibia Metastasis to the lungs is common
Antipsychotic method of action
First-generation antipsychotics (FGA) Mechanism of action: antagonism at the D2 receptor Second-generation antipsychotics (SGA) Mechanism of action 5HT2A receptor antagonism and D2 receptor antagonism (less pronounced than that of typical antipsychotics) but also interaction with several other receptors (i.e., D3, D4, α-adrenergic, and H1 receptors) (The greater affinity to 5HT2A receptors and the reduced D2 receptor antagonism, along with the interaction with other receptors, decreases the likelihood of extrapyramidal effects)
Which medication may be used to treat depression in Alzheimer's disease? Fluvoxamine (Luvox) Haloperidol (Haldol) Rivastigmine (Exelon) Quetiapine (Seroquel)
Fluvoxamine
Alzheimer's clinical manifestations
Forgetfulness emotional upset disorientation confusion lack of concentration decline in abstraction, problem solving andjudgment
Spiral
Fracture line encircling bone (as a spiral staircase) Most common fracture in child abuse
Embolic stroke
Fragments that break from a thrombus formed outside the brain
Noiceptors
Free nerve endings in the afferent PNS (pain receptors)
predisposing factors for type 1 diabetes
Genetic factors, such as family history Any physical condition that destroys pancreatic beta cells Possible viral infection that affects beta cells
Patterns and symptoms of bone tumors
Geographic pattern Moth-eaten pattern Permeative pattern vague May be attributed to trauma, degenerative changes, or inflammation
Myelogenic Tumors
Giant cell tumor Causes extensive bone resorption because of the osteoclastic origin and RANKL overexpression Located in the epiphyses of the femur, tibia, radius, or humerus Has a slow, relentless growth rate
hypoglycemia shock treatment
Glucose or glucagon (usually IV) if unconscious
Cushing's treatment
Gradually discontinuing corticosteroid therapy to avoid life-threatening adrenal insufficiency Reduction of the dose Converting to an alternate-day regimen
Ankylosing Spondylitis
Group of inflammatory arthropathies known as spondyloarthropathies (SpA) Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints Systemic, autoimmune inflammatory disease Primary pathologic site is the enthesis End result is fibrosis, ossification, and joint fusion
An acquired inflammatory disease causing demyelination of the peripheral nerves with acute onset, ascending motor paralysis and humoral and cellular immunologic reaction
Guillain-Barré syndrome
upper motor neurons
Have cell bodies in the cerebral cortex
motor changes
Hemiplegia (paralysis on one side of the body) Hemiparesis (weakness on one side of the body) Ataxia (gait disturbance) Hypotonia or hypertonia Apraxia Flaccid paralysis Incontinence of bowel and bladder
Neurologic Complications of AIDS
Human immunodeficiency virus-associated neurocognitive disorder (HAND) HIV myelopathy HIV-associated peripheral neuropathy Viral meningitis Opportunistic infections CNS neoplasms
Malignant Hyperthermia
Hypermetabolic reaction to certain anesthetics Mutation in the ryanodine receptor of skeletal muscle (RyR1) is responsible for the majority of cases Altered normal excitation-coupling process of muscle contraction Also causes hypermetabolism with extremely high body temperature, muscle rigidity, rhabdomyolysis, and death if not quickly treated with dantrolene infusion Pre-op evaluation is critical May be predicted with muscle-contracture test
disorders of expression
Hypermimesis Hypomimesis Dyspraxia/apraxia
Dietary modifications for hypothyroidism
Hypothyroidism: It is recommended to consume a low-calorie diet in order to treat a decreased metabolic rate and promote weight loss or prevent weight gain.
Polymyositis and dermatomyositis, and inclusion-body myositis
Idiopathic inflammatory myopathies Characterized by progressive, symmetric proximal muscle weakness and myalgia that develop over weeks to months Associated with an increased risk of malignancy Muscle biopsy showing inflammatory cells grouped around blood vessels and atrophy of cells in muscle fascicles Treatment is immunosuppressive drugs
mild concussion
Immediate but transitory clinical manifestations Confusion lasts for 1 to several minutes, possibly with amnesia
image processing amnesia
Inability to categorize (identify similarities and differences) or sort; inability to form concepts; inability to analyze relationships; misinterpretations; inability to interpret proverbs
Osteomalacia
Inadequate or delayed mineralization of osteoid Remodeling cycle proceeds through osteoid formation but calcification does not occur; the result is soft bones Pain, bone fractures, vertebral collapse, bone malformation Results from vitamin D deficiency Treatment varies by etiology
cerebral edema
Increase in the fluid (intracellular or extracellular) within the brain
Malignant Bone Tumors
Increased nuclear/cytoplasmic ratio Irregular borders Excess chromatin A prominent nucleolus An increase in the mitotic rate
peripheral sensitization
Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.
central sensitization
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.
cerebral palsy treatment
Individualized and immediate therapy Stimulation programs Assessment Speech therapy Physical therapy and regular exercise therapy Devices that can improve mobility and coordination Occupational therapy Monitoring of hearing and vision Use of alternate modes of communication
Meningitis
Infection of the meninges, the membranes that contain the brain and spinal cord
Bursitis
Inflammation of a bursa Skin over bone, skin over muscle, and muscle and tendon over bone Inflammation caused by overuse or excessive pressure
Tendinopathy
Inflammation of a tendon
Epicondylopathy
Inflammation of a tendon where it attaches to a bone Tennis elbow (lateral epicondylitis) Golfer's elbow (medial epicondylitis)
Allergic Conjunctivitis
Inflammation of the conjunctiva due to a reaction from allergy-causing substances such as pollen or pet dander.
Rheumatoid Arthritis
Inflammatory autoimmune joint disease Systemic autoimmune damage to connective tissue, primarily in the joints (synovial membrane) Similar symptoms to osteoarthritis Cause unknown; multifactorial with strong genetic predisposition
Classic inflammatory joint disease
Inflammatory damage or destruction in the synovial membrane or articular cartilage Systemic signs of inflammation Infectious or noninfectious
Myotonia
Inherited diseases caused by alterations in skeletal muscle sodium and calcium ion channels Delayed relaxation after voluntary muscle contraction
myasthenia gravis
Initial H&P exam often diagnostic. EMG antibody tests (which include tests for antibodies against the acetylcholine receptor and antibodies against MuSK (muscle specific kinase) proteins) The Tensilon test
Open brain injury
Injury breaks the dura and exposes the cranial contents to the environment Causes both focal and diffuse injuries
coup injury
Injury directly below the point of impact
countrecoup
Injury on the side opposite the site of impact
RA cont.
Insidious onset Systemic manifestations Inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness Painful, tender, stiff joints Joint deformities Rheumatoid nodules Caplan syndrome Diagnosed by presence of autoantibodies (ACPA or RF) Early treatment with disease-modifying antirheumatic drugs ULNAR DRIFT
In vertebrates epithelial tissue forms the basis of the?
Integumentary system
perceptual dominance
Intense pain at one location may cause an increase in the pain threshold in another location
Which diagnostic opportunity can be accomplished using cerebral angiography? Visualize a clot Identify a fracture Look for plaque buildup Intervention at the site of injury
Intervention at the site of injury
Skeletal muscle pain stimuli
Ischemia Connective tissue sheath injury Necrosis Hemorrhage Prolonged contraction Injection of irritating solutions
Heart pain stimuli
Ischemia Inflammation
Classification of CVAs
Ischemic (thrombotic, embolic) Hemorrhagic Associated with hypoperfusion
Clinical manifestations of alterations in arousal
Level of consciousness changes Pattern of breathing Pupillary reaction Oculomotor responses Motor responses Vomiting, yawning, hiccups
Which Parkinson's medications enhance the release or supply of dopaminergics (DA)? Select all that apply. Trihexyphenidyl Levodopa (L-dopa) Pramipexole (Mirapex) Apomorphine (Apokyn) Benztropine (Cogentin)
Levodopa Pramipexole Apomorphine
Characteristics of OA
Local areas of damage and loss of articular cartilage New bone formation of joint margins Subchondral bone changes Variable degrees of mild synovitis and thickening of the joint capsule
Brain or spinal cord abscess
Localized collection of pus within the parenchyma Extradural, subdural, or intracerebral Progresses from localized inflammation to a necrotic core with the formation of a connective tissue capsule
hemiagnosia
Loss of ability to identify source of pain on one side of body painful stimuli on that side of the body produce discomfort, anxiety, moaning, agitation and distress but no attempt to withdraw from stimulus associated with stroke
Classic cerebral concussion
Loss of consciousness <6 hours accompanied with amnesia with confusional state lasting hours to days Transient cessation of respiration can occur
Occlusion of large artery, such as internal carotid or middle cerebral artery
Loss of consciousness, coma, death
Which disease involves a two-step lab process for diagnosis? Lyme disease Rabies disease Viral encephalitis Bacterial meningitis
Lyme disease
Which test is more appropriate in considering an ischemic CVA? CT scan MRI or MRA Carotid duplex Cerebral angiography
MRI or MRA
Rhabdomyosarcoma
Malignant tumor of striated muscle Highly malignant with rapid metastasis Usually muscles of the head, neck, and genitourinary tract Types Anaplastic Embryonal Alveolar
Nutrition therapy for Parkinson's
Malnutrition and constipation are serious consequences of inadequate nutrition. Those with dysphagia and bradykinesia need foods which are easily chewed and swallowed. Diet should contain adequate fiber to avoid constipation. Food should be cut into bite-sized pieces. Consume six small meals because three large meals a day is more exhausting. Patients should allow extra time for eating to avoid frustration. Ingestion of protein and vitamin B6 impairs the absorption of levodopa; therefore, limit protein intake and consult with a health care provider for possible inclusion of vitamin B6 in a multivitamin
Manifestations and Diagnosis of Fibro
Manifestations Prominent symptom of fibromyalgia is diffuse, chronic (present more than 3 months) pain that is burning or gnawing in nature Only reliable finding on examination is the presence of multiple tender points; the pain often begins in one location, especially the neck and shoulders, but then becomes more generalized Profound fatigue Diagnosis Axial pain, left- and right-sided pain, and upper and lower segment pain; and a symptom severity (SS) score SS score includes symptoms such as fatigue, waking unrefreshed, and cognitive difficulty
Manifestations of indirect healing
Manifestations Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and decreased mobility Often transient numbness due to nerve trauma Treatment Immobilization Closed manipulation, traction, and open reduction Depends upon alignment, growth plate involvement in children, and severity of fracture Internal and external fixation
non-pharmacologic treatments for ALS
Many health care workers are involved in the patient's care, including a respiratory therapist, nutritionist, speech pathologist, occupational therapist, physical therapist, psychologist, and social worker. Treatment includes a well-balanced program which consists of moderate exercise and rest. Electronic communication devices are highly recommended in the early course of the disease Stem cell therapy is currently under investigation for treatment.
Autonomic hyperreflexia (dysreflexia)
Massive, uncompensated cardiovascular response to stimulation of the sympathetic nervous system Stimulation of the sensory receptors below the level of the cord lesion
Bone Tumors
May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue Osteogenic Chondrogenic Collagenic Myelogenic
Diseases of energy metabolism
McArdle disease Myophosphorylase deficiency Acid maltase deficiency Pompe disease Myoadenylate deaminase deficiency (MDD) Lipid deficiencies
receptive-Wernicke, receptive fluent or sensory dysphasia
Meaningless verbal language, inappropriate words or unable to monitor language for correctness so errors are not recognized Intonation, accent, cadence, rhythm, and articulation normal
Fast adapting receptors that sense movement and vibration across the skin
Meissner and pacinian corpuscles
slowly adapting receptors that sense light touch
Merkel disks
Immunosuppressant drugs
Mitoxantrone Dimethyl fumarate (Tecfidera) (disease modifying)
Tension-type headache
Most common Average onset 2nd decade Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head with gradual onset of pain Occurs in episodes and may last for several hours or several days Occurs at least 15 days per month for at least 3 months
Deep Brain Stimulation for Parkinson's
Most common and involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus, and connecting it to a generator placed in the upper chest (similar to a pacemaker). Is currently being used for patients whose symptoms cannot be controlled with medication. This device delivers a programmable specific current to the targeted brain locations, which reduces the increased neuronal activity produced by dopamine depletion It is preferred over ablation because it is reversible, programmable, and can be performed safely bilaterally. It may improve motor function and reduces dyskinesia.
prebycusis
Most common cause of diminished hearing in elderly patients
Osteosarcoma
Most common malignant bone-forming tumor Predominantly in persons under 20 years; occurs in 50- to 60-year-olds if they have a history of radiation therapy Tumors contain osteoid produced by anaplastic stromal cells Deposited as thick masses or "streamers" Located in the metaphyses of long bones 50% occur around the knees
Signs of ICP increase
Most common-change in level of consciousness. Other early signs of ICP include: Headache (occurs from stretching of the dura and walls of large blood vessels) Projectile vomiting (caused by pressure stimulating the emetic center in the medulla) Blurred vision Decreased visual acuity Diplopia Swelling of the optic disc Papilledema (caused by increased ICP and swelling of the optic disk)
Indirect Healing
Most often observed when a fracture is treated with a cast or other nonsurgical method Intramembranous and endochondral bone formation Callus formation Remodeling of solid bone
Direct Healing
Most often occurs when surgical fixation is used to repair a broken bone Intramembranous bone formation No callus formation
Enkephalins
Most prevalent natural opioids (Ex: Endorphins, Dynorphins, Endomorphins)
an acquired autoimmune, progressive, inflammatory, demyelinating disorder of the CNS
Multiple Sclerosis (MS)
Contractures
Muscle fiber shortening without an action potential Caused by failure of the calcium pump, even with available ATP
Alterations in Neuromuscular Function
Muscle tone: hypotonia hypertonia
Monoclonal antibody drugs
Natalizumab (Tysabri) Alemtuzumab (Lemtrada) Daclizumab (Zinbryta) (disease modifying)
Stress induced muscle tension
Neck stiffness, back pain, and headache Associated with chronic anxiety
Which pharmacologic agents are used to improve neuromuscular transmission temporarily in myasthenia gravis? Select all that apply. Prednisone Bevacizumab (Avastin) Neostigmine (Prostigmin) Temozolomide (Temodar) Pyridostigmine (Mestinon)
Neostigmine Pyridostigmine
amyotrophic lateral sclerosis (ALS)
Neurodegenerative disorder involving upper and lower motor neurons Causes progressive muscle weakness Unknown etiology Starts with muscle weakness and progresses to muscle atrophy, spasticity, and loss of manual dexterity and gait
Chronic Fatigue Syndrome
Neuroimmunoendocrine disease Characterized by Cognitive impairment Severe postexertional fatigue Unrefreshing sleep Decreased physical activity that affects daily functioning Diagnosis of exclusion Psychologic and physiologic involvement
Alzhiemer's Disease
No definitive diagnostic test exists for AD, except for postmortem brain biopsies showing neurofibrillary tangles. Dx is usually one of exclusion A complete health history is required, with particular focus on medications, physical examination, neurologic examination, and mental status exam Patients often able to hide sxs for many years and can find ways to trigger their memories using notes and pictures Since the initial symptoms can be subtle, they are often missed until the disease is advanced Labs, including blood tests and CSF analysis (also those involving lumbar punctures), are usually normal CSF analysis for tau protein and beta amyloid can be confirmatory, but are usually used in research settings
Spinal shock
Normal activity of the spinal cord ceases at and below the level of injury; sites lack continuous nervous discharges from the brain complete loss of reflex function (skeletal, bladder, bowel, thermal control and autonomic control) below level of lesion
afferent pathway
PNS Spinal gate in the dorsal horn Ascend to higher centers in the CNS
6 P's of Compartment Syndrome
Pain Pressure Pallor Paresthesia Paresis Pulselessness Volkmann ischemic contracture Diagnosis confirmed by measurement of intracompartmental pressure Surgical intervention indicated when pressure reaches 30 mm Hg
Manifestations of OA
Pain (worsens with activity) Stiffness (diminishes with activity) Enlargement of the joint Tenderness Limited motion Muscle wasting Partial dislocation Deformity
Motor neuron diseases
Paralytic poliomyelitis Guillain-Barré syndrome Progressive spinal muscular atrophy Progressive bulbar palsy Bulbar palsy
Parkinson disease characteristics
Parkinsonian tremor rigidity bradykinesia cognitive-affective symptoms
secondary spinal cord injury
Pathophysiologic cascade of events that begins immediately after injury and continues for weeks Life threatening if swelling occurs in cervical region
Global: Broca's and Wernicke's areas and connecting fibers
Patient cannot express self or comprehend others' language. Reading and writing ability are equally affected
Anticholinergics properties
Patients should consult with an HCP before using other drugs, especially sleeping aids and antihistamines.
anticholinergic properties
Patients should consult with an HCP before using other drugs, especially sleeping aids and antihistamines.
Bone pain stimuli
Periosteal injury Fractures Tumor Inflammation
2 classifications of neuropathic pain
Peripheral neuropathic pain Central neuropathic pain
anterograde amnesia symptoms
Person reports disorientation, confusion, "not listening," "not remembering"; reports by others of person being disoriented, not able to remember, not able to learn new information
retrograde amnesia symptoms
Person reports remote memory problems; others report that person cannot recall formerly known information
Artery pain stimuli
Piercing Inflammation
Brain tumors drug treatment
Polifeprosan with carmustine implant (Gliadel wafer)—chemotherapy-laden biodegradable wafers, which are implanted during surgery and deliver chemotherapy directly to the tumor. Methotrexate and procarbazine (Matulane). Temozolomide (Temodar)—oral agent which is capable of crossing the blood-brain barrier, but which causes myelosuppression. Bevacizumab (Avastin)—used to treat glioblastoma that continues to progress after standard treatment.
Which is the reason why there is an increased risk of urinary tract infections in Alzheimer's patients? Poor hygiene Catheter usage Increased fluid intake Swallowing difficulties Prostate shrinkage in men
Poor hygiene catheter usage
Osteoporosis
Poorly mineralized bone and increased risk of fractures due to alterations in bone microarchitecture Old bone resorbed faster than new bone made Spontaneous fractures
Endorphin (beta-endorphin)
Produces the greatest sense of exhilaration as well as substantial natural pain relief
Chronic Traumatic Encephalopathy
Progressive dementing disease
B-adrenegic blockers
Propanolol (Inderal) Atenolol (Tenormin) Metoprolol (Toprol)
anticholinergic drugs
Propantheline Oxybutynin (Ditropan XL)
anticholinergic drugs
Propantheline Oxybutynin (Ditropan XL) (Drugs for symptom management)
Hypoglycemia treatment
Provide concentrated carbohydrate intake, like sweetened fruit juice or regular soft drink or LifeSavers, honey, or jelly to replace glucose for functioning of central nervous system and all body cells. After recovery, provide a complex carbohydrate to prevent rebound hypoglycemia
radiation therapy
Radiation therapy may be used as a follow-up measure after surgery. Radiation seeds may also be implanted into the brain. Complications of radiation therapy include cerebral edema and rapidly increasing intracranial pressure; however, these can be managed with high doses of corticosteroids (dexamethasone, prednisone, or methylprednisolone [Solu-Medrol]).
Rhabdomyolysis
Rapid breakdown of muscle that causes the release of intracellular contents, including the protein pigment myoglobin, into the extracellular space and bloodstream Seen in elderly, young people, kidney issues Can result in hyperkalemia, cardiac arrhythmia, or acute RENAL FAILURE Triad of manifestations Muscle pain Weakness Dark urine
Frontotemporal Dementia
Rare, severe, degenerative Death of frontal lobe tissue and dementia Familial association Most cases involve gene mutation
intracranial aneurysm
Saccular (berry) aneurysms Fusiform (giant) aneurysms
Corticosteroid drugs properties
Salt intake should be restricted. Do not stop therapy abruptly. Patients should know drug interactions.
Corticosteroid properties
Salt intake should be restricted. Do not stop therapy abruptly. Patients should know drug interactions.
Drugs for Managing Exacerbations-corticosteroids
Salt intake should be restricted. Do not stop therapy abruptly. Patients should know drug interactions.
excitory neuromodulators
Sensitize nociceptors in the PNS (ex: substance P, histamine, glutamate and calcitonin gene-related peptide)
non-pharmaclologic treatments CP speech and language
Speech and language therapy assists parents with feeding and swallowing difficulties, positioning a child correctly, encouraging communication, and decreasing the effects of tongue thrusting.
spina bifida occulta
Spinous processes do not fuse. Herniation of spinal cord and meninges does not occur. Defect may not be visible. Dimple or a tuft of hair may be present on the skin over the site. Diagnosed by routine radiograph or on the basis of mild neurological signs
Causes of progressive dementing disease
Sports injuries Blast trauma Work-related head trauma
stereotactic radiosurgery procedure
Stereotactic radiosurgery utilizes a computer-guided precision apparatus to precisely deliver radiation to the target area of the brain. Three dimensional images of the brain are created which guide the focused radiation while the patient's head remains still in a stereotactic frame. A high dose of cobalt radiation is delivered to precisely targeted tumor tissue. Side effects of stereotactic radiosurgery may include fatigue, headache, and nausea.
Surgical treatment for acromegaly
Surgery (hypophysectomy) is the treatment of choice because it offers the best chance for a cure, especially for smaller pituitary adenomas. Most surgeries are done by using a transsphenoidal approach. Surgery produces an immediate reduction in GH levels followed by a drop in IGF-1 levels within a few weeks. Radiation therapy is used when surgery has failed to produce a cure or when patients are poor candidates for surgery.
Spascticity
Surgery (neurectomy, rhizotomy, cordotomy) Dorsal-column electrical stimulation Intrathecal baclofen (Lioresal) delivered by a pump Exercise which increases coordination and retrains unaffected muscles to substitute for impaired ones
Surgical treatment for pheochomocytoma
Surgical removal of the adrenal tumor is the primary treatment
Spina Bifida treatment
Surgical treatment may be performed prenatally as well as postnatally. This may range from cyst removal to closing the spinal cord defect. Some successful surgeries have been performed in utero before birth. The timing for postnatal surgery has been controversial with regard to whether it should take place immediately or be delayed. When it is delayed, rupture and infection are potential complications. Decision for surgery also depends on the presence of other anomalies that may be present in the infant. After surgery, ongoing occupational and physical therapies are required to manage any neurological deficits. Local community services as well as the Spina Bifida Association provide continuing support to the child and family.
Describes the role of impulse intensity and the repatterning of the CNS
The pattern theory
noiception
The processing of potentially harmful stimuli through a normally functioning nervous system
Nerve conduction enhancers properties
This drug may cause seizures, especially at high doses. Tablet should be taken whole. Do not take more than two in 24 hours. This drug improves walking speed in MS patients.
nerve conduction enhancers properties
This drug may cause seizures, especially at high doses. Tablet should be taken whole. Do not take more than two in 24 hours. This drug improves walking speed in MS patients.
An electroencephalogram (EEG) uses electrodes to monitor and record the electrical activity of the brain.
This test can be used to detect seizures, CVA lesions, sleep disorders, and brain injuries. This is a noninvasive test. The test involves putting electrodes on specific areas of the brain and looking at how the brain responds to stimuli such as noise or lights.
Transplantation
This treatment involves fetal neural tissue transplanted into the basal ganglia. This is designed to provide dopamine producing cells in the brain. Clinical trials and research for this is ongoing.
Ablation (destruction)
This treatment involves locating, targeting, and then destroying the brain tissue which is producing abnormal chemical or electrical impulses that lead to tremors or other symptoms. Typical targets of ablation are the thalamus (thalamotomy), globus pallidus (pallidotomy), and subthalamic nucleus (subthalamic nucleotomy)
Pathogenesis of RA
Three processes Neutrophils and other cells in the synovial fluid become activated Inflammatory cytokines: tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-21 (IL-21), induce enzymatic breakdown of cartilage and bone T cells also interact with synovial fibroblasts through TNF-α, converting synovium into a thick, abnormal layer of granulation tissue (pannus)
Which surgical procedure could be used for the treatment of myasthenia gravis? Neurectomy Thymectomy Thyroidectomy Pancreatectomy
Thymenctomy
Surgical treatment for Grave's
Thyroidectomy Subtotal thyroidectomy is the preferred surgical procedure which involves the removal of a significant portion (90%) of the thyroid gland.
Pain transduction begins when
Tissue is damaged by exposure to chemical, mechanical or thermal noxious stimuli
Why is pharmacologic treatment necessary prior to pheochromocytoma surgery?
To control blood pressure (BP) and prevent intraoperative hypertensive crisis
Ca normal range
Total calcium: 2-2.6 mmol/L Ionized calcium: 1.03-1.23 mmol/L
head pain stimuli
Traction Inflammation Displacement of arteries, meningeal structures and sinuses Prolonged muscle contraction
4 phases of nociception
Transduction Transmission Perception Modulation
A-beta fibers
Transmit touch and vibration sensations (normally do not transmit pain but play a role in pain modulation)
gout cont.
Trauma is most common aggravating factor Primary symptom is severe pain Approximately 50% of the initial attacks occur in the metatarsophalangeal joint of the great toe Other areas include the heel, ankle, instep of the foot, knee, wrist, or elbow 1000 times more likely to develop renal stones than general population
Glucocorticoid induced osteroporosis
Type of secondary osteoporosis Glucocorticoids improve osteoclast survival, which inhibits osteoblast formation and funct
Receptive (Sensory): Werincke's area Left temporal lobe, prefrontal
Unable to understand written or spoken language. Patient may be able to talk, but language is often meaningless. Neologisms (made up words) are common parts of speech
Cluster headache characteristics
Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations (tearing on affected side, ptosis of the ipsilateral eye, stuffy nose)
Surgical treatment for OA
Used to improve joint movement, correct deformity or malalignment, or create a new joint with artificial implants
therapeutic hypothermia
Used to slow metabolism and preserve ischemic tissue during surgery or limb reimplantation May lead to ventricular fibrillation and cardiac arrest
types of cerebral edema
Vasogenic Cytotoxic Interstitial
Hydrocephalus treatment
Ventricular shunts may be used to treat hydrocephalus due to a tumor that is obstructing cerebral spinal fluid (CSF) flow. A catheter with one-way valves is placed in the lateral ventricle and then tunneled under the skin to drain CSF into the peritoneal cavity. Rapid decompression in intracranial pressure may cause total body collapse and weakness, including a headache that may be prevented by gradually introducing the patient to the upright position. With children, a shunt must be replaced as the child grows. Patients must be closely monitored for shunt blockage, malfunction, or infection to prevent further brain damage. Malfunction may result in decreased level of consciousness, restlessness, headache, blurred vision, or vomiting. Infection may also occur, which would have symptoms of high fever, persistent headache, and stiff neck. These infections would be treated with antibiotics. These may require a shunt being revised or replaced.
Sedative-hypnotic drugs
Zolpidem [Ambien] Zaleplon [Sonata] Eszopiclone [Lunesta]
Pheochromocytoma
a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine
Which client will the nurse monitor most closely for autonomic dysreflexia? A client before spinal shock A client during spinal shock A client after spinal shock resolves A client who did not develop spinal shock
a client after spinal shock resolves
CSF flow in noncommunicating hydrocephalus usually results from
a fetal developmental abnormality (stenosis or neural tube infarct May be associated with myelomeningocele Arnold-Chiari malformation)
Namenda (memantine)
a partial antagonist of N-methyl-D-aspartate receptor (NMDAR), approved for moderate to severe Alzheimer's disease (AD)
Visceral pain
a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera (often radiates)
tentorium cerebelli
a septum that separates the cerebellum and brainstem from the rest of the cerebrum
Vegetative state
a state where there is loss of cerebral function
A lumbar puncture allows for the analysis of cerebrospinal fluid (CSF).
a sterile procedure that involves the introduction of a needle to the subarachnoid space between the L4 and L5 vertebrae. An opening pressure is measured and the fluid is collected and sent for laboratory evaluation. In addition to the role of LP in meningitis and encephalitis, it is also used in the workup of other diseases. A manometer can be attached to the needle to obtain a CSF pressure. A lumbar puncture should never be performed when there is increased intracranial pressure (ICP) or an infection at the site where the puncture would be performed.
A TIA results from a temporary localized reduction of blood flow to the brain. It can be caused by atherosclerosis, from a small embolus, a vascular spasm, or local loss of autoregulation. TIAs can be a warning sign for a CVA
a temporary localized reduction of blood flow to the brain. It can be caused by atherosclerosis, from a small embolus, a vascular spasm, or local loss of autoregulation. (TIAs can be a warning sign for a CVA)
Craniotomy
a type of cranial surgery that can be performed to remove a lesion or relieve increased intracranial pressure. allows for excision or partial resection of brain tumor. may involve the frontal, parietal, occipital, temporal, suboccipital, or a combination.
ischemic stroke
a type of stroke that occurs when the flow of blood to the brain is blocked (almost 87% of strokes)
communicating hydrocephalus
absorption of CSF through subarachnoid villi is impaired
Diffuse axonal injury (DAI)
acceleration/deceleration or rotational forces
diffuse brain injury
acceleration/deceleration or rotational forces Axonal damage (shearing, tearing or stretching of nerve fibers)
Encephalitis
acute febrile illness, usually viral origin with nervous system involvement, most common forms are caused by arthropod-borne viruses and herpes simplex virus
Second degree burn
affect both the dermis layers of the skin, symptoms include blistering of the skin, redness, pain and swelling
Contralateral
affecting or originating in the opposite side of a point or reference, such as a point on a body.
damage to the upper motor neurons
affects motor function/control reflexes and muscle tone still present and may be intensified voluntary movement control is impaired spastic paralysis occurs (excess muscle tone and loss of voluntary control of movement) no denervation induce atrophy
The nerves which carry impulses to the brain (carried through the dorsal root)
afferent
A client is brought to the emergency room after a motor vehicle accident in which the client sustained diffuse brain (axonal) injury. Which assessment findings would the nurse expect to accompany this injury? Weakness and no coma Agitation and spastic paralysis Memory deficits but good judgment skills Long attention span and no loss of consciousness
agitation and spastic paralysis
Antipsycotics treat
agitation, physical aggression, disinhibition
Data processing deficits
agnosia dysphasia aphasia
Which clinical terms refer to cognitive impairment? Select all that apply. Ataxia Alexia Agnosia Agraphia Hemianopsia
alexia agnosia agraphia
Which methods improve nutritional therapy in patients with Parkinson's disease? Increasing protein intake Allowing extra time for eating Eating three large meals a day Diet containing adequate fiber Providing food which is easily chewed
allowing extra time for eating diet containing adequate fiber providing food which is easily chewed
Which is the purpose of a lumber puncture? Diagnosing rabies Diagnosing Lyme disease Allowing for the collection of CSF Determining a change in level of consciousness
allowing for collection of CSF
neural plasticity
allows undamaged neurons to assume functions of damaged ones
Traumatic Brain Injury
alteration in brain function caused by external force (MVA, falls)
Traumatic Brain injury (TBI)
alteration in brain function, caused by external force, MVA, Falls
Graves disease
an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos
anterograde amnesia
an inability to form new memories
retrograde amnesia
an inability to retrieve information from one's past
Arousal
an individual's state of awakeness (content of thought)
Corticosteroids MOA
anti-inflammatory
Monoclonal antibody
antibody produced in a laboratory to attack antigens and to destroy cells; useful in immunotherapy works by targeting lymphocyte migration across the blood—brain barrier, an early step in MS lesion formation (disease modifying)
A client who has diabetes and arterial insufficiency in the lower extremities had a sudden loss of ability to speak and was unable to move the left arm and leg. This condition lasted for 9 minutes and then resolved, with no apparent lasting effects. What terms should a nurse use with another health professional to describe this situation? Select all that apply. Aphasia Paraplegia Left hemiplegia Transient ischemic attack Cerebrovascular accident
aphasia left hemiplegia transient ischemic attack
most common forms of encephalitis
are caused by arthropod-borne viruses and herpes simplex virus
TIA symptoms
are temporary and last a few minutes to less than 24 hours and usually resolve within 30-60 minutes may occur singly or in a series may damage brain tissue with repeated insults indicate a high stroke risk. (Not every patient who has a cerebrovascular accident (CVA) will have a TIA)
macula lutea
area of most distinct vision
Ischemic cerebral infarction
area pales and softens
subdural brain abscess
arise from sinus infection or vascular source
Intracerebral brain abscess
arise from vascular cause
Complications of a cerebrovascular accident (CVA) tend to be those related to immobility. Which problems are possible complications of a CVA? Aspiration Pneumonia Contractures Atherosclerosis Atrial fibrillation
aspiration pneumonia contractures
4 types of neuroglia cells
astrocytes microglia oligodendrocytes schwann cells
Primary brain tumors
astrocytoma oligodendroglioma ependymoma
cancer pain
attributed to advance of disease, treatment, or coexisting disease entities
Myasthenia gravis
autoimmune disease, weakness and fatigue of muscles of the eyes and throat causing diplopia and difficulty chewing and swallowing
The nerves that serve the viscera, involuntary nerves and secretory systems
autonomic
A client was injured 6 weeks ago in a diving accident and has been diagnosed with a spinal cord injury at the level of the fourth cervical vertebra. The client starts to have a pounding headache, bradycardia, and sweating above the level of the lesion. Which complication does the nurse suspect? Spinal shock Focal brain injury Horner syndrome Autonomic hyperreflexia
autonomic hyperreflexia
Huntington disease (aka chorea)
autosomal dominant hereditary degenerative disorder severe degeneration of the basal ganglia (caudate nucleus) and cerebral cortex (depletion of gamma-aminobutyric acid-GABA)
subdural hematomas
bleeding between the dura mater and brain
Epidural hematomas
bleeding between the dura mater and the skull
hemorrhagic cerebral infaction
bleeding occurs in infarcted area may be exacerbated by thrombolytic therapy
Hemorrhagic
bleeding occurs in infarcted area, treatment focuses on restoration of perfusion
intracerebral hematomas
bleeding within the brain
optic disc
blind spot
SSRIs (treat depression in Alzheimer's)
block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available
subarachnoid hemorrhage
blood escapes from defective or injured vasculature into subarachnoid space (between pia and dura mater)
Results of increased ICP on vision
blurred vision decreased visual acuity diplopia Increased pressure on the oculomotor nerve (cranial nerve III) affects the size and response of the pupils. Papilledema (swelling around optic nerve) Usually, one pupil ipsilateral to the lesion becomes fixed and dilated both pupils become fixed and dilated ("blown"). ptosis, or "droopy eyelid," (effect of pressure on cranial nerve III and due to abnormal or excessive eye movements, such as nystagmus)
Brain Death (Total Brain Death)
body can no longer maintain internal homeostasis
Fever of unknown origin (FUO)
body temperature of greater than 101° that remains undiagnosed after 3 days of hospital investigation or two or more outpatient visits
cartilaginous symphysis joint
bones united by a pad or a disc (pubic symphysis like with pregnancy)
In chronic pain sufferers, neuroimaging studies have demonstrated
brain atrophy (which may lead to cognitive deficits and ability to cope with pain)
During cerebellar herniation, which part of the brain is compressed? Midbrain Brainstem Cranial nerve III Posterior cerebral artery
brainstem
Cholinesterase
breaks down acetylcholine in the brain. If their action is inhibited, more acetylcholine is available for communication between brain cells.
A patient who sustained a motor vehicle accident has a vertebral injury. The nurse determines that the patient may have cord swelling in the cervical region based on which assessment finding? Hypertension Polycythemia Breathing difficulty Abdominal distention
breathing difficulty
Pennate muscle
broad, flat and fan shaped with fibers running obliquely to the muscles long axis (pecks)
dopamine receptor agonists
bromocriptine (Parlodel) Cabergoline Pramipexole (Mirapex) Ropinirole (Requip) Rotigotine (Neupro-transermal patch)
First degree burns
burns the epidermis, symptoms include redness, pain , and swelling
Which class of vertebral injury does the nurse expect in the patient with spinal cord trauma whose computed tomography (CT) scan shows that the patient's vertebral body has shattered into several fragments? Dislocation Burst fracture Simple fracture Wedge fracture
burst fracture
Impact of exercise on DM
can increase glucose uptake by muscles substantially without an increase in insulin use. It also assists in weight control, reduces stress, and improves cardiovascular fitness. ADA recommends at least 150 min/week (30 minutes, 5 days/week) of moderate exercise. ADA recommends patients with Type 2 diabetes mellitus perform resistance training three times a week.
posttraumatic seizures
can occur within days or up to 2-5 years post injury, hyper-excitable state related to injury and repair
etiologic pain
cancer dental inflammatory ischemic vascular
sensorineural hearing loss
caused by impairment of the organ of corti or its central connections may occur gradually or suddenly
acromegaly
caused by overproduction of growth hormone
Cerebral infarction
caused by vascular occlusion in brain, irreversible ischemia and necrosis, prompt infusion of thrombolytic agents (TPA) may restore perfusion
cerebral anoxia lasting longer than 10 minutes
causes cerebral infarction with irreversible changes
complications of heat stroke
cerebral edema degeneration of CNS swollen dendrites renal tubular necrosis hepatic failure delirium coma death if treatment not undertaken
Cerebral edema and increasing area of infarction in the first 24-48 hours tend to increase the neurologic deficits Neurologic deficits tend to be increased when there is
cerebral edema and increasing area of infarction in the first 24-48 hours
In which disease is the monitoring of a lipid profile important? Viral encephalitis Metabolic encephalopathy Cerebral vascular accident Abnormal brain and nerve function
cerebral vascular accident
behavioral responses to pain in infants
changes in facial expressions, crying and body movements with lowered brows drawn together; vertical bulge and furrows in forehead between brows; broadened nasal root; tightly closed eyes angular, square-shaped mouth chin quiver withdrawal of affected limbs rigidity flailing
conductive hearing loss
changes in the outer or middle ear impairs the conduction of sound from the outer to the inner ear
night terrors
characterized by sudden apparent arousals in which the child expresses intense fear or emotion child is not awake and can be difficult to arouse once awake, the child has no memory of event
trachoma
chlamydial conjunctivitis associated with poor hygiene leading cause of preventable blindness in the world
Drugs for Symptom Management
cholinergics anticholinergics muscle relaxants nerve conduction enhancers
Drugs for Symptom Management in MS
cholinergics anticholinergics muscle relaxants nerve conduction enhancers
The majority of the CSF is made in the
choroid plexus
Arteriovenous malformation (AVM)
clump of vessels
cones
color and detail receptors densest in the center of the retina
Migraine causes
combination of multiple genetic and environmental factors
mixed hearing loss
combination of sensorineural and conductive hearing loss
restless leg syndrome (RLS)
common sensimotor disorder associated with unpleasant sensations (prickling tingling crawling) that occurs at rest and is worse in the evening or at night
2 types of hydrocephalus
communicating non-communicating (obstructive hydrocephalus)
Open Fractures
communicating wound between bone and skin
anosmia
complete loss of smell
Brain herniation
complication of increased intracranial pressure occurs when something inside the skull produces pressure that moves brain tissues (most often the result of brain swelling from a head injury, stroke, or brain tumor)
traumatic injury of vertebral and neural tissues result from
compressing pulling shearing forces
Pain Transmission
conduction of pain impulses along the A-delta and C fibers into the dorsal horn and the spinal cord
Which are the common signs of a cerebrovascular accident affecting the anterior cerebral artery? Select all that apply. Confusion Blurred vision Temporary aphasia Personality changes Sensory loss in the legs Sensory loss in the arms
confusion personality changes sensory loss in the legs
sensorineural hearing loss is caused by
congenital/hereditary noise exposure aging Ménières disease ototoxicity systemic disease (syphilis, Paget, collagen DM) neoplasms autoimmune process
pain perception
conscious awareness of pain
suprachiasmatic nucleus (SCN)
controls circadian rhythms
A client has a neurilemmoma. When the family asks what neurilemmoma is and what part of the brain it affects, what structure or structures should the nurse mention? Frontal lobes Cranial nerves Choroid plexus Cerebral hemispheres
cranial nerves
An infant's head enlarges beyond normal size if
cranial sutures have not closed
Eponychium
dead epidermis that covers the proximal end of the nail (commonly the cuticle)
Cerebral death (irreversible coma)
death of the cerebral hemispheres exclusive of the brain stem and cerebellum
hypogeusia
decrease in taste sensation
A patient with back pain reports pain when sneezing and coughing. During the assessment, the nurse finds that the patient has impaired sensation at L4-L5 levels. What other clinical manifestation should the nurse anticipate to find in the patient? Decreased biceps reflex Decreased ankle jerk reflex Presence of paroxysmal hypertension Presence of severe edema in the chest
decreased ankle jerk reflex
Which is the most common symptom to indicate increased intracranial pressure (ICP) in early stages of presentation? Vomiting Papilledema Severe headache Decreasing level of consciousness
decreasing level of consciousness
astigmatism
defective curvature of the cornea or lens of the eye
Sedative-hypnotic properties
depress central nervous system (CNS) function Primarily used to treat anxiety and insomnia Antianxiety agents or anxiolytics Distinction between antianxiety effects and hypnotic effects is often a matter of dosage
Psychologic and behavioral changes that emerge as chronic pain progresses
depression difficulty eating and sleeping preoccupation with the pain avoidance of pain-provoking stimuli
Hypothermia produces
depression of the CNS and respiratory system vasoconstriction alterations in microcirculation and coagulation ischemic tissue damage In severe cases, ice crystals form on the inside of cells causing them to rupture and die
Affective-motivational system
determines an individual's conditioned avoidance behaviors and emotional responses to pain
In many cases it is possible with intensive therapy to
develop new neural pathways in the brain or to relearn a task, thus recovering some lost functions.
Which diseases are risk factors for a transient ischemic attack? Diabetes Heart disease Hypertension Kidney disease Amyotrophic lateral sclerosis
diabetes heart disease hypertension
where is yellow bone marrow found?
diaphysis of long bones
Which medications are commonly used as muscle relaxants for the treatment of multiple sclerosis? Prednisone Diazepam (Valium) Tizanidine (Zanaflex) Dantrolene (Dantrium) Dimethyl fumarate (Tecfidera)
diazepam tizanidine dantrolene
multiple sclerosis
difficult to diagnose. Symptoms, combined with typical patient (young, female) often imply the diagnosis. History often described as discreet neurologic signs, and symptoms are separated in space and time. (ex: double vision may occur and resolve; and then, difficulty controlling a hand may develop and resolve) Exam may show focal neurologic signs that cannot be explained by a single central nervous system (CNS) lesion. Blood tests (blood count, electrolytes, and liver tests) and electroencephalogram (EEG) are usually normal. A lumbar puncture with an analysis of cerebrospinal fluid (CSF) may show elevated protein (amyloid), gamma globulin, and lymphocytes.
Primary TBI
direct impact, focal or diffuse
primary traumatic brain injury
direct impact, focal or diffuse
Mėnières disease
disorder of the middle ear with an unknown etiology that can affect one or both ears
Dyssomnias
disorders of initiating or maintaining sleep
herniated vertebral disk
displacement of nucleus propulsus or annulus fibrosus
Herniated intervertebral disk
displacement of nucleus pulposus or annulus fibrosus
angle closure glaucoma
displacement of the iris toward the cornea with obstruction of the trabecular meshwork and obstruction of the outflow of aqueous humor from the anterior chamber (may occur acutely with a sudden rise in intraocular pressure, causing pain and visual disturbances)
Which assessment finding in a client with a spinal cord injury will most alert the nurse that autonomic hyperreflexia may occur? Dehydration Bowel movement Distended bladder Stress and anxiety
distended bladder
Losses due to aging or injury of differentiated neurons cannot be replaced because they
do not have the ability to divide (neural stem cells found in hippocampus and ventricles can divide and produce 2 daughter cells, one which retains stem cell characteristics but the other may differentiate into a neuron or glial cell. Most will not find a suitable location and will die but if we can figure out how to signal them to migrate to the right places, we might be able to treat degenerative diseases like Parkinson's)
dopaminergic clases
dopamine precursors dopamine receptor agonists dopamine agonists
Parkinson's drugs
dopaminergics anticholinergics antihistamine monoamine oxidase inhibitors (MAOIs) Catechol O-Methyltransferase (COMT) inhibitors
cerebral function causes
drug intoxication, metabolic disorder, or conditions that affect the brain delirium (hyperkinetic, hypokinetic)
A nurse is taking the history of a client with an intracranial aneurysm. There is no history of arteriosclerosis, trauma, or inflammation. Which area should the nurse ask about next? Drug use Alcohol use Sexual activity Cigarette smoking
drug use
Cholinergics/Parasympathomimetics
drugs that mimic the activity of the parasympathetic nervous system Drugs for Symptom Management
Cushing's syndrome
due to chronic exposure to excess corticosteroids, particularly glucocorticoids such as hydrocortisone and cortisol (most commonly due to exogenous corticosteroid therapy such as prednisone)
Peripheral neuropathic pain
due to trauma or disease to one or more peripheral nerves
The toughest layer of the meninges is the
dura mater
3 layers of meninges
dura mater arachnoid mater pia mater
What does sebum prevent skin from doing?
dying and cracking
Dystonia
dystonic postures and movements decorticate posture decerebrate posture basal ganglion posture senile posture
Alzeimer disease (AD)
early onset familial nonhereditary (sporadic, late onset) theoretical mutation for encoding emyloid precursor protein theoretical alteration in apolipoprotein E
Clinical manifestations of brain abscess
early: low grade fever, headache, neck pain, stiffness, confusion, drowsiness, sensory deficits, and communication deficits
Cerebrospinal fluid (CSF) is a clear, colorless, odorless solution that fills the ventricular system and subarachnoid space of the brain and spinal cord. It contains electrolytes, glucose, protein, oxygen, and CO2 dissolved in solution, and acts as a shock absorber.
electrolyes glucose protein O₂ CO₂
Hyperthermia
elevation of the body temperature without an increase in the hypothalamic set point
Which are the direct causes of a cerebrovascular accident? Select all that apply. Age Emboli Diabetes Atheroma Ruptured aneurysm
emboli atheroma ruptured aneurysm
Communication: Reflects _______________ through facial expressions, gland _________________.
emotions, secretions
Benzodiazepine method of action
enhance the action of the neurotransmitter, GABA(Gamma Amino Butyric Acid)
The skin of humans are composed of two layers called?
epidermis, dermis
A client is hit in the temporal portion of the skull during an altercation. Although the client initially loses consciousness, the client soon awakens and is conversant. Twenty minutes later the client is experiencing projectile vomiting, drowsiness, and confusion. The nurse suspects the client's symptoms are most likely related to which type of brain injury? Epidural Subdural Intracerebral Diffuse axonal
epidural
2 types of seizures disorders
epilepsy convulsion
where is red bone marrow found?
epiphysis
secondary spinal cord injury
events that begin immediately after injury and continues for weeks, life threatening if swelling occurs in cervical area>cervical nerves
SAIDH caused by
excess ADH either temporarily due to stress or an ectopic source
hydrocephalus
excess fluid within the cerebral ventricles, subarachnoid space or both
Hypersomnia
excessive daytime sleepiness
Noninsulin Injectable Agents
exenatide (Byetta) liraglutide (Victoza) pramlintide (Symlin)-always used with insulin
4 types of dysphasia
expressive receptive transcortical global
Epithelial tissues covers all________and ________ surfaces of the animal body.
external, internal
sensory inattentiveness
extinction neglect syndrome
Migraine headache
familial episodic disorder whose marker is headache and is defined as repeated, episodic headache lasting 4 to 72 hours
aqueous humor
fills anterior and posterior chambers of the anterior cavity of the eye
If LMNs are lost, the muscle fibers they used to synapse with will show
flaccid paralysis (no muscle tone and no voluntary contraction of those fibers) no reflexive contractions atrophy of those fibers over time
Lower motor neuron syndrome
flaccid paresis or flaccid paralysis hyporeflexia or areflexia fibrillation
lens
flexible, biconcave, crystal-like structure that divides the anterior chamber into two chambers; the aqueous and vitreous
Noncommunicating hydrocephalus is due to
flow of CSF through the ventricular system is blocked (obstruction leads to backpressure of fluid in the brain ventricles resulting in enlarged ventricles and the compression of blood vessels and brain tissue)
perilymph
fluid contained in the labyrinth of the inner ear
Which assessment finding is typical of a client with astrocytoma? Hearing loss and deafness Focal seizure disorder with headache Difficulty in balance with unsteady gait Inability to control fine motor movement
focal seizure disorder with headache
Cerebral infarction treatment
focused on restoration of perfusion and counteracting ischemia
Nail fold
fold of skin around the margin or the nail plate
Oligocendrocytes
form myelin sheaths similar to Schwann cells of the PNS
Epithelial tissue come in many different _______ and is used for many different ________________ in vertebrates and invertebrates
forms, functions
Pathologic
fracture at point where bone is weakened by disease (osteoporosis/tumors)
Impacted
fracture is pushed together (bone pushed into each other)
Linear
fracture line parallel to long axis of bone
Transverse
fracture line perpendicular to long axis
Avulsion
fragment of bone connected to a ligament or tendon detaches from main bone
diarthrosis
freely movable
The flow of CSF
from the fourth ventricle through the median or lateral aperture and into the subarachnoid space around the spinal cord and up over the cerebral hemispheres to the arachnoid villi absorption into the venous system
myofibrils
functional subunite--where you find the sarcomere
Neuron
functional unit of the nervous system
Meningitis causes
fungus virus bacteria
What is the purpose of the Glasgow Coma Scale? Diagnosing a CVA Looking for seizure activity Gauging change in neurological status Determining if a fracture has occurred
gauging change in neurological status
As MG progresses, there is an increase in
generalized weakness, with eventual weakness of the respiratory muscles
Obstructive sleep apnea syndrome
generally results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 seconds or longer
Cerebral palsy causes
genetic mutations abnormal fetal formation of functional brain areas damage in the perinatal period
Primary brain tumors
gliomas, very in extent, fastest growing, very invasive, fatal
pain tolerance
greatest intensity of pain a person can endure generally decreases with repeated exposure to pain, fatigue, anger, boredom, apprehension and sleep deprivation may increase with alcohol consumption, persistent use of opioid medications, hypnosis, distracting activities and strong beliefs or faith
Cerebral palsy
group of disorders marked by motor impairment
spina bifida
group of neural tube defects common developmental abnormality Failure of posterior spinous processes on the vertebrae to fuse (permit meninges and spinal cord to herniate, results in neurological impairment) Any number of vertebrae can be involved (most common location-lumbar area)
epiphyseal plate
growth plate, cartilaginous plate where new bone cells get deposited--once the body is done growing this plate calcifies over
Nail matrix
growth zone at proximal end of nail
transcortical-motor, nonfluent dysphasia
halting speech
2 places on your body that don't contain oil glands?
hands and sole of feet
Saccular (berry) aneurysm
has stem
lower motor neurons
have cell bodies in the brainstem or in the anterior horn of the spinal cord
Cluster headaches
headaches that occur in clusters (mins. to hrs.) for a period of days followed by a long period of spontaneous remission
4 forms of accidental hyperthermia
heat cramps heat exhaustion heat stroke malignant hyperthermia
vireous humor
helps to prevent the eyeball from collapsing inward
Upper motor neuron syndrome
hemiparesis or hemiplegia diplegia paraparesis or paraplegia quadriparesis or quadriplegia pyramidal motor syndromes spinal shock
The third most common cause of CVA
hemorrhage
meningocele
herniation of the meninges occurs through defect meninges and CSF form a sac on the surface transillumination confirms absence of nerve tissue in sac
heat stroke symptoms
high core temperature absence of sweating rapid pulse rate confusion agitation coma
viral conjuctivitis
highly contagious and caused by adenovirus
acute bacterial conjunctivitis
highly contagious and often caused by staphylococcus, haemophilus, streptococcus pneumoniae and morax-ella catarrhalis
A client is 64 years old and has experienced a hemorrhagic cerebrovascular accident (CVA). Based on the pathophysiology of a hemorrhagic cerebrovascular disease, a nurse should anticipate finding that the client had which risk factors? Polycythemia or thrombocythemia Hypertension and cerebral aneurysm Insulin resistance and atherosclerosis Atrial fibrillation or infective endocarditis
hypertension and cerebral aneurysm
The heat-producing mechanism begins with
hypothalamic thyrotropin-stimulating hormone-releasing hormone (TSH-RH) Anterior pituitary releases thyroid stimulating hormone (TSH) thyroid gland releases thyroxine (T4) adrenal medulla releases epinephrine into blood epinephrine causes vasoconstriction, glycolysis, increased metabolic rate and thus increases heat production
Temperature regulation (thermoregulation) is mediated by
hypothalamus (primarily) endocrine system
Most cases of low back pain are
idiopathic
Mild concussion
immediate but transitory clinical manifestations, confusion may last 1-several minutes, possible amnesia
synarthrosis
immovable joint--ex: skull sutures
Disease modifying drugs
immunomodulators immunosuppressants Sphingosine 1-phoshpate receptor monoclonal antibody
conductive hearing loss is caused by
impacted cerumen foreign bodies lodged in ear canal benign tumors of middle ear carcinoma of external auditory canal or middle ear eustachian tube dysfunction otitis media acute viral otitis media chronic suppurative otitis media cholesteatoma otosclerosis
Hyposmia
impaired sense of smell
aphasia
impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).
Increased ICP can
impede circulation to the brain impede absorption of CSF affect the function of nerve cells lead to brainstem compression and death
meningioma
in meninges
The large C-shaped ventricles are located
in the center of each hemisphere
The choroid plexus is located
in the lateral and third ventricles of the brain
insomnia
inability to fall asleep
selective attention deficit symptoms
inability to focus attention failure to perceive objects and other stimuli (history of injuries, falls, safety problems); can exhibit neglect syndrome (i.e., unilateral neglect with failure to groom or recognize one side of the body)
Dietary modifications for Addison's
increase salt intake to replace salt needs, especially during excess heat or humidity
physiologic pain symptoms in infants
increased heart rate, blood pressure, respiratory rate flushing or pallor sweating decreased oxygen saturation
Which condition would be a contraindication to performing a lumbar puncture (LP)? An infection in the brain Suspected seizure activity Increased intracranial pressure (ICP) Decreasing score on the Glasgow Coma Scale
increased intracranial pressure (ICP)
hyperesthesias
increased sensitivity and decreased pain threshold to tactile and painful stimuli is diffuse is modified by fatigue and stress is mixed with other sensations
As ICP rises, sytemic blood pressure
increases
Secondary TBI
indirect consequence of primary injury
secondary traumatic brain injury
indirect consequence of primary injury
Secondary brain injury
indirect result of primary brain injury
Secondary brain injury
indirect result of primary brain injury, trauma/stroke syndromes, management is related to prevention
other causes of brain damage
infection meetabolic abnormalities such as hypoglycemia in mother or child
keratitis
infection of the cornea
blepharitis
inflammation of the eyelid
color blindness
inherited
Descending inhibitory pathways (and nuclei)
inhibit pain through modulating or inhibiting afferent pain signals at the dorsal horn
neuropathic pain
initiated or caused by primary lesion or dysfunction in the nervous system (and leads to long-term changes in pain pathway structure-neuroplasticity and abnormal processing of sensory function)
coup injury
injury directly below the point of impact
contrecoup injury
injury on the side opposite the site of impact
retina
innermost layer of the eye
Diabetic ketoacidosis (DKA) or Hyperosmolar hyperglycemic state (HHS) occurs due to
insufficient insulin and therefore high blood glucose levels
DKA or HHS treatment
insulin and replacement of fluids and electrolytes (HHS requires greater volumes of fluid)
ventricles
interconnected hollow areas of the brain where CSF is produced, fills and flows
glaucoma
intraocular pressure greater than 12-20 mm Hg with death of retinal ganglion cells and their axons second leading cause of blindness
tardive dyskinesia
involuntary movements of the face, lip, tongue, trunk and extremities usually occurs as a side effect of prolonged antipsychotic drug therapy
nystagmus
involuntary unilateral or bilateral rhythmic movement of the eyes
pain modulation
involves many different mechanisms that increase or decrease the transmission of pain signals throughout the nervous system
bleeding causes compressed brain tissue which leads to
ischemia edema increased ICP necrosis
If autoregulation, a compensatory mechanism to maintain cerebral blood flow, is disrupted
it can lead to cellular hypoxia and ischemia
When discussing an electroencephalogram (EEG), which is a true statement? It is a noninvasive test. It uses monitors on the scalp. It can diagnose a bleed in the brain. It can record electrical activity of the brain. It requires a period of fasting before the test.
it is nonivasive it uses monitors on the scalp it can record electrical activity of the brain
Approximately one out of every 400-500 children has type 1 diabetes which is also known as
juvenile diabetes or insulin dependent diabetes
Function of sebum?
keeps hair moist and pliable
Hardness derived from what dense deposits?
keratin
benefits of fever
kills microorganisms decrease serum iron, zinc and copper (needed for bacterial replication) lysosomal breakdown and autodestruction of cells (prevents viral replication in infected cells) increases lymphocytic transformation and motility of PMNs (facilitating the immune response) enhanced phagocytosis and production of antiviral interferon is augmented
A CVA is an infarction of brain tissue that results from
lack of blood. Tissue necrosis (death) may be the outcome of total occlusion of a cerebral blood vessel or the result of a ruptured cerebral vessel, which causes hemorrhage.
Results of severe ischemia and neuronal death
lack of circulatory control and BP drops destroyed respiratory controls leading to abnormal respiratory patterns (Cheyne-Stokes) with alternating apnea and periods of increasing and decreasing respirations (depending on site of lesion)
postconcussion syndrome
lasts for weeks or months after concussion
formation of new bone
laying down of new bone by osteoblasts lining the walls of the resorption cavity
Neurological deficit from spina bifida depends on
level of defect and on status of nerve tissue
dopamine precursors
levodopa (L-dopa) levodopa/carbidopa (Sinemet)
Bulbs of Krause
light touch
Meissner´s corpuscles
light touch
Free nerve endings
light touch, temperature, pain
ependymal cells
line the ventricles and central canal of the spinal cord producing CSF and maintaining the CSF-brain barrier
Thermoregulation: Helps regulate _______________ through radiation, evaporation, skin capillaries dilation\ constriction
lipid
brain or spinal cord abscess
localized collection of pus with the parenchyma
interpretive centers
located in the brain stem, midbrain, diencephalon, and cerebral cortex
Classic cerebral concussion
loss of conciousness <6 hours accompanied with amnesia, confusional state lasting for days, loss of respiration can occur
paralysis
loss of voluntary movement
degenerative disorders of the spine
low back pain degenerative disk disease (DDD)
their axons synapse on muscle fibers and are also known as alpha motor neurons
lower motor neurons (LMNs)
Pain threshold in children
lower or same as adults
pain threshold
lowest intensity of pain that a person can recognize
The registered nurse instructs a student nurse to draft a care plan for a patient with a vertebral fracture who has developed symptoms of spinal shock. Which is the priority intervention in the care plan? Maintain a patent airway. Maintain electrolyte balance. Monitor blood glucose levels. Adjust room temperature as needed.
maintain a patent airway
Causes of brain damage in cerebral palsy
malformation mechanical trauma hypoxia hemorrhage hypoglycemia hyperbilirubinemia infection→necrosis
Seizures
manifestation of disease sudden, transient alteration of brain function caused by abnormal excessive discharges of cortical neurons
hypothermia
marked cooling of core temperature
4 types of brain bleeds
massive small slit petechial
autonomic hyperreflexia (dysreflexia)
massive, uncompensated cardiovascular response to stimulation of sympathetic nervous system
Congenital and neonatal hearing loss may be caused by
maternal rubella ototoxic drugs prematurity traumatic delivery erythroblastosis fetalis congenital hereditary malfunction
non-pharmaclologic treatments CP occupational therapy
maximizes hand function. teaches the use of adaptive devices. facilitates the developmental skills, which are associated with normal development and academic work. develops hand-eye coordination. develops reflex responses.
non-pharmaclologic treatments CP physical therapy
maximizes physical development. Braces can improve mobility and reduce deformities. MEDEK (CME) is an exercise program for infants and young children with developmental problems involving skeletal muscle, especially hypotonia. The program promotes strength, mobility, and independence without the use of devices or machines.
primary spinal cord injury
mechanical trauma or immediate tissue destruction, inadequate mobilization following injury, may occur in absence of vertebral fracture or dislocation
rods
mediate peripheral and dim light vision and are densest at the periphery
Sensory-discriminative system
mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain
Synthesis: Skin synthesizes _____________ (color), ___________ (toughness) and ____________________ (calcium metabolism)
melanin, ketanin, Vitamin D
Cluster headaches are usually found in
men between 20-50 years old
Extracerebral brain tumors
meningioma nerve sheath (neurofibroma, neurofibramatosis) metastatic
Analysis of cerebrospinal fluid (CSF) in the laboratory is an important diagnostic tool in such conditions such as
meningitis encephalitis traumatic brain injuries
Spina Bifida Signs and Symptoms
meningocele or myelomenigocele visible as a protruding sac over the spine
Seizures etiological factors
metabolic disorders congenital malformations genetic predisposition perinatal injury; postnatal trauma myoclonic syndromes infection brain tumor vascular disease substance abuse
Which condition can occur when metabolites such as ammonia increase in the blood? Viral encephalitis Bacterial meningitis Metabolic encephalopathy Cerebral vascular accident (CVA)
metabolic encephalopathy
oral hypoglycemic drugs
metformin: most widely used glipizide glyburide repaglinide nateglinide acarbose miglitol sitagliptin saxagliptin
stereotactic radiosurgery
method of delivering a highly concentrated dose of radiation to a precise location.
categories of diffuse brain injury
mild concussion classic cerebral concussion mild, moderate and severe diffuse axonal injuries (DAIs)
ALS treatment focuses on minimizing the complications of immobility, sustaining functions as long as possible, and supporting the patient's family.
minimizing the complications of immobility sustaining functions as long as possible supporting the patient's family.
Immunomodulator properties
modify disease progression and prevent relapses. Flu-like sxs should be treated with acetaminophen. These drugs are given subcutaneously. These drugs have anti-inflammatory properties. may cause serious liver dz; should be monitored. Pregnancy should be avoided.
Immunomodulators
modify the disease progression and prevent relapses (disease modifying)
Generally, CSF accumulates because
more is produced than reabsorbed
persistent low back pain
most common chronic pain condition results from poor muscle tone, inactivity, muscle strain, or sudden vigorous exercise
Tension headache
most common, mild to moderate bilateral headache that feels like tight band or pressure around head
Dynorphins
most potent of the endogenous opioids
myelomeningocele
most serious herniation of spinal cord and nerves, along with meninges and CSF considerable neurological impairment
spina bifida appears to have
multifactoral basis (radiation, gestational DM, deficits of folic acid) (high familial incidence)
Demyelinating Disorders
multiple sclerosis Guillain-Barre syndrome
Which symptom supports the nurse's suspicion that a patient with a neuromuscular junction disorder has myasthenia gravis? Nausea Diarrhea Muscle fatigue Intestinal cramping
muscle fatigue
Rabies testing
must be diagnosed in humans and other animals rapidly for timely administration of post-exposure prophylaxis
Insulin
must be used as replacement therapy for type I diabetes mellitus. Facilitates glucose entrance into cells Cannot be taken orally since it is a protein which is destroyed by digestive enzymes and therefore must be subcutaneously injected May be an insulin pen or continuous infusion via a small pump for better control of diabetes May also be used for Type 2 diabetes if oral medication does not provide glucose control
Global or nonfluent; summation of motor and sensory aphasia
mute
Spinal stenosis
narrowing of spinal canal that causes pressure on spinal nerves or cord
myopia
nearsightedness
A client with meningitis has nuchal rigidity. How should the nurse interpret this finding? Projectile vomiting that indicates brain abscess Neck stiffness that indicates meningeal irritation Difficulty moving that is diagnostic for parkinsonism Mild frontal headache that is diagnostic for encephalitis
neck stiffness that indicates meningeal irritation
neurogenic pain
neuralgia constant (sympathetically independent/dependent)
Alzheimer disease characteristics
neurofibrillary tangles senile plaques
Transient ischemic attacks (TIA)
neurological dysfunction lasting less than an hour, results from ischemic event, but then clot moves along
mechanisms of dementia
neuron degeneration brain tissue compression atherosclerosis brain trauma
categories of pain
neurophysiologic neurogenic temporal (time related, duration) tegional etiologic
Cerebral death criteria
no behavioral or environmental responses the brain can continue to maintain internal homeostasis
Parkinson's disease
no specific diagnostic test. Diagnosis is generally based on H&P Depression and dementia are often seen No specific laboratory tests are diagnostic. CSF analysis may help to rule out other diseases. The response to therapeutic agents (such as levodopa) can be diagnostic.
Fusiform (giant) aneurysm
no stem
chalazion
noninfectious lipogranuloma of the meibomian (oil producing) gland that often occurs in association with a hordeolum
what is osteoid?
nonmineralized bone matrix--non calcium part of the bone
Ischemic
not necrotic, not fully destroyed, area pales and softens
Which pathophysiologic process should the nurse remember when planning care for a client with a herniated intervertebral disk? Nucleus pulposus extrudes and compresses the nerve root. Gelatinous material inside the cord hardens and obstructs blood flow. Degeneration of the spine involves the lamina or neural arch of the vertebra. Vertebra slides forward possibly causing a fracture of the pars interarticularis.
nucleus propulsis extrudes and compresses the nerve root
Meningitis may cause __________ hydrocephalus
obstructive (fibrosis in meninges, impaired absorption)
lacunar stroke
occlusion of single, deep perforating artery causing ischemic lesions, rare
Cluster headache
occurs in men 20-50 years occurs in clusters then followed by long period of remission
Transtentorial (central) herniation
occurs when cerebral hemispheres, diencephalon, and midbrain are displaced downward
Myasthenic crisis
occurs when severe muscle weakness causes extreme quadriplegia, respiratory insufficiency with shortness of breath , and extreme difficulty swallowing
Uncal herniation
occurs when the uncus of the temporal lobe is displaced downward past the tentorium cerebelli, creating pressure on the third cranial nerve, the posterior cerebral artery, and the RAS
Neurogenic shock
occurs with injury above T5, caused by absence of sympathetic activity and unopposed sympathetic tone
lipid profile is important because
of the role of lipids in plaque formation which can cause TIA and stroke
strabismus
one eye deviates from the other when the person is looking at an object caused by weak or hypertonic muscle in one eye
jerk nystagmus
one phase of the eye movement is faster than the other
3 types of glaucoma
open angle angle closure congenital closure
Spondylolisthesis
osseous defect that allows vertebra to slide forward anteriorly
3 types of bone cells
osteoblasts, osteoclasts, osteocytes
resorption
osteoclasts from a "cutting cone" which gradually resorbs bone, leaving behind an elongated cavity termed a resportion cavity
epidural brain abscess
osteomyelitis in a cranial bone
open angle glaucoma
outflow obstruction of aqueous humor at the trabecular meshwork - often inherited - leading cause of blindness
extracerebral tumors
outside cerebral area
Embolic stroke
outside of brain, fragments that break from a thrombus formed outside of brain
cognitive-evaluative system
overlies the individual's learned behavior concerning the experience of pain and can modulate perception of pain (mediated through the cerebral cortex)
Deafferation pain
pain due to loss of sensory input into CNS caused by lesion in the peripheral nerves (ex: brachial plexus injury) or pathology of CNS common types include severe burning pain triggered by various stimuli
phantom limb pain
pain experience in amputated limb after stump has completely healed may be immediate or occur months later exact cause unknown thought to originate in brain can be influenced by emotions/sympathetic stimulation
referred pain
pain felt in a part of the body other than its actual source
It is thought that negative manifestations of continuous pain are reversible when
pain is controlled
Chronic or persistent pain
pain lasting well beyond the expected normal healing time following the initial onset of tissue damage or injury serves no purpose is poorly understood is thought that changes in the PNS and CNS that cause dysregulation of nociception and pain modulation processes lead to it
Diffuse noxious inhibitory control (DNIC)
pain relieved when two noxious stimuli occur at the same time from different sites (basis for pain relief with acupuncture, deep massage or intense cold or heat)
Influences patient perception of pain
pain threshold pain tolerance
pain threshold in infants
painful neonatal experiences increase pain sensitivity may be increased with future procedures
Surgical treatment for DM
pancreas transplant bariatric surgery for BMI over 35 kg/m2
characteristics of MS
paresthesia weakness impaired gait visual disturbances urinary incontinence
chronic postoperative pain
persistent pain that can occur with disruption or cutting of sensory nerves
cognitive
pertaining to the mental processes of comprehension, judgment, memory, and reasoning, as contrasted with emotional and volitional processes.
dysgeusia
perversion of taste in which substances possess an unpleasant flavor (i.e. metallic)
endogenous pyrogens
phagocytic cells (including tumor necrosis factor-alpha, interleukin-1, interleukin-6 and interferon)
While assessing a patient with a vertebral fracture, the nurse finds that the patient has developed symptoms of autonomic hyperreflexia syndrome. Which drug would be most helpful to this patient? A hypoglycemic Acetaminophen An antidepressant Phenoxybenzamine
phenoxybenzamine
Which symptoms support the nurse's suspicion that a patient is suffering from migraine? Phonophobia Throbbing pain Unilateral head pain Generalized convulsions
phonophobia throbbing pain unilateral head pain
The innermost layer of the meninges
pia mater
Major brain damage from Hypoxia or Ischemia
placental complications difficult delivery vascular occlusion hemorrhage respiratory impairment in premature infant high bilirubin levels
cerebrospinal fluid (CSF)
plasma like liquid that fills the space between the arachnoid and the pia mater layers to provide additional cushion and support circulates within the subarachnoid space, giving buoyancy to the brain
Pattern of breathing alterations in arousal
posthyperventilation (PHVA) cheyne-stokes respirations (CSR)
Malignant hyperthermia
potentially lethal complication of a rare inherited muscle disorder that may be triggered by inhaled anesthetics and depolarizing muscle relaxants. involves altered calcium function in muscle cells with hypermetabolism, uncoordianted muscle contractions, increased muscle work, increased oxygen consumption and raised level of lactic acid production acidosis develops and body temp. rises tachycardia cardiac dysrhythmias hypotension decreased cardiac output cardiac arrest
heat stroke
potentially lethal result of an overstressed thermoregulatory center regulatory center ceases to function and body's heat loss mechanisms fail
Migraine phases
premonitory aura headache
Organs of Ruffini
pressure
Pacinian corpuscles
pressure
Early indications of increased intracranial pressure (ICP) are the key to early diagnosis. Which is the best rationale for why projectile vomiting occurs with increased ICP? Loss of consciousness Swelling of the optic disk Pressure stimulating the emetic center in the medulla From stretching of the dura and walls of large blood vessels
pressure stimulating the emetic center in the medulla
management of secondary brain injury is related to
prevention
NMDA (N-methyl-D-aspartate) receptor antagonist (treats decreased memory and cognition)
prevents damage and destruction of brain cells that occurs due to increased levels of a chemical in the brain called glutamate.
CNS tumors
primary brain (gliomas) extracerebral intramedullary (gliomas) extramedullary (intradural, extradurall)
Narcolepsy
primary hypersomnia characterized by: hallucinations sleep paralysis cataplexy (rare)
Chronic traumatic encephalopathy CTE
progressive dementing disease, sports injuries, blast trauma, work-related head trauma
dementia
progressive failure of many cerebral functions including impairment of intellectual processes losses of: orientation, memory, language, judgement and decision making (can be genetically predisposed)
Multiple sclerosis (MS)
progressive, inflammatory, demyelinating disorder of CNS, loss of myelin disrupts nerve conduction with death of neurons and brain atrophy
Which are goals of the MEDEK (CME) exercise program used in patients with cerebral palsy? Select all that apply. Promote mobility Promote strength Promote independence Increase reflex response Increase hand-eye coordination
promote mobility promote strength promote independence
The epithelial tissue acts as a?
protective shield
fovea centralis
provides greatest visual acuity
Which techniques can be used to aid Alzheimer's patients who have eating and swallowing difficulties? Select all that apply. Use of bright lighting Providing finger food Keeping a television on Use of easy grip utensils Simulating natural sounds
providing finger food use of easy grip utensils simulating natural sounds
Which assessment is the priority if a client experiences a myasthenic crisis? Cardiac Vascular Pulmonary Neurologic
pulmonary
heat loss is achieved through
radiation conduction convection vasodilation evaporation decreased muscle tone increased respiration voluntary measure adaptation to warmer climates
herniated disk can lead to
radiculopathy pain paresthesia
A-delta fibers
rapidly transmit sharp, localized "fast" pain sensation - elicit the reflex withdrawal
congenital closure glaucoma
rare disease associated with congenital malformations and other genetic anomalies
In older children and adults, the amount of brain damage from ICP depends on the
rate of pressure increase and time of relief
Dietary modifications for Grave's disease or hyperthyroidism
recommended to consume high-calorie diet (4000 to 5000 calories/day) to treat an increased metabolic rate, prevent tissue breakdown, and decrease weight loss.
Dietary modification for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
recommended to restrict fluid ranging from 800 to 1000 mL/day. This prevents fluid overload, or, the body retaining more fluid than it needs
Which is the purpose of an electroencephalogram (EEG)? Looking for blood clots Looking for plaque buildup Recording electrical activity of the brain Recording changes in neurological status
recording electrical activity of the brain
Complications of CNS vascular disease
recurrent CVAs secondary problems related to immobility (such as pneumonia, aspiration, constipation or contractures related to paralysis)
function of articular cartilage
reduce friction in the joint and to distribute the forces of weight bearing
Sphingosine 1-Phosphate Receptor Modulator
reduce the frequency of clinical relapses and to delay the accumulation of physical disability thought to act by retaining certain white blood cells (lymphocytes) in the lymph nodes, thereby preventing those cells from crossing the blood-brain barrier into the central nervous system (CNS). Preventing the entry of these cells into the CNS reduces inflammatory damage to nerve cells (disease modifying)
amblyopia
reduced vision in affected eye caused by cerebral blockage of the visual stimuli
pendular nystagmus
regular back and forth movement of the eyes
Astrocytes
regulate ionic balance and maintain integreity of the blood-brain barrier
4 subtypes of MS
relapsing remitting secondary progressive primary progressive progressive relapsing
Diabetes insipidus treatment
replacement ofADH if the cause is central or neurogenic (due to a deficiency in ADH synthesis) For central diabetes insipidus, ADH replacement hormone of choice is desmopressin acetate (DDAVP). For nephrogenic diabetes insipidus, treatment measures include thiazide diuretics, like hydrochlorothiazide (Hydrodiuril, Microzide) diuretics normally cause an increase in urine output, in some people with DI, it works the opposite)
Signs of malignant hyperthermia
resemble those of coma: unconsciousness absent reflexes fixed pupils apnea occasionally a flat EEG Oliguria and anuria are common most common in children and adolescents
Which are signs or symptoms of a patient whose ventricular shunt for the treatment of hydrocephalus is malfunctioning? Select all that apply. Stiff neck High fever Restlessness Blurred vision Decreased level of consciousness
restlessness blurred vision decreased level of consciousness
myofascial pain
results from muscle spasm, tenderness, stiffness, or injury trigger points as it progresses, it becomes increasingly generalized
heat exhaustion
results from prolonged high core or environmental temperatures and results in: profound vasodilation profuse sweating dehydration decreased plasma volumes hypotension decreased cardiac output tachycardia
Arousal is mediated by
reticular activating system (RAS)
review muscle contraction
review muscle contraction
Clinical categories of FUO
rheumatic/inflammatory neoplastic miscellaneous disorders
tinnitus
ringing in the ears
Which is a cause of a cerebrovascular accident (CVA), but not a transient ischemic attack (TIA)? Emboli A vascular spasm Ruptured blood vessel Obstruction of a blood vessel
ruptured blood vessel
physiologic pain symptoms in elderly
same as children may be decreased in individuals with cognitive impairment
physiologic pain symptoms in children
same as infants and also nausea and vomiting
injury to the optic nerve causes
same side blindness
Iodine treatment i ncludes
saturate solution of potassium iodine (SSKI) and Lugol's solution (may be used with antithyroid drugs)
function of neuroglial cells
scaffold neural tissue isolate and protect neuron cell membranes regulate interstitial fluid defend the neuron against pathogens assist with neural repair
Monoamine Oxidase Inhibitors (MAOIs)
selegiline (Eldepryl) Rasagiline (Azilect)
Equilibrium receptors are located in the
semicircular canals and vestibule
vertigo
sensation of spinning that occurs with inflammation of the semicircular canals in the ear
Temperature receptors
sense heat and cold
Pain receptors
sense tissue damages
maculae
sensory receptors for static equilibrium
inhibitory neuromodulators
serotonin, GABA, norepinephrine, endogenous opioids
The severity of diffuse axonal injury corresponds to the amount of
shearing force applied to the brain stem (mild, moderate, severe)
axonal damage
shearing, tearing or stretching of nerve fibers
White muscle (type 2 fibers)
short term, anerobic metabolism (blinking eye)
Vertebral Injuries most commonly occurs due to
simple fracture compressed (wedged) fracture comminuted (burst) fracture disclocation
joints
site where two or more bone meet
The integumentary system of vertebrates includes the _________ and _________________ that develop from it?
skin, structures
where does marrow mostly reside in the bones of adults?
skull, vertebrae, ribs, sternum
somnambulism
sleepwalking
amphiarthrosis
slight movable joint--ex: pubic symphasis
factors affecting temperature regulation in elderly
slowed blood circulation structural and functional skin changes decreased heat producing activities decreased shivering response slowed metabolic rate decreased vasoconstrictor response diminished or absent ability to sweat decreased peripheral sensation desynchronized circadian rhythm decreased heat and cold perception decreased thirst decreased nutritional reserves decreased brown adipose tissue
Results of tissue hyperthermia
slowed cellular metabolism increased blood viscosity slowed circulatory blood flow blood coagulation is facilitated profound vasoconstriction
C-fibers
slowly transmit dull, aching or burning sensations
otoliths
small crystals in the fluid-filled vestibular sacs of the inner ear that, when shifted by gravity, stimulate nerve cells that inform the brain of the position of the head
olfactory hallucinations
smelling odors that are not really present
The nerves that go to skeletal muscles and are basically involved in voluntary movement
somatic
gait disorders
spastic scissors cerebellar basal ganglion senile frontal lobe ataxic
After the initial insult from a cerebrovascular accident (CVA), which symptom occurs as the nervous system recovers? Dysphagia Confusion Weakness Spastic paralysis
spastic paralysis
hypertonia
spasticity gegenhalten (paratonia) dystonia rigidity
Clinical manifestations of spinal cord abscess
spinal aching severe root pain weakness caused by progressive cord compression paralysis
Clinical manifestations of spinal cord abscess
spinal aching, severe root pain, accompanied by spasms, limited vertebral movement, weakness, paralysis caused by cord compression
PNS disorders start with the
spinal nerve root
which type of bone heals quicker?
spongy bone
short bones consist of mostly what?
spongy bone covered by a thin layer of compact bone
hordeolum (stye)
staph infection of a sebaceous gland in the eyelid
consciousness
state of awareness of oneself and the environment arousal (state of awakeness) awareness (encompasses all cognitive functions)
Pramipexole (Mirapex) is a medication used for the treatment of Parkinson's disease. Which is the mode of action of pramipexole (Mirapex)? Blocks dopamine reuptake Stimulates dopamine receptors Blocks the breakdown of dopamine Converted to dopamine in the basal ganglia
stimulates dopamine receptors
activation of the remodeling cycle
stimulus (hormone or drug) activate formation of osteoclasts
Cholinesterase inhibitor method of action
stop or inhibit enzymes (cholinesterase) from breaking down acetylcholine when it travels from one cell to another
A nurse must assess the client for a Kernig sign. Which action should the nurse take? Push on the feet. Passively flex the neck. Shine a light into both eyes in a dimly lit room. Straighten the knee with the hip and knee in a flexed position.
straighten the knee with the hip and knee in a flexed position
Effects and cautions of therapeutic hypothermia
stresses heart leading to v-fib and arrest exhausts liver glycogen stores may cause burns, frostbite and fat necrosis immunosuppresion with increased infection risk slows drug metabolism
Which are common causes of increased intracranial pressure (ICP)? Select all that apply. Stroke Diabetes Brain infection Brain hemorrhage Trauma to brain or head
stroke brain infection brain hemorrhage trauma to brain or head
Which statement regarding the epidemiology of transient ischemic attacks and strokes is true? Stroke is the fifth leading cause of death in the United States. Hemorrhagic strokes are more common than ischemic strokes. Cerebrovascular accident (CVA) is a warning sign of a transient ischemic attack (TIA). Cerebrovascular accident (CVA) and a transient ischemic attack (TIA) are the same disease.
stroke is the fifth leading cause of death in the United States
Alterations in Arousal
structural psychogenic
spondylolysis
structural defect due to degeneration, fracture, or developmental defect, most often occurs at L5
From which spinal cord space is CSF obtained in a lumbar puncture (LP)? Spinal cord Epidural space Meningeal space Subarachnoid space
subarachnoid space
Immunosupressants
suppresses the pathogenic immune response in MS with high efficacy but is also associated with high toxicity, limiting the long-term use of these agents (disease modifying)
Structural alterations in arousal
supratentorial infratentorial metabolic
spina bifida treatment
surgery ongoing assistance and OT/PT after repair
Which describes papilledema, a common manifestation of increased intracranial pressure (ICP)? Double vision Drooping of the eyelids Swelling around the optic nerve Buildup of excessive cerebrospinal fluid in the brain
swelling around the optic nerve
The hypothalamus triggers heat conservation by stimulating the
sympathetic nervous system
cartilaginous joint
symphysis and synchondrosis
trauma and stroke syndromes
systemic processes cerebral processes
fever
temporary "resetting of the hypothalamic thermostat" (in response to endogenous or exogenous pyrogens)
pupil
the adjustable opening in the center of the eye through which light enters
Proprioception
the awareness of the position of the body and its parts
at what stage can a cast be replaced?
the callus replacement stage
Nail plate
the clear keratinized portion of the nail
choroid
the deeply pigmented middle layer that prevents light from scattering inside the eye
closed brain injury
the dura remains intact and brain tissues are not exposed to environment
what is the periosteum compared to?
the enamel on our teeth
Hyponychium
the epithelium of the nail bed
communication between the C-shaped ventricles and the third ventricle in the diencephalon occurs by way of
the intraventricular foramen
Cerebrovascular accidents (stroke syndromes) are
the leading cause of disability the third leading cause of death in United States Classified
presbyopia
the ocular lens becomes larger, firmer and less elastic causing reduced near vision
Which finding in the patient with focal injury supports the nurse's conclusion that the patient has moderate blunt trauma? The patient has paraplegia. The patient has acute contusional swelling. The patient has subacute subdural hematoma. The patient has traumatic cerebral hemorrhage.
the patient has paraplegia
The nurse is caring for a patient with spinal shock due to a vertebral column injury. After assessing the patient, the nurse concludes that the spinal shock is terminating. Which finding enabled the nurse to reach this conclusion? The patient has reduced muscle tone. The patient's urine output is 500 ml/day. The patient's blood pressure is 90/60 mm Hg. The patient reports a tingling sensation in the legs.
the patient reports a tingling sensation in the legs
cornea
the portion of the sclera in the central anterior region that allows light to enter the eye
An increasing pulse pressure (the difference between systolic and diastolic pressures) is significant in people with ICP. The widening gap in pulse pressure results from
the slow heart rate and the intermittent, but rapid on-off cycle, of Cushing's reflex controlling systemic vasoconstriction
potential space
the space between each layer of the meninges (if there is a pathological process, we might see blood or fluid collection in this area and the space becomes real)
Which statement about TIAs is correct? TIA symptoms occur temporarily. TIA symptoms can last permanently. Every patient who has a TIA will have a CVA. Symptoms of a TIA last longer than 24 hours.
the symptoms occur temporarily
Antihyroid drugs inhibit
the synthesis of thyroid hormones
Meninges
the three membranes that encase the CNS and provide buoyancy and shock-absorbing capacity
Medications that are used to control conditions such as seizures must be at
therapeutic levels and require monitoring.
falx cerebri
thin wall of dura that folds down the cortical midline separating the 2 hemispheres
Cerebrovascular Accidents (CVA)
third leading cause of death in US, Ischemia, hemmorhagic, or associated with hypoperfusion
A prolonged increase in intracranial pressure (ICP) causes
tissue ischemia because cerebral blood flow and perfusion are compromised
Sensory reception: Senses ______________________________ damage (pain)
touch, pressure, heat, cold ,tissue
acute confusional states (ACS)
transient disorders of awareness that result from cerebral dysfunction
3 types of brain herniation
transtentorial (central) uncal cerebellar or tonsillar (infratentorial)
Causes of herniated disk
trauma, DDD or both
Sedative-Hyponotics
treat sleep disturbances
Pheochromocytoma treatment
treatment with α- and β-adrenergic receptor blockers is required preoperatively surgical removal
Non-pharmacological treatments Alheimer's
treatments for eating and swallowing infection prevention skin care elimination problems
Cluster headache causes
trigeminal activation autonomic dysfunction
Increased Intracranial Pressure (ICP) causes
tumor growth edema excessive CSF hemorrhage
cartilgainous synchondrosis
two bones united by a layer of hyaline cartilage (rib to sternum)
Hemorrhagic stroke
uncontrolled hypertension for years is primary cause, bleeding causes compressed brain tissue , leading to ischemia, edema, and necrosis
Migraine characteristics
unilateral throbbing worsened by movement moderate or severe any of the following: nausea, vomiting, photophobia or phonophobia
Both paresis and paralysis can occur due to damage to either
upper motor neurons or lower motor neurons
B-adrenergic blockers
used for symptomatic relief of thyrotoxicosis (thyroid storm) block effects of sympathetic nervous stimulation, thus decreasing tachycardia, nervousness, irritability and tremors
OpTune System
used to treat glioblastoma that recurs or progresses after receiving chemotherapy and radiation therapy. This medical device involves electrodes which are placed on the surface of the patient's scalp to deliver low-intensity, changing electrical fields called tumor treatment fields (TTFs) to the tumor site.
Tensilon test
uses intravenous edrophonium chloride (Tensilon®), a short-acting acetylcholinesterase inhibitor, to prolong the action of acetylcholinesterase (AChE) causing the build-up of acetylcholine at the myoneural junction, resulting in a rapid, short period of symptom improvement.
Radioactive iodine therapy (RAI)
uses radioactive iodine treatment of choice for most nonpregnant adults
synovial joint
usually, one of the bones is stable and serves as an axis for the motion of the other bone (collar bone and the scapula--humorous is the mover) -most movable and complex
behavioral responses to pain in elderly
varies and may be influenced by presence of painful chronic diseases individuals with cognitive impairment may demonstrate changes in behavior such as being combative, withdrawn or have increased confusion
pain threshold in elderly
varies but may be lower
injury to the optic chiasm causes
various defects, depending on the location of the injury
behavioral responses to pain in children
vary
cerebrovascular disorders
vascular malformations (arteriovenous malformation) subarachnoid hemorrhage (blood escapes from defective or injured vasculature into the subarachnoid space)
The majority of LMNs are in the
ventral horns of the spinal cord
Which are predisposing factors for type 1 diabetes? Select all that apply. Obesity Prediabetes Viral infection Family history Genetic factors
viral infection family history genetic factors
Hydroregulation: Prevents ______________ (due to keratin and sebum)
water
symptoms of heat exhaustion
weakness dizziness confusion nausea fainting
Characteristics of Myasthenia gravis
weakness and fatigue of muscles of the eyes and throat causing diplopia and difficulty chewing, talking and swallowing myasthenic crisis cholinergic crisis
Paresis
weakness of muscle
what stimulates osteoblastic activity?
weight bearing activity
intracerebral hemorhagic stroke
which is caused when vessel integrity is interrupted and bleeding occurs into the brain tissue or the space surrounding the brain. Aneurysms can rupture, causing hemorrhagic strokes.
Sclera
white part of the eye
Thrombotic stroke
within brain, arterial occlusions formed in arteries supplying brain with blood, arterial bleeds cause death of brain tissue
Migraines are usually found in
women 25-55 years old
Red muscle (type 1 fibers)
work under aerobic oxidative metabolism--found in postural muscle
What is the preoperative pharmacological treatment for pheochromocytoma surgery?
α-adrenergic receptor blocker (given first to reduce BP and alleviate other symptoms of catecholamine excess) After adequate α-adrenergic blockade, β-adrenergic receptor blockers are given (to decrease tachycardia and other dysrhythmias)