443 Exam 6

tonic-clonic seizure

"grand mal"; loss of consciousness, jerking, cyanosis, tongue/cheek biting, incontinence. Post seizure feeling of not feeling "normal", muscle soreness, fatigue, sleeping, memory loss

In patients with SCI T6 and above, what aspects of cardiac function are affected?

-Coronary blood flow -Contractility -HR

Physiologically, what is the difference between generalized and focal seizures?

-Generalized affects both hemispheres of the brain -Focal affects specific parts of the brain, typically one hemisphere over the other

What pulmonary-related functional impairments can occur in someone with a SCI?

-Impaired inspiration and forced expiration (related to intercostal muscle and diaphragm dysfunction) -Inability to clear (cough) secretions and mucus plugs -Autonomic NS dysfunction which involves clearance of secretions, bronchospasms, and pulmonary edema

What sorts of non-pharmacologic interventions can be used for patients with fibromyalgia?

-Massage in tandem with ultrasound -Alternating heat and cold -Gentle stretching -Yoga/Tai Chi and other relaxation techniques -Low impact aerobic exercise -Educate on limiting sugar, caffeine, and alcohol intake

typical absence seizure

-Occurs only in children and rarely into adolescence -May cease or develop into another type -Typical symptom is staring spell for only a few seconds and usually goes unnoticed.

2 diagnostic criteria for fibromyalgia

-Pain in 11 out of 18 points on palpation -history of widespread pain for 3 months on both sides of the body

Definition of Generalized Seizures and 3 types

-involves both brain hemispheres -tonic/clonic -absence -myoclonic

What is the lateral corticospinal tract responsible for, and where does it cross?

-main motor pathway from brain to periphery -crosses in the brainstem

What 2 things is the lateral spinothalamic tract responsible for, and where does it cross?

-pain and temperature -C6

What 4 things is the posterior column spinal tract responsible for, and where does it cross?

-position sense, 2 point discrimination, vibratory sense, light touch -crosses in brainstem

2 common seizure manifestations

-rapid onset -unstoppable through contact

Focal Seizure definition and 4 types

-seizure in 1 hemisphere -aware -impaired -motor -nonmotor

What are the three clinical indications for a patient to receive surgical treatment for seizures?

1.Confirmed diagnosis of a seizure disorder 2.Those that don't respond to medication management 3.Defined electroclinical syndrome

What should the goal MAP be to maintain spinal cord perfusion in someone with a SCI?

85 mmHg for at least 5-7 days

How is an MS relapse defined?

A new neuro symptom lasting 24+ hours

which risk factor associated with fibromyalgia should the nurse ask about while taking a history? A) family history b) history of osteoarthritis C) male gender D) age 20-40

A) family history

When planning care for a client with fibromyalgia, the nurse addresses potential activity intolerance. What will the nurse recommend to the client to address this problem? A) program of regular, low impact exercise B) referral to PT for an assistive device C) drinking more caffeinated beverages D) taking NSAIDS daily

A) program of regular, low impact exercise Walking, yoga, tai chi, and gentle stretching can help prevent atrophy. Caffeine, sugar, and alcohol can be muscle irritants.

A patient admitted following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response? A) "So many factors can cause epilepsy that it is impossible to say" B) "Epilepsy is inherited. Does anyone else in your family have it?" C) "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity" D) "Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges"

C) "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity"

A patient with focal impaired awareness seizures. Which characteristics are related to this type of seizures (SATA)? A: Formerly known as "grand mal" seizures B: often accompanied by incontinence of tongue/cheek biting C: Psychomotor seizures with repetitive behaviors and lip smacking D: altered memory, sexual sensations, and distortions of visual or auditory sensations E: loss of consciousness and stiffening of body, jerking of extremities, F: behavioral, emotional, and cognitive functions with altered consciousness

C: Psychomotor seizures with repetitive behaviors and lip smacking D: altered memory, sexual sensations, and distortions of visual or auditory sensations F: behavioral, emotional, and cognitive functions with altered consciousness

How is AIDS diagnosed

CD4 count less than 200 or an AIDS defining condition

Atypical absence seizures

Characterized by staring spell with other manifestations- eye blinking, lip jerking

True or False: Patients with SCI require more calories than those with TBIs?

F- muscles are inactive and thus require less energy

Loss of lower motor neurons causes __________

Flaccidity

What GI-related condition are patients with SCI at risk of developing?

Ileus

3 symptoms for SEID diagnosis

Impaired function with profound fatigue for 3 months Post exertional malaise Unrefreshing sleep Plus brain fog or orthostatic intolerance

McDonald Criteria

MS diagnostic criteria -Dissemination in Space: lesions in certain areas or evidence of inflammation in CSF -Dissemination in Time: evidence of new lesions

PEP

Post-exposure prophylaxis: can reduce the risk of HIV infection immediately AFTER exposure. within 72 hours of exposure, 28 days of HIV meds

PrEP

Pre-exposure prophylaxis: can reduce the risk of HIV BEFORE exposure. 1 pill, once a day reduces risk by 90%

Convulsive status epilepticus

Prolonged or repeated tonic/clonic seizures -Dangerous: leads to respiratory insufficiency, hypoxia, dysrhythmia, hyperthermia, systemic acidosis, injury, death -High risk if patient loses consciousness

Loss of upper motor neurons causes _________

Spasticity

What level of the spine has to be injured in order for neurogenic shock to occur?

T5 and above

Aside from direct cardiopulmonary complications, what are SCI patients especially at risk for?

VTE causing a PE

5. For a 65-year-old woman who has lived with a T1 spinal cord injury for 20 years, which health teaching instructions should the nurse emphasize? a. A mammogram is needed every year. b. Bladder function tends to improve with age. c. Heart disease is not common in people with spinal cord injury. d. As a person ages, the need to change body position is less important.

a. A mammogram is needed every year.

1. During rehabilitation, a patient with spinal cord injury begins to ambulate with long leg braces. Which level of injury does the nurse associate with this degree of recovery? a. L1-2 b. T6-7 c. T1-2 d. C7-8

a. L1-2

7. Teach the patient with fibromyalgia the importance of limiting intake of which foods (select all that apply)? a. Sugar b. Alcohol c. Caffeine d. Red meat e. Root vegetables

a. Sugar b. Alcohol c. Caffeine

5. Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more.

11. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking lamivudine (Epivir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact

a. Using sterile equipment to inject drugs

6. A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/µL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

a. a CD4+ T cell count below 200/µL.

3. Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including needles, syringes, pipes, and straws.

a. unprotected anal or vaginal sexual intercourse.

2. A patient with a T4 spinal cord injury experiences neurogenic shock as a result of sympathetic nervous system dysfunction. What would the nurse recognize as characteristic of this condition? a. Tachycardia b. Hypotension c. Increased cardiac output d. Peripheral vasoconstriction

b. Hypotension

8. HIV antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

b. decrease viral RNA levels.

3. A patient with spinal cord injury is experiencing severe neurologic deficits. What is the most likely mechanism of injury for this patient? a. Compression b. Hyperextension c. Flexion-rotation d. Extension-rotation

c. Flexion-rotation

9. Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

c. occur in the presence of immunosuppression.

4. A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the flu because he has a bad headache and nausea. The nurse's first priority is to a. call the HCP. b. check the patient's temperature. c. take the patient's blood pressure. d. elevate the head of the bed to 90 degrees.

c. take the patient's blood pressure.

4. During HIV infection a. reverse transcriptase helps HIV fuse with the CD4+ T cell. b. HIV RNA uses the CD4+ T cell's mitochondria to replicate. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.

Status Epilepticus

condition where seizures occur in rapid succession without return to consciousness in between -Any seizure over 5 mins -Neuro emergency- can exhaust neurons and cause permanent brain damage

aware focal seizure

conscious, alert- unusual sensations, sudden emotions, nausea, hallucinations

12. What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

7. Screening for HIV infection generally involves a. detecting CD8+ cytotoxic T cells in saliva. b. laboratory analysis of saliva to detect CD4+ T cells. c. analysis of lymph tissues for the presence of HIV RNA. d. laboratory analysis of blood to detect HIV antigen or antibody.

d. laboratory analysis of blood to detect HIV antigen or antibody.

Nonmotor focal seizure

emotional manifestations

Absence and myoclonic meds

ethosuximide, divalproex, clonazepam

Ictal phase of seizure

first symptom to end of seizure

Psychogenic nonepileptic seizures

history of abuse or trauma

impaired focal seizure

loss of consciousness, dangerous behaviors, memory loss

Central Cord Syndrome

loss of function in upper extremities caused by injury to the middle portion of the spinal cord. lower extremities still functional

Drugs for fibromyalgia pain

lyrica, cymbalta, savella

Major side effect of phenytoin

phenytoin may cause gingival hyperplasia

Tonic Clonic Meds

phenytoin, phenobarbital

Status epilepticus meds

rapid acting IV lorazepam and diazepam

Postictal phase of seizure

recovery

myoclonic seizure

rhythmic arm abduction with progressive arm elevation, jerking eyelids

Prodromal phase of seizure

sensation or behavior changes before the seizure

Aural phase of seizure

sensory warning before seizure occurs; still considered part of the seizure

Motor focal seizure

spasms, strange behavior, repetition, purposeless actions

Spinal Shock

temporary shock is characterized by decreased reflexes, loss of sensation, absent thermoregulation, and flaccid paralysis below the level of injury. This syndrome lasts days to weeks and may mask postinjury neurologic function.