Major Exam 2, 4322, Health Alterations

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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.

In the Mini-Cog, a score of _____ or higher is considered negative for dementia.

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?

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

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

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

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

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

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

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.

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

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.

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.

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

monoclonal antibody drugs properties

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

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.

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 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 patient with pheochromocytoma is having a suppression test done. Which drug will be administered? A Clonidine B Vasopressin C Cosyntropin D Dexamethasone

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

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.

Which diagnostic finding supports the presence of an endemic goiter? A Low T3 B High T4 C Low TSH D Thyroid antibodies

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.

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.

Which neurotransmitter is involved in determining a client's mood, anxiety, and sleep induction? A Serotonin B Histamine C Substance P D Acetylcholine

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.

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

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

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

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

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.

The rate of production of CSF is _________ of blood pressure or intraventricular pressure A dependent B independent

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.

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

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

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

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

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

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

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."

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.

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.

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.

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

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

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

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

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

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)

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