MS 2 Test 3

duration of delirium

hours to weeks

microbiota

the cells of the bacteria, viruses, and fungi

Which statement by the patient being discharged after gastric bypass surgery indicates the need for further teaching? A. "I may need to take a multivitamin every day." B. "I may develop constipation while I am taking pain medications." C. "I should not lift anything heavy until cleared by the surgeon." D. "I should drink at least one cup of fluids with every meal."

"I may need to take a multivitamin every day."

An older patient is admitted to the hospital with a urinary infection and possible bacterial sepsis. The family is concerned because the patient is confused and not able to carry on a conversation. Which statement by the nurse is most appropriate?

"The mental changes are most likely caused by the infection and most often reversible."

medical management of pheochromocytoma

alpha-adrenergic to vasodilate, then beta blockade to decrease the rate and get BP down; adrenalectomy

consciousness of pt with delirium

altered

a closed skull fracture

may be palpated through the scalp or visualized on x-ray or other radiographical imaging.

key characteristics that differ increased ICP from cerebral herniation

LOC: progressive confusion and increasing lethargy pupillary assessment: sluggish reaction and ovoid shape motor assessment: Focal contralateral motor weakness vital signs: no change

laboratory tests in stroke pts

are used to determine if hypercoagulability is the cause; Examples of tests that may be requested include lupus anticoagulant; anticardiolipin antibodies, protein C activity, protein S activity, and factor V Leiden mutation.

clinical manifestations of HHS

increased serum glucose; tachycardia and hypotension; altered LOC; dry, flushed skin because they are dehydrated; blurred vision; polyuria; weakness

normal ICP

0-15 mm Hg and is typically treated in a stepwise approach when the pressure exceeds 20 mm Hg

steps of individualized stress response from the environment

1. perception filter (selection) 2. primary appraisal (interpretation of the stressor; can either be positive, dangerous, or irrelevant) 3. if primary appraisal interprets stimuli as dangerous, secondary appraisal is utilized (analysis of the available resources) 4. if there is insufficient resources to deal with the stressor stimuli, than stress ensues 5. coping (overcoming of the stress)- can either be problem-focused (change situation itself) or emotion focused (change the relation to the situation) 6. reappraisal (pacing and learning)

an open skull fracture

is associated with a disruption of the scalp such that the skull is exposed to the atmosphere.

human body cell count ratio

1.3 microbiota cells to 1 human cell

increased BMI

is associated with decreased glomerular filtration rate with progression to CKD

in patient w/ physical characteristics of Cushing's disease

24-hour urine collection for urinary free cortisol excretion should be performed to assess for excessive cortisol secretion leading to weight gain

normal serum osmolarity

270-300

Cushing's Triad

3 late and most recognized clinical manifestations of cerebral herniation; include: widened pulse pressure (increased SBP/decreased DBP), bradycardia, and irregular respiratory pattern

In correlating contributing factors to the pathophysiology of obesity, which factor is considered environmental? A. Increased appetite B. Automation C. Growth hormone deficiency D. Obese family members

automation

A patient with a head injury has an intracranial pressure of 18 mm Hg. Her blood pressure is 144/90 mm Hg, and her mean arterial pressure is 108 mm hg. What is the cerebral perfusion pressure?

90 mm Hg

The nurse recognizes which patient to be at the highest risk for developing SLE? A. A 10-year-old Hispanic female B. An 18-year-old African American male C. A 30-year-old African American female D. A 50-year-old Caucasian male

A 30-year-old African American female

The nurse recognizes which patient is at greatest risk for death secondary to stroke? A. A 36-year-old Caucasian male B. A 45-year-old Asian male C. A 56-year-old African American female D. A 62-year-old Hispanic female

A 56-year-old African American female

electroencephalogram (EEG) nursing considerations

A patient must be completely still for this type of test because any movement, including shivering, is recorded as artifact and obscures the electrical tracing. Some patients may require mild sedation to reduce movement artifact on the recording. The technician records the amount of medication given so that the tracing can be interpreted in the context of sedation administration. During continuous monitoring, the scalp electrodes are typically placed by a technician, and the patient's head is wrapped in a bandage to keep the electrodes in place. It is important that the nurse inspects the head to ensure that all electrodes are in place so that the recording is continuous.

spinal cord injury at T1-T5 results in

paraplegia with trunk and leg involvement, normal arm and hand movement

class 2 and class 3 obesity in adults aged 45-64

is associated with premature death of at least 7 years from all-cause mortality and 10 years from CV disease-specific mortality

healthy lifestyle factors that may ensure a friendly gut microbiota and positively affect prevention and treament of metabolic disorders include:

breast lactations; appropriate antibiotics use; and the avoidance of excessive dietary fat intake

nursing actions for SLE

Administer analgesics and anti-inflammatory medications as ordered; Administer medications as ordered to treat specific clinical manifestations teach: disease process; sunscreen daily (photosensitivity is common); energy conservation and activity prioritization; keep up to date on immunization but avoid line vaccines; avoid oral contraceptives; assist in referrals to pulmonolgoist, nephrologist, neurologist, cardiologist, and dermatologist as needed

nursing actions for the pt with a brain tumor

Administer glucocorticoids as ordered, dexamethasone (Decadron) (typically given postoperative to treat and prevent further local cerebral edema) monitor serum electrolytes, particularly serum sodium and glucose (need to be monitored as dexamethasone may lead to elevated serum glucose levels) replace urine loss and electrolytes as ordered elevate head of bed 30-45 degrees and maintain head in good alignment administer stool softners administer antiepileptic medications as ordered (based on tumor location and a history or risk of seizure activity) apply mechanical VTE devices and administer pharmacological prophylaxis of VTE as ordered (presence of cancer as well as tissue injury during surgery increases a patient's risk of VTE; pharmacological prophylaxis may not be administered immediately after surgery because of concern for bleeding risk; however, medication may be initiated further into the patient's hospital course)

populations at increased risk of Delirium

African American; hispanic; male (vs. Female); non english speaker; medical ICU (vs. SICU)

patients that are better candidates for aneurysm clipping instead of coiling

Aneurysms with a wide neck and tortuous vascular anatomy

post-operative interventions for transsphenoidal hypophysectomy

Assess VS with neuro checks Hourly Intake and Output Assess urine specific gravity Monitor serum chemistries Check visual fields Check mustache dressing for drainage Monitor to see if CSF drainage, if clear fluid is coming out send it to lab to be tested for glucose Routine pre & post op care, pain mgt Watch for DI, meningitis

nerve damage from spinal cord tumor compression

is often permanent, with disabilities continuing after it is removed

The nurse knows that which of following statements regarding laboratory values and RA are true? (Select all that apply.) A. Patients with a positive rheumatoid factor definitely have RA. B. An elevated CRP is indicative of inflammation but is not specific only for RA. C. Certain DMARD therapy may cause laboratory abnormalities such as elevated liver enzymes, thrombocytopenia, and leukocytopenia. D. Approximately 25% to 30% of patients who have RA do not have a positive rheumatoid factor. E. Patients with RA have elevated cardiac enzymes due to pharmacological therapy.

B. An elevated CRP is indicative of inflammation but is not specific only for RA. C. Certain DMARD therapy may cause laboratory abnormalities such as elevated liver enzymes, thrombocytopenia, and leukocytopenia. D. Approximately 25% to 30% of patients who have RA do not have a positive rheumatoid factor.

presenting symptomology of a brain tumor in the optic chiasm

Bitemporal field cuts

other systemic complications that may occur secondary to SAH include

myocardial ischemia and infarction, acute left ventricular failure, and acute respiratory distress syndrome (ARDS)

When comparing osteoarthritis to RA, the nurse recognizes which of the following statements to be true? (Select all that apply.) A. Osteoarthritic pain tends to get worse with activity, but RA gets better with activity. B. Both RA and osteoarthritis are autoimmune diseases. C. Patients with RA are at risk for developing extra-articular manifestations such as eye inflammation and lung disease, whereas osteoarthritis affects only joints and surrounding structures. D. Patients with osteoarthritis typically have morning stiffness lasting less than 1 hour, whereas RA patients typically complain of morning stiffness lasting greater than 1 hour. E. Both RA and osteoarthritis affect joints in a symmetrical pattern.

C. Patients with RA are at risk for developing extra-articular manifestations such as eye inflammation and lung disease, whereas osteoarthritis affects only joints and surrounding structures.

if the dura is damaged in a skull fracture

CSF begins to leak, placing a patient at risk for infection and herniation syndrome as intracranial contents shift with the loss of CSF

clinical manifestations of delirium

Can present with a variety; Hypoactivity and lethargy Hyperactivity - including agitation and hallucinations MIXED usually develops over a 2- to 3-day period. Can develop within hours

A patient is admitted with a stroke/brain attack. Which predisposing factor in the patient's history places this patient at greatest risk for ischemic stroke? History of hypertension Right sided heart failure Carotid plaque DVT in subclavian vein

Carotid plaque

if vascular structures, such as jugular veins and carotid arteries are damaged due to skull fractures or TBI

life-threatening hemorrhage can result

medical management of ischemic strokes

Cerebral blood vessels may be opened or recanalized using IV recombinant tissue plasminogen activator (rt-PA), which allows a blood clot to be dissolved at the site and restores blood flow to ischemic neuronal tissue. intra-arterial thrombolytic administration; involves a cerebral angiogram to locate a vessel occlusion accompanied by delivery of thrombolytics directly into a blood clot (also called endovascular technique) using a device such as the MERCI clot retrieval system, where a corkscrew-shaped catheter is introduced into the clot, ensnaring it and allowing it to be retrieved using suction in the artery also includes measures to prevent complications including: VTE prophlylaxis, management of BP, and control of risk factors for stroke to prevent recurrence diagnostic work-up aimed at finding the cause is essential to guid focused treatment

a major complication of SAH affecting 30% of patients

Cerebral vasospasm causing delayed ischemic neurological deficits; occurring between days 4 and 14 after the stroke

Using the NIH classification for BMI, the nurse identifies the patient with a BMI of 32 kg/m2 as which category?

Class 1 obesity

patent foramen ovale

a hole or communication between the right and left atria; patients with this are at risk of a clot traveling from the periphery into the heart from the right to the left atrium and then out the left side of the heart through the aorta and ejected toward the brain

helpful tips when caring for the pt with delirium

Collaborate with the health care team to remove or treat risk or causative factors for acute confusion. To help prevent and manage delirium, use a calm voice to frequently reorient the patient. For example, playing tapes of soothing music may have a calming effect. Providing a doll or stuffed animal to "fidget" with may prevent the patient from removing important medical tubes or equipment. If the patient has a favorite item, such as an afghan blanket or a picture, ask the family or significant others to provide it for the same purpose.

consequences of adverse childhood experiences (ACE)

likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide 1,220 percent

peak risk period for cerebral vasospasm

occurs from days 5-9 after the SAH and is a narrowing of a segment of a cerebral artery that leads to local cerebral ischemia

patients with tumors in the pituitary gland may develop

DI

disorders related to ADH secretion

DI and SIADH; IMPORTANT TO REMEMBER: this hormone only effects water, so anything that happens to effect electrolytes have to do with hemodilution

hypo/hyperpituitarism

Deficiency or excess of one or more anterior pituitary hormones; clinical manifestations vary according to specific hormone involved; assessment: labs, CT, MRI; treatment: replacement of deficient hormones

key characteristics that differ cerebral herniation from increased ICP

LOC: unresponsive pupillary assessment: unilateral or bilateral pupillary dilation (depending on type of herniation) without reaction Motor assessment: contralateral hemiparesis including flexor or extensor posturing vital signs: cushing's triad (increased systolic pressure, widening of pulse pressure, bradycardia, and change in respiratory pattern)

treatment for hyperparathyroidism

Diuretics (Furosemide) Force fluids to 3000 cc/day Oral phosphates and Calcium chelators Will bind with calcium to help it be excreted Low Ca++ diet Prevent constipation Strain urine to check for renal stones Protect from injury Administer digitalis with caution

pt teaching for transsphenoidal hypophysectomies

Do not bend from waist because often times take graft to keep everything in place Don't want them to do anything that will cause an increase in ICP Avoid coughing, sneezing Avoid tooth-brushing; use mouth wash Explain vasopressin therapy if needed Increase fluids/fiber because straining will increase ITP and ICP

medical management of hyperpituitarism

Dopamine agonists- inhibit the release of GH, but not specifically, may effect the release of others; somatostatin analogs; radiation not useful in immediate management of acute disease; surgical procedure: transsphenoidal hypophysectomy

medical and surgical management of hypercortisolism

Drug therapy: Reduce cortisol production, Interfere with ACTH synthesis Radiation Depends on cause: Transsphenoidal hypophysectomy (pituitary tumor) Adrenalectomy (tumor or hyperplasia)

nursing considerations for serum osmolality test

Ensure that the blood sample is drawn within 1-2 hours of osmotic diuretic administration

Nursing Interventions for Complications of Radiation Therapy

Fatigue: nutritional supplements (i.e., Boost, Ensure); Those patients experiencing weight loss are more susceptible; therefore, maintaining weight is important. Skin: utilization of sunscreens, sun-protective covering, skin emollients; Reddened, dry areas of the skin and hair loss are sometimes complications. Ensuring proper sun protection and relief from dry, itching skin is essential. Headache/Nausea and vomiting: dexamethasone (Decadron), ondansetron (Zofran), dronabinol (Marinol); Radiation therapy of the brain can cause swelling around the area of the tumor, thereby increasing intracranial pressure, causing headache, nausea, and vomiting. Medications such as dexamethasone (Decadron) are used to reduce swelling. Medications to reduce effects such as nausea and vomiting are important because they can cause dehydration and weight loss and negatively impact quality of life.

Hunt and Hess Grading Scale for Subarachnoid hemorrhage

Grade I: Asymptomatic or slight headache and neck stiffness Grade II: Headache and neck stiffness, cranial nerve deficit Grade III: Headache, neck stiffness, focal motor deficit, lethargy Grade IV: Stuporous, dense hemiparesis or posturing Grade V: Comatose, posturing, moribund

anterior pituitary hormones

Growth hormone Prolactin Thyrotropin Corticotropin Follicle stimulating hormone (FSH) Luteinizing Melanocyte-stimulating

risk factors for SAH include

HTN, smoking, heavy alcohol use, use of SNS stimulants such as cocaine, female gender, history of cerebrovascular disease, and postmenopausal state

Which position does the nurse place the patient in to minimize complications in the patient with OHS? A. Prone with hips elevated B. Head of bed elevated 30 to 45 degrees C. Side lying with head flat D. Head of bed elevated 90 degrees

Head of bed elevated 30 to 45 degrees

In reviewing laboratory results for a patient diagnosed with Adrenal Insufficiency, the nurse correlates which finding to this disorder?

Hyperkalemia

CV system spinal cord injury complications

Hypotension, bradycardia, decreased cardiac output, venous pooling, impaired tissue perfusion

adrenalectomy post-op care

I & O's/Daily weights Pain Management because there are going to have a a lot of pain Observe for hemorrhage and shock Prevent infection/Wound care Cardiac monitoring primarily for the hyperkalemia

dysbiosis-related diseases

IBD and other autoimmune disorder, DM, ASD, obesity, and cancer

patients in a barbiturate coma are monitored using

ICP monitoring, and in some cases EEG recordings to document suppression of electrical activity in the brain

In reviewing admission orders for a patientadmitted with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), the nurse should question which order? Encourage increased salt intake Seizure precautions IV 5% Dextrose Water at 50 mL/hr Fluid restriction of 1000 mL/day

IV 5% Dextrose Water at 50 mL/hr

treatment for hypoparathyroidism

IV calcium to increase serum calcium; calcitriol (Rocaltrol) to increase vitamin D; magnesium replacement if indicated

treatment of adrenal insufficiency

IV fluids glucose IV hydrocortisone cardiac monitoring because potassium is going to go up electrolyte replacement symptomatic support

things that are critical to do after discharge of stroke patients to promote wellness and prevent recurrence

Implementation, teaching, and reinforcement of secondary stroke prevention measures such as taking antiplatelet therapy and lipid-lowering and antihypertensive medications and follow-up cerebrovascular care In addition to rehabilitation services, it is important to consider the psychosocial aspects of the illness affecting patients' position in their family (e.g., main wage earner), their employment, and their need for caregiver support.

management of skull fractures

In certain circumstances, require a surgical procedure to elevate and stabilize the bone (titanium plates and screws may be used). Direct visualization of the dura and underlying structures (e.g., arteries, dural sinuses, brain tissue) is possible in the operating room and is important in identifying additional injury.

significance of the problem

Increased Morbidity and Mortality Increased Length of Stay Increased risk for Adverse Events: Falls, Aspiration Pneumonia, and Pressure Ulcers Inability to return to same level of care at discharge Longterm Cognitive Impairment/ PTSD 2/3 of these patients have dementia only 4% is resolved at discharge 1/3 never return to baseline

The nurse correlates which clinical manifestations to the pathophysiology of obesity? (Select all that apply.) A. Increased waist circumference B. Increased basal metabolic rate C. Binge eating D. Joint pain E. Yellowish skin

Increased waist circumference binge eating joint pain

thyroid hormone function

Increases metabolic activity Increases protein synthesis and catabolism Increases glucose intake by cells Increases glycolysis and enhances gluconeogenesis Increases mobilization of fatty acids Increases oxidation of free fatty acids Decreases cholesterol, phospholipids Increases oxygen utilization Increases rate and strength of heart Increases rate and depth of respiration

nursing diagnoses for increased ICP

Ineffective airway clearance related to diminished protective reflexes (cough, gag) • Ineffective breathing patterns related to neurological dysfunction (brainstem compression, structural displacement) • Ineffective cerebral tissue perfusion related to cerebral edema, hemorrhage, or hydrocephalus • Fluid volume deficit related to osmotic diuretic administration • Ineffective thermoregulation related to damage to the hypothalamus • Interrupted family processes related to unresponsiveness of the patient, unpredictability of the outcome, prolonged recovery period, and the patient's uncertain residual physical, emotional, and cognitive disabilities

A patient is admitted to the neuroscience intensive care unit (NICU) after a TBI. If the goal of ICP monitor insertion is to measure ICP and drain CSF to control ICP, what device should the nurse anticipate being inserted?

Intraventricular catheter

patient teaching for brain tumors

It is important to provide clear direction to the patient and family regarding the tapering of the steroid dose over the prescribed number of days. Rapid withdrawal of glucocorticoids can cause an adrenal crisis. Some patients become hyperglycemic as a result of steroid administration and require home testing of glucose levels while they are receiving glucocorticoids. Typically, this monitoring is temporary until the medication is tapered off. Importance of continuing antiepileptic medications and obtaining prescribed blood levels Some antiepileptic medications may require serum medication levels to ensure that they are maintained at therapeutic levels. Because of previous or new motor weakness or visual deficits, patients may have an increased risk of experiencing a fall either in the hospital or at home. Discussions and planning with the patient regarding potential fall or tripping hazards in the hospital and at home are necessary. Wear hat or head covering as needed Chemotherapeutic agents affect cells that divide quickly, which makes the patient at risk for sores in the mouth. Using a soft toothbrush and non-alcohol-containing mouthwash decreases mouth discomfort.

Which assessment data does the nurse recognize as the most sensitive indicator of increased ICP?

LOC

common areas and causes of embolic stroke

Left atrium (atrial fibrillation or thrombus; atrial myoxma; atrial septal aneurysm) Left ventricle (recent MI; ventricular aneurysm; cardiomyopathy) heart valves (prosthetic valve complications; endocarditis; RHD; calcification; syphilis; valve prolapse) septal/shunt diseases and disorders (patent foramen ovale; atrial septal defect; ventriculoseptal defect; congenital heart disease; pulmonary arteriovenous fistula)

Neuro/musculoskeletal system spinal cord injury complications

Loss of sensation/function (paralysis), contractures, spasticity, muscle atrophy

delirium is common in older adults who have a short-term illness such as

Lung or heart disease Infection Poor nutrition Drug interaction

tests that can be used to diagnose a spinal tumor

MRI is considered gold standard; myelography with CT can be used if MRI is unavailable; if a primary mass is detected, the patient needs a biopsy to diagnose the type and a CT of the chest and abdomen (for staging purposes)

treatment options for spinal tumors include

Monitoring: often used for small, benign tumors that are not growing or pressing on surrounding tissues; periodic scans are needed to monitor the tumor Surgery: usually the first step in treating tumors that can be removed with an acceptable risk of nerve damage; often an option used with benign tumors Radiation therapy: used following an operation to eliminate the tumor remnants or to treat inoperable tumors; often first-line therapy for metastatic tumors Stereotactic radiosurgery: delivers a high dose of targeted radiation; effective in brain tumors and currently being studied for spinal cord tumors Chemotherapy: has not been proven effective for most spinal cord tumors Corticosteroids: to reduce swelling following surgery or during radiation treatments

osmotic diuresis secondary to hyperglycemia leads to

Na, K, Mg, and Cl losses; decreased GFR

The nurse assesses for which clinical manifestations of dumping syndrome in the patient after bariatric surgery? (Select all that apply.) A. Nausea B. Increased urine output C. Hypoglycemia D. Diarrhea E. Abdominal cramping

Nausea, diarrhea, abdominal cramping

nursing assessments for pt w/ brain tumor

Neurological assessment including level of consciousness, orientation, motor strength, and sensation. Cranial nerve assessment may also be helpful in monitoring a patient's response to a craniotomy Vital signs including temperature, blood pressure, heart rate, respiratory rate, and pulse oximetry estimated blood loss (should be taken into account during a handoff from the OR or RR) intake and urinary output (especially in patients who have undergone a craniotomy where the pituitary gland has been manipulated; these patients are at risk for DI, where the nurse observes a large UO per hours that can rapidly result in intravascular volume deficit) urine specific gravity and osmolality; serum sodium and osmolality pain (NSAIDs are not preferred due to increase in bleeding risk)

if the patient complains of problems swallowing with a halo device

Notify the health-care provider; The provider may need to adjust the halo to help resolve the problem, or a speech and language pathologist can be consulted to evaluate dysphagia.

The nurse is caring for a patient status post craniotomy for resection of a right frontal tumor. Upon admission, the patient was alert and oriented X 3, moving all extremities symmetrically, and the cranial nerves were intact. Three hours after admission, the nurse notes that the patient is slower to awaken than during previous assessments, requiring vigorous shaking, and cannot recall location. The patient also exhibits a left pronator drift. What are the nurse's next actions?

Notify the patient's provider and prepare the patient for a computed tomography (CT) scan.

SIADH

Occurs as result of excessive release of ADH (vasopressin) resulting in fluid and electrolyte imbalance causes: malignancies, pulmonary disorders, CNS disorders (trauma, stroke), and drugs CMs: decreased UO; specific gravity > 1.020, serum Na <130 mEq/L; weight gain due to holding on to water; decreased serum osmolality; increased urine osmolality; increased urine Na; GI changes (N&V); changes in LOC; headache

clinical manifestations of hyperparathyroidism

Recurring renal stones Low back pain Pathological fractures Muscle weakness and atrophy Behavioral symptoms GI symptoms ECG Changes Bradycardia with bursts of tachycardia Metabolic acidosis Potential for digitalis toxicity

short-term life-threatening complications of bariatric surgery include

PE; infection; anastomosis (surgical connection between structures that were surgically removed) leak

patients with SCIs are at risk for developing

PEs because of fluid shifts after injury; must be carefully monitored

In administering orlistat to a patient for weight loss, the nurse recognizes which as the mechanism of action of this medication?

Reducing fat absorption

nursing assessments for spinal tumors

Pain in the middle or lower back is the most common symptom of both benign and malignant types; Other clinical manifestations are related to the area of the spine involved. Common findings include: • Back pain radiating to other parts of the body • Loss of sensation or muscle weakness, often in the legs • Difficulty walking • Decreased sensitivity to pain, heat, or cold • Loss of bladder or bowel function • Paralysis • Scoliosis or other spinal deformity

GI system spinal cord injury complications

Paralytic ileus, septic or necrotic bowel, GI bleed, malnourishment, retention, neurogenic bowel, impaction

MRI nursing considerations

Patients must be screened for metal that may be embedded in and around the eyes (metal workers and welders) or in any other part of the body including joint implants, cardiac stents, pacemakers, and other implanted devices. If the patient has a history of working with metal, x-rays may be requested by a radiologist to locate or rule out the existence of metal fragments. During MRI, implanted metal can heat up, causing tissue damage. Certain implanted devices such as a pacemaker or deep brain stimulator (used in patients with movement disorders) may malfunction. Patients may not be able to have MRI because of the above-mentioned factors. An MRI clearance form is often used by MRI technicians to ensure that a patient is safe to be scanned. Transport of critically ill patients to MRI requires planning because the time to acquire the images is longer than a CT scan, and cardiorespiratory monitoring has to be changed to an MRI-compatible monitoring system. IV fluids or other necessary infusions have to be changed to an MRI-compatible infusion pump or lengthened with extension tubing so that the pump does not enter the room. Patients receiving mechanical ventilation must be changed over to an MRI-compatible ventilator. Conventional medical equipment including cardiac monitors, ventilators, infusion pumps, oxygen tanks, and IV poles may not enter the MRI scanning room because the strong magnetic field may pull metal equipment into the magnet, which could injure a patient or staff in the room. Many devices do not operate properly in the strong magnetic field. Assess the patient's ability to remain still during the procedure because movement of the head causes decreased clarity (artifact) of the images, which could obscure an abnormality. Patients with increased ICP may be confused, restless, or agitated, requiring sedation or anxiolysis to ensure capture of high-quality images. Many patients know that they are claustrophobic and require anxiolysis (benzodiazepines are commonly used for this purpose) in order to enter the small scanning tube of the MRI scanner. A pregnancy test should be performed prior to scanning a woman of childbearing age so that appropriate precautions may be applied depending on the stage of pregnancy and in consultation with a radiologist.

nursing considerations for sedatives used in the treatment of increased ICP

Patients should have a secure airway (typically an endotracheal tube) in place when any one of these continuous infusions is initiated in order to ensure that retention of carbon dioxide (hypercarbia) does not occur. Hypercarbia causes cerebral blood vessel dilation, resulting in increased cerebral blood volume and increased ICP. These infusions should be titrated to the desired effect, either a goal ICP measurement or a specific rating on a validated sedation scale such as the Nursing Instrument for the Communication of Sedation Scale (NICS) or the Richmond Agitation Sedation Scale (RASS). Propofol infusion syndrome (PrIS) may occur in patients receiving propofol for greater than 48 hours or in patients receiving high doses of propofol (greater than 75 mcg/kg/min). Signs and symptoms of PrIS include acidosis, hyperkalemia, hyperlipidemia, and rhabdomyolysis causing acute kidney injury. It is important to note that propofol is not an analgesic; therefore, if the patient is suspected to be in pain, it is important to advocate for medication to treat pain in addition to the sedative.

initial surgical management of brain tumors

Patients undergo biopsies to sample the tissue within the mass so that the cells can be examined and a specific diagnosis can be made; performed using advanced radiological techniques that allow the neurosurgeon to map the location of the mass in multiple dimensions. Radiographical images are obtained using CT and MRI scans and are transferred to a computer system that integrates each image into a precise, well-defined coordinate of the area to be biopsied to define an exact location and path for retrieval of brain tissue. This procedure allows for the retrieval of specimens for identification and assists in the determination of an appropriate treatment regimen while minimizing the risk of injury to blood vessels and surrounding healthy brain tissue. The sample of tissue is then examined by a pathologist, and a pathological or histological (cellular) diagnosis is made that guides further therapy and treatment planning.

patients that are better candidates for aneurysm coiling instead of clipping

Patients with high-grade Hunt and Hess scores (grade 4 or 5), as well as patients with multiple comorbid conditions and with hemodynamic instability at baseline

respiratory system spinal cord injury complications

Poor cough, atelectasis, pneumonia, ineffective breathing pattern, ARDS

patient teaching for spinal tumors

Preoperative teaching if scheduled for surgery to decrease anxiety level and help promote compliance; Report symptoms of increased weakness, loss of bowel/bladder function that may be due to recurrent tumor or spinal cord edema

integumentary system spinal cord injury complications

Pressure areas leading to skin breakdown and potential pressure ulcers

ADH

Produced by the hypothalamus Stored/ released from the posterior pituitary gland Conserves water to maintain blood pressure Acts on collecting ducts and tubules of kidney Secreted in response to: Increased serum osmolarity Decreased plasma volume Decreased blood pressure

Which action is the highest priority in the patient who presents with autonomic dysreflexia?

Remove the stimulus

examples of types of immune system disorders

SCID; medication induced; AIDS

Nursing assessment interventions for patients with stroke

Serial neurological assessments every 1 to 2 hours -- Neurological deterioration during or after IV rt-PA can signal intracranial hemorrhage. When IV rt-PA is administered, neurological assessments including level of consciousness, motor strength, and pupillary reflexes are performed every 15 minutes X 6 hours, every 30 minutes X 2 hours, and every 1 hour X 16 hours. Vital signs every 1 to 2 hours or more often when administering medications that alter BP. When IV rt-PA is given, the frequency of vital signs is as follows: BP, HR, and RR every 15 minutes X 6 hours, every 30 minutes X 2 hours, and every 1 hour X 16 hours. Electrocardiogram (ECG) and cardiac enzymes -- A possible etiology of ischemic stroke is atrial fibrillation, and continuous ECG monitoring assists in identifying cardiac dysrhythmias. In patients with hemorrhagic stroke, particularly after SAH, these patients may experience myocardial stunning or injury. Trending of 12-lead ECGs and cardiac enzymes allows identification of potential myocardial infarction and/or reversible myocardial stunning. Serum electrolytes, particularly sodium -- Hyponatremia is a common complication of ICH due potentially to SIADH, which increases the risk for cerebral edema and neurological deterioration. Intake and output, cumulative fluid balance-- Accurate accounting of fluid balance is important in evaluating potential sodium and water imbalances as well as approximating volume status, especially in patients with SAH receiving triple-H therapy.

Which laboratory result does the nurse correlate with a diagnosis of Diabetes Insipidus? Serum osmolarity 280 Serum sodium 150 Serum BUN 10 Urine specific gravity 1.030

Serum sodium 150

hypothyroidism clinical manifestations

Slow, intellectual function Slow, clumsy movement Decreased GI motility Weight gain Decreased heat production Cold sensitivity Bradycardia Coarse, dry skin Constipation Decreased fertility Irregular menstruation Susceptibility to infection Easily fatigued Skin changes Hypothermia Cardiovascular Changes Muscle aches and joint stiffness Hypersensitivity to Narcotics, barbiturates Anesthetics (may have to increase the interval because meds metabolize slowly)

ECG abnormalities that can be seen in obesity in the absence of clinical symptoms

T-wave abnormalities, left axis deviation; low QRS voltage

types of cerebral herniation syndromes

Tentorium cerebelli Tonsillar herniation Lateral ventricle Falx cerebri Subfalcine herniation Central herniation Uncal (trantentorial) herniation

right homonymous hemianopia

may be caused by stroke on the left optic radiation (more towards the occipital lobe)

bitemporal hemianopia

may be caused by stroke on the optic chiasma

left homonymous hemianopia

may be caused by stroke on the right optic radiation (more towards the occipital lobe)

unilateral blindness

may be caused by stroke present on the optic nerve

course of depression

may be chronic

placing a nasogastric tube or postpyloric feeding tube for stroke patients

may be placed to facilitate enteral feeding to allow time for swallowing function to improve or for more formal swallowing evaluation to be completed.

Nursing actions for increased ICP include:

The head of the bed should be maintained at greater than 30° with the patient's head in midline. Avoid sharp hip flexion. Avoid placing the patient in a position that allows pressure directly on the operative side after craniectomy Perform endotracheal suction only as necessary; pre-oxygenate with 100% oxygen for 1 to 2 minutes prior to suctioning Administer sedative medications as prescribed Administer osmotic agents (mannitol and hypertonic saline) Ensure continuous drainage of CSF through the external ventricular drainage system when applicable (Kinks in the ICP monitoring tubing decrease drainage and may result in increased ICP) Administer antipyretics and/or implement cooling measures (this prevents an increase in cerebral metabolism that accompanies elevated boy temp)

why blood pressure monitoring is so important in the patient with ischemic or hemorrhagic stroke

The injured brain is not able to effectively regulate blood flow independently of systemic blood pressure (this usual protective mechanism is called autoregulation); changes in blood pressure may require further medical management. Blood pressure values that exceed ordered limits may result in hemorrhage into a region of ischemic or infarcted tissue or place a patient at risk for increased ICP because of an inability of the brain to automatically constrict blood vessels (autoregulation), reducing intracranial blood volume.

craniotomy

The most common surgical procedure for all types of brain tumors; During this procedure, a section of the skull is removed (known as a bone flap) in order to provide access to the brain. In some instances, this can be done in order to biopsy brain tissue or to excise (remove) a tumor. If the entire tumor is not able to be removed, the tumor is debulked, removing as much of the tumor as possible. Following the procedure, the bone flap is then replaced with the use of small plates and screws. Should the bone flap not be returned, the procedure is then called a craniectomy.

nursing considerations for CT scan

The serum creatinine should be monitored at least once after the contrast administration in the critically ill patient and more often if acute kidney injury is suspected. Typically an increase in serum creatinine of at least 0.5 mg/dL is expected, which will decrease over 24 to 48 hours. If contrast material is expected to be given, risk factors for contrast-induced nephropathy (CIN), such as hypotension, diabetes, and chronic kidney disease, should be assessed and a serum creatinine (within 24 hours of test) should be evaluated because contrast can damage the kidney. If a patient is at risk for CIN, strategies to prevent CIN including prehydration with IV saline, administration of a bicarbonate-based IV solution, or administration of N-acetylcysteine (Mucomyst) IV may be employed. In emergent situations, full assessment of risk factors and prevention strategies may not be undertaken because of the urgency of obtaining needed scans to guide further care. Because of the exposure to ionizing radiation, a pregnancy test should be performed in women of childbearing age, and the abdomen should be shielded if no alternative to the CT scan exists. Assess the patient's ability to remain still during the procedure because movement of the head causes decreased clarity (artifact) of the images, which could obscure an abnormality. Patients with increased ICP may be confused, restless, or agitated, requiring sedation or anxiolysis to ensure capture of high-quality images. Assess the patient's ability to lie flat during the scan. Patients with congestive heart failure or lung disease may not be able to maintain adequate oxygenation while lying flat, as evidenced by decreased oxygen saturation and increases in work of breathing and restlessness. If the patient cannot lie flat for at least 5 minutes, the medical team should be made aware to consider another test or a strategy to manage the patient during the test. Assess allergy to iodine or shellfish because a patient with these allergies may also be allergic to some contrast agents. Assess the patient's IV access if IV contrast will be administered during the CT; a larger-gauge peripheral IV catheter (typically an 18-gauge) will be required for administration of the contrast through a device called a power injector. Certain types of central lines called power injectable lines may also be able to be utilized for this type of contrast injection.

What dietary interventions help adult patients with psoriasis and/or psoriatic arthritis reduce their disease severity?

The utility of gluten-free diet and supplementation with vitamin D varies by subpopulations of adults

serum osmolality

This blood test is used to monitor the diuretic effect of osmotic diuretics such as mannitol (Osmitrol). Osmotic diuretics cause interstitial fluid throughout the body to shift into the vascular space where it is filtered and eliminated by the kidneys, causing dehydration. This action is necessary to treat edema in the brain; however, severe dehydration as indicated by a rising levels of this which can cause renal failure. Mannitol is typically not given if this value reaches 320 mOsm in order to prevent acute kidney injury.

intraventricular catheter

This device and procedure are also commonly known as a ventriculostomy or external ventricular drain (EVD).; May be connected to a filled transducer system; May have an embedded ICP monitoring sensor/probe advantages: Ability to monitor pressure and drain CSF (is a monitor and a method of treatment for ICP); Considered "gold standard" for ICP measurement because of the location of the tip of the catheter in the lateral ventricle; Can be inserted at the bedside or in the operating room (OR) disadvantages: Increased risk of infection, particularly when the catheter dwells for greater than 7 days; Measurement drift exists over time when pressure is transduced with a fluid-filled transducer system.

important topics when assessing the endocrine system

Thorough history Nutritional status Energy level/sleep pattern Elimination pattern Sex and reproductive norms/changes Physical appearance and assessment ADLs/activity patterns because it affects everything, we really have to do a good job with a thorough assessment

genitourinary system spinal cord injury complications

Urinary incontinence, urinary tract infection, neurogenic bladder, chronic kidney disease

Which diagnostic result does the nurse assess in the patient with obesity to evaluate for concomitant Cushing's disease? A. Growth hormone B. Thyroid-stimulating Hormone C. Urine cortisol excretion D. Hemoglobin A1C

Urine cortisol excretion

important nursing assessments for bariatric surgical patients

Vital signs, using appropriately sized equipment oxygen saturation due to decreased ventilation due to obesity hypoventilation syndrome and opiod analgesics daily weight and intake/output skin using a pressure ulcer prevention protocol skinfolds (breast, groin, neck, abdomen, perianal) for irritation/fungal infections incisions and drains pain

RA

a chronic, systemic, autoimmune inflammatory disease characterized by an inflammatory process that affects diarthrodial, or freely moving joints causing pain and swelling; involved joints are usually distributed in a symmetrical fashion, meaning bilateral writs, ankles, or knees most commonly affects the synovial membrane and less commonly affects the lungs, hearts, eyes, and blood vessels; the synovial membrane becomes thickened and promotes destruction of the joint

obesity

a complex disease in which genetic, environmental, biochemical, and behavioral factors intertwine; most patients with this disease process have more than one factor contributing to their disease

body weight

a complex interplay between appetite and energy expenditure

leptin

a hormone produced by fat cells, plays a major role in body weight; two major roles of this hormone are: communicating to the hypothalamus satiety and regulating energy expenditures or balance

anatomosis leak

a life-threatening complication associated with infection and sepsis; type of complication related to surgery and specifically bariatric surgery; the nurse should monitor for tachycardia, fever, hypotension, and abdominal pain and should report them immediately

gastric plication

a new restrictive bariatric procedure; is still considered investigational; this procedure involves infolding of the greater curvature of the stomach to create gastric restriction

risk factors for contrast-induced nephropathy (CIN)

a nursing consideration for patients with increased ICP going in for a CT scan; include hypotension, diabetes, and CKD; should be assessed and a serum creatinine (within 24 hours of test) should be evaluated bc contrast can damage the kidney

hyperventilation

a physical intervention to reduce blood volume in the intracranial space; increasing the respiratory rate either through manual ventilation, using a resuscitation bag or mechanical ventilator, causes an increased clearance of carbon dioxide and constriction of cerebral blood vessels; established guidelines used for the management of patients with severe TBI recommend that arterial carbon dioxide (PaCO2) be maintained in the range of 30-35 mm Hg when this method is employed to decrease ICP

bariatric surgery

a procedure intended to lead to weight loss, is an option for patients who have a BMI greater than or equal to 40 kg/m2. Patients with a BMI of 35 to 39.9 kg/m2 with comorbidities or a significant reduction in quality of life should also be considered

if an excessive amount of CSF is drained rapidly through an IVC

a subdural hematoma (collection of blood in the subdural space) can result because of contraction of brain tissue that stretches small bridging blood vessels traversing the space between the dura and brain tissue

SAH is characterized by

a sudden severe headache, often termed a "thunderclap" headache bc of the intensity of the pain experienced at the onset; Subsequent neck stiffness and pain ensue because of the irritation of the meninges, particularly at the base of the skull where pooling of blood occurs. Photosensitivity may also be associated with meningeal irritation or inflammation.

ischemic penumbra

a zone of tissue surrounding an infarction that contains ischemic tissue that is not irreversibly damaged; this is the target of therapies aimed at opening blocked cerebral blood vessels and reestablishing blood flow to ischemic brain tissue, providing the optimal chance for functional recovery

risk factors for SCI include

activities such as participating in high-risk physical activities, nonuse of protective fear, and alcohol and substance use; in the older population, increased risk related to fall-related injuries

onset of delirium

acute (hours to days)

onset of depression

acute or insidious (wks to mnths)

nursing interventions for RA

administer analgesics, anti-inflammatories as ordered; administer glucocorticoids as ordered; administer DMARD therapy as ordered; administer biologics as ordered teach importance of adherences to treatment plan report signs and symptoms of infection immunosuppressive therapy should be discontinued while patients have an active infection assist with referral to an infectious disease specialist for patients with chronic or atypical infections keep current with vaccinations refer for physical and occupational therapies as needed

nursing actions for spinal tumors

administer medications (pain meds, corticosteroid therapy to decrease swelling and inflammation, and meds as ordered for patient comfort) increase intake of fluid and fiber in diet to decrease complications associated with bowel constipation that may develop ROM exercises to prevent contractures and loss of muscle tone; strengthen unaffected muscles reposition every 2 hours and as needed to prevent skin impairment and pressure ulcers and maintain comfort

Nursing Actions for patients w/ stroke

administer rt-PA as ordered -- In order to receive IV rt-PA, patients must present within 3 hours of stroke symptom onset. In some defined cases, IV rt-PA may be given up to 4.5 hours after stroke symptom onset. Perform bedside swallow screening Elevate head of bed greater than or equal to 30 degrees Place a nasogastric or postpyloric feeding tube for nutrition and medication administration implement aspiration precautions Bleeding precautions are necessary for patients who have received thrombolytics or anticoagulants. Specific precautions include utilizing an electric razor instead of a razor blade for shaving, utilizing a soft toothbrush for oral hygiene, alternating a BP cuff from the left to the right arm to prevent bruising during serial BP measurement, avoiding rectal temperature measurement, and observing strict fall precautions because these patients are at a greater risk for injury related to a fall. Frequent repositioning, elevate paralyzed or weak limbs to minimize dependent edema, advocate for evaluation of the patient by OTs and physical therapists (PTs) early

immediate treatment of seizures includes

administration of benzodiazepines to stop them and antiepileptic medications to prevent recurrence

ACEs have been linked to a greater likelihood of

adulthood substance use and abuse; depression; suicide ideation and attempts; obesity ; chronic physical health conditions (ischemic heart disease and liver disease), and premature mortality among the general population

factors that increase obesity-related risk factors

adults with a BMI of 25 -34.9 kg/m2; waist circumference in men of greater than 102 cm (greater than 40 in) and greater than 88 cm (greater than 35 in) in women

lorcaserin

affects chemicals in the brain that help to regulate appetite and increase the feeling of fullness after eating, so less food is eaten; taken twice daily, and then expected weight loss is 3% to 5% of an individual's weight common AEs: headache, dizziness, nausea, fatigue, constipation, and dry mouth; contraindicated in patients with severe depression and cardiac or valvular disease contraindicated in patients with severe depression and cardiac or valvular disease.

consequences of a leaky gut

affects the whole body; sinus and mouth (frequent colds, food sensitivities); brain (depression, anxiety, ADHD), Skin (acne, rosacea, eczema, psoriasis), thyroid (hashimotos, hypothyroidism, graves)

According to primary stroke center accreditation guidelines

after a stroke, patients should be discharged with antiplatelet therapy, lipid-lowering therapy if indicated, anticoagulation if indicated for atrial fibrillation, and a blood pressure control strategy in patients with hypertension.

later manifestations of delirium may include

agitation misperception misinterpretation hallucinations

lab testing in obesity

aimed at identification of secondary causes and comorbid risk factors, and specific tests are selected on the basis of results of the history and PE; may include screening for DM, dyslipidemia, thyroid dysfunction, and fatty liver disease; initial tests include fasting blood glucose or Hg A1C, LFT, fasting lipoprotein panel, and thyroid-stimulating hormone (TSH)

medical and surgical management of SAH

aims to prevent and mitigate complications such as aneurysm rebleeding and cerebral vasospasm.

spinal cord tumors

an abnormal tissue growth (benign or malignant) in or around the spine; primary types originate within the CNS; secondary types originate outside the CNS then metastasize or spread to the spine ; as this abnormal tissue grows, it causes compression and stretching of the fiber tracts; growth can be benign or malignant, primary, or secondary

when blood flow is disrupted

an area of brain tissue suffers irreversible damage, and this is referred to as in infarction

ANAs

antibodies that confirm the existence of an autoimmune disease; presence of them does not in itself confirm the diagnosis of SLE because approximately 2% of healthy individuals are positive

medications prescribed for secondary stroke prevention

antihypertensives (beta blockers, Ca channel blockers, diuretics) lipid-lowering medications (statins, niacin, bile acid sequestrants) platelet inhibitors (cyclooxygenase inhibitors, ADP receptor inhibitors, combination mediations like Aggrenox which is Dipyridamole and aspirin combined) anticoagulants (unfractionated heparin, warfarin (coumadin), dabigatran (Pradaxa))

Gardner-Wells tongs

are U-shaped tongs used for spinal traction; pressure-controlled pins are inserted into the skull at opposite ends to permit a longitudinal force to be applied to the axis of the spinal column; the tongs are attached to weights using a pulley system at the head of the bed

malignant brain tumors in particular

are associated with swelling as the rapid growth damages brain tissue

Patients with hemiparesis or hemiplegia

are at greater risk for development of pressure ulcers because of decreased mobility. Frequent repositioning allows off-loading of pressure from bony prominences (e.g., ankles, heels, ischium, and occiput). Occupational therapists and PTs recommend passive or active range-of-motion regimens and functional splinting, which prevent musculoskeletal and functional complications that can hinder a patient's rehabilitation.

cerebral herniation syndromes

are classified according to the region of tissue that is displaced; the most often recognized sings include increased systolic blood pressure with decreased diastolic BP (widened pulse pressure), bradycardia, and irregular respiratory pattern, actually occur late in the process as the brain stem is compressed and are referred to as "Cushing's triad";

clinical manifestations of brain tumors

are dependent upon their location in the brain; referred to as space-occupying lesions that may cause increased ICP depending on the rate of growth and location

clinical manifestations of SLE

are diverse, do not follow a clinical pattern, and vary greatly from on person to another; clinical course involves periods of remission and acute disease flares

pituitary tumors

are generally found in the anterior lob of the pituitary, the most common of which is the adenoma (typically a benign tumor)

secondary spinal tumors

are metastases and therefore always malignant unlike primary ones; these often spread from lung, breast, prostate, renal, gland, or thyroid cancer

subacute subdural hematomas

are more common in the elderly and in patients with a history of alcohol abuse bc of cerebral atrophy placing gradual stretch forces on the bridging veins coupled with a high risk of falling

Anti-dsDNA and anti-Sm antibodies

are most specific for SLE because these autoantibodies are rarely found in other conditions

clinical manifestations of pituitary adenomas

are related to hypersecretion of hormones by the pituitary gland, including acromegaly from hypersecretion of GH, amenorrheagalactorrhea from PL hypersecretion, changes in UO secondary to changes in ADH secretion, and disorders of the adrenal cortex from hypersecretion of adrenocorticotropic hormone; can be found within all age groups

most common causes of death for patients with SCI

are respiratory disease and cardiovascular events

acoustic neuromas (CNVIII)

are slow-growing benign tumors that generally do not invade other tissue; however compression on other cranial nerves (V, VIII, IX, and X) and tissue (cerebellum and brainstem) can manifest in severe complications; also known as schwannomas; originate from the protecting covering around nerve fibers (CN VIII) at the anatomical location of the cerebellopontine angle

meningiomas

are the most common form of brain cancer arising between the ages of 40-70 years, affecting females greater than males; arise from the meninges (layers of the brain); 90% are benign; but they can still cause devastating damage bc they are space-occupying lesions that can increase ICP; damage may occur based upon size and location

anaplastic gliomas (grade III)

are tumor cells out of control, lacking differentiation and/or orientation to one another and to surrounding vessels

conventional radiographs in RA

are used to assess for bony erosions and joint space narrowing; may be repeated during treatment to assess for disease progression and efficacy of drug therapy; MRI may detect erosions not detected by conventional radiographs

diagnostic tests in obesity

are used to evaluate for comorbidities; an overnight sleep study is used to test for sleep apnea; a RUQ US tests for fatty liver disease; transvaginal US is used to evaluate for ovarian cysts; an ECG may be used for pts with a high risk of CV disease; accurate ECG lead placement is particularly important for this population because patient size can obscure landmarks and result in improper placement

TTE and TEE

are utilized to directly visualize myocardial wall movement and contraction of the chambers of the heart. In stroke, the TTE is utilized to evaluate overall cardiac function as well as the presence of blood clots within the heart that could embolize to the brain. Presence of a patent foramen ovale (PFO) may be revealed on TTE with the assistance of an IV agitated saline injection, where small bubbles may be seen traversing an abnormality in the atrial septum. A TEE may reveal a PFO not found on TTE. A TEE allows better visualization of the left atrial appendage, which may be a source of blood clots, particularly in patients with atrial fibrillation.

oligodendrogliomas

arise from oligodendrocytes (main functions are to provide support and insulation to axons in the CNS, equivalent to the function of schwann cells in the PNS); these are slow-growing tumors that generally do not spread to surrounding tissue; arising from the fatty covering that protects nerves, they generally occur in the cerebrum; are generally found in middle-aged parents

A patient is admitted to a unit with a diagnosis of left middle cerebral artery acute ischemic stroke and is not eligible for thrombolytic therapy. The nurse recognizes that this patient is at a high risk for which complication?

aspiration

examples of types of overactive immune system

asthma; allergic rhinitis; eczema

different types of primary central nervous system tumors

astrocytoma; ependymoma; meningioma; neurofibroma; sarcoma; schwannoma

examples of foods with anti-inflammatory properties

avocados; ginger; blueberries; hemp seeds; broccoli; papaya; red cabbage; celery; chia seeds; turmeric; cranberries; walnuts

patient teaching for pt w/ immunodeficiency

avoid crowds or large gatherings and avoid exposure to anyone with an obvious illness; do not change cat litter boxes; avoid turtles and reptiles as pets; eat a low-bacteria diet; avoid salads, raw fruit and vegetables, undercooked meat fish and eggs; report any of the following (temp greater than 100, cough, cloudy urine, any drainage from a wound)

psychomotor changes in depression

may be slowed in severe cases

nursing diagnoses for spinal tumors

• Impaired physical mobility related to neuromuscular impairment • Acute pain related to nerve impingement • Ineffective coping related to diagnosis

long-term complications of bariatric surgery include

band slippage; obstruction; hernia; esophageal erosion; ulcers; acid reflux; vitamin deficiency; osteoporosis; anemia; and dumping syndrome

in situations where increased ICP does not respond to standard treatments

barbiturates such as pentobarbital can be used to induce a coma, significantly reducing metabolic demands in the brain

individual dietary approaches are essential

because each patient's immune system and microbiota may respond to food components differently

presenting symptomology of a brain tumor in the suprasellar

bitemporal field cuts with abnormal endocrine function

nursing management of pheochromocytoma

blood pressure management; monitor/manage fluids and electrolytes; headache management

spinal injuries to the cervical or high thoracic spinal cord may also result in

blood pressure problems, abnormal sweating, and difficulty maintaining normal body temp

complications of spinal tumors

both benign and malignant types can compress spinal nerves and cause loss of movement or sensation below the tumor level, spinal instability, changes in bowel and bladder function, and sexual dysfunction; unless the cause is quickly identified and removed, permanent nerve damage can occur

causes of intracerebral hemorrhage

brain tumor; AVMs; Moyamoya disease; cerebral amyloid angiopathy

overdrainage of CSF prevention methods

by maintaining proper leveling (0 point on drainage system leveled at the external auditory meatus) of the drainage system and proper adjustment of the drainage burette at the ordered level above the external auditory meatus

the effects of increased ICP on functional outcome

can be diminished with early recognition of deterioration and rapid treatment; identification and control of the primary problem is also essential

intracranial pressure monitoring

can be done by using a catheter or sensor placed in one of the lateral ventricles of the brain, in the brain tissue or parenchyma, or in the subarachnoid space; an additional assessment tool used to trend a patient's response to medical treatments and progression of an intracranial process causing increased ICP; recognized guidelines suggest that patients with TBI and a GCS score of 8 or less should have one placed

large cerebral blood vessel occlusion

can cause ischemia in large areas of brain tissue depending on the location of the occlusion (proximal or distal) called territories, and the territory name is based on the blood vessel that perfuses that particular area; a territory may contain more than one lob of the brain

mutations

can change gene regulation; can be harmless or can cause disease

probiotics like VSL#3, Align, Culturelle

can downregulate pro-inflammatory and upregulate anti-inflammatory

increased physical activity in obese patients

can increase daily energy expenditure and increase basal metabolic rate by increasing lean body mass

suctioning a patient with increased ICP

can introduce risk of further elevation of ICP because the act induces coughing, which raises pressure inside the chest and may transiently reduce drainage of blood from veins in the neck, causing a spike in ICP in some patients; should only be performed when the patient demonstrates mucus in the endotracheal tube or every 4-6 hours to maintain patency of the tube; administering 100% oxygen just prior to doing this is performed to prevent hypoxia, which can occur during the interruption of mechanical ventilation

cervical spinal cord injuries

can result in inability to breathe (above C4) and quadriplegia

the loss of autoregulation and reduced sympathetic stimulation in SCI patients result in

cardiac arrhythmias (interruptions to the cardiac accelerator nerves from a cervical SCI can cause the heart to beat dangerously slowly or pound rapidly and irregularly; medications and even pacemaker may be required to control the irregular heartbeat), hypotension, decreased blood vessel tone (causes blood to pool in the vessels , and results in low BP; IV fluids, vasopressors, and inotropes are often used to provide adequate fluid resuscitation, increase tone, and increase CO) and reduced cardiac output

spinal cord injury below L1 results in

cauda equina injury, variable motor and sensory loss in lower extremities; a reflexive bowel and bladder

restrictive bariatric surgical procedures

cause weight loss by reducing gastric capacity and include adjustable gastric banding (AGB), sleeve gastrectomy, and gastric plication

pheochromocytoma

caused by a catecholamine secreting tumor located in the adrenal medulla; clinical manifestations : paroxysmal (comes and goes) hypertensive episodes; bounding headaches; hyperglycemia and glucosuria; heat intolerance diagnostic evaluations: VMA test (measures the metabolites of catecholamines; indication there is an excessive catecholamine release); plasma catecholamines; X-rays

medical management of brain tumors

chemotherapy and radiation are used in place of or in conjunction with surgery depending on the type and location; chemotherapeutic agents used to treat them must have the ability to cross the BBB (including carmustine, lomustine, thiotepa, and high doses of methotrexate); Radiation treatment is provided in divided doses, maximizing the recovery of normal cells. Radiation is delivered in a focused manner, concentrating on the affected area. Other technologies such as the CyberKnife are used to direct radiation to the tumor, avoiding healthy brain tissue.

DI

characterized by ADH deficiency by either a decrease in synthesis or inability of kidneys to respond to it CMs: increased UO, specific gravity <1.005; serum Na > 145; increased serum osmolarity; decreased urine osmolarity; dehydration; thirst conscious patients should be encouraged to drink water orally

adrenal crisis

characterized by decreased glucocorticoids which results in decreased gluconeogenesis and hypoglycemia; results in decreased mineralocorticoid which leads to hyponatremia, hypovolemia, and hyperkalemia

hypercortisolism (Cushing's)

characterized by: Increased Protein Metabolism Increased Serum Cortisol/ACTH Increased Na+ Retention Hypokalemia Hyperglycemia Abnormal Fat Distribution (Buffalo Hump And Moon Face) Increased Susceptibility To Infection because glucocorticoids suppresses the immune system Friable Skin Bruises easily because all vessel integrity is based upon protein metabolism Hirsutism Oligomenorrhea- decrease in periods

adrenal insufficiency (Addison's)

characterized by: decreased mineralcorticoids (Aldosterone) which causes decreased K excretion, decreased Na retention, water loss, decreased blood volume, decreased BP, dehydration, hypovolemic shock; elevated BUN decreased glucocorticoids (cortisol) which leads to decreased gluconeogenesis, hypoglycemia, weakness, decreased ability to cope with stress both psychological and physiological

the brain-gut axis serves as a

circuit that incorporates the human experience, the state of mind, the gut microbiome, and the immune response that ultimately drives the phenotypic expression of inflammatory bowel disease

consciousness of pt with depression

clear

swan-neck deformity

common joint deformity in RA caused by hyperextension of the proximal interphalangeal joints, boutonniere deformity caused by abnormal flexion of the proximal interphalangeal joints, and ulnar deviation caused by the lateral deviation of the phalanges

anterior cerebral artery territory

colored in blue

middle cerebral artery territory

colored in red

posterior cerebral artery territory

colored in yellow

combination bariatric surgical procedures

combination approach that induces weight loss primarily through restriction but also creates a component of malabsorption; roux-en-y GB is a combination procedure that involves the creation of a restrictive 30 ml gastric pouch and bypass of a portion of the SI, causing mild malabsorption and is the most commonly performed bariatric surgery worldwide

RA diagnosed by

combining signs, symptoms, lab values, and radiographs or US; patient typically present with peripheral joint pain, which is usually symmetrical, and complain of morning stiffness lasting greater than 30 minutes; symptoms persisting 6 weeks or longer are consistent with this disease process; another important finding is synovitis presence of the antibodies, rheumatoid factor and anticyclic citrullinated peptides may assist in the confirmation, but the absence of these do not exclude the diagnosis because approximately 25% to 30% of patients are negative for antibodies.

hyponatremia

common complication in patients with SAH, which may be caused by syndrome of inappropriate antidiuretic hormone (SIADH) or by cerebral salt wasting syndrome, also known as renal salt wasting syndrome.

delirium

common yet underdiagnosed; 30-40% of cases are preventable; most hospitals do not have prevention programs Rarely caused by a single factor: Often the result of interaction of patient's underlying condition with a precipitating event; Can occur following a relatively minor insult in a vulnerable patient. In other nonvulnerable patients, it may take a combination of factors (e.g., anesthesia, major surgery, infection) to precipitate this disorder

diagnosis of delirium

complicated by inability to communicate includes: Medical history Psychologic history Physical examination Careful attention to medications Cognitive measures Confusion Assessment Method (CAM)- Extensively studied and is a reliable method of assessing for this disorder

brain tissue

composed primarily of water and makes up 80% of the intracranial contents; while blood and CSF each make up 10% of the remaining contents within the cranium

clinical manifestations of vasospasm include

confusion, changes in LOC, or new focal (localized area) motor weakness, often in a waxing and waning pattern

the initial approach to the emergency management of increased ICP

consists of airway management and therapies to decrease intracranial contents, such as administration of an osmotic diuretic and hyperventilation; vigilant monitoring of the patient's neuro status is critical during treatment bc there may be subtle changes in LOC that may indicate further compromise.

territory names of the brain

correlate to the blood vessel that perfuses the specific area

the Center's Circle program

could help usher in a new era of IBD care that takes into account nutrition, stress, and psychological issues while also rebalancing the relationship between providers and patients so patients have a greater role in their own care

secondary causes of obesity

cushing's disease (hypersecretion of cortisol), insulinoma (insulin secreting tumor of the pancreas), hypothyroidism, polycystic ovarian syndrome, hypogonadism, pregnancy, and growth hormone deficiency are a few examples

Fisher Grading Scale for Subarachnoid hemorrhage

determined by amount of blood visualized on CT scan Grade 1: No blood on CT scan Grade 2: Blood layering less than 1-mm thickness Grade 3: Blood layering greater than 1-mm thickness Grade 4: Intraparenchymal or intraventricular blood

potential complications of MERCI clot retrieval system include

damage or rupture of a blood vessel; breakage of the blood clot, which could travel forward and lodge in another blood vessel; and intracerebral hemorrhage

The nurse notes that the patient is hoarse after surgery and is concerned that this is due to what potential complication of thyroid and parathyroid surgery?

damage to laryngeal nerve

The nurse monitors for which expected outcomes after the administration of an osmotic diuretic in the patient with increased ICP?

decrease in ICP and increase in urine output

post-operative care for thyroidectomy

decrease strain on suture line; respiratory status; relieve sore throat; position 45-60 degree; assess to see if they aren't bleeding from the back of the neck

hypoparathyroidism

decreased PTH which causes decreased osteoclastic activity; kidneys secrete Ca; decreased intestinal reabsorption of Ca secondary to hypomagnesemia; interferes with PTH secretion and action causes hypocalcemia: serum (impacted by plasma proteins like albumin) vs ionized (more accurate reading of free active Ca); increased neuromuscular activity; tetany; anxiety

diversity of the microbiota in critical illness

decreases and contains more opportunistic pathogens and less beneficial bacteria

You administer the Confusion Assessment Method (CAM) tool to the patient to differentiate among various cognitive disorders, primarily because

delirium can be reversed by treating the underlying causes.

the pressure-volume curve

depicts the body's ability to compensate for the addition of one or more of the three intracranial components without a significant increase in ICP until a critical volume is reached (A). At this point, continued accumulation of volume causes a disproportionate increase in ICP referred to as decreased compliance (B). Finally, on the last section of the curve, any addition in volume causes a sustained increase in ICP, which represents a loss of compliance (C). Loss of intracranial compliance leads to cerebral herniation syndrome where brain tissue is displaced, and if the displacement is not resolved, the brainstem becomes compressed, eventually causing brain death.

CT scanning is performed in pts with signs and symptoms of stroke in order to

determine whether hemorrhage is the cause of symptoms; Radiographical changes associated with ischemic stroke are typically not visualized within the first several hours following a stroke. When initially evaluating a patient with suspected stroke, contrast is not used so that blood can be easily visualized. IV contrast may be helpful in visualizing a mass lesion in the brain (e.g., tumor).

patient teaching for increased ICP

devices used during the course of treatment medications used for treatment complications of the disease process (many complications may occur and are closely associated with the primary cause) rationale for helmet after craniectomy (often placed whenever patient is out of bed to prevent injury to the unprotected portion of the head) importance of allowing the patient rest (constant stimulation may exacerbate situation)

examples of drugs used for delirium extreme cases

dexmedetomidine (Precedx) for sedation neuroleptics (haldol, risperdal, zyprexa, seroquel) short acting benzos must be used cautiously as they may worsen it cuased by other factors

to prevent permanent spinal cord damage, spinal cord compression must be

diagnosed and treated immediately

management of DI

diagnostic evaluation: CT, water deprivation test (withholding water, to see if patient will continue to output urine); serum and urine chemistries diabinese-hyperlgycemic agent monitory; desmopressin (DDAVP)- type of synthetic ADH given PO; pitressin (synthetic ADH); increase fluid intake (orally if alert and awake; IV- fluid type based upon serum Na levels) going to watch serum levels closely, usually every 4 H FLUID MANAGEMENT: Monitor I&O Daily weights Increase fluid intake Mouth care Monitor labs and specific gravity PROTECT FROM INJURY Visual Disturbances MONITOR FOR INCREASED ICP

mainstays of all weight loss regimens

diet modifications; increased physical activity; behavior therapy

delirium is characterized by

disorganized thinking; difficulty concentrating; sensory misperceptions

clinical manifestations of a basilar artery stroke syndrome

dizziness ataxia tinnitus nausea and vomiting weakness on one side of the body that may be ipsilateral to the side of ischemia or injury or contralateral decrease in sensation on one side of the body that may be ipsilateral to the side of ischemia or injury or contralateral difficulty in the articulation of speech difficulty with swallowing and managing oral secretions

cytotoxic cerebral edema

does not impact BBB; and primarily involves individual cellular swelling caused by failure of the Na-K pump

spinal tumor classification

done in several ways including the area of the spine in which they occur (cervical, thoracic, lumbar), their location in the spine: anterior (front) or posterior (back), and their relationship to the dura (outermost membraneous layer surrounding the brain and spinal cord); types include extradural located outside the dura, intrdural located within the dura, extramedullary located inside the dura but outside the cord, and intramedullary located within the cord

common vasopressors given to SCI patients

dopamine hydrochloride (dopamine), norepinephrine bitartrate (Levophed), phenylephrine hydrochloride (Neosynephrine), epinephrine, vasopressin (Pitressin), and dobutamine

hyperthyroidism

excessive thyroxine (T4) leads to increased cellular metabolism; acceleration of cardiovascular system clinical manifestations: tachycardia nervousness, excitability increased heat production weight loss increased gastric activity exophtalamus full, bounding pulse increased CO & BP dysrhythmias angina increased heart sounds thyroid bruit CHF

transependymal cerebral edema treatment

drainage of cerebrospinal fluid is the primary method to decrease this type of edema

common causes of delirium

drugs or drug withdrawal infection electrolyte disturbance dehydration of constipation

secondary endocrine disorder

due to a disorder of the anterior pituitary gland

tertiary endocrine disorder

due to a disorder of the hypothalamus

in IBD we see

dysbiosis and decreased microbiota diversity; food components essentially influence the intestinal homeostasis by modulation of the microbiota and subsequent activation of the immune system

f there is evidence of spinal cord compression, progressive deficits, compound vertebral fractures, penetrating spinal cord wounds, or bony fragments in the spinal canal,

early surgery is performed for decompression and fusion to stabilize the spinal column. Otherwise, patients with neurological evidence of spinal instability are admitted to the ICU for a comprehensive diagnostic work-up, and neurological monitoring.

current management strategies for SCI focus on

early surgical intervention if indicated, immobilization, and hemodynamic and respiratory support to prevent secondary injury and optimize recovery

nutrition advice with anti-inflammatory properties

eat lots of fruits and vegetables minimize saturated and trans fats eat a good source of omega-3 fatty acids, such as fish or fish oil supplements and walnuts limit your intake of refined carbohydrates such as pasta and white rice eat lots of whole grains such as brown rice and bulgur wheat choose lean protein sources such as chicken; cutting back on red meat and full-fat diary foods avoid refined foods and processed foods use spices like ginger, curry, and other spices

treatment of thyroid storm

emergency stabilization; ABC's; seizure precautions; cardiac monitoring; antithyroid medications; glucocorticoids

cranial nerves IX, X, XI, and XII

exit from the medullar in the brainstem; contribute to swallowing and innervate the palate and pharynx, assisting in airway protection; when these cranial nerves have been damaged, aspiration of food or fluid into the lungs can occur

Vigilant monitoring of the neurological assessment, observing for changes from the patient's preoperative and postoperative baseline is

essential for early identification of potentially life-threatening neurological deterioration. Changes in level of consciousness are the most sensitive indicator of increased ICP and can signal complications of brain tumor resection and craniotomy, such as intracranial bleeding and cerebral edema (swelling). Subtle changes in motor strength on one side of the body when compared to the other are significant when they occur during the recovery period after a craniotomy. The baseline neurological assessment after a surgical procedure should be determined and agreed upon by the nurse and providers or nurse practitioners caring for the patient in order to facilitate future comparisons and interpretation. Pupil reaction to light is part of the assessment and changes in reaction is indicative to damage/compression to CN III (Oculomotor nerve).

GH deficiency

etiology: Sometimes due to lack of somatomedins by the liver; Lack of target cell response; Pituitary adenoma or damage clinical manifestations: dwarfism in children; osteoporosis in adults diagnosis: measurement of hormone; stimulation testing (insulin increases release) treatment: hormone replacement

GH excess

etiology: overproduction; typically caused by pituitary adenoma CMs: gigantism in children; acromegaly in adults bc once the epiphysis is closed you get get growth in length in bone but instead an increase in density; facial bones become more dense; shoe size increases; all of a sudden they can't wear their rings diagnosis: labs, physical exam, CT/MRI scan

thyroidectomy pre-operative care

euthyroid, rested, optimal weight

exclusion criteria 0- to 3-hour therapeutic window for the administration of rt-PA

evidence of intracranial hemorrhage on pretreatment CT scan minor or rapidly improving symptoms symptoms of subarachnoid hemorrhage even with normal head CT active internal bleeding: gastrointestinal or urinary bleeding within last 21 days or known bleeding risk, including not not limited to: platelet count less than 100,000; heparin during the preceding 48 hours associated with elevated aPTT; currently taking oral anticoagulants or recent use with an elevated prothrombin time greater than 15 seconds or INR greater than 1.7; major surgery or other serious trauma during preceding 14 days; stroke serious head trauma, or intracranial surgery during preceding 3 months; recent arterial puncture at a noncompressible site; recent lumbar puncture during preceding 7 days

the stress-diathesis model

examines how social circumstances and individual responses to stressful events affect health (at the cellular and physiological level); one's current health status reflects physiological responses to past experiences; diseases linked to str

CAM

extensively studied and is a reliable method of assess for delirium; includes: 1. Acute onset and fluctuating course (e.g., Is there evidence of an acute change in mental status from the patient's baseline?) 2. Inattention (e.g., Does the patient have difficulty focusing attention or keeping track of what is being said?) 3. Disorganized thinking (e.g., Is the patient's thinking and conversation disorganized or incoherent?) 4. Altered level of consciousness (e.g., Is the patient lethargic, hyperalert, or difficult to arouse?) the diagnosis by this is the presence of features 1 and 2 and either 3 or 4

NIH classification of a BMI greater than 40

extreme obesity (class 3)

risk factors for SLE

female to male ratio in children affected is 3:1 for women during childbearing years 15:1 AA women 4x times likely than caucasian americans occurs infrequently in blacks in Africa, Asians, and caribbeans hispanic americans have higher prevalences rate compared to americans of european descent in US age of onset varies according to gender and ethnicity but overall 65% of patietns are diagnosed between the ages of 16-55 relatives with disease have higher risk than general population many genes identified that predispose people

Rheumatoid arthritis risk factors

females (2.5 times more likely); ethnic groups such as Pima and cippewa indians; first degree relatives (1.5 fold higher than general population); cigarette smoke, bacteria, and viruses have been implicated as initiating factors in predisposed population

course of delirium

fluctuating

genetic determinants of health

gene regulation and mutations gene-environment interactions epigenetic mechanisms

gliomas

generally originate in the cerebrum; included to develop along the curved areas of the brain, making the frontal lobes more susceptible; are grade I and II and are slow-growing tumors

Disease-modifying antirheumatic drugs (DMARDs)

given to RA patients that do not respond well to analgesics, anti-inflammatory agents, and low-dose prednisone; alter the immune system in various ways, altering the inflammatory response to decrease inflammation and slow disease progression; include but are not limited to methotrexate (Rheumatrex), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), and tofacitinib (Xeljanz)

consequence of hyperventilation

global cerebral vasoconstriction, which may result in ischemia to uninjured brain tissue

nursing care of immunodeficiency

goal is to protect the patient from infection; need to assess for signs of infection such as a fever over 100 F (37.8 C), chills, or cloudy, foul-smelling urine (may indicate a UTI).; assess vital signs for increased fever, hypotension, and tachycardia; monitor WBC and differential; monitor breath sounds (decreased or adventitious breath sounds may be present with a respiratory infection; monitor for skin rashes or lesions that may indicate skin infections, which may occur with immunodeficiency actions: practice good hand washing (first step in preventing infections); treat infection with antibiotic or antivirals as ordered; anticipate changing or discontinuing the immunosuppressive medication if possible (only considered if the infection is deemed a greater risk than the primary problem being treated with the immunosuppressive medications)

a well-managed immunodeficient patient

has a good understanding of the immune disorder and accompanying risks; the patient takes all appropriate precautions, practices good hand washing, and knows when to contact the provider; if an infection does occur, it is treated promptly with the appropriate antibiotic or antiviral therapy

western diet

has a role in promoting an obseogenic gut microbiota

treatment of vasospasm

has historically been centered on hypertension, hypervolemia, and hemodilution, widely known as triple-H therapy, with the goal of maintaining arterial patency and preventing cerebral infarction. Hypertension may be accomplished by withholding antihypertensive medications in patients with a history of hypertension, or elevating the blood pressure may be induced with vasoactive medications. Hypervolemia may be achieved by administering crystalloid or colloidal solutions such as albumin, targeting a hemodynamic parameter that measures or approximates intravascular volume (e.g., central venous pressure, pulmonary capillary wedge pressure (PCWP), global end-diastolic volume). Cardiac output may also be chosen as an endpoint for therapy. The intent of hemodilution is to decrease the viscosity of the blood in order to facilitate flow through often narrowed arteries. Hemodilution may be achieved as hypervolemia is employed, although minimum thresholds for hemoglobin are typically maintained at approximately 30 g/dL with the intent of ensuring adequate oxygen delivery to the brain tissue.

clinical manifestations of a spinal tumor

has manifestations similar to low-back pain (LBP) and herniated nucleus pulposus, as well as multiple sclerosis; on the basis of location, the paitent may present with back pain that may radiate down the arms or legs; may include numbness and tingling, weakness in the distal extremities, urinary incontinence, and bowel pattern changes

Surgical management of intracranial hemorrhage above the tentorium cerebelli (supratentorial)

has not been shown to improve outcomes unless a hematoma is superficial in location.

Omega-3s and vitamin D,A

have protective functions and also promote immune function

clinical presentation observed in the pt with a brain tumor often includes

headache; change in LOC; pupillary changes secondary to compression of CN III; vision changes; seizure activity; elevated BP with widening pulse pressure; decreased HR; nausea and vomiting; numbness and tingling

roles of the nurse in autoimmune conditions

health promotor: teach your community and clients about diet and health advocate/policy: become the expert on the latest science and research findings to inform IDT practices and educate policy makers care coordinator: address the holistic needs of the client and family consider becoming a specialist and at the very least consult with them with clients who are not effectively managing their conditions patient navigator for clients with IBD: know the national experts (David Rubin, Robert Baldassano, David Suskind)

prebiotics such as insulin

help promote probiotic effects

complications of acute ischemic stroke

hemorrhage into the area of infarcted (nonviable or dead) brain tissue, termed hemorrhagic transformation, which patients may experience in the absence of thrombolytic therapy or anticoagulation therapy cytotoxic edema weakness or paralysis of the extremities disorders of speech apraxia depression

post-op thyroidectomy complications

hemorrhage; respiratory obstruction; hoarseness bc it runs very close to the laryngeal cord; hypocalcemia; hypocalcemia; thyroid storm due to surgical procedure

complications of ischemic stroke include

hemorrhagic transformation; cytotoxic edema; as ischemia persists and infarction occurs, cerebral edema may increase, causing increased ICP and placing a patient at risk for cerebral herniation syndrome; aspiration of fluid, food, or secretions into the lungs is a common due to decreased LOC, as well as potential impairment of CNs, facial muscles, and function of the palate

treatment for hypothyroidism

hormone replacement; treat symptoms: oxygenation, slowly warm patient because they can vasodilate too quickly; 50% glucose; fluid restriction

risk factors of obesity

hertiable factors contribute to more than 50% of variations in BMI; people with relatives are more likely to develop it; identical twins, regardless of whether they are raised together or apart, are likely to have similar BMIs; specific genetic mutations; genetic polymorphisms

thyroid storm clinical manifestations

high fever; severe tachycardia (need beat blockers); delirium (beta adrenergic blockers); dehydration (IV fluids); extreme irritability (beta blockers)

other modifiable risk factors for stroke

hypercholesterolemia and illicit drug use (cocaine use is associated with ICH); major ones include: age greater than 55, gender, and race.

The nurse correlates an increased risk of renal stones in the patient with which disorder?

hyperparathyroidism

The nurse correlates which clinical manifestations to autonomic dysreflexia in a spinal cord injured patient?

hypertension with bradycardia

clinical manifestations of hypoparathyroidism

hypocalcemia trousseau's sign (hand) Chvostek's sign (cheek) seizures mental status changes decreased cardiac contractility insensitive to digitalis bc you need Ca for it to work

The nurse notes that which disorder place the patient at greatest risk for sensitivity to narcotics and anesthetics?

hypothyroidism

older patients have limited compensatory mechanisms to deal with physiologic insults such as:

hypoxia; hypoglycemia; dehydration

patients with high cervical injuries require

immediate ventilatory support

attention of pt with delirium

impaired

Administration of nimodipine, a calcium channel blocker

improves outcomes in patients experiencing vasospasm; however, this drug is associated with hypotension, which may necessitate alteration in dosing by increasing the frequency of dosing and decreasing the dose or discontinuing the therapy in some instances.

IV rt-PA administration

in order to receive it; patients must present within 3 hours of stroke symptom onset in some cases, it may be given up to 4.5 hours after stroke symptom onset must be give as soon as possible after ischemic stroke but not outside established therapeutic windows most significant risk associated with this is intracranial bleeding, which occurs in approximately 6.4% of pts receiving it benefits approximately 30% of treated patients as evidenced by decreased or absence of neuro deficits at 90 days after treatment adhering strictly to established inclusion and exclusion criteria is associated with a lesser incidence of symptomatic ICH

cervical cord injuries that occur in the neck result

in symptoms that affect the arms, legs, and middle of the body; clinical manifestations include: difficulty breathing loss of bowel and bladder control numbness weakness or paralysis pain sensory changes spasticity

early manifestations of delirium often include

inability to concentrate irritability insomnia loss of appetite restlessness confusion

precipitating factors of HHS

inadequate insulin (type II DM); infection; elderly with dehydration; stress (increased catecholamines)

A list of all risk factors for stroke include

incidence greater in men than women until age 55 death secondary to it is greater in women and African Americans HTN cigarette smoking hypercholesterolemia illicit drug use age greater than 55 gender race

exclusion criteria 3- to 4.5-hour therapeutic window for the administration of rt-PA

include all exclusion criteria for the 0-3 hour therapeutic window, and additional ones including: age greater than 80 years old, receiving anticoagulants, even if the INR is normal, prior history of stroke and diabetes

nonpharmacological interventions for SLE

include avoiding prolonged sun exposure and using sunscreen on a daily basis; well balanced diet for proper nutrition; frequent rest periods and a regular sleep schedule; regular exercise improves strength and maintains range of motion as well as a healthy weight

types of surgery utilized to stabilize SCIs

include decompression laminectomies, using anterior cervical and thoracic approaches, with fusion in which one or more laminae are removed to allow for cord expansion because of edema, posterior laminectomy and fusion with bone graft to immobilize the neck and prevent further damage to the spinal column, and a posterior approach using either a bone graft or the insertion of rods or other instruments to correct and stabilize the deformities.

clinical manifestations of spinal shock

include flaccid paralysis of all skeletal muscles, absence of deep tendon reflexes, impaired proprioception, decreased visceral and somatic sensations, penile reflex, urinary and fecal retention, anhidrosis (absence of sweating), and paralytic ileus. This can last from 24 hours to 1 to 6 weeks, and the return of reflex activity below the level of injury indicates the end of it

complications of CSF drainage

include infection, overdrainage, and introduction of air into the ventricular system if proper leveling is not maintained

surgical management of RA

include joint replacement or fusion may be necessary to help alleviate pain but may not actually improve function; patients may choose to have surgical removal of rheumatoid nodules, but they may return over time

complications with the use of halo brace/traction devices to stabilize the head and neck

include pin infections, skin breakdown, loosening or movement of pins, swallowing problems, and possible dural tears The sites must be frequently assessed for signs of infection and site care provided once a shift and as needed.

nursing considerations to prevent CIN if patient is at risk

include prehydration with IV saline, administration of a bicarbonate-based IV solution, or administration of n-acetylcyseine (mucomyst) IV may be employed

clinical manifestations of neurogenic shock

include vasodilation, bradycardia, body temperature instability, and hypotension; can be very dangerous and can lead to serious complications such as organ dysfunction and even death if not promptly identified and treated.

MRI for suspected stroke

includes sequences that capture necrotic tissue and areas of the brain that are hypoperfused, and directly visualizes the blood vessels to detect blood vessel obstruction or another abnormality such as an aneurysm.

clinical manifestations of increased ICP

including subtle changes in LOC, increased BP, decreased pulse rate, widening pulse pressure, changes in resp pattern, and pupillary changes should be reported immediately to the HCP in order to ensure prompt intervention to decrease changes of permanent neuro injury

complications of surgical management of brain tumors include

increased ICP (which can severely hamper cerebral blood flow, causing decreases in cerebral perfusion pressure (CPP) leading to secondary injury of the brain via cytotoxic and anoxic injury and herniation of the brain) bleeding (risk of intracranial bleeding postoperatively is high variable and dependent upon features of the tumor, location in the brain, proximity of the tumor to blood vessels, and the surgical approach) cerebral edema (most commonly, vasogenic edema, where the BBB becomes increasingly permeable) seizures (pre or postoperatively; location closer to the upper regions of the brain are at greater risk when tissues are disrupted during a surgical procedure) Venous thromboembolism (VTE; the nurse should assure preventive measures such as mechanical VTE prevention devices like SCDs and pharmacological prevention like heparin are applied and administered as ordered

hyperaldosteronism

increased aldosterone secretion which causes more hypernatremia than HTN, causes hypokalemia; causes metabolic alkalosis diagnostic evaluation: tumor on CT, abnormal lab values medical management: adrenalectomy or aldactone

significance of the problem delrium causes

increased morbidity and mortality; increased length of stay; increased risk for AE (falls, aspiration, pneumonia, and pressure ulcers); inability to return to same level of care at discharge; long term cognitive impairment/PTSD; only 4% is resolved at discharge; 1/3 never return to baseline

psychomotor changes in delirium

increased or decreased

diets high in carbs and fats (depending on the type of fat) are linked to

increased risk of developing IBD

in brain tumor patients who have undergone pituitary surgery, DI can be diagnosed using a combo of conditions including

increased urinary output, decreased urine specific gravity (less than 1.005), and increased serum sodium concentration (greater than 145), and an increase in serum (greater than 280 mOsm/kg) and urine osmolality (less than 200 mOsm/kg); increased UO may decreased BP further, compromising CPP

hyperparathyroidism

increases PTH release which leads to increased bone breakdown; loss of Ca from bone; demineralization of bone; osteoclastic over activity characterized by hypercalcemia which causes increased urine excretion of Ca and decreased neuromuscular activity

all-cause mortality risk

increases in patients with BMI greater than 30 kg/m2; is 20% higher in obese adults compared to normal-weight adults

stress

increases intestinal permeability, which can facilitate intestinal translocation of bacteria; has an impact on symptoms in IBD, however there is limited evidence that it triggers increases intestinal inflammation;

effects of long-term obesity

increases mortality and morbidity; increase hospital length of stay and overall health care costs; annual hospital costs are $160 million higher in these patients who undergo the most common nonbariatric surgical procedures compared to their normal-weight counterparts; causes a marked decrease in life expectancy; linked to numerous chronic health conditions (type 2, HTN, and dyslipidemia); heart disease such as HF, atrial fibrillation, and CAD are more common; increases the risk of stroke and obstructive sleep apena; conditions such as GERD, cholelithiasis, and nonalcoholic fatty liver disease are increased; osteoarthritis is increased in non-weight bearing and weight bearing joints; increases cancer risk and also increases the likelihood of dying from cancer; reproductive abnormalities; psychosocial aspects of health such as well-being and quality of life; related to an increase in social stigmatization and discrimination

the effect of a high BMI on mortality

increases with age

the volume of water in brain tissue observed in cerebral edema is reduced by

increasing the osmolarity of the blood (increasing solute in the blood), thereby changing the osmotic gradient, resulting in diffusion of water from an area of low concentration (brain tissue) to an area of high concentration (the blood)

primary appraisal

individualized; first response to a stimuli (stressor) from the environment; is an interpretation of the stressor to either positive, dangerous, or irrelevant

secondary appraisal

individualized; second response to a stimuli once determined as dangerous; analysis of the available resources whether insufficient and sufficient

patient teaching for strokes

information regarding the specific type of stroke and usual course to enable them to become involved in their own care or the care of their family member. Activation of EMS Warning signs and symptoms of stroke Patient-specific and family risk factors for stroke smoking cessation Medications for secondary prevention of stroke (Adherence to medication regimens to reduce BP and hypercholesterolemia and prevent blood clotting is important in instructing patients about their care)

orlistat

inhibits pancreatic lipase, thereby reducing dietary fat absorption; should be taken 3x/day with any meal that contains fat; causes moderate weight loss of 5-7 pounds over a year period; pt may also report lowering BP and are less likely to develop type 2 diabetes common AEs: significant GI symptoms including increased flatus, loose and oily stools, abdominal cramping and nausea; rare cases of liver injury, dark urine, itching, light-colored stools, loss of appetitie, or jaundice; because of the MOA it may also decrease absorption of fat-soluble vitamins and beta caroteine

Nurses caring for patients play a central role in patient outcome along the continuum of stroke care from

initial presentation through rehabilitation and discharge to the community.

short-term stress response

initiated by a nerve impulse in the spinal cord that stimulates the preganglionic sympathetic fiber which stimulates the adrenal medulla to secrete catecholamines which cause: increased HR, increased BP, brochioles dilate, liver converts glycogen to glucose and releases glucose to blood, blood flow changes, reducing digestive system activity and UO, metabolic rate increases

long term stress response

initiated by a stimuli which causes the hypothalamus to release CRH, which causes the anterior pituitary gland to release ACTH to the blood which travels to the adrenal cortex to initiate glucocorticoid (cortisol) and mineralocorticoid (aldosterone) release; aldosterone causes the kidney to retain sodium and water so that blood volume and blood pressure will rise; cortisol causes proteins and fats to convert to glucose or break down for energy so that blood glucose increases and immune system supressed.

onset of dementia

insidious (months to years)

cerebral ischemia

insufficient blood flow to the brain to meet metabolic demand

several short-term RCTs show the benefits of prebiotics and probiotics on:

insulin sensitivity, inflammatory markers, postprandial incretins, and glucose tolerance

patients with SAH require

intensive multidisciplinary, neurological, and general intensive care monitoring in order to optimize functional outcomes.

When a balanced interaction between the gastrointestinal (GI) tract and the resident microbiota is disrupted:

intestinal and extraintestinal disease may develop (allergy, inflammatory bowel disease, obesity, cancer and diabetes, metabolic disorder, cardiovascular dyslipidemia, and neuropathology)

types of hemorrhagic strokes

intracerebral hematoma (ICH); subarachnoid hemorrhage (SAH)

Moyamoya disease

involves constriction or narrowing of the end of the internal carotid arteries and narrowing of the smaller branches of the arteries in the anterior circulation (e.g., middle cerebral artery, anterior cerebral artery). An arterial network (collateral circulation) develops in response to the narrowing of arteries over time in order to augment blood supply to the affected areas of the brain.

cerebral amyloid angiopathy (CAA)

involves the deposition of beta-amyloid into the walls of blood vessels, rendering them fragile and at risk for damage, resulting in intracerebral hemorrhage. Beta-amyloid is one of the substances thought to play a role in Alzheimer's disease, and in this case, the substance is deposited into blood vessels. Cerebral amyloid angiopathy occurs mainly in the elderly.

most common initial method of intracranial compensation

involves the displacement of CSF from the cranial vault down through the foramen magnum at the base of the skull and around the spinal cord

reversibility of demential

irreversible

a significant risk factor for stroke

is HTN, followed by cigarette smoking.

systemic lupus erythematosus (SLE)

is a chronic inflammatory disease that can affect virtually any organ system; triggered by multiple factors including pregnancy, exposure to sunlight, illness, major surgery, silica dust, and medication allergies; must CMs are attributed to antibodies and the creation of immune complexes that are deposited into tissues

Phentermine/topiramate-extended release

is a combination medication. Phentermine is approved by the Food and Drug Administration to suppress appetite for up to 12 weeks. Topiramate is approved for the treatment of seizures and migraines, and weight loss was observed to be a side effect. taken once a day and produces the most weight loss, as much as 9% of initial weight common AEs: altered taste, numbness, tingling, insomnia, dizziness, and anxiety may cause birth defects, females must use a reliable form of birth control and receive pregnancy tests on a monthly basis during treatment.

cerebral perfusion pressure (CPP)

is a commonly used parameter to indirectly measure cerebral blood flow and is generally maintained above 60 mm Hg; measured by subtracting ICP from mean arterial pressure (MAP - ICP)

the most sensitive indicator of ICP

is a decrease in LOC; in order to detect subtle changes in this it is imperative to establish an accurate baseline of functioning from which to judge deterioration; need to ask expanded orientation questions like what state are you in right now or what city are you in right now or why are you here today

Increased intracranial pressure (ICP)

is best described by the Monro-Kellie doctrine of hypothesis, which states that 3 components- brain tissue, blood, and CSF- occupy a rigid box, the skull; when one of these 3 components increases, the other components must decrease to maintain equilibrium within the fixed box

neurogenic shock

is a distributive type of shock that occurs in patients with brain, upper thoracic, and cervical injuries and is caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in the vessel walls. This results in loss of vasomotor tone and sympathetic innervation of the heart. The cardiac output decreases because the vessels lose tone, allowing blood to pool in the periphery and blood pressure to fall; the sympathetic pathways to the heart are blocked or damaged, resulting in bradycardia. Clinical manifestations include vasodilation, bradycardia, body temperature instability (poikilothermia), and hypotension. can be very dangerous and can lead to serious complications such as organ dysfunction and even death if not promptly identified and treated. Treatment often includes fluid, vasopressors, and other medications such as atropine.

the microbiota in a healthy individual

is a diverse ecosystem with beneficial and commensal bacteria and low abundances of opportunistic pathogens, which are not harmful in small numbers

the most frequent cause of autnomic dysreflexia

is a full bladder, and the second most is a full bowel; other causes include tight clothing, GI disturbances, DVT, pressure ulcer, bladder or kidney infection, temp extremes, shoes, lying or sitting on a hard object, or a minor injury

left atrial appendage

is a muscular outpouching of the left atrium where blood clots form; contribute to the pathogenesis of atrial fibrillation-associated cardiac emboli

a lacunar stroke

is a small infarction caused by an obstruction of a small blood vessel or group of small blood vessels; Neurological deficits may fluctuate between improvement and worsening in the acute phase.

autonomic dysreflexia

is a syndrome of massive imbalanced reflex sympathetic discharge occurring in 80% of patients with spinal cord injury above the T5-T6 level; It most often occurs after the first year of injury but can occur any time after spinal shock subsides. A strong sensory input, such as pain, distended bladder, rapid temperature changes, infection, or a full rectum, is carried into the spinal cord via intact peripheral nerves. This input travels up the spinal cord and evokes a massive sympathetic surge from the intact thoracolumbar sympathetic nerves, resulting in widespread vasoconstriction, causing peripheral arterial hypertension. The brain detects this hypertensive crisis through intact baroreceptors (receptor cells in the bloodstream that relay information about blood pressure to the brain) in the neck and utilizes two methods to stop its progression. First, the brain attempts to shut down the sympathetic surge by sending descending inhibitory impulses. Unfortunately, these impulses are blocked in the injured spinal cord. Second, the brain attempts to decrease blood pressure by slowing the heart rate via the vagus nerve (parasympathetic). This bradycardia is inadequate, and the hypertension continues. clinical manifestations include severe headache, HTN, bradycardia, tachycardia, diaphoresis, and flushing above and pallor below the injury level once the inciting stimulus has been removed, reflex HTN resolves

primary endocrine disorders

is always the gland itself; example: due to a disorder of the thyroid gland itself

acute spinal cord injury (SCI)

is an unexpected catastrophic event that results in the loss of function such as mobility or sensation; mechanism of this injury may be caused by hyperextension, hyperflexion, rotation, and vertical compression (axial loading), or penetrating injuries

transpendymal cerebral edema

is caused by increased pressure in the ventricular system that results in cerebrospinal fluid moving into the brain parenchyma

TBI

is classified by the GCS score into three different categories: mild (13-15), moderate (9-12), and severe (less than or equal to 8); This disease process is marked by heterogeneity in that there are several possible mechanisms of injury, which can cause different injury patterns and damage in the same patient. Often, more than one cranial or cerebral structure is involved in a; for example, a patient may have sustained a frontal contusion as well as a temporal epidural hematoma

A videographical swallowing assessment performed by an SLP

is common for stroke patients and enables the practitioner to visualize all phases of the swallowing process to determine the type and extent of swallowing dysfunction that is present. If swallowing dysfunction is thought to be a long-term problem or permanent, a percutaneous endoscopically placed gastrostomy tube may be placed by a surgeon or gastroenterologist.

the role of the nurse in performing, trending, and communicating neurological assessment findings in increased ICP

is critically important to the preservation of neuro function; positive patient outcomes are related to maximizing neuro function and minimizing complications associated with this disease process

IV rt-PA for use in treating patients with acute ischemic stroke

is currently the only treatment approved by the FDA for ischemic stroke; in order to receive it; patients must present within 3 hours of stroke symptom onset

spinal cord injury

is damage to the spinal cord with resulting functional loss of mobility and/or sensation; result from concussion, contusion, compression, tearing, laceration, transection or ischemia of the spinal cord; minutes after the initial injury, the SC can swell and fill the entire spinal cavity at the level of injury (resulting in anoxia due to lack of blood flow and oxygen to the spinal cord tissue); as the body loses its ability to self-regulate, BP drops, interfering with the electrical activity of neurons and axons

ability to elicit a neuro assessment from a patient in a barbiturate coma

is limited because of the suppression caused by the meds; therefore, other parameters such as pupillary size and reaction are performed: application of moisture chambers with artificial tears to prevent corneal injury and frequent repositioning to prevent pressure ulcer development.

serum sodium

is monitored when targeting a specific level of solute concentration in the blood with the administration of hypertonic saline solutions. A target above the normal range (135-145 mEq/L) is chosen on the basis of the severity of cerebral edema and the specific disease process. A goal range above 145 mEq/L and typically less than 160 mEq/L is set, and serum levels are measured every 4-6 hours to ensure that the goal is achieved and not exceeded.

Wrapping of cerebral aneurysms

is not considered a definitive treatment because it remains at risk for rupture because blood continues to flow through the weakened aneurysmal vessel wall.

diet

is one of the more easily studied, and therefore better understood, environmental factors in epigenetic change. The nutrients we extract from food enter metabolic pathways where they are manipulated, modified, and molded into molecules the body can use." ONE OF THE MOST IMPORTANT MODULATORS OF MICROBIOTA HOMEOSTASIS

pin site loosening of halo traction devices

is one of the most common complications associated with this treatment; can lead to cervical instability and infection. Signs that may indicate this include redness, swelling, drainage, site pain, or areas where the skin has pulled away from the site. If no infection is present, the health-care provider may tighten the pins. if left untreated, the halo ring may migrate, resulting in loss of immobilization The patient often complains of neck pain and that "the vest does not fit correctly/feel the same." Some patients may notice the ability to move their neck. If this occurs, notify the health-care provider immediately, place the patient in a hard c-collar for spinal immobilization, and prepare for radiological imaging to assess for a change in spinal alignment. The nurse also needs to perform a thorough neurological examination to determine if the patient has worsening or new deficits. The halo will likely be reapplied using new pin sites.

surgical intervention of subdural hematomas

is primarily dependent on the patient's initial neuro status; if poor (severe focal neuro deficits or coma), surgery may be perfomred emergently; however, pts with a mild neuro deficit or absence may be monitored for neuro worsening and undergo surgery later if needed

healthcare team management of patients with secondary immune dysfunction

is primarily preventative; to protect the patient from infection; good hand washing is the first step; avoiding contact with people who have obvious infections such as a cough or cold is recommended; regular follow-up with the provider is necessary; prompt action with any signs of infection such as fever, chills, or cough is essential; any signs of urinary tract infection such as difficulty with urination, bloody urine, or lower back pain should be reported immediately

BMI

is routinely used to classify body weight and correlates with total body adiposity; calculated by weight (kilograms)/ height (meters)2

the hypothalamus

is signaled by hormones, metabolites, and neural pathways to regulate appetite

cerebral angiography

is the "gold standard" for visualizing abnormalities such as aneurysms or occlusions in blood vessels as they pass into the skull and brain (intracranial vessels). The right and left carotid and vertebral arteries are entered separately in order to visualize the anterior (carotid arteries) portion of the circle of Willis and the posterior (vertebral arteries) portion of the circle of Willis, including the basilar artery. The femoral artery is typically cannulated for this procedure, although alternative sites such as the brachial artery may be used in specific instances. Procedures such as angioplasty and stent deployment for narrowed blood, flow-limiting atherosclerotic deposits, and coiling of aneurysms are performed using this radiographical modality.

Glioblastoma multiforme (grade IV astrocytoma)

is the most aggressive and lethal type of tumor, especially when located in or near the brainstem

A CT scan

is the most common test performed in critically ill patients with a deterioration of neurological status, such as a decrease in level of consciousness, new motor deficit, or new cranial nerve deficit, because the test can be performed quickly.

the optimal position for a patient with increased ICP and decreased intracranial compliance (inability to compensate for increase in intracranial contents)

is thought to be 45-90 degrees with the neck in a neutral position in order to promote drainage of venous blood through the jugular veins in the neck

hemorrhagic transformation

is thought to occur as a result of blood vessel spasm around a blood vessel that has been occluded by a blood clot, which in time resolves, causing the blood clot to break apart and restoring blood flow to surrounding ischemic and infarcted brain tissue. During ischemia, tissues may become friable or fragile, and when normal blood flow or pressure is reestablished, this pressure may cause tissue damage or bleeding.

ideal goal of therapy for spinal tumors

is to completely remove it; this is complicated by the type and location; removing some may result in permanent nerve damage

the initial goal in managing increased ICP

is to prevent cerebral herniation

The role of health-care providers, from initial encounters with EMS personnel to the ED and critical care units for patients with TBI

is to prevent or attenuate the effects of secondary brain injury; Treatment paradigms, algorithms, and protocols are aimed at preventing or aggressively managing hypotension and hypoxemia in the immediate period after injury because these factors have been implicated in increased mortality of patients with severe cases

subarachnoid hemorrhage

is typically caused by a ruptured aneurysm and less commonly by arteriovenous malformations (AVMs), which is a mass of arteries and veins that is not connected by a capillary network; despite intensive treatment, an estimated 50% of these types of pt survivors have significant, lasting neuro deficits grading scales include: Hunt and hess grading scale; fisher grading scale, determined by amount of blood visualized on CT scan

drug therapy in the pt with delirium

is used cautiously bc many of them used to manage agitation have psychoactive properties typically reserved for those with severe agitation meaning- interferes with needed medical therapy; puts patient at increased risk for falls and injury; used when nonpharmacologic interventions have failed

halo traction device

is used to maintain cervical immobilization for specific types of cervical fractures; made up of a ring around the patient's head attached to a special vest by four rods; Titanium screws are screwed into the skull bone and attached to the halo traction device; weights connect to the halo at the head of the bed over a pulley system. Weights are slowly added, with x-rays taken between each additional weight, until spinal alignment is achieved.

doppler ultrasound of the carotid arteries

is utilized to detect narrowing of the inner lumen of the carotid vessels by atherosclerotic plaque. Evaluation of this artery with ultrasound can detect narrowing in the carotid vessels before they enter the skull.

neurological and systemic complications of SAH include

ischemic stroke, cerebral edema, pulmonary edema, and myocardial ischemia. Morbidity and mortality of patients is influenced by the management of systemic medical complications, which can cause or exacerbate brain injury.

clinical manifestations of RA

joint pain, joint swelling, erythema, morning stiffness, and fatigue; onset is often insidious, with vague complaints of joint and muscle pain that evolves into joint pain with synovitis, inflammation of they synovial membrane, and can lead to joint destruction and deformity; if left untreated or inadequately treated, leads to irreversible joint damage and disability; also includes, bone erosion, increase of synovial fluid, swollen inflamed synovial membrane, and thinning cartilage

diagnosis of SLE

may be complicated; according to the ACR, 4 of 11 criteria must present in order to support it; no specific test used; rather lab finding are used to support or confirm when combined with patient history and physical examination findings

occlusion of small intracranial blood vessels supplying the peripheral regions of the brain and deep brain structures causes

lacunar stroke syndromes, which vary in the severity of functional deficits

different types of ischemic strokes

large vessel; small vessel (lacunar); embolic; cryptogenic defined as a sudden blockage of a cerebral blood vessel causes a reduction in supply of oxygenated blood to the region of the brain fed by the involved artery, resulting in an abrupt onset of clinical manifestations. These clinical manifestations are grouped into stroke syndromes, which can be correlated or localized to a particular cerebral blood vessel

loss of intracranial compliance

leads to cerebral herniation syndrome where brain tissue is displaced, and if the displacement is not resolved, the brainstem becomes compressed, eventually causing brain death

clinical manifestations of SCIs

level of injury helps predict what parts of the body might be affected; other effects include chronic pain, low BP, inability to sweat below the level of injury, and decreased temp control

presenting symptomology of a brain tumor in the brainstem

loss of cranial nerves on one side with loss of motor or sensory on contralateral side

lumbar sacral injuries occur at the lower back level; varying degrees of symptoms can occur including:

loss of normal bowel and bladder control numbness pain sensory changes spasticity (increased muscle tone) weakness and paralysis

thoracic cord injuries occur at chest level, and the following clinical manifestations can occur

loss of normal bowel and bladder control (may include constipation, incontinence, and bladder spasms) numbness sensory changes spasticity (increased muscle tone) pain weakness, paralysis

presenting symptomology of a brain tumor in the pineal gland

loss of upward gaze; loss of light reflex

presenting symptomology of a brain tumor in optic nerve

loss of vision in one eye

presenting symptomology of a brain tumor in the optic tract or occipital lob

loss of visual field on the same side in both eyes

attention of pt with depression

may be decreased

adrenal cortex disorders

may be due to alteration in hormone secretion (increased or decreased); may be caused by a hypersecreting tumor

examples of autoimmune diseases

lupus (SLE); Crohn's, type 1 DM; Myathenisa Gravis; RA; MS; Reiter's syndrome

the human microbiota

made up of trillions of cells, including bacteria, viruses, and fungi; biggest population reside in the gut; other popular habits include the skin and genitals; live with humans from birth and this relationship is vital to normal health; the population living inside the human GI tract amount to around 4 pounds of biomass; every individuals has a unique mix of species; important for nutrition, immunity, and effects on the brain and behavior; it is implicated in a number of disease that cause a disturbance in the normal balance

during the acute stage of SCI, treatment focuses on

maintaining airway patency, adequate breathing and oxygenation, preventing spinal shock, restoring and maintaining blood pressure, preventing further cord damage, spinal immobilization and avoiding possible complications; Patients are monitored for vital sign changes that may indicate spinal shock.

hyperosmolar hyperglycemic state

major complication you see in type 2 diabetics because they have enough insulin to keep them out of ketoacidosis but blood sugar becomes really high that cause major fluid shifts characterized by: insufficient insulin to control glucose; sufficient insulin to control lipolysis and ketogenesis; Hyperosmolarity secondary to hyperglycemia and hypernatremia; Intracellular to extracellular fluid shifts

different types of medications used to treat cerebral edema

mannitol (Osmitorl) and high-concentration sodium chloride solutions (3% for example)

some patients with an established spinal cord lesion depend on

manual evacuation (the digital removal of feces) as their routine method of bowel care because they have lose normal bowel function All nursing staff must be aware of the possible risk of autonomic dysreflexia occurring if the patient's bowel becomes distended because of constipation or impaction. Health-care staff requires training in the procedure of manual evacuation to prevent this medical emergency from occurring.

in severe DAI

many neurons have been injured, patients may not regain consciousness; treatment for this type of injury does not concurrently exist; can be visualized on MRI but may not be visible 24 hours after injury

rheumatoid nodules

may be formed in subcutaneous tissue over bony prominences; are usually mobile and nontender

clinical presentation of increased ICP

may be subtle, particularly in the early stages, and is in sharp contrast to the presentation of cerebral herniation; these signs must be detected early in order to implement treatment and prevent herniation syndrome

surgical interventions for lupus

may include renal transplant for patients with severe nephritis; may require joint replacement due to increased risk for avascular necrosis of large joints

decreased TSH and decreased triiodothyronine and thyroxine

may indicate secondary hypothyroidism

skull fractures occurring at the base of the skull

may involve a breach of the dura and subsequent cerebrospinal leak and can damage or impinge cranial nerves and blood vessels that traverse the foramina in the skull base; it is important to evaluate extraocular movements bc cranial nerves IV and VI could be damaged if a fracture occurs near the foramen through which they travel

elevations in TSH

may point to primary hypothyroidism

both antidepressants and antimicrobials

may relate to changes in gut permeability and microbiota composition; antimicrobial effect of antidepressants could be related to its effectiveness

central pontine myelinolysis

may result due to sodium levels rising too quickly (more than 10 mEq/L in 24 hours) in a patient with chronic hyponatremia; causes damage to myelin (the sheath covering neurons to enhance speed of impulse transmission) in the pons, resulting in a decrease in neuronal transmission in the pons. Features of this disorder may include generalized weakness on both sides of the body, quadriplegia in severe cases, lethargy, and paralysis of eye movements.

hypotension in the setting of vasospasm

may worsen ischemia caused by narrowing of the blood vessel

inclusion criteria for the administration of tissue plasminogen activator (rt-PA)

measurable neurological deficit using NIHSS no hemorrhage on head CT time since last time patient was seen to be normal is within 3 or 4.5 hours (if additional exclusions not present) before the infusion was begun symptoms present for 30 minutes, not rapidly improving of attributable to another disease imaging of head is consistent with an acute ischemic stroke not hemorrhage or brain tumor

intracerebral hemorrhage is typically managed using

medical therapies to manage BP and prevent expansion of the hematoma as well as therapies to reverse coagulopathy and treat increased ICP (osmotic therapy, hyperventilation, drainage of CSF)

obesity is more prevalent among:

middle-aged rural economically disadvantaged racial/ethnic minority populations yes these patients are unlikely to have bariatric surgery

factors that shape the gut microflora during infancy

mode of delivery, type of infant feeding, hospitalization, and prematurity

nursing interventions for the treatment of the patient with autonomic dysreflexia

monitor BP closely, at least every 5 minutes administer antihypertensive medication as ordered HOB at 45 degrees or sit the patient up loosen restrictive clothing; remove braces, antiembolism stockings, shoes, look for source of pain from these items check the bladder; if patient has an indwelling catheter, ensure patency and adequate drainage; if patient does not have one, perform intermittent catheterization or place indwelling catheter per order; collect sample for UA check the bowel for impaction check the patient's body for other sources of noxious stimuli- pressure ulcers, wounds, bites, scratches, etc

nurse management of hypercortisolism

monitor VS and serum electrolytes inerventions to reduce risk for injury (fall precautions; use lift sheet) high calorie diet with increased Ca and vit D decrease caffeiene and alcohol due to Aes of increased gastric secretions frequent skin assessment and monitor wound healing bc they aren't going to heal properly due to suppressed immune system soft toothbrush avoid adhesive tape because skin is fragile

SIADH management

monitor serum sodium (assess for seizure activity); fluid restriction (closely monitor I&O); vasopressin antagonists (inpatient only); diuretics; demeclocycline (helps get rid of the water); 3% saline solutions (more than 3x NS) a highly concentrated fluid, most be given through a central line, only given when everything else hasn't worked

duration of dementia and depression

months to years

osteoarthritis compared to RA

morning stiffness lasts less than 30 minutes; it is not immune mediated; typically joints that are affected involve large weight-bearing joints such as hips and knees; no systemic organ involvement; symmetrical joint involvement is not typical

nondisplaced skull fractures

must be visualized using radiographical imaging and rarely involve disruption of the meninges bc the edges of the fracture are approximated and have not moved from their original position

microbiome definition

name given for ALL the genes inside the cells of the microbiota

nursing assessment and analysis of patients with acute ischemic or hemorrhagic stroke include

neuro assessments is integral in detecting potentially treatable neuro deterioration rapidly, which allows for the best chance to preserve or restore function A clear understanding of a patient's baseline neurological status serves as the basis for future assessments and enables the nurse to quickly identify and analyze changes. In patients after hemorrhagic stroke, close monitoring of vital signs, particularly blood pressure, is necessary to prevent rebleeding or expansion of a hematoma. Identification of rhythm disturbances such as atrial fibrillation, ST segment, or T-wave changes associated with myocardial ischemia, is essential in determining potential causes of stroke and intervening in complications of stroke. Close monitoring of serum electrolytes, particularly sodium, is necessary to identify disorders of salt and water imbalance resulting in hyponatremia, which places patients who have suffered a stroke at high risk for cerebral edema and neurological deterioration. Regular assessment of systems enables the nurse to identify potential complications early, track progress, and make appropriate referrals to the interdisciplinary team, ensuring the best possible outcome for the patient.

nursing assessment interventions for spinal tumors

neuro status -- Locate level of function - sensory and motor to determine necessary interventions as well as to evaluate for signs of deterioration as well as for signs of improvement with treatments Pain Bowel or bladder function -- patient may present with incontinence, urinary retention, or constipation identify current coping skills that work and the patient's support system

when spinal cells are injured

neurons flood the injured area with an excitatory transmitter (glutamate) normally used to stimulate activity in neurons; this excessive release results in excitotoxicity, a process in which neurons are damaged and destroyed by overstimulation

proposed theories of delirium

neurotransmitters (DA, GABA, acetylcholine); alteration in synthesis, release, inactivation resulting in excess dopamine, acetylcholine depletion; additional neurotransmitter imbalances: serotonin imbalance, endorphin hyperfunction, increased noradrengergic activity

proposed theories of delirium

neurotransmitters (dopamine/gamma-aminobutyric acid; acetylcholine) involved; alteration in synthesis, release, inactivation resulting in excess dopamine, acetylcholine depletion; additional neurotransmitter imbalances: serotonin imbalance, endorphin hyperfunction, and increased nonadrenergic activity

malabsorptive bariatric surgical procedures

no longer commonly performed and account for 2% of the surgeries performed worldwide; these procedures induce weight los by decreased nutrient absorption; examples include: jejunoileal bypass and biliopancreatic diversion

attention of pt with dementia

normal except in severe cases

NIH classification of a BMI 18.5-24.9 kg/m2

normal weight

three main subtypes of hemorrhagic stroke

nontraumatic subarachnoid hemorrhage (SAH); intracerebral hemorrhage (ICH), and intraventricular hemorrhage (IVH)

uncal herniation

number 1 on graph; an expanding lesion causes the tip of the temporal lob (uncus) to shift downward and inward toward the midbrain and through the tentorium, compressing cranial nerve III; CN III is innervated by the PNS, and stimulation of this nerve causes pupillary constriction; compression of this CN causes dilation of the pupil and an inability to constrict (fixed and dilated pupil) clinical manifestations: unilateral dilated pupil; contralateral motor weakness or flexion/extensor posturing; positive Babinski's reflex; coma

clinical manifestations of hypocalcemia

numbness and tingling tetany laryngospasm trousseau's sign chvostek's sign seizures mental status changes decreased cardiac contractility insensitive to digitalis

NIH classification of a BMI 30-34.9 kg/m2

obesity (class 1)

NIH classification of a BMI 35-39.9 kg/m2

obesity (class 2)

nursing care of the patient with autonomic dysreflexia includes

observing for a rapid rise in BP (often 20-40 mm Hg above the patient's baseline); bradycardia, diaphoresis, flushing of the skin above the level of the lesion, chills, and pallor below the lesion level; the patient often reports a severe headache with one or more of the following clinical manifestations: nasal congestion, anxiety, blurred vision, chest pain, or a sense of impending doom

nursing actions for bariatric surgical patient

obtain appropriately sized equipment for care (bariatric gowns, beds, bariatric chair, bariatric bedside commode, bariatric wheelchair/stretcher) apply sequential compressive devices as ordered encourage self-care and mobility as appropriate encourage use of IS turn patients with decreased mobility frequently, a minimum of every 2 hours, using additional staff as needed use slide and transfer assistance devices as appropriate elevate head of bed 30-45 degrees if no contraindications assist patient with skin care administer pain medication do not reposition NGT; monitor NGT for patency if applicable introduce clear liquids as ordered inform transportation and other departments of weight prior to transport collaborate with appropriate members of the health-care team: WOCN

disorders of sodium imbalance

occur frequently in the neurosurgical population for reasons that are not clearly understood; common ones in this population are SIADH, diabetes insipidus, and cerebral salt wasting syndrome (also called renal salt wasting syndrome)

gene-environment interaction

occurs at cellular level; risk behaviors illustrate such interaction; family members for example can have the same mutation for an autoimmune disorder and they don't experience disease; this is why importance of prevention counseling once a family member is diagnosed

spinal shock

occurs immediately after injury and applies to all phenomena surrounding spinal cord transection. This results in a complete but temporary loss or depression of all or most spinal reflexes as well as sensory, motor, and autonomic activity below the injury level. the brain is unable to transmit signals to muscles and organs, resulting in loss of sensation, movement, and other body functions. Clinical manifestations include flaccid paralysis of all skeletal muscles, absence of deep tendon reflexes, impaired proprioception, decreased visceral and somatic sensations, penile reflex, urinary and fecal retention, anhidrosis (absence of sweating), and paralytic ileus. This can last from 24 hours to 1 to 6 weeks, and the return of reflex activity below the level of injury indicates the end of it

vasogenic cerebral edema

occurs when the blood-brain barrier (BBB) is disrupted; this type primarily impacts white matter and is caused by leakage of fluids out of capillaries into the interstitial space

weight gain

occurs when the intake of caloric nutrients exceeds the energy expenditure

occlusion of large cerebral blood vessels by atherosclerotic plaque

occurs when the plaque ruptures, causing a blood clot to form and block the vessel, or when the plaque accumulates to a point that it critically narrows and then completely obstructs blood flow

exclusive enteral nutrition (EEN)

often 1st line treatment in EU but not as well tolerated by aduls with IBD

management of cerebral edema regarding brain tumors

often includes increasing the dose of glucocorticoids as these medications decrease the inflammatory process associated with damage in and around the tumor

psychomotor changes in dementia

often normal

pressure ulcers that develop under the vest portion of the halo brace

often result from improper size, poor application, or insufficient padding Meticulous skin care and assessment for early signs of skin irritation are key to reducing/preventing breakdown. Other ways to prevent skin breakdown include turning and repositioning every 2 hours and as needed and making sure the vest fits properly and has sufficient padding.

thoracic spinal cord injuries

often result in paraplegia and can include poor trunk control

secondary injury countrecoup ("counter-blow")

one of the phases of TBI; encompasses all processes that occur subsequent to the initial injury

primary injury coup ("blow")

one of the phases of TBI; occurs with the initial mechanical insult

primary brain tumors

originate in the brain and range from slow-growing, benign tumors to highly malignant, aggressive ones; originate from brain cells, brain meninges, nerves, and glands; classification is generally based on the type of brain cells involved and the location in which the cancer evolves; can also be classified on the basis of the WHO classification system from least aggressive (grade I) to most aggressive (grade IV) depending on the rate of growth and behavior of the cells

vasogenic cerebral edema treatment

osmotic therapy (mannitol and/or hypertonic saline), hyperventilation, or surgical decompression

extra-articular clinical manifestations of RA include

osteopenia (decreased bone density), muscle weakness, episcleritis (red, painful inflammation of the episclera without discharge), scleritis, pleuritis (inflammation of the lining around the lungs), pleural effusion (excess fluid accumulation around the lungs), pericarditis, and anemia

NIH classification of a BMI 25-29.9 kg/m2

overweight

clinical manifestations of increased ICP due to space-occupying tumors

papilledema (swelling of the optic disk), headache, nausea, and vomiting, decreased alertness, cognitive impairment, personality changes, ataxia, hemiparesis, abnormal reflexes, and cranial nerve palsies

spinal cord injury at T6-T12 results in

paraplegia with fair ability to control balance and trunk, little or no voluntary bowel or bladder control

important nursing assessments for SLE

past health history/head-to-toe physical assessment; vital signs (hypertension may occur as a real or cardiac complication); fever may be present due to infection due to immunosuppresants; decreased oxygen saturation may be present bc of the complication of interstitial lung disease; monitor BUN, Cr, urinalysis, CBC, CRP/ESR, coagulation studies

important pt teaching for RA

patients must understand their disease and the measure they can take to help manage it; ROM exercises promote joint mobility, reduce stiffness, and improve muscle strength; aerobic exercise promotes cardiac health; PT and OT may be necessary to teach patients appropriate exercises; teach patients how to protect their joints, evaluate the need for assistive devices, and teach proper use of the devices; proper nutrition is important to maintain good health, prevent obesity, and decrease risk of heart disease; important to take rest periods to manage fatigue and joint pain

pharmacotherapy should be considered in

patients with a BMI greater than or equal to 30 kg/m2 or with a BMI greater than or equal to 27 kg/m2 with one or more obesity-associated comorbidities whose weight loss attempts have been unsuccessful in the bast; should be employed only in the presence of diet, exercise, and behavioral therapy and requires close observations by a HCP majority of weight loss occurs within first 6 months of starting; three meds currently available for long-term treatment: orlistat, lorcaserin, and phentermine/topiramate

Increased ICP is detected by

performing serial neuro assessments including the elements of wakefulness, arousal, cranial nerves, and motor function

symptoms of hypercortisolism (cushing's syndrome)

personality changes; hyperglycemia; moon face; CNS irritability; increased susceptibility to infection; NA and fluid retention (edema); gyencomastia; thin extremities; fat deposits on face and back of shoulders; GI distress (increased acid); females: amenorrhea, hirsutism; thin skin; purple striae; bruises and petechiae

behavioral factors that promote obesity

physical inability; binge eating and compulsive eating

diet therapy commanlities for IBS and IBD

plant based; low fermentable carbs; low sugar like the paleo diet; whole, organic, avoiding food additives

Which interventions are indicated to treat the loss of vasomotor tone in the patient with an acute SCI? (Select all that apply.) A. Positive inotropes B. Corticosteroids C. Antispasmodics D. IV fluids E. Vasopressors

positive inotropes, vaspressors, and IV fluids

role of nurse for patient with delirium

prevention by early recognition- especially those at risk: neurologic disorders (stroke, dementia, CNS, infection, PD); sensory impairment; and advanced age focus on eliminating precipitating factors (protect pt from harm; encourage family members to stay at bedside) if it is secondary to infection, antibiotic therapy should be started Reorientation and behavioral interventions—used in all patients Create a safe and quiet environment. Provide reassurance. Pay attention to environmental stimuli. Clocks, calendars, noise, and light levels If the patient uses eyeglasses or a hearing aid, these should be made readily available because sensory deprivation can precipitate it avoid the use of restraints should also focus on supporting the family and caregivers. Listen to the family Advocate for the family Educate the family assess for skin breakdown due to immobility

two phases of TBI

primary and secondary brain injury

risk factors for developing delirium

preexisting dementia African american hispanic male non english speaker medical ICU (vs. SICU) > 65 yo depression pain use of physical restraints immobility history of falls sensory deprivation sensory overload visual or hearing impairment malnutrition dehydration sedative hypnotics opioids severe acute illness electrolyte imbalances terminal illness orthopedic/cardiac surgery prolonged cardiopulmonary bypass older patients due to multiple drugs that may induce it

CT

preferred imaging modality for patients with obesity

In patients with delirium or high risk in hospital do:

provide environment and personal orientation ensure continuity of care encourage mobility reduce meds but ensure adequate analgesia ensure hearing aids and spectacles are available and in good working order avoid constipation maintain a good sleep pattern maintain good fluid intake involve relatives and carers avoid complications liaise with old age psychiatry service

glia

provides the physical structure of the brain and supports the endothelial cells of the BBB; also provides nutrients and ionic balance and is involved in the repair and scarring processes

intra-arterial thrombolytic administration

procedure includes the introduction of a catheter into the femoral artery that is then threaded up the aorta and across the direct visualization of the patency or nonpatency of the blood vessel dye is injected into the blood vessels through the catheter, and images are obtained in quick succession using x-ray. during this procedure, the catheter is advanced to the clot and small doses of rt-PA are injected directly onto the clot with goal of dissolving the clot

compression of the CN III

produced pupillary dilation on the same side as the cranial nerve compression, or ipsilateral to the CN compression

The ICP waveform

produces three waves, numbered P1, P2, and P3; in cases of decreased intracranial compliance, the P2 wave is elevated above the P1 and P3 waves

course of dementia

progressive

healthy people 2020 goal

promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights

obesogenic medications

promote increased appetite that contributes to obesity; medications for diabetes (insulin, sulfonylureas, thiazolidinedione); meds for HTN (beta blockers, alpha-adrenergic blockers); hormones (corticoids); antihistamines; anticonvulsants; antipsychotics; antidepressants

antithyroid medications

propylthiouracil; tapazole; iodine therapy (SSKI); adrenergic blockers; radioiodine therapy; surgery: remove the goiter and tumor but try to maintain a little piece of it

specific methods used to prevent aspiration include

providing supervision of the patient while eating to observe for signs of choking, maintaining the head of bed at least 45 degrees or greater while eating or drinking, reducing distractions to assist a patient in concentrating on eating and drinking, advocating for evaluation of the patient by an SLP. Some patients require additional measures, which are often recommended by an SLP and include tucking the chin when swallowing and thickening liquids with fiber additives. Ensure that patients receive the prescribed therapeutic food preparation such as a soft or pureed diet. Other members of the health-care team may be involved in the feeding of patients; therefore, it is critical for the nurse to communicate the appropriate precautions and diet to these team members in order to ensure safety around meals. Patients with dysphagia are typically evaluated by an SLP and may be able to take food and fluid by mouth with a customized plan to prevent aspiration of liquids or solids into the lungs.

nursing management of SCI also encompasses

pulmonary care (suctioning or assisting with cough), turning to prevent pressure ulcers, DVT prophylaxis, bowel and bladder training , and management of nutrition, limb edema, and orthostatic hypotension Throughout the hospitalization, providing emotional support is essential for the patient and family. Assisting with the challenging adjustment to the new onset in alterations of daily living is an important focus for this patient population.

spinal cord injury at C6, C7 results in

quadriplegia with biceps intact, diphragmatic breathing

spinal cord injury at C5, C6 results in

quadriplegia with gross arm movements, phrenic nerve intact

spinal cord injury at C1-C4 results in

quadriplegia with loss of spontaneous respiratory function

spinal cord injury at C4, C5 results in

quadriplegia with possible phrenic nerve involvement

spinal cord injury at C7, C8 results in

quadriplegia with triceps, biceps, and wrist extension intact and some function of intrinsic hand muscles

Which intervention is typically the initial treatment of a metastatic spinal cord tumor?

radiation therapy

diagnoses methods to determine the cause of increased ICP

radiographic imaging of the brain, typically a CT scan; lab testing such as serum osmolality and ABG testing is necessary to guide medical treatments

physical interventions to reduce the blood volume in the intracranial space

raising the head of the bed to greater than 45 degrees to facilitate drainage of venous blood through the jugular venous system positioning a patient so that the neck is in a neutral position and hip flexion is minimized also assists in facilitating venous drainage from the head hyperventilation external drainage of CSF is an effective method to for rapidly decreasing increased ICP; may be continuous or intermittent according to the patient's specific needs

prior to arrival to the hospital for SCI patients

rapid assessments of vital signs including the patient's respiratory effort need to be evaluated bc a high cervical cord injury at or above C3, 4, or 5 affects the phrenic nerve that innervates the diaphragm

In cases where neither clipping nor coiling the aneurysm is feasible,

reinforcement of the aneurysmal wall by wrapping the outside of the aneurysm with synthetic material or muscle during the surgery may be accomplished.

guidelines for the management of SAH

recommend management of blood pressure while considering the risk of either hypoperfusion or rebleeding in the period prior to securing the aneurysm.

nursing assessments for spinal cord injury patients

respiratory function (Loss of intercostal muscle function results in decreased tidal volume and may lead to hypoventilation; C5 and higher injuries result in complete loss of diaphragmatic effort.) vital signs motor function/sensory level pain (may be increased pain above the level of injury as a result of damage to the spinal cord or nerve roots.) intake and output surgical and/or pin sites (assessed for infection, bleeding, or CSF leak) bowel sounds (decreased perfusion to the GI tract can lead to decreased GI motility and paralytic ileus)

epigenetic mechanisms

refers to inheritance that is not explained by changes in the DNA; highly influenced by the internal and external cellular environment; two main mechanisms: DNA methylation and histone modification aging processes, environmental influences and lifestyle factors such as smoking or diet induce biochemical alterations to the DNA. Frequently, these lead to DNA methylation, a process in which methyl groups are added to particular DNA segments, without changing the DNA sequence

changes in vital signs

reflect late changes in increased ICP as herniation occurs

endocrine glands

release their secretions directly into blood stream

mineralocorticoids

released by the adrenal cortex; example: aldosterone functions: increased Na retention and increase potassium excretion

glucocorticoids

released by the adrenal cortex; example: cortisol functions include: Protein metabolism Fat metabolism Carbohydrate metabolism Increase Na+ retention Increase K+ excretion Suppress inflammatory and immune response

surgical management of refractory increased ICP

removing a section of the cranium and dura in order to create space for the swelling brain (a hemicraniectomy with a durotomy); involves removal of a section of the skull and opening of the dura; the skull is removed and typically stored in a tissue bank or stored in a tissue pocket within the patient's abdomen; the dura is replaced with a synthetic material that allows for brain tissue expansion and watertight closure of the meningeal layer

complications of lupus

renal failure; premature heart disease; interstitial lung disease; hypercoagulation; stroke; avascular necrosis of joints; and increased risk for infection; may also arise from toxicities related to pharmacological therapy

complications of lupus

renal failure; premature heart disease; interstitial lung disease; hypercoagulation; stroke; avascular necrosis of joints; increased risk for infection; may also arise from toxicities related to pharmacological therapy

cryptogenic classification

represents the portion of patients diagnosed with ischemic stroke, but the cause cannot be determined even after a comprehensive evaluation; meaning a discrete cause cannot be identified

The nurse correlates phrenic nerve damage to which complication in the patient with a spinal cord injury?

respiratory distress

lumbar and sacral spinal cord injuries

result in decreasing control of legs, bowel, and bladder function, and sexual function

a calorie reduction of 500-1000 calories daily

results in a 1-2 lb weight loss weekly if the patient is currently maintaining a stable weight

a complete spinal cord injury

results in a total loss of motor and sensory function below the level of injury

cytotoxic cerebral edema treatment

same interventions as vasogenic shock (osmotic therapy-mannitol and or/ hypertonic saline, hyperventilation, or surgical decompression)

meds that may increase the risk of developing delirium

sedative-hypnotics, opioids (especially meperidine [Demerol]), benzodiazepines, and drugs with anticholinergic properties

priority interventions for SIADH

seizure precautions; oral care; pt/family teaching about fluid restriction

diagnosis and treatment of HHS

serum glucose > 600 mg/dL; serum Osmo > 320 mOsm/L; profound dehydration; serum pH > 7.3 so they aren't acidotic; bicarbonate > 15 mEq/L; small/absent ketonemia and ketonuria; altered LOC; IV fluids; IV insulin may be required

delirium is common in older adults who have

short-term illness such as lung or heart disease, infection, poor nutrition, and drug interaction

all adults with a BMI greater than or equal to 30 kg/m2; those with a BMI greater than or equal to 25 kg/m2 or with a high risk waist circumference and greater than or equal to two other risk factors

should be assisted with developing weight-related goals and treatment;

things that should be considered and incorporated into the patient w/ a brain tumor's plan of care

should be customized to particular to type, location, and functional status; should include complications such as VTE, seizures, falls, infection, and aspiration

diet therapy

should be developed and individualized between the health-care provider and the patient

serum creatinine monitoring after CT scan

should be done at least once after the contrast administration in critically ill patient and more often if acute kidney injury is suspected; typically an increase of at least 0.5 mg/dL is expected, which will decrease over 24-48 hours

nursing considerations for serum sodium

should not rise by more than 10 mEq/L in 24 hours for patients who have chronic hyponatremia. If sodium levels rise too quickly in a patient with chronic hyponatremia, a disorder called central pontine myelinolysis may result. In patients with cerebral edema, a decrease in serum levels may affect the level of consciousness because of an exacerbation of cerebral edema.

D5W

should only be utilized in a DI patient with hypernatremia

pin site care for halo brace/traction devices

sites must be frequently assessed for signs of infection and site care provided once a shift and as needed are kept clean using a clean cotton-tipped applicator or gauze soaked with normal saline. A new clean applicator or gauze is used for each pin site. If crusting is noted on assessment, wrap a gauze soaked with normal saline around the pin site for 15 minutes. After removing the gauze, use a clean cotton-tipped applicator to gently remove the crust from the pin site. Ointments and solutions such as hydrogen peroxide should not be used because they can irritate the skin and may cause breakdown at the pin site.

intracranial compliance

the ability of the body to compensate by adjusting the levels of the three main components of the skull (brain tissue, blood, and CSF)

controllable risk factors for stroke

smoking, hypertension, and hypercholesterolemia. Knowledge of the role that these factors play in recurrent stroke may be empowering to patients who must be encouraged to take control of their health in order to prevent recurrent stroke or other conditions such as heart disease.

presenting symptomology of a brain tumor in the left inferior frontal lobe (Broca's area) or the left temporal lobe (Wernicke's area)

speech

basal metabolic rate

the amount of energy required to maintain vital organ function

Contraindications for t-pa

stroke or serious head injury in past 3 months hemorrhagic stroke recent Mi increased PTT anticoagulant therapy pregnancy

pituitary surgical approaches

sublabial transseptal approach and endoscopic (Nasal) approach

What family/friends can do for the pt with delirium

tell nurses and doctors what is "normal" for your family member when he or she is not in the hospital be present, visit often, let your love one know you are there; try to orient them to day and time but do not "force reality" bring in personal items from home that can help the person, such as pictures, glasses, hearing aids, dentures, maybe favorite foods if permitted get your loved one moving; encourage walks and even sitting in a chair; activity can prevent and or shorten the delirium ask the nurses to check if your loved one is in pain and in need of pain medication use a notebook as a "guest book" so your loved one can see that people are coming to visit them

displaced skull fracture

the edges of the fractured bone are no longer approximated and can be displaced or depressed downward toward the brain; fragments from a comminuted fracture may also be present. The edges of fractured bone or individual bone fragments are often sharp and irregular and can tear the dura mater covering the brain, underlying blood vessels, and venous sinuses, and in some circumstances, these sharp edges can violate the meninges, directly injuring brain tissue.

beriatrics

the medical specialty that focuses on the causes, prevention, and treatment of obesity, has expanded over the last decade

the two routes by which diet can influence our health

the metabolism of our cells which leads to catabolism, anabolism (which leads to pro-inflammatory molecules, new proteins, glycogen, and triglycerides); and the population of our gut microbiota (eubiosis- health wellness; dysbiosis- gut inflammation, systemic inflammation)

the higher the level of spinal cord injury

the more extensive the disability and the greater the risk of complications

nontraumatic intracranial hemorrhage has several causes

the most common of which is hypertension typically occurring in the deep structures of the brain such as the basal ganglia and thalamus. Another common cause is oral anticoagulation use (e.g., warfarin [Coumadin] and dabigatran [Pradaxa]). can also be caused by tumors and AVMs, as well as other disease processes such as Moyamoya disease and amyloid angiopathy

if the acute episode of autonomic dysreflexia is not identified and treated

the patient may develop seizures, pulmonary edema, myocardial infarction, cerebral hemorrhage, and death.

with spinal tumors in the cervical area

the patient may notice loss of manual dexterity and clumsiness

when caring for a patient with increased ICP, it is important for the nurse to evaluate

the patient's response to movements such as turning, side-lying, and lying flat; the nurse can evaluate the patient's response by assessing the patient's ICP during a given activity and noting how quickly the ICP value return to baseline after the activity is completed patients may tolerate routine patient care activities such as bathing, turning, and lying flat for diagnostic tests such as x-rays, and other patients may not.

cerebral autoregulation

the protective process by which cerebral blood vessels dilate when systemic BP is reduced and constrict when systemic blood pressure is elevated to maintain constant blood flow; this process is dysfunctional after stroke, making it necessary to implement interventions to protect the brain from abnormally low systemic blood pressure in the absence of this protective mechanism automatic alteration in size of cerebral arterioles sensitive to: changes in blood pressure PaCO2 high levels vasodilate PaO2 low levels vasodilate

once a SCI patient is stable, focus shifts to

the rehabilitation phase and the optimal recovery of neuro function; physical therapy is needed to minimize muscle wasting and to prevent contractures; patients require intense inpatient therapy and are often sent to a facility that specializes in spinal trauma.

dumping syndrome

the result of stomach contents being rapidly "dumped" into the SI and occurs because of this rapid delivery of large amounts of osmotically active solids and liquids into the duodenum CMs: nausea, vomiting, abdominal pain, cramps, diarrhea, dizziness, light-headedness, bloating, belching, fatigue, heart palpitations, rapid heart rate

when an epidural hematoma is caused by an artery

the speed and force of the blood collection has a rapid effect on intracranial pressure (ICP) and can cause neurological deterioration and coma very quickly; This type of injury typically requires emergency neurosurgery to evacuate the hematoma and decompress the brain structures displaced

different methods of monitoring ICP

the subarachnoid bolt (SAB); intraparenchymal monitors; intraventricular catheter (IVC); an alternative method is to place an intraparenchymal ICP-monitoring probe with the IVC, eliminating the need for attachment of a pressure transducer

if postoperative intracranial bleeding is identified

the surgical team determine whether an additional surgical procedure is required or whether medical management can be pursued

it is important for the nursing to closely monitor if blood pressure is lower than the prescribed target in patients after stroke bc

there is a risk of cerebral hypoperfusion

it is important for the nursing to closely monitor if blood pressure is higher than the prescribed target in patients after stroke bc

there is a risk of increased ICP and rebleeding

incomplete spinal cord injury

there is incomplete structural damage with some function preserved below the primary injury level; includes 4 types: central cord syndrome, anterior cord syndrome, posterior cord syndrome, brown-sequard syndrome

brown-sequard syndrome

type of incomplete spinal cord injury; etiology: hemisection of the spinal cord resulting from penetrating injury; may also occur as a result of primary ischemia, infection, or hemorrhagic event; clinical manifestations: ipsilateral loss of motor function, prioprioception, and vibration; contralateral loss of pain and temp

MERCI clot retrieval system

these procedures require highly specialized teams of physicans and nurses trained in neurointerventional radiology and have the benefit of extending the time window after which a pt is ineligible for a therapy that could recanalize a blood vessel, as these procedures may be performed up to 8 hours after the onset of stroke symptoms a corkscrew-shaped catheter is introduced into the clot, ensaring it and allowing it to be retrieved using suction in the artery

aneurysm management

they are secured either by applying a titanium clip to their neck during surgery using a microscope or by deploying platinum coils into the actual structure during angiography, both with the goal of reducing blood flow into it

When changes in neurological assessment are noted postoperatively (of the cranitomy) and reported to the physician or nurse practitioner

they localize the findings to their reference areas in the brain and may order CT imaging to determine whether a structural change has occurred to produce the new findings.

obesogenic environments

those that cause obesity, coupled with genetic factors likely account for the majority of the increase in obesity; like an increased availability and access to high-calorie, high-fat foods; automation have led to a decrease in energy expenditure, as the availability and preparation of food require much less activity

thyroid hormones include

thyroxine (T4-most abundant); T3 (triiodothyronine-most potent); thyrocalcitonin (lowers plasma Ca levels by inhibiting Ca release from bones and lower serum phosphates)

medical management of SCIs

time between SCI and treatment greatly affects patient outcome; if patient is admitted with this type of suspected injury, the spine is immobilized (cervical collar, spine backboard) until an exam is performed to identify the level of injury; any significant movement can result in further damage thorough physical and neuro exam, including reflexes is performed; an x-ray may be performed to look for damage to the vertebrae if patient has symptoms (inability to move/feel), a CT scan or MRI may be performed to show the location and extent of damage and to reveal problems such as hematomas. The level of injury refers to the vertebra closest to the site of the injury.

Patients who have received thrombolytics for acute stroke typically are considered

to be at risk for bleeding up to 24 hours after thrombolytic administration because of the inhibition of normal clotting mechanisms (decrease in fibrinogen) caused by rt-PA.

goal of pharmacological treatment of RA

to control inflammation that leads to joint and tissue destruction, decreasing joint pain, synovitis, and stiffness as well as maintaining joint function and preventing joint destruction; initial treatments include analgesics, NSAIDs and glucocorticoids.

blood clots ejected from the LV

travel up the aorta and often flow easily in the left common carotid artery, where they may lodge in a large or small-caliber blood vessel depending on the size of the blood clot

adrenalectomy pre-op care

treat electrolyte abnormalities; glucocorticoids usually given in AM of surgery to prevent adrenal insufficiency

gene regulation

turns genes "on" or "off" which is critical to maintaining life; can be changed by mutations

methotrexate

type of DMARD used in the treatment of RA; patients must be monitored closely for hepatic toxicity while the dose is being escalated and periodically while on a maintenance dose; take folic acid daily to prevent side effects such as oral ulcers; avoid alcohol while taking this medication bc of the risk of hepatotoxicity; counsel female patients on proper birth control methods because of significant risk of teratogenicity, the capability of producing fetal malformation; patients with renal insufficiency require lower doses

intraparenchymal sensor/probe

type of ICP monitoring device; Micro strain gauge attached to the tip of a small catheter used to measure ICP; Fiber-optic technology used to measure ICP advantages: Accurate measurement of ICP with less mechanical drift of the measurement over time when compared to devices using a fluid-filled transducer to measure pressure; Can be inserted at the bedside or in the OR disadvantages: inability to drain CSF

subarachnoid bolt (SAB)

type of ICP monitoring device; bolt or screw connected to a fluid-filled transducer system advantages: can be inserted at the bedside or in the OR; lower rate of infection when compared to the IVC because it does not have a fluid reservoir disadvantages: inability to drain CSF; inaccuracy of measurement due to measurement drift that is inherent with a fluid-filled transducer system

intraparenchymal hematoma subarachnoid hemorrhage

type of brain injury; is a focal area of bleeding in the brain tissue usually below the cortex. Surgical intervention is typically not performed for this injury because the procedure could cause additional injury, and the blood typically breaks down and is reabsorbed over time. These hematomas are associated with cerebral edema.

central herniation

type of cerebral herniation syndrome (number 2 on the graph); occurs when the structures of the diencephalon (thalamus, hypothalamus, pituitary gland) and the tips of both temporal lobes are displaced in a downward direction through the tentorium (portion of the dura that creates a seperation bw the occipital lobs and the cerebelli), compressing the brain stem clinical manifestations: abnormal flexion or extension (posturing); bilateral pupillary dilation; abnormal eye movements such as downward and outward eye movements as cranial nerves controlling eye movements are compressed; positive Babinski's reflex; coma; cushing's triad

subfalcine or cingulate herniation

type of cerebral herniation syndrome (number 3 on picture); in this type, brain tissue is shifted over and underneath the falx cerebri; one of the main concerns is the risk of compression to the anterior cerebral artery, which could cause a stroke in this region of the brain tissue. clinical manifestations: specific signs and symptoms do not exist; however, this type of herniation may be found on a CT scan when evaluating signs and symptoms of increased ICP, such as decreased LOC, unilateral weakness of extremities, or a change in pupillary assessment, and places the patient at risk for further herniation

tonsillar herniation

type of cerebral herniation syndrome (number 4 on the graph); occurs, and the bottom portion of the cerebellar hemispheres (tonsils) descend through the foramen magnum, damaging the medulla clinical manifestations: abnormal flexion/extension (posturing); bilateral pupillary dilation; positive Babinski's reflex; coma; cushing's triad

ideational apraxia

type of disturbance in the planning of motor activities that occurs in strokes that involve the frontal and temporal lobes of the brain; may be able to correctly identify an object such as a comb but proceed to brush their teeth with the comb (Occupational therapists (OTs) work with patients, families, and the health-care team to develop strategies for recoupling common meanings with objects or activities.)

skull fracture

type of head injury; can be linear or displaced. The skull fragments in a displaced fracture can remain in the same plane or can become depressed into the dura or brain tissue.

concussion

type of head injury; caused by blunt force to the head causing the brain to strike the inside of the skull. Although structural injury does not appear on conventional imaging such as a CT scan, damage has occurred at the cellular level causing an increase in cellular metabolism, resulting in an imbalance between supply of oxygen and glucose and demand because of a decrease in cerebral blood flow; multiple recurrences can result in permanent brain injury

diffuse axonal injury (DAI)

type of head injury; is caused by rotational and acceleration-deceleration forces and results in direct injury to the axon. Swelling and microscopic hemorrhages can occur. Often, this type of injury occurs deep within the white matter in the area of the reticular activating system, which controls wakefulness.

epidural hematoma

type of head injury; is often caused by damage to an artery traveling in grooves on the inside of the skull when the skull is impacted or fractured. This blood collects in the space between the inside of the skull and the dura, pushing the dura farther away from the skull. Because the dura is tethered to the inside of the skull at the suture lines, the collection of blood is confined in width and expands inward toward the brain, displacing structures laterally and having a convex appearance.

contusion

type of head injury; is superficial bleeding that occurs on the surface of the brain (cortex), often at the point of initial impact or "coup" location; they may expand into hematomas and are often associated with cerebral edema; Patients are often monitored in a setting where they can receive frequent neuro assessments to capture a neurological decline from development of cerebral edema or an expanding hematoma.

subdural hematoma

type of head injury; is typically caused by damage to a vein or network of veins called bridging veins. When the brain moves within the dural covering, small bridging veins that span the inside of the dura to the surface of the brain can be stretched or disrupted, causing bleeding; includes three types: acute where symptoms occur within 24 hours after injury, subacute where symptoms occur within 2 weeks of injury, and chronic where symptoms occur from 2 weeks to months or year after injury.

penetrating injury

type of head injury; occur often as a result of a projectile such as a bullet and can also be caused by a knife or other projectile such as a bomb fragment; can cause catastrophic brain injury depending on the location of the injury; shock wave-type forces also causes shearing and stretching injury to neurons, resulting in neuronal injury and death.

anterior cord syndrome

type of incomplete spinal cord injury; etiology: acute anterior compression from bony fragments or acute disk herniation; clinical manifestations: loss of motor function (paresis or paralysis), pain, temp, crude touch and pressure below the level of injury; preserved sense of proprioception (position sense), fine touch and pressure, and vibration

posterior cord syndrome

type of incomplete spinal cord injury; etiology: acute compression; clinical manifestations: loss of proprioception, fine touch, and pressure, and vibration; intact pain, temp, and crude touch and pressure

central cord syndrome

type of incomplete spinal cord injury; most common; etiology: hyperextension injury with central cord swelling; clinical manifestations: function motor loss greater in arms than legs, bladder dysfunction, and variable loss of sensation

mannitol (osmitrol)

type of medication used to increase the osmolarity in the blood in order to pull water from the interstitial spaces across the blood-brain barrier into the vascular space, and then a diuresis occurs at the level of the kidney; in order to compensate for systemic dehydration and hypovolemia that occurs with administration, IV fluid should be administered to replace losses.

ependymoma

type of primary central nervous system tumor; originate from cells lining the center of the spinal cord; most are benign

astrocytoma

type of primary central nervous system tumor; originate from cells of tissue that support nerve cells; most are benign or low-grade malignant tumors

schwannoma

type of primary central nervous system tumor; originate from cells that form myelin sheath around peripheral nerve fibers; are benign tumors

neurofibroma

type of primary central nervous system tumor; originate from peripheral nerve cells (arise from Schwann cells); usually are benign

sarcoma

type of primary central nervous system tumor; originates from connective tissue cells; are malignant tumors

meningioma

type of primary central nervous system tumor; originates from tissue cells covering the spinal cord (meninges); most are benign but can recur and can become malignant based upon location and damage to vital structures

sleeve gastrectomy

type of restrictive bariatric procedure; most of the greater curvature of the stomach is removed, creating a smaller sleevelike tube; the remaining stomach is approximately 25% of its original capacity

laparoscopic AGB

type of restrictive bariatric surgical procedure; involves placement of a silicone band around the fundus of the stomach, causing a restriction in the amount of food intake; the band can be adjusted by a health-care provider to decrease or increase amount of restriction by injecting saline through a SQ port in the abdominal wall

pharmacological therapy for SLE

typically based on disease manifestations; antimalarial meds such as hydroxychloroquine is not fully understood but is believed to impair complement-dependent antigen-antibody reactions; may be used in combination with glucocorticoids and immunosuppressive agents in order to treat more serious clinical manifestations; NSAIDs useful in treating arthralgias, myalgias, headaches, and fever; immunosuppressive agents usch as methotrexate may be necessary to treat joint inflammation; biologics

NIH classification of a BMI less than 18.5 kg/m2

underweight

other late signs of ICP excluding Cushing's triad

unilateral fixed and dilated pupil; this phenomenon occurs as the bottom portion of the temporal lob or uncus is displaced through the tentorium cerebelli and compresses CN III (oculomotor nerve) and is called uncal or transtentorial herniation; motor paresis accompanies pupillary dilation on the opposite side of the herniation

triple-H therapy

used to treat possible vasospasms in patients with SAH who are more susceptible to this post 4-14 days includes pushing BP high, trying to prevent those vessels from going into spasm; may give calcium channel blocker, hydrate them to try to increase the perfusion; ultimately try to buy some time to go in an fix the anuyersm

a few common assessments the nurse may find for the patient with SLE

• Fatigue • Difficulty concentrating • Joint pain • Rash • Photosensitivity • Oral or nasal ulcers • Dry eyes • Dry mouth • Hypertension • Leukopenia • Thrombocytopenia • Alopecia • Chest pain

fecal microbiota transplant (FMT)

used in c Diff that is refractory to antibiotics; encouraged to use family donors, DIY FMTs in IBD populations, children's boston studying pediatric population us

very low calorie diets, those less than 800 kcal/day

used only in limited circumstances and only under the supervision of a health-care practitioner in a medical setting where frequent monitoring can be accomplished bc of the potential risk for complications

metabolomics (metabolite profiles related to the gut microbiota)

used to identify biomarkers that could indicate the presence of a disease, or response to drug intervention; determine biochemical or environmental stresses; characterize microbial metabolism; characterize human health or disease can offer deep insights on the impact of lifestyle and dietary factors on chronic and acute diseases. a well-established and powerful top-down systems biology approach, is crucial to unravel the genetics-environment-health relation, as well as the typical clinical biomarkers of the different diseases.

reversibility of delirium and depression

usually

vitamin D

usually 2-5,000 IU daily or 50,000 IU once/week; need prescriber monitoring because is a fat soluble vitamins

consciousness of pt with dementia

usually clear

three types of cerebral edema

vasogenic; cytotoxic, and transependymal; all can impact ICP

posterior pituitary gland hormones

vasopressin (ADH) and Pitocin (oxytocin)

treatment for neurogenic shock often includes

vasopressors, and other medications such as atropine

The nurse receives report on a patient in the ICU with an SAH and clarifies that the date of the patient's initial bleed was 4 days before. The nurse needs this information to gauge the patient's risk of which complication of SAH?

vasospasm

ideally the well-controlled RA patient will have

very few or no ender or swollen joints with minimal morning stiffness while experiencing little or no adverse effects from drug therapy

nursing assessment and analysis for increased ICP include

vigilant serial assessments of a patient's neuro status to identify neuro deterioration that places a patient at risk for cerebral herniation syndrome; every 1-2 hours in the critical phase, decreasing in frequency as the risk of cerebral edema and secondary brain injury decreases assessments of oxygenation, ventilation, and hemodynamic parameters are needed to optimize therapy and prevent or mitigate brain injury; vital signs and SpO2 every 1-2 hours temperature every 1-2 hours; elevations may indicate damage to the hypothalamus, increasing cerebral metabolism may exacerbate existing brain injury by increasing the demand for oxygen and nutrients where there is existing poor blood flow intracranial pressure and CPP every 1-2 hours or more frequently if the patient is experiencing an increase in ICP and/or a deterioration of neuro assessment Cardiac rhythm; serum markers of myocardial injury (creatinine kinase, creatinine kinase specific to cardiac muscle, and troponin) intake and output every 1-2 hours BUN and Cr End-tidal carbon dioxide (EtCO2) continuously to guide hyperventilation therapy during treatment of increased ICP; When hyperventilation therapy is employed, EtCO2 is monitored in order to maintain carbon dioxide in a specified range (30-35 mm Hg). End-tidal carbon dioxide values may be higher or lower than PaCO2; therefore, it is necessary to document the EtCO2 value at the time that a blood sample for an ABG is performed so that a correlation can be made between the EtCO2 and the PaCO2 measured in the arterial blood sample. ABGs performing a full-systems assessment assists in identifying signs of complications or conditions that may negatively impact the patient, such as respiratory compromise. assessment of lab values such as serum electrolytes and serum osmolality is needed to detect electrolyte imbalance and dehydration, which can lead to renal insufficiency or failure medication levels may also be monitored (particularly when the dosage is decreased)

Injuries to the scalp

warrant careful inspection and palpation for irregularities signifying skull fractures and consideration of concomitant brain injury.

clinical manifestations of a right middle cerebral artery stroke syndrome

weakness of the left face, arm, and leg decrease in sensation on the left side of the body left homonymous hemianopia (loss of vision in the left temporal field of vision and right nasal field of vision, requiring patients to scan an area in order to visualize objects on their right side) inattention or neglect of the left side

clinical manifestations of a left middle cerebral artery stroke syndrome

weakness of the right face, arm, and leg (arm weakness greater than leg) decrease in sensation on the right side of the body right homonymous hemianopia (loss of vision in the right temporal field of vision and left nasal field of vision, requiring patients to scan an area in order to visualize objects on their right side) dysphasia- in most patients, the language center of the brain is located on this effected side; language deficits may involve the motor speech (Broca's area) and cause patients to have difficulty expressing thoughts and to make errors in speech that they are able to detect. Injury of ischemia to the sensory speech area (Wernicke's area) results in an inability to process speech input in the brain, causing patients to make errors in speech of which they are unaware inattention or neglect of the right side

chronic complications of stroke may include

weakness or paralysis of the extremities and associated risk of muscle contracture (splinting, passive ROM, and physical and occupational therapies assist in preserving function and increasing the probability of the return of function to the extremities) Neglect or inattention of one side of the body occurs on the opposite side of the body from the area of brain injury and causes a patient not to recognize or acknowledge the affected side of the body Visual field deficits, such as homonymous hemianopia, commonly occur and affect an entire side of vision (both nasal and temporal fields) Disorders of speech due to facial muscle or cranial nerve weakness and language are common residual deficits of stroke that often require intensive speech and cognitive therapies. Disturbances in the planning of motor activities, or apraxia, often occur when the frontal and temporal lobes of the brain are involved depression is important to consider when working with these patients because it can significantly impact recovery and rehabilitation.

SCI most commonly affects

young men between the ages of 15-35

nursing diagnoses for SCIs

• Alteration in respiratory function related to paralyzed muscles, hypoventilation secondary to loss of diaphragm function due to denervation of phrenic nerve • Decreased cardiac output related to loss of vasomotor tone secondary to spinal/neurogenic shock • Impaired physical mobility related to neuromuscular impairment secondary to loss of nerve cells at injured level • Fear/anxiety secondary to loss of motor function and potential for permanent impairment

if a patient with a spinal tumor requires surgery, other complications include:

• Bleeding or hematoma • CSF leak • Meningitis • Chronic pain • Injury to CNS tissue • Spine instability • Sensory loss • Sexual dysfunction • Paralysis • Infection • Ventilator dependence • Wound dehiscence

nursing diagnoses for strokes

• Impaired swallowing related to lower cranial nerve dysfunction or decreased level of consciousness • High risk for impaired gas exchange related to aspiration • Sensory perceptual alterations related to damage to sensory input areas in the brain and/or integration of sensory inputs • Impaired physical mobility related to hemiparesis • Impaired verbal communication related to decreased perfusion to the speech centers in the brain (Broca's [motor speech] and Wernicke's [sensory speech]) • Impaired family coping related to catastrophic illness and uncertain outcome

nursing diagnoses for brain tumors

• Impaired tissue perfusion (cerebral) related to decreased cerebral circulation secondary to increased ICP • Self-care deficit related to decreased level of consciousness and neuromuscular dysfunction • Fear related to the surgical procedure (craniotomy) to remove the brain tumor • Risk for infection related to the surgical procedure and immunosuppression secondary to chemotherapeutic agents • Altered body image secondary to potential hair loss secondary to chemotherapy, the surgical procedure, and radiation markings

complications specifically related to obesity in hospitalized patients include:

• Increased risk of venous thromboembolism • Increased risk of pressure ulcer • Increased risk of skin infections • Impaired breathing • Immobility • Urinary and fecal incontinence

complications related to surgery and specifically bariatric surgery include

• Infection • Increased risk of venous thromboembolism • Anastomosis leak (a leak where dissected bowel is reattached together) • Peritonitis • Intestinal obstruction • Atelectasis and pneumonia • Dehydration • Electrolyte imbalance related to vomiting • Bleeding

nursing actions for the spinal cord injury patient

• Maintain suction equipment at the patient's bedside With decreased cough effectiveness, the patient may require suctioning to clear the airway. • Facilitate cough effectiveness Because of muscle weakness or lack of diaphragmatic innervation, assistance is needed to remove secretions. • Maintain spinal immobilization and stabilization To prevent further injury from an unstable spinal column • Passive ROM Prevents contractures and loss of muscle tone; strengthens unaffected muscles • Reposition and maintain in good alignment Prevents pressure ulcers and decreases risk of DVT due to immobility • Perform routine pin site care Pin sites are kept clean using a clean cotton-tipped applicator or gauze soaked with normal saline. A new clean applicator or gauze is used for each pin site. If crusting is noted on assessment, wrap a gauze soaked with normal saline around the pin site for 15 minutes. After removing the gauze, use a clean cotton-tipped applicator to gently remove the crust from the pin site.

pt teaching for bariatric surgical patients

• Prevention of postoperative complications • Incentive spirometry, coughing, and deep breathing exercises Decreases risk of pneumonia and atelectasis • Sequential compression devices Decreases risk of venous thromboembolism • Ambulation Decreases risk of pneumonia, atelectasis, and venous thromboembolism • Home-care needs • Postoperative lifting restrictions Decreases hernia development or suture disruption • Postoperative and recovery activity Exercise should begin in the immediate postoperative period to decrease the risk of operative complications and to begin lifelong healthy weight management practices. • Postoperative dietary restrictions Decreases risk of dehydration, suture disruption, and vomiting • Medication side effects Pain medications may cause drowsiness and constipation. Patients should not drive, drink alcohol, or operate machinery while taking opioid pain medications. Patients should be taught about the increased risk of constipation as a side effect of opioid medications. • Care of wounds/drains Wounds should be kept clean, dry, and covered. Jackson-Pratt drains should be emptied when they are half-full to decrease pull on the surgical site and should be kept clean to prevent infection. • Signs and symptoms to report to the health-care provider Shortness of breath, tachycardia, severe abdominal pain, fever, rigors, purulent discharge or redness at wounds, and hypotension can be indicative of life-threatening complications such as pulmonary embolism, anastomosis leak, or infection. • Signs of dumping syndrome Symptoms include nausea, vomiting, diarrhea, diaphoresis, tachycardia, salivation, fatigue, and dizziness. • Available support groups Patients who attend support groups are more likely to have better outcomes.

patient teaching for spinal cord injury

• Signs and symptoms of autonomic dysreflexia To inform patients and their families about the signs and symptoms of this potentially life-threatening emergency • Skin care/management To help identify causes of and prevent skin breakdown. In patients who require a wheelchair, they need to be taught to refrain from sitting in one position too long because it can lead to decreased perfusion. • Signs and symptoms of respiratory distress To help patients and families identify potential respiratory complications

nurse assessment and analysis of RA

• Unsteady gait • Bony enlargement or swelling of affected joints • Warmth and redness of joints • Painful range of motion of affected joints • Increased incidence of infection • Elevated serum creatinine secondary to NSAID use • Elevated liver enzymes secondary to methotrexate or leflunomide • Constipation secondary to decreased physical activity and/or use of narcotic analgesics • Nausea and oral ulcers related to methotrexate use • Cough and/or shortness of breath due to interstitial lung disease, which can be caused by RA or by methotrexate therapy • Self-care deficit • Fatigue Joint pain and mobility are indicators of treatment efficacy and disease progression increase in temp is an indicator of infection CPR and ESR are indicative of inflammation Hgb may be less than normal in active patients, but decreased value may also indicate GI bleed, which can be caused by NSAID decreased albumin is correlated with increased disease severity bc it is a negative acute phase reactant and decreases in response to acute inflammation platelet count may be elevated in very active disease because inflammation causes elevated platelet count elevated levels of liver and renal function may be due to medications used assess for pleural effusion, pericarditis, pleuritis, scleritis, episcleritis, and osteopenia

evidence suggests that the following interventions reduce the rate of CAUTI in patients who require short-term indwelling catheterization:

• Using catheters only when medically necessary • Daily assessments of the need for catheterization and documenting the continued need • Using reminder systems targeting early removal of catheters • If appropriate, use external catheters on males • Consider intermittent catheterization instead of indwelling catheter insertion with the use of a portable ultrasound bladder scanner to check for residual amounts of urine • Early removal of all unnecessary urinary catheters Specific nursing interventions that have also been noted to reduce incidence include daily cleaning of the urethral meatus using a perineal cleanser, maintaining a closed urinary drainage system, use of catheter securement devices to prevent movement and urethral traction, maintaining the drainage bag below the level of the bladder, and changing the indwelling catheter only when necessary, not at a routine interval.