NR340 Exam 1 Review PDF

NR340 EXAM 1 REVIEW MENINGITIS: an inflammation of the meninges (membranes that protect the brain and spinal cord) Types 1.​ VIRAL or aseptic -​ Most common form of meningitis -​ Commonly resolves without treatment -​ Supportive care* like hydration, antipyretics,...

NR340 EXAM 1 REVIEW MENINGITIS: an inflammation of the meninges (membranes that protect the brain and spinal cord) Types 1.​ VIRAL or aseptic -​ Most common form of meningitis -​ Commonly resolves without treatment -​ Supportive care* like hydration, antipyretics, analgesics 2.​ BACTERIAL or septic -​ Contagious infection with a high mortality rate -​ Prognosis depends on how quickly care is initiated -​ You need an antibiotic* bc more severe form 3.​ Fungal -​ Common in clients with AIDS (immunocompromised) 3 vaccines available 1.​ Haemophilus influenzae type B aka (Hib) vaccine -​ Ensure infants receive bacterial men. on schedule -​ 4 doses: 2m, 12-15m 2.​ Pneumococcal polysaccharide vaccine (PPSV) -​ Primary intended to prevent respiratory infection -​ Also decreases the risk for CNS infections -​ Vaccinate adults who are immunocompromised, have a chronic disease, smoke cigarettes, live in long-term care facility -​ Follow CDC guidelines for reimmunization -​ Give one dose to adults older than 65 who have not previously been immunized/have history of disease 3.​ Meningococcal vaccine (MCV4/Neisseria meningitidis) -​ Ensure adolescents receive on schedule and prior to living in residential setting in college/ military -​ Initial dose recommended for healthy children between 11-12 booster at 16 Risk factors Viral: viral illness (measles, mumps, herpes, arbovirus), no vaccine available Fungal: Bacterial Expected findings Subjective: excruciating constant headaches, nuchal rigidity (stiff neck), photophobia (sensitivity to light) Objective: fever and chills, nausea and vomiting, altered LOC, positive Kernig’s sign, positive Brudzinksi’s sign (knees will flex), hyperactive tendon reflexes, tachy, seizures, red macular rash, restlessness/irritability Before you treat fever, you need to know where it's coming from. Urine analysis, culture- might have UTI Culture the nasal and throat Blood culture Stool culture CSF culture Wound culture Chest x-ray or catscan PAN culture when someone has a fever^ For meningitis: need a lumbar puncture for CSF fluid 1.​ Viral: clear CSF, normal glucose, slight increase in protein, slight increase in WBW, elevated CSF pressure, negative gram stain 2.​ Bacterial PARKINSON’S DISEASE -​ A progressively debilitating disease that grossly affects motor function 4 primary findings: (due to overstimulation of the basal ganglia by acetylcholine) 1.​ Tremor 2.​ Muscle rigidity 3.​ Bradykinesia (slow movement) 4.​ Postural Instability The secretion of dopamine and acetylcholine in the body produce inhibitory and excitatory effects on the muscle respectively Tx focuses on increasing the amount of dopamine or decreasing the amount of acetylcholine in a client’s brain Risk factors -​ Onset usually over the age of 50 -​ Clients assigned male at birth -​ Genetic predisposition -​ Exposure to environmental toxins/chemical solvents -​ Chronic use of antipsychotic medication Expected findings -​ Bradykinesia (movement that is slow) -​ Akinesia (no movement) Physical assessment findings: -​ Stooped posture -​ Slow, shuffling, and propulsive gait -​ Slow, monotonous speech -​ Tremors/ pill rolling tremor of the fingers -​ Muscle rigidity (rhythmic interruption, mild restrictive, total resistance to movement) -​ Bradykinesia/ akinesia -​ Maslike expression -​ Autonomic findings (orthostatic hypotension, flushing diaphoresis) -​ Difficulty chewing and swallowing (drooling, dysarthria, progressive difficulties with ADLs, moodswings, cognitive impairment aka dementia) There are no definitive diagnostic procedures* Diagnosis based on manifestations, their progression, and by ruling out other diseases Nursing care: -​ Administer meds at prescribed times. Monitor meds, make recommendations for changes (dosage and times) -​ Monitor swallowing and maintain adequate nutrition and weight. Consult speech and language therapist to assess swallowing if client shows choking risk -​ Maintain client mobility for as long as possible -​ Promote client communication for as long as possible -​ Monitor mental and cognitive status SEIZURES AND EPILEPSY Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharges of neurons within the brain that can cause alterations in the LOC and/or changes in motor and sensory ability and/or behavior Epilepsy: chronic recurring abnormal brain electrical activity resulting in 2 or more seizures Risk factors: -​ General predisposition -​ Acute febrile state -​ Head trauma -​ Cerebral edema -​ Abrupt cessation of antiepileptic drugs (AEDs) -​ Infection -​ Metabolic disorder -​ Exposure to toxins -​ Stroke -​ Heart disease -​ Brian tumor -​ Hypoxia -​ Acute substance withdrawal -​ Fluid and electrolyte imbalance Common triggers: -​ Increased physical activity -​ Excessive stress -​ Hyperventilation -​ Overwhelming fatigue -​ Acute alcohol ingestion -​ Excessive caffeine intake -​ Exposure to flashing lights -​ Substances such as cocaine, aerosols, and inhaled glue products -​ illness 1. Generalized seizures- involves both cerebral hemispheres. Can begin with aura (alteration in vision, smell, hearing, or emotional feeling) a.​ Tonic-clonic seizure: begins for only a few secs with a tonic episode (stiffening of muscles) and LOC. 1-2 min clonic episode (rhythmic jerking of the extremities) follows the tonic episode b.​ Tonic seizure: only the tonic phase is experienced, client suddenly lose consciousness and experience sudden increased muscle tone, LOC, and autonomic manifestations, generally last less than 30 secs c.​ Clonic seizures: only the clonic phase of rhythmic jerking of extremities is experienced, seizure lasts several mins, muscles contract and relax 2. Focal seizures- partial or focal/local seizure involves only one cerebral hemisphere a.​ Complete partial seizure: can cause LOC or blackouts for several mins b.​ Simple partial: consciousness maintained c.​ Unknown: unclassified or idiopathic do not fit into other categories. Account for ½ of all seizure activity and occur for no known reason 3. Unclassified or idiopathic seizures: occur for no known reason. ½ of all seizure activity 4 stages of seizures 1.​ Prodromal: symptoms appear prior to seizure aka a few days before. Client can become depressed, angry, sleep longer, anxious, etc. 2.​ Aura: not all patients will experience it, happens within seconds within seizure start like a warning sign that the seizure is about to happen. Those who experience focal, partial, generalized tonic-clonic seizures. 3.​ Ictus = seizure. When the actual seizure takes place. 4.​ Post ictus: after seizure recovery, the brain takes time to recover. Tonic-clonic recovery may take hours to days while absence seizures recovery can be immediate. STROKE/TIA aka cerebrovascular accidents or brain attacks A disruption in the cerebral blood flow secondary to ischemia, hemorrhage, or embolism 5th leading cause of death in the US* 2 types  1.​ Hemorrhagic: occur secondary to a ruptured artery or aneurysm. Prognosis is poor due to the amount of ischemia and ICP caused by expanding collection of blood. 2.​ Ischemic: most common type of stroke that accounts for 87% of all strokes. Caused by blockage of circulation to the brain. Can be reversed with fibrinolytic therapy using alteplase, aka tPA (tissue plasminogen activator) if given within 3-4.5 hrs of initial manifestations a.​ Thrombotic stroke: occurs secondary to the development of a blood clot on an atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion. Manifestations evolve over a period of several hours to days CLOT FORMS IN THE BRAIN***​ ​ -​ Forms in an artery of the brain blocking blood flow and develops slowly due to plaque buildup (atherosclerosis) b.​ Embolic stroke: caused by an embolus traveling from another part of the body to a cerebral artery. Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a LOC to instantly occur CLOT TRAVELS TO THE BRAIN*** -​ A clot or debris (embolus) forms elsewhere in the body (heart) and travels to the brain, suddenly blocking an artery Health promotion and disease prevention -​ HTN, DM, smoking can increase risk for a stroke -​ Early tx of HTN, maintenance of blood glucose within range, and refraining from smoking will decrease these RFs -​ Maintaining healthy weight and regular exercise can decrease -​ Remember FAST* -​ Facial drooping -​ Arm weakness -​ Speech impairment -​ Time to call 911 Transient ischemic attack aka TIA: brief interruption of cerebral blood flow. Manifestations resolve in 1-24hrs without any permanent deficits MYASTHENIA GRAVIS aka MG MG: rare autoimmune condition that produces progressive weakness and abnormal fatigue of voluntary skeletal muscle. Usually affects muscles of the face, eyes, lips, tongue, throat. Symptoms include: -​ Eyelid droopiness aka ptosis -​ Impaired speech -​ Difficulty swallowing -​ Trouble breathing (respiratory muscles may become affected) -​ Changes in facial expression -​ Double vision aka diplopia (strabismus) -​ Muscle weakness -​ Onset age 20-30 in women over 50 in men Diagnostic tests 1.​ Tensilon test: muscle weakness that dramatically improves after administering edrophonium (Tensilon) or neostigmine bromide (Prostigmin)- the drug will allow acetylcholine to bind at the receptor site on the muscle, where it should normally bind. 2.​ Blood test: + acetylchonine antibodies may be present in ppl with MG 3.​ Nerve conduction studies: repetitive nerve stimulation is used to confirm the diagnosis 4.​ Electromyogram (EMG): test that measures the electrical activity of a muscle. Can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions NO TREATMENT FOR MG*** Goal of tx: to increase muscle functions and prevent swallowing difficulties and aspiration HEAD INJURY -​ Any damage of the head because of a traumatic event Types of brain injury 1.​ Concussion, or mild traumatic brain injury: occurs after head trauma that results in a change in the clients neurologic function but no identified brian damage and usually resolves within a 72 hr period 2.​ Contusion: occurs when the brain is bruised and the client has a period of unconsciousness associated with stupor and or confusion 3.​ Diffuse axonal injury: widespread injury to the brain that results in coma and is seen in severe head trauma  4.​ Intracranial hemorrhage: can occur in the epidural, subdural, or intracerebral space. A collection of blood following head trauma. There can be a delay of weeks to months in presenting manifestations for a substance or chronic subdural hematoma -​ Open head injuries pose high risk for infection -​ Skull fractures can occur after forceful head injury. Nurse should be alert for drainage from the ears or eyes (CSF) -​ Cervical spine injury should always be suspected when head injury occurs. Must be ruled out prior to removing any devices used to stabilize the cervical spine Risk factors -​ Motor vehicle or motorcycle crashes -​ Illicit drug and alcohol use -​ Sport injuries -​ Assault -​ Gunshot wounds -​ Falls Expected findings -​ Amnesia (loss of memory) before or after injury -​ LOC. Length of time client is unconscious is significant* -​ CSF leakage through nose and ears can indicate a basilar skull fracture. Test for the “halo sign” clear or yellow tinted ring surrounding a drop of blood when bloody drainage is placed on a piece of gauze. -​ Manifestations of ICP -​ Severe headache, nausea, vomiting -​ Deteriorating LOC, restlessness, irritability -​ Dilated or pinpoint nonreactive pupils -​ Cranial nerve dysfunction -​ Alteration in breathing pattern -​ Deterioration in motor function, abnormal posturing -​ Crushings triad: a late finding characterised by severe hypertension with a widening pulse pressure (systolic-diastolic) and bradycardia* -​ Seizures Signs of increased intracranial pressure: headache, dilated pupils, decorticate/ decerebrate posturing, bradycardia, hypertension Respiratory status= priority assessment* Cranial nerve function Assess pupils for size, equality, and reaction to light Bilateral sensory and motor responses ICP MEDICATIONS: 1.​ Mannitol- an osmotic diuretic used to treat cerebral edema. When used for increased ICP, the med draws fluid from the brain into the blood -mannitol is a powerful osmotic diuretic, adverse effects include electrolyte imbalances such as hyponatremia 2.​ Barbiturates- clients can be placed in a barbiturate coma to decrease cellular metabolic demand until ICP can be decreased (med dosage adjusted to keep the client completely unresponsive) 3.​ Phenytoin- used prophylactically to prevent or treat seizures. It was the first medication used to suppress seizure that did not depress the entire CNS 4.​ Opioids: morphine sulfate or fentanyl are analgesics used to control pain and restlessness PNEUMONIA Nursing priority for clients who have acute respiratory disorders: maintain a patent airway to promote oxygenation* Health promotion and disease prevention -​ Perform hand hygiene -​ Encourage immunizations that prevent respiratory disorders like immuniazations for influenza and pneumonia ( to younger kids, older adults, clients with chronic illness, immunocompromised) -​ Limit exposure to airborne allergens -​ Promote smoking cessation Pneumonia: a complication of influenza and affects older adults and clients who are debilitated or immunocompromised -​ Inflammatory process in the lungs that produces excess fluid -​ Triggered by infectious organisms or by the aspiration of an irritant (fluid or foreign body) -​ Immobility is a contributing factor in the development of pneumonia -​ Types of pneumonia 1.​ Community-acquired pneumonia (CAP): most common* often occurs as complication of influenza 2.​ Healthcare associated pneumonia (HCAP): higher mortality rate more resistant to antibiotics and usually takes 24-48 hrs from the time the client is exposed to acquire HCAP. Related to non-hospital admission and contact with healthcare personnel 3.​ Hospital acquired pneumonia (HAP): when the condition manifests greater than 48 hrs after a hospital admission 4.​ Ventilator associated pneumonia (VAP): when the condition manifests greater than 48 hrs after client is intubated Expected findings -​ Anxiety -​ Fatigue -​ Weakness -​ Chest discomfort due to coughing -​ Confusion from hypoxia/most common manifestation in older adults* Physical assessment findings: Fever, chills, flushed face, diaphoresis, SOB, difficulty breathing, tachypnea, pleuritic chest pain (sharp), sputum production (yellow-tinged), crackles and wheezes, coughing, dull chest percussion over areas of consolidation, decreased O2 (expected 95-100%), purulent blood tinged or rust colored sputum-which may not always be present Increased risk: -​ Dysphagia: increased risk due to aspiration -​ AIDS: increased risk because immunocompromised -​ Mechanical ventilation:places client at risk for ventilator-associated pneumonia -​ Myasthenia gravis: client has general weakness and can have difficulty clearing airway secretions Laboratory tests: 1.​ Sputum culture and sensitivity 2.​ CBC 3.​ ABGs 4.​ Blood culture 5.​ Electrolytes Diagnostic procedures: 1.​ Chest x-ray: will show consolidation of lung tissue  2.​ Pulse oximetry: will have O2 less than expected range (95-100%) Medication 1.​ Antibiotics: given to destroy infectious pathogens (penicillins or cephalosporins) important to obtain culture prior to giving the first dose* 2.​ Bronchodilators: given to reduce bronchospasms and reduce irritation -​ Short-acting beta2 agonists (albuterol) provide rapid relief (watch for tremors and tachycardia for clients taking albuterol) -​ Cholinergic antagonists (anticholinergic meds) like ipratropium block the parasympathetic nervous system allowing for increased bronchodilation and decreased pulmonary secretions (observe for dry mouth and monitor heart rate. Adverse effects can include headache, blurred vision, and palpitations which can indicate toxicity) -​ Methyxanthines (theophylline) require close monitoring of blood med levels due to the narrow therapeutic range (adverse effects can include tachycardia, nausea, with diarrhea) 3.​ Anti-inflammatories: decrease airway inflammation -​ Glucocorticosteroids (like fluticasone and prednisone) are prescribed to reduce inflammation. Monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, and poor wound healing COMPLICATIONS 1.​ Atelectasis: airway inflammation and edema lead to alveolar collapse and increase the risk of hypoxemia. Silent reports SOB and exhibits findings of hypoxemia, has diminished or absent breath sounds over affected area, chest x-ray shows an area of density a.​ Bacteremia (sepsis): occurs if pathogens enter the bloodstream from the infection in the lungs 2.​ Acute respiratory distress syndrome: hypoxemia persists despite O2 therapy, lung volume capacity/elasticity reduced, dyspnea worsens, chest x-ray shows areas of density with ground-glass appearance, blood gas findings demonstrate high arterial blood levels of CO2 (hypercarbia) even though O2 shows decreased sat ASTHMA Chronic disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles. Obstruction occurs by inflammation or airway hyperresponsiveness. The cause is unknown. Manifestations: mucosal edema, bronchoconstriction, excessive mucus production Goals for Healthy People 2030: reduce asthma deaths, attacks, and ED visits Health promotion and prevention -​ Promote smoking cessation if client smokes -​ Advise client to wear protective equipment and ensure proper ventilation -​ Encourage influenza and pneumonia vaccines for older adults and clients with asthma -​ Instruct clients how to recognize and avoid triggers (air pollutants, strong odors, seasonal, temp changes, meds, etc) -​ Teach clients how to self-administer meds (nebulizers and inhalers) -​ Encourage regular exercise as part of asthma therapy 4 categories 1.​ Mild intermittent: symptoms occur less than twice a weel 2.​ Mild persistent: arise more than twice a week but not daily 3.​ Moderate persistence: daily symptoms occur in conjunction with exacerbations twice a week 4.​ Severe persistent: occur continually, along with frequent exacerbations that limit physical activity and quality of life Risk factors -​ Older adult clients have decreased pulmonary reserves due to physiologic lung changes that occur with the aging process -​ Family history -​ Smoking -​ Secondhand smoke exposure -​ Environmental allergies -​ Exposure to chemical irritants or dust -​ GERD Expected findings: dyspnea, chest tightness, anxiety/stress Physical assessment findings: coughing, wheezing, mucus production, use of accessory muscles, prolonged exhalation, poor O2, barrel chest or increased chest diameter Laboratory tests -​ Arterial blood gases -​ Hypoxemia, hypocarbia, hypercarbia -​ Sputum cultures: bacteria can indicate infection Diagnostic procedures -​ Pulmonary function tests (PFTs) -​ Chest x-ray Medications: 1.​ Bronchodilators (inhalers) a.​ Short-acting beta2 agonists (SABAs) i.​ Albuterol: provides rapid relief of acute manifestations and prevents exercise-induced asthma (watch for tremors and tachycardia) b.​ Anticholinergic medications i.​ Ipratropium: block the parasympathetic nervous system. These meds are long acting and used to prevent bronchospasms (Observe for dry mouth, suck on hard candies to relieve, increase fluid intake, report headache, blurred vision, palpitations) c.​ Methylxanthines i.​ Theophylline: require close monitoring of blood medication levels due to narrow therapeutic range. Use only when other treatments are ineffective (adverse effects= tachycardia, nausea, diarrhea) d.​ Long-acting beta 2 agonists (LABAs) i.​ Salmeterol: primarily used for asthma attack prevention (used to prevent asthma attack not at the onset of an attack) 2.​ Anti-inflammatory agents: for prophylaxis and are used to decrease airway inflammation a.​ Corticosteroids aka fluticasone and prednisone b.​ Leukotriene antagonist aka montelukast c.​ Mast cell stabilizers aka cromolyn d.​ Monoclonal antibodies aka omalizumab (can cause anaphylaxis) Complications 1.​ Respiratory failure 2.​ Status asthmaticus Chronic Obstructive Pulmonary Disease (COPD) Encompasses 2 diseases: emphysema and chronic bronchitis Emphysema is loss of lung elasticity and hyperinflation of lung tissue Chronic bronchitis is an inflammation of the bronchi and bronchioles due to chronic exposure to irritants COPD typically affects middle-age to older adults* Heath Promotion and Disease Prevention -​ Promote smoking cessation -​ Avoid exposure to second-hand smoke -​ Influenza and pneumonia immunizations are important especially for older adults Risk factors -​ Advanced age -​ Cigarette smoking = primary RF for developing COPD -​ Alpha1-antitrypsin (AAT) deficiency -​ Exposure to environmental factors (air pollution) Expected findings: chronic dyspnea (RR can reach 40-50/min during acute exacerbations) Physical assessment findings: dyspnea upon excretion, productive cough that is more severe in the morning, hypoxemia, crackles/wheezes, rapid and shallow respirations, use of accessory muscles, barrel chest, irregular breathing pattern, clubbing of fingers and toes, pallor and cyanosis of nail beds, decreased O2 Incentive spirometer* -​ Used to monitor optimal lung expansion -​ Keep tight mouth seal around the mouthpiece, inhale and hold breath for 3-5 seconds, during inhalation the needle of the spirometry machine will rise, will promote lung expansion