Chronic Neuro
What complication can arise form Myasthenia Gravis?
What are the triggers/what can it cause?
- Myasthenic Crisis
- causes acute respiratory failure
- Not taking medication properly, RI, surgery, emotional distress, pregnancy, corticosteroids, trauma, illness, stress, decreased potassium
What are "sick day rules"
- check BS Q4, maintain normal diet, continue taking diabetic meds
- Type 1: check urine ketones Q3-4 if the BS is greater than 240, contact HCP is over 300 x2 or urine ketones are present
- Type 2: use insulin if BS is persistently greater than 180
What are some CM of renal calculi?
- sharp/ severe pain in flank, back or lower abd, renal calculi, N/V, UTI S/S, low grade fever/chills, kidney stone dance.
What are the two diagnostic studies associated with upper GI conditions? Explain what they are.
EGD: views esophagus, stomach, ulcers, and Gerd.
NOP 8hrs prior, need driver, empty bladder, can cause pain, SOB, tachycardia, sudden temp spike
Barium swallow: drink contrast media to view structural abnormalities of esophagus, stomach, duodenum via Xray.
NPO prior, drink with laxative, may have white stool
What is the low-fodmap diet
List the clinical manifestations of Huntington's disease
-Chorea, poor movement sequence, uncoordinated, inability to sustain movements, dysphagia, deterioration of gait, and psych symptoms before motor symptoms.
What is DKA?
What can DKA also stand for (CM)?
What is the nursing management?
Diabetic Ketoacidosis
D- Dehydration/ BS >250
K- Ketones in blood/urine
A- Acidosis - pH <7.3, bicarb <16
RN management: O2 therapy, NS, D5/D10 when glucose approaches 250, K+ replacement, continuous regular insulin drip, sodium bicarb is pH <7.0
What are preventative measures for pyelonephritis?
How is it diagnosed
- emptying bowel/bladder regularly, wiping front to back, drinking 2-3L/day, avoiding unnecessary catheterization
- Urinalysis, urine culture, CBC, blood cultures, renal ultrasound, CT
What is the nursing management for a patient experiencing a hiatal hernia?
-lifestyle changes including: reduction of intraabdominal pressure, no alcohol/smoking, elevating HOB, decreasing body wt., antisecretory agents (PPI, h2 receptor blockers), antacids.
What are the CM of appendicitis?
- begins with periumbilical pain, pain shifts to Mcburney's point, anorexia, n/v, persistent pain, localized tenderness, rebound tenderness, muscle guarding, low grade fever, Rovsing's sign
List some management of ALS
- facilitating communication, reducing aspiration rx, decreasing pain from muscle weakness, promoting safety d/t muscle weakness, diversional activities, end of life care, moderate-intensity endurance-type exercises.
What are the CM of HHS
- Happens in type 2 diabetics
- Glycosuria, polyuria then oliguria, hypotension and tachycardia, no ketones, electrolyte imbalance, dehydration, decreased LOC, possible hypovolemic shock.
List the potential ways to remove renal calculi
potential indications?
Lithotripsy, open removal, ureteroscopy, ESWL, percutaneous nephrolithotomy
- stones too large, bacteriuria, impaired renal function, persistent pain/N, inability to be medically tx, pt w/ 1 kidney
Describe the difference between gastric and duodenal ulcers?
Gastric: Females >50yrs, increased obstruction, high reoccurrence, increased mortality, high pain, 1-2 hours after meals, burning gaseous pain, food may worsen
Duodenal: age 35-45, occur/disappear/recur, mid epigastric pain, 2-5 hours after meals, burning/cramping pain that radiates to back, alleviates with food
Compare and contrast chrones and ulcerative colitis and their CM's
UC: bloody diarrhea, severe constant abd pain, rare to have wt. loss, rectal bleeding, fever during acute attack, 10-20 stools/day
What does the acronym TRAP stand for?
What disease process is it correlated with?
What is the tx for said disease process?
- Tremor, Rigidity, Akinesia, Postural instability
- Parkinsons
- tx is aimed at correcting imbalances of neurotransmitters withing the CNS
- Dopaminergics: Levodopa, Carbidopa/Levodopa
-Anticholinergic: Benztropine
list some chronic complications of diabetes.
- angiopathy, macrovascular/microvascular damage, diabetic retinopathy, nephropathy, neuropathy (sensory/autonomic).
List the rx factors for BPH
What are the CM?
- aging, obesity, sedentary lifestyle, increased red meat/ animal fat intake, alcohol consumption, smoking, diabetes, family hx
- symptoms occur gradually:
Irritative symptoms: frequency/urgency, dysuria, bladder pain, nocturia, incontinence
Obstructive symptoms: decreased force of stream, difficulty starting stream, stop and start, dribbling at the end of voiding
What are the factors that affect the LES pressure?
What are the factors that influence intrabdominal pressure?
-alcohol, cholate, fatty foods, nicotine, peppermint, tea, coffee, narcotics, CCB, osteoporosis meds, K+
-obesity, pregnancy, belts, restrictive garments, large meals, supine position
Compare and contrast diverticulitis and diverticulosis and their CM's
-Osis: usually asymptomatic, abd pain, bloating, flatulence, changes in bowel habits
-Itis: abd pain over involved area, LLQ pain, fever, leukocytosis, a mass
What is Multiple Sclerosis?
What is the clinical manifestation?
-Motor: weakness in limbs/trunk/head, diplopia, scanning speech, spasticity
-Sensory: numbness/tingling, patchy blindness, blurred vision, vertigo, hearing loss
-Cerebellar: nystagmus, ataxia, dysarthria, dysphagia
-Emotional: anger, depression, euphoria
-GI/GU: constipation, spastic bladder, flaccid bladder
-Sexual: ED, decreased libido
-Cognitive: difficulty with short term memory, attention, information processing, word finding
*General intellect is intact
What education would the RN provide to a diabetic patient regarding exercise?
Carry a carb snack, eat a carb snack every 30 min during exercise, never exercise alone, monitor BS before/during/after exercise.
If BS is below 100 before exercise: eat a 15g carb snack, recheck BS after 15-30min, delay exercise if still less than 100.
If BS is greater than 250:
Type 1: Delay vigorous activity until ketones are gone, drink fluids
Type 2: BS >250 <300 exercise for 10 min if BS is maintaining delay exercise. If BS >300 do not exercise and contact HCP.
What is a TURP?
What is a major complication of this procedure?
- scope inserted in urethra to cauterize the obstructing prostate tissue. 3-way indwelling catheter is inserted into bladder and irrigated for the first 24 hours (CBI)
TURP syndrome: hyponatremia d/t over absorption of bladder irrigation during surgery
-N/V, confusion, bradycardia, increased BP
What are the three complications of PUD and how do we manage them?
Perforation: NGT decompression, IVF, blood, antibiotics, central line, PA cath, ECG, urinary catheter. small perf self seals, big perf needs surgery
Gastric outlet obstruction: NGT decompression, PPI/H2 receptor blocker, pain mgmt, fluid/electrolyte balance, surgery, balloon dilation
What is the nursing management of a bowel obstruction?
*Emergent surgery is required for a strangulated bowel
-monitor for dehydration, fluid overload in the elderly, pain mgmt, I&O, abd assessment, NG monitoring and care, oral care, abx, parenteral nutrition, electrolytes imbalance, NPO