Lectures 1 & 2
Hydration, lie flat, caffeine, analgesics, low stimulation (lights out, quiet)
Identify the clinical manifestations of Huntington disease.
Chorea, cognitive impairment, apathy, uncontrollable body movements, dementia
Describe clinical manifestations of meningitis.
Severe HA, nuchal rigidity, fever/chills, mental status changes, photophobia, rash, sepsis, coma, seizures, Kernig's sign, Brudzinski's sign
Identify 5 risk factors for stroke and specify whether they are modifiable or nonmodifiable.
Nonmodifiable: age, family history, race
Modifiable: smoking, obesity, alcohol, HTN, diabetes, atherosclerosis, OCP
What is the therapeutic serum level for phenobarbital?
15-40mcg/mL
A patient is exhibiting inward rotation of the legs, extended arms, and pronation of the hands. What type of posturing are they exhibiting?
Decerebrate
Describe early vs late clinical manifestations of Alzheimer's.
Early: forgetfulness, subtle memory loss
Late: disorientation, inability to recognize others, loss of direction, impulsive behavior, difficulty with daily tasks, personality changes, sun downing, incontinence, apraxia, agnosia
What type of isolation is required in a client with meningitis?
Droplet
What is the priority information the nurse should gather when a patient is exhibiting signs of a stroke?
LKWT
Identify one contraindication for the use of carbidopa-levodopa.
Narrow angle glaucoma
What are the three symptoms seen in Cushing's triad - a late manifestation of increased ICP?
Widened pulse pressure (elevated SBP, decreased DBP)
Bradycardia
Irregular respirations
Limit choices, don't use confrontation or try to reorient, distract the client. Allow pacing or rocking as a means of managing the physical stimulation.
Describe nursing interventions to prevent UTIs in clients with spinal cord injuries.
A client is exhibiting the following signs after an ischemic stroke: right-sided hemiparesis, visual deficits, aphasia. Which side of the brain was the stroke likely on?
Left
Describe administration techniques to reduce the risk of Purple Glove Syndrome when giving phenytoin.
Avoid small hand veins, use a filter, administer slowly at 50mg/min, monitor IV site closely, flush with saline after injection
Observe and record, ease pt to floor/bed, remove pillows and other objects, protect the head, raise and pad side rails, DO NOT restrain or pry mouth open or put anything in the mouth, place pt on their side, assess airway, loosen constrictive clothing, time the seizure.
What are the 4 cardinal signs of Parkinson's disease?
Tremor
Rigidity
Bradykinesia
Postural instability
Autonomic dysreflexia: Identify the most common cause, the symptoms, and the treatment.
Cause: Bladder distention
Sx: HA, bradycardia, HTN, hyperhidrosis, nausea, nasal congestion
Treatment: Sit pt up to lower BP, assess for the cause and remove it, treat with antihypertensives
Thickened liquids
Place food in unaffected side of the mouth
Small bites
Sit up during and after eating
Involve ST
Chin tuck
Identify 4 ABSOLUTE contraindications for the use of t-PA.
>4.5 hours since LKWT
INR > 1.7
SBP > 185, DBP > 110
Platelets < 100,000
Identify 3 factors that decrease cerebral perfusion pressure.
Increased ICP
Vasoconstriction
Hypotension (decreased MAP)
Decreased CO
Thicker viscosity blood (sickle cell, polycythemia, hypercoagulable states)
Describe nursing interventions for a client with Alzheimer's who experiences sun downing.
Room close to the nurses' station, bed/chair alarms, keep lights on and engage the patient during the day to promote normal circadian rhythms. Provide a consistent routine.
Identify 5 clinical manifestations of spinal cord injuries.
Pain, weakness/paralysis below level of injury, impaired sensation below level of injury, respiratory depression, hypotension, urinary retention, delayed gastric emptying, constipation, impaired thermoregulation, muscle atrophy, VTE
What should be included in the plan of care during an acute stroke?
Call Stroke Alert, check glucose, VS/neuro status, NIHSS, transport to CT, NPO until bedside swallow screen, provide support to pt and family
Your client weighs 180 lbs. You are administering t-PA according to the ischemic stroke protocol. What is the total dose to be administered, the bolus dose, and the infusion dose in mL if the concentration is 1mg t-PA / 1 mL?
Total dose: 73.6mL
Bolus dose: 7.36mL
Infusion dose: 66.24mL