Neuro
Describe nursing care following a lumbar puncture.
this is the insertion of a needle into the subarachnoid space in the lumbar area of the spinal column. the RN needs to monitor for headache & hypotension. The pt needs to remain flat and increase PO fluid intake to prevent the headache & hypotension. The RN needs to monitor for any changes in ICP (nausea, vomiting, vision changes, headache, changes in level of consciousness) and report them ASAP. The RN needs to do frequent CMS checks on the lower extremities and report any numbness, tingling, or loss of movement in the feet.
describe appropriate medication eduction for patients on antiepileptic drugs.
take meds daily and at the same time. report any breakthrough seizures. monitor LFTs and for s/s of liver dysfunction. monitor CBC and for infections b/c can cause leukopenia. women need another form of contraception. may cause osteoporosis in perimenopausal women.
describe s/s of increased ICP.
-decreased level of consciousness is early sign
-headache, seizures
-nausea, projectile vomiting
-behavior changes, changes in speech
-pupillary changes
describe different devices someone may have following a fracture.
casts- remember plaster casts will feel warm when first applied; assess daily for CMS
external fixation- there might be slight crusting around the pins post-op which is normal
traction-remember to always keep the weights dangling freely! never on the bed or the ground.
describe s/s of increased IOP that may follow post-operatively in patients getting eye surgeries OR in patients with glaucoma.
-loss in vision
-flashes of lights, spots in vision
what are the clinical s/s of retinal detachment and management.
s/s: shadow or curtain closing over vision, flashes of light, floaters, blurred vision, this is PAINLESS loss of peripheral vision
mgmt: prep for surgery since this is an emergency. post-op: no reading, writing, etc. for first 7 days! maintain eye patch & post-op positioning. monitor for retinal detachment and increased IOP. discuss ways to keep IOP decreased.
describe the differences between decorticate and decerebrate posturing?
decorticate: the arms are internally rotated and flexed to their core
decerebrate: the arms are externally rotated and extended away from their body
describe emergency care for someone in status epilepticus.
provide for safety. nothing in the mouth. loosen restrictive clothing around the neck. turn them into the recovery position. administer IVP benzos (diazepam is first choice).
describe the patho of parkinson's
there is a relative lack of dopamine in the brain and then too much acetylcholine in the brain
describe the s/s of fatty emboli that can occur secondary to fractures.
hypoxemia, tachypnea, lethargy, confusion, dyspnea, petechial rash over the neck/chest
name activities that increase IOP.
-blowing nose, coughing, sneezing, straining for a BM
-heavy lifting
-wearing tight shirts
describe best practices with hearing aid care
-clean the ear mold with mild soap & water but do NOT excessively wet the inside of the hearing aid that goes into the canal
-keep the part that goes inside the ear dry
-turn it off when not in use and be sure to remove the battery, too
-keep it at lowest setting that patient can hear comfortably at
describe the s/s of migraines.
they can have an aura before their migraine attack. pain is unilateral and a throbbing pain. they can have nausea, vomiting, photosensitivity or phonosensitivity. pain is worse with physical activity and lasts anywhere from 4-72 hours.
describe the management and patho of MS.
patho: this is an autoimmune disorder that results in the demyelination of neurons in the brain/nervous system
management: immune-modulating medications (remember- can cause infections!), interprofessional approach with OT, speech, and PT
why is carbidopa combined with levodopa?
describe the patho of osteoporosis and the management.
patho: bone loss d/t too much osteoclastic activity and not enough osteoblastic activity
mgmt:
-medications like bisphosphonates- full glass of h20, remain upright, empty stomach
-increase vitamin D, calcium
-walk daily- weight-bearing activities
-avoid caffeine, carbonated drinks, etoh
-avoid medications like steroids b/c can cause osteoporosis
what is the basic patho of glaucoma and describe the management.
patho: there is increased IOP b/c the fluid in the eye cannot drain out of the eye, while the eye is still making more fluid
mgmt: medications to help vasodilate and promote the outflow of the aqueous humor. BB eyedrops (remember- no asthma, COPD) are common
describe lifestyle mods for someone with Menieres.
avoid MSG. avoid heights. avoid alcohol & caffeine. Avoid smoking. avoid high salt intake. avoid stress. avoid driving if prone to sudden meniere's attacks
describe triptan medications used for migraine management.
these are 5HT receptor agonists, so they activate serotonin in the brain, causing vasoconstriction. they need to be avoided with other medications that can increase serotonin (SSRIs, MAOIs, TCAs, etc.). they also need to be avoided in someone with ischemic heart disease, HTN, PVD/PAD, etc. because of their ability to systemically vasoconstrict all vessels.
what is the difference between an ischemic and hemorrhagic stroke?
ischemic: there is an occlusion of the cerebral or carotid artery by either an embolus or a thrombus
hemorrhagic: there is a rupture of a vessel which causes bleeding into the brain
interdisciplinary care
describe RFs for osteomyelitis
patho: infection in the bony tissue
RFs: nearby skin ulcerations with sinus tract formation or infections, open fractures, infections in other body systems, animal bites, puncture wounds, bone surgery, etc
describe best practice with regard to eye drop administration.
-wash hands with soap & water before administering
-put only the correct amount of ordered drops into each time
-do not skip doses- if missed, do NOT double the dose at the next time
-apply pressure to inner canthus to prevent systemic absorption
-do not touch applicator tip to conjunctiva
-do not drive after this
describe OA vs. RA
RA: this is a chronic autoimmune disease causing systemic inflammation of the joints. the joints are red, inflamed bilaterally. bilateral and symmetric joint involvement. swan neck or ulnar deviations seen on their hands. can have very long morning stiffness in joints. can have sjogren's syndrome
describe the patho of seizures
the exact etiology is unknown, but there are sudden, uncontrolled, excessive discharges of electrical activity in the brain.
describe nursing care & considerations when administering tPA for an ischemia CVA.
-ensure the pt has ONLY an ischemic CVA- NOT to be used with hemorrhagic CVAs
-ask about recent trauma, falls, surgeries, or if taking any blood-thinners at home
-monitor BP and ensure BP is <185/110 before tPA
-ensure all invasive lines (NGT, foley, IVs) are placed before giving tPA
-monitor vitals closely throughout administration and for first 24 hours after
describe the function of the RN working in a rehabilitation setting.
to promote the function and autonomy of the patient. to encourage ADLs. to ensure the pt is receiving all of the therapies needed and actively engaging in them.
describe the management for someone with chronic lower back pain.
NSAIDs, antidepressants, muscle relaxers, steroids, acetaminophen, limit lifting/heavy exercise, PT, heat therapy, weight reduction, potential surgery, low impact exercises, TENS units, massage, etc.
describe s/s of macular degeneration.
dry is the most common type and causes a decrease in central vision, loss in night vision, and a loss in reading clearly
describe strains vs. sprains
strain: excessive stretching of tendon or muscle
sprain: excessive stretching of ligaments