Term
|
Definition
| the process in prioritizing patients |
|
|
Term
Triage
Emergent and examples |
|
Definition
red/ priority 1/ life, limb, eye threatening/ needs immediate treatment/
(ie: chest pain, bleeding broken fractures, severe resp distress, chemical burns, acute neuro deficits) |
|
|
Term
triage
urgent and examples |
|
Definition
| yellow/ priority 2/ needs treatment w/in 20-120 min/ (ie: pain>8, fractures, stable asthma, fever 104, increase (D) BP, abd distress) |
|
|
Term
triage
nonurgent and examples |
|
Definition
green/ priority 3/ can wait hours to days/
(ie: colds, sprains) |
|
|
Term
| what you evaluate during primary survey of emergencey situations |
|
Definition
| airway/ breathing/ circulation/ diability |
|
|
Term
primary survey
airway do these thru:
breathing
circulation
disability |
|
Definition
| jaw thrust with c-collar and/or taped to backboard/ suction/ artificial airway/ O2 and/or ambu bag/ (chest tube, CPR, control bleeding, IV resuscitation, IV pressors) |
|
|
Term
| causes of Life-threatening conditions to the airway |
|
Definition
| inhalation injury, foreign body or tongue obstruction, penetrating or blunt trauma |
|
|
Term
causes of Life-threatening conditions to
breathing |
|
Definition
| anaphylaxis, flail chest w/pulmonary contusion, hemo and/or pneumothorax |
|
|
Term
causes of Life-threatening conditions to
circulation |
|
Definition
| direct cardiac injury, tamponade, bleeding, shock |
|
|
Term
| causes of Life-threatening conditions that cause disabilities |
|
Definition
|
|
Term
| what you do for a secondary survey of emergency situations |
|
Definition
E:exposure/ F:full set of VS-5 interventions-family/ G:give comfort measures/ H:history (of injury and health
history) and head-to-toe assessment/ I:inspect posterior surfaces |
|
|
Term
| what are the 5 interventions during secondary survey |
|
Definition
| heart rhythm/ O2 sat/ foley/ NG tube insert/ blood for (BMP, CBC) |
|
|
Term
| health history during emergency |
|
Definition
A: allergies/ M: medication history (how much, how long, for what)/ P: past health history (medical, surgical, injury, drugs, smoking, tetanus, LMP)/ L: last meal/ E: events/environment preceding
illness or injury |
|
|
Term
| follow up treatment of emergencies |
|
Definition
| CT or other diagnostic tests/ admission to general floor or ICU/ transferred to another facility/ surgery/ discharged home |
|
|
Term
| special considerations of emergencies for pediatric patients |
|
Definition
| they are more likely to have internal injuries |
|
|
Term
| special considerations of emergencies for geriatric patients |
|
Definition
| lots of bruising with minor injuries/always look at med lists/ they have altered baseline vitals |
|
|
Term
| special considerations of emergencies for pregnant patients |
|
Definition
increased O2 requirements/ organ rupture/
lose of baby/ more likely to apirate/ anemic/ hypercoagulation |
|
|
Term
| special considerations of emergencies for death in the ER to remember |
|
Definition
| it is always sudden/ no organs can be percured (donated) but can do tissues for donation |
|
|
Term
| what you have to do for domestic violence dealing with forensics |
|
Definition
| Identify it/ document accurately/ and get DOB (date of birth of alleged abuser) |
|
|
Term
| what you have to do for domestic violence for forensics |
|
Definition
| preserve evidence (such as under nails)/ use a sexual assault kit/ use victims own words and quote threats |
|
|
Term
| things to do or remember with domestic violence |
|
Definition
-broken wrists usually have to do with falls/-may have to separate abusee from
abuser/-abuser acts concerned/-abussee lessons situation/-remember it starts out verbal and leads to pushing and abuse
-take pictures before cleaning up
patient |
|
|
Term
|
Definition
-leading cause of death w/<45 years of
age mainly 15-24/-4th leading cause of death in US/-150,000 deaths/-may cause physical impairment or permanent disability |
|
|
Term
| what makes a Level I trauma center |
|
Definition
everyone has to be ready/ need 24 hour anesthesia and surgery/ have to have PICU and NICU/ need 24 ortho and vascular surgeons/ hemodyalisis capabilities/ neuclear scanning/ CPB/
associated w/University and conducts clinical research |
|
|
Term
| what makes a level II trauma center |
|
Definition
| is a small community center/ aspects of surgery on call |
|
|
Term
| what makes a level III trauma center |
|
Definition
-is a critical link w/out Level I or
II capabilities |
|
|
Term
| what makes a level IV trauma center |
|
Definition
| remote w/one nurse that knows the ways of medicine and can call for assistance |
|
|
Term
| what are some diagnostic tests to evaluate head injuries |
|
Definition
| 1st is skull x-ray/ CT scan/ MRI/ cerebral angiography/ EEG/ Lumbar puncture (CSF analysis)/ evoked responses |
|
|
Term
| what is the main diagnostic test for head injuries |
|
Definition
|
|
Term
| What are the special considerations for MRI's |
|
Definition
-need a special vent
-no metal |
|
|
Term
| what is the purpose of a cerebral angiography for head injuries |
|
Definition
| evaluate vascular injuries in the head |
|
|
Term
| what is the purpose of an EEG for head injuries |
|
Definition
evaluate for seizures and help to diagnose brain death
also done when they are not sure why the patient is not waking up |
|
|
Term
| what is the purpose of a lumbar puncture for head injuries |
|
Definition
| to evaluate coma patients |
|
|
Term
| what is the purpose of evoked responses dealing with head injuries |
|
Definition
| to diagnose degenerative disorders |
|
|
Term
| what are the levels of brain injury |
|
Definition
| mild TBI/ moderate TBI/ severe TBI (traumatic brain injury) |
|
|
Term
| what is the Glascow coma scale |
|
Definition
| a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment |
|
|
Term
| what is the glascow score range for mild tramatic brain injury |
|
Definition
|
|
Term
| what is the glascow coma score range for moderate tramatic brain injury |
|
Definition
|
|
Term
| what is the glascow coma score range for severe tramatic brain injury |
|
Definition
|
|
Term
| what 3 values are scored on the glascow coma scale |
|
Definition
| eye, verbal, and motor responses |
|
|
Term
| what is the lowest score possible to get on the glascow coma scale |
|
Definition
|
|
Term
| what is recovery like in mild tramatic brain injury |
|
Definition
| usually full recovery w/some possible short term memory loss, has some change in mental status at time of injury |
|
|
Term
| what happens with bain function with moderate tramatic brain injury and what do you do with these patients |
|
Definition
| loss of counciousness from a few minutes to a few hours/ (you chemically sedate at this level and at the severe level) |
|
|
Term
| what state is the patient in with severe tramatic brain injury and what do you do with these patients |
|
Definition
they are in a coma or vegetative state/
(this patients get intubated always) |
|
|
Term
| what do you do with a patient with a score of <9 on the Glascow coma scale |
|
Definition
| these patients always get intubated |
|
|
Term
| benifits and hazards of open head injuries |
|
Definition
| leaves room for expansion or swellin of the brain, but can get meningitis |
|
|
Term
| injury occurring on the side of the brain on which a blow or impact was received is called a what |
|
Definition
|
|
Term
| injury occurring on the opposite side of the brain on which a blow or impact is received is called a what |
|
Definition
|
|
Term
| examples of primary head injuries |
|
Definition
skull fractures/ concussion or contusion/
diffuse axonal injuries (DAI)/ gunshot or stabbing |
|
|
Term
| what are the 4 types of skull fractures |
|
Definition
| linear/ basilar/ depressed/ compound |
|
|
Term
| what is the fracture called at the base of the skull |
|
Definition
|
|
Term
| what are the signs of a dural tear in a basilar fracture |
|
Definition
|
|
Term
| what causes an epidural hematoma in a basilar skull fracture |
|
Definition
| tearing of temporal artery |
|
|
Term
| can tinnitus occur in a basilar skull fracture |
|
Definition
| yes, this is rining of the ears |
|
|
Term
| what are battle signs of a basilar skull fracture |
|
Definition
| ecchymosis in the areas of the mastoid proccess and orbits of the eyes |
|
|
Term
| what happens with the pupils in a compound depressed skull fracture |
|
Definition
| dilated fixed pupil on SAME side of fx |
|
|
Term
| due you have changes in level of conscious with a compound depressed skull fx |
|
Definition
|
|
Term
| do patients c/o headaches with a compound depressed skull fx |
|
Definition
|
|
Term
| is there damage to the cochlear vestibular apparatus with a basilar skull fx |
|
Definition
|
|
Term
| how is a compound depressed skull fx cleaned up |
|
Definition
|
|
Term
| is there cerebral edema and typanic rupture with a compound depressed skull fx |
|
Definition
|
|
Term
| is there loss of conciousness with a concussion |
|
Definition
| yes, short term to maybe hours |
|
|
Term
| what is retrograde amnesia dealing with head injuries |
|
Definition
| forget event and some of preceding events before the injury |
|
|
Term
| how do you diagnose a concussion in head injuries |
|
Definition
|
|
Term
| what are the s/s of a concussion |
|
Definition
| headache/ vomiting/ memory loss/ decreased attention span/ loss of consciousness |
|
|
Term
| what lobes are involved more in contusions |
|
Definition
|
|
Term
| is a coup and contre coup involved in a contusion |
|
Definition
|
|
Term
| can you have vessel fx and hematoma in a contusion |
|
Definition
|
|
Term
| can you have a long period of loss of consciousness with a contusion |
|
Definition
|
|
Term
| what does DAI stand for dealing with brain injury |
|
Definition
|
|
Term
| which brain injury disorder may appear normal on x-ray |
|
Definition
| diffuse axonal injury (DAI) |
|
|
Term
| which brain disorder is like silly putty and then gets stiff |
|
Definition
| diffuse axonal injury (DAI) |
|
|
Term
| what is has happend to a baby or young child with shaken baby syndrome |
|
Definition
| has been aggressively shaken |
|
|
Term
| which disorder is similar to shaken baby syndrome |
|
Definition
|
|
Term
| which brain disorder is a forceful whiplash-like motion injury |
|
Definition
|
|
Term
| what is the death rate percentage of penetrating brain injuries |
|
Definition
|
|
Term
| what bleeds in an epidural hematoma artery or vein |
|
Definition
|
|
Term
| which artery is usually involved in an epidural hematoma |
|
Definition
|
|
Term
| which side is the pupil dilated in an epidural hematoma patients |
|
Definition
|
|
Term
| which side has extremity weakness with an epidural hematoma |
|
Definition
|
|
Term
| which brain disorder has loss of consciousness, then alert interval, then rapid deterioration |
|
Definition
|
|
Term
| which is invovled with a subdural hematoma vein or artery |
|
Definition
|
|
Term
| which pupil is dilated with a subdural hematoma |
|
Definition
|
|
Term
| which extemities have signs of extreme weakness with a subdural hematoma |
|
Definition
|
|
Term
| how long could it take for a subdural hematoma to develop |
|
Definition
|
|
Term
| you could have a spontaneous bleed in the brain with what medicine |
|
Definition
|
|
Term
| what is the most common cause of a subarachnoid hemorrhage |
|
Definition
|
|
Term
|
Definition
| arterial-venous malformation |
|
|
Term
| what do you have a risk for with the vessel that feeds an aneurysm |
|
Definition
|
|
Term
| what is the age range for an (AVM) arterial-venous malformation |
|
Definition
|
|
Term
| what are some s/s of cranial aneurysm |
|
Definition
|
|
Term
| what is a congenital lack of intervening capillaries between arteries and veins |
|
Definition
| (AVM) arterial-venous malformation |
|
|
Term
| which disorder has pain d/t sterile meningitis |
|
Definition
|
|
Term
|
Definition
| HTN, hypervolemia, hemodilution (over diluted) |
|
|
Term
| what does HHH therapy prevent |
|
Definition
|
|
Term
| what is going on in the ear with arterial-venous malformation |
|
Definition
|
|
Term
| trancrainial doppler shows what in an aneurysm |
|
Definition
|
|
Term
| what happens in "steal syndrome" |
|
Definition
| blood goes out but doesn't get back in |
|
|
Term
| s/s of congenital AVM show up when |
|
Definition
|
|
Term
| what is not d/t trauma but are treated like brain injuries |
|
Definition
|
|
Term
| what is it called when the brain does not receive any oxygen for a significant period of time |
|
Definition
|
|
Term
| what is it called when the brain receives some, but not enough oxygen |
|
Definition
|
|
Term
| what type of anoxic brain injury is d/t poor O2 carrying capacity |
|
Definition
|
|
Term
| which type of anoxic brain injury is caused by poisons that block O2 |
|
Definition
|
|
Term
| what can happen during an ischemic insult on the brain |
|
Definition
| low blood pressure/ hemorrhage/ low heart rate/ seizures or epilepsy |
|
|
Term
| what are the 2 types of sencondary brain injury |
|
Definition
| mechanical and biochemical |
|
|
Term
| what is the steal syndrome in brain injuries |
|
Definition
| it is the occlusion of subclavian artery |
|
|
Term
| which part of secondary brain injury is when the blood brain barrier is altered: with inflammation and edema |
|
Definition
|
|
Term
| why do we sedate brain injured patients |
|
Definition
| to minimize brain activity |
|
|
Term
| what can decrease O2 in brain injured patients |
|
Definition
| seizures/ infections/ patient is to flat/ patient is in high fowlers position/ suction/ pain |
|
|
Term
| what can cause mask effects in brain injuries |
|
Definition
| epidural and subdural hematomas |
|
|
Term
| hematomas and brain edema are secondary or primary brain injuries |
|
Definition
|
|
Term
| describe the pupils with herniation brain injury |
|
Definition
| both are fixed and dilated |
|
|
Term
| what is shifted in herniation dealing with brain injury |
|
Definition
|
|
Term
| where will the brain tissue go dealing with herniation in brain injuries |
|
Definition
| anywhere that it can find a way out |
|
|
Term
| what are the chances of full recovery with herniation dealing with brain injury |
|
Definition
|
|
Term
| how is secondary herniation brain injury found |
|
Definition
|
|
Term
| describe the biochemical cascade of secondary brain injury |
|
Definition
| excitotoxic neurotransmitters then inflammaory tissue changes then disruption of Na and Ca tansport |
|
|
Term
| what should you do with the off going nurse with all brain injury and neuro patients |
|
Definition
|
|
Term
|
Definition
| the triad is hypertension, bradycardia, and widening pulse pressure |
|
|
Term
| what are some physical assessments that can be performed with brain injury patients |
|
Definition
| Glasgow coma scale/ VS/ Pupil checks/ seizure activity/ CSF leak |
|
|
Term
| an alert patient with a brain injury will c/o what |
|
Definition
| headache/ N/ V/ blurred or loss of vision |
|
|
Term
| where do you place the intracranial pressure monitor |
|
Definition
| on the non-dominant side (this is more commonaly on the right side) |
|
|
Term
| which side of the brain is considered the non-dominant side in most people |
|
Definition
|
|
Term
| what is the normal reading of ICP |
|
Definition
| 0-15 but anything < 20 is acceptable |
|
|
Term
| what does the subarachnoid screw give the nurse |
|
Definition
| no drainage but a wave form |
|
|
Term
| which epidural catheter was mentioned in class for ICP monitoring |
|
Definition
|
|
Term
| how do you calculate cerebral perfusion pressure |
|
Definition
| CPP= MAP-ICP/ MAP increases so does CPP/ ICP increased CPP decreases |
|
|
Term
|
Definition
| partial pressure of O2 in the brain |
|
|
Term
| how do you increase PbO2 in brain injury patients |
|
Definition
| turn up FiO2 then titrate back down |
|
|
Term
| if PbO2 is < 20 what does this mean for survival of the patient |
|
Definition
|
|
Term
| what information is obtained thru ICP monitor |
|
Definition
| ICP value/ wave form/ cerebral perfusion pressure/ brain temp/ PbO2 |
|
|
Term
| what is the range of cerebral perfusion pressure |
|
Definition
|
|
Term
| when do you keep BP on the high side in which brain injury patient |
|
Definition
|
|
Term
| what do you treat hypotension with in brain injury patients |
|
Definition
|
|
Term
| what do you do with the HOB in a brain injury patient |
|
Definition
|
|
Term
| what do you use IV when ICP is increased |
|
Definition
| Osmotics ie Mannitol/ it is hypertonic but is just a bandaid and is hard on the kidneys |
|
|
Term
| what is used for pain management in brain injury patients |
|
Definition
|
|
Term
| what is used for sedation in brain injury patients |
|
Definition
| propofol (diprivan) or midazolam (versed) |
|
|
Term
| which sedating medication for brain injury patients is short acting |
|
Definition
|
|
Term
| which paralizing agent do you use when having trouble oxygenating a brain injury patient |
|
Definition
| Nimbex (cisatracurium besylate) |
|
|
Term
| what type of drug is versed |
|
Definition
|
|
Term
| what other drugs need to be used with a paralizing agent in brain injury patients |
|
Definition
|
|
Term
| what happens with blood vessels when CO2 is increased |
|
Definition
|
|
Term
| what happens with blood vessels when CO2 decreases |
|
Definition
|
|
Term
| what is not used much any more to control blood to the brain |
|
Definition
|
|
Term
| what is used to control the thermia state in brain injured patients |
|
Definition
| tylenol/ antibiotics/ cooling maneuvers ie fans and ice and nakedness |
|
|
Term
| what procedures are performed to remove clots in brain injured patients |
|
Definition
|
|
Term
| what manuevers are avoided with brain injured patients |
|
Definition
| valsalva and high fowler's position |
|
|
Term
| what is given to patients to avoid a valsalva response |
|
Definition
|
|
Term
| when on a ventriculostomy drain, what landmark is the unit leveled with on the patient |
|
Definition
|
|
Term
| how do you control CSF levels |
|
Definition
| elevate HOB/ CSF drainage as needed/ control fluid intake/ keep neck in alignment |
|
|
Term
| are there fluid restriction when a patient is on a ventriculostomy drain |
|
Definition
| no, I & O just have to be kept as equal as possible |
|
|
Term
| what do you do with the brain injured patient's neck that is on a ventriculostomy drain |
|
Definition
|
|
Term
| what can decrease the brain injured patient's PbO2 level |
|
Definition
| fever, pain, agitation, seizures, and nursing activities (suctioning, bath, and turning) |
|
|
Term
| what is a normal range for PbO2 |
|
Definition
|
|
Term
| what level of PbO2 do you not want to go below |
|
Definition
|
|
Term
| how do you assess for respiratory failure in brain injured patients |
|
Definition
| assess sputum (pink and frothy) |
|
|
Term
| how do you assess for meningitis in brain injured patients |
|
Definition
| with fever and ICP monitor and thru CSF drain |
|
|
Term
| which brain disorder do you see SIADH in |
|
Definition
|
|
Term
| treat which diabetes disorder aggressively in brain injured patients |
|
Definition
|
|
Term
| what are hazards of immobility in brain injury patients |
|
Definition
| skin breakdown/ thrombophlebitis, pneumonia, UTI, muscle atrophy, loss of ROM, constipation |
|
|
Term
| what are the hazards of immobility in brain injury patients d/t |
|
Definition
|
|
Term
| what are complications of brain injury patients |
|
Definition
| malnutrition, GI bleed, sepsis, aspiration, pneumonia, role changes (many patients not the same again) |
|
|
Term
| what is the stage called that is between the coma and vegetative states |
|
Definition
| minimally conscious state |
|
|
Term
| what are some things that are going on in the minimally responsive state of brain injured patients |
|
Definition
| primitive reflexes, inconsistent, awareness |
|
|
Term
| what disorder is caused by a degenerative neurological response |
|
Definition
|
|
Term
| which neurological disorder has progressive loss of all cognitive functions |
|
Definition
|
|
Term
| which neurological disorder can evolve into minimally conscious states or vegetative states |
|
Definition
|
|
Term
| this can result from severe tramatic brain injury |
|
Definition
|
|
Term
| this has no reflexes, no cranial nerve function, and no cognition |
|
Definition
|
|
Term
| this results from no brain stem |
|
Definition
|
|
Term
| what are some kinds of thermal burn injuries |
|
Definition
| radiant heat/ scald/ grease/ contact/ tar/ fire/ steam/ road rash |
|
|
Term
| which type of thermal burn is d/t the sun or radiation |
|
Definition
|
|
Term
| which type of burn injury is the leading cause of accidental deaths d/t burning |
|
Definition
|
|
Term
| how would one get a contact burn |
|
Definition
| with a curling iron or muffler |
|
|
Term
| what kind of worker is exposed to getting a tar burn |
|
Definition
|
|
Term
| what type of nutrient does a burn patient need a lot of for healing purposes |
|
Definition
|
|
Term
| what are the 3 classifications of burns |
|
Definition
| superficial/ partial/ full (the partial can be superficial or deep) |
|
|
Term
| what layers of skin does a superficial burn involve |
|
Definition
|
|
Term
| what layers does a partial burn involve |
|
Definition
| epidermis and parts of the dermis depending on how deep it is |
|
|
Term
| what is sometimes a treatment for a partial burn |
|
Definition
| skin graft on deep partials |
|
|
Term
| is there capillary refill with any type of partial burn |
|
Definition
|
|
Term
| would a patient complain of pain with a partial burn |
|
Definition
|
|
Term
| which classification of burn always gets grafted |
|
Definition
|
|
Term
| what is a classic sign of a partial thickness burn |
|
Definition
|
|
Term
| what is the name of the burnt tissue pertaining to a full thickness burn |
|
Definition
|
|
Term
| what are the 3 zones of injury dealing with burns |
|
Definition
| zone of: coagulation/stasis/hyperemia |
|
|
Term
| which zone of injury in a burn patient is dealing with cell death or necrosis |
|
Definition
|
|
Term
| which zone of injury dealing with a burn patient deals with injured cells suffering from vascular damage |
|
Definition
|
|
Term
| which zone of injury dealing with a burn patient deals with minimally injured cells, and will repair |
|
Definition
|
|
Term
| what do you do with a burn patient before ABC's |
|
Definition
|
|
Term
| what are the steps in the process to stop the burning process in a burn patient |
|
Definition
| remove clothing and diapers/cool the burn/remove jewelry, metal, contact lenses/check all over for any other burning/cover with clean dry sheet |
|
|
Term
| in the steps of stopping the burning process what do you use to cool the burn |
|
Definition
| cool H2O/ ice can cause frost bite |
|
|
Term
| what is the purpose of covering the patient with a clean dry sheet when stopping the burning process |
|
Definition
| to maintain fluids and temp |
|
|
Term
| what is the age limit when a burn is suspected as abuse |
|
Definition
| there is no age limit who will be abused with buring instruments |
|
|
Term
| is it a nurse's legal responsibility to report abuse (especially pertaining to burns) |
|
Definition
|
|
Term
| what are some things that a nurse can do for abused burn patients |
|
Definition
| listen objectively and document |
|
|
Term
| what should match pretty closely with burn patients |
|
Definition
| their story should match the burn |
|
|
Term
| are all inflicted burns intentional |
|
Definition
|
|
Term
| what type of injury is compared to a crushing injury |
|
Definition
|
|
Term
| what does low voltage, like in homes, lead to |
|
Definition
|
|
Term
| high voltage injuries lead to which kind of arrest |
|
Definition
|
|
Term
| in electrical burns what do palpate for |
|
Definition
|
|
Term
| when you have found a peripheral pulse in an electrical patient what do you do |
|
Definition
|
|
Term
| what is the first step in the emergency treatment for an electrical injury |
|
Definition
| turn the source off. don't touch patient until this is done |
|
|
Term
| what is the second step in emergency treatment of an electrical injury |
|
Definition
|
|
Term
| what do you assess for and stabilize in the third step of emergency treatment of an electrical injury |
|
Definition
|
|
Term
| in the 4th step in the emergency tx of an electrical injured patient what is applied |
|
Definition
| cervical collar and long board |
|
|
Term
| what is done ASAP in the emergency tx of an electrical injured patient |
|
Definition
|
|
Term
| what is seen with an lightening injury |
|
Definition
| resp arrest and poss v-fib |
|
|
Term
| what are the 3 classifications of a chemical burn |
|
Definition
| acid/ alkalotic/ and organic |
|
|
Term
| which of the 3 types of chemical burns deals w/coagulation necrosis |
|
Definition
|
|
Term
| which of the 3 types of chemical burns deals w/liquefaction necrosis |
|
Definition
|
|
Term
| which of the 3 types of chemical burns deals w/delipidation |
|
Definition
|
|
Term
| which of the 3 types of chemical burns deals w/when proteins in skin leave skin and die |
|
Definition
| coagulation necrosis or acidic chemical burn |
|
|
Term
| which of the 3 types of chemical burns deals w/when fats and lipids ooze out of the chemical burn |
|
Definition
| alkalitic or liquefaction necrosis |
|
|
Term
| which of the 3 types of chemical burns deals w/when the chemical burn just keeps going deeper and deeper |
|
Definition
| organic burn or delipidation |
|
|
Term
| what is an example of agent that can cause an acid burn |
|
Definition
| rust remover agent and agent that cleans pools |
|
|
Term
| what is an example of agent that can cause an alkalitic burn |
|
Definition
| fertilizer or liquid concrete |
|
|
Term
| what is an example of agent that can cause an organic burn |
|
Definition
|
|
Term
| which type of burn is harder to manage an acid or alkalitic burn |
|
Definition
| alkaline burns because they adhere to tissues causing protein hyfrolysis and liquefaction |
|
|
Term
| identify emergency treatments for chemical burns and in what you would do for the patient and caregiver |
|
Definition
| look at MSDS/ call Poison Control/ protect the caregiver with gown, gloves, and mask/ Protect uninjured areas/ immediate irrigation and proper disposal |
|
|
Term
| what do you do with dry chemical prior to flushing in a chemical burn treatment |
|
Definition
|
|
Term
| what do you do with dry chemical prior to flushing in a chemical burn treatment |
|
Definition
|
|
Term
| how long do you flush with copious amounts of irrigant |
|
Definition
| until the pH of skin is neutral |
|
|
Term
| flushing with copious amounts of irrigant could send the patient into what |
|
Definition
|
|
Term
| when flushing a burn what do you want to maintain in a chemical burnt patient |
|
Definition
|
|
Term
| what do you need to remove first when a patient has a chemical injury to their eye |
|
Definition
|
|
Term
| what amount of fluids do you flush an eye out with involving a chemical injury |
|
Definition
|
|
Term
| what sol'n do you rinse eyes out with in a chemical injury |
|
Definition
|
|
Term
| in which direction do you flush an eye involving a chemical injury |
|
Definition
|
|
Term
| what type of spaces is a person at increased risk for inhalation injuries |
|
Definition
|
|
Term
| what age groups are at higher risk for inhalation injuries |
|
Definition
|
|
Term
| what are some s/s of inhalation injuries |
|
Definition
| hoarseness/ SOB/ wheezing/ carbonaceous sputum (black sputum)/ singed nasal & facial hair/ Stridor/ red throat |
|
|
Term
| what increases mortality involving inhalation injuries |
|
Definition
| CO/ hoarseness above the glottis/ smoke, stridor, SOB below the epiglottis |
|
|
Term
| what is the injury above the glottis usually caused by |
|
Definition
| a thermal agent hot air/ steam/ or smoke |
|
|
Term
| what is the injury below the glottis usually caused by |
|
Definition
| chemicals and the extend of the injury is related to the length of exposure to the smoke of toxic fumes |
|
|
Term
| what are the 3 initial txs for inhalation injuries |
|
Definition
| cool mist mask (100% humidified O2)/ elevate HOB/ assess need for bronchoscope |
|
|
Term
| what are 3 secondary txs for inhalation injuries |
|
Definition
| bronchoscopy/ intubation & vent/ bronchodilators |
|
|
Term
| what nursing intervention are done in inhalation injuries |
|
Definition
| minimize activity to reduce O2 demands/ monitor pulse ox/ monitor cardiac, neuro, & resp status for hypoxia/ perform serial ABG's |
|
|
Term
| do the initial ABG and x-ray look bad with an inhalation injury |
|
Definition
| no they don't look bad initially |
|
|
Term
| what are primary assessments in burn patients |
|
Definition
| determine severity and airway, breathing, circulation, disability and exposure and exam |
|
|
Term
| what is done to expose a burn patient |
|
Definition
| remove clothing and jewlery and anything else that will come off that will restict getting to the burn area |
|
|
Term
| what do you monitor for involving cardiovascular/tissue perfusion in burn patients |
|
Definition
| hypo and hypervolemia and cardiac rhythm and rate |
|
|
Term
| what do you assess involving cardiovascular/tissue perfusion |
|
Definition
| peripheral pulses and need for escharotomy |
|
|
Term
| in burns what do you assess the degree of and what do you assess the skin for |
|
Definition
| degree of swelling and color & temp of skin |
|
|
Term
| which phase in burns is the first 24-48 hrs labeled as |
|
Definition
|
|
Term
| how is the length of emergent phase in burns measured |
|
Definition
| from time of burn to start of diuresis |
|
|
Term
| during the emergent phase of a burn what is the patient @ risk for happening |
|
Definition
| organ failure and possibly to gain fluid that goes to the burn |
|
|
Term
| what is reversed after 24-48 of a burn |
|
Definition
| third spacing is reversed |
|
|
Term
| gives examples of cases when a patient is referred to a burn center |
|
Definition
| partial thickness wounds to >10%/ burns to face, hands, feet, genitalia, perineum and major joints/ electrical burns including lightning/ third degree or full thickness burns in any age group/ chemical burns/ inhalation injury/ co-morbid dx that could complicate management/ burns and trauma/ when hospital is not prepared to handle kids |
|
|
Term
| remember that burns don't do what |
|
Definition
|
|
Term
| secondary assessments of burn patients involve what |
|
Definition
| head-to-toe, both sides/ assess for minor associated injuries/ observe for LOC/ monitor VS's/ and assess for systemic and local changes |
|
|
Term
|
Definition
| allergies/ meds/ past medical hx/ last meal/ events surrounding the injury |
|
|
Term
| what is the emotional reponse of a burn patient |
|
Definition
| the impact of the injury/ will they retreat or w/draw especially from society/ acknowledge the injury/ and reconstructive interventions |
|
|
Term
| what are the 3 phases of burn tx |
|
Definition
| emergent/resuscitative, acute rehab, and long term rehab |
|
|
Term
| the emergent phase of burns starts and stops when |
|
Definition
| start with the onset of the burn and ends until diuresis starts. could take up to 5 days but usually only 24-48 hours |
|
|
Term
| when does the acute phase in burns start and stop |
|
Definition
| start when diuresis starts and ends when burn is completely covered with skin grafts or when the wound is completely healed. this could take months |
|
|
Term
| when does the rehab phase in burns start and stop |
|
Definition
| starts when wound is completely covered or healed and ends when patient can resume a self-care activity. can occur in 2 wks or as long as 2-3 months |
|
|
Term
| what are the nursing interventions pertaining to the emergent phase in burns |
|
Definition
| airway manage/ fluid therapy/ wound care/ other care measures (ROM and other things)/ drug therapy/ nutritional therapy |
|
|
Term
| what are the nursing interventions pertaining to the acute phase in burns |
|
Definition
| wound care/ excision and grafting/ pain manage/ PT-OT/ nutritional therapy/ psychosocial |
|
|
Term
| what are the nursing interventions pertaining to the rehab phase in burns |
|
Definition
| a lot of psychosocial teaching/ dressing change education/ high protein high calorie diet |
|
|
Term
| what should the UO be in adults and kids dealing with fluid resuscitation in thermal burns |
|
Definition
@ least 30 ml/hr in adults &
1 ml/kg/hr in kids |
|
|
Term
| what type of sol'n should be used during fluid resuscitataion dealing with burns |
|
Definition
| LR because it is isotonic |
|
|
Term
| what is sometimes given to clear myosin in fluid resuscitation dealing with burns |
|
Definition
|
|
Term
| what does it mean when a patient's Hct is elevated in burn patients |
|
Definition
| the patient is dehydrated |
|
|
Term
| what is a good Hct level in burn patients |
|
Definition
|
|
Term
| what are the levels of UO in a patient that is over perfused and underperfused |
|
Definition
| >50 if over perfused and <30 if under perfused |
|
|
Term
| what is the modified brooke's formula |
|
Definition
|
|
Term
| what is the Parklands formula |
|
Definition
|
|
Term
| when is albumin given dealing with burn patients |
|
Definition
| not until after first 24 hours |
|
|
Term
| what does iatrogenic mean |
|
Definition
| induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures |
|
|
Term
| what are some respiratory treatments done for burn patients |
|
Definition
| continue resp assessment/ maintain airway/ maintain O2 support/ mobilize secretions/ Mobilize patient/ cultures PRN/ EXTUBATE ASAP |
|
|
Term
| what are some cardiovascular/tissue perfusion issues and interventions related to burns |
|
Definition
| issues: fluid shift that is hard on elderly/ cardio depressant factor/ increased peripheral resistance/ disrupted coag factor/ interventions: monitor hypo/hypervolemia, anemia/ monitor cardiac rhythm and rate/ vasopressors/ monitor for clots, DIC |
|
|
Term
| what is one possible reason for anemia in burns |
|
Definition
| RBC's are damaged and rest don't survive long |
|
|
Term
| what are some GI issues pertaining to burns |
|
Definition
| curling's ulcer/ constipation or diarrhea/ ileus/ chlecyctitis/ pancreatitis/ ischemic enterocolitis/ psuedo-obstruction of colon |
|
|
Term
| what are some of the GI issues that are d/t poor perfusion |
|
Definition
| cholecyctitis/ pancreatitis/ ischemic enterocolitis/ pseudo-obstruction of colon |
|
|
Term
| what are some GI interventions dealing with burns |
|
Definition
| assess abdomin and remember that initially there are no bowel sounds/ NG tube/ enteral and parenteral feeding/ protonix or pepcid/ temporary ostomy/ treament for elimination |
|
|
Term
| what are some nutritional issues with burn patients |
|
Definition
| increased metabolic needs/ neuroendocrine responses that interfere with protein, fat and glucose use/ insulin resistance |
|
|
Term
| how is a curling ulcer formed or what is happening in a burn patient to initiate a curling ulcer |
|
Definition
| is a loss of plasma volume leading to sloughing of the gastric mucosa |
|
|
Term
| what are some nutritional interventions dealing with burn patients |
|
Definition
| decrease energy expenditures/ nutritional support/ frequent metabolic nutritional assessments |
|
|
Term
| what metabolic elements are frequently assessed in nutritional care for burn patients |
|
Definition
| Protein/ Carbs/ Kcal/ zinc/ Mg/ Ca/ K |
|
|
Term
| how do you feed kids initially dealing with burns |
|
Definition
|
|
Term
| what is one intervention in kids with burns that can lead them to anorexia |
|
Definition
pain meds lead to anorexia
(ie morphine) |
|
|
Term
| what med would you use when doing dressing changes for a burn patient and what can this drug cause |
|
Definition
| morphine but causes constipation |
|
|
Term
| what are some sedating meds that can be used in burn patients |
|
Definition
|
|
Term
| what are some renal/tissue perfusion issues with burn patients |
|
Definition
| reflects changes in CV system/ renal blood flow decreases |
|
|
Term
| what are some renal interventions that can be done for burn patients |
|
Definition
| foley and fluid resuscitation |
|
|
Term
| what is given to all burn patients dealing with immulogical issues |
|
Definition
|
|
Term
| what interventions are done dealing with immulogical issues of a burn patient |
|
Definition
| always do wound assessments/ wound cultures are done/ and always monitor for s/s of sepsis |
|
|
Term
| what do you always remember dealing with larger burns |
|
Definition
| the larger the burn the more immonosuppresants/ this is persistant for life and possibly develop Cancer |
|
|
Term
| what are the two types of cleansing procedures used with burn patients |
|
Definition
|
|
Term
| what are the two recommended types of soap to use when cleansing a burn patients |
|
Definition
|
|
Term
| what are the two types of debridement performed on burn patients |
|
Definition
| shaving margins and/or blister removal |
|
|
Term
| what should you do to the room when cleansing or debriding a burn patient |
|
Definition
|
|
Term
| what are the two types of antimicrobials used on burn patients |
|
Definition
| silvadene (silver sulfadiazine) and sulfamyalon (mafenide acetate) |
|
|
Term
| which of the two types of antimicrobials are not consistanly effective but is better against MRSA |
|
Definition
| silvadene (silver sulfadiazine) |
|
|
Term
| which of the two types of antimicrobials dealing with burn patients does NOT have sulfa in it |
|
Definition
| sulfamylon (mafenide acetate) |
|
|
Term
| what do they do with the two antimicrobials dealing with burn patients |
|
Definition
|
|
Term
| which one of the antimicrobials dealing with burns causes an acid-base imbalance |
|
Definition
| sulfamyalon (mafenide acetate) d/t it being a carbonic anhydrase inhibitor |
|
|
Term
| what type of topical could be used on small burn areas |
|
Definition
|
|
Term
| what two type of dressings are there with burn patients |
|
Definition
|
|
Term
| in the open dressing wound care of burn patients what is done |
|
Definition
| the patient's burn is covered with an ointment and nothing else |
|
|
Term
| what parts of the body would you use the open dressing technique on |
|
Definition
| face, ears, neck, and perineum |
|
|
Term
| what is the purpose of a closed dressing on a burn patient |
|
Definition
| to absorb fluids and-or exudate/ protect wound from contamination and water loss/ can be less pain full |
|
|
Term
| with an open dressing change with a burn patient what seems to be easier |
|
Definition
|
|
Term
| what don't you want the burn area to do |
|
Definition
|
|
Term
| what are some of the purposes of skin grafting in burn patients |
|
Definition
| close wound and minimize infection/ prevent fluid loss/ restore appearance and function/ protect/dress a recipient bed for a permeanent graft |
|
|
Term
| what is the PRIMARY reason for skin grafting in a burn patient |
|
Definition
| close the wound and minimize infection |
|
|
Term
| where should the skin graft come from dealing with a burn patient |
|
Definition
|
|
Term
| what is a type of temporary biological dressing for burn patients |
|
Definition
|
|
Term
| what are the three types of skin grafts dealing with burn patients |
|
Definition
| auto/ allo/ and heterografts there are others |
|
|
Term
| what are the other types of grafts dealing with burn patients outside of the 3 main ones |
|
Definition
| transcyte/ integra/ and alloderm |
|
|
Term
| where does a transcyte graft come from dealing with burn patients |
|
Definition
| human fibroblast derivatives |
|
|
Term
| where does an alloderm grafts come from dealing with burn patients |
|
Definition
| from a cadaver that the tissue is specially treated |
|
|
Term
| what is an integra graft and how is applied dealing with burn patients |
|
Definition
| an artificial skin that has a bilayer membrane composed of dermis and silicone. the derman layer is layid down first and then the whole thing is wrapped with dressings |
|
|
Term
| what are the 2 thickness types of grafts that are used with burn patients |
|
Definition
| split-thickness and full-thickness |
|
|
Term
| what are the 3 types of split-thickness grafts that are used in burn patients |
|
Definition
| mesh/ sheet/ postage stamp |
|
|
Term
| what are the 2 types of full-thickness grafts used in burn patients |
|
Definition
|
|
Term
| what areas are split-thickness grafts used on in burn patients |
|
Definition
|
|
Term
| what areas are full-thickness grafts used on in burn patients |
|
Definition
| weight bearing areas and areas with a lot of friction |
|
|
Term
| how long does it usually take a graft donor site to heal in burn patients |
|
Definition
|
|
Term
| what is the tool called that is used to havest a skin graft in burn patients |
|
Definition
|
|
Term
| how long after taking a skin graft do you have to wait until that site can be used again in burn patients |
|
Definition
|
|
Term
| how long do you leave a dressing on a skin graft before changing it when dealing with a burn patient |
|
Definition
|
|
Term
| what are some causes of a skin graft to fail dealing with a burn patient |
|
Definition
| fluid collected under the graft/ movement caused a shearing effect/ there was eschar left on the graft bed/ there was edema and vascular compression/ presence of infection/ poor nutrition or negative nitrogen balance |
|
|
Term
| what are some skin or structural complications that can occur dealing with skin grafts and burn patients |
|
Definition
| hypertrophic scarring/ contractures/ pruritis/ loss of neurologicl function or sensation/ loss of pleasing cosmetic or beauty appearance |
|
|
Term
| what are some wound healing interventions that can be used in burn patients |
|
Definition
| positioning (elevate burnt extremity and keep extended)/ pressure garment 23/24 hrs per day (air dry after washing)/ gel pad or donuts/ splints/ exercise (to prevent contractures)/ skin lubicants (for itchy skin and to keep moist) |
|
|
Term
| what is the best way to get calories into a patient |
|
Definition
|
|
Term
| what are some off the wall miscellaneous complications that can occur dealing with burn patients |
|
Definition
| fecal impaction/ cystitis or urethritis/ decubitus ulcers/ pancreatitis/ hepatic function disturbed/ starvation/ depression/ chronic pain/ PTSD |
|
|
Term
| what is the progressive degenerative disorder where plaques form along myline sheath of white matter neurons in brain and spinal cord |
|
Definition
|
|
Term
| what age range does multiple sclerosis show up |
|
Definition
|
|
Term
| if your twin is diagnosed with multiple sclerosis what is the percentage that you will be diagnosed with it |
|
Definition
|
|
Term
| is there random demylination that happens with multiple sclerosis |
|
Definition
|
|
Term
| the demylination of multiple sclerosis is seen in which 3 areas mostly |
|
Definition
| optic nerve/ brainstem/ cerebellum |
|
|
Term
| what are the 2 main classifications of multiple sclerosis |
|
Definition
| relapsing-remitting -and- chronic-progressive |
|
|
Term
| which classification of multiple sclerosis does 80% fall into |
|
Definition
|
|
Term
| what is the MOST COMMON complaint with people that have the onset of and ongoing course of multiple sclerosis |
|
Definition
|
|
Term
| is the weakness on one side or both sides dealing with multiple sclerosis |
|
Definition
|
|
Term
| does one side or both sides experience sensory changes dealing with multiple sclerosis |
|
Definition
|
|
Term
| what visual deficits does a patient with multiple sclerosis usually have |
|
Definition
| color, perception, acuity and fatigue |
|
|
Term
| what are signs of pain and paresthesias does a patient with multiple sclerosis show |
|
Definition
| neuralgia or spasm/ clumbsy, or abnormal gait |
|
|
Term
| name some typical recoveries that may occur dealing with head injury patients of all levels |
|
Definition
| some deficits in cognitions, motor and sensory/ long rehab/ unpredictable outcomes/ increased dependence/ depression/ chronic seizure disorder/ hydrocephalus/ and-or pain |
|
|
Term
| during diagnostics of a patient with multiple sclerosis, what has to be indicated in the history assessment |
|
Definition
|
|
Term
| what is the purpose of an MRI of the brain and/or spine in a MS patient |
|
Definition
| to look for plaques/ but plaques may not show up on the first scan |
|
|
Term
| when testing the CSF of a MS patient what will be elevated in the test |
|
Definition
| oligoclonal immunoglobulin G |
|
|
Term
| why are evoked responses delayed in MS patients |
|
Definition
| d/t latency (or delays) in nerve conduction. the decrease nerve conduction is from the eye and ear to the brain |
|
|
Term
| in outcomes of a MS patient what is the major focus |
|
Definition
|
|
Term
| what is used IV to treat inflammation during exacerbations or relapses in MS patients |
|
Definition
| coticosteroids: prednisone, methylprednisolone, or ACTH |
|
|
Term
| what procedure is performed on the blood of MS patients to filter out toxins, and the patients usually have a 40% improvement |
|
Definition
|
|
Term
| what pharmacological therapy is used in MS patients that cost $10,000/yr, is usually given with the 1st episode of the disorder, and might protect surrounding cells from inflammation |
|
Definition
| interferon-B (betaseron) this is an anti-viral drug |
|
|
Term
| what new drug is used in MS patients which is a potent immunosuppressant and used in more progressive frequent relapses |
|
Definition
|
|
Term
| what drug is used in MS patients which is a polypeptide and helps with stimulation of the immune system |
|
Definition
| glatiramer acetate (copaxone) |
|
|
Term
| what drug is used in MS patients that was shown in the initial research to possibly reduce frequency of relapses |
|
Definition
|
|
Term
| what drug is used in MS patients to decrease the complication of fatigue |
|
Definition
|
|
Term
| what drugs in MS patients help to reduce the complication of spasms |
|
Definition
| baclofen (lioresal)/ dantrolene (dantrium)/ diazepam (valium) |
|
|
Term
| which 2 of the 3 antispastic drugs used in MS patients may make weakness worse |
|
Definition
| baclofen (lioresal) and dantrolene (dantrium) |
|
|
Term
| which 1 of the 3 antispastic drugs used in MS patients is common for causing fatigue and addiction |
|
Definition
|
|
Term
| what is a huge problem in MS patients dealing with the urinary system |
|
Definition
|
|
Term
| dealing with the neurogenic bladder in a MS patient which drug is used for spasms around the sphincter |
|
Definition
| propantheline (pro-banthine) |
|
|
Term
| dealing with the neurogenic bladder in a MS patient which drug is used to relax the smooth muscles |
|
Definition
|
|
Term
| dealing with the neurogenic bladder in a MS patient which drug is used for retention |
|
Definition
|
|
Term
| dealing with MS patients which drug is used for trigeminal pain |
|
Definition
|
|
Term
| which tricyclic antidepressant is given in low doses to treat pain in MS patients |
|
Definition
|
|
Term
| list some complications in MS patients |
|
Definition
| reduced energy/ inhibition of motor control/ interference with self-care/ alteration in sexual activity/ disruption in job and recreational activities/ contractures and pressure ulcers (both d/t immobility)/ sometimes tremors/ resp. complications/ depression/ alteration in coping/ infection esp in lungs and bladder |
|
|
Term
| 10% of MS patients do well for more than how many years |
|
Definition
|
|
Term
| what is part of discharge planning and teaching of the patient with MS |
|
Definition
| course of the disease/ identifying triggers (stress or fatigue)(avoid temp changes)/ medication management/ community resources available/ adaptive aids available |
|
|
Term
| which degenerative disorder is a disease of the basal ganglia characterized by a slowing down in the initiation and execution of movement(bradykinesia), increased muscle tone (rigidity), tremor at rest, and impaired postural reflexes |
|
Definition
|
|
Term
| which degenerative disorder was also known as shaking palsy and has been around for 7,000 years. |
|
Definition
|
|
Term
| this degenerative disorder is not diagnosed or symptoms show up until 70-80% of the neurons that produce dopamine are degenerated or destroyed |
|
Definition
|
|
Term
| what is the classic triad of clinical manifestations in parkinson's disease |
|
Definition
| bradykinesia/akinesia, tremor, rigidity |
|
|
Term
| what do the tremors in parkinson's patients look like, and how long do they usually last for and when are they seen |
|
Definition
| pill rolling, 3-4 seconds, and are always at rest |
|
|
Term
| in which degenerative disorder does the patient become frozen and there is nothing they can do about it |
|
Definition
|
|
Term
| which degenerative disorder will the patient have a slowed gait, shuffle their feet, posture is stooped, drool, and are soft spoken |
|
Definition
|
|
Term
| what is the best diagnostic test for parkinson's disease |
|
Definition
| see if they respond to carbidopa (levadopa) |
|
|
Term
| what is the biggest care management intervention you can do for a patient with parkinson's disease |
|
Definition
|
|
Term
| what is the best treatment for parkinson's disease |
|
Definition
|
|
Term
| what are some problems with levadopa or carbidopa (sinemet) |
|
Definition
| it has an on/off effect, the longer someone is on it the less effective it is then need to increase dose d/t a tolerance build up |
|
|
Term
| which parkinson's drug is used because some think that it will slow the process |
|
Definition
|
|
Term
| which 2 parkinson's drugs are a synthetic dopamine agonist that is used in the young |
|
Definition
| bromocriptine (parlodel) and pergolide (permax) |
|
|
Term
| which antiviral drug helps with some bladder problems in parkinson's patients |
|
Definition
|
|
Term
| which 2 anticholinergic drugs help to balance dopamine and acteylcholine in parkinson patients |
|
Definition
| trihexyphenidyl (artane) and beztropine bitartrate (cogentin) |
|
|
Term
| which surgical procedure is done in parkinson's patients to help control the tremors. it can be turned on and off by the patient. this is thought to be somewhat safer than other surgical procedures |
|
Definition
|
|
Term
| for the fetal neural tissue transplant procedure in parkinson's patients, how many fetus are needed to perform the procedure |
|
Definition
| 4-6 and there is a focus of research and ethical debate over this procedure |
|
|
Term
| what is a big issue with parkinson patients |
|
Definition
|
|
Term
| what kind of attack do parkinson's patients have when they become frozen |
|
Definition
|
|
Term
| what are some complications with parkinson's patients |
|
Definition
| falls/ fluctuations in mobility/ psychiatric effects/ sleep disturbance/ risk for injury/ impaired verbal communication/ aspiration and other pneumonias |
|
|
Term
| what disorder is the most common motor neuron disease where special nerve cells that control movement of voluntary muscles cease function and die |
|
Definition
| Amyotrophic Lateral sclerosis (ALS) |
|
|
Term
| around what age does ALS (amyotrophic lateral sclerosis) peak |
|
Definition
|
|
Term
| what does a patient with ALS (amyothrophic lateral sclerosis) usually die from |
|
Definition
|
|
Term
| what are some clinical manifestations in ALS |
|
Definition
| muscle weakness, atrophy and cramps, spasticity, fasciculations, hyperreflexia, bulbar symptoms, respiratory complications |
|
|
Term
| what are some bulbar symptoms in ALS patients |
|
Definition
| difficulty in swallowing and speach is hard to understand |
|
|
Term
| what functions are usually spared in ALS patients |
|
Definition
| cognition, sensation, bowel and bladder functions (except from immobility), autonomic functions, and extraocular movement |
|
|
Term
| what are 2 diagnostic tests done for ALS patients |
|
Definition
| EMG and muscle biopsy (will show atrophy) swallowing tests are done sometimes also |
|
|
Term
| what is the only drug approved by the FDA for ALS, and how long does it prolong life |
|
Definition
| Riluzole, prolongs life for only 3-6 months |
|
|
Term
| what is Quinine given to ALS patients for |
|
Definition
|
|
Term
| which outcome is most focused on in all of the degenerative diseases |
|
Definition
|
|
Term
| what kind of drugs are required for and ALS patient to have a peaceful, and pain-free death |
|
Definition
|
|
Term
| what are some care management interventions done for ALS patients |
|
Definition
| PT/ lag and hand braces/ dressing aids and or assistance/ communication devices/ tracheostomy, suction/ enteral feeding tube/ ventilator |
|
|
Term
| how long is it after a diagnosis of ALS will the patient die |
|
Definition
|
|
Term
| which degenerative disease has to due with infection polyneuritis progression usually starts in legs and then upwards and causes a flaccid paralysis |
|
Definition
|
|
Term
|
Definition
| no and prognosis depends on type |
|
|
Term
| what are some clinical manifestations in guillian-barre patients |
|
Definition
| paresthesias in the toes and fingertips/ few days later leg weakness/ weakness progresses to arms and face/ c/o pain/ diminished or absent DTR's/ LOC normal but are anxious |
|
|
Term
| what are some troubles that occur in severe cases of guillian-barre syndrome and what might the patient need to be put on |
|
Definition
| trouble swallowing/ trouble speaking or articulating (dysarthria)/ these severe patients may need to be put on a vent |
|
|
Term
| what is the main autonomic dysfunction in guillian-barre syndrome patients |
|
Definition
|
|
Term
| what are some autonomic dysfunctions in guillian-barre syndrome patients |
|
Definition
| elebating high BP/ PERRLA not present or normal/ urinary retention/ paralytic ileus/ cardiac dysrhythmias/ sweating disfunction/ |
|
|
Term
| during the history assessment in guillian-barre syndrome patients what is found |
|
Definition
| report of some infection before onset 1-2 weeks before |
|
|
Term
| on the physical exam of a guillian-barre syndrome patient what is found |
|
Definition
| muscle weakness/ respiratory weakness/ pulmonary fuction test is altered/ decrease in nerve conduction volocity on an EMG |
|
|
Term
| on a CSF test in a guillian-barre syndrome patient what might you see an initial drop in and then elevation in |
|
Definition
|
|
Term
| what are meds in guillian-barre syndrome usually used for |
|
Definition
| supportive measures but are not all that effective for anything else/ antibiotics may be used/ and steroids are no longer considered useful |
|
|
Term
| what are some nonpharmacologic interventions that are used in guillian-barre syndrome patients |
|
Definition
| foley for a short time/ PT and respiratory therapy/ adaptive aids/ plasmapheresis |
|
|
Term
| do guillian-barre syndrome patients recover fully very often |
|
Definition
| yes usually with no side affects |
|
|
Term
| what are some complications associated with guillian-barre syndrome |
|
Definition
| irreversible demyelination/ immobility/ respiratory compromise resulting in aspiration, pneumonia or both/ heart block/ Hypertension/ postural hypotension |
|
|
Term
| how long does the course of guillian-barre syndrome usually last |
|
Definition
|
|
Term
| when does muscle function start to improve in guillian-barre syndrome patients |
|
Definition
|
|
Term
| if symptoms of guillian-barre syndrome start in the upper extremities and moves down is there a better or worse prognosis |
|
Definition
|
|
Term
| what is a paroxysmal hypersynchronous discharge of neurons in the brain and are rapid spasm-like discharges |
|
Definition
|
|
Term
| what disease is recurring, nonmetabolic seizures |
|
Definition
|
|
Term
| what metabolic-nutritional disorders can cause seizures |
|
Definition
| F & E abnormalities/ hypoxia/ acidosis/ abrupt drug withdrawal |
|
|
Term
| what are some risk factors for seizures |
|
Definition
| genetic tendency and or chromosomal abnormalities/ head injury/ CVA/ CNS infections/ tumors/ |
|
|
Term
| what are some precipitating factors to seizures |
|
Definition
| sensory stimuli (flashing lights, sounds, computer games)/ specific cognitive, affective or motor activity/ fever or concurrent illness/ fatigue/ sleep deprivation/ stress, fear/ inadequate nutrition/ injury/ hyperventilation/ menses |
|
|
Term
| what are the 3 classifications of seizures |
|
Definition
| partial/ generalized/ unclassified |
|
|
Term
| what are the 2 types of partial seizures |
|
Definition
|
|
Term
| which type of partial seizure does NOT impair consciousness |
|
Definition
|
|
Term
| which type of partial seizure DOES impair the consciousness |
|
Definition
|
|
Term
| which classification of seizures might the patient have amnesia but kids can know everything |
|
Definition
|
|
Term
| what are the 5 types of generalized seizures |
|
Definition
| absence/ myoclonic/ clonic or tonic/ tonic-clonic/ atonic |
|
|
Term
| which type of seizure may have hallucinations, over feeling of dread, jerk of face on one side |
|
Definition
|
|
Term
| which type of seizure is the 2nd most commmon type and has a loss of awareness for a few seconds or minutes |
|
Definition
|
|
Term
| which type of seizure does the patient stare, and has little or no movement, short duration of 15 seconds and probably most common seizure |
|
Definition
|
|
Term
| which type of seizure has a sudden LOC, stiff neck, incontinent, may bite tongue, lasts 1-2 minutes, very lethargic and sleeps for few minutes to hours after the seizure |
|
Definition
|
|
Term
| which type of seizure has a sudden jerk of body for 1-2 seconds |
|
Definition
|
|
Term
| which type of seizure has a loss of muscle tone |
|
Definition
|
|
Term
| in the history assessment portion of a seizure patient what info needs to be obtained and what on physical assessment |
|
Definition
| med history/ family history/ history of infections/ and on physical exam history of head trauma and asymmetry of limbs |
|
|
Term
| when is an EEG helpful in seizure patients |
|
Definition
| only during the seizure, and normal does NOT rule out epilepsy |
|
|
Term
| what is brain imaging used for in seizure patients |
|
Definition
| rule out strokes, tumors, aneurysms, infections |
|
|
Term
| what observations are observed and noted for seizure patients |
|
Definition
| note time when start and finish seizure/ do they breathe or become cyanotic/ do they sweat, drool or incontinent/ are they able to respond during event/ what is their memory of the event/ do they have lethargy or confusion after the event/ do they complain of headache/ and assess for any other injuries |
|
|
Term
| what are some nonpharmacological interventions for seizures |
|
Definition
| avoid precipitating factors/ develop good coping skills/ TEACH, TEACH, TEACH |
|
|
Term
| what are some precipitating factors to seizures |
|
Definition
| fatigue and stress are big ones, sleep deprivation, concurrent illness |
|
|
Term
| if the seizure patient cannot avoid precipitating factors what should they do when they feel the seizure coming on |
|
Definition
| if they feel it coming on they should get to a safe place usually on the floor |
|
|
Term
| how many drugs should be started with to control seizures |
|
Definition
|
|
Term
| increase meds for seizures until what occurs |
|
Definition
| controlled seizures or side effects occur |
|
|
Term
| if the first drug is unsuccessful what should be done dealing with seizure patients |
|
Definition
|
|
Term
| what should be used a guide when dosing for seizure control |
|
Definition
|
|
Term
| what is very important to remember with the drug regiment for seizure patients |
|
Definition
| don't ever miss their doses, when they come into the hospital find out what the regiment is and continue with it |
|
|
Term
| what are some common drugs used for seizure control |
|
Definition
| for partial and generalized tonic-clonic: phenobarbital and phenytoin-dilantin for absence or other generalized: clonazepam-klonopin and depakote |
|
|
Term
| what treatment is the last resort for seizure patients |
|
Definition
| surgery and this is only done with they know for sure where the abnormal firing is going on |
|
|
Term
| what cause status epilepticus in seizure patients which is one of the complications in seizure patients |
|
Definition
| not taken meds or sudden withdraw of meds and mortality can approach 20% |
|
|
Term
| what are some complications in seizure patients |
|
Definition
| status epilepticus/ injuries (d/t falls, biting tongue or cheek, fractures, or burns)/ sudden unexplained death (d/t cardiac arrhythmias) |
|
|
Term
| what is a protein that causes an antibody response |
|
Definition
|
|
Term
| what is an immunoglobulin produced by lymphocytes |
|
Definition
|
|
Term
| when B cells recognize an antigen and stimulate Ab production what occurs |
|
Definition
| antigen-antibody reaction this stimulates B cells |
|
|
Term
| this increases B cell activity and causes lysis of the antigenic cells |
|
Definition
|
|
Term
| what is an altered immunologic reaction to an antigen that results in a pathologic immune response after re-exposure |
|
Definition
|
|
Term
| when there is a hypersensitivity to environmental antigens this is called a what |
|
Definition
|
|
Term
| when there is a hypersensitivity to an antigen from another person this is called a what |
|
Definition
|
|
Term
| when there is a disturbance in immunologic tolerance to self-antigens this is called what |
|
Definition
|
|
Term
| disorders that are associated with autoimmunity are called what |
|
Definition
|
|
Term
| when the immune system reacts against self-antigens and destroys host tissues and cannot differentiate between slef and non-self this is called what |
|
Definition
|
|
Term
|
Definition
| antibodies against self-antigens |
|
|
Term
| what part of the body does rheumatoid arthrits affect |
|
Definition
|
|
Term
| what part of the body does myasthenia gravis affect |
|
Definition
|
|
Term
| what part of the body does systemic lupus erythematosus affect |
|
Definition
|
|
Term
| what part of the body does scleroderma affect |
|
Definition
|
|
Term
| which autoimmune disease is a chronic systemic disease characterized by inflammation of connective tissue in the diarthroidal joints (freely moveable joints lined with synovium) |
|
Definition
| rheumatoid arthritis this is localized to joints but can have systemic effects |
|
|
Term
| what is a freely movable joint in which contiguous byny surfaces are covered by articular cartilage and connected by a fibrous connective tissue capsule lined with synovial fluid |
|
Definition
|
|
Term
| when does the incidence of Rheumatoid arthritis increase and when does it peak |
|
Definition
| increases in the 30's and peaks between 40's and 60's |
|
|
Term
| in the inflammatory response during Rheumatoid Arthritis neutrophils are activated and degrade surface layer of what |
|
Definition
|
|
Term
| in the inflammatory response during Rheumatoid Arthritis cytokines cause chondrocytes to attack what |
|
Definition
|
|
Term
| what digests nearby cartilage which releases more inflammatory molecules worsening the situation in Rheumatoid arthritis during the inflammatory response |
|
Definition
|
|
Term
| what are joint symptoms in rheumatoid arthritis |
|
Definition
| pain/ stiffness/ limited ROM/ inflammation-heat, swelling, tenderness/ symmetrical involvement on both sides/ morning stiffness/ ulnar drift/ subluxation (partial dislocation)/ swollen joints |
|
|
Term
| in rheumatoid arthritis what are the onset insidious (develop gradually before becoming apparent) and nonspecific clinical manifestations |
|
Definition
| fatigue/ anorexia/ weight loss/ generalized stiffness |
|
|
Term
| which joints in rheumatoid arthritis are the first to be affected |
|
Definition
| PIP & MIP and then move to larger joints |
|
|
Term
| what helps to relieve the pain in rheumatoid arthritis patients |
|
Definition
|
|
Term
| when is stiffness at its worst in rheumatoid arthrtits patients |
|
Definition
|
|
Term
| what is the treatment for raynaud's phenomenon |
|
Definition
|
|
Term
| how long does an episode of raynaud's last |
|
Definition
|
|
Term
| what part of the process is the most painful in raynaud's |
|
Definition
| when vessels re-dilate and blood comes rushing back to tips |
|
|
Term
| which parts of the body does raynaud's effect |
|
Definition
| fingers, toes, nose and ears |
|
|
Term
| what are the color changes of raynaud's |
|
Definition
|
|
Term
| what are some precipitating factors to raynaud's |
|
Definition
| cold, emotions, caffeine, tobacco |
|
|
Term
| what should you teach patients with raynaud's to avoid and about their clothing |
|
Definition
| wear loose clothing and avoid temp extremes and precipitating factors |
|
|
Term
| why is infection a complication in rheumatoid arthritis |
|
Definition
| because the meds they are on are immunosuppressants |
|
|
Term
| what are some complications of rheumatoid arthritis with two of them kind of going hand-in-hand |
|
Definition
| infection, osteoporosis, spinal cord compression, pain and decreased mobility (osteoporosis and spinal cord compression go hand-in-hand) |
|
|
Term
| if which antibody is positive will start the inflammatory process and is a diagostic test for rheumatoid arthritis, systemic lupus erythematosus, and myasthenia gravis |
|
Definition
| ANA (antinuclear antibody) |
|
|
Term
| which three autoimmune disorders is the diagnostic test ESR used in and what is it non-specific for |
|
Definition
| Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Scleroderma, it is nonspecific for inflammation |
|
|
Term
| which diagnostic test is the gold standard for rheumatoid arthritis |
|
Definition
| synovial fluid analysis (this is done by aspirating some synovial fluid from the joint) |
|
|
Term
| what does a CBC in rheumatoid arthritis show |
|
Definition
|
|
Term
| what are some care management subjective assessments for rheumatoid arthritis |
|
Definition
| past history of exacerbations (stress, child birth)/ medications/ surgery (any joint replacements)/ perception of health/ nutrition (wt. loss, dry mucosa)/ any elimination problems/ activity (do they c/o morning stiffness)/ |
|
|
Term
| what are some care management objective assessments for rheumatoid arthritis |
|
Definition
| any swollen glands/ is their skin taught, red, shiny, or do they have any nodules/ any changes in the tips of fingers, toes, nose, or ears/ what does their spleen look like/ which joints are involved at this time |
|
|
Term
| what are some drugs used to treat rheumatoid arthritis |
|
Definition
| DMARDS/ plaquenil/ ASA/ NSAIDS/ corticosteroids/ immunosuppressants/ gold-salts/ antibiotices |
|
|
Term
| how are gold-salts administered in rheumatoid arthritis and what do they inhibit |
|
Definition
| IV, sub-Q, or into the joint/ they inhibit T & B cells |
|
|
Term
| what does DMARDS stand for, this is a treatment for rheumatoid arthritis and what type of drug are these and what do they do |
|
Definition
| diesase-modifying antirheumatic drugs/ anti-inflammatory/ they inhibit the enzymes from destroying joint cartilage |
|
|
Term
| what are some bad things about the use of corticosteroids |
|
Definition
| bad wound healing/ hyperglycemia/ wt. loss/ stop taking suddenly and adrenal glands stop working and cause adrenal insufficiency |
|
|
Term
| what type of drug is plaquenil which is used in rheumatoid arthritis and what does it cause, and what must the patient get every 6 months, and how long are patients on this drug |
|
Definition
| anti-malarial drug/ causes retinal damage/ needs eye exam every six months/ on drug for life |
|
|
Term
| what are some interventions in rheumatoid arthitis |
|
Definition
| education/ nutrition/ balance activity/ heat or not to heat/ ambulate/ psychological support |
|
|
Term
| what do you educate rheumatoid arthritis patients about |
|
Definition
| triggers/ if sore after 30 minutes of activity they have over done it/ use of splints to stabalize joints |
|
|
Term
| what about nutrition do you need to teach a rheumatoid arthritis patient |
|
Definition
| make foods that are easy to prepare/ and limit Na |
|
|
Term
| when should you use heat or ice in a rheumatoid arthritis patient |
|
Definition
| ice during exacerbations and heat for maintainence |
|
|
Term
| which disorder is the chronic autoimmune disease of the neuromuscular junction characterized by muscle weakness and fatiguability |
|
Definition
|
|
Term
| what is going on with myasthenia gravis |
|
Definition
| antibodies are attacking the acetylcholine receptors at neuromuscular junctions, this prevents acetylcholine from attaching to the receptors to stimulate muscle contractions. there can also be a decrease in the production of acetylcholine in this disorder |
|
|
Term
| what are some clinical manifestations of myasthenia gravis |
|
Definition
| ocular weakness/ ptosis (droopy eyelids)/ blurred vision/ facial muscle weakness/ difficulty chewing and-or swallowing/ fatigue/ slurred speech/ stiffness/ parasthesia (sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect, feels like pins and needles)/ difficulty breathing |
|
|
Term
| what are some triggers of myasthenia gravis |
|
Definition
| emotional stress/ pregnancy/ 1st menses/ illness/ trauma/ temp extremes |
|
|
Term
| what are some breathing complications associated with myasthenia gravis |
|
Definition
| muscles are fatigue and cannot cough or deep breathe |
|
|
Term
| what is a swallowing complication with myasthenia gravis |
|
Definition
|
|
Term
| what may cause infections with myasthenia gravis |
|
Definition
| triggers or being on immunosuppressants |
|
|
Term
| should a tensilon test be positive or negative in myasthenia gravis and what does this test show |
|
Definition
| it is hopefully positive/ it reveals improved muscle contractility after IV injection of anticholinesterase agent (tensilon) |
|
|
Term
| after injecting the tensilon (anticholonesterase agent) when do you see improvement and how long will it last |
|
Definition
| improvement in 30-60 seconds and last for several minutes |
|
|
Term
| what are some assessments done on patients with myasthenia gravis |
|
Definition
| fatigability/ client and family coping (how is everyone dealing with it)/ RR and depth/ ABG's/ muscle strength and mobility/ ability to swallow/ speech (may need to consult for this)/ cough and gag reflexes |
|
|
Term
| what is the difference between a myasthenic and chlinergic crisis |
|
Definition
| both are acute exacerbations of muscle weakness/ myashtenic follows a precipitating factor, or failure to take med, or dose is to low/ cholinergic crisis is d/t overdose of antichlinesterase, and will detiorate if given antichlinesterase |
|
|
Term
| one intervention in myasthenia gravis is to give anticholinesterase when and why |
|
Definition
| before meals in order to increase responses so they can chew, eat and swallow |
|
|
Term
| one intervention in myasthenia gravis patients is to do a thymectomy why |
|
Definition
| it can resolve some problems/ thymus gland in located in the chest behind the upper sternum |
|
|
Term
| one intervention in myasthenia gravis is to plan activities what does this involve |
|
Definition
| doing baths and other things early in the day as not to wear the patient out later in the day |
|
|
Term
| what kind of nutritional intervention is seen in myasthenia gravis patients |
|
Definition
| mechanical soft food, increased protein, and need to be watched when eating |
|
|
Term
| one intervention in myasthenia gravis patients is to have suction set up at bed side why |
|
Definition
|
|
Term
| what can be used if they are to exhausted to speak with myasthenia gravis |
|
Definition
|
|
Term
| in plasmapheresis what is removed from the plasma, what is this procedure reseved for, and how much is withdrawn at a time |
|
Definition
| inflammaory mediators & antibodies are removed and plasma re-infused/ this is reserved for acute exacerbations/ 500 ml removed at one time |
|
|
Term
| which disorder is a chronic mulisystem inflammatory disease affecting skin, joints, serous membranes (pleura, percardium), renal, hematologic, and neurologic systems |
|
Definition
| systemic lupus erythematsus |
|
|
Term
| what are some possible causes of systemic lupus erythematsus |
|
Definition
| genetic influence/ hormonal influence (onset after females 1st period, during use of BCP's/ or during or after pregnancy)/sun exposure has a link/ infectious agents/ medications |
|
|
Term
| how old are most peolpe when developing system lupus erythematsus |
|
Definition
| 20-40 and greater in african americans than whites |
|
|
Term
| in systemic lupus erythematosus there is an autoimmune reaction against comonents of cell nucleus especially what |
|
Definition
|
|
Term
| in systemic lupus erythematosus patients immune complexes form and deposit where |
|
Definition
| basement membranes of glomerulus of the kidney, brain, heart, spleen, GI tract, skin and peritoneum |
|
|
Term
| manifestations of systemic lupus erythematosus depend on what |
|
Definition
| which cells types or organs that are involved |
|
|
Term
| what are some generalized clinical manifestations of systemic lupus erythematosus |
|
Definition
| fever, wt. loss, arthralgia (achy joints), excessive fatigue |
|
|
Term
| what are some dermtological clinical manifestations of systemic lupus erythematosus |
|
Definition
| sub-acute cutaneous lupus red areas all over, ulcers in nose membranes, alopacia, malar or butterfly rash on cheeks and bridge of nose (in 50% of lupus patients) |
|
|
Term
| what are some musculoskeletal clinical manifestations of systemic lupus erythematosus |
|
Definition
| 92% have achy joints and muscles and have AM stiffness |
|
|
Term
| what are some cardiopulmonary clinical manifestations in systemic lupus erythematosus |
|
Definition
| pluerasy, tachypnea, can have accelerated CAD (heart attack or stroke) |
|
|
Term
| what are some renal clinical manifestations of systemic lupus erythematosus |
|
Definition
| renal insufficiency (protein uria, increased BP) lupus nephritis (may be mild protien uria to glomerial nephritis) |
|
|
Term
| what are the neurological clincial manifestations of systemic lupus erythematosus |
|
Definition
| anything from seizures, neuropathies to psych problems |
|
|
Term
| what are the hematological clinical manifestations of systemic lupus erythematosus |
|
Definition
| anemias and coagulopathies |
|
|
Term
| what are the muscles most involved in systemic lupus erythematosus |
|
Definition
| eyes, eyelids, chewing, swallowing, speaking, and breathing muscles strongest in the morning and very fatigued later in the day |
|
|
Term
| what is infection usually caused by in systemic lupus erythematosus |
|
Definition
| meds and decreased production of antibodies |
|
|
Term
| when do exacerbations occur during pregnancy in myasthenia gravis |
|
Definition
late in pregnancy or right after birth
infants that develop this usually have pericarditis and can cause conduction problems |
|
|
Term
| one of the main complication of systemic lupus erythematosus is pneumonia what usually causes this |
|
Definition
| immuno compromised and restricted lung disease |
|
|
Term
| stroke is a major complication in systemic lupus erythematosus patients what is usually the cause for this |
|
Definition
| d/t increase of atherosclerosis (CAD) and coagulopathy |
|
|
Term
| most diagnostic dealing with systemic lupus erythematosus are used for process of elimination which one is specific to systemic lupus erythematosus |
|
Definition
| Anti-SM (Smith) antibody test and is present in 30% of systemic lupus erythematosus patients and there is an increase in this antibody |
|
|
Term
| what is the skin biopsy called when trying to diagnose systemic lupus erythematosus and will be positive if patient has systemic lupus erythematosus |
|
Definition
| Lupus Erythematosus cell prep test |
|
|
Term
| what is a general assessment and skin assessment found with patients that have systemic lupus erythematosus |
|
Definition
| generally have fever and skin has rashes |
|
|
Term
| what are some respiratory assessments with systemic lupus erythematosus patients |
|
Definition
|
|
Term
| what are some cardiovascular and GI assessments found in systemic lupus erythematosus patients |
|
Definition
| CV-murmurs and raynaud's GI-ulcers and spleenomegaly |
|
|
Term
| what are some neurologic and musculoskeletal assessments found in systemic lupus erythematosus patients |
|
Definition
| N-seizures and hallucinations M-joint deformity |
|
|
Term
| is pervention possible with systemic lupus erythematosus |
|
Definition
|
|
Term
| what interventions are done with patients on steroids if they have systemic lupus erythematosus |
|
Definition
| Monitor I&O, daily weights, strict fluid management |
|
|
Term
| what do you educate systemic lupus erythematosus patients on to avoid |
|
Definition
|
|
Term
| how long will systemic lupus erythematosus patients be on NSAIDS |
|
Definition
| for life t prevent inflammation |
|
|
Term
| when are corticosteroids used in patients with systemic lupus erythematosus |
|
Definition
|
|
Term
| what is the name of the immunosuppressant that a patient with systemic lupus erythematosus will be on |
|
Definition
|
|
Term
| what is the name of the anit-malarial drug that the patient with systemic lupus erythematosus will be on |
|
Definition
|
|
Term
| in systemic lupus erythematosus patients that are pregnant, where do complexes deposit and what could happen after it is deposited |
|
Definition
| deposit in the placenta and umbilical cord, can cause decreased blood flow to baby, low bth wt or death of baby |
|
|
Term
| a disorder of connective tissue characterized by fibrotic degenerative and inflammatory changes. affects skin, blood vessels, synovium, skeletal muscle, internal organs |
|
Definition
|
|
Term
| what is the cardinal feature in scleroderma but amount varies in each stage |
|
Definition
|
|
Term
| what does the skin look like in scleroderma patients |
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Definition
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Term
| what are some risks to aquiring scleroderma |
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Definition
| occupational exposure to coal, plastics, silica dust |
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Term
| what becomes overproduced in the patho of scleroderma |
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Definition
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Term
| what happens to the platelets in scleroderma patients |
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Definition
| they become aggregated and fibrosis occurs and this leads to disruption of normal functioning |
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Term
| *what are the 3 stages of scleroderma* |
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Definition
| diffuse, crest, (linear, localized, or limited) not sure what the third one is the book called it localized or limited |
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Term
| which one of the three stages of scleroderma is the most severe, what is it onset and what does it damage |
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Definition
| diffuse is most severe, onset is rapid, and damages internal organs |
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Term
| which one of the 3 stages of scleroderma has a better prognosis, what is its onset, what is most affected in this stage |
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Definition
| crest stage has a slow onset, it affects the skin on the hands and feet mostly, internal organs less severe damage, and this stage is limited |
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Term
| what does CREST stand for in the disorder of scleroderma |
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Definition
C-calcinosis (painful deposits in skin)
R-raynaud's phenomen
E-esophageal dysfunction (difficult swallowing d/t scarring)
S-sclerodactyly (tightening of skin on hands)
T-telangiectasia (spider veins) |
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Term
| what does the skin all over the body look like in scleroderma patients |
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Definition
| symmetric PAINLESS swelling, leathery & thickening, decreased elasticity, appears taut and shiny, masklike face, tightly pursed lips, digital ulcers |
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Term
| what is going on with the scleroderma patient d/t esophogeal fibrosis |
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Definition
| dysphagia, severe reflux, constipation, bowel obstruction and poss. perferation of bowels |
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Term
| what is going on with the lungs in a scleroderma patient |
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Definition
| pleural thickening, pulmonary fibrosis, they develop a cough and dyspnea, all of this is d/t tightening of the skin around the chest wall |
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Term
| what is going on cardiac wise with a scleroderma patient |
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Definition
| they develop a cardial rub and arrhythmias, pericarditis, pericardial effusion. patients in diffuse stage develop CHF d/t the fibrosis |
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Term
| what is the major cause of death in scleroderma patients |
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Definition
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Term
| what is going on in the renal system of scleroderma patients |
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Definition
| deposits in glomerulus, malignant hypertension associated with rapidly progressive and irreversible renal insufficiency is often present |
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Term
| how long after the diagnosis of scleroderma does a patient usually live |
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Definition
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Term
| which diagnostic test is specific to scleroderma skin or visceral biopsy, CXR, anticentromere antibody, or SCL-70 |
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Definition
| anticentromere antibody SCL-70 is only positive in 30% of scleroderma patients |
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Term
| in the assessment of the skin in scleroderma patients what are you looking for |
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Definition
| skin breakdown and checking for sensation |
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Term
| when assessing the respiratory system in a scleroderma patient what are you listening for |
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Definition
| friction and listening to lung sounds |
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Term
| when doing an assessment of the cardiac system in a scleroderma patient what should you ask them if they are feeling |
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Definition
| palpitations, syncope, or dizziness |
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Term
| when doing an assessment of the GI tract in a scleroderma patient what sould you ask them if they are experiencing or not |
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Definition
| dysphagia (difficulty swallowing), dyspepsia (build up of acid as in reflux), or constipation |
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Term
| what does therapeutic exercise do for a scleroderma patient and what should you apply to their skin to keep moist |
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Definition
| exercise maintains joints and flexibility, aquaphor should be used to keep skin moist |
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Term
| should you do finger sticks on scleroderma patients, why or why not |
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Definition
| no, d/tcompromised circulation and poor healing |
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Term
| what should people with scleroderma do after eating |
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Definition
| sit up right at least 1-2 hours after meals |
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Term
| what is used for the dyspepsia in scleroderma patients |
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Definition
| antacids (usually 45-60 minutes after meals), H2 blockers, and PPI's |
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Term
| what is D-penicillamine used for in scleroderma |
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Definition
| it increases slouility of collegen and thins the skin |
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|
Term
| what is Ca channel blockers used for in scleroderma |
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Definition
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Term
| what are Anti-hypertension meds used for in scleroderma |
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Definition
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