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What is Parkinson's Disease caused by?
Deficiency of Dopamine
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4 Cardinal symptoms of Parkinson's?
- Tremor (pill rolling)
- Rigidity (cogwheel)
- Bradykinesia
- Postural Instability
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What should you be aware of about Dopamine Agonist drugs such as Levodapa & Sinement used for Parkinson's?
Cause Orthostatic Hypotension, drowsiness, hullicanations, etc.
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Which Stage of Parkinson's?
Unilateral
Minimal weakness
Trembling
Stage 1
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Which Stage of Parkinson's?
Bilateral
Masklike facies
Shuffling gait
Stage 2
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Which Stage of Parkinson's?
Postural Instability
Gait Disturbance
Stage 3
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Which Stage of Parkinson's?
Akinesia
Rigidity
Stage 4
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Which Stage of Parkinson's?
Complete Dependence
Stage 5
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Patient teaching for Eldepryl for Parkinson's?
Avoid TYRAMINE (cheese, wine, beer)
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What are the Side Effects of Cogentin used for Parkinson's?
Dry Secretion... cant pee, cant see, cant spit, cant shit etc.
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Nursing Diagnosis for Parkinson's?
Risk for Falls, Aspiration, & Risk for poor Nutrition
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Which types of therapy should you do for Stage 1 Alzheimer's Disease?
Reality Orientation & Reminiscence Therapy
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Which types of therapy should you do for Stage 2 Alzheimer's Disease?
Validation & Redirection
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Intervention for alzheimer's pt?
- Establish daily routine
- Do not overstimulate
- Place armband on them
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Nursing Diagnosis for Alzheimers?
- Chronic Confusion
- Risk for Injury
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What is Huntington's Disease due to?
Decrease in GABA & Ach
EXCESS DOPAMINE
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S/S of Huntington's?
Choreiform Movements (rapid, jerk movements) & Mental status change r/t dementia
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Nursing Diagnosis for Huntington's?
- **Risk for aspiration r/t impaired swallowing
- Imblanaced nutrition
- Impaired skin integrity
- Impaired verbal communication
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What disorder is characterized by many exacerbations and remissions that progesses to an increasing loss of function?
Multiple Sclerosis
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What is affected in Multiple Sclerosis that causes the problems?
Myelin Sheath
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What are some thing people with MS should avoid?
- Alcohol
- Laxatives
- Stress
- Fatigue
- Overexertion
- Extreme temps
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What are the 2 main early manifestations you will notice with MS?
Vision changes (double/blurred) & FATIGUE
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What is Myasthenic crisis due to?
UNDERMEDICATION
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what is Cholinergic Crisis due to?
OVERMEDICATION
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If someone has a Myasthenic Crisis, how would we treat this?
Watch for sudden respiratory distress BUT drugs would be held for 2 days then resumed slowly
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Myasthenic or Cholinergic Crisis?
S/S: Tachycardia, tachypnea, hypertension, dysphagia
Myasthenic
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Myasthenic or Cholinergic Crisis?
S/S: N/V, diarrhea, blurred vision, pallor, hypotension, facial muscle twitching
Cholinergic Crisis
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How would you treat Cholinergic Crisis?
Hold drugs and give ATROPINE 1 mg
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What is the antidote for Tensilon?
Atropine
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Tensilon Test:
Improvement in muscle strength within 30-60 seconds for 5 min
Myasthenia Gravis
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Tensilon Test:
Improvement
Myasthenic Crisis
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Tensilon Test:
No improvement
Cholingergic Crisis
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What are you at risk for when doing a Tensilon test?
VFib & Cardiac Arrest
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Pt. teaching about meds for Myasthenia Gravis?
Take on time & take before activities
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What should family members know for Myasthenia Gravis?
CPR
O2 and intubation tray at bedside & airway resuscitation supplies at bedside
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What disease is where the muscles cannot contract?
Myasthenia Gravis
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Which syndrome causes ascending paralysis?
guillian barre
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What is the biggest concern for gullain barre?
Respiratory Statues - elevate HOB, suction, humidified O2, etc.
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What causes excruciating facial pain? (cranial nerve 5)
Trigeminal Neuralgia
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What are triggers for Trigeminal Neuralgia?
Light touch, wind, talking, chewing, brushing, sneezing, shaving, washing, etc.
Fear of Attack
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Nursing Diagnosis for Trigeminal Neuralgia?
Acute PAIN
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Post op care for Rhizotomy?
Assess corneal reflex, facial nerve, clench teeth
Ice pack to effected side
Avoid chewing/rubbing effected side
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Bell's palsy occurs on which cranial nerve?
7
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Treatment for Bell's Palsy?
Corticosteroids, Analgesics, Acyclovir
Heat & gentle massage
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What is Bell's Palsy sometimes related to?
Herpes simplex virus
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Kernig's Sign?
Pain upon trying to extend lower leg after hip and knee is flexed 90 degrees - positive sign suggests meningitis
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Brudzinski's Sign?
place hands behind neck and gently elevate head toward chest & hips and knees will rise as well - suggests meningitis
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CSF analysis of Bacterial Meningitis?
- Cloudy
- Decreased Glucose
- Increased pressure
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What are the 3 S/S of Cushing's Triad?
- Widened pulse pressure
- Bradycardia
- Hypertension
NOTIFY PHYSICIAN!!!
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