orev

  1. Sa endo, ang tinanong, bakit daw may seizure ang dm? + diagnostic test and treatment
    • May seizure ang DM dahil sa hypoglycemia
    • Ang brain kailangan ng sugar para makapagfunction, paghypogly ang isang tao mababa ang sugar niya, so decreased ang sugar na napupunta sa brain kaya nagkakaroon ng abnormal impulses sa brain na nagdudulot ng seizure.

    • Diagnostic Tests:
    • Check blood sugar levels with glucometer.

    • Treatment for diabetic seizure:
    • Huwag irerestrain ang patient during seizure, hayaan lang sa movements niya.
    • Do not put anything sa mouth ng patiet, kasi pwede magcause ng injury.
    • Make sure to clear surroundings to prevent injury.
    • After seizure, make the client take biscuits, or orange juice.
    • To prevent, dapat palaging readily available yung mga simple sugars.
  2. How to know if hypoglycemic in a emergency situation
    • Dapat alam ang signs (warning signs) and symptoms ng hypoglycemia para malaman agad in an emergency situations.
    • Signs and Symptoms of Hyperglycemia:
    • Confusion, dizziness, nausea
    • Feeling hungry
    • Feeling shaky, nervous, irritable
    • Sweating, chills, pale, clammy skin
    • Rapid heartbeat
    • Weakness, and tiredness
  3. Sa neuro, ang pt daw may a-fib, ano raw type of stroke? + bakit yun nangyayari?
    • Ang type of stroke is embolic ischemic stroke.
    • - embolic stroke is usually attributed sa heart problems whereas ang nangyayari ay nagkakaroon ng pooling of blood sa heart (but hindi nagtatravel sa brain, sa heart palang impeded na ang circulation) kaya ang tendency is magkaroon ng ischemia Nangyayari yun dahil sa irregular rhythm nung heart ng patient, since irregular yung heartbeat nagkakaroon ng pooling of blood doon sa atria na pwedeng magcause ng increase formation of clot.- ayan tama sa heart lang, walang BV na affected
  4. What is diabetic polyneuropathy (same lang daw ito sa diabetic neuropathy). Give manifestations, dx procedures, treatment.
    Ito yung nawawalan ng sensation, na pwedeng mag lead sa gangrene (necrosis), or decreased wound healing.

    • Manifestations:
    • Numbness or paresthesia
    • Diminished sensation
    • Decrease libido, painful coitus
    • Absent peripheral pulses

    • Diagnostic Procedures:
    • Assess tendon reflexes
    • Assess overall muscle strength and tone
    • Filament test: yung doctor ay ibrubrush yung areas ng skin para matest yung sensitivity to touch
    • Sensory testing: para malaman kung nagrerespond ba yung nerves sa vibration at changes in temperature
    • Nerve conduction testing: para mameasure kung gaano kabilis yung pagconduct ng electrical signals sa nerves ng arms and legs

    • Treatment:
    • Foot care, skin care para maprevent ang gangrene
    • Icontrol ang hypertension and glucose levels
    • If prescribed, pain meds are given
    • Provide DM meds, if necessary
    • Kung ano management ng DM pwede sa neurodegen
  5. Difference between ischemic and hemorrhagic
    • ISCHEMIC
    • Blood clot sa vessel or narrowing ng artery natin na naglilimit sa oxygenation ng brain cells

    TypesEmbolism: mula sa ibang part ng katawan tapos travel to brainThrombosis: nagform sa artery wall within neck or brain [common example ay atherosclerosis]

    Risk factors“STROKES HAPPEN”

    S/sxFacial drooping, arm weakness, slurred speech, aphasia

    Dx Procedure:CT Scan  

    Treatment: tPA (Tissue plasminogen activator)w/in 3 hours of s/sx onset (!!! contraindicated in hemorrhagic stroke)

    Dini-dissolve ni tPA yung clot by protein activation na ncagcacause ng fibrinolysis (sabihin lang to pag tinanong) Criteria (pag tinanong): dapat sure na walang bleeding na makikita sa CT scan, normal labs, controlled BP, no recent heparin or anticoagulant meds

    • HEMORRHAGIC
    • Bleeding sa brain dahil sa break in blood vessel so walang blood na magpeperfuse sa brain cells and pwede magcause ng excessive swellingE.g. Ruptured aneurysm

    Dx Procedure:CT Scan to rule out bleeding

    Risk factors“STROKES HAPPEN”

    S/sxFacial drooping, arm weakness, slurred speech, aphasia

    Treatment    - craniotomy - gagawin to para irelieve yung pressure sa brain at maalis yung blood

        - surgical clipping - ic-clamp yung base ng aneurysm para matigil ang blood flow
  6. Management ng diabetic seizure during hypoglycemia
    • Huwag irerestrain ang patient during seizure, hayaan lang sa movements niya.
    • Do not put anything sa mouth ng patiet, kasi pwede magcause ng injury.
    • Make sure na clear ang surroundings to prevent injury.
    • After seizure, make the client take biscuits, or orange juice.
    • To prevent, dapat palaging readily available yung mga simple sugars.
  7. Ano raw function ng parathy tapos management kapag may problem? calcium carbonate calcium supplements
    PTH = substance na pinaka affected ay Calcium Nastistimulate ang parathy gland kapag mababa ang serum Calcium or vice versa




    Physio: 

    Mababang Serum Calcium > parathyroid gland stimu > release PTH > dalawa ang affected (BONES + KIDNEY) > (Bones) osteoclast activity = meaning binrebreakdown ang bone for calcium (key word: “clast” = “kalas”) > (Kidney) Ca reabsorption, Phosphate excretion (dahil sa relationship with Ca) & Vit. D activation > Increase Ca levels
  8. Ano raw function ng parathy tapos management
    • HYPERparathyroidism
    • Hypercalcemia + Hypophosphatemia

    • Management:
    • Monitoring VS, ECG, urine (strain) Ca & phosphate, I & O
    • Encourage low Ca diet + high phosphate levels (BUT!! Watch out ang phosphate levels pag may renal problem dahil may tendency na nagkeekeep ng Phosphate) 

    • Parathyroidectomy: 
    • Monitor respi status (dahil sa position ng gland), semi-fowler’s (avoid strain sa surgical site), trach kit by the bed side
    • Watch out for s/sx of decreased CaTingling, numbness, twitching+ Trousseau's or Chvostek’s sign
    • Changes sa voice and possible swallowing problems

    • Medications:
    • Normal saline for hydration

    Calcimimetics: sensipar to decrease PTH, Ca and phosphate 

    Calcitonin: lower Ca levels and protect bones

    Lasix; loop diuretics to inhibit calcium resorption sa renal tubules.. Watch out sa K+ levels kasi wasted


    • HYPOparathyroidism
    • Management: Monitor Ca + Phosphate levels
    • Airway monitoring due to tetany > need trach kit, suctioning, O2 @ bedside
    • Seizure precautionsDiet --- high cal low phosphate
  9. Discuss gbs (manifestation, management, dx test, meds)
    Although rare, GBS is a disorder of the immune system since it attacks or damages nerve cells. Kaya nakakaramdam ng muscle weakness yung patient or yung tinatawag na ascending paralysis.

    • Manifestations:
    • Ascending paralysis (simula sa lower extremities, pataas usually 24-72 hrs)
    • Paresthesia (tingling sensation)
    • Hypotonia (absent deep tendon reflex)
    • Alterations in ANS
    • Alternate hpn and HPN; most feared complication is ARRHYTHMIA
    • Loss of sweating mechanism

    • Diagnostic tests:
    • EMG (nerve conduction is slowed)
    • CSF ANALYSIS/Lumbar puncture (albuminocytologic dissociation; increased protein, slight increase in cell count)
    • SYMPTOMATOLOGY AND HISTORY (for differential diagnosis)

    • Management: No specific therapy; so usually supportive care yung ibinibigay lalo sa mga patient na paralyzed. (monitor breathing, HR and BP).
    • Patients may be put into mechanical ventilation to assist breathing.
    • Monitor for complications.
    • Full recovery often occurs if good supportive care is adequately implemented depends on the extent of damage
    • Intravenous immunoglobulin (IVIG) infusion ng antibodies sa katawan to help calm or modulate immune response
    • Kapag nasa acute phase na, plasmapheresis para matanggal yung excess antibodies. (reverse isolation)

    • Medications:
    • ANTI-ARRHYTHMIC → PROPRANOLOL, ATROPINE
    • INCREASED HR (BETA-BLOCKERS)
    • DECREASED HR (ATROPINE)
    • CONTINUOUS ASSESSMENT!
  10. Hepatic encephalopathy (ammonia)
    Since severely damage na yung liver, hindi na niya makakayang iremove yung toxins sa blood natin hanggang sa magtravel na hanggang sa brain, especially yung ammonia. Nagccross siya sa BBB kasi aromatic in nature.

    • Management:
    • Reduce protein kasi byproduct niya ay ammonia
    • Administer duphalac to excrete ammonia
    • Give neomycin sulfate para malabas yung ammonia sa GIT
    • Administer lactulose to reduce the amount of ammonia in the blood, decreasing the intestinal production and absorption of ammonia.
  11. Differentiation ng gbs at mg
    • MG
    • AutoimmuneInaatake ng body natin ang muscle receptor (acetylcholine receptor) na nagcocontrol ng voluntary muscle movement → muscle weakness

    Signs: drooping eyelids, double vision, strabismus; voice changes, dysphagia; respiratory problems

    PathoYung patient na may MG, nagp-produce sila ng antibodies para sa nicotinic acetylcholine receptor so hindi nakakapagbind ang lahat ng Ach sa receptor edi hindi magko-contract ang muscle leading to weakness

    Possible causeAng thymus gland ay still enlarged sa ibang tao kaya nagp-produce sila ng maraming antibodies na umaattack sa receptor site ng neuromuscular junction

    ComplicationMyasthenic crisisCholinergic crisis

    Diagnostic test: Tensilon TestMagiinject ng tensilon sa patient, ang tensilon nagpreprevent siya na breakdown yung acetylcholine, isang neurotransmitter na nirerelease ng nerve cells para mastimulate yung muscles.Ginagawa rin to para malaman kung myasthenic or cholinergic crisisAng patient magpopositive sa myasthenia gravis kapag yung muscle nila lumakas dahil sa tensilon.Myasthenic crisis: px will get better = inc muscle strengthCholinergic crisis: px will get worse = inc muscle weakness

    Nursing interventionMonitor respiratory statusAssess neuromuscular fxnEducation: larger meals at AM, smaller meals later in the day; meds 30-1hr AC; thicken liquids; perform activities in the AM

    ManagementNo cure = palliative onlyAnticholinesterase = 30min-1hr ACThymectomy to improve s/sxPlasmapheresis = IV IgG filters blood and antibodies



    • GBS
    • AutoimmuneImmune system attacks the myelin sheath of PNS & CN

    CauseUnderlying illnessCampylobacter pylori

    Types (sabihin lang pag tinanong!)Acute inflammatory demyelinating polyneuropathy: begins in the feet (paresthesia) and migrates upward until pt is paralyzedMiller fisher syndrome: paralysis start in the eyes

    Dx testEMG: ina-assess yung demyelination ng nerves thru determining the ability ng muscle natin na magrespond sa nerve stimulationLumbar puncture: id-drain ang CSF; elevated protein w/o elevated WBC = (+) GBS

    Pag tinanong ang nursing considerations:

    Before: empty bladder

    During: lateral recumbent position w/ knees up to abdomen & bend chin to the chest

    After: lie flat; consume fluids to help replace CSF lost

    TreatmentPalliativeIV immunoglobulin: stop antibodies na nagdadamage sa nervesPlasmapheresis: fini-filter ang dugo para maremove ung antibodies mula sa plasma na nagaattack sa myelin sheath
  12. Er nurse ako at may 2 patients ako na may stroke, isa ay hemor at isa ay isch, pano ko malalaman sino sa kanila may hemo at isch.
    • Through CT scan
    • CT scan' most important intervention ay manormalize MAP
  13. pathophysio ng ALS
    Nagkakaroon ng MYELIN SHEATHS DESTRUCTION and this will be REPLACED WITH SCAR TISSUE habang nagproprogress yung dse continuous yung destruction patuloy pa rin yun scar tissue in which magkakaroon na ng DISTORTION/ BLOCKAGE OF NERVE IMPULSES kung ganun maboblock din yung blood vessels and hindi siya (the nerve) nakakakuha ng nutrients na kailangang kaya nagkakaroon ng NERVE CELLS DEATH and usually motor neurons yung affected, ibigsabihin hindi nagwowork yung muscles which would lead to MUSCLE ATROPHY--- PROGRESSIVE MOTOR DYSFUNCTION pagnagtagal, spastic gait --- to kailangan na ng wheelchair --- patients may lose hand and arm function, and experience difficulty walking, speaking, and even breathing.
  14. Ano diagnostic test for diabetes
    Most accurate indicator po sir sa DM is Glycosylated Hgb yung glycosylated hemoglobin test minemeasure niya po yung amount ng blood sugar (glucose) attached to hemoglobin yung test po na to kukuha ng sample blood sa patient tapos iattach po yung excess glucose sa blood sa hemoglobin 

    • Reflects serum sugar levels for the past 3 months
    • RBC survive for 8-12 weeks before renewal

    • Also used to determine if diabetes is controlled and if the pt is compliantNormal value: 4% to 6% for nondiabetics
    • For client With diabetic: 7.5% or less

     A1C - measures your average blood sugar for the past two to three months.

    • Fasting Plasma Glucose (FPG)-  This test checks your fasting blood sugar levels. 
    • Fasting means after not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.

    Oral Glucose Tolerance Test (OGTT)- The OGTT is a two-hour test that checks your blood sugar levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.

    • Random (also called Casual) Plasma Glucose Test 
    • This test is a blood check at any time of the day when you have severe diabetes symptoms.
  15. Neuro: what predisposes seizures?
    RISK FACTORS:ATHEROSCLEROSIS- Patients above 50 kasi nagkakaroon ng Plaque formationCNS infection - Brain is irritatedToxic substance 

    - Interferes with brain metabolism or with supply of O2/ glucose to the brain

    - Some alcoholics get episodes during consumption or withdrawalGenetics - If you have a family history of seizures, you may be at an increased risk of developing a seizure disorder.
  16. First thing na iaasses kapag may increase ICP sa due to head injury?
    Ans: Level of Consciousness
  17. ano difference ng seizure sa status epilepticus tapos ano defining characteristics or main difference nila
    • The main difference is yung seizure one time or single occurrence lang pero yung epilepsy is multiple occurrence ng seizure.
    • Ang status epilepticus ay continuous seizure lasting more than 30 mins, 2 or more seizures without full recovery of consciousness between any of them
  18. ano yung diagnostic procedures ng MG tapos explain
    • Tensilon Test
    • Magiinject ng tensilon sa patient, ang tensilon nagpreprevent siya na breakdown yung acetylcholine, isang neurotransmitter na nirerelease ng nerve cells para mastimulate yung muscles.

    Ginagawa rin to para malaman kung myasthenic or cholinergic crisis

    Ang patient magpopositive sa myasthenia gravis kapag yung muscle nila lumakas dahil sa tensilon.

    Myasthenic crisis: px will get better = inc muscle strength

    Cholinergic crisis: px will get worse = inc muscle weakness
  19. Trauma and ICP, anong connection? Ano management?
    • Head Injury/Trauma = Increased ICP
    • Head Injury leading to brain swelling or bleeding
    • Since the skull cannot expand, IICP will occur. So unang compensatory mechanism is yung sa CSF para malessen yung IICP, kaya nakakakita tayo ng CSF leak thru halo ring kapag may head injury si px

    Then pressure on the Cerebral Blood Volume will decrease Cerebral Blood Flow.  If lessen ang Cerebral blood flow, magkakaroon ng hypoxia thus leading to ischemia

    So ICP will further increase if continuous pa rin yung swelling or bleeding thus leading to herniation. Then if the MAP and ICP becomes equal, magcecease na yung cerebral blood flow thus leading to death

    • Management for IICP
    • Osmotic diuretics(Mannitol 20%)
    • Fast drip 50-100cc every 6 hrs
    • No regulationWithhold if 90/60 mmHg BP

    • Furosemide
    • Monitor electrolyte status
    • Steroids
    • Prevent fluid shifts

    • Anticonvulsant (Phenytoin)
    • Prophylactic for Seizure Management

    • Analgesics
    • NOT MORPHINE because IICP

    • Barbiturates (Phenobarbital)
    • To reduce metabolic demands ng brain
    • Monitor ICP
  20. anong pinagkaiba ng ALS sa lahat ng neurodegenerative dse
    • Unknown cause
    • Type ng neurodegenerative disease na nagc-cause ng damage or breakdown sa brain natin at spinal cord na nagcocontrol ng muscle movement natin.
    • Kapag nagprogress pa to, mawawalan na ng ability yung brain natin na magsend ng message sa spinal cord.
Author
eayilat_alghabat
ID
355533
Card Set
orev
Description
endo, neuro
Updated