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?
    Stress, missed medications, underlying diseases (diabetes, epilepsy)

    Usually naman ang seizure ay symptom talaga ng underlying disease

    • Pathophysiology
    • Paroxysmal discharge in cortical neurons → abnormal firing of neurons → distubrbance in normal inhibitory synaptic currents → if local, focal seizure; if wide, generalized seizure

    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.
  21. Bakit nakakarecover si GBS at namamatay si ALS
    • Sa GBS kasi may remyelination kaya pt slowly get better  and pwedeng i-treat like
    • Plasmapheresis: fini-filter ang dugo para maremove ung antibodies mula sa plasma na nagaattack sa myelin sheath.

    while sa ALS ay namamatay talaga neurons and i gets worse overtime where overall paralysis ang mangyayari and included dito yung affected yung respiration.


    walang cure sa als compare sa gbs na ginagawa plasmapheresisals namamatay na ang cell pero sa gbs may remyelination pa
  22. Predominant manifestation ng als
    -generalized weakness, muscle wasting, atrophy
  23. pathophysiology of Head Injury and Increased ICP
    Kapag po yung brain nag suffer sa traumatic injury, nagkakaroon po ng swelling or bleeding sa brain so nag increase po ng intracranial pressure. Pag may pressure po sa blood vessels nagkakaroon po ng constriction and yung blood flow po bumabagal. Nagreresult po sa cerebral hypoxia and ischemia, kapag patuloy pa rin yung increase of ICP brain may herniate and cerebral blood flow po continue to stop
  24. Manifestation of Grand Mal seizure
    • Ang grand mal seizure po is associated with 2 phases:
    • Prodromal phase and

    Seizure/Ictal phase na divided din po to 4 stages.

    Prodromal phase: nangyayari to about minutes to hours; makikita natin si patient na parang irritable, may mood changes, headache at sleep disturbanco

    Seizure/Ictal phase:Aura (warning sign) - gising pa dito si patient pero unaware na sa paligid; ang mga mararamdaman nya ay dizziness, altered vision/hearing, inability to speak

    Tonic - body stiffening; dito na mawawalan ng malay si patient naglalast less than a minutes lang; before mangyari, nagkakaron pa ng loud cry or hyperventilation ang pasyente

    Clonic - recurrent jerking; unconscious pa rin ang patient dito pero resumed na ang breathing 

    Flaccid - total muscle relaxation na; ang dila ni patient pwede magfall backward, grunting, and incontinence
  25. Primary progressive multiple sclerosis and manifestation
    PRIMARY PROGRESSIVE

    - Disease begins with a slow progression of neurologic deficits.

     - Common problems include spastic paraparesis (gradual muscle weakness), cerebellar ataxia (unsteady gait), urinary incontinence. 

    - No history of relapse and remission 

    - Problems gradually worsens over time

    • MANIFESTATIONS:
    • Trouble walking
    • Vision problems
    • Muscle weakness
    • Trouble staying balanced
    • Paralysis
    • Numbness
    • Urinary Incontinence
  26. SECONDARY CHRONIC progressive multiple sclerosis and manifestation
    Halos same lang sila ni remitting-relapsing. So may periods din exacerbation and remission. At mas lumalala ang effect kay patient during exacerbation, ang manifestations ay paralysis, numbness, and urinary incontinence. Hindi na bumabalik sa dating function si patient pag nagkaroon ng remission, ang result lang ay permanent disability na talaga.
  27. TOTAL COLECTOMY WITH CONTINENT ILEOSTOMY (KOCK POUCH)
    Total colectomy which is the removal of the entire colon. And continent ileostomy or Kock pouch, connection of the end of the small intestine duon sa skin of ng abdomen. This is done so that yung waste can leave your body, because it can't leave the usual way.

    Unlike other ileostomies, the K-pouch has a valve that the surgeon makes. They sew the intestine in a special way so that waste material doesn't leak out. Instead, you insert a tube called a catheter when it's time to empty the pouch.

    For: Pagbadly diseased yung rectum, or walang rectal sphincter tone.
  28. LIVER CIRRHOSIS, MGT
    Sa tuwing nai-injured si liver, whether by disease, excessive alcohol consumption, it tries to repair itself.

    And overtime, scar tissue to gradually replace your healthy liver cells.

    forms tough scar tissue. When too much scar tissue builds up, the organ can't work properly.

    (NICE TO KNOW)And the liver is important  It filters toxins from the blood, makes enzymes that help you digest food, stores sugar and nutrients, and helps you fight infections.

    • Management
    • Rest – kasi it symptoms din po ay may fatigue and weakness

    • Diet – early: h cal, h carb, h protein, l fat
    • Late: h cal, h carb, l protein, l fat

    Avoid trauma/ injury ---- patient bruise easily

    Prevent infection – kasi damage si liver na involve diin sa fighting infections

    • Avoid sedatives - 
    • Avoid aspirin --- it would cause more bleeding for pt

    Eliminate alcohol --- usually cause
  29. GASTRITIS VS PUD
    • GASTRITIS
    • Inflammation in the gastric mucosa

    • CAUSES
    • Ingestion of food na may microorganism
    • Highly seasoned food
    • Alcoholism
    • NSAIDs overuse --- git irritant

    • PATHOPHY
    • May injury sa mucosa kaya magi-stimulate ng inflammatory response then magkakaroon ng edema, may fluid and blood, injured yung wall so may erosion, secretion of scanty gastric juices, then ulceration that will lead to bleeding

    • MANIFESTATIONS
    • Abdominal pain
    • Anorexia
    • Heartburn
    • Nausea and vomiting
    • Sour taste kapag kumakain

    • DX
    • Endoscopy
    • Exfoliative cytology
    • UGIS
    • Urea breath test

    • MEDICAL MGT
    • Antibiotics, Antacids – sodium bicarb,,,para maneutralize HCl acidanti-ulcer

    • NURSING MGT
    • Reduce anxiety
    • Promote optimal nutrition
    • Promote fluid balance
    • Relieve pain
    • Promote healthy lifestyle



    PUD

    Excavation or ulceration na talaga sa mismong esophagus, pylorus, mucosal wall of the stomach, duodenum

    • CAUSES
    • NSAIDs overuse
    • Alcoholism
    • Genetics
    • Cigarette smoking
    • ZES
    • Infection (H. pylori)
    • Stress 

    • PATHOPHY
    • May disturbance sa acid secretions and mucosal protection kaya may increase ng acidity at decrease ng mucosal resistance. It will lead to erosion and ulceration

    • MANIFESTATIONS
    • Epigastric pain
    • Indigestion

    • TYPES of PUD
    • Esophageal ulcer: may reflux ng acidic gastric secretions kaya naging defective ang cardiac sphincter

    Stress ulcer: cushing’s - head injuries, tumor. Curling’s - burns

    Gastric ulcer --- hindi makakain kasi sumasakit, pain 1-1 ½ h aftermeal, hematemesis

    Duodenal ulcer – eating relieves pain, melena

    • COMPLICATIONS
    • GI bleeding
    • Peritonitis (perforation of stomach lining)
    • High risk of GI cancer

    • DX
    • UGIS
    • CT scan of abdomen
    • Blood test and stool test
    • UREA breath test

    TXMeds: Antibiotics, antacids, anti-ulcer

    Surgery: Vagotomy, pyloroplasty, gastric resection

    • NURSING MGT
    • Asses VS, bowel, and stool
    • Ask patient onset of pain
    • Obtain medical history
    • Monitor for complication of PUD
    • Monitor for post-op complication like dumping syndrome
    • Lie down for 30 mins after eating
    • Drink fluids 1 hr before and after mean
    • Avoid spicy foods, acidic foods, caffeine, chocolate, alcohol, fried foods
  30. NEGATIVE FEEDBACK THYROID
    life saving sya since iniistmulate nya mga dapat istimulate tapos iniinhibit mga dapat iinhibit 

    Hypothalamus – TRH--- Anterior Pit --- TSH ---Thyroid G.--- Thyroxine, Triiothyronine, thyrocalcitonin

    Isang example is thyroid glands whereas: May tatlong components: T3,T4, Thyrocalcitonin 

    T3: metabolism 

    • T4: thermoregulation 
    • Thyrocalcitonin: calcium 

    Kay Thyrocalcitonin, pag overstimulated sya mababa ang Ca levels tapos kapag understimulated mataas ang Ca level bale baliktad kaya kapag hyperthyroidism hypocalcemia sya, tas pag hyperthyroidism hypercalcemic si patient
  31. THYROID STORM
    Thyroid Storm: An acute life threatening condition in a client with uncontrolled hyperthyroidism. Can be caused by manipulation of the thyroid gland during surgery. 

    Treatment: anti thyroid meds, beta blockers, glucocorticoids can be given before surgery to prevent occurrence. 

    Assessment: Elevated temp, tachycardia, systolic HTN, nausea vomiting and diarrhea, agitation, tremors, seizures, delirium, and coma. 

    Interventions: Maintain open airway and proper ventilation, give antithyroid meds, beta blockers, and glucocorticoids, monitor vitals, monitor EKG for dysrhythmias.
  32. MYXEDEMA COMA, INTERVENTIONS, MANAGEMENT
    Myxedema Coma : Rare but serious. Results from persistently low thyroid production …. 

    Assessment: Hypotension, bradycardia, hypothermia, hyponatremia, hypoglycemia, general edema, respiratory failure, cardiovascular collapse, shock, coma. 

    Interventions : Maintain patent airway, institute aspiration precautions, IV hypertonic saline, administer levothyroxine IV, IV glucose, corticosteroids, assess hourly temp, keep the client warm, monitor LOC and electrolytes/ glucose.
  33. ADDISONIAN CRISIS
    In addisonian crisis, the patient has extremely LOW CORTISOL levels (life threatening).

    • Remember the 5 S’s
    • Sudden pain in stomach, back, and legs
    • Syncope (going unconscious)
    • Shock
    • Super low blood pressure
    • Severe vomiting, diarrhea and headache

    • NEED IV Cortisol STAT:
    • Solu-Cortef and IV fluids (D5NS to keep blood sugar and sodium levels good and fluid status)

    Watch for risk for infection, neuro status (confusion, agitation), electrolyte levels (sodium and potassium, glucose)
  34. CUSHING VS ADDISON’S DSE
    CUSHING’S

    INCREASE secretion of cortisol

    Pathophy:from exogenous exposure sa gluccorticoids, nagkakaroon ng adenoma tas yung adenoma sa adrenal gland nagttrigger ng increased cortisoltapos pag increased si cortisol, bumababa symepres yung cth pero nananatiling mataas acth(yung pagbaba ng crh ay isnag example din ng negative feedbackk)kaya ang definitin ni cushing ay too much acth dahil di na sila balanced ni crh

    Manifestation: STRESSED

    Skin fragile

    Truncal obesity

    Round face/ “moon face”

    Ecchymosis, elevated bp

    Striae on extremities/ab

    Sugar extremely high (hypergly)

    Excessive body hair

    Dorsocervical fat pad, depression





    ADDISON’S

    DECREASE secretion of cortisol + aldosterone

    Pathophy:Auto immune siya,  bababa si gluccocorticoids at mineralocoticoidstapos dahil mababa increased si crh at acthtapos dahil mababa increased si crh at acthtapos kaka stimulate kay acth mapapagod sya kaya hindi na kaya mag compensate so mababa ang acth levels

    Manifestation: STEROID

    Sodium and sugar, dahil mababa ang cortisol tataas ang sugar, tapos dahil mababa ang aldosterone, tataas din ang sodium

    Tired and weak muscles

    Electrolyte imbalances

    Reproductive changes like irregular mens

    lOw blood pressure

    Increased pigmentation sa skin

    Diarrhea, nausea, depression
  35. ALS VS MS
    • Amyotrophic Lateral Sclerosis
    • Unknown cause
    • Type ng neurodegenerative disease na nagc-cause ng damage or breakdown sa brain natin at spinal cord na nagkokontrol ng muscle movement natin.
    • Kapag nag-progress pa to, mawawalan na ng ability yung brain natin na mag-send ng message sa spinal cord.

    • Pathophysiology
    • Pag namatay (degenerate) yung motor cell neurons natin so marereduce ang number nya tapos ang mangyayari sa muscle fibers ay magiging atrophic at magkakaroon ng loss of voluntary muscle movement. Pwede siyang mangyari sa upper and lower motor neurons natin

    • S/sx
    • General muscle weakness: usually nag i-start sa upper extremities tapos progress to arms, shoulder at neck
    • Primary signs: dysarthria, dyspnea, dysphagia
    • Muscle wasting and atrophy

    • Dx test
    • Electromyography:  use of needle electrodes to stimulate the muscle and evaluate muscle functioning and ano yung mga nagiging response nung muscle
    • CK-MM Elevated >70 U/l

    • Management
    • Manage the symptoms
    • Physical therapy
    • Anti- spasms
    • Delayed interdependence





    • Multiple Sclerosis
    • Autoimmune Inaatake ng katawan natin ang myelin sheath sa CNS → magiging inflamed and scarred ang neuron natin
    • Unknown cause
    • No cure

    • Dx Test
    • MRI Lumbar puncture: idrain ang CSF icheck ang high amount of proteins 
    • Evoked potential studies: sending electrical signals sa CNS & assess yung response

    • S/sx
    • Emotional & cognitive issues: depressed, mood swings,trouble thinking
    • Sensation: Tremor, spasm, clumsy, numbness/tingling, +Romberg’s sign
    • Vision: nystagmus, double vision, blurry
    • Elimination: cant hold urine, urine retention

    • Nursing intervention
    • Promote safety
    • Prevent progress of s/sx
    • Exercise
    • Bladder: retention
    • Increase fiber, stool softeners, skin care
  36. HIERARCHY NG MS DX
    1. CT SCAN/ MRI (most sensitive): reveals plaque formation and demyelination

    2. Electromyography: reveals slowing of nerve conductions

    3. Review of History/ Symptomatology: serves as basis for differential diagnosis

    4. Papilledema seen during ophthalmic exam

    5. ANGIOGRAPHY 

    • 6. CSF ANALYSIS
    • IgG – 90% of MS clients
    • Absence of IgG does not rule out MS
  37. 4 TYPES NG MS PROGRESSION AND WHAT HAPPENS
    • 1. Benign Multiple Sclerosis
    • -Mild infrequent sensory exacerbations pero may  full recovery 

    • 2. Relapsing Remitting Multiple Sclerosis
    • -may episodes of exacerbations and remissions, and hindi lahat ng  symptoms ay na re-resolve completely
    • - Pt. left with permanent disability which may vary in severity
    • - Relapses also become more severe with time

    • 3. Secondary Chronic Progressive
    • - Condition of patients with relapsing/remitting disease begins to gradually worsen over time with resulting accumulation of neurologic signs and symptoms. 
    • - Relapse becomes more severe, remission lessens  

    • 4. Primary Progressive
    • - Disease begins with a slow progression of neurologic deficits. 
    • - Common problems include spastic paraparesis, cerebellar ataxia, urinary incontinence.
    • -No history of relapse and remission 
    • -Problems gradually worsens over time
  38. 4 SITES NG MS AND WHAT HAPPENS
    • 1. Corticospinal - nagkakaroon ng vertigo spinal, tas posture is affected din kasi nasa spinal column
    • -symmetrical muscle weakness, spastic paralysis, paresthesia, bowel and urinary incontinence

    2. Cerebellar - intellect is affected

    • 3. Cerebral - emotional disturbances
    • - optic neuritis, impaired vision, intellectual and emotional deterioration

    • 4. Brainstem - CN 3-11/12 is affected.
    • - dysfunction of the EOM and innervation to the muscles for speech
  39. GRAND MAL SEIZURE AND MANIFESTATIONS
    • Causes loss of consciousness and violent muscle contractions
    • Also known as GENERALIZED TONIC-CLONIC SEIZURE, dahil sa abnormal electrical activity sa brain.

    PHASES of Grand mal seizure

    • (PRODROMAL)- prior to actual seizure; pero hindi lahat ng patients nakukuha to
    • AURA - parang yung deja vu, or may halo sa paningin nila, kaya they cant be under disco lights
    • ICTAL PHASE
    • =TONIC - stiff; di gumagana ang lungs; biglang may ungol ganon; conscious si patient
    • =CLONIC - nangingisay
    • POST ICTAL PHASE

     PETIT MAL

    -   “absence seizure”

    -   Common among children

    -   May disappear after puberty

    -   Lasting 5-30 seconds

    -   this condition only involves the loss of consciousness without the motor symptoms

    -   (such as violent jerking of the entire body, drooling or frothing of the mouth and loss of bladder control).
  40. PARTIAL MOTOR SEIZURES “JACKSONIAN”
    • Focal motor or sensory effect
    • No LOC
    • Arises from the motor cortex
    • Begins in the fingers and hands and spreads centrally to involve entire limb → Jacksonian march
    • May progress to grand mal
    • nagstay lang sa kamay = jacksonian
    • pagkumalat = grad mal
  41. PARKINSON’S DISEASE

    mec of action ng levodopa
    Carbidopa/Levodopa (combination)….most common “Sinemet”: adds more dopamine to the brain

    Carbidopa helps to prevent levodopa from being broken down in the blood before it enters the brain (hence more enters the brain) and lessens the side effect of nausea and when levodopa enters the brain it turns into dopamine.
  42. ischemicxhemorrhagic stroke tas nanganganak tanong
    The period immediately after delivery (the postpartum period) is the period of highest stroke risk. During this time, there is an increasing tendency to form blood clots, which can lead to clots in the veins of the brain. This can cause headaches, seizures, brain swelling, bleeding in the brain and loss of function.
Author
eayilat_alghabat
ID
355533
Card Set
orev
Description
endo, neuro
Updated