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Stroke (Brain Attack)
Ishemic = Thrombotic/Embolic
Hemorrhagic = bleeding-severe HA
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CVA- Who are the high risk Patients?
- Age older then 55, Male, African American, And HTN.
- Other are: DM, obesity, smoking, heat disease, hyperch olesterolemia and periodontal diease.
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CVA- Primary Assessments
- History, complete physical and neurlogical examination.
- Other: CT, MRI, Ultrasound.
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CVA- Clinical Manifestations
Confusion, changes in mental status, Slurred speech, paralysis, visual disturbances, dizziness, loss of balance, difficulty walking and sudden severe HA.
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CVA- Nursing interventions
Elevate head of the bed 35-40 degrees. Airway patency, frequent neuro assestments, bowel ad bladder trainging, self care, skin integrity, Rehab and sensory perception.
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CVA- Complication
- Decrease blood flow, cerebral hypoxia, vasospasma, Increase ICP and HNT.
- ICP: Monitor inter cranial pressure.
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CVA- Intervention
- Maintain airway, o2,UTI monitoring, TPA, anticoagulation therapy, neuro assessment and vital signs.
- Hemoonopsea: Half vision field is gone.
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Seizures
Partial and generalized.
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SEIZURE UNCONSCIOUS-
MORE interventions airway, aspiration risk and ABC.
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SEIZURE UNCONSCIOUS-
Intervention
Privacy, safety , side lying position , clear area , padding and not bite tongue or check.
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Multiple Sclerosis
Auto immune DI9SEASE THAT ATTACKS MYELINSHEATH.
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MULTIPLE SCLEROSIS- Pathophysiology
Brain and spinal canal are effected. The immune system destroys the myelin sheath, plaques develop and slows transmission of impulses.
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MULTIPLE SCLEROSIS- Clinical Manifestations
Numbness, weakness, loss of coordination, fatigue, dizziness, blurred vision and diplopia (double vision)
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MULTIPLE SCLEROSIS- Patient Teaching
- Avoid triggers, heat sun and stress.
- Others: Exercise and rest, assistive devices, Rest in cool environment, bladder and bowel training.
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Myasthenia Gravis
Muscle weakness from activity, autoimmune.
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MYASTHENIA GRAVIS- Assessment data
History, muscle weakness, difficulty breathing and talking, fatigue, ptosis (dropping) and diplopia (doube vision).
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MYASTHENIA GRAVIS- Test to r/o
- Tensilon (eproponium chloride) given IV to see if muscle strength increases after 0 - 40 seconds.
- If not have MG you will get muscle twitches in < then 5 minutes.
- Tensilon side effects are bradycardia, have Atropein to counter -act it.
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Trigeminal Neuralgia
Pain in 5th cranial nerve.
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TRIGEMINAL NEURALGIA- What precipitates attacks
washing face, shaving, brushing teeth, eating, drinking , cold air and direct pressure.
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Bell's Palsy
Inflammation of the 7th cranial nerve.
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BELL'S PALSY- Clinical Manifestations
Facial, paralysis, inability to close eye, increase tearing, painful sensations in face, drooping and speech difficulty.
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BELL'S PALSY- Nursing Interventions
Protect eye from injury with eye shield and eye drops (so eyes don't dry out and maintain muscle tone).
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ALS - ( Lou Gehrig's Disease)
Loss of motor neurons in brain stem and spinal chord. (so neurone can't send messages to muscles).
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ALS(LOU GEHRIG'S DISEASE)
Management
- Medications: Baclofen, Valium, Dantrium, Rilutek and CPAP.
- Baclofen decrease muscle spams.
- Emotional support and prevent aspiration and aspiration pheumonoa.
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Huntington DISEASE
Hereditary disease of nervous system of involuntary movement and dementia ONSET ABOUT 40-50 YRS OLD.
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HUNTINTONS DISEASE- Clinical Manifestations
Chorea ( abnormal involuntary movement) slurred speech, dysphagia, impaired memory, dementia, personality changes and hallucinations.
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Post - polio
Complications in Patients years after the initial infection.
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POST-POLIO- Management
Physical therapy, occupational therapy, speech therapy and respiratory therapy.
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Migraine
Severe head ache.
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MIGRANES- Effects of alcohol
Acts as a trigger and set off migraines.
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Muscular Dystrophy
Incurable neuro disease where these is progressive weakening and wasting of muscles.
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MUSCULAR DYSTROPHY- Medical Management
Physical therapy, corticosteroids, braces, orthotic jacket and assistive devices.
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Stress
Relation to infectious diseases?
Stress decreases immune system and makes us more prone to infections and disease.
- What has the greatest impact?
- Stress is a stimulus for disease.
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HIV/ AIDS
Prevention is # 1 intervention.
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HIV/AIDS- Transmission
Blood and body fluids!!!
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HIV/AIDS- Clinical Manifestation of encephalopathy
Is Characterized by a progressive decline in cognitive, behavioral, and motor function.
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HIV/AIDS- Common infection
pneumocystis pneumonia, mycocaterium repitory infection, TB, oral candidiasis, wasting syndrome, kaposi's sarcoma, B- cell lymphomas, prephrial neuropathy, HIV encephalopy, cryptococcus neoformans, progressive multifocal leukoencephalopathy and depression.
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HIV/AIDS- Common tx for diarrhea
Give ocreotide ( Sandostain) Increase absorption of fluids and electrolytes from GI and increases transit time.
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HIV/AIDS- Common Tx for weight gain
Give Megestrol ( megace) = increase appetite and weight.
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HIV/AIDS-Nutritional goal
- God nutrition and balanced diet with oral supplements.
- ( idea is to maintain weight and gain when necessary).
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HIV/AIDS- Prevention
Abstinence, stop Iv drug use, stop homosexual relationships and correct use of condom ad standard precautions.
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Cancer
Disease when an abnormal cell is transformed by the genetic mutation of cellular DNA.
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CANCER- Primary prevention
Avoid carcinogens, dietary and life style changes, ware sun screen, stop smoking and decrease processed food take.
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CANCER- Secondary prevention
- Screening and early detection.
- Breast, testicular, pap and mammogram.
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Radiation =
Use beams of high x-rays to destroy cancer cells.
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RADIATION- Common side effects
mouth sores, hair loss, anorexia, N/V, fatigue, malaise, anemia, leukopenia and thrombocytopenia.
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Chemo=
Antincoplastic agents
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Chemo= Antineoplasitc Agents
Common side effects
N/V/D Anemia, Leukopenia, Thrombocytopenia, anorexia, HF, RF, sterility, fatigue, weakness, numbness, hematuria, stomatitis, etc.
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Chemo= Antineoplasitc Agents
Disposal of meds
Hazardous waste, thick gloves, long sleeved protective gown and double bag.
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Bone Marrow Transplant
Replace bone marrow in bones that makes RBC, WBC and platelets.
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Bone Morrow Transplant- 100 day concern
monitor for infection, restrictive abnormality in pulmonary system and recurrent pneumonia.
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Breast Cancer
Prevention Strategies: 2 yearly breast exams, yearly mammogram, MRI, self breast exam monthly, avoid carcinogens and dietary and life style changes.
- When they would be used?
- Before the cancer disease takes effect.
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phenytoin (dilantin) Anticonvulsant
side effetcts- pruritus, rash, N/V, dizziness (Ataxia), slurred speech, nervousness, coordination problems, HA and insomnia.
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caramazepine (Tegretol) Anti convulsant.
Side effects N/V, hypertension, hypotension, lightheadedness, dizziness, confusion, clumsiness and diplopia (double vision).
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lioressel ( Baclofen) - Skeletal muscle relaxant.
purpose of drug- is a CNS depressant and , decreases muscle spasms..
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Thrombolytic - TPA ( Tissue Plasminagen Activator)
- Time frame - 24 hr after embolus or thrombus.
- Contraindications - Dissolves ay clots, so can not have resent surgery.
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Imitrex (Sumatriptan)- AntiMigrane
- Not given to who - Uncontrolled HTN CVA or perpheral vascular syndromes.
- Don't give to uncontrolled HTN, angina, MI stroke, or cardiac issues.
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