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FOCUS! AND AIM HIGH WITH GOD

FOCUS! AND AIM HIGH WITH GOD Graphics & Edited By: J. F. ADORABLE, RN. Text from

Graphics & Edited By:

J. F. ADORABLE, RN.

Text from Pentagon Review Center

Overview of structures and functions:

Central Nervous System

BrainOverview of structures and functions: Central Nervous System Spinal Cord Peripheral Nervous System Cranial Nerves Spinal

Spinal Cordof structures and functions: Central Nervous System Brain Peripheral Nervous System Cranial Nerves Spinal Nerves

Peripheral Nervous System

Cranial NervesNervous System Brain Spinal Cord Peripheral Nervous System Spinal Nerves Autonomic Nervous System Sympathetic nervous

Spinal NervesBrain Spinal Cord Peripheral Nervous System Cranial Nerves Autonomic Nervous System Sympathetic nervous system

Autonomic Nervous System

Sympathetic nervous systemSystem Cranial Nerves Spinal Nerves Autonomic Nervous System Parasympathetic nervous system AUTONOMIC NERVOUS SYSTEM

Parasympathetic nervous systemNerves Autonomic Nervous System Sympathetic nervous system AUTONOMIC NERVOUS SYSTEM NERVOUS SYSTEM   Sympathetic

AUTONOMIC NERVOUS SYSTEM

NERVOUS SYSTEM

 

Sympathetic Nervous System

Parasympathetic Nervous System ( CHOLINERGIC, VAGAL , SYMPATHOLYTIC )

 

(

ADRENERGIC )

­ Involved in fight or aggression response.

­ Involved in fight or withdrawal response.

­ Release of Norepinephrine (cathecolamines) from adrenal glands and causes vasoconstriction.

­ Release of Acetylcholine.

­ vasodilation bronchoconstriction

­ Increase all bodily activity except GIT

­ Decreases all bodily activities exce pt GIT.

EFFECTS OF SNS

 

EFFECTS OF PNS

­ Dilation of pupils ( mydriasis) in order to be aware.

­ Constriction of pupils ( meiosis) .

­ Dry mouth (thickened saliva).

­ Increase salivation.

­ Increase BP and Heart Rate.

­ Decrease BP and Heart Rate.

­ Bronchodilation, Increase RR

­ Bronchoconstriction, Decrease RR.

­ Constipation.

 

­ Diarrhea

­ Urinary Retention. FLUID VOLUME EXCESS

­ Urinary frequency. FLUID VOLUME DEF.

­ Increase blood supply to brain , heart and skeletal muscles.

­ antihypertension

­ SNS

I. Adrenergic Agents

Give Epinephrine. [ADRENALIN] Signs and Symptoms:

­

I. Cholinergic Agents

Mestinon , N eostigmine . Side Effects

­

­

SNS

­

PNS

Contraindication:

   

­

Contraindicated to patients suffering from COPD

(Broncholitis, Bronchoectasis, Emphysema, Asthma).

II. Anti ­ cholinergic Agents

II. Beta ­ adrenergic Blocking Agents

­

To counter cholinergic agents.

­ Also called Beta ­ blockers .

Atropine Sulfate decreased mucus production Side Effects

­

­ All ending with “ lol

­ Propranolol [Inderal] , Atenelol , Metoprolol .

­

SNS

 

Antipsychotic s:  Effects of Beta ­ blockers

 

Effects of Beta ­ blockers

 

Haloperidol [Haldol], chlorpromazine

B

roncho spasm

Thorazine, etc.

E

licits a decrease in myocardial cont raction.

Side effect of THORAZINE: atopic dermatitis and foul smelling odor.T – reats hypertension.

T

reats hypertension.

A

V conduction slows down.

Side effect of all antipsychotic: signs of PARKINSON’S DISEA SE, therefore antipsychotic are given together with antiparkinson drugs PARKINSON’S DISEA SE, therefore antipsychotic are given together with antiparkinson drugs

Should be given to patients with Angina Pectoris, Myocardial Infarction , and Hypertension .

Anti­ parkinson drugs:ANTI­ HYPERTENSIVE AGENTS

ANTI­ HYPERTENSIVE AGENTS

 

C.A.P.A.B.L.E.S

1. Beta­ blockers – “lol”

 

2. Ace Inhibitors – Angiotensin, “pril” (Captopril,

Enalapril)

3.

Calcium Antagonist Nifedipine (Calcibloc)

In chronic cases of arrhythmia give Lidocaine ( Xylocaine )

CENTRAL NERVOUS SYSTEM

Brain and Spinal Cord. [Spinal cord terminates at L 1 to L 2 therefore a LUMBAR TAP is perf ormed at L 3 , L 4 or L 5 no risk for spinal cord damage]

3 , L 4 or L 5 no risk for spinal cord damage] Basic cells for

Basic cells for nerve impulse and conduction.3 , L 4 or L 5 no risk for spinal cord damage] I. CELLS A.

I. CELLS

A. NEURONS

PROPERTIES Excitability ability of neuron to be affected by changes in external environment. Conductivity ability of neuron to transmit a wave of excitation from one cell to another. Permanent Cell once destroyed not capable of regeneration.

TYPES OF CELLS BASED ON REGENERATIVE CAPACITY

1.

Labile

Capable of regeneration.1. Labile Epidermal cells, GIT cells, GUT cells, cells of lungs. 2. Stable Capable of regeneration

Epidermal cells, GIT cells, GUT cells, cells of lungs.1. Labile Capable of regeneration. 2. Stable Capable of regeneration with limited time, survival period. Kidney

2.

Stable

Capable of regeneration with limited time, survival period.cells, GIT cells, GUT cells, cells of lungs. 2. Stable Kidney cells, Liver cells, salivary cells,

Kidney cells, Liver cells, salivary cells, pancreas.Capable of regeneration with limited time, survival period. 3. Permanent Not capable of regeneration. Myocardial

3.

Permanent

Not capable of regeneration.Liver cells, salivary cells, pancreas. 3. Permanent Myocardial cells, Neurons, Bone cells, Osteocytes, Retinal

Myocardial cells, Neurons, Bone cells, Osteocytes, Retinal Cells.period. Kidney cells, Liver cells, salivary cells, pancreas. 3. Permanent Not capable of regeneration. B. NEUROGLIA

B.

NEUROGLIA

Support and p rotection of neurons.

TYPES

1. Astrocytes maintains blood brain barrier semi­ permeable.

Majority of brain tumors (90%) arises from called astrocytoma .

2. Oligodendria Produces myelin sheath in CNS. Act as insulator and facilitates rapid ne rve

3. Microglia

4. Epindymal

impulse transmission

SUBSTANCES THAT CAN PASS THE BLOOD ­ BRAIN BARRIER

1. Ammonia

Cerebral toxin

Hepatic Encephalopathy (Liver Cirrhosis)

Ascites

Esophageal Varices

Early Signs of Hepatic Encephalopathy

asterixis (flapping hand tremors).

Late Signs of Hepatic Encephalopathy

Headache

Dizziness

Confusion

Fetor hepaticus (ammonia like breath)

Decrease LOC [hepatic coma]

[AIRWAY FOR HEPATIC COMA]

2. Carbon Monoxide and Lead Poisoning

Can lead to Parkinson’s disease . [PILL ROLLING TRE MORS]

Epilepsy

Treat with ANTIDOTE: Calcium EDTA For Lead poisoning Hyperbaric oxygenation (100% O 2 ) For carbon monoxide poisoning

with ANTIDOTE : Calcium EDTA For Lead poisoning Hyperbaric oxygenation (100% O 2 ) For carbon
 

PATHOGNOMONIC SIGNS

1.

PTB

­ Low ­grade afternoon fever.

2. PNEUMONIA

­ Rusty sputum.

3. ASTHMA

­ Wheezing on expiration.

4. EMPHYSEMA

­ Barrel chest.

5. KAWASAKI DISEASE

­ Strawberry tongue.

6. PERNICIOUS ANEMIA

­ Red beefy tongue.

7. DOWN SYNDROME

­ Protruding tongue / semian crease on palm

8. CHOLERA

­ Rice watery stool.

9.

MALARIA

­ Stepladder like fever and chills.

10.

TYPHOID

­ Rose spots in abdomen.

11.

DIPTHERIA

­ pseudo membrane formation (pharynx, tonsils, nasal)

12. MEASLES

­ Koplik’s spots.

 

13. SLE

­ Butterfly rashes.

14. LIVER CIRRHOSIS

­ spider angioma, due to esophageal varices

15. LEPROSY

­ lioning face

16. BULIMIA NERVOSA

­ Chi pmunk face. Parotid gland swelling

17. APPENDICITIS.

­ rebound tenderness

18. DENGUE

­ petechiae or (+) Herman’s sign

19. MENINGITIS

­ Kernig’s sign (leg pain ), Brudzinski sign (neck pain).

20.

TETANY

­ HYPOCALCEMIA (+) Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spasm).

21. TETANUS

­ risus sardonicus.

22. PANCREATITIS

­ Cullen’s sign (ecchymosis of umbilicus); (+) Grey turners spots.

23. PYLORIC STENOSIS

­ olive SHAPE mass on the abdomen

24.

PDA

­ machine like murmur

25.

ADDISON’S DISEASE

­ Bronze like skin pigmentation.

26.

CUSHING’S SYNDROME

­ Moon face appearance and buffalo hump.

27.

HYPERTHYROIDISM/GRAVE’S DISEASE

­ Exopthalmus

28.

INTUSSUSCEPTION

­ sausage shaped mass

29.

PARKINSON’S DISEASE

­ Pill rolling tremors

30.

HEPATITIS

­ Jaundice

31. THROMBOPHEBITIS

­ Homan’s sign

32. CATARACT

­ Hazy vision / loss of central vision

33. GLAUCOMA

­ Tunnel vision / loss of peripheral vision

34. RETINAL DETACHMENT

­ Curtain veil ­like vision / flashes and floaters

35. CHOLECYSTITIS

­ Murphy’s sign (pain on deep inspiration, a inflammation of the gallbladder

36. ANGINA PECTORIS

­ Levine’s sign [hand clutching in the chest]

37. MYASTHENIA GRAVIS

­ Ptosis [drooping of the upper eyelid]

38. TETRALOGY OF FALLOT

­ Clubbing of fingers

3. Type 1 DM (IDDM)

[KETONES]

4. Hepatitis

5. Bilirubin

Causes diabetic ketoacidosis.

And increases breakdown of fats.

And free fatty acids

Resulting to cholesterol and (+) to Ketones (CNS depressant).

Resulting to acetone breath odor/fruity odor.

KUSSMAUL’S respiration, a rapid shallow respiration.

This may lead to diabetic coma.

shallow respiration.  This may lead to diabetic coma.  Signs of jaundice (icteric sclerae). 

Signs of jaundice (icteric sclerae).

Caused by bilirubin (yellow pigment)

Increase bilirubin in brain ( Kernicterus).

Causing irreversible brain damage.

DEMYELINATING DISORDERS

1. ALZHEIMER’S DISEASE

Atrophy of brain tissues. Progressive, irreversible, degenerative neurologic disease characterized by gradual losses of cognitive fx. And disturbances in behavior and affect.

Sign and Symptoms

4 A’s of Alzheimer

behavior and affect. Sign and Symptoms 4 A’s of Alzheimer a. Amnesia – partial or total

a. Amnesia partial or total loss of memory.

b. Agnosia no recognition of inanimate objects.

c. Apraxia no recognition of objects function.

d. Aphasia no speech (nodding).

*Expressive aphasia ( Broca’s Aphasia) frontal lobe

“motor speech center”

N ursing mgt. provide PICTURE BOARD

*Receptive aphasia (Wernicke’s Aphasia) temporal lobe

Inability to understand spoken words .

Irrational thoughts/illogical

General Knowing Gnostic Area or General Interpretative Area.

DRUG OF CHOICE : ARICEPT ( taken at bedt ime) and COGNEX. [increasing acetylcholine]

2. MULTIPLE SCLEROSIS [ Autoimmune process]

Chronic intermittent disorder of CNS characterized by white patches of demyelination in brain and spinal cord.

Characterized by remission and exacerbation.

Women ages 15­ 35 are prone

Unknown Cause

Slow growing virus

Autoimmune disorders

Pernicious anemia

Myasthenia gravis

Lupus

Hypothyroidism

GBS

Myasthenia gravis  Lupus  Hypothyroidism  GBS Ig G – only antibody that pass placental

Ig G only antibody that pass placental circulation causing passive immunity. ­ Short term protectio n. ­ Immediate action. Ig A present in all bodily secretions (tears, saliva, colostrums). Ig M acute in inflammation. Ig E for allergic reaction. Ig D for chronic inflammation.

* Give palliative or supportive care. Signs and S ymptoms

1. Visual disturbances

blurring of vision (primary)

Diplopia (double vision)

scotomas (blind spots)

2. Impaired sensation

Pain, pressure, heat and cold. [do not give hot packs b’coz of dec. sensation to heat which can lead to burns.]

tingling sensation

paresthesia

numbness

3.

Mood swings

euphoria (sense of well being)

4. Impaired motor function

weakness

spasticity

paralysis

5. Impaired cerebral function

scanning speech

TRIAD SIGNS OF MS Ataxia

CHARCOTS TRIAD ANI
CHARCOTS TRIAD
ANI

(Un steady gait, (+) Romberg’s test )

Intentional tremors

Nystagmus

6. Urinary retention/incontinence

7. Constipation

8. Decrease sexual capacity

DIAGNOSTIC PROCEDURE

CSF analysis (increase in IgG and Protein ).

MRI (reveals site and extent of demyelination).

(+) Lhermitte’s sign a continuous and increa se contraction of spinal column/cord following laminotomy.

NURSING MANAGEMENT

1. Administer medications as ordered

a. ACTH (Adreno Corticotropic Hormone)/ Steroids for acute exacerbation to reduce edema at site

of demyelination to prevent paralysis. [Best given in Morning to mimic body normal rhythm]

b. Baclofen (Dioresal)/ Dantrolene Sodium (Dantrene) muscle relaxants.

c. Interferons alter im mune response.

d. Immunosupresants

2. Maintain side rails to prevent injury related to falls.

3. Institute stress management techniques.

a. Deep breathing exercises

b. Yoga

4. Increase fluid intake and increase fiber to prevent constipation.

5. Catheter ization to prevent retention.

a. Diuretics

b. Bethanicol Chloride (Urecholine) treat urinary retention Nursing Management

Only given subcutaneous.

Monitor side effects bronchospasm and wheezing.

Monitor breath sounds 1 hour after subcutaneous admi nistration.

c. For Urinary Incontinence Anti spasmodic agent a. Prophantheline Bromide (Probanthi ne) antispasmodic drug to treat urinary incontinence

Acid ash diet like cranberry juice, plums, prunes, pineapple, vitamin C and orange.

To acidify urine and prevent bacterial multiplication.

COMMON CAUSE OF UTI Female

short urethra (3 ­ 5 cm, 1 ­ 1 ½ inches)

poor perineal hygiene

vaginal environment is moist

Nursing Management

avoid bubble bath (can alter Ph of vagina).

avoid use of tissue papers

avoid using talcum powder and perfume.

Male

Urethra (20 cm, 8 inches)

urinate after intercourse

MICROGLIA

stationary cells that carry on phagocytosis (engulfing of bacteria or cellular debris, eating), pinocytosis (cell drinking).

MACROPHAGE

ORGAN

Microglia

Brain

Mon ocytes

Blood

Kupffers cells

Kidney

Histiocytes

Skin

Alveolar

Lung

Macrophage

EPINDYMAL CELLS

Secretes a glue called chemo attractants that concentrate the bacteria.

COMPOSITION OF BRAIN

80% brain mass

10% blood

10% CSF

I. Brain Mass PARTS OF THE BRAIN

1. CEREBRUM

largest part

Composed of the Right Cerebral Hemisphere and Left Cerebral Hemisphere enclosed in the Corpus Callosum.

Functions of Cerebrum

integrative

sensory

motor

Lobes of Cerebrum

1. Frontal

higher cortical thinking

controls personality

controls motor activity

Broca’s Area (motor speech area) when damaged results to garbled speech.

2. Temporal

hearing

short term memory

3. Parietal

for appreciation

Discrimination of sensory impulses to pain, touch, pressure, heat, cold, numbness.

4. Occipital

for vision

Insula (Island of Reil)

Visceral function activities of internal organ like gastric motility.

Limbic System (Rhinencephalon)

controls smell and if damaged results to Anosmia (absence of smell).

controls libido [the true sense of sexual ar ousal is when you smelled the fume s of the natural body]

controls long term memory

2. BASAL GAGLIA

areas of grey matter located deep within each cerebral hemisphere.

release dopamine (controls gross voluntary movement. )

NEURO TRANSMITTER

DECREASE

INCREAS E

Acethylcholine

Myasthenia Gravis

Bi­ polar Disorder

Dopamine

Parkinson’s Disease

Schizophrenia

3. MIDBRAIN/ MESENCEPHALON

acts as relay station for sight and hearing.

size of pupil is 2 3 mm .

equal size of pupil is isocoria.

unequal size of pupil is anisocoria .

hearing acuity is 30 40 dB .

positive PERRLA [Pupils equal, round, reactive to light and accommodation]

4. INTERBRAIN/ DIENCEPHALON

Parts of Diencephalon

A.

Thalamus

Acts as relay station for sensation.

B.

Hypothalamus

Controls temperature (thermoregulatory center).

controls blood pressure

controls thirst

appetite/satiety

sleep and wakefulness

Controls some emotional responses like fear, anxiety and excitement.

controls pituitary functions

Androgenic hormones promote secondary sex characteri stics.

early sign for males are testicular and penile enlargement

late sign is deepening of voice.

early sign for females telarche and late sign is menarche.

5.

BRAIN STEM

 

located at lowest part of brain

Parts of Brain Stem

1. Pons

pneumotaxic center cont rols the rate, rhythm and depth of respiration.

2. Medulla Oblongata

Controls respiration, heart rate, and swallowing, vomiting, hiccup, vasomotor center (dilation and constriction of bronchioles). [damage to medulla is most life threatening]

3. Cerebellu m

Smallest part of the brain.

Lesser brain.

Controls balance, equilibrium, posture and gait.

INTRA CRANIAL PRESSURE

Monroe Kellie Hypothesis

INTRA CRANIAL PRESSURE Monroe Kellie Hypothesis Skull is a closed container Any alteration or increase in

Skull is a closed container

Monroe Kellie Hypothesis Skull is a closed container Any alteration or increase in one of the

Any alteration or increase in one of the intracranial components

alteration or increase in one of the intracranial components Increase intra ­ cr anial pressure (

Increase intra ­ cr anial pressure ( normal ICP is 0 15 mmHg )

Cervical 1 also known as ATLAS. Cervical 2 also known as AXIS. Foramen Magnum

Medulla Oblongata

Brain Herniation

Increase intra cranial pressure * Alternate hot and cold compress to prevent HEMATOMA CSF c ushions brain (shock absorber) Obstruction of flow of CSF will lead to enlargement of skull posteriorly called hydrocephalus . Early closure of posterior fontanels causes posterior enlargement of skull in hydrocephalus.

NEUROLOGIC DISORDERS

INCREASE INTRACR ANIAL PRESSURE increase in intra ­ cranial bulk brought about by an increase in one of the 3 major intra cranial components. NORMAL ICP: 0­ 15 mmhg Causes:

head trauma/injury

localized abscess

cerebral edema

hemorrhage

Signs and Symptoms (Early)

decrease LOC

restlessness/agitation

irritability

Signs and Symptoms (Late)

inflammatory condition (stroke)

hydro cephalus

tumor (rarely)

lethargy/stupor

coma

changes in vital signs

Blood pressure ( systolic blood pressure increases but diastolic remains the same ).

Widening of pulse pressure is neurologic in nature (if narrow cardiac in nature).

heart rate decrease

respiratory rate decrease

Temperature increase directly proportional to blood pressure.

projective vomiting

headache

papilledema (edema of optic disc)

abnormal posturing , [may positive to babins ki reflex]

Decorticate posturing (damage to cortex and spinal cord).

decerebrate posturing (damage to upper brain stem

 decerebrate posturing (damage to upper brain stem that includes pons, cerebellum and midbrain). 

that includes pons, cerebellum and midbrain).

unilateral dilation of pupils called uncal herniation

bilateral dilation of pupils called tentorial herniation

resulting to mild headache

possible seizure activity

Nursing Management

1. Maintain patent and adequate ventilation by:

a. Prevention of hypoxia and hypercarbia

Early signs of hypoxia

R estles sness

Agitation

T achycardia

Late signs of hypoxia

B radycardia

Extreme restlessness

D

yspnea

C

yanosis

E xtreme restlessness  D yspnea  C yanosis HYPERCARBIA  Increase CO 2 (most powerful

HYPERCARBIA

 D yspnea  C yanosis HYPERCARBIA  Increase CO 2 (most powerful respiratory stimulant)

Increase CO 2 (most powerful respiratory stimulant) retention.

In chronic respiratory distress syndrome decrease O 2 stimulates respiratio n.

b. Before and after suctioning hyper oxygenate client 100% and done 10 15 seconds only.

c. Assist in mechanical ventilation

2. Elevate bed of client 30 35 o angle with neck in neutral position unless contraindicated to promote venous drainage.

3. Lim it fluid intake to 1200 1500 ml/day (in force fluids 2000 3000 ml/day).

4. Monitor strictly input and output and neuro check

5. Prevent complications of

6. Prevent further increase ICP by:

a. provide an comfortable and quite environment.

b. avoid use of restraints.

c. maintain side rails.

d. instruct client to avoid forms of valsalva maneuver like:

straining stool

straining stool

excessive vomiting (use anti emetics)

excessive vomiting (use anti emetics)

excessive coughing (use anti tussive like dextromethorphan)

excessive coughing (use anti tussive like dextromethorphan)

avoid stooping/bending

avoid stooping/bending

avoid lifting heavy objects

avoid lifting heavy objects

e. avoid clustering of nursing activity together.

7. Administer medications like:

a. Osmotic diuretic (Mannitol)

for cerebral diuresis Nursing Management monitor vital signs especially BP (hypotension). monitor strictly input and output e very 1 hour notify physician if output is less 30 cc/hr. administered via side drip Regulated fast drip to prevent crystal formation.

side drip Regulated fast drip to prevent crystal formation. b. Loop diuretic (Lasix, Furosemide) Nursing Manageme

b. Loop diuretic (Lasix, Furosemide)

Nursing Manageme nt

Drug of choice for CHF (pulmonary edema)

Loop of Henle in kidneys.

Monitor vital signs especially BP (hypotension).

monitor strictly input and output every 1 hour notify physician if output is less 30 cc/hr.

Administered IV push or oral.

given early morning

Immediate effect of 10 15 minutes.

maximum effect of 6 hours . [monitor for potassium depletion]

c. Corticosteroids

Dexamethasone (Decadron)

Hydrocortisone

Prednisone (to reduce edema that may lead to increase ICP)

Prednisone (to reduce edema that may lead to increase ICP)  Mild Analgesics (Codeine Sulfate for

Mild Analgesics (Codeine Sulfate for respiratory depression)

Anti Convulsants (Dilantin, Phenytoin )

*CONGESTIVE HEART FAILURE Signs and Symptoms

dyspnea

orthopnea

paroxysmal nocturnal dyspnea

productive cough

frothy salivation

cyanosis

rales/crackles

bronchial wheezing

pulsus alternans

anorexia and general body malaise

PMI (point of maximum impulse/a pical pulse rate) is displaced laterally

S3 (ventricular gallop)

Predisposing Factors/Mitral Valve

(ventricular gallop)  Predisposing Factors/Mitral Valve  RHD  Aging TREATMENT M orphine Sulfate A

RHD

Aging

TREATMENT M orphine Sulfate Aminophelline

igoxin

D

D

O

G ases, blood monitor

iuretics

xygen

RIGHT CONGESTIVE HEART FAILURE (Venous congestion) Signs and Symptoms

jugular vein distention (neck)

ascites

pitting edema

weight gain

hepatosplenomegaly

jaundice

pruritus

esophageal varices

anorexia and general body malaise

Signs and Symptoms of Lasix in terms of electrolyte imbalances

1. Hypokalemia

decrease potassium level

normal value is 3.4 5.5 meq/L

Sign and Symptoms

weakness and fatigue

 decrease potassium level  normal value is 3.4 – 5.5 meq/L Sign and Symptoms 

constipation

positive U wave on ECG tracing

Nursing Management

administer potassium supplements as ordered ( Kalium Durule, Oral Potassium Chloride )

increase intake of fo ods rich in potassium

FRUITS

VEGETABLES

Apple

Asparagus

Banana

Brocolli

Cantalope

Carrots

Oranges

Spinach

Brocolli Cantalope Carrots Oranges Spinach 2. Hypocalcemia/ Tetany  decrease calcium level 

2. Hypocalcemia/ Tetany

decrease calcium level

normal value is 8.5 10.5 mg/100 ml

Signs and Symptoms

tingling sensation

paresthesia

numbness

(+) Trousseau’s sign/ Carpopedal spasm

(+) Chvostek’s sign

Complications

Arrhythmia

Seizures

Nursing Management

Calcium Gluconate per IV slowly as ordered

*

Calcium Gluconate toxicity results to SEIZURE

* Calcium Gluconate toxicity – results to SEIZURE Magnesium Sulfate Magnesium Sulfate toxicity [B.U.R.P] S/S

Magnesium Sulfate

toxicity – results to SEIZURE Magnesium Sulfate Magnesium Sulfate toxicity [B.U.R.P] S/S B P U rine

Magnesium Sulfate toxicity [B.U.R.P] S/S

B P U rine output R espiratory rate Patellar relfex absent
B
P
U
rine output
R
espiratory rate
Patellar relfex absent

DECREASE

3. Hyponatremia

decrease sodium level

normal value is 135 145 meq/L

Signs and Symptoms

hypotension

dehydration signs (Initial sign in adult is THIRST , in infant TACHYCARDIA)

agitation

dry mucous membrane

poor skin turgor

weakness and fatigue

Nursing Management

force fluids

administer isotonic fluid solution as ordered

4. Hyperglycemia

normal FBS is 80 100 mg/dl

Signs and Symptoms ­ 3 P’s

polyuria

polydypsia

pol yphagia

Nursing Management

monitor FBS

5. Hyperuricemia

increase uric acid (purine metabolism)

foods high in uric acid (sardines, organ meats and anchovies)

*Increase in tophi deposit leads to Gouty arthritis.

Signs and Symptoms

joint pain (great toes)

swe lling

Nursing Management

force fluids

administer medications as ordered

a. Allopurinol (Zyloprim)

Drug of choice for gout.

Mechanism of action : inhibits synthesis of uric acid .

b. Colchecine

Acute gout

Mechanism of action : promotes excretion of uric acid .

KIDNEY STONES

Signs and Symptoms

renal colic

Cool moist skin

Nursing Management

force fluids

administer medications as ordered

a. Narcotic Analgesic

Morphine Sulfate

ANTIDOTE: Naloxone (Narcan)

toxicity leads to tremors.

b. Allopurinol (Zyloprim)

Sid e Effects

Respiratory depression (check for RR)

Sid e Effects  Respiratory depression (check for RR) PARKINSON’S DISEASE/ PARKINSONISM  Chronic progressive

PARKINSON’S DISEASE/ PARKINSONISM

Chronic progressive disorder of CNS characterized by degeneration of dopamine producing cells in the SUBSTANCIA NIGRA of the midbrain and basal ganglia .

Predisposing Fa ctors

1. Poisoning (lead and carbon monoxide)

2. Arteriosclerosis

3. Hypoxia

4. Encephalitis

5. Increase dosage of the following drugs:

a. Reserpine(Serpasil)

dosage of the following drugs: a. Reserpine(Serpasil) b. Methyldopa(Aldomet) c. Haloperidol(Haldol) d.

b. Methyldopa(Aldomet)

c. Haloperidol(Haldol)

d. Phenothiazine

AntihypertensiveS

a. Reserpine(Serpasil) b. Methyldopa(Aldomet) c. Haloperidol(Haldol) d. Phenothiazine AntihypertensiveS AntipsychoticS

AntipsychoticS

SIDE EFFECTS RESERPINE Major depression leading to

Aloneness Multiple loss causes suicide
Aloneness
Multiple loss
causes suicide

Loss of spouse

suicide
suicide

Loss of Job

direct approach towards the client

close surveillance is a nursing priority

time to commit suicide is on weekends early morning

Signs and Symptoms for Parkinson’s

pill rolling tremors of extremities especially the hands.

bradykinesia (slowness of movement)

rigidity (cogwheel type)

stooped posture

shuffling and propulsive gait

over fatigue

mask like facial expression with decrease blinking of the eyes.

difficulty rising from sitting position.

Dysphonia soft slurred Monotone type speech

mood lability (in state of depression)

Micrographia ­ shrinking slow handwriting

increase salivation ( drooling type )

autonomic changes

salivation ( drooling type )  autonomic changes a. increase sweating b. increase lacrimation c. seborrhea

a. increase sweating

b. increase lacrimation

c. seborrhea

d. constipation

e. decrease sexual capacity

Nursing Management 1. Administer medications as ordered

Anti Parkinsonian agents

Levodopa (L ­ dop a) short acting

Amantadine Hydrochloride (Symmetrel)

Carbidopa (Sinemet)

Mechanism of Action

increase level of dopamine

Side Effects

GIT irritation (should be taken with meals

orthostatic hypotension (CBQ)

arrhythmia

hallucinations

Contraindications

clients with narrow angle closure glaucoma

clients taking MAOI’s (no foods with tryptophan and thiamine : cheese, beer, avocado, wine )

urine and stool may be darkened

no Vitamin B6 (Pyridoxine) reverses the therapeutic effects of Levodopa

(Pyridoxine) reverses the therapeutic effects of Levodopa * Increase Vitamin B w hen taking INH (Isoniazid),

* Increase Vitamin B w hen taking INH (Isoniazid), Isonicotinic Acid Hydrazide

Anti Cholinergic Agents ( ARTANE and COGENTIN ) ­ to relieve tremors

Mechanism of Action

inhibits action of acethylcholine

Side Effects

SNS

Anti Histamine (Dipenhydramine Hydrochloride)

Side Effe cts

Adult: drowsiness

Children: CNS excitement (hyperactivity) because blood brain barrier is not yet fully developed.

Dopamine Agonist ­ relieves tremor rigidity

Bromocriptene Hydrochloride (Parlodel)

Side Effects

Respiratory depression

2. Maintain side r ails to prevent injury

3. Prevent complications of immobility

4. Decrease protein in morning and increase protein in afternoon to induce sleep

5. Encourage increase fluid intake and fiber.

6. Assist/supervise in ambulation

7. Assist in

Stereotaxic Thalamot omy

a portion of thalamus is destroyed to reduce tremors

MAGIC 2’s IN DRUG MONITORING [D.L.A.D.A]

   

TOXICITY

   

DRUG

NORMAL RANGE

LEVEL

INDICATION

CLASSIFICATION

Digoxin/ Lanoxin ( Increase force of cardiac output)

.5 1.5 meq/L

2

CHF

Cardiac Glycoside

Lithium/ Lithane ( Decrease level of Ach/NE/Serotonin )

.6 1.2 meq/L

2

Bipolar

Anti­ Manic Agents

Aminophylline (Dilates bronchial tree)

10

19 mg/100 ml

20

COPD

Bronchodilators

Dilantin/ Phenytoin

10

19 mg/100 ml

20

Seizures

Anti­ Convulsant

Ace taminophen/Tylenol

10

30 mg/100 ml

200

Osteo arthritis

Non ­ narcotic Analgesic

1. Digitalis Toxicity

Signs and Symptoms

nausea and vomiting / anorexia

diarrhea

confusion / fatigue / depression / malaise

photophobia

changes in color perception (yellowish or green halo around lights or “snowy” vision )

Antidote: Digibind digoxin immune FAB

2. Lithium Toxicity

Signs and Symptoms

digoxin immune FAB 2. Lithium Toxicity Signs and Symptoms – anti­ manic agent/ mood stabilizing agent

anti­ manic agent/ mood stabilizing agent

anorexia

nausea and vomiting

diarrhea

dehydration causing fine tremors

hypothyroidis m ( cretinism the only endocrine disorder that can lead to mental retardation)

Nursing Management

force fluids

increase sodium intake to 4 10 g% daily

3.

Signs and Symptoms

Aminophylline Toxicity

tachycardia

palpitations

CNS excitement (tremors, irrit ability, agitation and restlessness)

Nursing Management

Only mixed with plain NSS or 0.9 NaCl to prevent development of crystals or precipitate.

administered sandwich method

avoid taking alcohol because it can lead to severe CNS depression

avoid caffeine

4.

Signs and Symptoms

Dilantin phenytoin Toxicity

gingival hyperplasia (swollen & tender gums)

hairy tongue

ataxia

nystagmus

Nursing Management

provide oral care

massage gums

5.

Signs and Symptoms

Acetaminophen Toxicity

hepatotoxicity (monitor for liver enzymes)

SGPT/ALT (Serum Glutamic Pyruvate Transaminace)

SGOT/AST (Serum Glutamic Oxalo ­ Acetil Transaminace)

nephrotoxicity monitor BUN (10 20) and Creatinine (.8 1)

hypoglycemia

T remors, tachycardia Irritability R estlessness Extreme fatigue D iaphores is, depression Antidote: Acetylcisteine (mucomyst) prepare suction apparatus at bedside.

(mucomyst) prepare suction apparatus at bedside. MYASTHENIA GRAVIS  Neuromuscular disorder characterized

MYASTHENIA GRAVIS

Neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction leadi ng to descending muscle weakness .

Incidence rate : women 20 40 years old Predisposing factors

unknown

Autoimmune: it involves release of cholinester ase an enzyme that destroys Acetylcholine

Signs and Symptoms

initial sign is ptosis a clinical parameter to determine ptosis is palpebral fissure. (drooping of eyelid)

diplipia

mask like facial expression

dysphagia

hoarseness of voice [dysphonia ­ voice impairment ]

respiratory muscle weakness that may lead to respiratory arrest (tracheostomy at bed side)

extreme muscle weakness especially during activity or exertion

Diagnostic Procedure

Tensilon test (Edrophonium Hydrochloride) provides temporary relief of signs and symptoms for about 5

10 minutes and a maximum of 15 minutes.

if there is no effect there is dama ge to occipital lobe and midbrain and is negative for M.G.

Nursing Management

1. Airway

2. Aspiration

3. Immobility

* assist in mechanical ventilation and monitor pulmonary function test

* monitor strictly vital signs, input and output and neuro check

* monitor strength or motor grading scale

4. Maintain side rails to prevent injury related to falls

5. Institute NGT feeding

6. Administer medications as ordered

Institute NGT feeding 6. Administer medications as ordered maintain patent airway and adequate ventilation a.

maintain patent airway and adequate ventilation

a. Cholinergic (Mestinon) pyridos tigmine bromide

b. Anti Cholenisterase (Prostigmin) neostigmine bromide

Mechanism of Action

increase level of Ach

Side Effects

PNS

Cortocosteroids suppress immune response

monitor for 2 types of crisis:

MYASTHENIC CRISIS

CHOLINERGIC CRISIS

Causes:

Cause:

under medication

under medication

over medication Signs and Symptoms

over medication Signs and Symptoms

stress (disease exacerbation, high temp.) infection Signs and Symptoms The client is unable to see,

stress (disease exacerbation, high temp.) infection Signs and Symptoms The client is unable to see, swallow, speak, breathe Treatment administer cholinergic agents as ordered

and Symptoms The client is unable to see, swallow, speak, breathe Treatment administer cholinergic agents as
and Symptoms The client is unable to see, swallow, speak, breathe Treatment administer cholinergic agents as
and Symptoms The client is unable to see, swallow, speak, breathe Treatment administer cholinergic agents as
PNS Tensilon test doesn’t improve MG
PNS Tensilon test doesn’t improve MG

PNS Tensilon test doesn’t improve MG

 

Treatment Administer anti cholinergic agents (Atropine Sulfate)

Treatment Administer anti cholinergic agents (Atropine Sulfate)

7. Assist in surgical procedure known as thymectomy because it is believed that the thymus gland is responsible for M.G.

8. Assist in plasma paresis and removing auto immune ant i bodies

9. Prevent complications

INFLAMMATORY CONDITIONS OF THE BRAIN

Prevent complications INFLAMMATORY CONDITIONS OF THE BRAIN MENINGITIS Meninges  3 fold membrane that covers brain

MENINGITIS

Meninges

3 fold membrane that covers brain and spinal cord.

for support and protection

for nourishment

blood supply

LAYERS OF THE MENING ES

Dura matter outer layer

2.

3.

1.

Arachnoid middle layer

Pia matter inner layer

subdural space between the dura and arachnoid

Subarachnoid space between the arachnoid and pia, CSF aspiration is done.

A. Etiology

1.

2. Pneumococcus

3.

4.

Meningococcus most dangerous

Streptococcus ­ c auses adult meningitis

Hemophilus Influenzae causes pediatric meningitis

B.

Mode of transmission

airborne transmission (droplet nuclei)

C. Signs and Symptoms

headache

photophobia

projectile vomiting

fever & chills, anorexia, general ized body malaise and weight loss

Possible increase in ICP and seizure activity

Abnormal posturing (decorticate and decerebrate)

Signs of meningeal irritation

and decerebrate)  Signs of meningeal irritation a. Nuchal rigidity or stiff neck b. Opisthotonus (arching

a. Nuchal rigidity or stiff neck

b. Opisthotonus (arching of back)

c. (+) Kernig’s sign (leg pain)

d. (+) Brudzinski sign (neck pain)

D. Diagnostic Procedures

Lumbar puncture: a hollow spinal needle is inserted in the subarachnoid space between the L3 L4 to

L5.

Nursing Management for LP

Before Lumbar Puncture. [note all surgery procedure explain by the doctor, diagnostic procedure is by the nurse]

1. Secure informed consent and explain procedure.

2. Empty bladder and bowel to promote comfort.

3. Encourage to arch back to clearly visualize L3 ­ L4. (fetal position)

Post Lumbar Puncture

1. Place flat on bed 12 24 o

2. Force fluids

3. Check punctured site for any discoloration, drainage and leakage to tissues.

4. Assess for movement and sensation of extremities.

CSF analysis reveals

1. Increase CHON and WBC

2. Decrease glucose

3. Increase CSF opening pressure (normal pressure is 50 100 mmHg)

4. (+) cultured microorganism (confirms meningitis)

CBC reveals

1. Increase wbc

notes on hematology:

E.

1.

2.

Nursing Manag ement

Enforce complete bed rest

Administer medications as ordered

 

INCREASED

DECREASED

RBC

Polycythemia

Anemia

WBC

Leukocytosis

Leukopenia

PLATELETS

Thrombocytosis

Thrombocytopenia

a. Broad spectrum antibiotics (Penicillin, Tetracycline)

b. Mild analgesics

c. Anti pyretics

3.

4.

5.

6.

7.

8.

9.

Institute strict respiratory isolation 24 hours after initiation of anti biotic thera py

Elevate head 30­ 45 o

Monitor strictly V/S, input and output and neuro check

Institute measures to prevent increase ICP and seizure.

Provide a comfortable and darkened environment.

Maintain fluid and electrolyte balance.

Provide client health care and discharge planning concerning:

a. Maintain good diet of increase CHO, CHON, calories with small frequent feedings.

b. Prevent complications

most feared is hydrocephalus

hearing loss/nerve deafness is second complication

consult audiologis t

c. Rehabilitation for neurological deficit

mental retardation

delayed psychomotor development

CVA (STROKE/BRAIN ATTACK/ ADOPLEXY/ CEREBRAL THROMBOSIS)

a partial or complete disruption in the brains blood supply.

2 most common cerebral artery affecte d by stroke

a. Mid Cerebral Artery

b. Internal Cerebral Artery the 2 largest artery

A. Incidence Rate

men are 2­ 3 times high risk

B. Predisposing Factors

thrombus (attached)

embolus (detached and most dangerous because it can go to the lungs and cause pulmonary embolism or the brain and cause cerebral embolism .

Signs and Symptoms of Pulmonary Embolism  Sudden sharp chest pain  Unexplained dyspnea 
Signs and Symptoms of Pulmonary Embolism
 Sudden sharp chest pain
 Unexplained dyspnea
 Tachycardia
 Palpitations
 Diaphoresis
 Mild restlessness
Signs and Symptoms of C erebral Embolism
 Headache and dizziness
 Confusion
 Restlessness
 Decrease LOC
 Fat embolism is the most feared complications after femur fracture.

Yellow bone marrow are produced from the medullary cavity of the long bones and produces fat cells.

If there is bone fracture there is hemorrhage and there would be escape of the fat cells in the circulation.

Compartment syndrome (compression of arteries and nerves)

C.

Risk Factors

1. Hypertension, Diabetes Mellitus, Myocardial Infarction, Atherosclerosis, Valvular Heart Disease, Post Cardiac Surgery

(mitral valve replacement)

2. Lifestyle (smoking), sedentary lifestyle

3. Obesity (increase 20% ideal body weight)

4. Hyperlipidemia more on genetics/genes that binds to cholesterol

5. Type A personality

a. deadline driven

b. can do multiple tasks

c. usually fells guilty when not doing anything

6. Related to diet: increase intake of saturated fats like whole milk

7. Related stress physical and emotional

8. Prolong use of oral contraceptives promotes lypolysis (break down of lipids) leading to atherosclerosis that will lead to

hypertension and eventually CVA.

that will lead to hypertension and eventually CVA. Notes: “ Plegia” – paralysis Ex: Hemiplegia –

Notes:

“ Plegia” paralysis Ex: Hemiplegia paralysis of one side of the body.

“Paresis” weakness Ex: Hemiparesis ­ weakness of one side of the body.

D.

1.

Signs and Symptoms

TIA
TIA

dependent on stages of development

Initial sign of stroke or warning sign

Signs and Symptoms

headache and dizziness

tinnitus

visual and speech disturbances

paresis to plegia

possible increase ICP

2.

­ progression of signs and symptoms of stroke

3. Complete stroke

Stroke in evolution

resolution phase characterized by:

Signs and Symptoms

headache and dizziness

Cheyne Stokes Respiration

anorexia, nausea and vomiting

dysphagia

(+) Kernig’s sign and Brudzinski sign which may lead to hemorrhagic stroke

focal neurological deficits

a. phlegia

b. aphasia

c. dysarthria (inability to articulate words)

d. alexia (difficulty reading)

e. agraphia (difficulty writing)

f. homonymous hemianopsia (loss of half of visual field)

E. Diagnostic Procedure

1. CT Scan reveals brain lesions

2. Cerebral Arteriography

reveals the site and extent of malocclusion

uses dye for visualization

mos t of dye are iodine based

check for shellfish allergy

after diagnostic exam force fluids to release dye because it is nephro toxic

check for distal pulse (femoral)

check for hematoma formation

F. Nursing Management

1. Maintain patent airway and adequate ventilation by:

a. assist in mechanical ventilation

b. administrate O2 inhalation

2. Restrict fluids to prevent cerebral edema that might increase ICP

3. Elevate head 30 45 o

4. Monitor strictly vitals signs, I & O and neuro check

5. Prevent complications of immobility by:

a. turn client to side

b. provide egg crate mattresses or water bed

c. provide sand bag or foot board.

mattresses or water bed c. provide sand bag or foot board. 6. Assist in passive ROM

6. Assist in passive ROM exercise every 4 hours to promote proper bodily alignment and prevent contractures

7. Institute NGT fe eding

8. Provide alternative means of communication

NGT fe eding 8. Provide alternative means of communication a. non verbal cues b. magic slate

a. non verbal cues

b. magic slate

9. If positive to hemianopsia approach client on unaffected side

10. Administer medications as ordered

a. Osmotic Diuretics (Mannitol)

b. Loop Diuretics (Lasix, Furos emide)

c. Cortecosteroids

d. Mild Analgesics

e. Thrombolytic/Fibrinolytic Agents dissolves thrombus

Streptokinase

Side Effect: Allergic Reaction

Urokinase

Tissue Plasminogen Activating Factor

Side Effect: Chest Pain

f. Anti Coagulants

Heparin (short acting)

check for partial thromboplastin time if prolonged there is a risk for bleeding.

give Protamine Sulfate

Comadin/ Warfarin (long acting)

give simultaneously because Coumadin will take effect after 3 days

check for prothrombin time if prolonged ther e is a risk for bleeding

give Vit. K (Aqua Mephyton)

g. Anti Platelet

PASA (Aspirin)

Contraindicated for dengue, ulcer and unknown cause of headache because it may potentiate bleeding

11. Provide client health teachings and discharge planning concerning

a. avoidance of modifiable risk factors (diet, exercise, smoking)

b. prevent complication (subarachnoid hemorrhage is the most feared complication)

c. dietary modification (decrease salt, saturated fats and caffeine)

d. importance of follow up care

GUILLAIN BARRE SYNDR OME (Acute Ediopathic Polyneuropathy)



a disorder of the CNS characterized by bilateral symmetrical polyneuritis leading to

paralysis /weakness .

A. Predisposing Factors

1. Autoimmune

ascending muscle

B. Signs and Symptoms 1. Clumsiness (initial sign) 2. Dysphagia 3. Ascending muscle weakness leading

B. Signs and Symptoms

1. Clumsiness (initial sign)

2. Dysphagia

3. Ascending muscle weakness leading to paralysis

4. Decreased of diminished deep tendon reflex

5. Alternate hypotension to hypertension

** ARRYTHMIA (most feared complicat ion)

6.

Autonomic symptoms that includes

a. increase salivation

b. increase sweating

c. constipation

Diagnostic Procedures

CSF analysis reveals increase in IgG and protein

C.

1.

D.

1.

2.

Nursing Management

Maintain patent airway and adequate ventilation by:

a. assist in mechanical ventilation

b. monitor pulmonary function test

Monitor strictly the following

a. vital signs

b. intake and output

c. neuro check

d. ECG

3.

4.

5.

6.

7.

Maintain side rails to prevent injury related to fall

Prevent complications o f immobility by turning the client every 2 hours

Institute NGT feeding to prevent aspiration

Assist in passive ROM exercise

Administer medications as ordered

a. Corticosteroids suppress immune response

b. Anti Cholinergic Agents Atrophine Su lfate

c. Anti Arrythmic Agents

Lidocaine, Zylocaine

Bretylium blocks release of norepinephrine to prevent increase of BP

8.

9.

Assist in plasma pharesis (filtering of blood to remove autoimmune anti ­ bodies)

Prevent complications

a. Arrythmia

b. Para lysis or respiratory muscles / Respiratory arrest

* Sengstaken Blakemore Tube

for liver cirrhosis

to decompress bleeding esophageal verices (prepare scissor to cut tube incase of difficulty in breathing

to release air in the balloon

for hemodialysis prep are bulldog clips to prevent air embolism.

CONVULSIVE DISORDER/ CONVULSION

Disorder of CNS characterized by paroxysmal seizure with or without loss of consciousness abnormal motor activity alternation in sensation and perception and changes in behavior.

Seizure first convulsive attack

Epilepsy second or series of attacks

Febrile seizure normal in children age below 5 years

A. Predisposing Factors

1. Head injury due to birth trauma

2. Genetics

3. Presence of brain tumor

4. Toxicity from

a. lead

b carbon monoxide

5. Nutritional and Metabolic deficiencies

6. Physical and emotional stress

7. Sudden withdrawal to anti convulsant drug is predisposing factor for status epilepticus (drug of choice is Diazepam,

Valium)

B. Signs and Symptoms

Dependent on stages of development or types of seizure

I. Generalized Seizure

1. Grand mal Seizure (tonic ­ clonic seizure)

a. Signs or aura with auditory, olfactory, visual, tactile, sensory experience

b. Epileptic cry is characterized by fall and loss of consciousn ess for 3 5 minutes

c. Tonic contractions ­ direct symmetrical extension of extremities Clonic contractions ­ contraction of extremities

d. Post ictal sleep unresponsive sleep

2. Petit mal Seizure absence of seizure common among pediatric clients characterized by

a. blank stare

b. decrease blinking of eyes

c. twitching of mouth

d. loss of consciousness (5 10 seconds)

II. Partial or Localized Seizure

1. Jacksonian Seizure (focal seizure)

Characterized by tingling and jerky movement of index finger and thumb that spreads to the shoulder and other side of the body.

2. Psychomotor Seizure (focal motor seizure)

a. automatism stereotype repetitive and non propulsive behavior

b. clouding of consciousness not in contact with environment

c. mild hallucinatory sensory experience

III. Status Epilepticus

A continuous uninterrupted seizure activity, if left untreated can lead to hyperpyrexia and lead to coma and eventually death.

Drug of choice : Diazepam, Valium and Glucose

C.

Diagnostic P rocedures

1.

CT Scan reveals brain lesions

2.

EEG reveals hyper activity of electrical brain waves

D.

Nursing Management

1.

Maintain patent airway and promote safety before seizure activity

a. clear the site of blunt or sharp objects

b. loosen clothing of client

c. maintain side rails

d. avoid use of restrains

e. turn clients head to side to prevent aspiration

f. place mouth piece of tongue guard to prevent biting or tongue

2.

Avoid precipitating stimulus such as bright/glaring lights and noise

3. Administer medications as ordered

a. Anti convulsants (Dilantin, Phenytoin)

b. Diazepam, Valium

c. Carbamazepine (Tegretol) Trigeminal neuralgia

d. Phenobarbital, Luminal

4. Institute seizure and safety precaution post seizure attack

a. administer O2 inhalation

b. provide suction apparatus

5. Document and monitor the following

a. onset and duration

b. types of seizures

c. duration of post ictal sleep may lead to status epilepticus

d. assist in surgical procedure cortical resection

COMPREHENSIVE NEURO EXAM

GLASGOW COMA SCALE

objective measurement of LOC sometimes called as the quick neuro check

Components

1. Motor response

2. Verbal response

3. Eye opening

Conscious 15 14

Lethargy

13 11

Stupor

10 8

Coma

7

Deep Coma

3

Survey of mental status and speech

a. LOC

b. Test of memory

Levels of orientation

Cranial nerve assessment

Sensory nerve assessment

Motor nerve assessment

Deep tendon reflex

Autonimics

Cerebellar test

a, Romberg’s test – 2 nurses, positive for ataxia

b. Finger to nose test positive result mean dimetria (inability of body to stop movement at desired point)

c. Alternate supination and pronation positive result mean dimetria

I. LEVEL OF CONSCIOUSNESS 1. Conscious ­ awake 2. Lethargy – lethargic (drowsy, sleepy, obtunded)
I. LEVEL OF CONSCIOUSNESS
1. Conscious ­ awake
2. Lethargy – lethargic (drowsy, sleepy, obtunded)
3. Stupor
 stuporous (awakened by vigorous stimulation)
 generalized body weakness
 decrease body reflex
4. Coma
 comatose
 light coma (positive to all forms of painful stimulus)
 deep coma (negative to all forms of painful stimulus)

DIFFERENT PAINFUL STIMULATION

1. Deep sternal stimulation/ deep sternal pressure

2. Orbital pressure

3. Pressure on great toes

4. Corneal or blinking reflex Conscious client use a wisp of cotton Unconscious client place 1 drop of saline solution

II. TEST OF MEMORY

1. Short term memory

ask m ost recent activity

positive result mean anterograde amnesia and damage to temporal lobe

2. Long term memory

ask for birthday and validate on profile sheet

positive result mean retrograde amnesia and damage to limbic system

consider educa tional background

CRANIAL NERVES

FUNCTION

I. OLFACTORY

S

II.

OPTIC

S

III OCCULOMOTOR

M

 

M

IV. TROCHLEAR

(Smallest)

 

B

V. TRIGEMINAL

(Largest)

VI. ABDUCENSE

M

VII. FACIAL

B

VIII. ACOUSTIC

S

IX. GLOSSOPHARYNGEAL

B

 

B

X. VAGUS

(Longest)

XI. SPINAL ACCESSORY

M

XII. HYPOGLOSSAL

M

III. LEVELS OF ORIENTATION

1. Time first asked

2. Person second asked

3. Place third asked

CRANIAL NERVES

CRANIAL NERVE I: OLFACTORY

sensory function for smell

Material Used

don’t use alcohol, ammonia, perfume because it is irri tating and highly diffusible.

use coffee granules, vinegar, bar of soap, cigarette

Procedure

test each nostril by occluding each nostril

Abnormal Findings

1. Hyposnia decrease sensitivity to smell

2. Dysosmia distorted sense of smell

3. Anosmia abse nce of smell

Indicative of

1. head injury damaging the cribriform plate of ethmoid bone where olfactory cells are located

2. may indicate inflammatory conditions (sinusitis)

located 2. may indicate inflammatory conditions (sinusitis) CRANIAL NERVE II: OPTIC  sensory function for vision

CRANIAL NERVE II: OPTIC

sensory function for vision or sight

Functions

1. Test visual acuity or central vision or distance

use Snellen’s Chart

Snellen’s Alphabet chart: for literate clients

Snellen’s E chart: for illiterate clients

Snellen’s Animal chart: for pediatric clients

normal visual acuity 20/20

numerator is constant, it is t he distance of person from the chart (6 7 m, 20 feet)

denominator changes, indicates distance by which the person normally can see letter in the chart.

­ 20/200 indicates blindness

20/20 visual acuity if client is able to read letters above the red line .

a. Superiorly

b. Bitemporaly

c. Nasally

d. Inferiorly

COMMON VISUAL DISORDERS

1

. Glaucoma

increase IOP

normal IOP is 12 21 mmHg

preventable but not curable

A.

Predisposing Factors

Common among 40 years old and above

Hereditary

Hypertension

Obesity

B.

1.

2.

C.

1.

2.

3.

Signs and Symptoms

Loss of peripheral vision

pathognomonic sign is tunnel vision

Headache, nausea, vomiting, eye pain ( halos around light )

steamy cornea

may lead to blindness

Diagnostic Proce dures

Tonometry

Perimetry

Gonioscopy

D. Treatment

1.

Miotics constricts pupil

a. Pilocarpine Sodium , Carbachol

2.

3.

Epinephrine eyedrops decrease formation of aqueous humor

Carbonic Anhydrase Inhibitors

formation of aqueous humor Carbonic Anhydrase Inhibitors a. Acetazolamide (Diamox) – promotes increase outflow
formation of aqueous humor Carbonic Anhydrase Inhibitors a. Acetazolamide (Diamox) – promotes increase outflow

a. Acetazolamide (Diamox) promotes increase outflow of aqueous humor or drainage

4.

E.

1.

Timoptics ( Timolol Maleate )

Surgical Procedures

TRABECULECTOMY (Peripheral Indectomy) drain aqueous humor

2. CATARACT  Decrease opacity of lens A. Predisposing Factor 1. Aging 65 years and
2. CATARACT
 Decrease opacity of lens
A.
Predisposing Factor
1.
Aging 65 years and above
2.
Related to congenital
3.
Diabetes Mellitus
4.
Prolonged exposure to UV rays
B.
Signs and Symptoms
1.
Loss of central vision
C.
Pathognomonic Signs
1. Blurring or hazy vision
2. Milky white appearance at center of pupils
3. Decrease perception to colors
 Complication is blindness
D. Diagnostic Procedure 1. Opthalmoscopic exam E. Treatment 1. Mydriatics (Mydriacyl) –

D.

Diagnostic Procedure

1.

Opthalmoscopic exam

E.

Treatment

1.

Mydriatics (Mydriacyl) dilating pupils

2.

Cyclopegics (Cyclogyl) paralyses cilliary muscle

F.

Surgical Procedure

apsular

ataract

C

C

apsular

ataract

Extra

C

C

L ens Extraction ­ Partial removal

Most feared complication post op is RETINAL DETACHMENT

Intra

L ens

Extraction

­ Total removal of cataract with its surrounding capsules

3. Retinal Detachment  Separation of epithelial surface of retina A. Predisp osing Factors 1.
3.
Retinal Detachment
Separation of epithelial surface of retina
A.
Predisp osing Factors
1.
Post Lens Extraction
2.
Myopia (near sightedness)
B.
Signs and Symptoms
1.
Curtain veil like vision
2.
Floaters
C.
Surgical Procedures
1.
Scleral Buckling
2.
Cryosurgery – cold application
3.
Diathermy – heat application
4. Macular D egeneration  Degeneration of the macula lutea (yellowish spot at the center
4.
Macular D egeneration
 Degeneration of the macula lutea (yellowish spot at the center of retina)
A. Signs and Symptoms
1. Black Spots
CRANIAL NERVE III, IV, VI: OCULOMOTOR, TROCHLEAR, ABDUCENS
A. normal retina
B.
 Controls or innervates the movement of extrinsic ocular muscle (EOM)
c.
 6 muscles
Superior Rectus
Superior Oblique
Lateral Rectus
Medial Rectus
Inferior Oblique
Inferior Rectus

“wet” macular degeneration

“dry” macular degeneration

trochlear controls superior oblique

abducens controls lateral rectus

oculomotor controls the 4 r emaining EOM

Oculomotor

controls the size and response of pupil

normal pupil size is 2 3 mm

equal size of pupil: Isocoria

Unequal size of pupil: Anisocoria

Normal response: positive PERRLA

CRANIAL NERVE V: TRIGEMINAL

largest cranial nerve

consists of o phthalmic, maxillary, mandibular

sensory: controls sensation of face, mucous membrane, teeth, soft palate and corneal reflex)

motor: controls the muscle of mastication or chewing

damage to CN V leads to trigeminal neuralgia/t ic douloureux (nerve pain)

medication: Carbamezapine(Tegretol) ­ anticonvulsant

CRANIAL NERVE VII: FACIAL

Sensory: controls taste, anterior 2/3 of tongue

pinch of sugar and cotton applicator placed on tip of tongue

Motor: controls muscle of facial expression

Instruct client to smile, frown and if results are negative there is facial paralysis or Bell’s palsy and the primary cause is forceps delivery.

CRANIAL NERVE VIII: ACOUSTIC/VESTIBULOCOCHLEAR

Controls balance particularly kinesthesia or position sense, refers to movement and orien tation of the body in space.

Parts of the Ear 1. Outer Ear  Pinna  Eardrum 2. Middle Ear 
Parts of the Ear
1. Outer Ear
 Pinna
 Eardrum
2. Middle Ear
 H ammer
M alleus
 Anvil
Incus
 Stirrup
Stapes
3. Inner Ear
 Vestibule: Meinere’s Disease
 Cochlea
 Mastoid Cells

Endolymph and Perilymph

COCHLEA: controls hearing, contains the Organ of Corti (the true organ of hearing)

Let client repeat words uttered

CRANIAL NERVE IX, X: GLOSOPHARYNGEAL, VAGUS NERVE

Glosopharyngeal: controls taste, posterior 1/3 of tongue

Vagus: controls gag reflex

Uvula should be midline and if not indica tive of damage to cerebral hemisphere

Effects of vagal stimulation is PNS

CRANIAL NERVE XI: SPINAL ACCESSORY

Innervates with sternocleidomastoid (neck) and trapezius (shoulder)

CRANIAL NERVE XII: HYPOGLOSSAL

Controls the movement of tongue

Let client prot rude tongue and it should be midline and if unable to do indicative of damage to cerebral hemisphere and/or has short frenulum.

of damage to cerebral hemisphere and/or has short frenulum. ENDOCRINE SYSTEM Overview of the structures and

ENDOCRINE SYSTEM

Overview of the structures and functions

1. Pituitary Gland (Hypophysis Cerebri)

o

Located at base of brain pa rticularly at sella turcica

o

Master gland or master clock

o Controls all metabolic function of body PARTS OF THE PITUITA RY GLAND

1.

Anterior Pituitary Gland

o called as adenohypophysis

2.

Posterior Pituitary Gland

o called as adenohypophysis 2. Posterior Pituitary Gland 2. o o o o called as neurohypophysis

2.

o

o

o

o