Comprehensive Study Guide for Neurological and Renal Disorders, Exams of Nursing

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NR 283: FINAL EXAM STUDY GUIDE fully

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What are the clinical manifestations for alterations in arousal? - ANSWER- level of conscious changes which is the most critical evidence, pattern of breathing evaluates level of brain dysfunction, pupillary changes indicate level of brain stem dysfunction, oculomotor responses and motor response which help evaluate level of dysfunction and damaged side Brain Death is what? - ANSWER- total brain death, body can no longer maintain internal homeostasis, unresponsive coma, no spontaneous respirations, no brain stem function and flat EEG What is cerebral death? - ANSWER- irreversible coma and death of the cerebral hemispheres exclusive of the brain stem and cerebellum, and the bran can continue to maintain internal homeostasis. what are the 4 types of cerebral death? - ANSWER- coma, vegetative state which they can open their eyes and have normal sleep, minimal conscious state which they have small movements and follow commands and locked-in syndrome which the brain is conscious and body is paralyzed. what is a seizure - ANSWER- sudden, transient, alteration of brain function caused by abrupt discharge of cerebral neurons what is the cause of a seizure - ANSWER- cerebral lesions or trauma, biochemical disorders Epilepsy is what, and results from what? - ANSWER- continuous seizure with no known trigger, results from interaction of mutations and environmental factors and epileptic neurons.

What are the phases of seizures? - ANSWER- tonic phase which is contraction, clonic phase which is relaxation and postictal phase which is sleepiness or tired. what are the CM of seizures? - ANSWER- aura which is a warning sign, prodroma which are physical symptoms, fatigue, N and headache, increase in oxygen consumption, prolonged seizure can cause damage what are the 3 types of dysphasia? - ANSWER- expressive which is Broca and deficit of expression, receptive which is wernicke and deficit of comprehension, and transcortical which is echolalia. what is acute confusional state or ACS - ANSWER- transient disorder of awareness that result from cerebral dysfunction. ACS is caused by - ANSWER- secondary to drug intoxication, metabolic disorder, nervous system disease ACS cm - ANSWER- impaired or lost detection, inability to concentrate, restless, irritable, and compulsive behavior what is delirium - ANSWER- more severe type of ACS, with worsening symptoms. what is dementia - ANSWER- group of symptoms that cause progressive failure of cerebral functions of orientation, memory, language, behavior and judgement and decision making dementia CM and causes - ANSWER- infection, atherosclerosis, trauma, and genetics alzheimer disease or AD is caused by - ANSWER- deficiencies of neurochemical factors, trauma and genetic mutations AD pathologic features are - ANSWER- neuron tangles, plaques and degeneration AD CM IS WHAT - ANSWER- forgetfulness, emotional upset, memory loss, confusion, mood changes, problem solving and judgement difficulty increased intracranial pressure or IICP is caused by and what are the 4 stages - ANSWER- increased in intracranial content, stage 1 there is no change in ICP, stage 2 there is slight ICP change with expansion, stage 2 there is hypoxic tissue and deterioration, stage 4 there is herniation of brain tissue

what is a cerebral edema, where does it occur and cause - ANSWER- increase in fluid in the brain, which occurs after brain injury and will cause harmful effects by distorting and displacing tissue what are the types of cerebral edema - ANSWER- vasogenic which is increased capillary permeability, cytotoxic which is caused by toxins, and interstitial which is seen with hydrocephalus. Hydrocephalus is what? - ANSWER- excess fluid within the cranial vault, subarachnoid space or both what causes hydrocephalus - ANSWER- interference in CSF flow with decreased reabsorption, increased fluid production, obstruction within the ventricular system what are the CM of hydrocephalus - ANSWER- headache, change in LOC, vomiting what is the triad of symptoms for adult hydrocephalus - ANSWER- unsteady gait, signs that mimic dementia, and incontinence what is huntington's disease and caused by what - ANSWER- chorea, autosomal dominant hereditary degenerative disorder and degeneration of basal ganglia Huntington's disease CM - ANSWER- progresses slowly, chorea (dancing movement), athetosis (twisting) and ballism (body throwing) Parkinson's Disease - ANSWER- common disorder of movement, unknown cause and degeneration of basal ganglia, loss of dopamine and excess activity of neural cells Parkinson's disease CM - ANSWER- tremors, rigidity, and bradykinesia (slow movement) what are focal brain injuries - ANSWER- contusions, epidural hemorrhage and subdural hemorrhage contusions - ANSWER- blood leaking from injured vessels, immediate loss of consciousness/reflexes and changes in memory, behavior and attention

epidural hemorrhage - ANSWER- arterial bleed, loss of consciousness temporary, medical emergency, gets worse, sudden death subdural hematomas/hemorrhage - ANSWER- torn veins, acute which develops rapidly and worsen over time, and chronic which is common in elderly, develos slowly and CM are headache or mimic dementia spinal cord trauma is most common, forms and replaced by what - ANSWER- most common in cervical and thoracic vertebrae, hemorrhage and edema form, injured axons are removed and replaced with fibrous tissue spinal shock is - ANSWER- normal activity of the spinal cord ceases at and below the level of injury, resolves with the reappearance of reflex activity autonomic dysreflexia - ANSWER- life threatening cardiovascular response to stimulation of the sympathetic nervous system, caused by sensory stimulation below the level of injury CM of spinal cord trauma - ANSWER- hypertension and headache hemorrhagic stroke - ANSWER- HTN, aneurysms, tremors, trauma, mass of blood compresses and displaces tissue, edema, ischemia and IICP occur, blood is reabsorbed. thrombotic CVA - ANSWER- starts in brain and leads to arthosclerosis embolic CVA - ANSWER- leads to TIA and caused by a clot bacterial meningitis - ANSWER- meningococcus, pneumococcus, neutrophils enter subarachnoid space leading to inflammation and brain tissue damage, CM are systemic infection, meningeal irritation and neurological signs encephalitis - ANSWER- acute febrile illness, viral origin with nervous system involvement, caused by herpes simplex virus and arthropod borne viruses, capability of causing edema, IICP, hemorrhage, necrosis and CM range from mild to life threatening multiple sclerosis or MS - ANSWER- autoimmune inflammatory disorder, develops after viral infection, inflammation and demyelination of axon, nerve conduction is disrupted and neuron death

MS CM - ANSWER- vision and sensory impairment, dysphagia, muscle weakness, slurred speech, fatigue amyotrophic lateral sclerosis or ALS - ANSWER- lou gehrig disease, unknown cause, motor neurons of brain and spinal cord, leads to progressive weakness leading to respiratory failure and death, patient has normal intellectual and sensory function until death with CM of muscle weakness and twithces myasthenia gravis - ANSWER- autoimmune, antibody produced against acetylcholine receptors to clock the binding of acetylcholine, decreased nerve transmission and lack of muscle depolarization and CM of weakness and fatigue renal calculi or kidney stones and risk factors - ANSWER- masses of crystals, protein, calcium which obstruct urinary tract, risk factors are gender, race, diet, fluid intake, fluid retention, changes in urine pH renal calculi pathophysiology and CM - ANSWER- supersaturation of salt, precipitation of salt, growth of stone and presence or absence of stone inhibitors with CM of renal colic NEUROGENIC BLADDER - ANSWER- dyssynergia, problems with loss of sensation, automatic emptying, and uncoordination of sphincters overactive bladder syndrome - ANSWER- detrusor over-activity, urgency and involuntary detrusor contraction, urinary retention and incontinence the CM of patient would be frequency, urgency and nocturia other lower urinary tract obstructions - ANSWER- urethral strictures, prostate enlargement, and pelvic organ prolapse acute cyctitis (UTI) - ANSWER- most common, bacteria caused leads to inflammation and edema of bladder with CM of frequency, urgency, dysuria, hematuria and pain interstitial cystitis - ANSWER- nonbacterial infectious, other micro-organisms, hypersensitivity or altered immune response pyelonephritis - ANSWER- infection of ureter, renal pelvis, medulla and cortex caused by kidney stones, reflux, and trauma

acute pyelonephritis - ANSWER- obstructions or reflux, inflammation of structures, kidneys become infiltrated with WBC Chronic pyelonephritis - ANSWER- recurring acute pyelonephritis with chronic obstructions, progressive inflammation, destruction and scarring, leads to kidney failure glomerulonephritis - ANSWER- inflammation of glomerulus and caused by immunologic abnormalities, drugs/toxins/infections/systemic diseases glomerulonephritis patho and CM - ANSWER- immune complexes get lodged in glomeruli, inflammation, injury and damage to glomeruli with CM of oliguria, HTN, renal failure, hematuria, and proteinuria nephrotic syndrome - ANSWER- protein in urine from glomerular injury with hypoalbuminemia, edema, and vitamin D deficiency acute kidney injury - ANSWER- sudden decline in kidney function, decreased GFR, and accumulation of waste products with prerenal, intrarenal, and postrenal prerenal - ANSWER- renal hypoperfusion, decrease in GFR intrarenal - ANSWER- results from acute tubular necrosis or ATN due to toxins, drugs, infection and ischemia postrenal - ANSWER- rare, urinary tract obstructions Chronic kidney disease or CKD - ANSWER- progressive loss of renal function affecting all organ systems associated with HTN, diabetes, intrinsic kidney disease CKD patho - ANSWER- glomerular HTN, hyperfiltration and hypertrophy, glomerulosclerosis, tubule inflammation and fibrosis with destruction of nephrons CKD CM - ANSWER- azotemia which is increased levels of urea and nitrogenous compunds, uremia which is associated with azotemia, proteinuria which is interstitial tissue damage from inflammation, creatinine and urea clearance which as GFR falls creatinine increases and fluid/electrolyte imbalances