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Med surg Galen exam 1 with answers
What |are |the |three |main |types |of |headaches? |- |correct |answer |-Migraine, |Tension, |Cluster Steps |to |Pain |Assessment |- |correct |answer |-Provoking Quality Radiation Severity | Time Provoking |- |correct |answer |-has |anything |made |it |better |or |worse Quality |- |correct |answer |-Sharp, |dull, |achy, |throbbing Radiation |- |correct |answer |-Does |it |radiate |to |another |part |of |the |body Severity |- |correct |answer |-Pain |scale, |1-10 |scale, |intense |pain, |Other |symptoms: |N/V, |photophobia Time |- |correct |answer |-how |long |has |it |been |going |on? |how |long |does |it |usually |last? Tension |Headache |- |correct |answer |-Bandlike, |tightness Describe |a |Migraine |- |correct |answer |-Unilateral, |supra |and |retro |orbital, |pulsating |or |throbbing, | worse |with |movement, |sensitivity |with |light |and |sounds Cluster |- |correct |answer |-Lancinationg |or |stabbing, |5-30 |minutes. |Extreme |pain Migraine |Pathophysiology |- |correct |answer |-Pathophysiology |- |Not |entirely |clear.; |theories?
Prevalence: |May |be |seen |in |children |and |adults; |Among |children |more |common |in |boys; |among | adults |more |common |in |women. | |History |of |patient |with |migraine: |Otherwise |healthy, |usually |female |in |30's Individualized |triggers |(stress, |smells, |foods, |hormones, |menses) Tyramine |rich |foods- |chocolate, |cheeses, |beer, |wine, |cigar, |sweet |and |low. Treatment |for |Migraine |- |correct |answer |-Vasoconstriction |works |the |best, |irritation |of |the |5th | cranial |nerve, |Estrogen |hormone |can |causes |migraines. Migraine |Manifestations |- |correct |answer |-Manifestations Pain: |Usually |unilateral, |supra/retro-orbital, |pulsating. |Worse |with |movement. | Accompanied |by |non-h/a |symptoms: |N/V, |photophobia, |phonophobia, | Aura: |(20% |of |cases): Migraine |Interventions |- |correct |answer |-Pain |management Symptom |management | Ex. |Pitch |black, |turn |off |all |the |lights, |N/V |causes |dehydration Migraine |Drug |Therapy |- |correct |answer |-APAP/Caffeine/ |Butabital |(Fioricet) NSAIDS |: |Naprosyn CCBs |and |Beta- |Blockers |(Preventative |therapy) |: |Verapamil Triptans |and |ergotamine's: |Sumatriptan |and |Cafergot Anticonvulsants |(Preventative |therapy): |Topiramate Botox |Injections |(monthly) | Magnesium Migraine |Complementary |and |alternative |therapies |- |correct |answer |-Acupuncture, |Yoga, |Stress | reduction |activities, |Supplemental |mag, |Distraction |sometimes |works. Pound |acronym |- |correct |answer |-P:Pulsating
Somatic: |rising |epigastric |sensation Hallucinations: |Visual, |gustatory, |olfactory Halos, |Zig-zags, |h/a, |paresthesias, |psychiatric |phenomenon, |deja-vu Epilepsy |Partial: |- |correct |answer |-Partial |(also |called |focal |or |local |seizures): |Occurs |in |a |specific | part |of |the |brain. |May |be |characterized |by |automatism |or |tic. |Ex: |Jerk, |reflex, |lip |smacking | (complex) Epilepsy |Simple: |- |correct |answer |-Client |does |not |consciousness. |Localized |jerking/movement. | Strange |sensations. |Autonomic |symptoms. Focal |awareness |they |do |not |lose |consciousness. Epilepsy |Complex |- |correct |answer |-Involves |altered |LOC; |may |or |may |not |have |total |loss |of | consciousness. |Automatisms. |Patient |may |wander |at |start |or |have |amnesia |after. |Most |common | among |older |adults |and |difficult |to |diagnose |bc |symptoms |appear |similar |to |those |of |dementia, | psychosis, |or |neurobehavioral |disorder, |esp |post-ictal. Generalized |epilepsy |- |correct |answer |-Affects |brain |as |a |whole, |bilateral |seizure; |we |differentiate | them |based |on |how |they |appear |while |observing |them. absence |epilepsy |- |correct |answer |-(petit |mal): |Generalized |seizure |involving |sudden, |brief |loss |of | consciousness. |Usually |diagnosed |in |children. |Appears |as |if |they |are |staring |off |into |space. |Lasts | seconds. tonic-clonic |epilepsy |- |correct |answer |-"Grand |mal." |Stereotypical |body |convulsions. |Lasts |minutes, | involves |muscle |rigidity |and |convulsions. |Tonic=stiffening, |Clonic=jerking Myoclonic |Epilepsy |- |correct |answer |-Brief |muscle |jerks, |lasts |seconds Atonic |(akinetic) |Seizure |(drop |seizure) |- |correct |answer |-Involves |brief |loss |of |tone. |May |be | confused |with |Fainting. Acute |Seizure |Management |(Observation) |- |correct |answer |-History |(if |reported)
Look |for |underlying |cause! Record |time |sz |began |and |ended. Duration Types |of |movements Ongoing |seizure |observations Post-ictal |assessment |- |often |involves |reorientation. Patient |safety If |the |client |is |sitting |or |standing, |place |the |client |on |the |floor Continual |assessment |of |the |ABCs Acute |Seizure |Management |(things |to |do) |- |correct |answer |-Patent |IV, |suction, |oxygen, |padded |side |rails, |pillow, |and |privacy. Side-lying |position Suction |secretions No |restraints | Loosen |restrictive |clothing | Never |force |anything |into |the |patient's |mouth Absolutely |NO |tongue |blade! DO |NOT |ATTEMPT |TO |STOP |MOVEMENTS! Acute |Seizure |Management |(meds) |- |correct |answer |-Benzos |Break |the |seizure may |include: Lorazepam |(Ativan) Diazepam |(Valium) IV |phenytoin |(Dilantin) |or |fosphenytoin |(Cerebyx) Status |Epilepticus |- |correct |answer |-Prolonged |seizures |that |last |more |than | 5 |min |or |repeated | seizures |over |course |of | 30 |min |- |medical |emergency! Number | 1 |cause |is |pt |not |taking |their |medication.
Evaluate |most |current |blood |level |of |medication, |if |appropriate Be |aware |of |drug-drug/drug-food |interactions Need |to |Stress |adherence Teaching |for |Status |Epilepticus |- |correct |answer |-Driving |and |high |reliable |occupations State |of |FL |restrictions |- |two |years*. | Rest, |stress |reduction, |diet Ketogenic |diet | Medication |compliance Follow-up |drug |levels Neurologist Medic |alert |tag | Social |service |resources |to |assist |with |medication |costs Evaluation |of |employment |safety |needed |to |decrease |risks Vocational |rehabilitation |may |be |subsidized Parkison's |Disease |Pathophysiology |- |correct |answer |-Familial, |males |are |more |affected; | |3:2 |male |to |female |ratio Progressive |and |chronic | Degradation |of |dopamine | Substantia |nigra |contains |dopaminergic |neurons |which |contribute |to |controlled |movement |pattern Parkison's |Disease |Onset |- |correct |answer |-Usually |asymmetric Patient |may |first |notice |resting |tremor |in |upper |extremity, |then |will |spread |to |other |parts |of |the | body |in |an |unpredictable |way Restlessness |during |sleep, |kicking |and |thrashing |when |trying |to |sleep Decreased |sense |of |smell |(very |gradual) Parkison's |Disease |Cardinal |Signs |- |correct |answer |-Bradykinesia
Resting |Tremor Rigidity Postural |Instability |(leaning |forward |and |dragging |feet) Parkison's |Disease |"Other |Signs" |- |correct |answer |-Pill |rolling: |Clenched |fist |with |thumb |moving | around Reduction |in |dexterity Masked |facies: |Decreased |facial |expressions Sleep |disturbances Autonomic |dysfunction: |Constipation, |sweating, |sexual |dysfunction Bradyphrenia: |Reduction |of |cognition—can't |think |as |quickly |or |clearly Dementia: |Advanced |Parkinson's |Disease Night |time |drooling (Patients |may |become |depressed) Parkison's |Diseases |Physical |Exam |- |correct |answer |-Resting |Tremor Cogwheel |Rigidity |(stiff) Signs |reflective |of |bradykinesia: |Decreased |speed |of |repetitive |movement Micrographia |(small |hand |writing) | Small, |quiet |voice |with |poor |articulation Festinating |gait Nursing |Care |for |Parkison's |Diseases |- |correct |answer |-Multidisciplinary |approach |(SLT, |PT, |OT, | Neurology, |Dietician) Fall |precautions!!! Aspiration |precautions: |Aspiration | pneumonia |is |a |major |cause |of |death |in |Parkinson's |Disease | Medications |on |time, |every |time Continual |nutritional |assessment |
Secondary |progressive Progressive-relapsing Multiple |Sclerosis |Assessment |- |correct |answer |-Ask |about |vision, |mobility, |and |sensory |perception | changes Symptoms |are |often |vague Are |symptoms |intermittent |or |becoming |progressively |worse? | Symptoms: |See |chart |43-1, |page | 889 LOPDUV: |Limb |weakness, |Optic |neuritis, |Paresthesia, |Diplopia, |Urinary |incontinence, |Vertigo Physical |Exam: |Weakness, |numbness, |tingling, |brisk |reflexes, |gait |disturbances |(more |progressive | cases), |intention |tremors Multiple |Sclerosis |(MS) |Disgnosis |- |correct |answer |-Symptom |presentation |as |well |as |an |MRI | (lesions) Lumbar |Puncture Muscle |cramping |secondary |to |spasticity Weakness Charcot |Triad: |Dysarthria, |Nystagmus, |Intention |Tremor Dysmetria Trigeminal |Neuralgia Twitching |of |facial |muscles HEAT |INTOLERANCE Fatigue |and |dizziness Cognitive |difficulties Depression/euphoria Dementia Lumbar |Puncture |(MS) |- |correct |answer |-Obtain |consent Spinal |needle |injected |into |subarachnoid |space Position |patient |in |a |fetal |side-lying |position |
Local |anesthetic Three |to |five |tubes |CSF |collected Post |LP: |Obtain |VS, |neuro |checks, |observe |needle |site |for |leakage, |bedrest Nursing |Care |for |MS |(Risk |for, |Airway, |Body, |Urinary |and |Bowel |incontinence) |- |correct |answer |- Risk |for |infection: |MS |drugs |alter |immunity, |teach |patents |to |avoid |crowds |and |sick |people Dysarthria/dysphagia: |SLP |referral Fatigue |Encourage |rest |- |but |encourage |participation |to |keep |the |client |active. |Plan |accordingly |for | activities |and |allow |time |for |completion Urinary |and |bowel |incontinence | |Anticholinergics: |Oxybutynin | |UTI |Surveillance |- |Encourage |fluids |Avoiding |caffeinated |products Nursing |Care |for |MS |(Pain, |Medications, |Vision |Changes) |- |correct |answer |-Pain |Pain |control, |as |prescribed: |Baclofen, |Diazepam | Medications |Teach |how |to |administer |parenteral |forms |Interferons Vision |changes |Eye |patch |for |diplopia |Encourage |vision |exams | |Teach |the |client |how |to |scan |a |room |(peripheral |vision |loss) Drug |Therapy |for |(MS) |for |Acute |exacerbations |- |correct |answer |-with |IV |methylprednisolone: |Iv |x | 2-3 |days |followed |by |po |steroid |taper |x |3-4 |months Drug |Therapy |for |Disease |progression |- |correct |answer |-Interferon |beta-1a |(IM) |or |Interferon |B-1b | (SQ). |Glatiramer |(SQ): |Relatively |safe |during |pregnancy. |These |drugs |are |immunomodulators, |makes |patients |vulnerable |to |infection. |Must |report |any |s/s |infection |to |PMD |immediately.
Most |common |type |of |stroke. Thrombotic Hx: |HTN, |Vascular |disease Prodromal |TIA Embolic | Hx: |AFIB, |Endocarditis | Hemorrhagic Hx: |HTN, |Vessel |disorders Stroke |Numbers |- |correct |answer |-Accounts |for |1/19 |deaths |in |US. |Ranked |number | 5 |among |cause | of |death |in |the |US. 14% |of |patients |in |the |hospital |suffer |from |a |stroke. They |often |suffer |the |worst |prognosis. Stroke |PT |history |- |correct |answer |-Hypertension, |Hypercoagulability, |Use |of |Oral |Contraceptives, | Hyperlipidemia, |Diabetes, |Obesity, |Smokers, |Genetic |Factors, |A-fib, |Alcoholism, |Illicit |drug |use | (cocaine) Stroke |Symptoms |- |correct |answer |-Altered |LOC, |Face, |Arm, |Speech |alterations, |gait |disturbances Stroke |Manifest |- |correct |answer |-people |who |are |older, |but |always |consider |stroke |in |a |patient | with |acute |onset |neurological |deficits, |regardless |of |age Stroke |Risk |Factors |- |correct |answer |-Smoking A-Fib Age Illicit |drug |use |(cocaine) Alcoholism | Uncontrolled |HTN: |#1 |risk |factor Sedentary |lifestyle
Obesity Hypercoagulability Hyperlipidemia | Oral |contraceptives | Sickle |cell |disease Diabetes |mellitus*** Stroke |Assessment |- |correct |answer |-Facial |dropping Arm |drift Speech |articulation Time Vision |changes Gait |disturbances Ataxia Confusion Stroke |Diagnostics |- |correct |answer |-CT |Scan |at |a |stroke |center Symptom |presentation MRI | Carotid |US |(not |immediate) Stroke |Immediate |Interventions |- |correct |answer |-ABCs GCS Routine |labs EKG Assess |for |hypoglycemia |or |hypoxia, |INR Onset |of |symptoms NIH |Stroke |Scale |
Pressure |ulcer |prevention ADLs | Avoid |hot |and |cold Positioning | DVT |prophylaxis Rehabilitative |Nursing |Care: |Sensory |- |correct |answer |-Injury |risk |to |flaccid |extremity Homonymous |hemianopsia Encourage |the |client |to |scan |the |room. |Place |objects |near |the |client. | Diplopia |- |eye |patch Rehabilitative |Nursing |Care: |Dysphagia |- |correct |answer |-Aspiration |precautions NPO |until |Swallow |screening Thickened, |as |prescribed Nutritional |alteration Rehabilitative |Nursing |Care: |Speech |- |correct |answer |-Aphasia | Receptive |- |loss |of |comprehension Expressive |- |loss |of |production |of |language | Global |- |total |inability |to |communicate Perseveration, |dysarthia | Be |clear |and |concise | Use |cues |and |gestures | Avoid |yes |or |no |questions Alternative |forms |of |communication. Rehabilitative |Nursing |Care: |Bowel |and |Bladder |- |correct |answer |-Constipation Stool |softeners, |as |prescribed Fiber |Fitness |Fluids
UTI |surveillance Rehabilitative |Nursing |Care: |Ineffective |Coping |- |correct |answer |-Emotional |labiality | Psych |consult | Care |giver |support | Be |patient |with |those |recovering Rehabilitative |Nursing |Care: |Discharge |- |correct |answer |-HHC | Home |safety Tertiary |prevention Cataracts |- |correct |answer |-Medical |condition |characterized |by |opacity |of |the |crystalline |lens. |Most | commonly |seen |in |older |adults. |Causes |a |gradual, |painless, |progressive |loss |of |vision. Cataracts |Pathophysiology |- |correct |answer |-Lens |is |mostly |protein |and |water. |With |aging, |lens | loses |water, |dries |up |and |becomes |thicker. |As |it |thickens |it |loses |transparency. Cataracts |Risk |Factors |- |correct |answer |-Advanced |age, |cigarette |smoking, |uncontrolled |DM, |HLD, | HTN, |trauma. Cataract |Symptoms |- |correct |answer |-Visual |impairment |is |the |chief |complaint. |Pt |may |c/o |blurry, | cloudy, |hazy, |foggy, |or |yellowing |of |vision. |Also |diplopia |that |doesn't |go |away |when |one |eye |is | covered. |Halos—particularly |when |looking |at |light |or |with |night-time |driving PE: |Diagnosed |with |a |slit-lamp |exam Cataracts: |Treatment |- |correct |answer |-Treatment |is |surgical |removal |of |the |cataract |material Prognosis: |95% |of |adults |will |have |increased |visual |acuity |following |surgery Cataracts: |Aftercare |- |correct |answer |-Post-operative |care:
Normal: |10-21mmHg Glaucoma: |22-32 |mmHg IOP |measured |by |tonometry Glaucoma: |Drug |Therapy |- |correct |answer |-Timolol: |Reduces |production |of |aqueous |humor |by |the | ciliary |body Pilocarpine: |Opens |the |trabecular |meshwork, |allowing |aqueous |humor |to |flow |out Mannitol: |Osmotic |diuretic; |removes |water |from |aqueous |humor; |decreases |volume |of |AH |leading | to |decrease |in |IOP Glaucoma: |Nursing |Role |- |correct |answer |-Priority |nursing |intervention |for |pt |with |glaucoma |is | teaching Drug |(eye |gtt) |adherence If |more |than |one |drug |is |prescribed, |wait |5-10 |minutes |between |instillations |to |prevent |one |drug | from |diluting |another |drug Good |Handwashing Avoid |touching |the |tip |to |any |part |of |eye Punctal |occlusion |to |prevent |systemic |absorption |of |the |drug |(BB's) Macular |Degeneration |- |correct |answer |-Macula: |Part |of |the |retina |responsible |for |central |vision | Unknown |etiology, |there |are |some |risk |factors. Chronic |condition |affecting |the |eyes |causing |progressive |central |vision |loss Macular |Degeneration: |Dry |- |correct |answer |-Most |Common-90% |of |cases A/W |Development |of |characteristic |yellow |drusen |(yellow |cellular |debris)
Drusen |accumulates |in |the |retina |causing |loss |of |central |vision Macular |Degeneration |- |correct |answer |-10% |of |cases More |severe |faster |progressing A/W |neovascularization |of |the |choroid |leading |to |hemorrhage |and |ischemia Macular |Degeneration: |Symptoms |- |correct |answer |-Older |patient Blurry |central |vision Dark |spots Metamorphopsia Decreased |visual |acuity: |Difficulty |reading Decreased |contrast |sensitivity Macular |Degeneration: |Risk |Factors |- |correct |answer |-Advanced |age/Female |Gender HTN Obesity HLD Caucasian |Race SMOKING Diet |poor |in |Vitamin |E |and |Carotenoids |(lutein) Macular |Degeneration: |Treatment |- |correct |answer |-Dry: |None. |Regular |follow |up |with |eye | specialist |and |increase |oral |vitamins |and |antioxidants. Wet: |Laser |therapy, |anti-VEGF |signal |proteins Dietary |therapy |for |all |patients Nursing |Care |for |the |Patient |with |Visual |Impairment |Pt | 1 |- |correct |answer |-General |Guidelines: Promote |independence Telephones |with |large, |raised |block |numbers
