Final - Med Surg - Questions that might be on the exam

Monitor for this after lumbar puncture.

headache

This test for CNS damage and involves stroking sole of foot.

Babinski reflex

Prior to CT scan with contrast, what allergy should be checked?

shellfish/iodine

priority to remove before MRI ?

metal or jewelry - ask about implants

Patient just had angiogram and should be kept in this position.

flat - 4 to 6 hours

foot drop prevention

high top tennis shoes

Patient says "Sky is dish". What is this called?

Expressive Aphasia

Patient cannot understand simple commands.

Receptive Aphasia

No dilation when light shined. What CN damage?

oculomotor

CN that controls BP & HR

vagus

Meningitis

+ Kernig & Brudzinski & stiff neck

what type of precautions with meningitis?

Droplet

Meningitis - priority sign to monitor

increasing ICP

late sign of ICP

Cushing's Triad - slow HR, reduced resp, arterial HTN

widening pulse pressure

monitor this with TBI

aura

warning of seizure - vision change, odor, sound

automatism

partial seizure with dream-like state w/smacking lips

Pt education for re-occurring headaches

record triggers, timing and s/s

absence or petit mal

common w/ kids - includes staring

Postictal

seizure recovery period

Abruptly stopping anticonvulsants can cause this.

status epilepticus

TBI - closed head injury

bruising but skull remains in tact

TBI - open head injury

break in skull - infection risk

This osmotic diuretic can help reduce ICP.

Mannitol

may indicate CSF leak

blood tinged drainage w/ yellow ring around it

what to monitor after myelogram?

seizures

heavy lifting can cause this

herniated disc

cath used for urine retention

intermittent

Log rolling

maintain spine alignment while moving

C3 or above injury

breathing muscles paralyzed

T6 or higher injury

autonomic dysreflexia - stroke risk - med emergency

Autonomic Dysreflexia - 3 B's

bladder, bowel, and skin breakdown

What dementia med slows progression?

donepezil (aricept)

Parkinson's

stiff muscles, slow movement, posture change, shuffling- not enough dopamine -

This med to treat Parkinson's disease may discolor urine and sweat.

levodopa/carbidopa (sinemet)

Huntington Disease

genetic disorder that causes dementia, choreiform movements, dysphagia, depression, & death

A person with down syndrome has high risk of this.

Alzheimer's

Best environment for pt with nuchal rigidity and +Kernig

dark, quiet room

Stage 2 Alzheimer pt throwing food - best action?

offer alternative food, stay with patient during mealtime

Priority action for cervical spine injury + spike in BP?

perform bladder scan

TIA

May last mins-hours; warning sign of stroke

Stroke major warning

sudden severe headache & numbness on one side

Left Brain impact

R weakness, aphasia

Right Brain impact

L weakness, impulsive, poor judgement

3-4.5 hours

give tPA within ____ after ischemic stroke.

What to monitor w/ plavix?

bruising, bleeding, LOC

What to monitor w/ Warfarin?

INR

What to monitor w/ statins?

muscle pain or weakness

What is a clot stuck in lungs?

pulmonary embolism

What should be added for A-Fib patient?

blood thinner

stroke prevention - what to monitor

weight, HTN, cholesterol

Aneurism

weakness in artery wall

trauma (i.e. MVA)

can trigger aneurism to rupture

#1 sign of aneurism

severe headache

aneurism rupture prevention

craniotomy - clamp, wrap, remove

swallowing evaluation

prevent aspiration after stroke

cannot comprehend language

receptive aphasia

Multiple Sclerosis

myelin sheath destroyed, scar tissue blocks nerve path - virus can trigger

Dilantin

muscle relaxant that helps MS fall risk

Cytoxin

"red devil" immunosuppressant drug - 10 min push

Priority for Myasthenia Gravis patient?

prevent infection, frequent rest periods

Myasthenia Gravis

antibodies destroy ACh receptors, progressive muscle weakness

sign of undermedicated myasthenia gravis pt?

ptosis - drooping eyelid

cholinergic crisis

too much med - facial weakness 1st sign

ALS

"Lou Gehrig's" progressive motor neuron degeneration - difficulty swallowing late stage

GBS

demyelination and remyelination - begins in toes and goes up - 2 yr recovery

GBS - what to monitor?

ABG's & vital capacity

Restless Legs

Dopamine & Serotonin imbalance; pins & needles feeling. (Med - Mirapex & Requip)

Trigeminal Neuralgia

intense pain on one side of face - forehead, cheek, nose, jaw - s/s frequent blinking, tearing of eye

Bells Palsy

Sudden one-sided facial paralysis. May include: Forehead, cheek, nose, or jaw; common after infection OR in 3rd trimester (med: acyclovir)

ALS patient reports coughing & sneezing during meals - best action?

NPO, notify HCP risk of aspiration, swallow assessment with speech therapist

Myasthenia Gravis patient too tired to take shower in evening. Best action?

change to morning bath - more energy

MS causes damage to _____.

myelin sheath

symptoms of cholinergic crisis?

urination, vomiting, lacrimation

priority assessment for GBS?

Respiratory rate & depth

Who should avoid cold windy weather?

Pt w/ trigeminal neuralgia

Photoreceptors

rods (night) cones (color)

These colors are clearer with age.

yellow, orange, red

eye/aging

lens loses elasticity, decreased tear production

snellen chart

measures visual acuity

what is nystagmus?

involuntary eye movement

PERRLA

pupils equal round reactive to light and accommodation

6 cardinal fields of vision

can patient move eye in all directions

normal intraocular pressure

10-21 mm Hg

regular eye exams

age 18-64 every 2 years

what vitamin in low supply can cause night blindness and corneal damage?

vit A

punctual occlusion

close eyelids 2 mins & apply pressure to tear duct

What sound do we lose 1st?

high pitch sounds

what part of ear contains receptors?

inner

presbycusis

progressive hearing loss

Rinne Test

vibrating tuning fork on mastoid process

Weber test

vibrating tuning fork on forehead

Romberg test

balance test - stand w/ feet together

Audiometric testing

headphones in soundproof booth, signals w/ tone

tympanometry

pressure to tympanic membrane - may cause vertigo

If a patient is congested, he or she should avoid this?

flying in airplane

signs of ototoxicity

dizzy, tinnitus, reduced hearing (ex - aspirin)

how to prevent infection from moving to ear?

blow nose with BOTH nostrils open

Patient reported fullness in ear and dizziness. best action?

implement fall risk precautions, obtain more info

what can put elderly patient at risk?

decreased depth perception, difficult night vision, glare sensitivity