depassement par la gauche, tripler

# Neuro Exam Essentials Only what your instructor said to know: lectures, live class, slides, and the assigned book pages (with the "do not read" parts left out). Read in book = a part your instructor told you to read in the textbook. How to use this ## One tab. One chunk. Then flip cards. - Read the colored **60-second box** first. That's the big idea. - Open **one** chunk at a time. Close it when done (it'll say ✓ seen). - Do the **tap-to-flip cards**, then the **quiz**. - Hit **Mark done** at the bottom. Take a break between tabs. **Your instructor's study advice:** the nursing care **overlaps** across all these diseases. Eye problem → protect the eye. Can't swallow → nutrition support (weights, calorie counts, prealbumin). Weak or stiff → mobility and fall prevention. **Don't memorize slide by slide. Understand the idea.** But do notice how brain, spinal cord, and peripheral nerve problems look different. The nervous system map Think of a house. The brain is the electrical panel. The spinal cord is the main cable running down the wall. Peripheral nerves are the wires going out to every room. | Central (CNS) | Peripheral (PNS) | | --- | --- | | Brain + spinal cord | Spinal nerves (from the spine) · **12 cranial nerves** (from the brain) · autonomic system | **Autonomic system** = automatic, not under your control: - **Sympathetic** = "fight or flight." Speeds things up (heart rate, breathing). - **Parasympathetic** = "rest and digest." Slows things down. Word bank (terms that show up everywhere) | Word | Plain meaning | | --- | --- | | **intracranial pressure (ICP)** | Intracranial pressure: pressure inside the skull | | **level of consciousness (LOC)** | Level of consciousness: how awake and aware | | **Glasgow Coma Scale (GCS)** | Glasgow Coma Scale: scores LOC from 3 (no response) to 15 (normal) | | **Aura** | A warning sign right before a migraine or seizure | | **Dysphagia** | Trouble swallowing → aspiration risk | | **Dysarthria** | Trouble speaking clearly (slurred) | | **Diplopia** | Double vision | | **Nystagmus** | Eyes jerk side to side on their own | | **Ptosis** | Drooping eyelid | | **Photophobia** / **phonophobia** | Light hurts / sound hurts | | **Paresthesia** | Numbness or tingling | | **Acetylcholine (ACh)** | The "go" chemical that makes muscles move | | **Dopamine** | The "brake" chemical that smooths movement (also pleasure) | Your instructor's 15 neuro terms have their own tab: **Terms**. Review class: exam breakdown + how to study Review class From the in-class exam review (Joline case study + NCLEX questions). | Exam section | Points | | --- | --- | | Peripheral nervous system (PNS) | 28 | | Trauma: stroke, head injury, intracranial pressure (ICP) | 32 | | Renal: acute and chronic kidney disease (lecture recordings) | 18 | | Michelle's content (use her posted study guide) | 10 | | **Total** | **90** · about 1 hr 35 min. Don't rush. | - You only need what she **did not cross off** in the book + what's in the **lecture recordings** and **PowerPoint**. Some lecture content isn't in the book. That's okay, it still counts. - Use the **outline in the syllabus** as quiz questions. - Studying alone? **Record yourself answering out loud** on your phone, then play it back next to your notes. Saying it out loud moves it to long-term memory. - On her big day-one med chart, write **only the "exception to the rule"** facts. Those are what get tested. - Stuck? **Email her** instead of going down a YouTube rabbit hole. Quick recall · tap to flip The 60-second version ## 15 words. Break them into pieces and they explain themselves. - **a-** = without · **dys-** = hard or bad · **hemi-** = half (one side) - **-plegia** = paralyzed (can't move) · **-paresis** = weak (can move a little) - **-phasia** = speech/language · **-lexia** = reading · **-graphia** = writing - **-opia / -opsia** = vision · **gnosia** = knowing/recognizing · **praxia** = doing From your instructor's "Neurology – Medical Terminology" list Talking, reading & writing (4) ### 1. Aphasia **Word parts:** a- (without) + phasia (speech) **Means:** trouble with **language**. The brain can't make or understand words. The brain's dictionary is broken. The mouth works fine; the words don't come out right, or what you hear makes no sense. **Example:** a stroke patient wants water but says "chair," or can't understand "squeeze my hand." **3 types:** **Expressive (Broca)** = understands, can't speak · **Receptive (Wernicke)** = can't understand · **Global (mixed)** = both. ### 2. Dysarthria **Word parts:** dys- (hard) + arthr (joint/articulate) **Means:** **slurred speech** because the mouth, tongue, or face muscles are weak. The words are right, but the mouth is clumsy, like talking after a dentist numbs you. **Example:** the patient knows exactly what to say, but it sounds mumbled. **Don't mix up:** **Aphasia = a word problem** (brain's language center). **Dysarthria = a muscle problem** (words are right, just slurred). ### 3. Alexia **Word parts:** a- (without) + lexia (reading) **Means:** **can't read**, even though they could before and their eyes work. **Example:** the patient looks at a menu but the letters mean nothing. ### 5. Agraphia **Word parts:** a- (without) + graphia (writing) **Means:** **can't write**, even though the hand can hold the pen. **Example:** asked to sign a consent form, they can't form the letters of their name. Eyes & vision (4) ### 4. Papilledema (choked disc) **Word parts:** papilla (optic disc) + edema (swelling) **Means:** the **optic disc** (where the eye nerve connects, at the back of the eye) is **swollen**. The provider sees it with an ophthalmoscope. Pressure in the skull pushes on the eye nerve and "chokes" it, like a garden hose swelling when the water can't get out. **Key point:** papilledema = **always a sign of ↑intracranial pressure (ICP)**. ### 9. Nystagmus **Means:** the eyes **jerk or bounce side to side** (or up and down) on their own. Like the eyes are watching a fast tennis match that isn't there. **Seen in:** multiple sclerosis (MS), meningitis, stroke, brainstem problems. ### 12. Ptosis **Means:** a **drooping upper eyelid**. Ptosis sounds like "toe-sis": the lid falls down toward your toes. **Seen in:** myasthenia gravis, uncal herniation (CN III), stroke. ### 13. Diplopia **Word parts:** dipl (double) + opia (vision) **Means:** **double vision**. Sees two of everything. **Nursing:** eye patch, switched between eyes every few hours. ### 14. Homonymous hemianopsia **Word parts:** homonymous (same) + hemi (half) + an (without) + opsia (vision) **Means:** blind in the **same half** of the vision field **in both eyes**. For example, they can't see anything to their left. Like someone put tape over the left half of both lenses of their glasses. **Nursing:** teach to **turn the head side to side (scan)**. Put food and items on the side they can see. They may eat only half the plate. Movement & coordination (5) ### 7. Hemiparesis **Word parts:** hemi (half/one side) + paresis (weakness) **Means:** **weakness** on one side of the body. They can still move it, just not strongly. **Example:** weak right hand grip and right leg after a left-brain stroke. ### 15. Hemiplegia **Word parts:** hemi (one side) + plegia (paralysis) **Means:** **paralysis** on one side of the body. Can't move it at all. **Memory trick:** **Paresis = Partial** (weak). **Plegia = Paralyzed** (can't move). Both are on the side **opposite** the brain injury. ### 8. Apraxia **Word parts:** a- (without) + praxia (doing/action) **Means:** can't do **learned, planned movements**, even though the muscles are strong and they understand the request. The muscles work, but the brain lost the "instructions" for the task. **Example:** handed a toothbrush, they don't know the steps to brush their teeth. **Nursing:** simple, short, one-step directions; be patient. ### 10. Ataxia **Word parts:** a- (without) + taxia (order/coordination) **Means:** **poor coordination and balance**. Wobbly, unsteady walking; clumsy movements. Walking like you're on a moving boat. **Nursing:** **fall precautions**. ### 6. Proprioception **Means:** your body's sense of **where its parts are** without looking (body position sense). It's how you can touch your nose with your eyes closed. **If lost:** the patient doesn't know where their arm or foot is → falls, injuries. Watch the affected limb. Recognizing things (1) ### 11. Agnosia **Word parts:** a- (without) + gnosia (knowing) **Means:** can't **recognize** familiar objects, people, or sounds, even though their senses work. The eyes see a fork, but the brain can't name it or tell what it's for. **Nursing:** safety. They might misuse objects. **The "A" trio:** **Apraxia** = can't **do** (action) · **Agnosia** = can't **know** (recognize) · **Ataxia** = can't **coordinate** (wobbly). All 15 at a glance | # | Term | Simple meaning | | --- | --- | --- | | 1 | **Aphasia** | Trouble with language (words) | | 2 | **Dysarthria** | Slurred speech (weak mouth muscles) | | 3 | **Alexia** | Can't read | | 4 | **Papilledema** | Swollen optic disc = ↑intracranial pressure (ICP) | | 5 | **Agraphia** | Can't write | | 6 | **Proprioception** | Sense of where your body is | | 7 | **Hemiparesis** | One-sided weakness | | 8 | **Apraxia** | Can't do learned movements | | 9 | **Nystagmus** | Jerky, bouncing eyes | | 10 | **Ataxia** | Poor coordination/balance | | 11 | **Agnosia** | Can't recognize things | | 12 | **Ptosis** | Droopy eyelid | | 13 | **Diplopia** | Double vision | | 14 | **Homonymous hemianopsia** | Blind in the same half of both eyes | | 15 | **Hemiplegia** | One-sided paralysis | Flashcards · tap to flip Practice A client clearly says "I want my glasses," but the words are mumbled and hard to understand. This is: The right words, but slurred = a muscle problem = dysarthria. Practice A client eats only the food on the right side of the plate. The nurse suspects: They can't see the left half of their field. Teach head scanning; turn the plate. Practice A client holds a comb but can't figure out how to use it, even though the arm is strong. This is: Strong muscles, lost "how-to" for a learned task = apraxia. Practice The provider documents papilledema. The nurse knows this means: A swollen optic disc is always a sign of ↑ICP. Practice A client after a stroke can lift the right arm a little but it's weak. Correct term? Paresis = partial (weak). Plegia = paralyzed. Practice A client walks with a wide, wobbly gait and loses balance. Priority nursing action? Ataxia = poor coordination → fall risk. The 60-second version ## Stroke = a "brain attack." Time is brain. - **transient ischemic attack (TIA)** = mini warning stroke; symptoms gone in 30–60 min. Prevent the real one. - **\~90% are ischemic** (clot). The rest are **hemorrhagic** (bleed). - **computed tomography (CT) head WITHOUT contrast first**, to rule out a bleed. - **tissue plasminogen activator (tPA) (alteplase)** within **3 to 4.5 hrs** of when symptoms started, only for ischemic. - First sign of trouble (↑intracranial pressure (ICP)) = **change in mental status**. A stroke is a heart attack of the brain. Ischemic = a clogged pipe (no blood gets through). Hemorrhagic = a burst pipe (blood leaks where it shouldn't). The treatment for one is dangerous for the other, which is why the computed tomography (CT) comes first. transient ischemic attack (TIA): the warning sign - Brief drop in blood flow to the brain → **temporary** stroke-like symptoms. - Usually gone in **30–60 minutes**, often before reaching the emergency room (ER). Many people never go. - Symptoms are **one-sided**: numbness or weakness of face/arm, blurred or double vision, slurred speech, trouble swallowing. - It's a **red flag**: high risk of an ischemic stroke soon. **Prevention is the key intervention:** - #1 risk factor = **hypertension**. Control blood pressure (BP). - **Diabetes**: keep glucose in range. Exercise, healthy food. - **Antiplatelets**: **aspirin** and **clopidogrel**. Both together = **dual antiplatelet therapy** (same as after a myocardial infarction (MI)). **Don't mix up the classes:** **Antiplatelets** = aspirin, clopidogrel (stop platelets sticking). **Anticoagulants** = heparin, warfarin, direct oral anticoagulants (DOACs) like apixaban, rivaroxaban, dabigatran. Ischemic vs. hemorrhagic Blood flow cut off for more than a few minutes → brain cells starve of oxygen → **brain infarction** (like a myocardial infarction (MI), but in the brain). | Type | Cause | Onset | | --- | --- | --- | | **Thrombotic** (ischemic) | Clot builds slowly from **atherosclerosis**, often where arteries split (carotids, circle of Willis) | **Slow/gradual**: symptoms come and go, or slowly worsen. Body grows **collateral circulation**. | | **Embolic** (ischemic) | Clot travels, usually from the **left side of the heart**. Big risk: **A-fib**, valve disease | **Sudden**; often improves quickly too | | **Hemorrhagic** | Vessel breaks: **severe hypertension (HTN)** (incl. **cocaine**), ruptured **aneurysm**, or an ischemic stroke that turned into a bleed | Sudden or slow (depends on the bleed) | Right-heart clot → lungs (PE). Left-heart clot → brain (stroke). Left vs. right brain stroke The brain controls the **opposite** side of the body. Left brain stroke → **right** side weak. Right brain stroke → **left** side weak. | Left hemisphere (dominant) | Right hemisphere | | --- | --- | | Language, math, analytical thinking | Visual and spatial awareness | | Trouble **understanding and using language** (aphasia) | **Unilateral neglect**: ignores the left side of the body | | **Slow, cautious**; anxious with new tasks | **Impulsive**, poor judgment, unaware of deficits, denial | | Depressed, guilty, quickly angry and frustrated (they know something's wrong) | Memory loss, disoriented | | Right-side weakness | Left-side weakness · top priority: **risk for injury** | Brain-area map slide: your instructor said **do not memorize it**. BE FAST: teach the public B**Balance**: loss of balance or coordination, dizzy E**Eyes**: blurred or double vision F**Face**: smile. One side drooping? A**Arms**: raise both. One weak or drifting down? S**Speech**: repeat "You can't teach an old dog new tricks." Slurred? Garbled? T**Time**: call **911** right away. Note the **exact time symptoms started**. **Why call 911 instead of driving?** The ambulance **calls ahead**: computed tomography (CT) room ready, stroke scale started, tissue plasminogen activator (tPA) prepared, oxygen and glucose checked. In the emergency room (ER): assessment & computed tomography (CT) - Priority = get them to a **stroke center**. Not the time for a full head-to-toe. - **airway, breathing, circulation (ABCs) first**, then a rapid neuro (stroke) assessment. - **National Institutes of Health (NIH) Stroke Scale**: trained, certified staff; checks level of consciousness (LOC), movement, feeling, speech, understanding. Broader than BE FAST. **Don't memorize its parts**; just know it's a valid, reliable, evidence-based tool for consistent tracking. **CT of the head WITHOUT contrast** (or magnetic resonance imaging (MRI)) is one of the first tests. Why no contrast? Contrast would look like a bleed. CT shows a **hemorrhage**, sets a **baseline**, rules out tumors. An ischemic stroke often **doesn't show for 24 hrs**, so a negative CT doesn't rule it out. tissue plasminogen activator (tPA) (alteplase): clot buster - For **ischemic only**. **Never** for hemorrhagic. - Must start within **3 hours** of symptom onset (often extended to **4.5 hrs**). Counted from when symptoms **started at home**, not emergency room (ER) arrival. You don't need the extension criteria. - Not everyone qualifies: check bleeding risk. **Before you hang tPA:** make sure the **head computed tomography (CT) is done** and shows no bleed. Not ordered? Get it ordered. - Big risk = **bleeding** → bleeding precautions. - Keep blood pressure (BP) controlled so ischemic doesn't turn hemorrhagic. - **Repeat CT** after the infusion to check for a new bleed. **Other procedures (know the name and idea only):** - **Intra-arterial thrombolysis**: tPA put directly into the clot; up to **6 hrs**. - **Endovascular thrombectomy**: catheter pulls the clot out. - **Prevent future strokes:** angioplasty with **stent** (filter catches pieces) or **carotid endarterectomy** (neck incision to remove plaque). **After any of these:** check the site for bleeding, vital signs, **neuro checks** (new stroke from loose clots?), **hoarseness and trouble swallowing** (nerves in the neck, like the vagus), and **cerebral hyperperfusion** (a rush of blood into an area used to low flow → can bleed). Signs to assess - **Cognition**: restless, confused, memory, focus. level of consciousness (LOC) drop = late. - **Motor**: hand grips, push/pull feet. Equal both sides? - **Flaccid** paralysis = limp, can't beat gravity (e.g., **foot drop**). **Spastic** = constant contraction → **contractures**. - **Sensory**: touch, pain, numbness, neglect. - **Eyes**: pupils equal, round, reactive to light and accommodation (PERRLA) *plus* the whole visual field (lost side vision?). - **Heart**: usually hypertensive; **murmur** (clot on a valve?); **rhythm** (A-fib). - Psychosocial: personality and emotion changes. Nursing priorities (acute stroke) 1. **Oxygen first.** oxygen saturation (SpO₂) under 94%? Think: **partial airway obstruction** (tongue), **hypoventilation**, **aspiration** (most common). 2. **intravenous (IV)** (emergency meds; they may not swallow). 3. **Cardiac monitor** (A-fib). 4. **nothing by mouth (NPO) until a swallow screen.** The registered nurse (RN) does the bedside screen. Coughing, pocketing food, slurred speech → **speech therapy** consult. 5. **Glucose under 140** (high sugar blocks reperfusion). 6. **blood pressure (BP) slightly high** to push blood to the brain. Book guideline **≤150 systolic**, but follow the patient's own orders and baseline. 7. Watch for **↑intracranial pressure (ICP)**. Neuro checks **every 15–30 min** acutely; BP at least every 15 min. **Never skip pupils.** **Patient declining 24 hrs after a stroke** (more lethargic, vitals changed, sluggish pupils)? **Call Rapid Response** and the provider. Expect a computed tomography (CT). - Most likely complication = **↑ICP** (→ seizures, respiratory failure, ↓level of consciousness (LOC)). - Don't take BP on the **affected arm**: inaccurate (less vascular tone). Aspirin & stroke core measures **Why no aspirin right away (unlike a myocardial infarction (MI))?** Could be a **bleed**, may be getting **tissue plasminogen activator (tPA)**, may have **dysphagia**. Giving it early doesn't improve stroke outcomes. - Give aspirin **325 mg within 24–48 hrs** after onset. - **No aspirin within 24 hrs of tPA.** **Core measures** (hospital must do + document to get paid): 1. **tPA** if they qualify (3–4.5 hrs). 2. **venous thromboembolism (VTE) prevention**: sequential compression devices (SCDs), enoxaparin/heparin, walking. 3. By end of **day 2**: **antiplatelet** or **anticoagulant** (A-fib/flutter → anticoagulant). Discharged on it. 4. Discharged on a **statin** (cholesterol med). 5. **Stroke education** documented (signs, 911, meds). 6. **physical therapy (PT)/occupational therapy (OT) rehab** assessment. Tests & swallow nerves (Mr. Stokes case) | Test | Why | | --- | --- | | Non-contrast computed tomography (CT) head | Rule out bleed, baseline, rule out tumor | | Cardiac monitor | A-fib (with rapid ventricular response (RVR)) | | **Echocardiogram** | Shows **heart valves** (clots?) and ejection fraction | | **Carotid ultrasound** | **% of plaque** blocking the carotids | | Swallow study | Diet texture (thickened liquids, pudding, no water) | **The 2 cranial nerves you MUST know:** **cranial nerve (CN) IX (glossopharyngeal)** and **CN X (vagus)**, the swallowing nerves. They must be intact before the patient eats or drinks. "If you don't know, pick vagus." **Delegation tip** from class: licensed practical nurse (LPN) can give **routine injections** (like insulin). Hygiene → **unlicensed assistive personnel (UAP)**. NCLEX wants you to use each person's role wisely. Hemorrhagic stroke treatment Goal: **stop the bleeding** and **lower pressure on the brain**. - Stop any meds that cause bleeding; may need blood products. - Anti-seizure meds (a seizure raises intracranial pressure (ICP)). - **Bed rest** and supportive care so the body can absorb the blood. Don't push them up to the chair. **Surgery:** - **Aneurysm** → **coiling** (coils fill the bulge) or **clipping** (clip at its base). - **arteriovenous malformation (AVM)** (arteriovenous malformation: tangled weak vessels, often in kids) → surgically removed. Read in book Iggy Ch. 38, pp. 941–955 · skipped per your list: National Institutes of Health Stroke Scale (NIHSS) table, Box 38.3, alteplase dosing, calcium channel blocker paragraph transient ischemic attack (TIA) workup (book)Read in book - Symptoms usually resolve in **30–60 min** but can last up to **24 hrs**. - Box 38.2 signs: blurred/double vision, tunnel vision, one-eye blindness; arm/leg weakness, **ataxia**; numbness, **vertigo**; aphasia, dysarthria. - Workup: National Institutes of Health Stroke Scale (NIHSS), labs (**prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT)**, lipids), electrocardiogram (ECG), **head computed tomography (CT)** then magnetic resonance imaging (MRI), computed tomography angiography (CTA)/magnetic resonance angiography (MRA) of brain and neck. - Common causes: **carotid stenosis** (narrowed artery from plaque) and **A-fib**. - **ABCD2 score** predicts stroke risk: **A**ge ≥60 · **B**P ≥140/90 · **C**linical signs (one-sided weakness, speech) · **D**uration · **D**iabetes. - Treatment: carotid endarterectomy or stent, **aspirin/clopidogrel**, lower blood pressure (BP). Stroke types & risk (book)Read in book Brain can't store oxygen or glucose. Blood flow cut for **a few minutes** → infarction. "Brain attack" = treat like a myocardial infarction (MI). | | Thrombotic | Embolic | Hemorrhagic | | --- | --- | --- | --- | | Onset | Gradual; steps/worsening | Sudden | Sudden (gradual if from hypertension (HTN)) | | level of consciousness (LOC) | Awake | Awake | Deepening lethargy → coma | | Linked to | HTN, atherosclerosis; transient ischemic attack (TIA) first | Heart disease (A-fib) | HTN, vessel problems, genetics | | Headache | Slight | — | **Severe**; seizures common | | Recovery | Weeks–months | Usually rapid | Variable; often permanent deficits | - **Intracerebral hemorrhage (ICH)**: bleeding into brain tissue, usually from **severe HTN**; cocaine can trigger it. - **Subarachnoid hemorrhage (SAH)**: bleeding between pia and arachnoid, usually a ruptured **aneurysm** or **arteriovenous malformation (AVM)**. **Vasospasm** (artery clamps down) afterward → more ischemia. - Leading causes: **smoking, obesity, HTN, diabetes, high cholesterol**. Also cocaine, heavy alcohol, birth control pills in at-risk women, family history. - 5th leading cause of death; #1 cause of long-term disability. "Stroke belt" = 8 southeastern states. - Prevent with the **ABCS**: **A**spirin when appropriate, **B**lood pressure, **C**holesterol, **S**moking cessation. Assessment (book)Read in book - First priority: get to a **stroke center**. Assess within **10 minutes** of arrival (ABCs, neuro). - History: **exact time symptoms started**, did they get better or worse, meds (anticoagulants), drug use. - Sudden drop in level of consciousness (LOC)? Rule out **low blood sugar or low oxygen** first. They look like a stroke but are easy to fix. - **subarachnoid hemorrhage (SAH)**: "worst headache of my life," nausea/vomiting, photophobia, stiff neck. - Most important ongoing check = **LOC** (GCS or National Institutes of Health Stroke Scale (NIHSS)). - **Impaired airway defense**: weak cough + dysphagia → aspiration pneumonia. Screen swallowing. - Heart: murmur, A-fib, heart failure, endocarditis. - **blood pressure (BP)**: often 180–200/110–120 on arrival. A somewhat high BP (about **150/100**) keeps the brain perfused; higher can extend the stroke. - **Psychosocial**: body image, coping, money worries; screen for **depression**. **Emotional lability** = sudden laughing or crying for no reason (frontal lobe or right brain). Tell the family it's the stroke, not them. - Labs: no test confirms stroke. High **Hgb/Hct** = severe stroke; high white blood cell count (WBC) = infection or stress; glucose and **hemoglobin A1C (A1C)** check diabetes. NIHSS (Table 38.2): your instructor said don't memorize it, just be familiar. It scores 0 (normal) to 42 (worst) and helps decide who gets tissue plasminogen activator (tPA). tissue plasminogen activator (tPA) (alteplase) rules (book)Read in book - Explain to patient/family and get **informed consent**. - Door-to-needle goal: **45 minutes** from emergency department (ED) arrival. - If blood pressure (BP) is too high, give a fast antihypertensive first. BP must be **below 185/110** to start, and kept there. **Box 38.4: care during and after alteplase** - Admit to critical care or a stroke unit. **Double-check** the drug. - Give with a **programmable pump** over 60 min (10% as a 1-minute bolus). **Never push it by hand.** - Neuro checks + vitals: **every 10–15 min during the infusion**, then **every 30 min for at least 6 hrs**, then **hourly for 24 hrs**. - Use the **same BP device** each time (manual vs. automatic vs. arterial line readings differ). - BP **≥185/110 before** tPA, or **>180/105 after** (first 24 hrs) → give antihypertensive as ordered, e.g., **intravenous (IV) labetalol**. - **No invasive tubes** (NG tube, Foley) until stable, usually **24 hrs** (bleeding). - **Stop the infusion** and call for severe headache, sudden high BP, nausea/vomiting. - Follow-up computed tomography (CT)/magnetic resonance imaging (MRI) **before** starting anticoagulants or antiplatelets. **Drug Alert:** watch closely for bleeding: brain bleed (headache, level of consciousness (LOC) change) and any other site. Procedures & intracranial pressure (ICP) after stroke (book)Read in book - **Endovascular**: intraarterial tissue plasminogen activator (tPA) (within **6 hrs**), mechanical embolectomy (pull clot out), carotid stent. - After a **carotid stent**, teach to report: severe headache, level of consciousness (LOC) change (drowsy), muscle weakness, severe neck pain, **neck swelling**, **hoarseness or trouble swallowing** (nerve damage). - Hemorrhagic from arteriovenous malformation (AVM)/aneurysm: procedure to stop bleeding. - **↑ICP risk is highest the first 72 hrs**. Reassess every 1–4 hrs. **Critical Rescue:** the **first sign of ↑ICP is a declining LOC**. Report any decline to the provider or Rapid Response right away. **Prevent ↑ICP:** - **head of bed (HOB) up** per protocol. **Head midline**, neutral. - O₂ if oxygen saturation (SpO₂) **under 95%**. - No sharp hip or neck bending. - **Don't cluster care** (bath right after linen change spikes ICP). - **Hyperoxygenate** before and after suctioning; avoid unneeded suctioning and coughing. - Quiet room, **dim lights**. - Watch blood pressure (BP), rhythm, SpO₂, glucose, temperature. **Box 38.5 signs of ↑ICP:** ↓LOC (earliest), restless/irritable/confused, headache, vomiting (may be projectile), speech changes, pupil changes (dilated nonreactive = "blown"), seizures, Cushing's triad and posturing (very late). Meds, blood pressure (BP) & swallowing (book)Read in book **BP Critical Rescue:** no tissue plasminogen activator (tPA) or embolectomy → BP may be allowed up to **220** systolic. After tPA/embolectomy → report systolic **above 180**. Avoid a sudden BP drop: it can cause brain ischemia. - **Aspirin and clopidogrel** = standard for ischemic stroke and preventing the next one. - **Anticoagulants** (heparin, warfarin, direct oral anticoagulants (DOACs)) for **A-fib**. High-alert: bleeding risk. - Low-dose **aspirin within 24–48 hrs**; **not within 24 hrs of tPA**. Teach to report bruising or bleeding. - Stool softeners (no straining = no intracranial pressure (ICP) spike), pain and anxiety meds. - **nothing by mouth (NPO) until a swallow screen**. Positive screen → speech-language pathologist. - Weigh daily; check prealbumin; dietitian. - **Flaccid arm**: support it on a pillow so the shoulder doesn't dislocate (subluxation). Don't pull on it. - Early mobility; prevent deep vein thrombosis (DVT) with **compression devices**. Aphasia & communication (book)Read in book | Expressive (Broca) | Receptive (Wernicke) | Global (mixed) | | --- | --- | --- | | **Frontal** lobe. Understands but **can't speak** (or write). Knows it → frustrated, angry. | **Temporoparietal**. **Can't understand**. Can talk, but words are often meaningless. | **Both**: can't speak **and** can't understand. Reading and writing are affected the same way. Usually a large stroke involving the **left** (dominant) side. | "Broca = broken speech. Wernicke = words wacky. Global = gone both ways." - One idea at a time. Simple one-step commands. - Speak **slowly, not loudly**. Use gestures. - Yes/no questions for expressive aphasia. - **Global aphasia**: rely on **gestures, pictures, touch, and facial expression**. Keep a calm tone; watch body language for needs. - Picture boards, tablets, flash cards. **Don't rush**. - Work with the speech-language pathologist. Vision, neglect & left vs. right (book)Read in book **Right-brain stroke** (trouble with space and distance, right vs. left): - Use frequent verbal and touch cues; break tasks into small steps. - **Approach from the unaffected side.** Patient faces the door. **Unilateral neglect** (usually right-brain stroke): ignores one side. - Teach to **touch and use both sides**. Dress the **affected side first**. - **Homonymous hemianopsia**: teach to **turn the head side to side (scan)** while eating and walking. Put objects in the field of vision. - **Diplopia**: patch the affected eye; switch every 2–4 hrs. **Left-brain stroke** (memory problems): - Reorient to day and time; **structured routine** with repetition. - **Apraxia**: give simple, short directions; be patient. Core measures & going home (book)Read in book **Core measures (ischemic stroke):** venous thromboembolism (VTE) prevention · discharged on antithrombotic · anticoagulant for A-fib/flutter · tissue plasminogen activator (tPA) when eligible · antithrombotic by end of day 2 · discharged on statin · stroke education · rehab assessed. **Box 38.6 discharge teaching:** - Drugs: name, purpose, dose, timing, side effects. - Climbing stairs, getting in and out of bed, chair, and car safely; using mobility aids. - Who to call with questions; what to do in an emergency. - They're **at risk for another stroke**. Teach **FAST** (face drooping, arm weakness, speech difficulty, time to call 911). - Watch for **depression or dementia within 3 months** (poststroke depression). - Caregivers get overwhelmed → **respite**, social services, American Stroke Association. - Return demonstrations to check family skills. Book · NCLEX Challenge 38.1 · Select all A client has a **left middle cerebral artery** embolic stroke. Which findings does the nurse expect? Left brain → right side of the body. The left side controls speech, so dysarthria fits. Ataxia and vertigo point to the back of the brain (vertebrobasilar). Book · NCLEX Challenge 38.2 A client was just admitted to the emergency department (ED) with new-onset ischemic stroke. Which drug does the nurse anticipate? New ischemic stroke in the time window = tPA (after the CT shows no bleed). Aspirin waits 24–48 hrs. Book · Mastery Q1 A client with an acute ischemic stroke is receiving alteplase. Priority nursing action? Bleeding (especially into the brain) is the biggest danger with tPA. Book · NGN Challenge 38.1 **Case:** 74-year-old with diabetes in the ED. Right arm felt weak and tingly; now feels "more normal." **Bilateral carotid bruits.** blood pressure (BP) 168/92, heart rate (HR) 88, oxygen saturation (SpO₂) 96%. History: type 2 diabetes, hypertension (HTN), alcohol, **69 pack-year smoking**. Glucose 231. Quick recall · tap to flip NCLEX The nurse has an order to start alteplase for a client with stroke symptoms. What must the nurse confirm first? tPA in a hemorrhagic stroke could be fatal. CT first, every time. NCLEX A client just admitted with an ischemic stroke asks for water. What does the nurse do? Aspiration is the most common cause of hypoxia in stroke. Screen first; refer to speech if any concern. NCLEX A client with a right-hemisphere stroke keeps trying to get out of bed alone. Priority problem? Right-brain strokes cause impulsivity and poor judgment. Safety first. NCLEX A client's wife says his face drooped "about 2 hours ago, then got better, now it's back." Most important info for the nurse? tPA eligibility is timed from first symptom onset. The 60-second version ## The skull is a closed box. Swelling has nowhere to go. - Normal **intracranial pressure (ICP) 10–15**. Over **20** = brain cells die. - **cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) − ICP**. Keep it **above 70**. - First sign of ↑ICP = **mental status change**. Late = **Cushing's triad**, posturing. - **Glasgow Coma Scale (GCS) 8 or less → intubate.** A **2-point drop** = call. - Head injury → **assume neck injury** too (jaw thrust). The skull holds 3 things: brain, blood, and cerebrospinal fluid (CSF). It's a full suitcase that can't stretch. If one thing gets bigger (swelling, a bleed, extra fluid), something gets crushed, starting with the blood vessels. Types of brain injury **Primary injury** = direct damage from the hit. Most common causes: **car crashes** and **falls** (teach seat belts, helmets, fall prevention). | Term | Meaning | | --- | --- | | **Open** head injury | Skull broken/pierced (e.g., gunshot) → **infection risk** | | **Closed** head injury | Blunt hit, skull intact. **More dangerous**: swelling has no escape → ↑intracranial pressure (ICP) | | Contusion | Bruised brain | | Laceration | Torn vessels (inside of skull is bumpy and sharp) | | Diffuse axonal injury | Widespread damage from high-speed crash (speed up, sudden stop) | | Severity | Glasgow Coma Scale (GCS) | Unconscious for | | --- | --- | --- | | **Mild** (= concussion) | — | Usually sent home | | **Moderate** | **9–12** | 30 min – 6 hrs | | **Severe** | **8 or less** | Over 6 hrs → intensive care unit (ICU) | Concussion discharge teaching Your instructor: "Don't memorize the list, but know it. You'll get yes/no examples." - **Acetaminophen** for pain is OK. **No nonsteroidal anti-inflammatory drugs (NSAIDs)** (Motrin, Advil): bleeding risk. - Return to the emergency room (ER) for signs of **↑intracranial pressure (ICP)** (swelling or bleed): worse headache, vomiting, confusion, hard to wake, weakness, seizures, vision changes. - **Clear fluid from the nose or ears** → return. Could be a **cerebrospinal fluid (CSF) leak** or **skull fracture**. The full book list (Box 38.8) is in the "Mild traumatic brain injury (TBI) teaching" chunk below. Secondary injury: hypoxia & ↑intracranial pressure (ICP) Happens **after** the first hit and makes it worse. End result: brain tissue damaged, blood flow interrupted. - **Post-concussion syndrome** (mild injury): headaches, dizziness, foggy thinking for weeks to months. - **Cerebral hypoxia**: from clots, respiratory failure, **low blood pressure (BP)**. Risk for **neurogenic shock**. Brain perfusion drops when **mean arterial pressure (MAP) is under 65–70**. **↑ICP numbers:** - Normal ICP = **10–15 mmHg**. Coughing, sneezing, straining (Valsalva) raise it briefly. OK. - **Over 20** for long = **neurons die**. - **cerebral perfusion pressure (CPP)** (blood flow to the brain) = **MAP − ICP**. Goal **above 70**. Example: MAP 85, ICP 25 → CPP = 60. Too low! The brain isn't getting enough blood. **ICP monitors** (just recognize the names): **ventriculostomy** (intraventricular catheter, can also drain cerebrospinal fluid (CSF)) and **subarachnoid screw / ICP bolt** (placed through a **burr hole**). Signs of ↑intracranial pressure (ICP) - **First: mental status change** (restless, confused). level of consciousness (LOC) drop comes later. - Pupil changes: unequal, dilated, **non-reactive**. **Cushing's triad** (late sign; near death). Really 4 parts:\ 1\. **Severe hypertension**\ 2\. **Bradycardia**\ 3\. **Widened pulse pressure**\ 4\. **Irregular breathing** (Cheyne-Stokes) | Decorticate | Decerebrate | | --- | --- | | Abnormal **flexion**: arms bent in toward the "core" | Abnormal **extension**: arms straight out. **Worse** | Both are late signs. Brain bleeds (hematomas) No room in the skull → life-threatening. Your instructor: "kind of something you just have to memorize." | Type | Where | Key sign | | --- | --- | --- | | **Epidural** | **Above** the dura ("epi" = above) | **Lucid interval**: knocked out → wakes up and talks (seems better) → **rapidly declines**. Emergency surgery. Neuro checks every 5–10 min. | | **Subdural** | **Below** the dura ("sub" = below) | **Slow**: weeks to months. Easy to miss. | | **Subarachnoid** | Subarachnoid space | **"Worst headache of my life,"** sudden | | **Intracerebral** | Deep in brain tissue | — | Hydrocephalus & herniation **Hydrocephalus** = too much cerebrospinal fluid (CSF) (not absorbed, or blocked) → big ventricles → ↑intracranial pressure (ICP). **Herniation** = brain shifts to make room: - **Uncal**: sideways (temporal lobe). - **Central**: downward onto the **brainstem**. Don't memorize which pupil means which. Know: pupils change (unequal, dilated), **always non-reactive** → call **Rapid Response** and the provider. level of consciousness (LOC) drops, Cheyne-Stokes breathing. Assessment after head injury - **airway, breathing, circulation (ABCs) first.** Assume a **cervical spine injury** → spinal precautions; open airway with **jaw thrust**. - **Autoregulation is lost**: blood pressure (BP) and heart rate (HR) can swing **either way**. Get a baseline; may seem stable then crash. - Do the **neuro exam BEFORE sedatives** or paralytics. - **Pupils**: any change → call right away. - **Motor**: deficit on the **opposite side** of the lesion. **Skull fracture signs:** - cerebrospinal fluid (CSF) leak: clear fluid from nose/ears; **positive glucose** on dipstick; **halo sign**. - **Battle sign**: bruising behind the ear (mastoid). - **Raccoon eyes**: bruising around the eyes. Glasgow Coma Scale practice Your instructor: **don't memorize the scale**. You'll be given it; know how to **apply** it. - Highest = **15**. Lowest = **3**. - **7 or less** = coma. "**Less than 8, intubate.**" - A **2-point drop** = clinically significant → Rapid Response / provider. Eyes open Verbal Motor Preloaded with the class example: opens eyes to pain (2) + withdraws (4) + moans (2) = **8**. Interventions to lower intracranial pressure (ICP) **Respiratory:** prevent low oxygen, and keep **carbon dioxide (CO₂) 35–45**. **"High CO₂ dilates, low CO₂ constricts."** High → brain vessels swell → ↑ICP. Low → vessels clamp → poor blood flow. Both bad. - **Cardiovascular:** know the patient's blood pressure (BP) range; call if above or below. **Cardiac monitor** (lost autoregulation → dysrhythmias). - **Therapeutic hypothermia:** cooling lowers the brain's oxygen demand. **Mannitol** (osmotic diuretic): - Pulls water **out of brain tissue into the blood** → kidneys pee it out → less swelling, lower ICP. - Dosed by **serum osmolality**; goal **310–320** (normal \~300), slightly "salty" blood. - Watch: **dehydration**, electrolyte imbalance, **acute kidney injury**. **Foley + hourly I&O** (an exception to avoiding Foleys). - Often given with **furosemide**: mannitol pulls fluid from the brain, furosemide removes it from the body. **Hypertonic saline (3% or 5%)** works like mannitol. intensive care unit (ICU) only, and it shows why it's dangerous for regular patients. Your instructor said a case study (due next week, from the book) covers ICP prevention in detail, plus post-op craniotomy care. Brain tumors & craniotomy - **Primary** = starts in the brain. **Secondary** = spread from elsewhere (lung, breast). - Any tumor → **↑intracranial pressure (ICP)** and squeezes brain tissue and vessels. - **Meningioma** (benign, common) → usually removed with a good outcome. Malignant → surgery + radiation/chemo. - Common signs: **headache, seizures**, dizziness, memory loss. | Craniotomy | Decompressive craniectomy | | --- | --- | | Skull opened, fixed, closed right away | Piece of skull **removed** and frozen; put back weeks/months later. Leaves room to swell. Patient wears a **helmet**. | Read in book Iggy Ch. 38, pp. 956–973 · skipped per your list: chronic traumatic encephalopathy (CTE) paragraph, pinpoint/ovoid pupil sentences, supra/infratentorial paragraph, chemo & direct drug delivery traumatic brain injury (TBI) basics (book)Read in book - **TBI** = brain damage from an outside force. Affects cognition, movement, senses, and emotions. - **Acceleration** injury = something hits the still head. **Deceleration** = moving head hits something still. Shearing → diffuse axonal injury. - **Open** = skull or dura broken (infection risk). **Closed** = skull intact. - Top causes: **falls**, self-harm, car crashes, assaults. Alcohol/drugs contribute. Young men most; **falls** most in older adults and kids. | Mild (concussion) | Moderate | Severe | | --- | --- | --- | | Blow to the head + brief confusion or feeling dazed, plus one or more: out **up to 30 min**, memory loss right before/after, focal neuro deficit. **Doesn't need** loss of consciousness. **computed tomography (CT)/magnetic resonance imaging (MRI) normal.** Symptoms usually gone in **72 hrs**. | Out **30 min–6 hrs**; Glasgow Coma Scale (GCS) **9–12**. CT/MRI often shows injury. Memory loss up to **24 hrs**. Short acute/critical care stay to watch for swelling, bleeding. | GCS **3–8**; out **over 6 hrs**. Critical care: hemodynamic, neuro, possibly **intracranial pressure (ICP) monitoring**. High risk for secondary injury. | - **Postconcussion syndrome** (most common secondary injury after mild TBI): headache, foggy thinking, dizziness for **4+ weeks**. Also posttraumatic headaches or vertigo; irritability, depression, anxiety, mood swings; insomnia; trouble concentrating or memory loss; **lower alcohol tolerance**. - **Second-impact syndrome**: a second hit before the brain heals → rapid brain swelling, can be catastrophic. Mostly athletes. Teach return-to-play rules. Secondary injury numbers (book)Read in book - **Hypotension** = mean arterial pressure (MAP) **under 70**. **Hypoxemia** = partial pressure of arterial oxygen (PaO₂) **under 80**. Both starve the brain → swelling → worse perfusion (vicious cycle). - intracranial pressure (ICP) normal **10–15**; coughing or straining spikes are OK. Sustained **over 20** → neurons die. - Body compensates: shifts cerebrospinal fluid (CSF), absorbs more CSF, moves venous blood out. When it can't, ICP rises → herniation. - **↑ICP is the leading cause of death** in head-trauma patients who reach the hospital alive. Bleeds & herniation (book)Read in book | Bleed | Book detail | | --- | --- | | **Epidural** | **Arterial** (middle meningeal artery), often a temporal skull fracture. Brief unconsciousness → **lucid interval** (awake, talking for minutes) → rapid decline. **Critical Rescue:** neuro checks **every 5–10 min**; loss of consciousness = **neurosurgical emergency** → provider/Rapid Response now. Document trends. | | **Subdural (SDH)** | **Venous**, slower. Acute (within 48 hrs), subacute (48 hrs–2 wks), chronic (weeks–months). Common in **older adults** and people on **anticoagulants/antiplatelets**. Signs: worsening headache, confusion, ↓level of consciousness (LOC). | | **Intracerebral (ICH)** | Bleeding into brain tissue; may appear up to 10 days later. | - **Uncal herniation**: pushes on **cranial nerve (CN) III** → dilated nonreactive pupil, **ptosis**, fast LOC decline. - **Central herniation**: downward onto the brainstem → **Cheyne-Stokes** breathing, then nonreactive pupils, unstable vitals. - All herniations are life-threatening → **Rapid Response / provider immediately**. - **Hydrocephalus**: **communicating** = cerebrospinal fluid (CSF) not absorbed (after subarachnoid hemorrhage (SAH) or meningitis); **noncommunicating** = outflow blocked (swelling, tumor, debris). traumatic brain injury (TBI) assessment (book)Read in book - History: **when, where, how**; lost consciousness, and how long? Get it from witnesses if needed. Amnesia is common. Older adults: screen for abuse/neglect. - **carbon dioxide (CO₂)**: high (over 45) → vasodilation → ↑intracranial pressure (ICP). Low (under 35, from hyperventilating) → vasoconstriction → ischemia. Track with **end-tidal carbon dioxide (ETCO₂)**. - Treat as a **cervical spine injury** until x-rays prove otherwise. **Rigid collar**; spine precautions: bed rest, no neck or back bending or twisting, **log roll**, check skin under the collar. Spine "clearance" is the provider's call. - Brainstem injury → Cheyne-Stokes or apnea; may need a ventilator. - **Cushing's triad** = severe hypertension (HTN), widened pulse pressure, bradycardia → **death is near**. - **Glasgow Coma Scale (GCS) change of 2 points** = report. **level of consciousness (LOC) is the most important thing to assess**; a change is the **first sign** of worsening. - Pupils: unequal, sluggish, or dilated = herniation until proven otherwise. **Fixed and dilated ("blown") = poor prognosis**. - Check vision (read your name tag, count fingers). - Late ↑ICP signs: severe headache, vomiting (often projectile), seizures. **Papilledema = always ↑ICP**. - Highest ICP risk: first hours, up to **3–4 days** after injury. - Motor loss is on the **opposite** side. - **cerebrospinal fluid (CSF) leak**: clear fluid from nose/ear, **positive glucose**, **halo sign** on white gauze. **Raccoon eyes**, **Battle sign** = basilar skull fracture. - **computed tomography (CT) first**. magnetic resonance imaging (MRI) shows diffuse axonal injury but **not with ICP monitors**. **Critical Rescue:** check pupils (size, shape, reaction) often, especially if they can't follow directions. Report any change to Rapid Response; it may mean ↑ICP. traumatic brain injury (TBI) interventions (book)Read in book - Vitals every **1–2 hrs** or more. Report dysrhythmias, high or low blood pressure (BP); get target ranges from the provider. - **Fever** = worse outcomes. Goal is **normal temperature** (targeted temperature monitoring). - Keep partial pressure of arterial carbon dioxide (PaCO₂) normal; avoid over-hyperventilating. **Positioning Action Alert:** head **midline**, no extreme neck flexion/extension. **Log roll**. head of bed (HOB) **at least 30°** (or as ordered). Avoid sudden HOB changes; a big BP drop when sitting up can hurt the brain. **Mannitol** (book adds): - Pulls water out of swollen brain tissue. Works best as **boluses**, not a continuous drip. - Give through a **filter** in the intravenous (IV) tubing, or draw up with a **filtered needle** for IV push (removes tiny crystals). - Serum **electrolytes and osmolarity every 6 hrs**; goal osmolarity **310–320**. Serum and urine osmolarity and sodium checked **at least daily**. - **Strict hourly urine output**, I&O. Watch for **severe dehydration**, **acute kidney failure**, weakness, edema, urine output changes. - **Furosemide** (loop diuretic) is often added: prevents mannitol "rebound," boosts its effect, lowers edema and blood volume, and **reduces cerebrospinal fluid (CSF) production**. **Hypertonic saline (HTS)**: draws fluid out like mannitol. Usually **3%** sodium chloride (NaCl) (can be up to 23%). Nursing: constant neuro checks, **serial sodium levels**, fluid status, watch for **pulmonary edema** (especially heart or kidney disease). Some hospitals require **intensive care unit (ICU) + central line**. Evidence box: HTS is at least as effective as mannitol for lowering intracranial pressure (ICP); some studies say better. Choice depends on the patient. **Opioids** (fentanyl, morphine) and sedation (propofol, dexmedetomidine) may help ventilated patients; check neuro first. **Brain death** requires: coma of known cause, temp **above 96.8°F (36°C)**, systolic **≥100**, at least 1 neuro exam. Before it's declared, call the **organ procurement** agency (the nurse doesn't bring up donation alone). Support grieving families; ethics, chaplain, social work. Cognition, seizures & trauma-informed care (book)Read in book - **Memory and thinking**: cognitive rehab; reorient; hazard-free room. - **Sensory stimulation** for comatose patients: one stimulus at a time (show a family photo and say who it is). Audio no longer than **10–15 min** or it becomes "white noise." - Seizure precautions and antiepileptic drugs (AEDs) as ordered. - **Trauma-informed care** (6 principles): **safety**, **trust and transparency** (plain language), **peer support**, **collaboration**, **empowerment** (patient has a voice), **cultural and historical sensitivity**. Mild traumatic brain injury (TBI) teaching: Box 38.8Read in book - Headache → **acetaminophen every 4 hrs** as needed (no nonsteroidal anti-inflammatory drugs (NSAIDs)). - **No sedatives, sleeping pills, or alcohol** for at least **24 hrs** (unless the provider says otherwise). - **No strenuous activity** for at least **48 hrs**. - Caregiver: balance problems can cause falls; plan safe movement. - **Call 911 / return** for: seizure, severe or worsening headache, persistent vomiting, blurred vision, **clear drainage from ear or nose**, increasing weakness, slurred speech, **progressive sleepiness**, **unequal pupils**. - Keep follow-up appointments. Home care after traumatic brain injury (TBI) (book)Read in book - Rehab goal: **highest possible function** (OT, physical therapy (PT), speech). - Home safety: working **smoke and fire alarms**; brain injury often takes away the **sense of smell**. - Dietitian: many gain weight within a year (inactivity, stress eating). - Personality and behavior changes: **structured, consistent routine** with repetition. Reinforce **positive** behavior. - Expect fatigue, irritability, temper outbursts, depression, memory problems. Some need constant supervision. - Families feel isolated → regular **respite**, support groups (Brain Injury Association of America). Brain tumors (book)Read in book - **Primary** tumors start in the central nervous system (CNS) and rarely spread out of it. **Secondary** tumors spread from lung, breast, kidney, skin, gastrointestinal (GI). - Any tumor → swelling, ↑intracranial pressure (ICP), possible herniation. Pituitary tumors can cause **syndrome of inappropriate antidiuretic hormone (SIADH)** or **diabetes insipidus** (fluid and sodium problems). - **Meningiomas** (benign) can usually be removed with a good outcome. - Malignant tumors mostly at ages **40–70**. **Signs:** **headache worse on waking**, nausea/vomiting, seizures, numbness or vision changes, dizziness, one-sided weakness, trouble speaking, personality changes. **Diagnosis:** computed tomography (CT) first, then magnetic resonance imaging (MRI) for detail. **Symptom meds:** - Codeine/acetaminophen for headache. - **Dexamethasone** (steroid) for brain swelling. - **Levetiracetam** or other antiepileptic drugs (AEDs) to prevent seizures. - proton pump inhibitors (PPIs) to prevent **stress ulcers**. **Gamma Knife / CyberKnife** (stereotactic radiosurgery): focused radiation, no incision, for hard-to-reach tumors or arteriovenous malformations (AVMs). **Tumor Treating Fields**: electric fields through skin pads. **Glioblastoma** = most aggressive; few survive 5 years. Craniotomy care (book)Read in book **Before surgery:** very anxious (head opened, hair shaved, fear of new deficits). Reassure; teach what to expect after. **Action Alert:** neuro checks + vitals **every 15–30 min for 4–6 hrs**, then **hourly**. Stable 24 hrs → every 2–4 hrs. Report: ↓level of consciousness (LOC), new weakness or paralysis, aphasia, less feeling, **sluggish pupils**, agitation, personality change. | Supratentorial (top of brain) | Infratentorial (brainstem/back) | | --- | --- | | **head of bed (HOB) 30°** (venous drainage). Head midline; no extreme hip or neck bending. Turn side to side or supine. | Keep **flat or 10°**. **Side-lying**, alternating every 2 hrs, for 24–48 hrs. **nothing by mouth (NPO) until fully awake** (swelling near medulla → vomiting, aspiration). | - Check the head **dressing every 1–2 hrs**; mark drainage once a shift. - Drain (Hemovac/Jackson-Pratt (JP)): measure every 8 hrs; usually **30–50 mL / 8 hrs**. **Critical Rescue:** report a **saturated dressing** or drainage **over 50 mL in 8 hrs** right away. Watch for ↑intracranial pressure (ICP). - Swollen, bruised eyes are normal → **cool compresses**; rinse with warm saline or artificial tears. - Cardiac monitor (dysrhythmias). Strict **I&O for 24 hrs**; fluid limit \~**1500 mL/day** if the pituitary is involved. - Labs: complete blood count (CBC), electrolytes, osmolality, clotting. Watch for **low sodium** (SIADH, steroids) → confusion, weakness. **High sodium** (DI, dehydration) → thirst, restlessness. - venous thromboembolism (VTE): compression devices until walking. Deep breathing every 2 hrs. **Box 38.9 complications:** - **Early:** ↑ICP, hematomas, subarachnoid hemorrhage (SAH), hypovolemic shock, hydrocephalus, breathing problems (atelectasis, pneumonia, neurogenic pulmonary edema). - **Late:** wound infection, meningitis, fluid/electrolyte problems, seizures, **cerebrospinal fluid (CSF) leak**, cerebral edema. Book · NCLEX Challenge 38.4 A client just returned from an open craniotomy for a frontal lobe tumor. Which finding needs immediate report to the surgeon or Rapid Response? ↓level of consciousness (LOC) = possible ↑intracranial pressure (ICP) or bleeding. Headache and eye swelling are expected; 25 mL is under the 50 mL limit. Book · NCLEX Challenge 38.3 A client with a mild traumatic brain injury (TBI) is learning about home care. Which statement shows a need for **more teaching**? Box 38.8: no strenuous activity for at least 48 hrs, and balance problems make construction work unsafe. The others are correct teaching. Book · Mastery Q3 Which finding is an **early** change in LOC in a client with a mild TBI? Behavior changes (irritable, restless) come first. Posturing and lost reflexes are late. Book · Mastery Q2 · Select all The nurse is giving mannitol to a client with a severe TBI. Which actions are appropriate? Only A is wrong: urine output is measured **every hour**, not every 4–8. Filtered needle, electrolytes, osmolarity, and dehydration watch all match p. 964. (My answer; check your book's key.) Book · NGN Challenge 38.2 **Case:** 79-year-old fell at home 2 days ago and broke her right arm. Over 2 days: Glasgow Coma Scale (GCS) **15 → 14**, headache **4 → 5 → 8/10**, blood pressure (BP) and pulse creeping up. Review class: Joline head-injury case (what she stressed) Review class From the in-class exam review (Joline case study + NCLEX questions). Joline fell from a third-story balcony. Think: head injury **and** spine injury until proven otherwise. 1. **Most important thing to monitor: level of consciousness (LOC).** First sign of trouble = changes in behavior. 2. **Cushing's triad** (the "triad" that has **4** parts): severe hypertension, widened pulse pressure, **bradycardia**, irregular breathing. Normally high blood pressure makes the heart speed up, so slow heart rate + high blood pressure is the weird exception. It is a **late** sign of increased intracranial pressure. **Be able to apply it:** "blood pressure 200/80, heart rate 40" = Cushing's. 3. **Neuro assessment, know what's wrong AND how you check it:** pupils equal, round, reactive to light and accommodation (PERRLA), LOC, Glasgow Coma Scale (GCS), motor (squeeze my hands, push/pull feet, raise arms), sensory, reflexes, cranial nerves, vital signs (which part is off and why), breathing pattern. 4. **Orogastric (OG) tube, not nasogastric (NG)**, with severe facial trauma or skull fracture (like basal skull fracture). A tube through the nose could go up through the fracture into the brain. Going through the mouth avoids that. 5. **Blood alcohol** makes the neuro assessment **unreliable**. 6. **When she wakes up:** first tell her where she is and what happened ("You're in the hospital. You were in an accident."). This lowers fear. **Then** check orientation. (Students often pick "ask where she is." That's second.) 7. **Epidural hematoma:** knocked out right away → **lucid interval** (seems better, "it's a trick") → then crashes. 8. **Bruising and swelling around the eyes** (periorbital edema and ecchymosis) is expected with this injury. Apply **cold compresses** (decrease swelling) and **artificial tears** (comfort). Assess, and notify the provider as needed. 9. **3 reasons for a fever:** infection, inflammation (body's response to brain injury), and damage to the **hypothalamus** (the body's thermostat). **Glasgow Coma Scale:** don't memorize the scale. The test will give it to you. Just know how to apply it. The tricky part is motor: **withdraws / pulls in = 4**. **Pushes the stimulus away = 5** (localizes pain). Her examples: eyes to pain 2 + verbal none 1 + withdraws 4 = **7**. Eyes to sound 3 + incomprehensible sounds 2 + localizes 5 = **10**. Review class: spinal precautions + preventing ↑intracranial pressure (ICP) Review class From the in-class exam review (Joline case study + NCLEX questions). **Backboard and cervical collar:** used because spinal cord injury and head injury go together. They stay until spinal cord injury is ruled out. - **Spinal precautions:** supine (bed rest), spine in **neutral** position. No twisting, no neck flexion forward or back, **no pillow**. - **Remove the long backboard as soon as possible**: go back to basics: a hard board causes **skin breakdown**. - **Repositioning = log roll** as a unit, with help. - **Every time the patient is moved** (turns every 2 hrs, trip to head computed tomography (CT) scan), do **another neuro assessment**. - **Head of bed position depends on cerebral perfusion pressure (CPP).** Up can pull blood away from the brain; flat can send too much and raise ICP. It's individualized. **Don't memorize** the book's exact rules; just know CPP guides the choice. **Nursing care to avoid increasing ICP:** 1. **Quiet, calm room.** Noise, bright light, anxiety, agitation all raise ICP. Limit upsetting visitors (a screaming parent may need to step out). 2. **No Valsalva** (bearing down): give **stool softeners**; manage coughing. 3. **Suction only if you must** (airway, breathing, circulation (ABCs) come first). Try repositioning and other measures first. If you suction, **hyperoxygenate first**. 4. **Keep the whole body straight:** no head flexion, **no pillow under the knees** (bent knees block blood flow back from the head). 5. **Frequent vital signs + neuro checks.** 6. **Arterial blood gas (ABG): watch carbon dioxide (CO₂)** closely. CO₂ is a **potent vasodilator** → more blood in the brain → ↑ICP. 7. **Do NOT cluster care.** Exception to the rule! Repositioning + bath + linen change + suppository all at once = ICP spike. **Space activities out.** 8. **Control fever.** Fever → shivering → more oxygen demand → more CO₂ → vasodilation → ↑ICP. 9. **Mannitol** (see below). | Mannitol: know it cold | | | --- | --- | | Class | Osmotic diuretic | | How it works | Treats brain swelling. Pulls water out of the brain tissue into the blood vessels → kidneys excrete it. Sometimes given with **furosemide** (loop diuretic) to work together. | | Dosing guide | **Serum osmolality.** Normal ≈ 300 (just remember 300). Goal = slightly hypertonic, **310–320**. Pump rate is adjusted to stay there. | | Filter needle | **Always.** It has microscopic crystals. Any time you read "use a filter needle," remember it. | | Monitor | Intake and output (I&O); urinary catheter is often used here (an exception, we usually avoid catheters); dehydration; blood pressure; labs: **sodium, potassium, serum osmolality** | **Legal/ethical (organ donation):** Joline is an adult whose **driver's license** says organ donor. In **Michigan, Ohio, and Kentucky** that is **legally binding**, so the hospital follows it even if family disagrees (it varies by state). Help the grandmother: let her express feelings; involve the **chaplain, social services, organ donation team**, and possibly the **ethics committee**. Quick recall · tap to flip NCLEX A client hit his head, was knocked out, then woke up talking normally. An hour later he's hard to wake. The nurse suspects: Lucid interval then rapid decline = epidural. Emergency surgery. NCLEX MAP 80, ICP 22. What is the CPP, and what does the nurse do? 80 − 22 = 58. Under 70 means poor brain perfusion, and ICP over 20 is dangerous. NCLEX A client's GCS dropped from 13 to 11. Best action? A 2-point drop is clinically significant. NCLEX Which finding in a client on mannitol needs follow-up first? Mannitol should cause big diuresis. Very low output suggests acute kidney injury. NCLEX Clear fluid is draining from a head-injury client's nose. Best assessment? CSF contains glucose and forms a halo on gauze. Possible skull fracture. The 60-second version ## Migraine = overexcited nerves + swollen, widened brain blood vessels - One-sided, **throbbing** pain. Nausea. Light and sound hurt. Some get an **aura** first. - **Pain management is the priority.** First step: avoid triggers. - Most migraine meds work by **narrowing the blood vessels**. - **Triptans:** NO for heart disease, high blood pressure (BP), peripheral vascular disease (PVD), or with selective serotonin reuptake inhibitors (SSRIs). The vessels are like a garden hose that's swollen too wide and throbbing. The fixes squeeze the hose back down: caffeine, triptans, even a cool cloth. Signs & finding the cause - Usually **one-sided**, throbbing. - Nausea, **photophobia**, **phonophobia**. - **Aura** = warning before it hits (vision changes). **Nurse's job:** detailed interview. How often? How long? What sets it off? **Headache diary** → finds patterns and triggers. Common triggers: **caffeine, red wine, monosodium glutamate (MSG)** (a food flavor additive). Treatment step 1 & 2: triggers + comfort 1. **Avoid triggers.** 2. **Comfort measures:** lie down in a **dark room**, **cool cloth** on the forehead, relaxation, yoga, massage, acupuncture. 3. **Medications** if still needed. Abortive meds (stop it now) Take **as soon as symptoms start**, ideally during the aura. - **First:** acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, naproxen), or over-the-counter (OTC) combos with **caffeine** (like Excedrin). Caffeine narrows blood vessels. - **Next: triptans**, like **sumatriptan (Imitrex)** and **rizatriptan (Maxalt)**. They activate serotonin → narrow brain arteries → less pain. **Triptan safety:** they narrow vessels *everywhere*, not just the brain.\ • Think twice with **high blood pressure (BP)** or **heart disease**.\ • **Peripheral vascular disease: absolutely not.**\ • Teach: report **chest pain** right away (heart not getting enough blood).\ • Don't mix with **selective serotonin reuptake inhibitors (SSRIs)** (sertraline, fluoxetine) or **St. John's wort** → **serotonin syndrome**. **Lasmiditan:** newer, doesn't narrow vessels outside the brain, so safer. Side effects: **sleepiness, dizziness**. **Rebound headache:** a new headache after the first one goes away. Caused by taking the medicine **too often or too much**. Preventive meds (stop it from coming) For migraines that are **frequent** or **severe**: - nonsteroidal anti-inflammatory drugs (NSAIDs) - **Beta blockers** - **Topiramate** (an anti-seizure drug) Read in book Iggy Ch. 36, pp. 899–902 · crossed-out parts skipped Migraine basics (book)Read in book - Recurrent attacks of head pain that serve **no protective purpose**. - Throbbing, unilateral. Nausea + sensitivity to **light, sound, or head movement**. - Lasts **4 to 72 hours**. Runs in families. **Women** more than men. - Linked to **major depression**, and higher risk of **stroke** and **epilepsy**. **How the pain happens:** cerebral arteries dilate → **prostaglandins** released → inflammation, swelling, leaking → throbbing pain. Full trigger listRead in book - **Caffeine**, **red wine**, **monosodium glutamate (MSG)** - High-intensity light, stress, excessive fatigue, change in weather - **Tyramine**: pickled foods, aged cheese, smoked sausage, beer - Preservatives, artificial sweeteners Triggers set off **hyperexcitable neurons**. Each patient's triggers are different. Types & phases (Box 36.8)Read in book | With aura ("classic") | Without aura ("common") | | --- | --- | | Aura right before the headache | **Most migraines** are this type | **Chronic** = 15+ days a month. **Episodic** = less often. 1. **Prodrome** (1–2 days before): yawning a lot, constipation, mood changes, food cravings. 2. **Aura** (5–60 min, usually one-sided): flashing lights, spots, zigzag lights; numb or tingling lips/tongue, confusion, aphasia, vertigo, one-sided weakness, drowsiness. 3. **Migraine phase**: nausea/vomiting; one-sided throbbing pain, often worse **behind one eye or ear**; photophobia, phonophobia. Without aura: pain gets worse with routine activity; often early morning, with stress, or premenstrual. **Diagnosis:** history + physical, neuro, and psych assessment. Patients tend to have the same symptoms each time. **Women over 50 with migraines:** teach cardiovascular risk factors. **Call 911** for facial drooping, arm weakness, or trouble speaking (stroke). Abortive drugs: the full lineupRead in book **Priority of care = pain management.** | Severity | Drugs | | --- | --- | | Mild | Acetaminophen; nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, naproxen); over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) + caffeine | | Nausea | Antiemetics; **metoclopramide** with NSAIDs (speeds stomach emptying) | | Severe | Triptans, ditans | **Caffeine** narrows vessels by blocking **adenosine** (which widens vessels and adds inflammation). **Triptans** (sumatriptan, eletriptan, naratriptan, almotriptan) activate **5-HT (serotonin)** receptors → vasoconstriction. Sumatriptan comes as a pill, injection, or nasal spray. **Contraindicated:** ischemic heart disease, cerebrovascular ischemia, hypertension (HTN), peripheral vascular disease (PVD), **Prinzmetal angina** (coronary vasospasm risk). **Triptan teaching (Drug Alert):** take as soon as symptoms start · report chest pain right away · **use birth control** (not safe in pregnancy) · expect **flushing, tingling, hot feeling** that fades · no selective serotonin reuptake inhibitors (SSRIs) or St. John's wort. **Ditans (lasmiditan):** block one serotonin receptor **without** constricting vessels → safer and more effective than triptans. When to start preventive drugsRead in book Start prevention when **any** of these is true: - More than **2 migraines a month** - Headache lasts more than **24 hours** - Interferes with activities of daily living (ADLs) for **3+ days** - Abortive meds used more than **twice a week** - Not relieved by acute treatment | Drug | Key point | | --- | --- | | **Beta blockers** (propranolol, timolol) | Calm hyperexcitable neurons, block vasodilation. **Lower blood pressure (BP) and heart rate (HR).** | | **Calcium channel blocker** (verapamil) | | | **Topiramate** (AED) | Use in **low doses** | | **Nortriptyline** (TCA) | Dry mouth, urinary retention, constipation. **Not for older adults** (delirium). | **beta blocker (BB) / calcium channel blocker (CCB) teaching:** take your **pulse** · report **bradycardia**, fatigue, shortness of breath · change position slowly (orthostatic hypotension). Diary, comfort & complementary careRead in book - **Headache diary**: type of headache + response to meds. - Report if the headache **changes** in quality or intensity, has **new visual changes**, or the drug stops working. - At onset: lie down, dark room, **both eyes covered**, cool cloth, undisturbed. - **Cannabis:** cannabidiol (CBD) eases pain better; tetrahydrocannabinol (THC) is the mind-altering part. Tolerance can develop. - Yoga, meditation, massage, exercise, **biofeedback**, acupuncture/acupressure. - Riboflavin and **magnesium** supplements may help prevent migraines. - All herbs must be **approved by the provider** first (drug interactions). Heads-up: the book prints "vitamin B12 (riboflavin)," but riboflavin is actually **vitamin B2**. Book · NCLEX Challenge 36.4 · Select all Client prescribed propranolol (prevention) and sumatriptan (acute). Which teaching statements should the nurse include? Beta blockers cause **bradycardia** (report a LOW pulse, not >100) and orthostatic hypotension. Triptans go in early, and chest pain = possible ischemia. Vitamin D isn't part of this plan. Review class: migraine meds (prevent vs. abortive) Review class From the in-class exam review (Joline case study + NCLEX questions). | Goal | Drug | Key point | | --- | --- | --- | | **Prevent** migraines | **Propranolol** (beta blocker) | Taken regularly to prevent attacks | | **Abortive** (once headache starts) | **Triptans** (sumatriptan): "triptan" is in the name | Activates serotonin → **vasoconstriction** of the dilated brain vessels | Triptans squeeze blood vessels. They don't only squeeze the brain's vessels, they squeeze them **everywhere**. **Do NOT give triptans with:** - **Hypertension**, **peripheral vascular disease** (vessels already narrowed) - **Angina / heart disease**: chest pain after a triptan = coronary vasoconstriction - **Selective serotonin reuptake inhibitors (SSRIs)** like fluoxetine (Prozac), paroxetine → too much serotonin = **serotonin syndrome** - **St. John's wort** (and grapefruit) interact with lots of meds. If it shows up as an answer choice, don't pick it. Quick recall · tap to flip NCLEX A client is prescribed sumatriptan. Which history should the nurse report first? Triptans narrow blood vessels, which makes PVD worse. NCLEX After taking a triptan, the client says "my chest feels tight." What does the nurse do? Narrowed vessels can starve the heart of oxygen. Chest pain is a red flag. NCLEX Which statement shows the client understands migraine self-care? The diary finds triggers. Meds go early, daily use causes rebound headaches, and red wine is a trigger. The 60-second version ## A seizure is an electrical storm in the brain - Seizure with a clear cause (fever, electrolytes, alcohol withdrawal, brain injury) = **NOT epilepsy**. Treat the cause. - **Epilepsy** = seizures that keep coming back on their own. - During a seizure: **turn to side, move objects, never restrain, nothing in the mouth**. - **Status epilepticus** (>5 min) = emergency → **airway** first, then **lorazepam intravenous (IV)**. Think of a power surge in a house. Anti-seizure meds are surge protectors: they keep surges from happening, but they don't rewire the house (no cure). **Caption alert:** the video captions say "fentanyl," but your instructor means **phenytoin** (Dilantin). "Phosphantinoin" = **fosphenytoin**. Seizure vs. epilepsy **Seizure** = sudden, uncontrolled burst of electrical activity in brain cells. **Secondary causes** (fix these first): **high fever, electrolyte imbalance, alcohol withdrawal, brain injury**. These are NOT epilepsy. **Epilepsy** = chronic, **recurrent, unprovoked** seizures. Cause: abnormal brain cells or a chemical imbalance (like **gamma-aminobutyric acid (GABA)**, the brain's calming chemical). Diagnosis starts with a detailed **history and physical**. Seizure types (slides)Slides Your instructor said these are **review from Peds**. You won't be tested on each type directly, but the words may show up in a question. **Generalized** = **both** sides of the brain: - **Tonic-clonic** (2–5 min): stiffening + level of consciousness (LOC) (tonic), then rhythmic jerking (clonic). Tongue biting, incontinence. - **Myoclonic:** quick jerks of arms or legs. - **Atonic:** suddenly goes limp → falls → injury. - **Absence:** brief blank stare; lip smacking or picking (automatisms). **Partial (focal)** = **one** side: **complex** (blacks out 1–3 min, no memory after) or **simple** (stays awake, has an aura). electroencephalogram (EEG) test prep EEG records the brain's electrical activity. Electrodes are glued to the scalp. - **Clean hair**: no conditioner, gel, or spray (electrodes won't stick). - **Eat before the test.** Low blood sugar changes the reading. - **No sedatives, stimulants, or caffeine.** - Quiet room, sign on the door. We want a picture of the brain's normal self. Anything that speeds it up, slows it down, or starves it ruins the picture. Anti-seizure meds **Slide drugs:** phenytoin (Dilantin), carbamazepine (Tegretol), valproic acid (Depakote), topiramate (Topamax). You don't need to know which drug is for which seizure type. Know these rules: - They slow the brain → **drowsiness**. - Can cause **depression and suicidal thoughts**. Screen mood. - **Liver damage** → check liver enzymes. **Low white blood cells (WBCs)** → infection risk. - **Narrow safe range** → regular **blood levels**. - **Phenytoin** → **gums overgrow** (gingival hyperplasia). Teach: soft toothbrush, regular dentist visits. **Never stop suddenly.** Seizures come back and can turn into status epilepticus. - **Pregnancy category D**: can cause birth defects, but uncontrolled seizures hurt the baby too. Tough decision with the provider. - **Birth control pills** work less well → use a **second method**. - **Warfarin** needs close monitoring. **No grapefruit** (toxicity). Vagal nerve stimulator (VNS) For seizures meds can't control. A device in the **left chest** (like a pacemaker) sends pulses up the **vagus nerve** to the brain. - Feels an **aura**? **Swipe the magnet** over the device to stop the seizure. - Like a pacemaker: **magnetic resonance imaging (MRI) can be dangerous**, sets off airport metal detectors, wear a **medical alert bracelet**, carry a wallet card. Before: seizure precautions - **Suction + oxygen** at the bedside. - **intravenous (IV) access** (saline lock). They can't swallow pills during a seizure. - **Padded side rails?** Debated (could count as a restraint). **Follow hospital policy.** Some use a mattress on the floor. - Keep them **active and independent**. Don't keep them stuck in bed. **NO padded tongue blades.** A chipped tooth can be breathed in, or the blade can block the airway. During a seizure **Patient safety is the priority.** 1. Turn to the **side** so spit drains out → no aspiration. 2. **Move objects** away so they don't get hurt. 3. **Never restrain.** Nothing in the mouth. 4. **Watch and document** what happens, in order. It tells the provider the seizure type → which drug. Status epilepticus: emergency Seizure lasting **longer than 5 minutes**, or seizures back-to-back over 30 minutes. Over 10 minutes can be deadly. **Call the Rapid Response Team.** 1. **Airway** (may need intubation) + **oxygen**. 2. **intravenous (IV) with normal saline**. Draw blood: **arterial blood gases (ABGs), electrolytes, drug levels**. 3. **Stop it:** **lorazepam (Ativan)** or diazepam (Valium) IV push. 4. **Prevent the next one:** **fosphenytoin** (preferred, safer) or phenytoin. Firefighter first (lorazepam puts out the fire). Then the sprinkler system (fosphenytoin stops the next fire). Patient & family teaching - Meds: take every dose, know interactions, keep blood level appointments. - Family knows what to do during and after a seizure, and when to call 911. - **Seizure diary.** Medical alert bracelet or card. - **Driving laws** by state: **Michigan = 6 months** seizure-free · Wisconsin = 3 months · Ohio = no waiting period. - Employment concerns → refer to **social services / case manager**. - Support groups: Epilepsy Foundation. Read in book Iggy Ch. 36, pp. 902–907 · crossed-out parts skipped (seizure types, Table 36.2) Definitions & secondary causesRead in book **Seizure** = sudden, excessive, uncontrolled electrical discharge of neurons → changes in level of consciousness (LOC), motor/sensory ability, or behavior. **Epilepsy** = chronic, **repeated, unprovoked** seizures. Cause: abnormal electrical activity and/or neurotransmitter imbalance, especially **gamma-aminobutyric acid (GABA)**. **Primary (idiopathic)**: no clear cause, likely genetic. **Secondary**: from a brain lesion (tumor, trauma) or: - Metabolic disorders, **electrolyte problems** (hyperkalemia, water intoxication, hypoglycemia) - Acute alcohol withdrawal, substance abuse - High fever, stroke, head injury, heart disease **Triggers:** more physical activity, stress, fatigue, alcohol or caffeine, certain foods or chemicals. Assessment & diagnosisRead in book - How many seizures, how long, any **pattern**? Have family describe them. - Any **aura** before (the **preictal phase**)? - Meds, herbs, head trauma, high fever, alcohol or drug use, past stroke or hypertension (HTN). - New seizures: ask about any past **loss of consciousness or brain injury**, even in childhood. **Tests:** electroencephalogram (EEG), computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT)/positron emission tomography (PET). antiepileptic drug (AED) teaching (book adds)Read in book - Provider adds **one AED at a time**. - Keep lab appointments: **complete blood count (CBC) + liver enzymes** (most antiepileptic drugs (AEDs) cause **leukopenia** and liver dysfunction) + drug levels. - Take on time. Sensitivity can build with age ("drug decline and sensitivity") → frequent levels. - **Phenytoin + warfarin** = don't combine. - **Grapefruit juice** raises drug levels → toxicity. **Women with epilepsy:** hormones and birth control pills change AED effects → monitor more often. AEDs can add to **osteoporosis** after menopause. During a seizure: Box 36.9Read in book - Protect from injury; **nothing forced in the mouth**. - Turn to the **side** (prevents aspiration, keeps airway clear). - Remove objects; **suction gently** if possible; **loosen clothing**. - **Don't restrain**; guide movements if needed. - **Record start and end time.** **After:** vital signs, neuro checks, keep on side, let them rest. **Document:** pupils and eye deviation, level of consciousness (LOC), apnea/cyanosis/salivation, incontinence, eye fluttering, how motor activity spread, lip smacking, tongue biting, length, aura, behavior after, time to return to baseline. **Cyanosis** during tonic-clonic seizures is common and usually self-limiting. High-risk patients may get O₂ postictally. Status epilepticus: book detailsRead in book **Acute seizures** (more intense, more often, or in clusters) → lorazepam or diazepam to **prevent** status. **Common causes of status:** **suddenly stopping antiepileptic drugs (AEDs)**, infection, alcohol/drug withdrawal, traumatic brain injury (TBI), cerebral edema, metabolic problems. **Critical Rescue:** **airway is the priority** → call provider / Rapid Response → O₂ → **large-bore intravenous (IV)** with 0.9% sodium chloride (NaCl) → usually intensive care unit (ICU). **Untreated:** hypoxia, hypotension, hypoglycemia, dysrhythmias, lactic acidosis. Muscle breakdown → **myoglobin → acute kidney injury** (especially older adults). - **Lorazepam IV push over 2 minutes** (may repeat). Diazepam rectal gel is an option. - **Phenytoin IV:** infusion pump · **normal saline only** (precipitates in other fluids) · flush normal saline (NS) before and after · then oral doses. - **Fosphenytoin:** water-soluble, works with most IV fluids **including dextrose**, fewer heart complications. vagal nerve stimulator (VNS): book detailsRead in book - Device in the **left chest wall**, lead on the **left vagus nerve**. \~2 hrs under general anesthesia. - Turned on in the operating room (OR) or, more often, **2 weeks after surgery**. Runs continuously. - **Voice change** = the nerve is being stimulated (expected). - Complications: **hoarseness (most common)**, cough, dyspnea, neck pain, dysphagia. - Avoid **magnetic resonance imaging scans (MRIs), microwaves, shortwave radios, ultrasound diathermy**. Patient & family teaching: Box 36.10Read in book - Know drug name, dose, timing, side effects, what to do if a dose is missed. - **Never stop antiepileptic drugs (AEDs)**, even if seizures stop. - Keep blood-level appointments. No over-the-counter (OTC) drugs without asking. - Wear a **medical alert** bracelet or carry an ID card. - Family knows how to help during a seizure and **when to call emergency medical services (EMS)**. - Follow **state driving and machinery laws**. - Avoid **alcohol and excessive fatigue**. Balanced diet, rest, stress reduction. **Seizure diary.** - Can't afford meds? Refer to **social services** / case manager. - Discrimination is illegal, but risky jobs (construction, heavy equipment, pilots) may need to change. Book · Mastery Q3 · Select all A hospitalized client has a tonic-clonic seizure. Which actions are most appropriate *during* the seizure? During: suction gently, remove hazards. Nothing goes in the mouth. Vitals come **after**. Benzos are for status or clusters, not every single seizure. Book · NGN Challenge 36.1 **Case:** 54-year-old had **3 tonic-clonic seizures** (2–3 min each) in the past hour. Got intravenous (IV) lorazepam; fosphenytoin infusing; O₂ 2 L. Now back to baseline, A&O ×4, vitals normal. Review class: seizure priorities + meds Review class From the in-class exam review (Joline case study + NCLEX questions). - **Tonic-clonic seizure, loses consciousness → priority: turn to the side** (aspiration risk). If there's no trauma/fall in the story, you're not worried about spinal injury. - **Status epilepticus** = seizure that keeps going. **Stop it** with a benzodiazepine ending in **-pam**: **diazepam** or lorazepam. - **Phenytoin / fosphenytoin** (fosphenytoin more common) **do NOT stop** a seizure in progress. They **prevent future** seizures. Quick recall · tap to flip NCLEX A client is having a tonic-clonic seizure in bed. What should the nurse do first? Side-lying protects the airway. Never restrain, never put anything in the mouth, never leave. NCLEX A client has been seizing for 6 minutes. Priority action? Over 5 minutes = status epilepticus. Airway first. Nothing by mouth. NCLEX A client on an anti-seizure drug takes birth control pills. Best teaching? These drugs make the pill less effective. Never stop them suddenly, and no grapefruit. NCLEX Which finding in a client on long-term anti-seizure meds needs follow-up first? These drugs can cause depression and suicidal thoughts. Safety first. The 60-second version ## Infected brain covering = pressure + sepsis danger - **Meningitis** = inflamed **meninges** (the wrapping around brain and spinal cord). - **Viral** = more common, gets better in 7–10 days. **Bacterial** = emergency, can kill in 24 hrs. - **Meningococcal** (bacterial) → **droplet precautions**. - Diagnose with a **lumbar puncture**, but **computed tomography (CT) first** if signs of ↑intracranial pressure (ICP). - Top 3 checks: **neuro, vital signs, circulation**. The brain sits in a sealed jar. Swelling raises the pressure inside. Opening the bottom of the jar (lumbar puncture) can make the brain shift down. Check the pressure with a computed tomography (CT) before you open it. How it gets in A germ gets into the blood and **crosses the blood-brain barrier**. - Sources: **brain or spine surgery**, **ear or sinus infection**, **flu or pneumonia**. - Prevention = **vaccines**: flu, pneumonia, meningococcal. - **Meningococcal vaccine: age 11–12, booster at 16.** Viral vs. bacterial | | Viral | Bacterial (meningococcal) | | --- | --- | --- | | How common | **More common** | Less common | | How bad | Most recover in **7–10 days** | **Emergency.** Can kill within **24 hrs** | | Spread | — | Highly contagious; outbreaks in **dorms**, group homes | | Isolation | **Standard** | **Droplet** | **Encephalitis** = inflamed **brain tissue** itself. Same signs, but more **long-term brain damage**. Signs & symptoms - **Nuchal rigidity**: stiff, sore neck. - **Severe headache**, **photophobia**, **nystagmus**, pupil changes. - Altered mental status, **seizures**, **↑intracranial pressure (ICP)**, **positive Babinski**, **sepsis**. **Fever may be missing. Why?**\ 1\. **Older adults** run cooler, so 98.6°F might already be a fever for them.\ 2\. They're **already on antibiotics** for the first infection (like sinusitis). The drug didn't kill the germ, and it reached the brain. Babinski reflex **How:** stroke the bottom of the foot from the **heel up to the toes**. | Toes do… | Name | Adult meaning | | --- | --- | --- | | **Curl down** | Absent Babinski | **Normal** (what we want) | | Big toe **up**, others **fan out** | Positive Babinski | **Problem in the brain or spinal cord** | **Exception:** positive Babinski is **normal under age 2**. Their nervous system isn't mature yet. Lumbar puncture (spinal tap) Meningitis is diagnosed by testing **cerebrospinal fluid (CSF)**. - Position: **side-lying, knees to chest** (fetal position). - Patient must stay **very still** (may need help holding or sedation). **Danger:** if there are signs of ↑intracranial pressure (ICP), letting CSF out fast can make pressure worse. **computed tomography (CT) scan first.** Cultures & antibiotics: the exception **Normal rule:** get cultures first, then antibiotics. **Exception** (signs of ↑intracranial pressure (ICP), no time for computed tomography (CT) + lumbar puncture (LP)): 1. Draw **blood cultures** immediately. 2. Start a **broad-spectrum antibiotic right away**. 3. Skip the cerebrospinal fluid (CSF) culture (LP too risky). 4. Germ identified → switch to a **narrow-spectrum** antibiotic. Top 3 nursing priorities 1. **Neuro status.** **First sign of ↑intracranial pressure (ICP) = change in behavior** (restless, irritable, "something's off"). Seizure precautions. 2. **Vital signs**: clues to rising ICP. 3. **Circulation check**: color, temperature, cap refill, pulses in hands and feet. Watch for **bleeding** (gums, urine, intravenous (IV) site). **Why bleeding?** Sepsis makes tons of tiny clots. They use up all the platelets and clotting factors, so none are left for normal clotting → bleeding. This is **disseminated intravascular coagulation (DIC)** (disseminated intravascular coagulation). Read in book Iggy Ch. 36, pp. 907–909 · crossed-out parts skipped What & how it enters (book)Read in book Infection of the **pia mater and arachnoid mater**. Usually bacterial or viral; also fungal or protozoal. **Sterile meningitis** can come from cancer, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous (IV) immunoglobulin. **Ways in:** bloodstream, or directly through penetrating trauma, brain/spine surgery, ruptured brain abscess. **Basilar skull fracture:** clear "runny nose" (**rhinorrhea**) or ear drainage (**otorrhea**) may actually be **cerebrospinal fluid (CSF)** → path for infection. **Higher risk:** head/neck infections (otitis media, sinusitis, tooth abscess, even tongue piercing); immunocompromised (no spleen, immunosuppressants, transplant, cancer); older adults. Can cause permanent cranial/spinal nerve damage and **↑intracranial pressure (ICP)**. Organisms & vaccinesRead in book **Viral = "aseptic" meningitis** (no organism grows in cerebrospinal fluid (CSF) culture): enterovirus, herpes simplex virus (HSV)-2, varicella zoster, mumps, human immunodeficiency virus (HIV). **Bacterial:** *Streptococcus pneumoniae* and *Neisseria meningitidis* (= meningococcal). Outbreaks: dorms, **military barracks**, crowded housing. **Vaccine schedule (CDC):** highest risk = **ages 16–21**. First meningococcal dose at **11–12**, booster at **16**. Adults: shared housing, travel, or no spleen. Booster OK as early as 8 weeks after first dose. Other vaccines that prevent meningitis: **Hib**, pneumococcal, mumps, varicella, meningococcal. Key features: Box 36.11Read in book - **↓level of consciousness (LOC)**, disorientation - **Photophobia**, **nystagmus** (jerky repetitive eye movements) - Motor normal early → later hemiparesis/hemiplegia - Cranial nerve problems: **cranial nerve (CN) III, intravenous (IV), VI, VII, VIII** - Short attention span, personality changes - Severe, unrelenting headache; myalgia; N/V; fever, chills; tachycardia - **Red macular rash** = meningococcal Nuchal rigidity, **Kernig** and **Brudzinski** signs show up in only a **small percentage**. Diagnostics (book)Read in book **computed tomography (CT) before lumbar puncture (LP)** for: age **over 60**, immunocompromised, or signs of ↑intracranial pressure (ICP). - LP delayed? Draw **blood cultures** (C&S) first. - Broad-spectrum antibiotic **right after the LP** (or right away if LP is delayed). - cerebrospinal fluid (CSF) tested for cell count, differential, protein, glucose, culture, Gram stain. - **complete blood count (CBC):** white blood cell count (WBC) well above normal. Electrolytes checked. - X-rays of chest, sinuses, mastoids (find the infection source). - CT/magnetic resonance imaging (MRI): ↑ICP, hydrocephalus, abscess. Treatment & isolationRead in book - Broad-spectrum antibiotic until culture and Gram stain return. - Bacterial: usually a **2-week intravenous (IV) antibiotic course**. Start within **1–2 hours** of the order. - **Mannitol** for ↑intracranial pressure (ICP); antiepileptic drugs (AEDs) for seizures. **Droplet Precautions** (in addition to Standard) for *N. meningitidis* and *H. influenzae*: private room · stay **3 feet** away without a mask · patient wears a mask outside the room · teach visitors. All other meningitis: **Standard Precautions**. Nursing care: Box 36.12Read in book **Most important nursing action:** accurately monitor and document **neuro status**. Neuro checks + vital signs (VS) **every 2–4 hours**. - airway, breathing, circulation (ABCs) first. Cranial nerve checks. - **Vascular check every 4 hrs**, especially the **hands**: temp, color, pulses, nail cap refill. Missed compromise → gangrene → loss of the arm. - Strict I&O, prevent fluid overload; **daily weight**. - Quiet room, **dim lights** (photophobia). - Bed rest, **head of bed (HOB) 30°**. Reposition (pressure injuries); range of motion (ROM) every 4 hrs. - Watch for: ↑intracranial pressure (ICP), vascular problems, fluid/electrolyte imbalance, seizures, shock. Also septic shock, clotting disorders, acute respiratory distress syndrome (ARDS), septic arthritis. Book · NGN Challenge 36.2 **Case:** 21-year-old with suspected bacterial meningitis. Temp 101.6 → **102.4°F** → 100.8°F. white blood cell count (WBC) **18,000**. At 0600: A&O ×4, headache 8/10. At 0700: **drowsy, oriented ×2**, unsure of day and time, "very sleepy," headache 5/10. Review class: bacterial meningitis: order of actions Review class From the in-class exam review (Joline case study + NCLEX questions). 1. **Isolation first** (protect yourself and the team). **Droplet** precautions: regular **surgical mask**, private room. No negative-pressure room needed. 2. **Insert an intravenous (IV) line** (circulation; emergency meds). 3. **Computed tomography (CT) of the head before the lumbar puncture**: rule out ↑intracranial pressure (ICP). A lumbar puncture with high ICP pushes it even higher. 4. **Broad-spectrum antibiotic** right away while waiting on the culture and sensitivity (C&S). 5. Once the organism is identified → switch to a **narrow-spectrum** antibiotic. **NCLEX mindset:** even if the patient is blue, you don't skip your own protection. Quick recall · tap to flip NCLEX A client with suspected bacterial meningitis becomes newly restless and irritable. Priority? Behavior change is the earliest sign of ↑ICP. Sedation would hide the neuro exam. NCLEX A college student has meningococcal meningitis. Which precautions? Meningococcal spreads by droplets. Viral meningitis uses standard precautions. NCLEX Stroking an adult's sole makes the big toe go up and the toes fan out. This means: In adults, toes should curl down. Fanning up signals a brain or spinal cord problem. The 60-second version ## Not enough dopamine → movement gets shaky, stiff, and slow - Progressive brain disease that affects **movement**. - Signs = **TRAP** + low blood pressure (BP) when standing, drooling, peeing at night. - Main drug: **carbidopa-levodopa (Sinemet)**. Take with carbs, **not protein**. - Biggest nursing job: **fall prevention** and nutrition. Acetylcholine is the gas pedal. Dopamine is the brake. In Parkinson's the brake wears out but the gas stays the same → shaky, jerky, hard-to-control movement. Signs: TRAP T**Tremor**: "pill rolling" (thumb rubs finger) at rest. Handwriting gets tiny and squiggly. R**Rigidity**: muscles can't relax → **mask-like face**, less blinking/smiling, trouble speaking, **trouble swallowing**, drooling. A**Akinesia/bradykinesia**: slow movement. Eating, writing, shaving get hard. P**Postural instability**: stooped, shuffling, **freezing gait** ("feet stuck to the floor") → **falls**. Automatic-body problems Dopamine also helps run the "fight or flight" system. Less dopamine → it underperforms: - **Orthostatic hypotension**: blood pressure (BP) drops on standing → dizzy → falls. - **Drooling**: less automatic swallowing. - **Nocturia**: peeing at night. Meds: carbidopa-levodopa (Sinemet) Your instructor said these are the most common Parkinson's meds and **the only ones you need to know**. Replaces the missing dopamine (the brake). - **Nausea** is common → take with food, but **carbs, not protein** (protein blocks absorption). - Long-term: **dyskinesia** (uncontrolled movements). - **"On-off"**: symptoms controlled (on), then back (off), several times a day. Meds: dopamine agonists Copy dopamine. Side effects are less common but **more serious** → often **not safe for older adults**. - **Impulse control problems**: gambling, hypersexuality (dopamine = pleasure). - Mood changes. Tolerance, toxicity & drug holiday | Tolerance | Toxicity | | --- | --- | | Med just isn't working as well | **Delirium** (sudden confusion) | **Delirium = sudden. Dementia = slow and long-term.** **Fix for both:** lower the dose or frequency, change meds, or a **drug holiday** (off the med 1 week up to 10 days, then restart). Deep brain stimulation (DBS) When meds aren't enough. Approved for **severe tremors**. - Electrodes go into the brain; wires run under the skin to a device in the **left chest** (like a pacemaker). - Sends pulses that **decrease involuntary movements** and block tremors. - **Not a cure.** Disease still progresses. - Same precautions as a pacemaker: avoid **electromagnetic fields and magnetic resonance imaging scans (MRIs)**. Nursing management (slides)Slides - **Injury prevention (falls)**: muscle strengthening, stretching, flexibility, balance and coordination. - Exercise, range of motion (ROM), walking; self-care; sleep problems. - Communication and speech help; emotional support; support groups. - **Nutrition:** **high protein, high calorie** (unless liver or kidney disease) · soft diet, thickened liquids · **weigh weekly** · swallow evaluation. Watch the trap: high-protein diet for weight, but keep protein away from the Sinemet dose. Captions mishear: `Echinacea` = bradykinesia · `pastoral` = postural · `cinnamon` = Sinemet · `bacteria` = nocturia Read in book Iggy Ch. 36, pp. 894–899 · crossed-out parts skipped (stages box, monoamine oxidase (MAO)-B/catechol-O-methyltransferase (COMT) drugs, imaging, other surgeries) Patho & early signs (book)Read in book **Primary (idiopathic)** is most common. **Secondary** parkinsonism: brain tumors, some **antipsychotics**. Substantia nigra degenerates → less dopamine. Protein **alpha-synuclein** is thought to drive it. Symptoms appear only after a big dopamine drop (book: 70–80%). **Non-motor signs can appear YEARS before TRAP:** constipation, soft voice, **micrographia** (tiny handwriting), **loss of smell**, sexual dysfunction, sleep problems. - **traumatic brain injury (TBI)** raises Parkinson's disease (PD) risk → teach contact-sport athletes to wear **helmets**. - Veterans: TBI, **Agent Orange** exposure. - **Lewy bodies** (abnormal proteins) → some get Lewy body dementia. - About **50% more men** than women. Assessment (book)Read in book - **Rigidity** = resistance to **passive** movement; present early. - Stage 4: needs a **walker** and help with activities of daily living (ADLs). Stage 5: trouble chewing and swallowing. - Late: dementia, psychosis (delusions, paranoia, hallucinations), depression, anxiety, apathy. - Autonomic: **excessive sweating**, orthostatic hypotension. - Speech: soft, slurred, monotone, halting, or rapid. - Bladder: incontinence **or** trouble urinating. Bowel: **constipation**. **No specific test.** Diagnosis is clinical, after ruling out other neuro diseases. **Priority problems:** 1) ↓mobility (self-care deficit) · 2) impaired cognition. **Priority of care: keep mobility and activities of daily living (ADL) independence as long as possible.** Box 36.7: best-practice careRead in book - Give patients **extra time** to answer and to do activities of daily living (ADLs); help only as needed. - Give meds **on time, on their individual schedule** (steady drug levels). - Fall Precautions; physical therapy (PT)/occupational therapy (OT). - Prevent immobility complications: constipation, pressure injuries, contractures. - Schedule activities **late morning** or at their best time of day. - Teach to speak slowly and clearly; communication board; refer to **speech-language pathologist (SLP)**. - Monitor swallowing and intake; **high-protein, high-calorie** foods. - Focus on strengths (self-esteem). Assess depression, anxiety, cognition, insomnia. Drug details (book)Read in book **Dopamine agonists** (apomorphine, pramipexole, ropinirole; **rotigotine patch**): best in the first **3–5 years**; fewer dyskinesias and less "wearing off." **Agonist Drug Alert:** orthostatic hypotension, hallucinations, **sleepiness** → no driving or heavy machinery · rise slowly · shouldn't be prescribed to older adults. **Carbidopa/levodopa:** nearly everyone takes it eventually. Cheaper and better for motor function than agonists. Comes as immediate-release (IR), controlled-release (CR), enteral infusion, and an **inhaled form for "off" periods**. **Safinamide** is an add-on. **Book says:** give levodopa **before meals** for better absorption. **Lecture says:** if it causes nausea, take with carbs, not protein. Both point the same way: **keep protein away from the dose**. **Toxicity** = delirium, hallucinations, less effect. Compare to the pre-drug baseline. **Tolerance** = effects wear off sooner. Drug holiday lasts up to 10 days; monitor and document Parkinson's disease (PD) symptoms during it. **Symptom helpers:** baclofen (spasms), **sublingual atropine** (drooling), zolpidem (insomnia). Medical cannabis: stay **nonjudgmental**. Freezing gait, sleep, eating & speechRead in book **Freezing gait tricks:** step **sideways, then forward** · shift weight side to side, then step · picture an object on the floor to **step over**. Yoga and tai chi help early. range of motion (ROM), stretching, out of bed. **Sleep:** poor nights + short naps they may not notice → risk of **falling asleep while driving**. - speech-language pathologist (SLP) swallowing evaluation. **Soft diet, thick cold fluids** (milkshakes), small frequent meals, thickener (Thick-It). - **Elevate the head** to prevent aspiration. Weigh **weekly**. - Speech: slow, deep breaths, exaggerate words; reduce background noise; listener watches lips. Cognition, home care & deep brain stimulation (DBS) (book)Read in book - About **50%** develop cognitive problems. Depression is common (venlafaxine may be used). - Don't force social events; emphasize strengths. - Teach to report **dizziness, falls, delirium, hallucinations**. - Constipation: fluids, high fiber, bowel program. Sleep hygiene: no alcohol or caffeine, dark room. - Impulse control problems: remind family the patient **can't control** them. Watch for caregiver strain. - Late disease → palliative or hospice care. - **DBS**: reduces the need for levodopa; usually **not offered while meds still work**. Book · Mastery Q2 An ambulatory client was recently diagnosed with **early** Parkinson's. What finding does the nurse expect? Resting tremor is an early sign. Dementia and swallowing problems come late. Book · NCLEX Challenge 36.3 · Select all Client prescribed **ropinirole**. Which teaching statements should the nurse include? Ropinirole is a dopamine agonist: orthostatic hypotension, sleepiness, possible dyskinesias. The patch is rotigotine, and the food rule is for monoamine oxidase inhibitors (MAOIs). Review class: Parkinson's meds + earliest sign Review class From the in-class exam review (Joline case study + NCLEX questions). - **Earliest (initial) sign: tremor.** All the classic signs are Parkinson's, but tremor usually comes first. - **Ropinirole = dopamine agonist** (mimics dopamine). **Caution in older adults:** orthostatic hypotension and drowsiness → falls. - **Carbidopa-levodopa** (Sinemet): levodopa is turned into dopamine. Causes **nausea** → take **with food, but NOT protein** (protein blocks absorption: no peanut butter, eggs). Quick recall · tap to flip NCLEX Which breakfast is best with the morning carbidopa-levodopa dose? Protein blocks levodopa. Carbs help nausea without blocking it. NCLEX Top safety concern for a client with Parkinson's? Low BP on standing + poor balance = high fall risk. NCLEX A family says their dad on a dopamine agonist is suddenly gambling a lot. The nurse knows: Dopamine drives pleasure and reward, so agonists can cause impulse control problems. The 60-second version ## Inherited disease: dementia + "dancing" movements - **Hereditary.** Symptoms start at **age 30–50**. - Brain cells die → **progressive dementia** + **chorea**. - Child of a parent with it: **50/50 chance**. - **No cure.** Control symptoms, prevent complications. "Chorea" is Greek for dance (like "choreography"). Picture fast, jerky dance moves the person can't stop. Chorea & treatment **Chorea** = rapid, jerky movements of the **arms, legs, and face**. The term is used only for Huntington's. - The movements have **no purpose**. - The patient **can't stop or control them**. Care is the same as for anyone with a movement or memory disorder (Parkinson's, Alzheimer's): - Assistive devices; physical therapy (PT), occupational therapy (OT), speech therapy. - **Keep familiar routines.** Break tasks into **small steps**. - **Avoid open-ended questions** (ask yes/no or simple choices). - To-do lists and calendars. Genetics & testing - Parent has it → each child has a **50% chance**. - Child **doesn't carry the gene** → won't get it and **can't pass it on**. - A test can show the gene. Hard question: is it better to know? - **Not done under age 18**: they may feel pressured and aren't mature enough for the results. - **Genetic counseling** is very important for the children (ethical dilemma). Quick recall · tap to flip NCLEX A 16-year-old whose father has Huntington's asks to be tested. Best response? No testing under 18. Risk is 50%, and it doesn't skip generations. NCLEX Which communication works best for a client with Huntington's? Avoid open-ended questions. Simple yes/no choices work better with cognitive decline. The 60-second version ## multiple sclerosis (MS): the immune system strips the wire coating - **Autoimmune.** Damages **myelin** in the brain and spinal cord → signals weak or blocked. - Comes in waves: **flare-ups** and **remissions**. - Top symptoms: **fatigue, mobility problems, vision changes**. - Avoid **heat, stress, fatigue**. No hot showers, no hard exercise. - amyotrophic lateral sclerosis (ALS): **movement only**. Mind and senses stay intact. Myelin is the plastic coating on a phone charger cord. Strip patches off and the signal flickers or cuts out. What multiple sclerosis (MS) is - Myelin **cushions and protects** nerves and helps signals travel between brain, cord, and body. - Demyelination → signals are **weaker**, or don't get through. - Progresses at **different speeds** in different people. **Why diagnosis takes so long** (frustrating for patient and family): - No single test confirms it. - Symptoms look like other neuro problems, which must be ruled out. - Symptoms go away for a while, so people don't seek care. Signs & symptoms - **Overwhelming fatigue.** - **Weak, stiff legs**: hard to move them, hesitant → **fall risk**. - **Vision** (optic nerve): **nystagmus**, **double vision**, blurry vision. - **Dysarthria**: slurred or **scanning speech** (long pauses between words; can sound like stuttering). - Spasticity, numbness/tingling, **intention tremor** (shakes when reaching), poor coordination, positive Babinski. - Trouble swallowing; bowel, bladder, and sexual problems; memory and focus problems. **Don't mix up tremors:** Parkinson's = shakes **at rest**. multiple sclerosis (MS) = shakes **when moving** (intention). Nursing care **Prevent flare-ups:** avoid **fatigue, stress, temperature extremes** (hot showers). **Keep them independent:** - Stay organized; keep often-used items **within reach** (saves energy). - Speech therapy for swallowing trouble. **Eye patch** for double vision. - **Strength and stretching** exercises (PT/occupational therapy (OT)) for balance and coordination. - **No rigorous exercise**: raises body temp → more fatigue, less movement. **Main goal = symptom control.** multiple sclerosis (MS) meds (only 2 to know) No cure. **Immunomodulators** slow the disease and make attacks fewer and milder. Your instructor said know only these: | Drug | Key points | | --- | --- | | **Interferon beta** | Shot under the skin (every other day or weekly). **Infection risk**, bone marrow suppression, **flu-like symptoms**. | | **Glatiramer** | Shot under the skin. **Fewer side effects.** | amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease) - **Motor neurons** die → weakness, muscle wasting, stiffness → **paralysis**. Cause unknown. - **Only movement is affected.** They can still see, hear, and feel, and **thinking stays intact**. - Starts in one area, then spreads. Lose the ability to talk, swallow, and breathe. - Signs: tired while talking, **tongue shrinking**, slurred speech, trouble swallowing, **face twitching** (fasciculations). - Death usually within **3 years**, from **respiratory failure**. - No cure. Meds treat pain, spasms, **extra secretions**, sleep problems. Communication aids. - May need a feeding tube and ventilator. Get **advance directives** early. **Hospice** supports the family. Read in book Iggy Ch. 37, pp. 913–920 · crossed-out parts left out (MS types except relapsing-remitting multiple sclerosis (RRMS), cerebrospinal fluid (CSF)/evoked potentials, other MS drugs) What happens in multiple sclerosis (MS)Read in book - Cause: **immune, genetic, and/or infectious** factors. - **Demyelination** slows or stops nerve signals → patchy **plaques** in white matter. - Early on, myelin repairs itself and symptoms fade. Over time, damage builds and **muscle atrophy** sets in. - Often hits the **optic nerves**, spinal tracts, brainstem, and the area around the ventricles. - A leading cause of neuro disability in **young and middle-age adults**. Types of multiple sclerosis (MS)Read in book | Type | Pattern | | --- | --- | | **relapsing-remitting multiple sclerosis (RRMS)** (relapsing-remitting) | **Most common.** Flares over weeks to months, then back to baseline. | RRMS is a roller coaster that returns to the station. Who gets itRead in book - **Women 2–3×** more than men (some studies say up to 4×). - Ages **20–50**. About 1 million people in the US. - More common in **colder climates** (Great Lakes, Pacific Northwest). - A **first-degree relative** with multiple sclerosis (MS) raises risk. multiple sclerosis (MS) vs. amyotrophic lateral sclerosis (ALS) (Table 37.1)Read in book | | MS | ALS | | --- | --- | --- | | Cause | Immune attack on myelin; remissions + flares | Unknown (genetic + environmental); progressive muscle wasting → **respiratory paralysis** | | Who | Common; women 2× men; ages 20–50 | Uncommon; **men** more; ages 40–60 | | Signs | Fatigue, spasticity, **diplopia**, scotomas, nystagmus, paresthesias, bladder problems, intention tremor | Fatigue, muscle atrophy (incl. tongue), twitching of face and tongue, dysarthria, dysphagia | | Outlook | Many disease-modifying drugs | **100% fatal**; no cure. Supportive + palliative care | Signs & symptoms (Box 37.1)Read in book **History:** early symptoms are **vague** and come and go, so diagnosis often takes years. Ask about vision, motor, and sensory changes. Ask what makes it worse: **fatigue, stress, temperature extremes, hot showers or baths**. **Common:** - Muscle **weakness and spasticity**; flexor spasms - **Fatigue**, worse with heat - **Paresthesia** (numbness, tingling) - Vision: **diplopia** (double vision), **nystagmus**, ↓acuity, **scotomas** (blind spots) - Bowel and bladder problems (flaccid or spastic); sexual dysfunction - Cognitive changes: memory, judgment, problem solving - Depression, emotional changes - **"MS hug"** (dysesthesia): squeezing feeling around the torso. Often an early sign. - Trouble walking, **dysmetria** (can't control movement range), vertigo, pain, itching **Less common:** **intention tremor** (shaking when reaching for something), hypalgesia, dysarthria, dysphagia, hearing loss, tinnitus, loss of taste, seizures. **Don't mix up the tremors:** Parkinson's = **resting** tremor (pill-rolling at rest). multiple sclerosis (MS) = **intention** tremor (during movement). PsychosocialRead in book - Long road to diagnosis → **anger and frustration**. Let them vent. - After diagnosis: anxiety. Later: apathy, emotional lability. - **Secondary depression** is the most common mental health problem in multiple sclerosis (MS). - Some are **euphoric** (from the disease or the drugs). - Cognition changes are usually **late**: memory, concentration, calculation, judgment. - Fatigue affects sexuality. Women: less sensation and orgasm. Men: erection and ejaculation problems. DiagnosisRead in book **No single test.** Results are put together. - **magnetic resonance imaging (MRI)** of brain and spinal cord showing plaques in **at least 2 areas** = diagnostic. Drug therapyRead in book Goal: slow the disease and reduce flares. Most drugs **suppress immunity** → infection risk. Teach: **avoid crowds and sick people**, wash hands. | Drug | Key nursing point | | --- | --- | | **Interferon beta**; **glatiramer** | Subcutaneous self-injections. **Rotate sites**. Flulike symptoms → acetaminophen/ibuprofen. Bone marrow suppression → report infection. | **Symptom drugs:** **baclofen** or tizanidine (spasticity; severe → intrathecal baclofen pump) · carbamazepine or tricyclic antidepressants (TCAs) (paresthesia) · propranolol, clonazepam (ataxia). Medical cannabis may ease pain and stiffness. Stem cell therapy is being studied. multiple sclerosis (MS) drugs are **very expensive** (health equity issue). Nursing care: mobility, vision, cognitionRead in book - physical therapy (PT)/occupational therapy (OT): **range of motion (ROM)**, stretching, strengthening. - **Avoid things that raise body temp** (worsen fatigue and vision). - Home safety: remove rugs and clutter; adapt for a wheelchair. Plan rest periods. - **Dysarthria / dysphagia** → speech-language pathologist (SLP); thickened liquids if needed; watch for aspiration. - **Diplopia:** **eye patch, switched eye to eye every few hours**. - Peripheral vision loss: teach **scanning** (turn the head side to side). - Cognition: single-date calendar, written lists, keep items in familiar places, phone reminders. Going homeRead in book **Teach to avoid triggers:** overexertion, stress, **temperature extremes** (fever, hot baths, saunas, hot tubs, overheating, getting chilled), humidity, people with infections. - Energy conservation: balance rest and activity. - Know every med: dose, time, route, side effects. - Personality changes: family can agree on a signal for inappropriate behavior. - Sexual dysfunction: phosphodiesterase (PDE)-5 inhibitors (sildenafil) for men; refer to counseling or urology. - Refer to the National multiple sclerosis (MS) Society. Book · NCLEX Challenge · Select all A client was recently diagnosed with MS. Which common findings does the nurse expect? Weakness, vision changes, spasticity, and fatigue are common early. Cognitive changes come later; hallucinations aren't typical. Book · Mastery Q2 · Select all A client will start **interferon beta-1a**. What should the nurse teach? Interferon = immune suppression, subcutaneous injections, flulike aches. The pulse and confusion options belong to other MS drugs that are crossed out of your reading. Quick recall · tap to flip NCLEX Which MS client statement needs more teaching? Heat worsens MS symptoms. NCLEX A client starting interferon beta asks what to watch for. Best answer? Interferon suppresses immunity and often causes flu-like symptoms. NCLEX The family of a client with late ALS asks if he still understands them. Best response? ALS spares thinking and senses. The 60-second version ## Spinal cord injury: protect the neck, watch the blood pressure (BP), find the trigger - Trauma = **safety first**, then **airway, breathing, circulation, disability, exposure (ABCDE)**, then head-to-toe. - Open the airway with a **jaw thrust** (protects the neck). - **Neurogenic shock** = low BP + **LOW heart rate**. - **Autonomic dysreflexia** = sudden **HIGH BP** → **sit up**, check the bladder. The spinal cord is the phone line between brain and body. Cut it, and messages can't get through either way. Below the cut, the body can panic, and the brain's "calm down" message never arrives. Basics - Top causes: **car crashes** and **falls**. About **80% are men**. - **Complete** = no messages below the injury. **Incomplete** = some movement or feeling left. - **Primary injury** = the trauma: bending forward too far (hyperflexion), back too far (hyperextension), crushed downward (axial loading), twisted, or stabbed/shot. - **Secondary injury** = makes it worse: bruising, **swelling** presses on the cord → low blood flow; bleeding; neurogenic shock. Trauma steps: safety, A & B 1. **Safety first**: scene and team. **personal protective equipment (PPE) on** (gloves, gown, eye protection, mask, cap, shoe covers). 2. **Primary survey (ABCDE)**: find and fix life threats. 3. **Secondary survey**: head-to-toe exam. **A = Airway.** Suction; check for face injuries blocking it. **Protect the neck:** **jaw thrust**, not head tilt. Keep the neck straight and in line. **"C3, 4, 5 keeps the diaphragm alive."** These nerves run the breathing muscle. A high neck injury can stop breathing. **Glasgow Coma Scale (GCS) under 8 → intubate.** **B = Breathing.** Breathing isn't enough; it must be **effective**. - Weak effort (gasping, respiratory rate (RR) about 6) → **bag-valve mask**. Oxygen alone won't help. - Breathing well on their own → **non-rebreather mask**. - Check **both sides of the chest rise equally** (collapsed lung?). C, D & E **C = Circulation.** - Outside bleeding: **direct pressure**, pack the wound, **tourniquet above** it. Log roll to check the back. - Inside bleeding shows as **shock**: low blood pressure (BP), fast heart rate (HR), weak pulse. Check the belly and **pelvis**. - **Two big intravenous lines (IVs) (16-gauge)** in the inner elbows. - **No BP cuff? Feel for pulses.** Systolic is at least: **radial 80 · femoral 70 · carotid 60**. **Exception:** **massive uncontrolled bleeding** → order becomes **C-A-B**. Stop the bleeding first. **D = Disability** (quick neuro): Glasgow Coma Scale (GCS), pupils, can they feel and move all 4 limbs? **E = Exposure.** Remove clothing to see everything. - Burns: clothing can melt into skin. - **Save evidence** (weapons, rape kits) for court. - Prevent **hypothermia**: blankets, warm room, warm intravenous (IV) fluids. Cover for dignity. **Secondary survey:** head-to-toe exam, splints, dressings, **nasogastric (NG) or orogastric (OG) tube** (empties stomach), **urinary catheter** (monitors kidneys). Neurogenic shock vs. spinal shock | | Neurogenic shock | Spinal shock | | --- | --- | --- | | What | Lost "fight or flight" tone → vessels go slack | Cord's reaction to injury and **swelling** (not a true shock) | | Signs | **Low blood pressure (BP)** (SBP \<90 or mean arterial pressure (MAP) \<65) + **LOW heart rate**, low temp, abnormal rhythms | Temporary loss of movement, feeling, reflexes, and automatic functions below the injury; **limp paralysis**; bowel stops (**paralytic ileus**) | | Care | **Emergency!** Fluids, vasopressors | Usually gone within **48 hrs** as swelling goes down | **The trick:** every other shock has a **fast** heart rate. Neurogenic shock has a **slow** one. Positioning, collars & halo - **Constant, detailed** movement and feeling checks catch problems early. - Keep the body **aligned**: log roll, turning sheet, slider board. - Thoracic or lumbar injury: may wear a **brace** out of bed. - Possible neck injury: **hard cervical collar** stays on until a **specific provider order** says remove. - Cord being squeezed → **surgery**: remove blood clot, bone pieces, or object; **spinal fusion**. **Halo device** (pins in skull, ring, vest), worn **8–12 weeks**: - **Never** tighten or loosen the screws. **Never** pull on it to move them. - **Wrench taped to the vest** for emergencies (CPR). - **Pin care**: watch for redness, drainage; clean them. Prevents skull bone infection. - Check skin under the vest. Itchy? **Nothing goes inside** (like a cast). - Drinks through a **straw**. Autonomic dysreflexia: emergency A huge, uncontrolled "fight or flight" surge. Usually after the acute phase (often first seen **3–6 months** after injury). **Cause:** something irritating below the injury. Most often a **full bladder** or **constipation**. Also pressure sores, pain, a wrinkled sheet. | Sign | Why | | --- | --- | | **Sudden severe high blood pressure (BP)** | Vessels below clamp down → risk of **stroke** | | **Slow heart rate** | Body tries to lower BP | | Severe **headache**, vision changes | High BP | | **Sweating + flushing ABOVE** injury | Vessels above open up | | **Cool, pale skin BELOW** injury | Vessels below stay tight | 1. **Sit them up** (High Fowler's) right away. 2. **Find and fix the cause.** Kinked Foley? Feel for a full bladder. No catheter → insert one. Check for constipation. 3. **Call the provider.** **Nifedipine** or a nitrate as ordered. 4. Check BP every **2–5 minutes**. Body systems after spinal cord injury (SCI) | System | Watch for / do | | --- | --- | | Lungs | Secretions build up → assisted coughing, incentive spirometer | | Heart | Low blood pressure (BP), low heart rate (HR), low temp, abnormal rhythms, **dizzy when sitting up**, autonomic dysreflexia, **blood clots** (compression devices, low molecular weight heparin) | | Gut | Belly bleeding, paralytic ileus, nutrition | | Bowel/bladder | Retention or incontinence; constipation (fluids, fiber, stool softeners); may learn self-cath | | Muscles/bones | Muscle wasting, spasticity → contractures; **osteoporosis** → fractures | | Skin | Turn **every 1–2 hrs** in bed. In a wheelchair, shift weight **more than every hour** (**wheelchair push-ups**, chair pad) | | Feelings | **Anger** (don't want to depend on others), depression. Check the home for safety and equipment. | Read in book Iggy Ch. 10 (trauma), pp. 208–210 Mechanism of injury (MOI)Read in book | Type | Examples | | --- | --- | | **Blunt** | Car crash, fall, assault (fists, kicks, bat), **blast effect** from a bomb | | **Acceleration-deceleration** (a blunt type) | High-speed crash, fall from a height → tearing, shearing, compression of tissues | | **Penetrating** | Knives, ice picks, gunshot wounds (GSW), shrapnel, falling onto a sharp object | A **GSW to the chest or abdomen** or a **stab wound to the neck** automatically calls the trauma team. Safety & primary survey (book)Read in book - **Scene safety** first, in the field and the emergency department (ED). Standard Precautions every time. - personal protective equipment (PPE): impervious gown, gloves, eye protection, facemask, surgical cap; shoe covers if heavy blood loss is expected. - Resuscitation happens **at the same time** as the survey. Fix airway, breathing, circulation, disability, exposure (ABCDE) problems before lower priorities like splints and dressings. **Airway Critical Rescue:** minutes without oxygen → anoxic brain injury. Clear the airway (suction or by hand), keep the neck **neutral and in line**, use a **jaw thrust**, give O₂. - Breathing on own → **non-rebreather**. Needs help → **bag-valve mask (BVM) with 100% O₂**. - **Glasgow Coma Scale (GCS) 3–8** → endotracheal tube + ventilator. - Breathing check: breath sounds, effort, chest expansion, chest trauma. **Circulation:** - Firm **direct pressure** with thick dry dressing first. Tourniquet if pressure fails. Wound packing, hemostatic dressings. - Suspect **internal bleeding** in any shock state. - **Hypotension is a late sign**: the body's compensation is already used up. - intravenous lines (IVs): two **16-gauge antecubital**; central line or **intraosseous** if veins can't be reached. - Fluids: **lactated Ringer's or 0.9% normal saline (NS)**; hypertonic saline for head trauma. **Warm** all fluids and blood. - Blood: packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, or whole blood. But the priority is always to **stop the bleeding**. **Disability:** **AVPU** = Alert, responds to Voice, responds to Pain, Unresponsive. **GCS** 3 (totally unresponsive) to 15 (normal). Low blood sugar, hypoxia, drugs, or alcohol can lower level of consciousness (LOC). Reassess often. **Exposure:** **cut clothing off with scissors** (fast access, avoid moving injured limbs, burned fabric stuck to skin). Preserve **evidence** (clothing, weapons, bullets, drugs) for rape, abuse, assault, homicide, overdose. Nurses may testify in court. **Hypothermia** = 96.8°F (36°C) or lower. Secondary survey & after (book)Read in book - Gastric tube (prevent vomiting and aspiration), urinary catheter (urine output), diagnostic tests, head-to-toe exam, splints, temporary dressings. - **Disposition:** straight to operating room (OR) or interventional radiology, admit, or **transfer to a trauma center**. - Then assess **psychosocial needs**: social services, rehab, pastoral care, mental health, substance use counseling. Include the family. Book · NCLEX Challenge 10.3 Which mechanism of injury does the nurse document for a client with one gunshot entry point and two stab wounds? Bullets and knives both pierce the body = penetrating trauma. Read in book Iggy Ch. 37, pp. 920–929 · crossed-out parts left out (neuro level/dermatomes, clonidine) Types & mechanisms of injuryRead in book **Complete** spinal cord injury (SCI) = no function below the injury. **Incomplete** = some function left (more common). | Mechanism | Example | | --- | --- | | **Hyperflexion** | Head snaps forward: head-on crash, diving | | **Hyperextension** | Head snaps back: rear-end crash, fall hitting the chin | | **Axial loading** | Vertical compression: diving, landing on buttocks or feet | | **Excessive rotation** | Head turned past normal range | | **Penetrating** | Knife (low speed) or gunshot (high speed) | **Secondary injury** (worsens the first): hemorrhage, ischemia, hypovolemia, low perfusion from neurogenic shock, swelling. **Top causes of death:** **pneumonia** and **septicemia**. **Leading cause:** trauma (more than 1/3 vehicle crashes); falls in older adults; violence; sports. **Prevention:** helmets and padding, seat belts, no impaired driving, water at least **9 feet deep** before diving. Assessment termsRead in book | Term | Meaning | Injury level | | --- | --- | --- | | **Tetraplegia** (quadriplegia) | Paralysis of all 4 limbs | Cervical / upper thoracic | | **Quadriparesis** | Weakness of all 4 limbs | | | **Paraplegia** | Paralysis of legs only | Lower thoracic / lumbosacral | | **Paraparesis** | Weakness of legs only | | - Reflexes: biceps **C5**, triceps **C7**, patella **L3**, ankle **S1**. Absent during spinal shock. Autonomic dysreflexia: book detailsRead in book **Box 37.2 key features:** - Sudden big rise in blood pressure (BP) **+ bradycardia** - Profuse **sweating above** the injury (face, neck, shoulders) - **Flushing above** the injury; goose bumps - **Blurred vision, spots** in the visual field - **Nasal congestion** - Severe **throbbing headache** - Feeling of apprehension **Triggers:** bladder distention, urinary tract infection (UTI), scrotal compression, constipation/impaction, hemorrhoids, pain, **tight clothing**, hard or sharp objects, temperature changes. **Box 37.3: what to do** 1. **Sit them up** (first priority). 2. Check the bladder: retention, catheter **kinks**. No catheter → check for distention and catheterize (anesthetic ointment on the tip). 3. Check for UTI or bladder stones. 4. Check for **fecal impaction** using anesthetic ointment. 5. Check skin for pressure injuries. 6. BP every **10–15 minutes**. 7. **Nifedipine** or a nitrate as ordered. Lecture said BP every 2–5 min; the book says 10–15 min. Go with your instructor on exams, but know both. Airway & breathing (book)Read in book **Airway is the priority** for cervical spinal cord injury (SCI). Injuries at or above **T6**: risk of respiratory distress and **pulmonary embolism (PE) in the first 5 days**. - Breath sounds every **2–4 hrs** the first few days. Act if **oxygen saturation (SpO₂) drops below 95%**. - Incentive spirometer; suction as needed. - **Cough assist** ("quad cough"): hands on the upper abdomen below the ribs; push **inward and upward** as the patient coughs. Neurogenic shock: book detailsRead in book Usually within **24 hrs**, in injuries **above T6**. **Critical Rescue (check at least hourly):** warm, flushed skin (temp dysregulation) · symptomatic bradycardia · ↓level of consciousness (LOC) · ↓urine output · systolic blood pressure (SBP) \<90 or mean arterial pressure (MAP) \<65 → Rapid Response. - intravenous (IV) and oral fluids. **Dextran** (plasma expander). - **Atropine** if heart rate (HR) drops below 50–60. - Severe hypotension: IV vasopressors (phenylephrine, dopamine). Collar, surgery & halo (book)Read in book - Hard collar (**Miami J, Philadelphia**) until an order says remove. Pad pressure points, especially the **back of the head**. - Keep alignment; **log roll**. - After spinal fusion: neuro checks + vital signs (VS) **every hour for 4–6 hrs**, then every 4 hrs. - Thoracic/lumbar fusion: Harrington rods, molded plastic brace. **Halo:** 4 pins into the skull, worn **6–12 weeks** (lecture said 8–12). **Halo Action Alert:** never move the patient by the halo · never adjust screws · **one finger** should fit between the jacket and skin · **wrench taped to the vest** · nothing sharp under the vest · pin care per policy. Report fever or pus from pins. Serious complications: **osteomyelitis of the skull**, subdural abscess. Meds for spinal cord injury (SCI)Read in book | Drug | Why | | --- | --- | | **Pantoprazole** (PPI) | Prevent **stress ulcers** | | Anticoagulant (LMWH) | Prevent venous thromboembolism (VTE) | | Bulk laxatives, stool softeners | Prevent constipation | | Celecoxib | Prevent heterotopic ossification (↑myocardial infarction (MI) and stroke risk) | | Calcium, bisphosphonates | Prevent osteoporosis | | **Intrathecal baclofen (ITB)** | Spasticity. Sedation, fatigue, headache, hypotension. **Never stop suddenly** → seizures, hallucinations. | Long-term complicationsRead in book - **Paralytic ileus** within **72 hrs**; check bowel sounds. Stress ulcers. - **Heterotopic ossification (HO)**: bony overgrowth into muscle. Not visible on x-ray for several weeks. - Pressure injuries, venous thromboembolism (VTE), osteoporosis → fractures, contractures (splints, range of motion (ROM)). - **Orthostatic hypotension**: change position slowly. - Transfers: paraplegic patients often transfer alone; tetraplegic may use a **sliding board**. | Lesion | Bowel/bladder | Care | | --- | --- | --- | | **Upper motor neuron** (cervical, high thoracic) | **Spastic**; reflex emptying still works | Bladder/bowel training; rectal suppositories | | **Lower motor neuron** (lower thoracic, lumbosacral) | **Flaccid**; no reflex | Intermittent catheterization; manual disimpaction | All: **1.5–2 L fluid a day** + stool softeners. Psychosocial, sexuality & rehabRead in book - Often **young men**; may feel guilt (diving, racing). Many veterans (blast injuries). - Be realistic but offer hope. - Men with injuries **above T6** may have reflex erections. A vasodilator before sex can prevent autonomic dysreflexia (AD). - Women can still become pregnant. - Rehab goal: **live independently**. Functional electrical stimulation (FES), exoskeletons. - Older adults with spinal cord injury (SCI): vaccines (respiratory infections are the top cause of death), osteoporosis prevention, skin care. Book · NCLEX Challenge A client with a recent **T1** spinal cord injury (SCI) is flushed and sweating on the face and neck and reports "seeing spots." Which action first? Autonomic dysreflexia. Sitting up lowers blood pressure (BP) immediately. Then find the cause. Book · NCLEX Challenge 37.3 A client with SCI is in a halo fixator with vest. Which action is **most important** for safety? The wrench lets staff remove the vest fast for cardiopulmonary resuscitation (CPR). That's life-saving; the others are routine care. Book · Mastery Q1 A client with a **C6** fracture just got a halo device. Which statement needs **immediate** follow-up? A **new** change in sensation moving upward = possible worsening cord injury. Numb feet were already there. Book · NGN Challenge 37.1 (C7 SCI, halo + vest) **Case:** 21-year-old, C7 SCI. At 1435: new throbbing frontal headache, blurred vision, very sleepy, face and neck flushed with sweating. T 99°F, **heart rate (HR) 58**, **BP 184/95**, oxygen saturation (SpO₂) 95%. Foley draining. At 1450: BP 192/98, headache 8/10. Review class: spinal shock, autonomic dysreflexia, trauma priority Review class From the in-class exam review (Joline case study + NCLEX questions). - **Spinal shock:** swelling right after the injury knocks out movement, feeling, and reflexes. It does **not** mean permanent paralysis. The injury **can't be classified until spinal shock resolves** (about **48 hours**). - **Spinal shock is over when** things come back: they can urinate, reflexes return, they feel an itch or pain, they can move. - **Autonomic dysreflexia:** blood pressure shoots up + pounding headache. Caused by any irritating stimulus. Even a **fan's cool breeze** can trigger it. Find and remove the cause. - **Trauma (Ch. 10 pages):** normally airway, breathing, circulation, disability, exposure (ABCDE), but **massive uncontrolled external bleeding comes first**. No airway will help if they bleed out. Exception to the rule. Quick recall · tap to flip NCLEX A client with a T4 injury suddenly has BP 210/110, HR 48, a pounding headache, and a flushed face. First action? Autonomic dysreflexia. Sitting up lowers BP right away. Then check the bladder. NCLEX Which vital signs suggest neurogenic shock? Low BP with a LOW heart rate. Low BP + fast HR points to bleeding (hypovolemic shock). NCLEX A trauma client is gasping with a respiratory rate of 6. Priority? Weak breathing needs breaths given. Oxygen alone won't help. NCLEX A client in a halo vest says the skin under it itches. Best response? Nothing inside the vest. Never touch the screws or pull on the frame. The 60-second version ## Back pain: mostly a squished disc pressing a nerve - **Neck** and **low back** get hurt most (most flexible parts). - #1 cause of **workplace injury**. Protect your own back! - Comfort: **Williams position**, heat or ice, nonsteroidal anti-inflammatory drugs (NSAIDs). - After back surgery: **cerebrospinal fluid (CSF) leak** = lower head of bed (HOB), call. Must **void** before going home. - After neck surgery: **airway first**. A disc is a jelly donut between two bones. Squeeze it wrong and the jelly (nucleus pulposus) leaks out and presses on the nerve next to it. Protect your own back - **Bend at the knees**, not the back. - **Raise the bed** when repositioning a patient or giving a 2–3 minute intravenous (IV) push. - Good posture, proper shoes, weight control, ergonomics. - Use **ceiling lifts** and get help. No equipment? **Advocate** for it. Disc problems & nerve pain - Disc's jelly center = **shock absorber**. - **Bulging** disc = pushes out. **Herniated** disc = **much worse**, the wall breaks open. - Pressure on a nerve → **burning or stabbing** pain, spasms, numbness, tingling. - Low back → pain down the **leg** (sciatic nerve). Neck → pain down the **arm**. - Big herniation can press on the **spinal cord** → leg/arm weakness, bladder or bowel problems. - **Spinal stenosis** = narrowed spinal canal (from a disc, arthritis, infection, trauma, swelling). Tests | Test | Shows | | --- | --- | | **magnetic resonance imaging (MRI)** | Cord, bones, discs, and **nerve root compression** | | **electromyography (EMG)** | Needle in the muscle checks its electrical activity → nerve damage | | **Nerve conduction study** | **How fast** nerves send signals | Comfort & meds - **Williams position**: semi-Fowler's with a **pillow under the knees**. A recliner works too. - **Firm mattress.** Change positions often. - **Moist heat or ice: 20–30 min, 4 times a day** (whichever works for them). - physical therapy (PT), weight control, massage, chiropractor, acupuncture, **transcutaneous electrical nerve stimulation (TENS) unit**. | Med | Know this | | --- | --- | | **nonsteroidal anti-inflammatory drugs (NSAIDs)** (first choice) | Block prostaglandins (inflammation). Side effect: **gastrointestinal (GI) upset**. Adverse: **bleeding**. | | **Muscle relaxants** (baclofen, cyclobenzaprine) | **Drowsiness, fatigue** | | **Gabapentin** | Anti-seizure drug used for nerve pain | | **Tramadol (Ultram)** | If an opioid is needed: least potent, low dependency | | **Epidural injection** | Steroid + numbing med | Surgery | Minimally invasive | Open | | --- | --- | | Scope removes the piece pressing the nerve. Less pain and blood loss. **Home same or next day**. Walk daily. | Bigger incision. Used when the **spinal cord is compressed**. | - **Discectomy** = remove disc. **Laminectomy** = remove part of a vertebra. - Spine unstable → **spinal fusion**, often with bone from the **hip** → 2 painful sites that can get infected. After open back surgery - Vitals + neuro checks **every hour for 4–6 hrs**, then every 4 hrs. - Watch for fever, low blood pressure (BP), fast heart rate (HR). **cerebrospinal fluid (CSF) leak:** clear drainage, a **"halo"** ring on the dressing, bulging at the incision, or a sudden headache → **lower the head of the bed** and **call the provider**. - Check for a **hematoma**. Check the hip donor site. - Patient **must void before discharge**. - Turn **as a unit** (log roll). **No twisting. No overhead trapeze.** Neck (cervical) surgery - **Front of the neck** (anterior) is most common. Back (posterior) = more pain. **Priority = airway.** Swelling can press on the windpipe. Check **swallowing** and **hoarseness**. Read in book Iggy Ch. 37, pp. 929–937 · crossed-out parts left out (muscle relaxant list, ziconotide, failed back surgery syndrome) Nonsurgical care (book pp. 932–933)Read in book - **Non-drug measures come first.** A short period of bed rest with **heat** may help; heat gives short-term relief. - Start stretching and **resume normal activity as soon as possible**. Aerobic exercise has good evidence. - **Change position often**: long standing, sitting, or lying increases pain. Shoe insoles or floor pads can help. - **Williams position** for acute low back pain from a bulging or herniated disc. - Reassure patients: many fear the pain won't go away. Most won't have another episode with good care. - Chronic pain: stress reduction, mindfulness, progressive muscle relaxation, yoga. **cognitive behavioral therapy (CBT) + physical therapy (PT)** helps pain lasting over 12 months. - **McKenzie exercises** (extension and flexion) move pain toward the center of the back. Start only **after acute pain eases**. Water therapy builds muscle without strain. - **Weight loss** if more than 10% over ideal weight. Meds & muscle relaxant alert (book)Read in book - **nonsteroidal anti-inflammatory drugs (NSAIDs)** (aspirin, ibuprofen, naproxen) help. - Antidepressants and gabapentin are often prescribed, but national guidelines **don't recommend them** for low back pain (antidepressants OK if the patient is also depressed). - Opioids: very limited role, used sparingly and short-term for acute pain. - Topical **capsaicin**: short-term relief. Lidocaine patches: no real benefit. - **Ziconotide**: strong analgesic for severe persistent pain. **Drug Alert:** centrally acting muscle relaxants cause **sedation, dizziness, lightheadedness** and anticholinergic effects (dry mouth, urinary retention, blurred vision, constipation, tachycardia). **Avoid in older adults** (falls). No driving, alcohol, or other central nervous system (CNS) depressants. **Metaxalone** can damage the liver. Surgery details (book)Read in book Done when conservative care fails or **neuro deficits keep getting worse**. minimally invasive surgery (MIS) isn't used if the disc presses on the spinal cord. **Pre-op teaching:** getting in and out of bed, turning, **report new numbness, tingling, or weakness** in the legs, home restrictions. | Minimally invasive | Open | | --- | --- | | **Microdiskectomy** (1-inch incision, endoscope) · **PED** (percutaneous endoscopic diskectomy, may add laser) · **Laser-assisted laparoscopic** (belly-button incision; bulging discs only; risks: infection, nerve root injury) · robot-assisted. Home same day or in 23–48 hrs. | **Diskectomy** (remove disc) · **laminectomy** (remove part of the lamina) · **spinal fusion** (bone graft, metal rods/screws) · interbody cage fusion (titanium mesh) · artificial disc. Pain control may use intrathecal or epidural patient-controlled analgesia (PCA). | **Open-surgery complications:** nerve injury, **diskitis** (disc inflammation), **dural tears**. - Book: vital signs (VS) **at least every 4 hrs for 24 hrs** (fever, hypotension, severe pain); neuro checks every 4 hrs (movement, strength, sensation in legs). - Check ability to **void after catheter removal**. Pain and lying flat make voiding hard, **especially for men**. Lecture said VS every hour for the first 4–6 hrs, then every 4 hrs. The book only says "at least every 4 hrs." Use your instructor's version for exams. Causes & risk factorsRead in book - Muscle strain or spasm, ligament sprain, disk degeneration, **herniated nucleus pulposus (HNP)**. - **Spinal stenosis**: narrowing of the spinal canal, usually over age 50. - Most common in ages 30–60; women a bit more than men. - Risks: heavy lifting, falls, crashes, repetitive bending and twisting, **obesity**, **smoking** (less blood flow to disks), scoliosis. - Older adults: osteoporosis, vertebral fractures, arthritis. Prevention (Box 37.5)Read in book - Safe lifting; ask for help with heavy chores. - Regular exercise: swimming, walking, back strengthening. - No high heels; good posture; footstool and ergonomic chairs. - Avoid prolonged sitting or standing. - Weight within **10% of ideal**. Enough calcium and vitamin D. - **Stop smoking.** **Nurses:** avoid lifting patients by hand. Use the lift equipment. AssessmentRead in book - Main complaint: **continuous pain**. Stiff, flexed posture; limp; can't bend. - **Sciatic pain:** sharp, burning down the back of the thigh or calf, maybe to the ankle or toes. Worse with **sneezing, coughing, straining**. - Raising the straight leg causes severe pain (nerve compression). - Check both legs for sensation (cotton ball, paper clip) and strength. - Ask about **bladder or bowel changes** (new incontinence or retention). - Ask about sadness and suicidal thoughts with persistent pain. - Tests: imaging only if severe; **electromyography (EMG)** and nerve conduction studies. Treatment & meds (slides)Slides **Diagnosis:** magnetic resonance imaging (MRI), electromyography (EMG), nerve conduction study. **Interventions:** positioning · moist heat or cold · physical therapy · weight control · complementary therapies · meds (NSAIDs, muscle relaxants, gabapentin, tramadol, epidural injection). | Class | Examples | | --- | --- | | **NSAIDs** (block prostaglandins → less inflammation and nerve sensitivity) | over-the-counter (OTC): aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve). Rx: **celecoxib** (Celebrex), **meloxicam** (Mobic) | | **Muscle relaxants** | Baclofen, **cyclobenzaprine** (Flexeril), tizanidine (Zanaflex), methocarbamol (Robaxin) | **Surgery:** minimally invasive (microscopic or endoscopic discectomy: shorter stay, less blood loss and pain) or open (**discectomy, laminectomy, spinal fusion**). **Post-op (slide):** vital signs (VS) **hourly for 4–6 hrs**, then every 4 hrs (fever, ↓blood pressure (BP), tachycardia) · neuro checks (movement, strength, sensation) · cerebrospinal fluid (CSF) leak signs → **head of bed (HOB) flat** and call the provider · ability to void · log roll · pain control. After lumbar surgery (Table 37.2)Read in book | Complication | Watch for / do | | --- | --- | | **cerebrospinal fluid (CSF) leak** | Clear fluid on dressing; "halo" ring. **Lay flat**, report to surgeon now. | | Fluid deficit | I&O, hypotension, tachycardia | | **Urinary retention** | Get them to the bathroom early; men may stand to void | | Paralytic ileus | Flatus or stool, distention, N/V | | Fat embolism | Chest pain, dyspnea, anxiety, confusion; **petechiae** on neck, chest, mouth | | Nerve root pain | Pain not relieved by meds | | Infection | Temp spike after **day 2** post-op | **Critical Rescue:** a sudden headache + clear drainage = possible CSF leak. Keep on bed rest, lower the head of the bed, report right away. Bulging at the incision = CSF leak or hematoma. - **Log roll every 2 hrs**. **No overhead trapeze** (strains the back). - Sit in a straight-back chair, feet flat. - venous thromboembolism (VTE) prevention: early mobility, compression devices, anticoagulant. **Home (first 4–6 weeks):** limit stairs and driving · lift nothing over **5 lb** · no bending or twisting · walk daily. Clear drainage from incision → call the surgeon. **Spinal cord stimulation** may help persistent pain: check neuro status below the device and make sure they can void. Cervical neck painRead in book - Usually a herniated disk at **C5–C6** or **C6–C7**. - Pain radiates to the shoulder and arm with numbness or tingling; may disrupt sleep. - Conservative care: exercises (shoulder shrugs, squeezes); soft collar at night, **no longer than \~10 days**. - Surgery: anterior cervical discectomy and fusion (ACDF) (fusion with bone graft) or newer anterior interbody cervical fusion (AICF)/lateral interbody cervical fusion (LICF) (titanium device; shorter recovery). Collar for 2–3 weeks after ACDF. **After ACDF, priority = airway.** Neck swelling can narrow the trachea; the surgery can affect swallowing. Check **swallowing** and breathing; keep suction ready; sit upright; report changes now. **Box 37.6 discharge:** someone stays with them the first few days · no lifting · no driving until cleared · walk daily · call if pain, numbness, or swallowing get worse. Book · Mastery Q3 · Select all A nurse teaches a community group about preventing back injury. Which recommendations are correct? Log rolling is post-op care, not prevention. Everything else is in Box 37.5. Review class: after disc surgery Review class From the in-class exam review (Joline case study + NCLEX questions). - **Distended bladder = urinary retention** → possible spinal nerve damage. Priority finding. - **Reposition every 2 hours** (not every 4). - **Nothing by mouth (NPO) is based on sedation / gag reflex return**, not on whether they've voided or have nausea. - An indwelling catheter, echo, or dietary assessment isn't needed unless the story gives a reason. Quick recall · tap to flip NCLEX Best position for a client with low back pain? Bent knees take pressure off the nerve and relax back muscles. NCLEX After lumbar fusion, a client wants to use the overhead trapeze. Best response? No twisting after back surgery. NCLEX After a laminectomy, the dressing has a clear ring around blood and the client has a sudden headache. First action? Halo sign + headache = possible CSF leak. The 60-second version ## Problems in the wires outside the brain and cord - **Myasthenia gravis**: muscles get weak with use. Keep meds with them always. - **Peripheral nerve injury**: protect the numb area. - **Trigeminal neuralgia (CN V)**: lightning-bolt face pain. - **Bell's palsy (CN VII)**: one side of the face droops. Protect the eye. **Cranial nerves:** your instructor said **don't memorize all 12**. Know V (trigeminal) and VII (facial), plus the swallowing nerves **IX (glossopharyngeal) and X (vagus)** from the stroke lecture. Myasthenia gravis: what it is Acetylcholine is a key. The muscle has locks. In myasthenia gravis (MG), the immune system jams the locks, so the key can't make the muscle move. - **Autoimmune.** Attacks **acetylcholine receptors** where nerve meets muscle. - **Extreme fatigue**; muscles weaken very easily. - First: **eyes** (droopy eyelid = ptosis, double vision). Then **face**: hard to smile, chew, swallow, shave, brush teeth. - Advanced: all muscles, including bowel, bladder, and **breathing**. Edrophonium test & pyridostigmine **Edrophonium (Tensilon) test:** gives more acetylcholine. myasthenia gravis (MG) → muscles improve **within 1 minute**, lasting 4–5 min. **Can cause serious bradycardia.** **Atropine** (the antidote) must be at the bedside. **Pyridostigmine:** keeps more acetylcholine around. Controls symptoms; **doesn't cure**. - Dose can change day to day (weaker days = higher dose). - **Eat 45–60 min after** the dose: muscles strongest → **no aspiration**. Myasthenic vs. cholinergic crisis | | Myasthenic crisis | Cholinergic crisis | | --- | --- | --- | | Cause | **Not enough** medicine | **Too much** medicine | | Edrophonium test | Muscles **improve** | No improvement; may get **weaker** | | Clue | Worsening weakness, **breathing trouble** (may need ventilator) | **Extra secretions**: drooling, sweating, lung secretions | | Treat | More medicine | **Atropine** | Memory trick: **cholinergic = "too much choline" = too much fluid pouring out** (spit, sweat, secretions). Other myasthenia gravis (MG) treatments - **Steroids** (calm the immune system). - **Plasmapheresis & intravenous immunoglobulin (IVIG)**: **short-term only**, for emergencies like breathing distress. Work fast; last weeks to a couple of months. - **Plasmapheresis** = filters out the plasma carrying the bad antibodies; returns the blood cells. Watch for: **low blood pressure (BP)** (fluid loss), **electrolyte imbalance**, **hypothermia**, **access-site infection**. - **IVIG** = donor antibodies that block the bad antibodies. - **Thymectomy** = remove the thymus. MG is linked to a thymus tumor, and the bad antibodies are made there. myasthenia gravis (MG) nursing care - **Breathing support** first. - Plan activities around **peak medicine times**. - Keep pyridostigmine **with them always**: nightstand, car, work. - **Rest is essential.** Repetitive movement can trigger a myasthenic crisis. - Help with communication and nutrition (weak face muscles). - **Eye protection** at night (eyes may not close); **artificial tears** during the day. Peripheral nerve injury From a cut, burn, crush, stretch, and more. The nerve past the injury dies back → weakness, limp paralysis, burning, numbness. - Both nerve ends try to grow back together. **Lined up** → normal function. **Not lined up** → weakness, spasms, less feeling. - **Infection** or **older age** slows healing. - Some function can return early through **backup (collateral) nerves**. - Treatment: **splint or cast** to rest it; surgery to realign the ends. **Teach:** they can't feel the area well → **protect it**. Cover it in cold and heat. Keep skin moisturized. Trigeminal neuralgia (CN V) Irritated **cranial nerve 5** (one on each side of the face) → **one-sided**, excruciating, sharp, shooting bursts of pain. - Triggers: touch, chewing, **brushing teeth**, even **smiling**. Patients start avoiding these things. **Priority = pain management.** 1. **Antiepileptics**: carbamazepine (Tegretol), gabapentin, pregabalin. 2. **Nerve block.** 3. **Surgery** (see below). - **Rhizotomy**: heated needle destroys nerve fibers → that side is **permanently numb**. Teach to **look for injuries** (poked eye, cavity) they can't feel. - **Microvascular decompression**: moves an artery pressing on the nerve. More serious: needs a **craniotomy**. Bell's palsy (CN VII) Sudden paralysis of the **facial nerve (CN 7)**, triggered by the **herpes simplex virus** waking up (infection, cold exposure). - **One side** of the face: can't close the eye, smile, or wrinkle the forehead. Taste is affected. - Can hurt **body image**. - **Antivirals**: acyclovir, valacyclovir. - **Protect the eye** (can't blink or close it). - Nutrition, massage, warm moist heat, facial exercises, emotional support. - Most recover fully in **weeks to months**; a few keep some weakness. Review class: myasthenia gravis + trigeminal neuralgia Review class From the in-class exam review (Joline case study + NCLEX questions). **Pyridostigmine**: **cholinesterase inhibitor** for **myasthenia gravis**. Keeps more acetylcholine around so nerve signals reach the muscles. - **Never miss a dose.** - **Take it so it peaks before activities that need energy**, like **eating**. Eating at a low level → weak swallow → **aspiration**. - **Dose changes daily** based on symptoms and energy (like sliding-scale insulin). Exception to the rule! | Myasthenic crisis | Cholinergic crisis | | --- | --- | | **Not enough** pyridostigmine → weakness, poor oxygenation | **Too much** pyridostigmine ("cholin-" is in the name) | - **Plasmapheresis** (myasthenia gravis treatment) risks: fluid and electrolyte loss, blood pressure changes, site infection. - **Trigeminal neuralgia:** brushing teeth or shaving triggers intense pain, so patients may stop doing them. Address hygiene. Quick recall · tap to flip NCLEX A client with myasthenia gravis (MG) has severe weakness, drooling, sweating, and heavy lung secretions after extra pyridostigmine. The nurse suspects: Too much medicine → too much acetylcholine → secretions. Atropine reverses it. NCLEX Most important teaching for an MG client going home on pyridostigmine? Weakness can hit anytime. Eat 45–60 min after the dose, and rest often. NCLEX Priority teaching for a client with Bell's palsy? The eye can't close, so it can dry out and get hurt. NCLEX A client with a nerve injury to the hand is going outside in winter. Best teaching? Decreased sensation means they can't sense cold or heat injury. Cover it and keep skin hydrated. The 60-second version ## Every med from your lectures & slides, in one place - Only meds your instructor mentioned (no book-only drugs). - **★** = your instructor stressed it most. - Learn the **one big safety point** for each, not every detail. Think of each drug as having one "headline." Sinemet: no protein. Phenytoin: gums. Pyridostigmine: eat 45–60 min later. Mannitol: hourly urine. Migraine | Drug | Know this | | --- | --- | | Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, naproxen), over-the-counter (OTC) + **caffeine** (Excedrin) | First try. Caffeine narrows vessels. Take at first sign/aura. | | **★ Triptans**: sumatriptan (Imitrex), rizatriptan (Maxalt) | Activate serotonin → narrow vessels. **NO** with heart disease, hypertension (HTN), **peripheral vascular disease (PVD)**. Report **chest pain**. No selective serotonin reuptake inhibitors (SSRIs) or St. John's wort (serotonin syndrome). | | Lasmiditan | Doesn't narrow body vessels. Causes sedation, dizziness. | | Prevention: NSAIDs, **beta blockers**, **topiramate** | For frequent or severe migraines | **Rebound headache** = taking meds too often or too much. Seizures | Drug | Know this | | --- | --- | | **★ Phenytoin (Dilantin)** | **Gingival hyperplasia** → soft toothbrush, dentist | | Carbamazepine (Tegretol), valproic acid (Depakote), topiramate (Topamax) | Same class rules below | **All anti-seizure meds:** drowsiness · depression/**suicidal thoughts** · liver damage · low white blood cells (WBCs) · **blood levels** (narrow range) · **never stop suddenly** (status epilepticus) · pregnancy category D · birth control less effective (use 2nd method) · watch **warfarin** · no **grapefruit**. **Status epilepticus:** 1. **★ Lorazepam (Ativan)** or diazepam (Valium) intravenous (IV) → **stops** the seizure 2. **Fosphenytoin** (preferred, safer) or phenytoin → **prevents** the next one Meningitis - **Broad-spectrum antibiotic** right away (after blood cultures) if ↑intracranial pressure (ICP) signs. Switch to **narrow-spectrum** once the germ is known. - **Vaccines**: meningococcal (age 11–12, booster 16), flu, pneumonia. Parkinson's | Drug | Know this | | --- | --- | | **★ Carbidopa-levodopa (Sinemet)** | Replaces dopamine. Nausea → take with **carbs, NOT protein**. Long-term: dyskinesia, "on-off." | | Dopamine agonists | **Impulse control** problems (gambling). Not for older adults. | **Tolerance** (stops working) or **toxicity** (delirium) → lower dose, change meds, or **drug holiday** (1 week–10 days). multiple sclerosis (MS) (only 2 to know) | Drug | Know this | | --- | --- | | **★ Interferon beta** | Shot under the skin. **Infection risk**, bone marrow suppression, **flu-like symptoms** | | **★ Glatiramer** | Shot under the skin. Fewer side effects | Both slow the disease and make attacks fewer and milder. **No cure.** Spinal cord injury - **Nifedipine** or a nitrate → autonomic dysreflexia (after sitting up and fixing the cause). - **Fluids, vasopressors** → neurogenic shock. - **Low molecular weight heparin** → prevent blood clots. - **Stool softeners** → constipation. Back & neck pain | Drug | Know this | | --- | --- | | **nonsteroidal anti-inflammatory drugs (NSAIDs)** (first choice): aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic) | Block prostaglandins. Side effect: **gastrointestinal (GI) upset**. Adverse: **bleeding** | | **Muscle relaxants**: baclofen, cyclobenzaprine (Flexeril), tizanidine (Zanaflex), methocarbamol (Robaxin) | **Drowsiness**, fatigue (act on central nervous system (CNS)) | | Gabapentin | Anti-seizure drug for **nerve pain** | | **★ Tramadol (Ultram)** | If an opioid is needed: least potent, low dependency | | Epidural injection | Steroid + numbing med | Myasthenia gravis | Drug | Know this | | --- | --- | | **★ Pyridostigmine** | Keeps more acetylcholine (ACh) around. **Eat 45–60 min after** (no aspiration). **Carry it always.** Dose changes daily. | | Edrophonium (Tensilon) | **Test** drug. myasthenia gravis (MG) improves within 1 min. Can cause **bradycardia**. | | **★ Atropine** | Antidote for edrophonium; treats **cholinergic crisis**. Keep at bedside. | | Corticosteroids, intravenous immunoglobulin (IVIG) | Calm the immune system; IVIG is short-term for crises | **Too little med** = myasthenic crisis. **Too much** = cholinergic crisis (secretions). Trigeminal neuralgia & Bell's palsy - **Trigeminal**: carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica); nerve block. - **Bell's palsy**: antivirals **acyclovir**, **valacyclovir** (HSV-1). Stroke & transient ischemic attack (TIA) | Drug | Know this | | --- | --- | | **★ tissue plasminogen activator (tPA) (alteplase)** | Ischemic only. Within **3 (up to 4.5) hrs** of symptom onset. **computed tomography (CT) first.** Bleeding risk. Repeat CT after. | | **Antiplatelets**: aspirin, clopidogrel | Prevent clots. Both together = dual antiplatelet therapy | | **Anticoagulants**: heparin, warfarin, direct oral anticoagulants (DOACs) | For **A-fib** | | Aspirin 325 mg | 24–48 hrs after stroke. **Not within 24 hrs of tPA** | | Statin | Must be discharged on one (core measure) | | Enoxaparin / heparin | Prevent blood clots | | Anti-seizure meds | Hemorrhagic stroke (seizure ↑intracranial pressure (ICP)) | Head injury & intracranial pressure (ICP) | Drug | Know this | | --- | --- | | **★ Mannitol** | Pulls water out of the brain. Osmolality goal **310–320**. **Hourly urine** (Foley). Watch dehydration, electrolytes, kidney injury. | | Furosemide | Given with mannitol; removes fluid from the body | | Hypertonic saline (3% or 5%) | Works like mannitol. intensive care unit (ICU) only | | Acetaminophen | Concussion pain. **No nonsteroidal anti-inflammatory drugs (NSAIDs)** (bleeding) | Dialysis (kidney lecture) - **Hold** antihypertensives and antidysrhythmics until after (low blood pressure (BP)). - **Give after**: antibiotics, anticonvulsants, vitamins (dialyzed out). - **Heparin** during dialysis lasts **4–6 hrs**. Antidote: **protamine sulfate**. Review class: med "exceptions" she stressed Review class From the in-class exam review (Joline case study + NCLEX questions). - **Mannitol:** filter needle; dose by serum osmolality (goal 310–320); intake and output (I&O); sodium, potassium. - **Propranolol** prevents migraine; **triptans** abort it (avoid with hypertension, peripheral vascular disease, angina, selective serotonin reuptake inhibitors (SSRIs)). - **Diazepam/lorazepam** stop status epilepticus; **phenytoin/fosphenytoin** only prevent future seizures. - **Ropinirole**: careful in older adults (orthostatic hypotension). **Carbidopa-levodopa**: with food, not protein. - **Pyridostigmine**: don't miss doses, take before eating, dose changes daily. Quick recall · tap to flip NCLEX Which med should the nurse hold before a client's dialysis? Antihypertensives wait until after dialysis (low blood pressure (BP) risk). NCLEX A client on phenytoin says, "I feel fine, so I stopped my pills." Priority concern? Stopping anti-seizure meds suddenly can trigger status epilepticus. NCLEX Which client should NOT get sumatriptan? Triptans narrow vessels everywhere. NCLEX A client on a dopamine agonist starts gambling heavily. The nurse: Impulse control problems are a known adverse effect. The 60-second version ## Dialysis = an artificial kidney - Started based on **symptoms**, not lab numbers. - **Fistula/graft arm:** feel the **thrill**, hear the **bruit**. No blood pressure (BP), intravenous lines (IVs), or sticks in that arm. - **Hold** antihypertensives and dialyzable meds until **after** dialysis. - After: watch for **low BP** and **bleeding** (heparin lasts 4–6 hrs). - Peritoneal dialysis: biggest risk = **peritonitis**. The dialyzer is a coffee filter. Blood flows on one side, a clean solution (dialysate) on the other. Waste and extra fluid pass through the filter and get thrown away. **Note:** this is renal (kidney) content from a different lecture. It's here because you asked to add it. What dialysis is - **Kidney replacement therapy** = umbrella term for **dialysis or transplant**. Those are the only 2 options. - Used when kidneys fail (acute or chronic) to remove extra **fluid and waste**. - Blood passes through an artificial **semipermeable membrane** in the **dialyzer** (artificial kidney). - **Dialysate** = solution that looks like plasma. Fixes electrolytes and acid-base balance. Pause activity: added vs. removed during dialysis. The answer slide wasn't in your transcript; standard answer: **removed** = urea (BUN), creatinine, potassium, uric acid, extra fluid; **added** = bicarbonate (fixes acidosis). Check against your slide. When to start dialysis - Based on **signs and symptoms**, NOT labs (BUN, creatinine, glomerular filtration rate (GFR)). - chronic kidney disease (CKD): started when **uremic** symptoms appear. **Emergency dialysis:** - **Pulmonary edema** - Severe electrolyte or acid-base imbalance, e.g., **hyperkalemia with electrocardiogram (EKG) changes** - **Pericarditis** Pause question: why does pericarditis need emergency dialysis? Standard answer: it's caused by **uremic toxins** irritating the heart sac. Fluid can build up around the heart → **cardiac tamponade**. Dialysis removes the toxins. Check against your slide. Intermittent vs. continuous | | Intermittent hemodialysis | Continuous (CRRT) | | --- | --- | --- | | Schedule | **3×/week, 4 hrs** each | Over **24 hrs** | | Flow | \~300–500 mL/min → **big fluid shifts**, blood pressure (BP) changes | Only 10–80 mL/min (gentler) | | Who | Stable patients | **Unstable** (heart problems) · **intensive care unit (ICU) only** | | Also called | — | Hemofiltration, ultrafiltration | Access: dialysis catheter Regular veins can't handle the high flow, so special access is needed. - **Short-term** (a few sessions or weeks). - Tip in the **superior vena cava** (just above the right atrium); 2 ports: one out to the machine, one back. - Watch for **infection and bleeding** at the site. - **Sterile** dressing changes by the **dialysis nurse only**, not floor nurses. **Dialysis only.** Nothing else goes through it: no intravenous (IV) fluids, no meds. Access: arteriovenous (AV) fistula or graft - **Long-term** dialysis. - **Fistula** = artery and vein sewn together in the arm. **Graft** = synthetic tube connects them. - Needs time to **mature** (fistula \~**12 weeks**). Meanwhile, a catheter is used, so a patient may have **both**. **"Feel the thrill, hear the bruit."** **Thrill** = palpate (buzzing). **Bruit** = auscultate (whooshing, like a loud murmur). Check and document **every 4 hrs**. Also check circulation below the site to the fingertips. **Protect the arm (keep it from clotting):** - **No intravenous lines (IVs), no blood pressure (BP), no compression** on that arm. - No carrying heavy things with it. - Don't sleep on it. Caring for patients after hemodialysis **Meds:** - Most meds are **dialyzable** (removed by dialysis). Give **antibiotics, anticonvulsants, vitamins AFTER**. - **Hold antihypertensives and antidysrhythmics** until after (dialysis already drops blood pressure (BP)). - **Heparin** is used during dialysis and stays active **4–6 hrs** → **no invasive procedures**, watch for bleeding. Antidote = **protamine sulfate**. **Vital signs** for several hours: - **Hypotension** is the big risk. - Slightly **warm** temp is normal (dialysate is warmed: prevents hypothermia, vasodilation speeds toxin removal). **Ongoing fever** → infection or **sepsis**. **Weights** before and after. After = **dry weight**. **1 kg = 1 L** of fluid. Peritoneal dialysis (PD) The **peritoneum** (belly lining) is the filter. Done at home; more freedom (even on vacation). **Won't work** with belly scarring or adhesions from past surgery. 1. **Infuse**: 1–2 L dialysate flows in by gravity. 2. **Dwell**: stays 4–8 hrs. Patient disconnects and walks around. Extra weight can cause **back pain**. 3. **Drain**: fluid flows out by gravity into a bag. Outflow = **effluent**. Types: continuous ambulatory (CAPD), small machines, or overnight while sleeping. Depends on needs and insurance. peritoneal dialysis (PD) complications | Problem | Fix | | --- | --- | | **Peritonitis** (#1) | From contamination at the connection. **Sterile technique**: hand hygiene, sterile gloves, clean and assess site, **mask** when connecting/disconnecting. | | Pain with infusion | Common the first 1–2 weeks. **Warm** the dialysate (warmer or heating pad). **Never the microwave.** | | Poor flow | Kinks or clots. Top causes: **position** (turn to other side, supine or low Fowler's, align body) and **constipation** (high fiber, stool softeners). | | Leakage | Clear fluid around catheter, from too much volume at first. Builds up to a full \~**2 L** over a couple weeks. | Non-compliance (Carlos) - Dialysis for life, 3–4 hrs, 3 days a week. Many feel **denial**: "I feel better, I'll skip today." - Find the **reason** first: money, work, **no ride** to the clinic. - Don't just tell them what to do. Ask what they're **thinking and feeling**. Class prep: how will you bring up non-compliance with Carlos? Try an open question, like "Tell me what makes getting to dialysis hard." Quick recall · tap to flip NCLEX A client returns from hemodialysis. Which order should the nurse question? Never use the access arm for IVs, BP, or compression. NCLEX A client is scheduled for dialysis at 0900. Which 0800 med should the nurse hold? Dialysis already lowers BP. Antihypertensives wait until after. NCLEX A client on peritoneal dialysis has cloudy effluent and belly pain. The nurse suspects: Peritonitis is the major PD complication, from contamination at the connection. NCLEX A client weighed 82 kg before dialysis and 79.5 kg after. How much fluid was removed? 82 − 79.5 = 2.5 kg = 2.5 L.

History 1020 - TRISLER - EXAM 2

Thriller Album Tracklist

Annual Plants: Centerpieces (Thrillers and Fillers)

[Music] [Music] this is the story of the greatest scientific discovery ever the discovery that everything is made of atoms the vast variety and richness of everything we see around us in the world and beyond how it's built up how it all fits together is all down to atoms and the mysterious laws they obey as scientists delve deep into the atom it's the very part of matter they unraveled nature's most shocking secrets they had to abandon everything they believed in and create a whole new science a science that today underpins the whole of physics chemistry biology and maybe even life itself but for me the story of how humanity solved the mystery of the atom is both inspiring and remarkable it's a story of great geniuses of men and women driven by their thirst for knowledge and glory it's a story of false starts and conflicts of ambition and revelation a story that leads us through some of the most exciting and exhilarating ideas ever conceived of by the human race and for a working physicist like me it's the most important story there is [Music] [Music] on the 5th of October 1906 in a hotel room near Trieste a German science is called Ludwig Boltzmann hanged himself Boltzmann had a long history of psychological problems and one of the key factors in his depression was that he'd been vilified even ostracized for believing something that today we take for granted he believed that matter cannot be infinitely divisible into ever smaller pieces instead he argued that ultimately everything is made of basic building blocks atoms it seems incredible now that Boltzmann's revelation was so controversial but a hundred years ago arguing atoms were real was considered by most to be a waste of time although philosophers since the Greeks had speculated that the world might be made out of some kind of basic unit of matter they realized that they were far too small to see even under the most powerful microscopes speculating about them was therefore a complete waste of time but then in the middle of the 19th century whether or not the atom was real was suddenly a question of burning importance the reason was this steam by the 1850s it was changing the world it powered the mighty engines the trains the ships the factories of the Industrial Revolution so figuring out how to use it more effectively became a matter of crucial commercial political and military significance not surprisingly then it became the key question of 1965 [Music] the demand to build more powerful and efficient steam engines in turn created an urgent need to understand and predict the behavior of water and steam at high temperatures and pressures not the alts Minh and his scientific allies showed that if you imagine steam is made of millions of tiny rigid spheres atoms then you can create some powerful mathematical equations and those equations are capable of predicting the behavior esteemed with incredible accuracy but these same equations plunge Boltzmann and his fellow atomists into controversy their enemies argued that since the atoms referred to in their calculations were invisible they were merely a mathematical convenience rather than real physical objects to claim that imaginary entities were real seem presumptuous even blasphemous you see boss most critics argued that it was sacrilegious to reduce God's miraculous creation down to a series of collisions between tiny inanimate spheres Boltzmann was condemned as an irreligious materialist the tragic irony of Boltzmann's story is that when he took his own life in 1906 he was unaware that he'd been vindicated you see a year before he died a young scientist had published a paper which undeniably irrefutable proclaimed the reality of the atom you might have heard of this young scientist his name was Albert Einstein in 1905 the year before Boltzmann suicide Albert Einstein was 26 years old his brash arrogance had upset most of his professors and teachers and he was barely employable then he got his girlfriend pregnant that was followed by a hasty marriage he needed a job any job having not quite distinguished himself a university he took up a job as a patent clerk here in bern in switzerland he'd moved into the small one-bedroom Apartments on cram gasser with his young wife from a laborer despite dire personal straits the young Einstein had a burning ambition he was desperate to make his mark as a physicist and in 1905 during one miraculous year the mark he made was truly incredible having an undemanding job meant that young einstein had plenty of time on his hands both at work and here in his tiny apartment to think deep thoughts in the space of just a few months he was to publish several papers that would change science forever now everyone's heard of his theory of relativity even if they don't understand it and his paper on the nature of light was to win him the Nobel Prize a few years later but ironically it wasn't either of these two papers that had the most impact on the discovery of atoms the one that made all the difference was a short paper on how tiny grains of pollen danced in water almost 80 years earlier in 1827 a Scottish botanist called Robert Brown sprinkled pollen grains in some water and examined it through a microscope what he found was really strange because instead of the pollen grains floating gently in the water they danced around furiously almost as though they were alive now while this so called Brownian motion was strange scientists soon forgot about it they found it mundane even boring I mean who cared if the pollen giggled about in the water and what had the jiggling to do with atoms anyway for nearly 80 years brown's discovery remained a little-known scientific anomaly then Einstein changed everything in one staggering insight I Stein saw that Brownian motion was all about atoms in fact he realized that the jiggling of pollen grains in water could settle the raging debate about the reality of atoms forever his argument was simple the pollen will only jiggle if they were being jostled by something else so I said that the water must be made of tiny atoms like particles which themselves are jiggling and are continually buffeting the pollen if there were no atoms then the pollen would stay still so Boltzmann and his contemporaries had been rowing furiously about this question for nothing the answer was there all along Einstein proved that for Brownian motion to happen atoms must exist Einstein später went way beyond just verbal arguments with flawless mathematics he proved that the dance of the pollen revealed the size of the atom and it's mind-numbing ly tiny 1/10 of a millionth of a millimeter across a single human hair itself one of the narrowest things visible to the naked eye is over a million atoms wide let me put it another way there are more atoms in a single glass of water than there are glasses of water in all the oceans of the world sort of hurts your head just to think about it Einstein's paper ended the debate about whether the atom was real or not and Boltzmann had been totally vindicated the atom had to be real [Music] [Music] by the early years of the 20th century the atom had arrived scientists we'd argued that the atom was real were no longer heretics in a dramatic sudden reversal they became the new orthodoxy but they were to pay a huge price for their success before that even had a chance to congratulate each other on discovering the atom it ripped the rug out from under their feet and sent them spiraling into a bizarre and at times terrifying new world and it all kicked off here in what by 1910 was the world center for atomic physics Manchester two of the most extraordinary men in the history of science worked here in the physics departments of Manchester University between 1911 and 1916 they were Ernest Rutherford and Niels Bohr on the face of it two very different personalities and the unlikeliest of collaborators Rutherford was from a remote part of New Zealand and grew up on a farm Bohr was born in Copenhagen wealthy and erudite virtually an aristocrat Rutherford was the ultimate experimentalist he loved technology and ingenious arrangements of batteries coils magnets and radioactive rocks but he was also blessed with a profound intuition in contrast war was the ultimate theoretician to him science was about deep thought and abstract mathematics pen and paper chalk and blackboard were his tools logic was his path to truth although their approaches to their work couldn't have been any more different they had one thing in common they were prepared to ditch three centuries of scientific convention if it didn't fit what they believed to be true they were genuine revolutionaries Rutherford and Bohr were two of the most extraordinary minds ever produced by the human race but it would take every bit of their dogged tenacity and inspirational brilliance to take on the atom in 1907 ernest rutherford took over the physics departments in manchester this was a period of momentous scientific change just over ten years earlier in germany came the first demonstration of weird rays that see through flesh to reveal our bones these rays were so inexplicable scientists didn't know what to call them so they were named x-rays and a couple of years after that in Cambridge it was shown that powerful electric currents could produce strange streams of tiny glowing charged particles that were called electrons and in 1896 in Paris came the most significant discovery of all one that more than any other would unlock the secrets of the atom the metal uranium was shown to emit a strange and powerful energy that was named radioactivity it seemed straight out of science fiction radioactive metals were warm to touch they could even burn the skin and the rays could pass through solid matter as if it wasn't there it truly was a marvel of the modern age Rutherford was obsessed with radioactivity all sorts of questions plagued him how has it made why did it come in different forms how far could it travel through a vacuum or through air did it alter the materials that are encountered in Manchester together with his assistants hands Geiger of Geiger counter fame and Ernest Marsden he devised a series of experiments that would probe the Enigma of radioactivity 1909 Manchester University these are the props goldleaf Beaton said it's just a few atoms thick a movable phosphorescent screen that flashed when struck by radioactive rays and inside this box is the star attraction a tiny piece of the metal radium radium is an extraordinarily powerful source of a kind of radioactivity the Rutherford had named alpha rays they weren't really rays they were more like a steady stream of particles and radium spat up these particles like a machine gun that never ran out of bullets Rutherford set his students a simple enough task use the radium gun shoot the alpha radioactivity at the gold leaf and with the phosphorescent plate count the number of particles that come out the other side in practice that meant sitting alone in the dark and counting tiny almost invisible flashes on the phosphorescent screen it was deeply tedious but Rutherford insisted that they keep at it weeks passed and the team of researchers found nothing unusual the alpha particles seemed to punch through the gold almost as though it wasn't there very occasionally they would swerve slightly as they went through hardly front-page news now comes what must be the most consequential off-the-cuff remark in the history of science one that changed the world the story goes that Rutherford bumps into his assistant Geiger in the corridor outside the lab Geiger reported that so far they've seen nothing unusual now in response Rutherford could have easily just nodded and walked on but he didn't he later claimed that he said what he said at the time for the sheer hell of it but I don't believe him Rutherford had great scientific intuition and I think he had a hunch that something was about to happen here's what he said to Geiger tell young Marsden to go back and see if he can detect any alpha particles on the same side of the gold leaf as the radium source in other words see if any alpha particles are bouncing back now it's an extraordinary suggestion from Rutherford and one day he had no logical reason to make after all Geiger Marsden had spent weeks seeing alpha particles do nothing but streams straight through the gold leaf almost as though it wasn't there why would any bounce back the Geiger Marsden were young and in all the big New Zealand er they did their master's bidding and went back into their dark lab and watched patiently for days they saw absolutely nothing they strained their eyes to the points of myopia but didn't see a single alpha particle bouncing back off the gold it seemed that rather for suggestion really was a stupid one but then the impossible happened one afternoon in 1909 Geiger burst into Rutherford's office with some astonishing news very very occasionally an alpha particle would indeed ricochet back off the gold leaf Geiger calculated that only 1 in 8,000 alpha particles would do this it's a tiny percentage but Rutherford's mind reeled with the news he would later say it was like firing a shell at a piece of tissue paper and have it bounce back at you there and then Rutherford knew he'd struck physics cold although it would take him over a year to fully understand why the alpha particles would do this when he did he would show humanity for the first time the inside of an atom now people had barely got used to the idea that atoms existed but now Rutherford knew that this my new world 1/10 of a millionth of a millimetre across had his own internal structure within the atomic there's a sub atomic world and Ernest Rutherford believed he knew what it looked like Rutherford realized that the bouncing alpha particle revealed an atom that was totally unexpected it had no familiar analogy on earth so Rutherford looked for one in the heavens he pictured the atom as a tiny solar system electrons tiny particles of negative electricity orbit around a minut positively charged object called the nucleus [Music] Rutherford calculated that the nucleus was 10,000 times smaller than the atom itself that's why only 1 in 8,000 alpha particles bounce back they're the ones that hit the Tony nucleus by chance the rest whizzed by without hitting anything the first astonishing consequence of this idea is that Rutherford's atom is almost entirely empty space that's why nearly all the alpha particles race through the gold atoms as if there's nothing there there really is nothing there consider the bizarre implications of Rutherford's atom by imagining it on a bigger scale if the nucleus were the size of a football then the nearest electron will be an orbit half a mile away the rest of the atom will be completely empty space let me explain another way if you were to suck out all the empty space from every atom in my body then I would shrink down to a size smaller than a grain of salt of course I'd still weigh the same and if you did the same thing to the entire human race then all 6 billion of us would fit inside a single Apple the atom was unlike anything we had ever encountered before and it would only get stranger and stranger almost immediately a problem surfaced and it was a big one according to the tried and trusted science of the time the electrons should lose their energy run out of speed and spiral into the nucleus in less than a blink of an eye Rutherford's atom contradicted the known laws of science the atom didn't care that it defied scientific convention it's almost entirely empty space and it's gonna stay that way I show no signs of shrinking down to the size of a grain of salt and the earth is well the size of the earth it's not getting smaller not surprisingly all the established scientists of the day including Einstein were battled scientific ideas they put their faith in all their lives had failed completely to explain the atom the atom now required a new generation of scientists to follow in Rutherford's footsteps bold brilliant and above all young it was crucial they had no loyalty or attachment to ideas held by previous generations one of the first of this new breed was niels bohr he sailed from Denmark in 1911 and made his way it's English soil having finished his studies in Copenhagen war decided to move abroad and be at the center of the new physics the trail led you to britain manchester university ernest rutherford or made it his mission to solve the puzzles of why the atom didn't collapse and why there was so much empty space as one of the new breed of theoretical physicists he was fearless in his thinking and was prepared to abandon common sense and human intuition to find an explanation so in a leap of genius he started to look for clues about the atoms structure not by looking at matter but by examining the mysterious and wonderful nature of light our atoms and lights are clearly connected most substances glow when they're heated and for centuries people had realized that different substances glow with their own distinctive colors a bit like a signature so the green of copper the yellow of sodium and the red of lithium these colors associated with different substances are called spectra and Bohr's great insights was to realize that spectra are telling us something about the inner structure of the atom that they could explain all that empty space Bohr's idea was to take Rutherford's solar system model of the atom and replace it with something that's almost impossible to imagine or visualize so sensible ideas like empty space and particles moving around in orbits fade away and they're replaced with something that is one of the most misunderstood and misused concepts in the whole of science the quantum jump now it takes most working physicists many years to come to terms with quantum jumps and in fact or himself said that if you think you've understood it then you haven't really thought about it enough so I'm going to take a deep breath and under 30 seconds try and explain to you one of the most complicated concepts in the whole of science but one that underpins the entire universe Bohr described the atom not as a solar system but as a multi-story building the ground floors where the nucleus lives were the electrons occupying the floors above mysterious laws mean the electrons can only live on the floors never in between and other mysterious laws mean that sometimes that can instantaneously jump from one film to another these are what we call quantum jumps now Bohr had absolutely no idea what these laws were but thinking like this allowed him to make a startling prediction when an electron jumps from a higher floor to a lower one it gives off light more significantly the color of the light depends on how big or small the quantum jump the electron makes so an electron jumping from the third floor to the second floor might give off red light when an electron jumping from the tenth floor to the second floor blue light to test his new theory Bohr used it to make a prediction could it explain the mysterious signature in the spectrum of hydrogen after months of calculating furiously who finally came up with the results and his prediction was surprisingly accurate for the first time ever it looked like the spectrum can be explained back in 1913 that was big news but Bohr's new idea rested on a single seriously controversial supposition why should the electrons in the atom behave as though they were in a multi-story building and why should they magically perform quantum jumps from one story to another there was no precedent for it anywhere else in science when one physicists claimed the jumps were nonsense Moore replied yes you're completely right but that doesn't prove the jumps don't happen only that you cannot visualize them but not being able to visualize things seem to go against the whole purpose of science all the scientists in particular felt that science was supposed to be about understanding the world not about making up arbitrary rules that seemed to fit the data conflict between the two generations of scientists was inevitable cause weird new Adam and his crazy quantum jumps were a shot across the bow silence and the old school reacted and leading the traditionalists was giant of the physics world Albert Einstein he hated all his ideas and he was going to fight them anything from a sexual assault on Nats [Music] borther is undeterred and as the 1920s gone the battery needs for one of the greatest conflicts in all science Woodlawn so far the debates about the new atomic physics had been polite from gentlemen now the two sides wheeled out their biggest guns two of the greatest names in physics they were two very true trusting characters on those dicho for the new revolutionary science was a buttoned-up uber competitive German called Verner Heisenberg for the Conservatives as a debonair byron esque Austrian called Owen Schrodinger [Music] [Applause] Oh in Schrodinger passionate and poetic a philosopher and a romantic he wrote books on the ancient Greeks on philosophy on religion he was influenced by Hinduism there's also a very flamboyant character cool suave sophisticated a dapper dresser and a big hit with the ladies [Music] [Applause] schrödinger's promiscuity was legendary he had a string of girlfriends throughout his married life some of them much younger than him in 1925 38 year-old Schrodinger stayed at the Alpine resort of yoson Switzerland for a secret liaison with an old girlfriend whose identity remains a mystery to this day but their passion proved to be the catalyst but Schrodinger's creative genius another physicist said of Schrodinger's week of sexually inspired physics he had two tasks that week satisfy a woman and solved the riddle of the atom fortunately he was up to both he took de Bru's idea of mysterious pilot waves guiding electrons around an atom one crucial step further he argued that the electron actually was a wave of energy vibrating so fast it looked like a cloud around the atom a cloud like wave of pure energy and what's more he came up with a powerful new equation which completely described this way and so described the whole atom in terms of traditional physics the equation he came up with we now call schrödinger's wave equation it's incredibly powerful what's unique about it is that it features a new quantity called the wave function which Schrodinger claimed completely describe the behavior on the subatomic world [Music] Schrodinger's equation and the picture of the Atome painted created during a sexually charged holiday in the Swiss Alps once again allowed scientists to visualize the atom in simple terms it's hard to overestimate the relief Schrodinger's idea brought to the traditional physics community strange though his picture of the Aten was at least it was a picture and scientists love pictures they allowed them to use their intuition but there was still a deep nagging problem one that the radicals felt Schrodinger just couldn't reconcile his new theory still couldn't account for balls strange instantaneous quantum jumps the time had come for the radicals to hit back [Applause] in the summer of the same year one of Niels Bohr's protegees Verner Heisenberg was travelling to an obscure island of the north coast of Germany he was fiercely competitive and took Schrodinger's ideas as a personal affront he felt strongly that the strangeness of the instant quantum jumps was actually the key to understanding the atom he thought the atom was so unique and unusual it shouldn't be compromised through a simple analogy like a wave or an orbit or even a multi-story building he believed it was time to give up any picture of the atom at all Verner Heisenberg while the true geniuses of the 20th century young athletic a great mountain climber an excellent pianist he was also an exceptional student at the age of just 20 who was well on his way to finishing his ph.d and being courted by the great universities across Europe now in the summer of 1925 he was suffering from a particularly bad bout of hay fever his face was swollen up almost beyond recognition he decided to escape alone here to this beautiful but isolated island of helgeland he walked along the beaches he swam he climbed the rock and he pondered ever since he'd encountered atomic physics Heisenberg felt in his bones that all human attempts to visualize the atom to model it with familiar images would always fail the atom he believed was too capricious too strange to ever be explained that simply so he decided to abandon all pictures of it and describe it using pure mathematics alone but as he pondered he realized that the atom didn't just defy visualization it even defied traditional mathematics it was while he was here on helgeland the Heisenberg had an incredible revelation he realized that in order to describe certain properties of atoms he had to use a strange new type of mathematics it seems that certain properties like where an electron is at a given time and how fast it's moving where multiplied together the order in which you multiply there matters let me try and explain if we multiply two numbers together it doesn't matter which or do we do it in so 3 times 4 is clearly the same as 4 times 3 but when it came to atoms Heisenberg realized that the order in which he multiplied quantities together gave a different answer this quickly led him to other discoveries and he was convinced that he'd cracked a code in the atom that he'd somehow found the hidden mathematics within he was so excited he was also very scared that night he climbed to the top of a rock and sat there waiting till dawn he called it his night of helgeland when he returned to his University in getting and he told his colleague Max Born about it and they then worked together intensely for several months developing a whole new theory of the atom a theory that today we call matrix mechanics [Music] matrix mechanics uses complex arrays of numbers rather like a spreadsheet by manipulating these arrays Heisenberg and his mentor the brilliant physicist max all could accurately predict atomic behavior but from Einstein and the traditionalists this was pure scientific heresy an atom can't actually be a matrix of numbers surely we made of atoms not numbers back in Copenhagen Bohr and Paulie were thrilled with matrix mechanics so what if we couldn't imagine the atom as a physical object they exalted in the purity of the mathematics and launched into vicious attacks against Schrodinger's vulgar sensual waves Heisenberg wrote the more I reflect on the physical portion of Schrodinger's equation the more disgusting I find it in fact it's just [ __ ] but Schrodinger was equally scathing of Heisenberg saying he was repelled by his methods and found his mathematics monstrous in Munich in 1926 their enmity began to reach boiling points Schrodinger was to give a lecture on his wave equation Heisenberg scraped together the money to travel down to Munich for the lecture to finally come face to face with his rival what was at stake was more than just Heisenberg's reputation he believed Schrodinger's simplistic approach wasn't just misguided but totally wrong and his intention was nothing less than to destroy Schrodinger's theory Schrodinger delivers his lecture on the new wave mechanics to a packed audience the standing-room-only he writes down his new wave equation to Schrodinger this describes a real physical picture of the atom with electrons as waves surrounding the atomic nucleus 24-year old Verna Heisenberg is in the audience it can hardly contain himself at the end of the lecture he stands up and delivers a monologue attacking Schrodinger's approach for Heisenberg it's impossible to ever have a picture of what the atom is really like the audience is on Schrodinger side they'd much prefer his simple physical interpretation to Heisenberg's abstract complicated mathematics Heisenberg is booed he's told to sit down and be quiet he leaves the lecture sad and depressed Heisenberg returned to Copenhagen with his confidence severely dented there at the Institute he and Bohr reached their darkest moment almost all of the scientific community was against them they felt isolated desperate their backs were against the wall despite this they stubbornly refused to give up their controversial theory this attic room was Heisenberg study back in 1926 Bohr would come up here night after night we're here in Heisenberg would argue about the meaning of the new quantum mechanics they would argue so passionately but on one occasion apparently Heisenberg was reduced to tears and then as Heisenberg stared out of his attic window in despair the part below an extraordinary thought occurred to him it struck him why an atom can't be visualized why can't be understood intuitively it's not just because it's tiny tricky and difficult is because it's inherently unknowable he realized that there was a fundamental limit to how much we can know about the subatomic world for instance if we know where an electron is at a particular moment in time then we cannot know how fast it's moving but if we knew its speed we wouldn't know his position this ambiguity isn't a shortcoming in the theory itself nor was it due to the clumsiness of the way we carry out our measurements but a fundamental truth about the way nature behaves at the subatomic scale it became known as Heisenberg's uncertainty principle and is probably the most profound incredible yet unsettling concepts in the whole of science [Music] what Heisenberg had uncovered through his abstract matrix mechanics was a deep and shocking truth about the atomic world atoms are willfully obscure we can never fully know an atoms position and speed simultaneously the atomic world just refuses to allow that to happen it was completely mind-boggling but once they accepted it Heisenberg and Bohr who found the boost of confidence to be even more bold they realized uncertainty forced them to put a paradox right at the very heart of the atom atoms are not just unimaginable they're self-contradictory they behave both like particles and waves and it gets weirder when you're not looking at an atom it behaved like a spread-out wave but when you look to see where it is it behaves like a particle this is insane first atoms couldn't be visualized at all now it seems they change completely in character depending on whether or not you're looking at them the uncertainty principle had changed everything it revealed a shocking contradiction at the heart of nature everything we see is made of atoms and yet atoms themselves are unknowable they can only be understood through mathematics for the first time for Bohr and Heisenberg everything about the atom fell into place by the autumn of 1927 full of confidence and smarting for a fight they knew they were finally ready to take on the Conservatives [Music] for this physics showdown they chose the Solvay conference in Brussels all the world's leading atomic physicists would attend if war and Heisenberg was successful then they would lead a total scientific revolution this is amazing I'm looking at original footage of the Solvay delegates coming out of these doors there's Bohr talking to Schrodinger and and this Heisenberg behind them and there's Paolo Li strange looking guy on there's Einstein coming down with a big smile on his face for the week of the conference all that the delegates could think and talk about was Bohr's quantum mechanics with uncertainty now a central plank it was a truly formidable theory and over the week the final showdown played out between Bohr and his archrival Albert Einstein Einstein hated quantum mechanics and every morning he'd come to war with an argument that he felt picked a hole in the new theory war would go away very disturbed and think very hard about it and by the end of the day he'd come back with a counter argument that dismissed Einstein's criticism and this happened day after day until by the end of the conference Bohr had brushed aside all of Einstein's criticisms and Bohr was regarded as having been victorious and with that his vision play-actor which became known as the Copenhagen interpretation was suddenly at the very heart of atomic physics at the end of the conference they all gather for the team photo never before or since have so many great names of physics being together in one place at the front the elder statesmen of physics Hendrik Lorentz flanked on either side by Madame Curie and Albert Einstein Einsteins looking rather glum because he's lost the argument Louis debris has also failed to convince the delegates of his views victory goes to Niels Bohr he's feeling very pleased with himself next to him one of the unsung heroes of quantum mechanics the German Max Born who developed so much of the mathematics and behind them the two young disciples of Bohr Heisenberg and Pauli Poly's looking rather smugly across at Schrodinger bit like the cat who's got the milk this was the moment in physics when it all changed the old guard was replaced by the new chance of probability became interwoven into the fabric of nature itself and we could no longer describe atoms in terms of simple pictures but only using pure abstract mathematics the Copenhagen view had been victorious although Einstein went to his grave never believed in quantum mechanics solve a 1927 was the turning point at which the rest of the science establishments came to embrace the Copenhagen interpretation and that interpretation is still accepted today all the physics that I use in my research certainly the quantum mechanics that I teach my students and that fills the textbooks on my shelves is based on ideas that were hammered out and crystallized here at the Solvay conference in October 1927 in a sense everything I know about the way the world around me is made up started here the quantum mechanical description of the atom is one of the crowning glories of human creativity over the last of 18 years it has been proven right time after time and it's Authority has never been in doubt it's a monumental scientific achievement between 1905 and 1927 science changed our view of the world it also changed our view of science itself as scientists probed the tiniest building blocks of matter they created the most successful and powerful theory ever quantum mechanics it allows us to describe what everything in the universe is made of how it interacts and how it all fits together but it comes at a huge price at its most fundamental level we have to accept that nature is ruled by chance and probability Heisenberg's uncertainty principle dictates that there are certain limits on the sorts of questions we can ask the atomic world and most crucially while we now know so much more about what an atom is and how it behaves we have to give up any possibility of imagining what it looks like our human nature has forced us to ask questions of everything we see around us in the world what we've discovered has been beyond our wildest imagination [Music]

Absolutely. Your list is very broad, so the best way to study it is not to memorize every disease. We can turn it into a high-yield nursing reviewer based on: What is it? → What will I see? → What should I assess? → What should I do? → What medications/treatments matter? → What is the priority/emergency? → What should I teach? Below is a condensed master reviewer. I’ll keep it nursing-focused and use simple language. ⸻ 🩺 MEDICAL-SURGICAL NURSING REVIEWER 1. ENDOCRINE SYSTEM Diabetes Mellitus Type 1 Type 2 Main problem Little/no insulin Insulin resistance + progressive insulin deficiency Usually Younger onset, but can occur any age More common in adults Treatment Insulin required Lifestyle + oral/injectable meds ± insulin Major acute problems DKA HHS Signs of hyperglycemia “3 Ps” * Polyuria – urinating frequently * Polydipsia – excessive thirst * Polyphagia – excessive hunger Other: * Fatigue * Blurred vision * Slow wound healing * Recurrent infections Hypoglycemia Think FAST: * F – Feeling shaky * A – Altered behaviour/confusion * S – Sweating * T – Tachycardia Treatment if conscious: 15 g fast carbohydrate → recheck glucose in 15 min → repeat if necessary. Examples: * Glucose tablets * Juice * Regular pop If unconscious/severe: * Glucagon if appropriate * IV dextrose in a healthcare setting DKA Usually associated with Type 1. Think: Hyperglycemia + ketones + metabolic acidosis Signs: * Dehydration * Abdominal pain * Nausea/vomiting * Fruity/acetone breath * Kussmaul respirations * Altered LOC Priority treatment: 1. IV fluids 2. Insulin 3. Monitor/correct electrolytes, especially potassium 4. Monitor glucose and acid-base status HHS Usually Type 2. * Extremely high glucose * Severe dehydration * Altered LOC * Little/no significant ketoacidosis Major nursing priority: fluid replacement and monitoring. Diabetes teaching Remember: * Foot care * Inspect feet daily * Proper footwear * Don’t walk barefoot * Don’t cut corns/calluses yourself * Monitor blood glucose * Know signs of hypo/hyperglycemia * Medication adherence * Sick-day management * Regular eye/kidney/foot assessments ⸻ ❤️ 2. CARDIOVASCULAR SYSTEM Stroke Two major types: * Ischemic → blocked blood vessel * Hemorrhagic → bleeding Recognize stroke: BE FAST B – Balance loss E – Eye/vision changes F – Face drooping A – Arm weakness S – Speech difficulty T – Time to call emergency services Nursing priorities * ABCs * Determine last known well * Neurological assessment * Blood glucose * Prepare for CT/imaging * Swallow assessment before oral food/fluids/medications * Prevent aspiration * Maintain safety Do not give food or water until swallowing is assessed. ⸻ Myocardial Infarction (MI) Think: “Time = muscle.” Common symptoms: * Chest pressure/pain * Radiation to arm/jaw/back * Dyspnea * Diaphoresis * Nausea * Anxiety Some patients, especially older adults and people with diabetes, may have atypical or minimal pain. Nursing priorities * ABCs * ECG * Vital signs * Cardiac monitoring * IV access * Blood work including cardiac biomarkers * Oxygen if hypoxemic/clinically indicated * Administer prescribed medications promptly Common medications: * Aspirin * Nitroglycerin * Antiplatelet drugs * Anticoagulants * Beta blockers * Statins Nitroglycerin Can cause: * Hypotension * Headache * Dizziness Never combine nitrates with PDE-5 inhibitors because of potentially severe hypotension. ⸻ Heart Failure Left-sided Think Lungs * Dyspnea * Crackles * Orthopnea * Pulmonary edema * Pink/frothy sputum in severe pulmonary edema Right-sided Think Body * Peripheral edema * Weight gain * JVD * Hepatomegaly * Ascites Nursing priorities * Daily weight * I&O * Respiratory assessment * Edema assessment * Fluid/sodium management as ordered * Medication adherence Sudden weight gain can indicate fluid retention. Common drugs: * Diuretics * ACE inhibitors/ARBs/ARNI * Beta blockers * Mineralocorticoid antagonists * SGLT2 inhibitors * Digoxin in selected patients Digoxin Watch for: * Bradycardia * Nausea/vomiting * Visual disturbances * Dysrhythmias Low potassium increases risk of digoxin toxicity. ⸻ Peripheral Vascular Disease Arterial Think: “Pain + Pale + Pulseless + Cold” * Cool extremity * Weak pulses * Pale colour * Pain with activity * Poor wound healing Venous Think: “Swollen + Warm + Edema” * Edema * Warm skin * Aching * Venous ulcers often near ankles ⸻ 🩸 3. HEMATOLOGY Anemia Reduced oxygen-carrying capacity. Signs: * Fatigue * Pallor * Weakness * Dyspnea * Tachycardia * Dizziness Iron-deficiency anemia May see: * Low hemoglobin * Low ferritin * Microcytic/hypochromic RBCs Iron teaching: * Take as directed * Vitamin C can improve absorption * Dark stools are common * Constipation can occur * Liquid iron may stain teeth ⸻ Leukemia Cancer of blood-forming tissues. Possible findings: * Infection → abnormal WBC function * Anemia → fatigue/pallor * Bleeding → low platelets * Bone/joint pain Think: Leukemia = infection + anemia + bleeding Nursing priorities: * Infection prevention * Bleeding precautions when indicated * Monitor CBC * Oral care * Avoid unnecessary invasive procedures * Monitor treatment adverse effects ⸻ 🍽️ 4. GASTROINTESTINAL SYSTEM Crohn’s vs Colitis Crohn’s Ulcerative Colitis Can affect anywhere mouth → anus Colon/rectum “Skip lesions” Continuous inflammation Transmural Mainly mucosal Fistulas common Bloody diarrhea common Strictures possible Toxic megacolon risk Crohn’s Watch for: * Diarrhea * Abdominal pain * Weight loss * Malnutrition * Fistulas Ulcerative colitis Watch for: * Bloody diarrhea * Abdominal cramps * Urgency * Risk of toxic megacolon ⸻ Diverticulitis Inflammation/infection of diverticula. Signs: * Usually LLQ abdominal pain * Fever * Change in bowel habits During acute inflammation: * Follow prescribed bowel-rest/diet plan * Monitor pain, fever and abdominal status * Watch for perforation/peritonitis ⸻ Colorectal Cancer Red flags: * Change in bowel habits * Blood in stool * Unexplained weight loss * Iron-deficiency anemia * Abdominal discomfort Important: Screening is important even before symptoms occur. ⸻ Constipation Risk factors: * Opioids * Immobility * Low fluid intake * Low fibre * Some medications Management: * Fluids if not contraindicated * Fibre * Activity * Bowel routine * Appropriate laxatives/stool softeners ⸻ Diarrhea Priority concerns: Fluid + electrolytes + cause Assess: * Frequency * Stool characteristics * Blood * Fever * Abdominal pain * Hydration * Recent antibiotics/travel/exposure ⸻ Peptic Ulcer Disease Major complications: * Bleeding * Perforation * Gastric outlet obstruction Warning signs: * Hematemesis * Melena * Sudden severe abdominal pain * Rigid abdomen Common causes: * H. pylori * NSAIDs ⸻ Appendicitis Classic: * Pain may begin around umbilicus and migrate to RLQ * Fever * Nausea/vomiting * Rebound/guarding may occur Priority Prevent rupture. Avoid: * Laxatives * Enemas * Applying heat to abdomen ⸻ 🚰 5. RENAL SYSTEM UTI Symptoms: * Dysuria * Frequency * Urgency * Suprapubic discomfort If infection reaches kidneys: * Fever * Flank pain * Chills * Nausea/vomiting Nursing * Obtain urine specimen correctly * Culture before antibiotics when ordered/appropriate * Encourage fluids if not contraindicated * Complete antibiotics ⸻ Renal Failure Major problems: Think: * Fluid overload * Electrolyte imbalance * Acid-base imbalance * Uremia * Anemia Possible findings: * Edema * Hypertension * Fatigue * Decreased urine output * Nausea * Confusion Particularly important: Hyperkalemia can cause life-threatening dysrhythmias. ⸻ Dialysis Hemodialysis Blood is filtered through a machine. Assess: * Weight * BP * Fluid status * Access site AV fistula Remember: “Feel + Hear” * Thrill → feel it * Bruit → hear it Protect the access: * No BP on that arm * No blood draws on that arm when avoidable * Don’t compress unnecessarily ⸻ Incontinence Types: Stress → coughing/sneezing Urge → sudden strong urge Overflow → bladder doesn’t empty Functional → can’t get to toilet Mixed → combination Management depends on cause. ⸻ 🫁 6. RESPIRATORY SYSTEM COPD Includes chronic bronchitis and emphysema. Common: * Dyspnea * Chronic cough * Sputum * Wheezing * Reduced exercise tolerance Nursing: * Position upright * Pursed-lip breathing * Energy conservation * Smoking cessation * Oxygen as prescribed * Inhaler technique Don’t automatically assume oxygen should be withheld from COPD patients. Oxygen is prescribed/titrated according to the patient’s clinical status and target saturation. ⸻ Asthma Usually reversible airway obstruction/inflammation. Symptoms: * Wheezing * Cough * Dyspnea * Chest tightness Rescue medication Short-acting bronchodilator, e.g. salbutamol. Controller Often: Inhaled corticosteroid Severe attack Red flags: * Difficulty speaking * Severe respiratory distress * Exhaustion * Altered LOC * Silent chest Silent chest = very serious. ⸻ Pneumonia Signs: * Fever * Cough * Sputum * Dyspnea * Crackles * Pleuritic chest pain Nursing: * Oxygen if needed * Antibiotics if bacterial/ordered * Hydration if appropriate * Mobilization * Cough/deep breathing * Monitor respiratory status ⸻ Lung Cancer Risk factors: * Smoking * Environmental/occupational exposures Symptoms: * Persistent cough * Hemoptysis * Weight loss * Dyspnea * Chest pain ⸻ Tuberculosis Classic: * Persistent cough * Fever * Night sweats * Weight loss * Possible hemoptysis Nursing priority Airborne precautions for suspected/confirmed infectious pulmonary TB according to institutional policy. ⸻ Atelectasis Collapsed alveoli, often after surgery. Prevention: * Deep breathing * Coughing * Incentive spirometry * Early mobilization * Adequate pain control ⸻ Pneumothorax Air in pleural space → lung collapse. Possible: * Sudden dyspnea * Chest pain * Decreased/absent breath sounds Tension pneumothorax Emergency. May cause: * Severe respiratory distress * Hypotension * Distended neck veins * Tracheal deviation * Cardiovascular collapse Requires immediate emergency treatment. ⸻ Hemothorax Blood in pleural space. Think: Respiratory compromise + blood loss. Chest tube may be required. ⸻ 🦴 7. MUSCULOSKELETAL Osteoporosis Loss of bone density. Risk: * Fractures * Vertebral compression * Hip fracture Prevention: * Weight-bearing activity * Calcium/vitamin D as appropriate * Fall prevention * Avoid smoking * Limit excessive alcohol ⸻ Fractures Priority: ABCs → bleeding → neurovascular status Assess the 6 Ps: * Pain * Pallor * Pulselessness * Paresthesia * Paralysis * Poikilothermia/coolness Neurovascular assessment is critical. ⸻ Arthritis Osteoarthritis Think: Wear and tear * Pain with activity * Stiffness * Often affects weight-bearing joints Rheumatoid arthritis Think: Autoimmune * Symmetrical joint involvement * Morning stiffness * Systemic effects ⸻ Scoliosis Abnormal lateral curvature of spine. Assess: * Posture * Shoulder/hip asymmetry * Spinal curvature * Respiratory effects if severe ⸻ Multiple Sclerosis Autoimmune demyelinating disease affecting CNS. Possible: * Weakness * Fatigue * Visual disturbances * Sensory changes * Balance problems * Bladder dysfunction Important nursing concept: Fatigue and heat can worsen symptoms. ⸻ 🦠 8. INFECTION/IMMUNE SYSTEM MRSA Methicillin-resistant Staphylococcus aureus. Key: * Resistant to several antibiotics * Contact precautions may be required * Strict hand hygiene ⸻ VRE Vancomycin-resistant enterococci. Key: * Resistant organism * Contact precautions according to facility policy * Hand hygiene * Environmental cleaning ⸻ C. difficile Often associated with antibiotic exposure. Symptoms: * Frequent watery diarrhea * Abdominal cramping * Fever VERY IMPORTANT Soap and water handwashing is preferred because alcohol-based hand sanitizer does not reliably kill C. difficile spores. Use appropriate contact/spore precautions according to facility policy. ⸻ Influenza * Fever * Cough * Myalgias * Fatigue * Headache Prevention: Annual vaccination + respiratory hygiene. ⸻ Sepsis Think: Infection + organ dysfunction Potential signs: * Fever or hypothermia * Tachycardia * Tachypnea * Altered mental status * Hypotension * Reduced urine output * Elevated lactate Nursing priority Recognize early and escalate rapidly. Expect: * Cultures * Lactate * IV fluids when indicated * Prompt antimicrobials when sepsis is suspected * Source control * Frequent reassessment ⸻ 🔬 9. DIAGNOSTIC TESTS Don’t memorize only the test. For every test ask: 1. Why is it being done? 2. What does it tell me? 3. What does the nurse do before? 4. What does the nurse do after? 5. What complications should I watch for? ⸻ CT Uses X-rays to create detailed cross-sectional images. Contrast may be used. Nursing: * Check allergies/previous contrast reactions * Assess kidney function when appropriate * Follow contrast-specific instructions ⸻ MRI Uses magnetic field. NO metal/unsafe metallic objects. Assess: * Implanted devices * Metal fragments * Claustrophobia ⸻ X-ray Useful for: * Fractures * Chest conditions * Some abdominal problems ⸻ Ultrasound Uses sound waves. Common: * Pregnancy * Abdomen * Pelvis * Blood vessels No ionizing radiation. ⸻ Mammogram Breast imaging for screening/assessment. ⸻ Endoscopy Allows direct visualization of GI tract. Nursing: * Usually NPO beforehand * Sedation may be used * Monitor airway and vital signs afterward * Ensure gag/swallow reflex has returned before oral intake when applicable ⸻ Bronchoscopy Visualizes airways. Post-procedure: * Monitor respiratory status * Watch for bleeding * Keep NPO until protective reflexes return if sedated/topical anesthetic used ⸻ Pulmonary Function Tests Measure lung function. Important for: * Asthma * COPD * Other pulmonary disorders ⸻ 🧪 10. LABORATORY VALUES For exams, know what the lab means, not just the number. CBC Hemoglobin/Hematocrit Think: oxygen-carrying capacity Low → anemia/bleeding/etc. WBC Think: infection/inflammation/immune response Platelets Think: clotting Low → bleeding risk. ⸻ INR Measures effect of warfarin therapy. Higher INR generally = increased anticoagulation and bleeding risk. Monitor for: * Bleeding * Bruising * Hematuria * Melena ⸻ Glucose Think: current blood glucose ⸻ HbA1c Think: “3-month-ish glucose picture.” Used for longer-term diabetes management. ⸻ BUN + Creatinine Think: Kidney function. Creatinine is particularly useful when evaluating renal function. ⸻ GFR Estimates kidney filtration. Lower GFR generally = worse kidney function. ⸻ Electrolytes Sodium Think: water balance + neurological function Potassium Think: heart rhythm Abnormal potassium can cause dangerous dysrhythmias. Calcium Think: bones + muscles + nerves ⸻ Cholesterol LDL “Lousy” cholesterol Higher LDL → increased cardiovascular risk. HDL “Healthy” cholesterol Generally protective. ⸻ Urinalysis Can help identify: * UTI * Protein * Blood * Glucose * Ketones * Kidney problems ⸻ Culture & Sensitivity Culture = What organism? Sensitivity = Which antibiotic is effective? ⸻ 💊 11. PHARMACOLOGY For every medication, memorize: Class → Why given → Major adverse effects → Contraindications/precautions → Nursing assessments → Patient teaching ⸻ Acetaminophen (Tylenol) Used for: * Pain * Fever Major concern: Liver toxicity with excessive dosing. ⸻ NSAIDs Examples: * Ibuprofen * Naproxen Watch for: * GI bleeding * Kidney injury * Fluid retention * Cardiovascular risks ⸻ Morphine Opioid. Watch: * Respiratory depression * Sedation * Hypotension * Constipation * Nausea Antidote for opioid-induced respiratory depression: Naloxone ⸻ Antibiotics Key nursing principle: Complete the prescribed course unless directed otherwise. Watch: * Allergic reactions * Diarrhea * Superinfection * C. difficile ⸻ Warfarin (Coumadin) Anticoagulant. Monitor: INR Major complication: Bleeding Teaching: * Consistent vitamin K intake rather than suddenly changing intake * Drug interactions matter * Report unusual bleeding ⸻ Heparin Anticoagulant. Monitor: * Bleeding * Platelets * aPTT for unfractionated heparin, depending on protocol Major complication: Bleeding Important adverse reaction: HIT – heparin-induced thrombocytopenia ⸻ Insulin Major adverse effect: HYPOGLYCEMIA Know: * Onset * Peak * Duration * Administration technique * Glucose monitoring ⸻ Nitroglycerin Used for angina. Can cause: * Headache * Hypotension * Dizziness Avoid with PDE-5 inhibitors. ⸻ Digoxin Remember: “Slow heart + low potassium = danger.” Monitor: * Apical pulse * Potassium * Signs of toxicity ⸻ Diuretics Example: Furosemide (Lasix) Causes: * Increased urine output * Decreased fluid volume Watch: * BP * Electrolytes * Dehydration * Potassium ⸻ Corticosteroids Example: Prednisone Long-term effects: * Infection risk * Hyperglycemia * Osteoporosis * Fluid retention * Skin changes * Adrenal suppression Do not abruptly stop long-term corticosteroids without medical direction. ⸻ Bronchodilators Example: Salbutamol Can cause: * Tremor * Tachycardia * Nervousness ⸻ Inhaled corticosteroids Important: Rinse mouth after use. Helps prevent oral candidiasis. ⸻ Statins Example: Atorvastatin Used to lower cholesterol. Watch: * Muscle pain/weakness * Liver-related adverse effects ⸻ Stool medications Psyllium Bulk-forming. Requires adequate fluid intake unless contraindicated. Docusate Stool softener. Stimulant laxatives Increase intestinal motility. ⸻ 🧠 12. NEUROLOGICAL Seizure During seizure: Protect, don’t restrain. * Protect from injury * Turn to side if possible * Protect airway * Remove nearby hazards * Don’t put anything in mouth * Time the seizure After: * Assess airway * Vital signs * Neurological status * Document characteristics Status epilepticus Emergency. ⸻ Increased Intracranial Pressure Think: Headache + vomiting + decreased LOC + pupil changes Late sign: Cushing’s triad * Increased BP/widened pulse pressure * Bradycardia * Irregular respirations Nursing: * Elevate head as ordered * Maintain neutral neck alignment * Avoid unnecessary stimulation * Monitor neurological status * Prevent hypoxia/hypercapnia ⸻ Parkinson’s Disease Classic: TRAP T – Tremor R – Rigidity A – Akinesia/bradykinesia P – Postural instability Nursing: * Fall prevention * Mobility support * Medication timing * Swallowing assessment * Nutrition ⸻ Spinal Cord Injury Priority: Airway + breathing + immobilization + neurological assessment Possible complications: * Neurogenic shock * Autonomic dysreflexia * Respiratory compromise * Loss of bowel/bladder control * Pressure injuries Autonomic dysreflexia Usually associated with injuries at/above T6. Signs: * Sudden severe hypertension * Headache * Flushing/sweating above injury * Bradycardia Priority: Sit patient upright and identify/remove the trigger. ⸻ 👁️ 13. SENSORY Cataracts Clouding of lens. Symptoms: * Blurred vision * Glare * Reduced visual acuity Treatment: Surgical removal when significantly affecting vision. ⸻ Glaucoma Optic nerve damage often associated with increased intraocular pressure. Key distinction: Glaucoma → pressure/optic nerve Cataract → cloudy lens Acute angle-closure glaucoma: * Severe eye pain * Headache * Halos * Nausea/vomiting * Red eye Emergency. ⸻ Hearing Loss Conductive Problem with sound transmission through outer/middle ear. Sensorineural Problem involving inner ear/auditory nerve. Communication: * Face patient * Speak clearly * Don’t shout * Reduce background noise * Verify understanding ⸻ 🔥 14. BURNS Think: Airway → Breathing → Circulation Inhalation injury Red flags: * Facial burns * Soot * Singed nasal hairs * Hoarseness * Stridor * Carbonaceous sputum Airway edema can worsen rapidly. ⸻ Burn priorities * Airway * Breathing * Circulation * Fluid resuscitation for significant burns * Pain management * Infection prevention * Temperature control * Nutrition * Wound care ⸻ 15. WOMEN’S & MEN’S HEALTH Menopause Decrease in estrogen. Common: * Hot flashes * Night sweats * Sleep problems * Vaginal dryness * Mood changes Long-term: * Bone loss * Cardiovascular considerations ⸻ Birth Control Know: * Effectiveness * How it is used * Contraindications * STI protection Most hormonal birth control does NOT protect against STIs. Condoms help reduce STI transmission. ⸻ STIs Examples: * Chlamydia * Gonorrhea * Syphilis * HPV * Herpes * HIV Nursing: * Testing * Treatment adherence * Partner notification/treatment when appropriate * Safer sex education * Prevention ⸻ Breast Cancer Warning signs: * New breast lump * Skin changes * Nipple changes/discharge * Axillary lymph node changes Know current screening recommendations and individual risk factors. ⸻ Prostate Cancer Possible: * Urinary hesitancy * Weak stream * Frequency * Hematuria Important: Early prostate cancer may have no symptoms. ⸻ 🚨 16. EMERGENCY NURSING Shock Basic concept: Tissues aren’t receiving enough oxygen/perfusion. Signs: * Tachycardia * Hypotension * Altered LOC * Cool/clammy skin in many shock states * Decreased urine output * Tachypnea Major types Hypovolemic → blood/fluid loss Cardiogenic → pump failure Distributive → vasodilation (e.g., septic/anaphylactic) Obstructive → obstruction to circulation Priority: ABCs + identify/treat cause + restore perfusion. ⸻ Hemorrhage Look for: * Tachycardia * Hypotension * Pallor * Weakness * Decreased LOC * Decreased urine output Priority: Control bleeding + support circulation + escalate. ⸻ Anaphylaxis Severe allergic reaction. Signs: * Airway swelling * Wheezing * Dyspnea * Hypotension * Hives * GI symptoms FIRST-LINE MEDICATION: IM epinephrine Do not delay epinephrine while waiting for other treatments. ⸻ 💧 17. FLUID & ELECTROLYTES Dehydration Signs: * Thirst * Dry mucous membranes * Tachycardia * Hypotension * Poor skin turgor * Decreased urine output * Weight loss ⸻ Fluid overload Signs: * Edema * Crackles * Dyspnea * Weight gain * JVD * Hypertension ⸻ Potassium Hypokalemia Think: Weak + irregular heart Causes: * Diuretics * GI losses Hyperkalemia Think: Dangerous heart rhythm Causes: * Renal failure * Tissue breakdown * Certain medications ⸻ Acid-Base Use: ROME Respiratory = Opposite Metabolic = Equal Examples: Respiratory acidosis CO₂ ↑ → pH ↓ Respiratory alkalosis CO₂ ↓ → pH ↑ Metabolic acidosis HCO₃ ↓ → pH ↓ Metabolic alkalosis HCO₃ ↑ → pH ↑ ⸻ 👶 MATERNAL-CHILD NURSING Prenatal Care Monitor: * Maternal vital signs * Weight * Blood pressure * Urine * Fetal growth * Fetal heart rate * Laboratory screening * Risk factors Important warning signs: * Vaginal bleeding * Severe headache * Visual changes * Severe abdominal pain * Fluid leakage * Decreased fetal movement * Sudden swelling/other signs of hypertensive disorders ⸻ Fetal Development High-yield concept: First trimester → organ formation Second trimester → growth and development Third trimester → maturation and preparation for birth ⸻ Labour Stage 1 Onset of true labour → complete cervical dilation. Stage 2 Complete dilation → birth of baby. Stage 3 Birth of baby → delivery of placenta. Stage 4 Immediate postpartum recovery. ⸻ Apgar At approximately 1 and 5 minutes. A P G A R A – Appearance P – Pulse G – Grimace A – Activity R – Respiration Each scored 0–2. Apgar helps assess newborn adaptation; it does not by itself diagnose asphyxia or determine long-term prognosis. ⸻ Newborn Assessment Assess: * Respiratory effort * Heart rate * Temperature * Colour * Tone * Feeding * Reflexes * Weight * Head circumference * Urine/stool ⸻ Breastfeeding Benefits: * Nutrition * Immune protection * Bonding Signs of effective feeding: * Good latch * Audible swallowing * Appropriate wet/dirty diapers * Expected weight pattern ⸻ 👶 PEDIATRIC NURSING Development General progression: Head → toe Simple → complex Large muscles → fine motor Always consider developmental stage when communicating with children. ⸻ Pediatric Safety Big priorities: * Falls * Choking * Burns * Poisoning * Drowning * Car-seat safety * Medication dosing * Safe sleep Medication principle Pediatric medications are often based on: weight (kg) Always verify calculations and concentrations. ⸻ Pediatric Asthma Same basic principles as adults: * Bronchodilator for acute symptoms * Controller medications for long-term control * Trigger avoidance * Asthma action plan ⸻ RSV Common in infants/young children. Signs: * Rhinorrhea * Cough * Wheezing * Increased work of breathing * Poor feeding Priority: Respiratory assessment and hydration. ⸻ Croup Classic: Barking cough + stridor Often worse at night. Severe respiratory distress requires urgent intervention. ⸻ Cystic Fibrosis Thick secretions affect lungs and GI system. Think: “Thick mucus + lung infections + malabsorption.” Nursing: * Airway clearance * Nutrition * Pancreatic enzymes when prescribed * High-calorie/high-protein nutrition * Infection prevention ⸻ Gastroenteritis Major concern: Dehydration. Assess: * Wet diapers/urine * Mucous membranes * Tears * Capillary refill * Weight * Activity/LOC ⸻ Pyloric Stenosis Classic: Projectile, non-bilious vomiting Often occurs in young infants. Possible: * Hunger after vomiting * Dehydration * Weight loss ⸻ ASD vs VSD ASD Hole between atria. VSD Hole between ventricles. VSD can produce: A significant murmur and increased pulmonary blood flow. ⸻ Sickle Cell Disease Problem: Abnormal hemoglobin → sickled RBCs → vaso-occlusion and hemolysis. Crisis triggers: * Dehydration * Infection * Hypoxia * Stress Management: * Hydration * Oxygen if hypoxemic * Pain management * Treat infection * Rest * Disease-specific therapies ⸻ Meningitis Think: Fever + headache + stiff neck + altered mental status May also have: * Photophobia * Vomiting * Seizures Emergency. Use appropriate isolation precautions according to suspected organism and institutional policy. ⸻ Hydrocephalus Excess CSF. Infants may have: * Increasing head circumference * Bulging fontanelle * Irritability * Poor feeding * “Sunsetting” eyes Older children: * Headache * Vomiting * Visual changes * Altered LOC ⸻ 🧠 MENTAL HEALTH NURSING Therapeutic Communication DO: * Use open-ended questions * Listen * Reflect * Clarify * Validate feelings * Maintain appropriate boundaries DON’T: * Give false reassurance * Judge * Argue * Give excessive advice * Say “everything will be fine” ⸻ Depression Symptoms: * Persistent sadness * Anhedonia * Sleep changes * Appetite changes * Fatigue * Poor concentration * Feelings of worthlessness * Suicidal thoughts Nursing priority: Assess suicide risk directly. ⸻ Bipolar Disorder Mania * Elevated/irritable mood * Increased energy * Decreased need for sleep * Rapid speech * Impulsivity * Grandiosity Nursing: * Reduce stimulation * Maintain safety * Set clear limits * Encourage nutrition/hydration * Administer medications as prescribed ⸻ Schizophrenia Positive symptoms: * Hallucinations * Delusions * Disorganized speech/behaviour Negative symptoms: * Flat affect * Social withdrawal * Reduced motivation Communication Don’t argue with delusions. Instead: Acknowledge the patient’s feelings while presenting reality. ⸻ OCD Obsessions: Intrusive thoughts Compulsions: Repetitive behaviours/mental acts ⸻ Eating Disorders Watch: * Electrolytes * Cardiac rhythm * Nutrition * Weight * Refeeding complications * Psychological safety ⸻ Substance Use Priorities: * Airway/breathing/circulation * Overdose recognition * Withdrawal * Safety * Nonjudgmental communication ⸻ 🧪 HIGH-YIELD DIAGNOSTIC TEST THINKING When you see a test question, ask: “Why are they ordering this?” Examples: CT head after sudden neurological deficit → looking for bleeding/structural abnormalities. MRI → detailed soft tissue/neurological/musculoskeletal imaging. ECG → electrical activity/ischemia/dysrhythmia. Troponin → myocardial injury. HbA1c → long-term glucose control. Creatinine/GFR → kidney function. INR → warfarin effect. Culture and sensitivity → organism + effective antimicrobial. Pulmonary function test → lung function/obstruction/restriction. ⸻ 💊 PHARMACOLOGY MASTER MEMORY MAP Instead of memorizing 100 medications individually, memorize the danger associated with each class: Drug/Class Think Insulin Hypoglycemia Opioids Respiratory depression Warfarin Bleeding + INR Heparin Bleeding + HIT Furosemide Fluid/electrolyte loss Digoxin Bradycardia/toxicity ACE inhibitors Hyperkalemia + cough/angioedema Beta blockers Bradycardia/hypotension Steroids Hyperglycemia + infection NSAIDs GI bleeding + kidney injury Statins Muscle/liver effects Bronchodilators Tachycardia/tremor Inhaled steroids Oral candidiasis Antibiotics Allergy + C. diff ⸻ 🚨 THE “PRIORITY QUESTION” METHOD When you’re stuck on an exam question, ask: 1. Is the airway threatened? If yes → AIRWAY 2. Is breathing compromised? If yes → BREATHING 3. Is circulation/perfusion compromised? If yes → CIRCULATION 4. Is there an acute neurological deterioration? Think neurological emergency. 5. Is there a safety risk? Falls, suicide, aspiration, seizures, etc. 6. Which patient is deteriorating? Unstable beats stable. ⸻ ⭐ TOP THINGS I WOULD MEMORIZE FIRST If you have limited study time, prioritize these: 🚨 Emergencies * Anaphylaxis → IM epinephrine * Stroke → BE FAST + last known well * MI → ECG + rapid intervention * Sepsis → early recognition + rapid treatment * Tension pneumothorax → emergency * Severe hypoglycemia → rapid glucose treatment * Status epilepticus → emergency * Increased ICP → neurological deterioration * Hemorrhage → control bleeding + perfusion * Severe burns → ABCs 💊 Medications * Insulin → hypoglycemia * Morphine → respiratory depression * Warfarin → INR/bleeding * Heparin → bleeding/HIT * Digoxin → pulse/potassium/toxicity * Furosemide → fluid/electrolytes * Nitroglycerin → hypotension + PDE-5 interaction * Steroids → infection/hyperglycemia * Antibiotics → allergy/C. diff * Inhaled steroids → rinse mouth 🧪 Labs * Hb → oxygen carrying * WBC → infection/immune response * Platelets → bleeding/clotting * INR → warfarin * Glucose → current sugar * HbA1c → long-term glucose * Creatinine/GFR → kidney * K⁺ → heart rhythm * Na⁺ → neurological/fluid balance * Culture → organism * Sensitivity → antibiotic choice 🩺 Nursing skills * Infection control * Medication administration * IVs * Oxygen * Suction * Tracheostomy * Chest tubes * Urinary catheter * Wound care * Ostomy care * Vital signs * Neurovascular assessment * Respiratory assessment ⸻ 📚 How I’d recommend studying this huge syllabus Don’t try to study all of these diseases in one sitting. Use system blocks: Day 1: Diabetes + cardiovascular Day 2: Respiratory + renal Day 3: GI + liver Day 4: Hematology + immune/infection Day 5: Neuro + musculoskeletal Day 6: Maternal/newborn Day 7: Pediatrics Day 8: Mental health Day 9: Pharmacology Day 10: Labs + diagnostics + clinical skills Day 11: Emergency/priority questions Day 12: Full mixed practice exam + review weak areas For each condition, make yourself answer only 5 questions: 1. What is happening? 2. What will I assess? 3. What is the biggest complication? 4. What will I do first? 5. What do I teach the patient? That approach will help you think like a nurse rather than memorize isolated facts, which matches the study framework you were given.

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What are some examples of human behaviors that might be considered instinctual? Human instinctual behaviors include newborn reflexes (like grasping), fear responses (like loud noises or heights), bonding between parents and children, facial expressions (like smiling and crying), the fight-or-flight response, imitation, language learning ability, and the need for social connection. In Drive-Reduction Theory, what is meant by a “drive”? What about “homeostasis”? In Drive-Reduction Theory, a “drive” is an internal state of tension or discomfort caused by an unmet biological need, such as hunger or thirst, that motivates a person to act. “Homeostasis” refers to the body’s tendency to maintain a stable and balanced internal state, so behaviors are motivated by the desire to reduce drives and restore balance. How is the Arousal Theory different from Drive-Reduction Theory? Arousal Theory focuses on seeking an optimal level of stimulation, while Drive-Reduction Theory focuses on reducing biological needs. Arousal explains thrill-seeking; drive-reduction explains behaviors like eating when hungry. How does Maslow’s Hierarchy suggest we prioritize our goals? Maslow's Hierarchy of Needs suggests that people tend to prioritize basic needs before higher-level goals. According to the theory, physiological needs like food and sleep come first, followed by safety, love and belonging, esteem, and finally self-actualization, which involves reaching one’s full potential. The idea is that lower-level needs usually must be reasonably satisfied before a person focuses strongly on higher-level needs. Give a real-life example of each level of Maslow’s hierarchy. In Maslow's Hierarchy of Needs, physiological needs include food and sleep, safety needs include shelter and security, love and belonging involve friendships and family, esteem needs include confidence and respect, and self-actualization involves reaching personal goals and potential. Why might Maslow's theory be criticized across different cultures?+ù Maslow's Hierarchy of Needs may be criticized across cultures because it reflects individualistic values, such as personal achievement and self-actualization, which may not be prioritized equally in all societies. In some cultures, community, family, or group needs may be considered more important than individual goals. What is the difference between intrinsic and extrinsic motivation? Intrinsic Motivation comes from internal enjoyment or personal satisfaction, while Extrinsic Motivation comes from external rewards or pressures, such as money, grades, or praise. Which type of motivation do you think leads to more lasting change? Why? Intrinsic Motivation usually leads to more lasting change because the behavior is driven by genuine interest, enjoyment, or personal meaning, so it continues even without external rewards. Extrinsic Motivation can be effective in the short term, but the behavior often stops when rewards or pressure are removed, since the motivation depends on outside factors rather than internal commitment. What are the traits of someone with a high need for achievement? A person with a high need for achievement sets challenging but realistic goals, prefers tasks with clear personal responsibility, seeks feedback, and is persistent. They are motivated by doing well and improving rather than just external rewards. Why might low achievers choose tasks that are either very easy or very hard? People with a low need for achievement may choose very easy tasks because they are almost guaranteed success, which helps them avoid failure and protect their self-esteem. They may also choose very hard tasks because failure can be blamed on the difficulty of the task rather than their ability, which also protects their self-image. What role does the hypothalamus play in hunger? The hypothalamus helps regulate hunger by monitoring the body’s energy needs and signaling when to eat or stop eating. Different parts work together: one area triggers hunger when energy is low, while another signals fullness after eating. It responds to hormones, blood sugar levels, and signals from the stomach to maintain balance. What is the difference between set point theory and settling point theory? Set point theory says the body has a fixed, biologically controlled weight it tries to maintain. Settling point theory says weight is flexible and depends on lifestyle and environment, so it can change over time. What psychological and social cues can influence how much we eat? Psychological cues like stress, mood, and distraction can increase or decrease how much we eat. Social cues such as eating with others, portion sizes, and cultural expectations also strongly influence eating behavior. What are the symptoms of anorexia nervosa? Anorexia Nervosa includes extreme food restriction, significant weight loss, intense fear of gaining weight, and a distorted body image. It can also cause fatigue, dizziness, feeling cold, and in some cases, serious health problems. How does bulimia differ from anorexia? Bulimia Nervosa involves binge eating followed by purging and often normal weight. Anorexia Nervosa involves severe food restriction and very low body weight. How might perfectionism be linked to the development of eating disorders? Perfectionism can lead people to set unrealistically high standards for their body, weight, or eating habits, which increases stress and dissatisfaction. This pressure can contribute to restrictive eating or binge-purge behaviors as they try to “achieve” an ideal body image. According to James-Lange theory, what comes first: the emotion or the physical response? According to James-Lange Theory, the physical response comes first. The body reacts to a stimulus, and then the brain interprets those physical changes as an emotion. How does Cannon-Bard theory explain simultaneous emotion and bodily reaction? Cannon-Bard Theory says emotion and bodily reaction happen at the same time. A stimulus triggers the brain to send signals that produce both the emotional experience and the physical response simultaneously, rather than one causing the other. What evidence supports the idea that emotions are biologically universal? Evidence shows people across cultures recognize the same facial expressions, and even blind people show them, suggesting emotions are biologically universal. Similar brain activity patterns also support this idea. . What are Paul Ekman’s universal emotions? Paul Ekman identified six universal emotions: happiness, sadness, anger, fear, disgust, and surprise. How might facial expressions influence how we feel? Facial expressions can shape emotions through the idea that acting a certain way can influence how we feel internally. For example, smiling may increase feelings of happiness, while frowning can intensify sadness. Body and facial feedback to the brain helps reinforce or even create emotional experiences. Why is it important to recognize that emotions can be expressed differently across cultures? Paul Ekman shows some emotions are universal, but recognizing cultural differences matters because people can display and interpret emotions in different ways across cultures. Misunderstanding these differences can lead to miscommunication or incorrect judgments about others’ feelings or intentions

Genera: Postmodernism – after modernism, reaction to modernism, bleed into popular music.is a late 20thcentury movement in philosophy, art, and culture that questions established norms, embraces pluralism, and often rejects the idea of objective truth Pendercki – graphic scores, microtones, extended technique Cage – Conceptual art Glass – Minimalism Pop(ular)- made to sell, simple and easy. Edison invents sound recording, frank Sinatra in jazz Blues- originated among African Americans in the Deep South of the United States around the 1860s. Blues is party music, sad songs. Country- largely from the British (Irish) tradition, Appalachia called “Hillbilly” – oral tradition. Made into pop, appellation mountains. From Ireland. Rock and Roll – fast and organic, Baby Boomers R&B and Country mix Bill Hayley and the Comets Elvis Presley - debatably greatest selling artist of all time Soul- rhythm and blues with gospel singing. musical representation of the Civil Rights Movement R&B + Gospel, Ray Charles, James Brown – Cells becomes Funk, becomes Hip Hop, seeking end segregation. Folk- (music of the people) like country long unwritten tradition), social activism. Bob dylan Rock- music is a genre of popular music characterized by strong beats, electric guitar-driven sound, and a cultural emphasis on rebellion and self-expression. Disco- pop in 70’s, whole bunch of money it does go to gay club. Edm, influences pop music. Punk – united by nihilism- no value in anything, reaction corporate in the 70’s Rap- dance halls of Jamaica influenced by disco, Jamaica making up lyrics, 70’s house parties. Alternative- 90’s, alternative to modern music, to pop, rock hits. Nouns: Penderecki - Polish composer, noted for his highly individual orchestration Cage- concept composition Glass- minimalist composition Frank Sinatra- pop singer, jazz? Miles Davis- trumpet jazz composer best album Baby Boomers- born after world war 2 Elvis- selling artist of all time, started then helped James Brown- soul Bob Dylan- folk Beatles- influential group, introduces rock and roll in pop music, psychedelia involved Michael Jackson- king of pop, thriller- greatest album Public Enemy-golden age rap music, politcal Nirvana- 1990s reinvents rock, metal with punk, grunge, alternative Napster- music file-sharing computer service created by American college student Shawn Fanning in 1999. Max Martin- song writer, producer Technical: Social Activism- music for political change Concept Album- story by album, dark side of moon Psychedelia- movement of drugs, philosophy Nihilism- punk philosophy, belief that nothing matters at all Scratching- scratching records like in the video Synthesizer- electronic instruments, 80’s

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Perception The process of organizing and interpreting sensory information to give meaning to our environment. Bottom-up processing An approach where perception starts with sensory input and works up to the brain's integration of this information. Top-down processing Information processing guided by higher-level mental processes, drawing on experience and expectations to construct perceptions. Schema A concept or framework that organizes and interprets information. Perceptual set A mental predisposition to perceive one thing and not another. Gestalt psychology Emphasizes that we often perceive the whole rather than the sum of the parts. Closure The perceptual tendency to mentally fill in gaps in a visual image to perceive objects as wholes. Figure and ground The organization of the visual field into objects (figures) that stand out from their surroundings (ground). Proximity The perceptual tendency to group together visual and auditory events that are near each other. Similarity The perceptual tendency to group together elements that seem alike. Attention The focusing of mental resources on select information. Selective attention The focusing of conscious awareness on a particular stimulus. Cocktail party effect The ability to focus auditory attention on a particular stimulus while filtering out other stimuli. Inattentional blindness Failing to see visible objects when attention is directed elsewhere. Change Blindness Failing to notice changes in the environment. Binocular depth cues Depth cues, such as retinal disparity, that depend on the use of two eyes. Retinal disparity A binocular cue for perceiving depth by comparing images from the retinas in the two eyes. Convergence A binocular cue for perceiving depth by the extent to which the eyes converge inward when looking at an object. Monocular depth cues Depth cues, such as interposition and linear perspective, available to either eye alone. Relative clarity A monocular cue for perceiving depth; hazy objects are seen as farther away than sharp, clear objects. Relative size A cue that allows determining the closeness of objects to an object of known size. Texture gradient A gradual change from coarse to fine texture signaling increasing distance. Linear perspective Parallel lines appear to converge with distance. Aptitude tests Tests designed to predict a person's future performance; aptitude is the capacity to learn. Fixed mindset The idea that we have a set amount of an ability that cannot change. Growth mindset The belief that one's skills and qualities can change and improve through effort and dedication. Explicit memory Memory of facts and experiences that one can consciously know and 'declare.' Episodic memory The collection of past personal experiences that occurred at a particular time and place. Semantic memory Memory for factual information. Implicit memory Retention independent of conscious recollection. Procedural memory A type of long-term memory of how to perform different actions and skills. Prospective memory Remembering to perform a planned action or recall a planned intention at some future point in time. Long-term potentiation An increase in a cell's firing potential after brief, rapid stimulation. Believed to be a neural basis for learning and memory. Working memory model A model that suggests that memory involves a series of active, temporary memory stores that manipulate information. Working memory A newer understanding of short-term memory that involves conscious, active processing of incoming auditory and visual-spatial information, and of information retrieved from long-term memory. Central executive The part of working memory that directs attention and processing. Phonological loop The part of working memory that holds and processes verbal and auditory information. Visuospatial sketchpad The part of working memory that holds visual and spatial information. Multi-store model A model of memory that suggests information passes through three stages: sensory memory, short-term memory, and long-term memory. Sensory memory The immediate, very brief recording of sensory information in the memory system. Iconic memory A momentary sensory memory of visual stimuli; a photographic or picture-image memory lasting no more than a few tenths of a second. Echoic memory A momentary sensory memory of auditory stimuli; if attention is elsewhere, sounds and words can still be recalled within 3 or 4 seconds. Short-Term Memory Activated memory that holds a few items briefly before the information is stored or forgotten. Long-Term Memory The relatively permanent and limitless storehouse of the memory system. Includes knowledge, skills, and experiences. Automatic processing Unconscious encoding of incidental information, such as space, time, and frequency, and of well-learned information. Effortful processing Encoding that requires attention and conscious effort. Encoding The processing of information into the memory system—for example, by extracting meaning. Storage The retention of encoded information over time. Retrieval The process of getting information out of memory storage. Levels of processing model The theory that deeper levels of processing result in longer-lasting memory codes. Shallow encoding Processing information based on its surface characteristics. Deep encoding Processing information based on its meaning and the significance of the information. Mnemonic devices Memory aids, especially those techniques that use vivid imagery and organizational devices. Method of loci A mnemonic device that involves imagining placing items around a room or along a route. Chunking-Grouping Organizing items into familiar, manageable units; often occurs automatically. Categories-Grouping Grouping information into categories that share common attributes. Hierarchies-Grouping Organizing items into a hierarchy, starting with general categories and working down to specific examples. Spacing effect The tendency for distributed study or practice to yield better long-term retention than is achieved through massed study or practice. Massed practice Cramming information all at once. It is less effective than spaced practice. Distributed practice Spacing the study of material to be remembered by including breaks between study periods. Serial position effect Our tendency to recall best the last and first items in a list. Primacy effect The tendency to remember information at the beginning of a body of information better than the information that follows. Recency effect The tendency to remember information that is presented last. Maintenance rehearsal Repeating information over and over to keep it active in short-term memory. Elaborative rehearsal A method of transferring information from short-term to long-term memory by making that information meaningful in some way. Memory retention The ability to retain information over time through the storage and retrieval of information. Autobiographical memory The memory for events and facts related to one's personal life story. Retrograde amnesia An inability to retrieve information from one's past. Anterograde amnesia An inability to form new memories. Alzheimer's disease A progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning. Infantile amnesia The inability to retrieve memories from much before age 3. Recall A measure of memory in which the person must retrieve information learned earlier, as on a fill-in-the-blank test. Recognition A measure of memory in which the person need only identify items previously learned, as on a multiple-choice test. Retrieval cues Stimuli that aid the recall or recognition of information stored in memory. Context-dependent memory The theory that information learned in a particular situation or place is better remembered when in that same situation or place. Mood-congruent memory The tendency to recall experiences that are consistent with one's current good or bad mood. State-dependent memory The theory that information learned in a particular state of mind (e.g., drunk, sober) is more easily recalled when in that same state of mind. The forgetting curve A graph showing retention and forgetting over time. Encoding failure The failure to process information into memory. Proactive interference The disruptive effect of prior learning on the recall of new information. Retroactive interference The disruptive effect of new learning on the recall of old information. Tip-of-the-tongue phenomenon The temporary inability to remember something you know, accompanied by a feeling that it's just out of reach. Repression The basic defense mechanism that banishes from consciousness anxiety-arousing thoughts, feelings, and memories. Misinformation effect Incorporating misleading information into one's memory of an event. Source amnesia Attributing to the wrong source an event we have experienced, heard about, read about, or imagined. Constructive memory The process by which memories are influenced by the meaning we give to events. Memory consolidation The neural storage of a long-term memory. Imagination inflation The increased confidence in a false memory of an event following repeated imagination of the event. Health Psychology A branch of psychology that focuses on how physical activities, psychological traits, and social relationships affect overall health and illness. Stress The process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging. Hypertension High blood pressure, often associated with stress, which can increase the risk of heart and kidney diseases and stroke. Immune Suppression Reduction in the effectiveness of the immune system, which can be caused by various forms of stress. Stressors Events or conditions in your surroundings that may trigger stress. Daily Hassles Everyday minor events that cause stress, such as traffic jams or overwhelming chores. Significant Life Changes Major life transitions like moving, leaving a job, or divorcing, which can be stressful. Catastrophes Unpredictable, large-scale events that cause significant stress and alter the lives of many people. Eustress (motivating) Positive stress which results from striving toward a challenging goal. Distress (debilitating) Negative stress that can make a person sick or keep a person from reaching a goal. Adverse Childhood Experiences (ACEs) Potentially traumatic events that occur in childhood and can have negative, lasting effects on health and well-being. General Adaptation Syndrome (GAS) The three-stage process (alarm, resistance, exhaustion) that describes the physiological changes the body goes through when under stress. Alarm Reaction Phase The initial reaction to a stressor, activating the body's defense systems. Resistance Phase The body's response after the initial shock of a stressful event, where the body attempts to return to normal functioning. Flight-Fight-Freeze Response A physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. Exhaustion Phase The third stage of the GAS, during which the body depletes its resources in responding to a prolonged stressor. Tend-and-Befriend Theory A theory that suggests people seek social support and tend to others in times of stress. Problem-focused Coping Strategies aimed at tackling the cause of stress in practical ways which directly tackle the problem causing the stress. Emotion-focused Coping Strategies aimed at relieving or managing the emotional distress associated with stress. Positive Psychology The scientific study of human strengths and virtues that enable individuals and communities to thrive. Subjective Well-being An individual's own assessment of their happiness and satisfaction with life. Resilience The ability to mentally or emotionally cope with a crisis or to return to pre-crisis status quickly. Posttraumatic Growth Positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. Positive Emotions Feelings that engage us, elevate us, and promote growth and well-being. Gratitude A feeling of thankfulness and appreciation, especially in response to someone doing something kind or helpful. Signature Strengths & Virtues Character strengths and virtues that are personally fulfilling, intrinsic to one's identity, and contribute to the collective well-being. Categories of Virtues Broad categories that encompass character strengths, such as wisdom, courage, humanity, justice, temperance, and transcendence. Abnormal Psychology The study of psychological disorders, including their symptoms, etiology (i.e., their causes), and treatment. Clinical Psychology A branch of psychology that studies, assesses, and treats people with psychological disorders. Psychology Student Syndrome A phenomenon where psychology students begin to believe they have the disorders they are studying. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) The updated manual that describes and categorizes mental disorders in order to improve diagnoses, treatment, and research. International Classification of Mental Disorders (ICD) A standard diagnostic tool for epidemiology, health management, and clinical purposes. It is maintained by the World Health Organization (WHO) and covers a broad range of health conditions, including psychological conditions. Deviation In psychology, typically refers to departing from the norm, which can either be statistical, social, or functional in nature. Distress Negative stress that can lead to anxiety, depression, and potentially to physical problems. Dysfunction Abnormal functioning, as opposed to normal functioning, often used to refer to individual behaviors or the functioning of social systems. Eclectic Approach An approach to clinical practice that involves selecting the best treatment techniques from various disciplines based on the client's unique problems, strengths, and preferences. Behavioral Perspective Focuses on how we learn observable responses and how the environment impacts those responses. Psychodynamic Perspective Emphasizes the influence of the unconscious mind on behavior and the importance of childhood experiences. Humanistic Perspective Focuses on the importance of being your true self in order to lead the most fulfilling life. Cognitive Perspective Focuses on how we encode, process, store, and retrieve information. Evolutionary Perspective How the natural selection of traits promotes the perpetuation of one's genes. Sociocultural Perspective Examines how the social environments and cultural upbringing influence an individual's behavior and thoughts. Biological Perspective Explores the links between brain and mind, and how the body and brain enable emotions, memories, and sensory experiences. Biopsychosocial Model An integrated approach that incorporates biological, psychological, and social-cultural levels of analysis to better understand health and illness. Diathesis-Stress Model Suggests that a person may be predisposed for a psychological disorder that remains unexpressed until triggered by stress. Stigma Disapproval or discrimination against a person based on perceivable social characteristics that serve to distinguish them from other members of society. Anxiety Disorders Mental health disorders characterized by significant feelings of anxiety and fear. Specific Phobia An anxiety disorder characterized by irrational and persistent fear of a specific object, situation, or activity. Acrophobia Fear of heights. Arachnophobia Fear of spiders. Agoraphobia Fear of open or crowded spaces. Panic Disorder An anxiety disorder that consists of sudden, overwhelming attacks of terror. Ataque de nervios A cultural syndrome primarily seen in Latin Americans, involving symptoms of intense emotional upset, acute anxiety, fear, or anger. Social Anxiety Disorder A chronic mental health condition in which social interactions cause irrational anxiety. Taijin Kyofusho A Japanese culture-specific syndrome characterized by an intense fear that one's body, body parts, or bodily functions give others a negative impression. Generalized Anxiety Disorder An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Obsessive-Compulsive Disorders Disorders involving intrusive obsessions and compulsions which impede daily life. Obsessions Persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress. Compulsions Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession. Hoarding Disorder A disorder characterized by the persistent difficulty discarding or parting with possessions, regardless of their actual value. Trauma and Stressor-Related Disorders Disorders related to the exposure to a traumatic or stressful event. Posttraumatic Stress Disorder A disorder characterized by failure to recover after experiencing or witnessing a terrifying event. Depressive Disorders Disorders that involve the presence of sad, empty, or irritable mood, accompanied by physical and cognitive changes that significantly affect the individual's capacity to function. Major Depressive Disorder A mood disorder causing a persistent feeling of sadness and loss of interest. Persistent Depressive Disorder A form of depression that is less severe than major depressive disorder but more chronic. Bipolar Disorder A disorder associated with episodes of mood swings ranging from depressive lows to manic highs. Bipolar Cycling The process of cycling through episodes of mania and depression in bipolar disorder. Bipolar I Disorder A type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode. Bipolar II Disorder A type of bipolar disorder marked by milder episodes of hypomania that alternate with periods of severe depression. Neurodevelopmental Disorders A group of conditions with onset in the developmental period, often before school age, that are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning. Attention-Deficit/Hyperactivity Disorder (ADHD) A chronic condition including attention difficulty, hyperactivity, and impulsiveness. Autism Spectrum Disorder (ASD) A disorder that affects communication and behavior. Feeding and Eating Disorders Disorders characterized by abnormal or disturbed eating habits, which negatively affect a person's health. Anorexia Nervosa An eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of body weight. Bulimia Nervosa An eating disorder characterized by binge eating followed by purging. Schizophrenic Spectrum Disorders A range of disorders that involve psychosis, including schizophrenia. Delusions False beliefs, often of persecution or grandeur, that may accompany psychotic disorders. Delusions of Persecution The belief that others are out to get one. Delusions of Grandeur A false belief that one is more important or influential than they really are. Hallucinations False sensory experiences, such as seeing something in the absence of an external visual stimulus. Disorganized Thinking A symptom of psychosis, manifested as illogical or incoherent thought and speech. Disorganized Speech A style of talking involving incoherence and a lack of typical logical patterns. Word Salad A confused or unintelligible mixture of seemingly random words and phrases. Disorganized Motor Behavior Includes a variety of unusual behaviors including problems with goal-directed behavior leading to difficulties performing activities of daily living. Catatonia A state of unresponsiveness to one's outside environment, usually including muscle rigidity, staring, and inability to communicate. Flat Affect A lack of emotional responsiveness. Dopamine Hypothesis The theory that schizophrenia results from an excess of dopamine activity. Positive Symptoms Symptoms of schizophrenia that are excesses of behavior or occur in addition to normal behavior; hallucinations, delusions, and disorganized speech. Negative Symptoms Symptoms of schizophrenia that are marked by deficits in functioning, such as apathy, lack of emotion, and slowed speech and movement. Dissociative Disorders Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Dissociative Amnesia A disorder characterized by the sudden and extensive inability to recall important personal information, usually of a traumatic or stressful nature. Dissociative Fugue A rare dissociative disorder in which a person loses awareness of their identity or other important autobiographical information and also engages in some form of unexpected travel. Dissociative Identity Disorder A disorder characterized by the presence of two or more distinct personality states. Personality Disorders Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning. Cluster A Personality Disorders Odd, eccentric thinking or behavior (including paranoid, schizoid, and schizotypal personality disorders). Paranoid Personality Disorder Type of personality disorder characterized by extreme distrust and suspicion of others. Schizoid Personality Disorder A personality disorder characterized by persistent avoidance of social relationships and little expression of emotion. Schizotypal Personality Disorder A personality disorder characterized by severe social anxiety, thought disorder, paranoid ideation, derealization, transient psychosis, and often unconventional beliefs. Cluster B Personality Disorders Dramatic, overly emotional or unpredictable thinking or behavior (including antisocial, borderline, histrionic, and narcissistic personality disorders). Antisocial Personality Disorder A personality disorder characterized by a lack of conscience for wrongdoing, even toward friends and family. Histrionic Personality Disorder A personality disorder characterized by excessive emotionality and attention seeking. Narcissistic Personality Disorder A disorder in which a person has an inflated sense of self-importance. Borderline Personality Disorder A personality disorder characterized by severe instability in emotions and self-image, along with impulsive and reckless behavior. Cluster C Personality Disorders Anxious, fearful thinking or behavior, including avoidant, dependent, and obsessive-compulsive personality disorders. Avoidant Personality Disorder A personality disorder characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Dependent Personality Disorder A personality disorder characterized by psychological dependence on other people. Obsessive-Compulsive Personality Disorder A personality disorder characterized by preoccupation with orderliness, perfection, and control. Deinstitutionalization The release of institutionalized individuals from institutional care to community-based care. Evidence-Based Interventions Treatments based on scientific evidence. Cultural Humility An approach to engagement across cultures emphasizing openness and self-awareness of one's own cultural identities. Therapeutic Alliance The relationship between a healthcare professional and a client. Conformity Adjusting one's behavior or thinking to coincide with a group standard. Normative Social Influence Influence resulting from a person's desire to gain approval or avoid disapproval. Social Norms Expected standards of conduct, which influence behavior. Social Comparison Evaluating one's abilities and opinions by comparing oneself to others. Relative Deprivation The perception that one is worse off relative to those with whom one compares oneself. Upward Social Comparison Comparing oneself with others who are better off. Downward Social Comparison Comparing oneself with others who are worse off. Informational Social Influence Influence resulting from one's willingness to accept others' opinions about reality. Obedience Following the directives of authority. Social Facilitation Improved performance on simple or well-learned tasks in the presence of others. Group Polarization The enhancement of a group's prevailing inclinations through discussion within the group. Groupthink The mode of thinking that occurs when the desire for harmony in a decision-making group overrides a realistic appraisal of alternatives. Bystander Effect The tendency for any given bystander to be less likely to give aid if other bystanders are present. Diffusion of Responsibility Diminished sense of responsibility among group members to act because others are seen as equally responsible. Social Loafing The tendency for people in a group to exert less effort when pooling their efforts toward attaining a common goal than when individually accountable. Deindividuation The loss of self-awareness and self-restraint occurring in group situations that foster arousal and anonymity. Attribution Theory The theory that we explain someone's behavior by crediting either the situation or the person's disposition. Dispositional Attributions Attributing behavior to the person's disposition and traits. Situational Attributions Attributing behavior to the environment. Explanatory Style A person's habitual way of explaining events, typically assessed along three dimensions: internal/external, stable/unstable, and global/specific. Optimistic Explanatory Style Explaining bad events as results of temporary, external causes. Pessimistic Explanatory Style Explaining bad events as results of stable, internal causes. Fundamental Attribution Error The tendency for observers, when analyzing others' behavior, to underestimate the impact of the situation and to overestimate the impact of personal disposition. Actor-Observer Bias The tendency to attribute one's own actions to external causes while attributing other people's behaviors to internal causes. Self-Serving Bias A readiness to perceive oneself favorably. Internal Locus of Control The perception that one controls one's own fate. External Locus of Control The perception that chance or outside forces beyond one's personal control determine one's fate. Altruism Unselfish regard for the welfare of others. Social Responsibility Norm An expectation that people will help those needing their help. Stereotype A generalized belief about a group of people. Confirmation Bias The tendency to interpret new evidence as confirmation of one's existing beliefs or theories. Belief Perseverance Clinging to one's initial conceptions after the basis on which they were formed has been discredited. Self-Fulfilling Prophecy A belief that leads to its own fulfillment. Prejudice An unjustifiable and usually negative attitude toward a group and its members. Discrimination Unjustifiable negative behavior toward a group and its members. Implicit Attitudes Attitudes that influence a person's feelings and behavior at an unconscious level. Just-World Phenomenon The tendency for people to believe the world is just and that people therefore get what they deserve. Out-Group Homogeneity Bias Perception of out-group members as more similar to one another than are in-group members. In-Group Bias The tendency to favor one's own group. Mere Exposure Effect The phenomenon that repeated exposure to novel stimuli increases liking of them. Ethnocentrism Evaluating other cultures according to the standards and customs of one's own culture. Collectivism Giving priority to the goals of one's group and defining one's identity accordingly. Multiculturalism The practice of valuing and respecting differences in culture. Superordinate Goals Shared goals that override differences among people and require their cooperation. Social Traps A situation in which conflicting parties, by each rationally pursuing their self-interest, become caught in mutually destructive behavior. Persuasion The process of creating, reinforcing, or changing people's beliefs or actions. Elaboration Likelihood Model A theory of how persuasive messages lead to attitude changes. Central Route of Persuasion Attitude change path in which interested people focus on the arguments and respond with favorable thoughts. Peripheral Route of Persuasion Attitude change path in which people are influenced by incidental cues, such as a speaker's attractiveness. Halo Effect The tendency to draw a general impression about an individual on the basis of a single characteristic. Foot-in-the-Door Technique The tendency for people who have first agreed to a small request to comply later with a larger request. Door-in-the-Face Technique The strategy of getting someone to agree to a modest request by first asking them to agree to a much larger request that they will likely turn down. False Consensus Effect The tendency to overestimate the extent to which others share our beliefs and behaviors. Cognitive Dissonance The theory that we act to reduce the discomfort we feel when two of our thoughts are inconsistent. Industrial-Organizational (I/O) Psychologists Psychologists who apply psychology's principles to the workplace. Instincts A complex behavior that is rigidly patterned throughout a species and is unlearned. Drive-Reduction Theory The idea that a physiological need creates an aroused tension state (a drive) that motivates an organism to satisfy the need. Homeostasis The tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry, such as blood glucose, around a particular level. Ghrelin Hormone secreted by an empty stomach; sends 'I'm hungry' signals to the brain. Leptin Hormone secreted by fat cells; when abundant, causes brain to increase metabolism and decrease hunger. Hypothalamus A neural structure lying below the thalamus; directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward. Pituitary Gland The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. Belongingness The human emotional need to be an accepted member of a group. Arousal Theory The theory that people are motivated to maintain an optimal level of alertness and physical and mental activation. Yerkes-Dodson Law The principle that performance increases with arousal only up to a point, beyond which performance decreases. Sensation-Seeking Theory The search for experiences and feelings that are varied, novel, complex, and intense. Thrill Seeking Pursuing activities that provide a rush of adrenaline. Adventure Seeking Engaging in unusual and exciting activities. Disinhibition Acting impulsively, without considering the consequences. Boredom Susceptibility Tendency to experience boredom and frustration when not engaged in stimulating activities. Incentive Theory A theory that states that behavior is motivated by a desire for reinforcement or incentives. Extrinsic Motivation A desire to perform a behavior to receive promised rewards or avoid threatened punishment. Self-Determination Theory A theory of motivation that is concerned with the beneficial effects of intrinsic motivation and the harmful effects of extrinsic motivation. Intrinsic Motivation A desire to perform a behavior effectively for its own sake. Lewin's Motivational Conflicts Theory A theory that describes situations in which conflicting motivations produce indecision and difficulty. Approach-Approach Conflicts Conflict that results from having to choose between two attractive alternatives. Avoidance-Avoidance Conflicts Conflict that results from having to choose between two distasteful alternatives. Approach-Avoidance Conflicts Conflict that results when a single action or event has both attractive and unattractive features. Emotion A response of the whole organism, involving (1) physiological arousal, (2) expressive behaviors, and (3) conscious experience. Affect A broad range of feelings that people experience. Facial-Feedback Hypothesis The idea that facial expressions can influence emotions as well as reflect them. Display Rules Culturally determined rules about which nonverbal behaviors are appropriate to display. Elicitors Stimuli that trigger emotional responses. Broaden-and-Build Theory of Emotion Theory proposing that happiness predisposes us to think more openly. Universal Emotions Basic emotions that are expressed by all cultures around the world such as happiness, sadness, fear, disgust, anger, and surprise. Psychodynamic Theory A view that explains personality in terms of conscious and unconscious forces, such as unconscious desires and beliefs. Preconscious Mind The level of consciousness that is not currently in focal awareness. Unconscious Mind A reservoir of mostly unacceptable thoughts, wishes, feelings, and memories. Denial Psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful realities. Displacement Defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person. Projection Defense mechanism by which people disguise their own threatening impulses by attributing them to others. Rationalization Defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions. Reaction Formation Defense mechanism by which the ego unconsciously switches unacceptable impulses into their opposites. Regression Defense mechanism in which an individual faced with anxiety retreats to a more infantile psychosexual stage. Repression Defense mechanism by which anxiety-provoking thoughts and feelings are forced to the unconscious. Sublimation Defense mechanism by which people re-channel their unacceptable impulses into socially approved activities. Humanistic Psychology A historically significant perspective that emphasized the growth potential of healthy people. Unconditional Regard An attitude of total acceptance toward another person. Self-Actualizing Tendency The human motive toward realizing our inner potential. Social-Cognitive Theory Views behavior as influenced by the interaction between people's traits (including their thinking) and their social context. Reciprocal Determinism The interacting influences of behavior, internal cognition, and environment. Self-Concept All our thoughts and feelings about ourselves, in answer to the question, 'Who am I?' Self-Efficacy One's sense of competence and effectiveness. Self-Esteem One's feelings of high or low self-worth. Trait Theories Theories that endeavor to describe the characteristics that make up human personality in an effort to predict future behavior. Big Five Theory The theory that there are five basic personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism (emotional stability). Personality Inventories A questionnaire (often with true-false or agree-disagree items) on which people respond to items designed to gauge a wide range of feelings and behaviors; used to assess selected personality traits. Factor Analysis A statistical procedure that identifies clusters of related items (called factors) on a test; used to identify different dimensions of performance that underlie one's total score. Openness to Experience One of the five factors; willingness to try new things and be open to new experiences. Conscientiousness One of the five factors; a tendency to show self-discipline, act dutifully, and aim for achievement. Extraversion One of the five factors; energy, positive emotions, and the tendency to seek stimulation and the company of others. Agreeableness One of the five factors; a tendency to be compassionate and cooperative rather than suspicious and antagonistic towards others. Behavioral Perspective Emphasizes learning and behavior in explaining thoughts, feelings, and actions. Associative Learning Making connections between events to learn. Habituation Becoming less responsive to a repeated stimulus. Classical Conditioning Pairing two stimuli to elicit a response. Unconditioned Stimulus (UCS) Naturally triggers a response without learning. Conditioned Stimulus (CS) Initially neutral, triggers a conditioned response. Acquisition Initial learning stage where a response is established. Extinction Diminishing of a conditioned response. Spontaneous Recovery Reappearance of an extinguished response after a pause. Stimulus Discrimination Ability to differentiate between stimuli. Stimulus Generalization Conditioned stimulus evokes similar responses. Higher-Order Conditioning Pairing a conditioned stimulus with a new one. Counterconditioning Uses conditioning to change responses to triggers. Taste Aversion Avoidance of food associated with discomfort. One-Trial Conditioning Learning with only one pairing of stimulus and response. Biological Preparedness Inclination to form associations between stimuli and responses. Operant Conditioning Learning through rewards and punishments. The Law of Effect Behaviors with favorable consequences are repeated. Reinforcement Strengthens behavior it follows. Primary Reinforcers Innately reinforcing stimuli satisfying biological needs. Secondary Reinforcers Gains reinforcing power through association. Punishment Event decreasing behavior it follows. Shaping Positive reinforcement of behavior patterns. Instinctive Drift Tendency to revert to instinctive behaviors. Fine Motor Coordination The ability to make small, precise movements, typically involving the coordination of the hands and fingers with the eyes. Gross Motor Coordination The ability to make large, general movements, such as crawling and walking. Maturation Biological growth processes that enable orderly changes in behavior, relatively uninfluenced by experience. Reflexes Automatic responses to sensory stimuli, like grasping a finger tightly with the hands. Rooting Reflex A baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple. Visual Cliff A laboratory device for testing depth perception in infants and young animals. Critical Periods Specific time periods during which an organism must experience stimuli in order to develop normally. Sensitive Periods Times in development when a person is particularly open to certain kinds of experiences. Imprinting The process by which certain animals form strong attachments during early life. Growth Spurt A rapid increase in growth during puberty. Puberty The period of sexual maturation, during which a person becomes capable of reproducing. Primary Sex Characteristics The body structures (ovaries, testes, and external genitalia) that make sexual reproduction possible. Secondary Sex Characteristics Nonreproductive sexual traits, such as female breasts and hips, male voice quality, and body hair. Menarche The first menstrual period. Spermarche The first ejaculation. Menopause The time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines. Sex The biologically influenced characteristics by which people define males and females. Gender The socially influenced characteristics by which people define men and women. Socialization The process by which people learn the norms, rules, and information of a culture or society. Jean Piaget A psychologist known for his study of cognitive development in children. Sensorimotor Stage The first stage in Piaget's theory of cognitive development, from birth to about 2 years of age, during which infants know the world mostly in terms of their sensory impressions and motor activities. Object Permanence The awareness that things continue to exist even when not perceived. Preoperational Stage The second stage in Piaget's theory, from about 2 to 7 years of age, during which a child learns to use language but does not yet comprehend the mental operations of concrete logic. Mental Symbols Internal depictions of information that the mind can manipulate. Chronosystem In Bronfenbrenner's theory, this system encompasses changes over time in child development. Authoritarian Parenting A parenting style characterized by high demands and low responsiveness. Parents with this style have very high expectations of their children, yet provide very little in the way of feedback and nurturance. Authoritative Parenting A parenting style characterized by high demands and high responsiveness. Parents with this style set limits and enforce rules but also listen to their children. Permissive Parenting A parenting style characterized by low demands with high responsiveness. These parents tend to be very loving, yet provide few guidelines and rules. Attachment Styles Patterns of attachment, defined by different ways of interacting and behaving in relationships. Secure Attachment An attachment style characterized by trust, a lack of concern with being abandoned, and the view that one is worthy and well liked. Insecure Attachment Attachment styles characterized by fear of abandonment and the feeling that one's needs might not be met. Avoidant Attachment An attachment style characterized by difficulty in learning to trust others. Anxious Attachment An attachment style where individuals are often anxious about the stability of their relationships. Disorganized Attachment An attachment style characterized by a lack of clear attachment behavior. Temperament A person's characteristic emotional reactivity and intensity. Separation Anxiety Emotional distress seen in many infants when they are separated from people with whom they have formed an attachment. Contact Comfort The physical and emotional comfort that an infant receives from being in physical contact with its mother. Parallel Play Activity in which children play side by side without interacting. Pretend Play Play involving imaginary people and situations; also called fantasy play, dramatic play, or imaginative play. Egocentrism The inability to differentiate between self and other. More specifically, it is the inability to understand that others have different feelings, desires, and perspectives from one's own. Imaginary Audience A concept in adolescent psychology where an individual believes that his or her behavior is the main focus of others' attention and concern. Personal Fable An adolescent's belief that they are unique and protected from harm. Social Clock The culturally preferred timing of social events such as marriage, parenthood, and retirement. Emerging Adulthood A phase of the life span between adolescence and full-fledged adulthood which encompasses late adolescence and early adulthood, generally ages 18 to 25. Stage Theory of Psychosocial Development (Erikson) Erik Erikson's theory that identifies eight stages through which a healthily developing human should pass from infancy to late adulthood. Trust vs. Mistrust The first stage of Erik Erikson's theory of psychosocial development. This stage occurs between birth and approximately 18 months of age. During this stage, the infant learns if they can trust the world to fulfill their needs. Autonomy vs. Shame and Doubt The second stage of Erik Erikson's stages of psychosocial development. This stage occurs between the ages of 18 months to approximately 3 years. The child learns to be independent and confident or experiences shame and doubt about their abilities. Initiative vs. Guilt The third stage of Erik Erikson's stages of psychosocial development. This stage occurs during the preschool years, between the ages of 3 to 5 years. Children begin to assert control and power over their environment. Industry vs. Inferiority The fourth stage of Erik Erikson's stages of psychosocial development. This stage occurs between the ages of 5 and 12 years. Children learn to cope with new social and academic demands, success leads to a sense of competence, while failure results in feelings of inferiority. Identity vs. Role Confusion The fifth stage of Erik Erikson's stages of psychosocial development. This stage occurs during adolescence, from about 12-18 years. During this stage, adolescents explore their independence and develop a sense of self. Intimacy vs. Isolation The sixth stage of Erik Erikson's theory of psychosocial development. This stage occurs during young adulthood between the ages of approximately 19 and 40 years. Young adults need to form intimate, loving relationships with other people. Generativity vs. Stagnation The seventh stage of Erik Erikson's theory of psychosocial development. This stage takes place during middle adulthood between the ages of approximately 40 and 65. Individuals establish careers, settle down within relationships, begin families, and develop a sense of being a part of the bigger picture. Integrity vs. Despair The eighth and final stage of Erik Erikson's stages of psychosocial development. This stage occurs during old age and is focused on reflecting back on life. Adverse Childhood Experiences (ACEs) Potentially traumatic events that occur in childhood (0-17 years), such as experiencing violence, abuse, or neglect, witnessing violence in the home or community, and having a family member attempt or die by suicide. Achievement (adolescent development) In the context of identity development, this term refers to the successful integration of various aspects of self-concept, based on explorations of roles, values, and beliefs. Diffusion (adolescent development) A status of identity development where an individual has not yet experienced a crisis or made any commitments. They are undecided and uninterested in occupational and ideological choices. Foreclosure (adolescent development) A status of identity development where an individual has made a commitment without experiencing a crisis. This occurs when people commit to roles or values without exploring alternatives. Moratorium (adolescent development) A status of identity development where an individual is in the midst of a crisis but whose commitments are either absent or are only vaguely defined. Racial/Ethnic Identity An individual's awareness and experience of being a member of a racial or ethnic group, including the degree to which one's cultural, historical, and social aspects of identity are embraced. Sexual Orientation An inherent or immutable enduring emotional, romantic, or sexual attraction to other people. Religious Identity An individual's sense of belonging to a religious group, along with the importance of this group membership as it pertains to one's sense of self. Occupational Identity How a person identifies themselves based on their job or career choices and how they feel those roles impact their personal identity. Familial Identity The part of an individual's identity that is formed by the relationships they have with their family members. Possible Selves The aspect of oneself that includes all the ideas of what one might become, what one hopes to become, and what one is afraid of becoming. Evolutionary Perspective A way of looking at human behavior that emphasizes the role of natural selection and survival of the fittest in shaping our actions. Natural Selection A process where organisms better adapted to their environment tend to survive and produce more offspring. Nature Refers to the genetic or hereditary influences on behavior and traits. Nurture Refers to the environmental influences that shape behavior and traits after conception. Twin Studies Research that compares the similarities between identical and fraternal twins to understand the influence of genetics versus environment. Adoption Studies Studies that compare adopted children to their adoptive and biological parents to understand genetic and environmental influences. Family Studies Research that examines behavioral patterns or genetic markers across generations within families. Heredity The passing on of physical or mental traits genetically from one generation to another. Genetic Predisposition The increased likelihood of developing a particular disease or behavior based on a person's genetic makeup. Eugenics A controversial historical movement aimed at improving the genetic composition of the human race. Cerebral Cortex The outermost layer of the brain involved in high-level functions such as thought, language, and memory. Association Areas Parts of the brain that integrate different types of information from the senses and link it with stored memories. Lobes of the Brain Regions of the brain differentiated by their functions, including frontal, parietal, occipital, and temporal lobes. Frontal Lobes Areas of the brain involved in complex processes like reasoning, planning, and emotion. Prefrontal Cortex The part of the frontal lobes directly behind the forehead, involved in decision-making and self-control. Executive Functioning Higher-level cognitive processes including thinking, planning, and problem-solving. Motor Cortex The part of the brain that controls voluntary movements. Parietal Lobes Areas of the brain that process sensory information such as touch, temperature, and pain. Somatosensory Cortex A part of the parietal lobes that processes sensory input from various body areas. Occipital Lobes The part of the brain that processes visual information. Temporal Lobes Areas of the brain involved in processing auditory information and encoding memory. Corpus Callosum A large band of neural fibers that connects the left and right cerebral hemispheres and allows communication between them. Brainstem The central trunk of the brain continuing downward to form the spinal cord. Medulla The base of the brainstem that controls vital life-sustaining functions like heartbeat and breathing. Reticular Activating System A network of neurons in the brainstem that plays a role in waking and sleep. Cerebellum A part of the brain at the back of the skull that coordinates and regulates muscular activity. Limbic System A complex system of nerves and networks in the brain, controlling basic emotions and drives. Reward Center Brain regions that regulate the experience of pleasure, particularly related to survival and reward. Thalamus A structure deep within the brain that relays sensory signals to the cerebral cortex. Hypothalamus A small region at the base of the brain that directs several functions, including temperature regulation and energy maintenance. Pituitary Gland A gland at the base of the brain that controls growth and development. Hippocampus A part of the limbic system involved in learning and memory. Amygdala A structure in the limbic system involved in emotion, particularly fear and aggression. Nervous System The network of nerve cells and fibers that transmits nerve impulses between parts of the body. Central Nervous System The part of the nervous system consisting of the brain and spinal cord. Peripheral Nervous System All the nerves that lie outside the brain and spinal cord. Autonomic Nervous System The part of the nervous system responsible for control of the bodily functions not consciously directed, like breathing and the heartbeat. Sympathetic Nervous System The part of the autonomic nervous system that prepares the body for rapid action in emergencies. Parasympathetic Nervous System The part of the autonomic nervous system that calms the body and conserves energy. Somatic Nervous System The part of the peripheral nervous system associated with voluntary control of body movements via skeletal muscles. Neurons The basic working units of the brain, specialized cells that transmit information to other nerve cells, muscle, or gland cells. Glial Cells Cells in the nervous system that support, nourish, and protect neurons. Motor Neurons Neurons that carry outgoing information from the brain and spinal cord to the muscles and glands. Sensory Neurons Neurons that carry incoming information from the sensory receptors to the brain and spinal cord. Interneurons Neurons within the brain and spinal cord that communicate internally and intervene between the sensory inputs and motor outputs. Reflex Arc A neural pathway that controls a reflex action. Neural Transmission The process by which neurons communicate with each other by sending electrical or chemical signals. Threshold The level of stimulation required to trigger a neural impulse. Action Potential A neural impulse; a brief electrical charge that travels down an axon. All-or-Nothing Principle The rule that neurons are either on or off. Depolarization A change in a cell's membrane potential, making it more positive. Refractory Period A period immediately following stimulation during which a nerve or muscle is unresponsive to further stimulation. Resting Potential The state of the neuron when not firing a neural impulse. Reuptake A neurotransmitter's reabsorption by the sending neuron. Multiple Sclerosis (MS) A disease in which the immune system eats away at the protective covering of nerves. Myasthenia Gravis A chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles. Neurotransmitters Chemicals transmitting information across synapses to dendrites of receiving neurons. Excitatory Neurotransmitters Chemical messengers increasing the likelihood of neuron firing an action potential. Glutamate An excitatory neurotransmitter strengthening synaptic connections between neurons. Inhibitory Neurotransmitters Chemical messengers decreasing the likelihood of neuron firing an action potential. GABA A major inhibitory neurotransmitter in the brain. Dopamine A neurotransmitter influencing movement, learning, attention, and emotion. Serotonin A neurotransmitter affecting mood, hunger, sleep, and arousal. Endorphins Neurotransmitters influencing the perception of pain or pleasure. Substance P A neurotransmitter involved in transmitting pain messages to the brain. Acetylcholine A neurotransmitter enabling learning, memory, and triggering muscle contraction. Hormones Chemicals produced by glands regulating activities of different body cells. Ghrelin A hormone stimulating appetite, increasing food intake, and promoting fat storage. Leptin A hormone helping regulate energy balance by inhibiting hunger. Melatonin A hormone regulating sleep-wake cycles. Oxytocin A hormone acting as a neurotransmitter, influencing social behavior and emotion. Adrenaline A hormone released in response to physical or mental stress. Norepinephrine A hormone and neurotransmitter involved in arousal and fight-or-flight response. Plasticity The brain's ability to change and adapt due to experience. Split Brain Research Studies on patients with severed corpus callosum to understand brain hemisphere functions. Contralateral Hemispheric Organization Arrangement where the brain's right hemisphere controls the left side of the body and vice versa. Hemispheric Specialization Control of distinct functions by the brain's right and left hemispheres. Linguistic Processing Brain functions involved in understanding and producing language. Broca's Area Frontal lobe area directing muscle movements involved in speech. Broca's Aphasia Condition from damage to Broca's area causing impaired speaking and writing. Opioids A class of drugs including heroin and prescription pain relievers. Heroin An opioid drug made from morphine, derived from opium poppy plants. Tolerance Diminishing drug effect with regular use, necessitating larger doses. Addiction Compulsive craving for drugs or behaviors despite adverse consequences. Withdrawal Symptoms post cessation of drug intake in addicted individuals. Sensation Reception and representation of stimulus energies by sensory receptors. Transduction Conversion of stimulus energies into neural impulses in sensation. Perception Organization and interpretation of sensory information for object recognition. Absolute Threshold Minimum stimulus energy to detect a stimulus 50% of the time. Just-noticeable Difference Smallest difference in stimulus intensity detectable by a sense. Sensory Adaptation Decrease in sensitivity to constant stimulation levels. Weber's Law Principle that stimuli must differ by a constant proportion for detection. Synesthesia Condition where one sense is perceived as if by additional senses. Retina Light-sensitive eye surface with rods, cones, and neural processing layers. Blind Spot Point where optic nerve exits the eye, lacking receptor cells. Visual Nerve Nerve transmitting neural impulses from the eye to the brain. Lens Transparent eye structure behind the pupil, aiding image focus. Accommodation Process of lens shape change for focusing on near or far objects. Nearsightedness Clear vision for close objects but blurry for distant ones. Farsightedness Clear vision for distant objects but blurry for close ones. Photoreceptors Rods and cones in the retina converting light into neural signals. Rods Photoreceptors detecting black, white, and gray for peripheral vision. Cones Photoreceptors concentrated for daylight vision, color, and detail. Trichromatic Theory Theory of three color receptors in the retina for color perception. Opponent-process Theory Theory of opposing processes in color vision enabling perception. Psychology the scientific study of mental processes and behavior. Mental Processes Thoughts, feelings, and motives that each of us experiences privately but that cannot be directly observed. Behavior Any action that people can observe or measure Confirmation Bias The tendency to favor information that confirms your existing beliefs. Hindsight Bias The feeling after something happens that you knew it was going to happen. Overconfidence Being more confident than correct; overestimating the accuracy of your beliefs. Empirical Evidence Information from experiments or observations rather than theories. Scientific Method A step-by-step method for conducting research. Hypothesis A prediction that you can test through study and experimentation. Falsifiable Something that can be proven wrong through tests. Peer Review The process of having other experts examine your work to check its validity. Replication Repeating a study to see if the same results are obtained. Reliability The consistency of a research study or measuring test. Validity The accuracy of a test or research to measure what it claims to measure. The American Psychological Association (APA) A major organization for psychologists in the United States. Research Design The plan for a research study, determining how to collect and analyze data. Methodology The specific procedures or techniques used to identify, select, process, and analyze information about a topic. Quantitative Data Data that can be counted or measured and given a numerical value. Qualitative Data Data that describes qualities or characteristics. Likert Scales A scale used to represent people's attitudes or feelings; respondents specify their level of agreement to a statement. Structured Interviews Interviews where everyone is asked the same questions in the same way. Survey Technique A method of gathering information by asking questions to people. Wording Effect How the way a question is phrased can influence the answers given. Social Desirability Bias: The tendency of respondents to answer questions in a manner that will be viewed favorably by others. Naturalistic Observation Watching behaviors occur naturally without interfering. Case Study A detailed examination of a single subject or group. Correlational Research A study that investigates the relationship between two variables to determine if they vary together. Third Variable Problem A situation where an unseen variable affects the results of a study. Scatterplot A graph in which the values of two variables are plotted along two axes, the pattern of the resulting points revealing any correlation present. Correlation Coefficient A number between -1 and 1 that describes the strength and direction of a relationship between variables. Positive Correlation A relationship where if one variable increases, the other does too. Negative Correlation A relationship where if one variable increases, the other decreases. Experimental Method: A method where the researcher manipulates one variable to see if it affects another. Independent Variable The variable that is changed or controlled in a scientific experiment. Dependent Variable The variable that is tested and measured in a scientific experiment. Confounding Variable An extra variable that wasn't accounted for that could affect the results of an experiment. Operational Definitions Clearly defining how you will measure your variables in research. Experimental Group The group in an experiment that receives the variable being tested. Control Group The group in an experiment that does not receive the test variable. Random Assignment Assigning participants to experimental and control groups by chance, which helps ensure that any differences observed after the treatment are due to the treatment and not a preexisting difference. Placebo Effect A change in a participant's illness or behavior that results from a belief that the treatment will have an effect, rather than the actual treatment. Experimenter Bias When a researcher's expectations influence the outcome of a study. Single-Blind Study When the participants do not know whether they are receiving the treatment or not. Double-Blind Study When neither the participants nor the researchers know who is receiving a particular treatment. Placebo Condition A condition in which participants receive a placebo instead of the actual treatment. Sample A group of subjects selected from a larger population for study. Representative Sample: A randomly chosen sample of subjects from a larger population that accurately reflects the characteristics of the larger population. Random Sample A sample that fairly represents a population because each member has an equal chance of being included. Sample Bias A sample that does not accurately represent the population from which it was drawn. Generalizability The extent to which research findings can be applied to larger populations. Statistics The science of collecting, analyzing, presenting, and interpreting data. Descriptive Statistics Statistics that summarize data, such as mean or standard deviation Inferential Statistics: Statistics used to infer the properties of a population, based on a sample of data. Measure of Central Tendency: A statistical measure that describes the center of a data set; includes mean, median, and mode. Mean The average of a set of numbers. Median The middle number in a set of numbers arranged in order. Mode The number that appears most frequently in a data set. Range The difference between the highest and lowest values in a data set. Normal Curve A bell-shaped curve that shows data distribution; most scores fall near the middle. Regression to the Mean The phenomenon that extreme values in data tend to be closer to the average on subsequent measurements. Positive Skew When more scores fall on the low side of the scale and tail on the high side. Negative Skew When more scores fall on the high side of the scale and tail on the low side. Standard Deviation A measure of how spread out numbers are around the mean. Percentile Rank The percentage of scores in a distribution that a specific score is greater than. Bimodal Distribution A distribution of data with two modes or peaks. Statistical Significance The likelihood that a result from data collected by an experiment is not due to chance. Effect Sizes A measure of the strength of the relationship between two variables. Meta Analysis A method of combining data from many different research studies. Institutional Review Boards (IRB) Groups of people responsible for reviewing proposed research to ensure that it is ethical. Informed Consent Permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Informed Assent Agreement by a minor or other not able to give legal consent to participate in the activity. Confidentiality Keeping information given by participants in a research study private. Deception Misleading participants about the true purpose of a study or the events that will transpire. Confederates Actors who take part in a study pretending to be real participants. Debriefing Explaining to participants at the end of a study the true purpose of the study and exactly what transpired.

History 1020 Final Exam- Bo Trisler

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