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N474 ADULT MIDTERM EXAM
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N474 ADULT MIDTERM EXAM...
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multiple sclerosis definechronic, progressive autoimmune disease that causes the body to attack the
myelin sheath
multiple sclerosis Manifestations
●Fatigue (most common)
●Muscle weakness/spasticity
●numbness/tingling
●Ataxia (decreased motor coordination)
multiple sclerosis Diagnosis
health history, MRI to look for plaques/lesions in the myelin sheath, &
blood/CSF collection to look for elevated proteins, increased WBC & increased
IGG bands
multiple sclerosis treatment
focuses on the prevention of progression & treatment of symptoms
●Immunosuppressants
●Corticosteroids (help reduce inflammation)
●PT
●Meds for symptom management
multiple sclerosis Nursing interventions
●Teach ways to prevent infection d/t decreased immunity
●Provide ways to manage fatigue (taking breaks, prioritizing tasks, exercise, &
mobility devices)
●Educate about the increased risk for falls & safety
●Educate about UTI prevention d/t increased risk for urinary retention
●Help manage chronic pain
Parkinsons define
degeneration of dopamine causing accumulation of lewy bodies
Parkinsons Manifestations
T-tremors, shaking (usually starts on 1 side)
R- rigidity/stiffness of limbs/neck/trunk
A-akinesia (loss/impairment in power of voluntary movement)
P- postural/balance losses
Parkinsons Diagnosis
hx, look for TRAP s/s, MRI, dopamine transporter scan, blood work
Parkinsons Treatment
,● Meds:
○ Levodopa-carbidopa (Sinemet): helps w/ movement symptoms
○ Dopamine agonist, MAO inhibitors, adenosine 2A antagonists,
anticholinergics, amantadine
● Exercise programs
● Massage therapy
● Diet
● Speech therapy
● High intensity focused ultrasound: uses soundwaves to treat tremors
● Deep brain Stimulator: last resort, an invasive surgery
Parkinsons nursing interventions
goal is to maintain independence as long as possible while remaining safety
● Mobility: high risk for falls, use assistive devices
● Sleep: insomnia is a big concern
● Nutrition: may have difficulty swallowing which can lead to impaired
nutrition
● Communication: use speech path & alternative methods for communication
Ischemic stroke define
lack of blood blow to area in brain, most common stroke
Ischemic stroke: Embolic
a clot is formed in one place & travels to the brain
Ischemic stroke: Thrombotic
a clot is formed in the brain vessel overtime, most common
○ s/s generally begin in the morning or during sleep & PTs will awake w/
deficits
○ Deficits will become progressively worse & may come and go
Hemorrhagic stroke
rupture of blood vessel in brain causing blood to leak into surrounding brain
tissue
● Can cause increased ICP in brain & a reduction of blood flow
● Most common cause: uncontrolled HTN
Intracerebral hemorrhage:
poor prognosis, not common, treatment aimed at treating ICP
Subarachnoid hemorrhage:
bleeding into cerebrospinal space, characterized as worst headache
Hemorrhagic stroke treatment
clipping/coiling (surgery)
, ○ All PTs will be kept in ICU for 14 days d/t increased risk for vasospasm
which can cause an ischemic stroke
Hemorrhagic stroke s/s
● One sided weakness
● numbness/paralysis of face, arms, or legs
● Blurred vision
● Difficulty speaking
● Slurred speech
● Facial droop
● Loss of balance/coordination
● Severe headache
Right sided brain damage s/s
○Left side paralysis
○Left-side neglect
○Spatial-perceptual deficits
○denial/minimizes problems
○Rapid performance/short attention span
○Impulsive
○Impaired judgement
Left sided brain damage s/s
○Ride side paralysis
○Receptive aphasia: can’t understand language
○Expressive aphasia: can’t express language
○Fluent dysphasia: speech present, but little meaningful communication
○Non-fluent dysphasia: slow comprehension of language
○Aware of deficits
○depression/anxiety
○Impaired time concepts
Wernicke's area: language reception area, if damaged impairs...
ability to understand spoken or written words
Broca's area: language expression area, if damaged...
can’t express words
Dysarthria
disturbance in muscular control of speech
Brain damage Diagnosis
●CT scan, MRI, PET, angiogram to rule out aneurysm, & doppler
○CT scan always done first, if it shows up inconclusive MRI is done
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