234652147 MS Nursing Reviewer
Transcript of 234652147 MS Nursing Reviewer
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MEDICAL SURGICAL REVIEWER
Nervous System
Central NS Peripheral NS Autonomic NS
Brain & spinal cord 31 spinal sympathetic NS
Parasympathatic NS
Somatic NS
C- 8 ex. Breakfast 8am – diaphragm, chest wall muscles, shoulder’s & arms
T- 12 ex. Lunch 12nn – upper body, GI functions
L- 5 ex. Dinner 5pm (napaa aga haha) – lower body, bladder, bowel
S- 5 ex. Dinner ulit kasi matakaw
C- 1 ex. Midnight snack 1am
SNS (involved in fight or aggression response / LABAN)
Release of norepinephrine (adrenaline –
cathecolamine)
Adrenal medulla (potent vasoconstrictor)
Increases body activities
Except GIT – decrease GIT motility Why GIT is not increased = GIT is not important!
Increase blood flow to skeletal muscles, brain &
heart.
Effects of SNS (anti-cholinergic/adrenergic)
1. Dilate pupil – to aware of surroundings
- medriasis
2. Dry mouth
3. BP & HR= increased- bronchioles dilated to take more oxygen
4. RR increased
5. Constipation & urinary retention
I. Adrenergic Agents – Epinephrine (adrenaline)
SE: SNS effect
II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’)
Blocks release of norepinephrine.
Decrease body activities except GIT (diarrhea)
Ex. Propanolol, Metopanolol
Sie effects:B – broncho spasm (bronchoconstriction)
E – elicits a decrease in myocardial contraction
T – treats HPN
A – AV conduction slows down
-
Given to angina & MI – beta-blockers to rest heart
Anti HPN agents:
1. Beta blockers (-lol)
2. Ace inhibitors (-pril)
Ex. ENALAPRIL, CAPTOPRIL
3.
Calcium antagonist
Ex. CALCIBLOC or NEFEDIPINE
S/E- of Anti-HPN drugs:
1. orthostatic hpn
2.
transient headache & dizziness.
Mgt. Rise slowly. Assist in ambulation.
Parasympathetic Nervous System: (Cholinergic / BAWI) Effect of PNS: (cholinergic/ opposite ng SNS) Involved in fly or withdrawal response 1. Meiosis – contraction of pupils
Release of acetylcholine (ACTH) 2. Increase salivation
Decrease all bodily activities except GIT (diarrhea) 3. BP & HR decreased
4. RR decrease – broncho constriction
I. Cholinergic agents 5. Diarrhea – increased GI motility
Ex. Mestinon 6. Urinary frequency
Antidote – anti cholinergic agents Atropine Sulfate – S/E – SNS
CENTRAL NS (brain & spinal cord)
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I. Cells – A. Neurons – 10 billion
o Properties and characteristics
a.
Excitability – ability of neuron to be affected in external environment.
b. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another
c. Permanent cells – once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes)
Regenerative capacity
Labile – once destroyed cant regenerate
Epidermal cells, GIT cells, resp (lung cells). GUT
Stable – capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cells
Permanent cells – retina, brain, heart, osteocytes can’t regenerate.
*Neuroglia – attached to neurons.
o Supports neurons. Where brain tumors are found.
Types:
1.
Astrocyte
2. Oligodendria
Astrocytoma – 90 – 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte, most common.
*Astrocyte – maintains integrity of blood brain barrier (BBB).
BBB – semi permeable / selective
Toxins that can pass in BBB:
1.
Ammonia - liver cirrhosis.2.
Carbon Monoxide – seizure & parkinsons.
3. Bilirubin - jaundice, hepatitis, kernicterus/hyperbilirubenia.
4. Ketones –DM.
*OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulse transmission.
No myelin sheath – degenerates neurons
Damage to myelin sheath – demyellenating disorders
**DEMYELLENATING DISEASES
1. ALZHEIMER’S DISEASE – atrophy of brain tissue due to a deficiency of acetylcholine.
S/S: FOUR A’s
A – amnesia – loss of memory A – apraxia – unable to determine function & purpose of object
A – agnosia – unable to recognize familiar object
A – aphasia –
o Expressive – brocca’s aphasia – unable to speak
o Receptive – wernickes aphasia – unable to understand spoken words
Common to Alzheimer – receptive aphasia
Drug of choice – ARICEPT (taken at bedtime) & COGNEX.
Mgt: Supportive & palliative.
*MICROGLIA – stationary cells, engulfs bacteria, engulfs cellular debris.
II. Compositions of Cord & Spinal cord
80% - brain mass
10% - CSF
10% - blood
*MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP.
Normal ICP: 0-15mmHg
BRAIN MASS
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1. Cerebrum – largest part
Corpus collusum - connects R & L cerebral hemisphere.
Function:
1. S - Sensory
2. I - Integrative
3. M – Motor
4.
**LOBES
1.) Frontal
a. Controls motor activityb. Controls personality development
c. Where primitive reflexes are inhibited
d. Site of development of sense of umor
e. Brocca’s area – speech center
Damage - expressive aphasia
2.) Temporal –
a. Hearing
b. Short term memory
c. Wernickes area – gen interpretative or knowing Gnostic area
Damage – receptive aphasia
3.) Parietal lobe – appreciation & discrimation of sensory imp
- Pain, touch, pressure, heat & cold
4.) Occipital - vision
6.) Rhinencephalon/ Limbec
- Smell, libido, long-term memory
2. BASAL GANGLIA – areas of gray matteR located deep within a cerebral hemisphere
Extra pyramidal tract
Releases dopamine
Controls gross voluntary unit
**TRIVIA
Decrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse.
Decrease acetylcholine – Myasthenia Gravis & Alzheimer’s
Increased neurotransmitter = psychiatric disorder Increase dopamine – schizo
Increase acetylcholine – bipolar
3. MID BRAIN – relay station for sight & hearing
Controls size & reaction of pupil 2 – 3 mm
Controls hearing acuity
CN 3 – 4
Isocoria – normal size (equal)
Anisocoria – uneven size – damage to mid brain
PERRLA – normal reaction
4. DIENCEPHALON - between brain
Thalamus – acts as a relay station for sensation
Hypothalamus – (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center, emotionalresponses, controls pituitary function.
5. BRAIN STEM –
a. Pons – or pneumotaxic center – controls respiration
Cranial 5 – 8 CNS
b. Medulla Oblangata - controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus
Vasomotor center, spinal decuissation termination, CN 9, 10, 11, 12
6. CEREBELLUM – lesser brain
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Nursing priority:
1.) Maintain patent a/w & adequate ventilation
a. Prevention of hypoxia – (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention).
o Hypoxia – cerebral edema - increase ICP
o Hypoxia – inadequate tissue oxygenation
Late symptoms of hypoxia ----------- B – bradycardia
E – extreme restlessness
D – dyspnea
C – cyanosis**Early symptoms --------- R – restlessness
A – agitation
T – tachycardia
Increase CO2 retention/ hypercarbia – cerebral vasodilatation = increase ICP
Most powerful respiratory stimulant increase in CO2 ----- remember this!
Hyperventilate decrease CO2 – it excretes CO2 kaya nga dapat i-“brown bag” to retain CO2
Respiratory Distress Syndrome (RDS) – decrease Oxygen
*Suctioning – 10-15 seconds, max 15 seconds.
o Suction upon withdrawal
*Ambu bag – pump upon inspiration
** Assist in mechanical ventilation
1. Maintain patent airway
2. Monitor VS & I&O
3. Elevate head of bed 30 – 45 degrees angle neck in neutral position unless contra indicated to promote venous drainage
4. Limit fluid intake 1,200 – 1,500 ml/day
(side note: FORCE FLUID means = Increase fluid intake/day – 2,000 – 3,000 ml/day) - not for inc ICP.
5. Prevent complications of immobility
6. Prevent increase ICP by:
a. Maintain quiet & comfy environment
b. Avoid use of restraints – lead to fractures
c. Siderails up
d. Instruct patient to avoid the ff:* Avoid valsalva maneuver or bearing down, avoid straining of stool
(give laxatives/ stool softener Dulcolax/ Duphalac)
* Avoid Excessive cough – antitussive
Ex. Dextrometorpham
* Avoid Excessive vomiting – anti emetic (Plasil – brand name sa pinas) / Phenergan
* Avoid Lifting of heavy objects
* Avoid Bending & stooping
* Avoid clustering of nursing activities
7. Administer MEDS as ordered:
1.) Osmotic diuretic – Mannitol./Osmitrol - promotes cerebral diuresis by decompressing brain tissue
Nursing considerations:
o Monitor BP – SE of hypotension
o
Monitor I&O every hr. report if < 30cc out put
o Administer via side drip
o Regulate fast drip – to prevent formation of crystals or precipitate
2.) Loop diuretic - Lasix (Furosemide)
Nursing Mgt:
o Same as Mannitol except
o Lasix is given via IV push (expect urine after 10-15mins) should be in the morning. If given at 7am. Pt will urinate at 7:15
o Immediate effect of Lasix within 15 minutes. Max effect – 6 hrs due (7am – 1pm)
**S/E of Lasix
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1. Hypokalemia (normal K-3.5 – 5.5 meg/L)
S&Sx
Weakness & fatigue
Constipation
() “U” wave in ECG tracing
Nursing Mgt:
o Administer K supplements – ex Kalium Durule, K chloride
o
Potassium Rich food:ABC’s of K
Vegetables Fruits
A - asparagus A – apple
B – broccoli (highest) B – banana – green
C – carrots C – cantalope/ melon
O – orange (highest) –for digitalis toxicity also.
o Vit A – squash, carrots yellow vegetables & fruits, spinach, chesa
o Iron – raisins
o Food appropriate for toddler – spaghetti! Not milk – increase bronchial secretions
o Don’t give grapes – may choke
2. Hypocalcemia (Normal level Ca = 8.5 – 11mg/100ml) or Tetany:
S&Sx
weakness
Paresthesia
(+) Trousseau sign – pathognomonic – or carpopedal spasm. [Put bp cuff on arm = hand spasm.]
(+) Chevostek’s sign - nerve hyperexcitability (tetany) [FACE will contract or twitch kapag haplusin mo]
Arrhythmia
Laryngospasm
Administer – Ca gluconate – IV slowly
*Ca gluconate toxicity: Sx – seizure – administer Mg SO4
*Mg SO4 toxcicity – administer Ca gluconate
B – BP decreaseU – urine output decrease
R – RR decrease
P – patellar reflexes absent
3. Hyponatremia – (Normal Na level = 135 – 145 meg/L)
S/Sx
Hypotension
Signs of Dehydration: dry skin, poor skin turgor, gen body malaise.
Early signs – Adult: thirst and agitation / Child: tachycardia
Mgt: force fluid
Administer isotonic fluid solution
4. Hyperglycemia – increase blood sugar level
P – polyuria
P – polyphagia
P – polydipsia
Nsg Mgt:
Monitor FBS (N=80 – 120 mg/dl)
5.) Hyperurecemia – increase serum uric acid.
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- Tophi- urate crystals in joint.
- kidney stones- renal colic (pain), cool moist skin
- Gouty arthritis - Sx: joint pain & swelling usually at great toe.
Nsg Mgt of Gouty Arthritis
a.) Cheese - dairy products may lower your risk. (Not good if pt taking MAOI – tyramine may lead to HTN crisis)
b.) Force fluid
c.) Administer meds – Allopurinol/ Zyloprim – inhibits synthesis of uric acid – drug of choice for gout
Colchicene – excretes uric acid. Acute gout drug of choice.
d.) Avoid sardines, anchovies, organ meat
**Kidney stones – renal colic (pain). Cool moist skin
Mgt:
o Force fluid
o Meds – narcotic analgesic
o Morphine SO4
SE of Morphine SO4 toxicity
o Respiratory depression (check RR 1st
)
o Antidote for morphine SO4 toxicity –Narcan (NALOXONE)
o Naloxone toxicity – tremors
**BALIK TAYO INCREASE ICP ------------------------------------------------------------------------------------------------------------------
Increase ICP meds:
3.) Corticosteroids - Dexamethsone – decrease cerebral edema (Decadrone)
4.) Mild analgesic – codeine SO4. For headache.
5.) Anti consultants – Dilantin (Phenytoin)
Question: Increase ICP what is the immediate nsg action?
Administer Mannitol as ordered --- mannitol kagad basta ordered
Elevate head 30 – 45 degrees
Restrict fluid
Avoid use of restraints
Question: Pt suffering from epiglotitis. What is nsg priority?
a.
Administer steroids – least priority
b. Assist in ET – n/a
c. Assist in tracheotomy – permanent (Answer)
d. Apply warm moist pack? Least priority
Rationale: Wont need to pass larynx due to larynx is inflamed. ET can’t pass. Need tracheostomy only
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Drug Monitoring
Drug N range Toxicity Classification Indication
D – digoxin 0.5 – 1.5 meq/L 2 cardiac glycosides CHF
L - lithium 0.6 – 1.2 meq/L 2 antimanic bipolar
A – aminophylline 10 – 19 mg/100ml 20 bronchodilator COPD
D – Dilantin 10 -19 mg/100 ml 20 anticonvulsant seizures
A – acetaminophen 10 – 30 mg/100ml 200 analgesic osteoarthritis
Digitalis – increase cardiac contraction = increase CO // Digitalis toxicity – antidote - DigivineNursing Mgt
1.
Check PR, HR (if HR below 60bpm, don’t giveDigoxin)
a. Anorexia -initial sx. GIT
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b. nausea/vomiting
c. Diarrhea
d.
Confusion
e. Photophobia
f. Changes in color perception – yellow spots
(Ok to give to pts with renal failure. Digoxin is metabolized in liver not in kidney .)
L – lithium (lithane) - decrease levels of norepinephrine, serotonine, acetylcholine
Antimanic agent
S/Sx -a.) Anorexia
b.)
Diarrhea
c.) Dehydration – force fluid, maintain Na intake 4 – 10g daily
d.) Hypothyroidism
(CRETINISM – the only endocrine disorder that can lead to mental retardation)
A – Aminophyline (theophylline) – dilates bronchioles.
Take bp before giving aminophylline.
S/Sx : Aminophylline toxicity:
1.
Tachycardia
2.
Hyperactivity – restlessness, agitation, tremors
Question: Avoid giving food with Aminophylline
a. Cheese/butter – food rich in tyramine, avoided only if pt is given MAOI
b.
Beer/ wine -
Hot chocolate & tea – caffeine – CNS stimulant, can cause tachycardia
c. Organ meat/ box cereals – anti parkinsonian
**MAOI – antidepressant // 3 – 4 weeks - before MAOI will take effect
m AR plan
n AR dil Avoid tyramine rich foods, can lead to CVA or hypertensive crisis
p AR nate
Anti Parkinsonian agents – Vit B6 Pyridoxine reverses effect of Levodopa
D – dilatin (Phenytoin) – anti convulsant/seizure
Nursing Mgt:
1.
Mixed with plain NSS or .9 NaCl to prevent formation of crystals or precipitate
Do sandwich method
Give NSS then Dilantin, then NSS!
2. Instruct the pt to avoid alcohol – bec alcohol + dilantin can lead to severe CNS depression
Dilantin toxicity:
S/Sx:
G – gingival hyperplasia – swollen gums
Oral hygiene – soft toothbrushMassage gums
H – hairy tongue
A - ataxia
N – nystagmus – abnormal movement of eyeballs
A – acetaminophen/ Tylenol – non-opoid analgesic & antipyretic – febrile pts
Acetaminophen toxicity :
Hepato toxicity
Monitor liver enzymes
**SGPT (ALT) – Serum Glutamic Piruvate Tyranase
**SGOT- Serum Glutamic Acetate Tyranase
Monitor BUN (10 – 20)
Creatinine (.8-1)
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Acetaminophen toxicity can lead to hypoglycemia
T – tremors, Tachycardia
I – irritability
R – restlessness
E – extreme fatigue
D – depression (nightmares) , Diaphoresis
Antidote for acetaminophen toxicity – Acetylcesteine =
causes outporing of secretions. Suction.
Prepare suctioning apparatus.
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PARKINSONS (parkinsonism) chronic, progressive disease of CNS char by degeneration of dopamine producing cells in substancia nigra at mid brain &
basal ganglia
Function of dopamine: controls gross voluntary motors.
Predisposing Factors:
o Poisoning (lead & carbon monoxide). Antidote for lead = Calcium EDTA
o Hypoxia
o Arteriosclerosis
o Encephalitis
o High doses of the ff:
a. Reserpine (serpasil) anti HPN, Side Effect – 1.) depression 2.) breast cancer
b. Methyldopa (aldomet)
c. Haloperidol (Haldol)- anti psychotic
d. Phenothiazide - anti psychotic
**SE of anti psychotic drugs – Extra Pyramidal Symptom Over meds of anti psychotic drugs – neuroleptic malignant syndrome char by tremors (severe)
S/Sx: Parkinsonism –
1. Pill rolling tremors of extremities – early sign
2. Bradykinesia – slow movement
3.
Over fatigue
4. Rigidity (cogwheel type)
a. Stooped posture
b. Shuffling – most common
c.
Propulsive gait
5. Mask like facial expression with decrease blinking eyes
6. Monotone speech
7. Difficulty rising from sitting position
8.
Mood labilety – always depressed – suicide
Nsg priority: Promote safety
9. Increase salivation – drooling type
10. Autonomic signs:
Increase sweating
Increase lacrimation – iyakin!
Seborrhea (increase sebaceous gland) – oily!
Constipation
Decrease sexual activity
**Nsg Mgt:
1. Anti parkinsonian agents
Levodopa (L-Dopa) – short acting
Carbidopa (Sinemet) – long acting Amantadine Hcl (Symmetrel) – eto hindi ko alam haha
Mechanism of action
Increase levels of dopa – relieving tremors & bradykinesia
*S/E of anti parkinsonian
o Anorexia
o n/v
o Confusion
o Orthostatic hypotension
o Hallucination
o Arrhythmia
*Contraindication:
o Narrow angled closure glaucoma o Pt taking MAOI (Parnate, Marplan, Nardil)
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*Nsg Mgt when giving anti-parkinsonian:
Take with meals – to decrease GIT irritation
Inform pt – urine/ stool may be darkened
Instruct pt- don’t take food Vit B6 (Pyridoxine) cereals, organ meats, green leaf y veg
Cause B6 reverses therapeutic effects of levodopa
Give INH (Isoniazide-Isonicotene acid hydrazide.) SE-Peripheral neuritis.
2. Anti cholinergic agents – relieves tremors
o Artane
o
Cogentin
3. Antihistamine – Diphenhydramine Hcl (Benadryl)
S/E: Adult – drowsiness, – avoid driving & operating heavy equipt. Take at bedtime.
Child – hyperactivity CNS excitement for kids.
4. Dopamine agonist
Bromotriptine Hcl (Parlodel) – respiratory depression. Monitor RR.
**Nsg Mgt – Parkinson
1.) Maintain siderails
2.) Prevent complications of immobility
o
Turn pt every 2ho Turn pt every 1 h – elderly
3.) Assist in passive ROM exercises to prevent contractures
4.) Maintain good nutrition
CHON (protein) – in am
CHON (protein) – in pm – to induce sleep – due Tryptopan – Amino Acid
5.) Increase fluid in take, high fiber diet to prevent constipation
6.) Assist in surgery – Sterotaxic Thalamotomy
Complications in sterotaxic thalmotomy- 1.) Subarachnoid hemorrhage 2.) aneurism 3.) encephalitis
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MULTIPLE SCLEROSIS (MS) - myelin sheathChronic intermittent disorder of CNS – white patches of demyelenation in brain & spinal cord.
Remission & exacerbation
Common – women, 15 – 35 yo cause – unknown
Predisposing factor:
1. Slow growing virus
2. Autoimmune – (supportive & palliative treatment only)
*Normal Resident Antibodies:
Ig G – can pass placenta – passive immunity. Short acting.
Ig A – body secretions – saliva, tears, colostrums, sweat
Ig M – acute inflammation
Ig E – allergic reactions
IgD – chronic inflammation
**S & Sx of MS: (everything down)
1. Visual disturbances
a. Blurring of vision
b. Diplopia/ double vision
c. Scotomas (blind spots) – initial sx
2. Impaired sensation to touch, pain, pressure, heat, cold
a. Numbness
c. Paresthesia – tingling sensation
3. Mood swings – euphoria (sense of elation )
4. Impaired motor function:
a. Weakness
b. Spasiticity –“ tigas”
c. Paralysis –major problem
5. Impaired cerebellar function
Triad Sx of MS aka (Charcot’s triad)
I – intentional tremors
N – nystagmus – abnormal rotation of eyes
A – Ataxia & Scanning speech
6. Urinary retention or incontinence
7. Constipation
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8. Decrease sexual ability
**Dx – MS
1. CSF analysis thru lumbar puncture
- Reveals increase CHON & IgG
2. MRI – reveals site & extent of demyelination
3. Lhermitte’s response is (+). Introduce electricity at the back. Theres spasm & paralysis at spinal cord.
Nsg Mgt MS
Supportive mgt1.) Meds
a. Acute exacerbation
ACTH – adenocorticotopic
Steroids – to reduce edema at the site of demyelination to prevent paralysis
2. Maintain siderails
3. Assist passive ROMexercises – promote proper body alignment
4. Prevent complications of immobility
5. Encourage fluid intake & increase fiber diet – to prevent constipation
6. Provide catheterization die urinary retention
7. Give diuretics
Urinary incontinence – give Prophantheline bromide (probanthene)
Antispasmodic anti cholinergic
8. Give stress reducing activity. Deep breathing exercises, biofeedback, yoga techniques.
9. Provide acid-ash diet – to acidify urine & prevent bacteria multiplication
Ex. Grape, Cranberry, Orange juice, Vit C
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MYASTHENIA GRAVIS (MG) disturbance in transmission of impulses from nerve to muscle cell at neuro muscular junction.
Common in Women, 20 – 40 yo, unknown cause or idiopathic
Autoimmune – release of cholenesterase – enzyme [REMEMBER! Lumabas sa boards yan.]
Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine
Descending muscle weakness
Nsg priority:
o a/w o aspiration o immobility
S/ Sx:
Ptosis – drooping of upper lid of the eye ( initial sign)
Check Palpebral fissure – opening of upper & lower lids = to know if (+) of MG.
Diplopia – double vision
Mask like facial expression
Dysphagia – risk for aspiration!!!
Weakening of laryngeal muscles – hoarseness of voice
Resp muscle weakness – leads to respiratory arrest. [Prepare at bedside tracheostomy set]
Extreme muscle weakness during activity especially in the morning.
Dx test
Tensilon test (Edrophonium Hcl) – temporarily strengthens muscles for 5 – 10 mins. Short term- cholinergic. PNS effect.
o Remember ung aso sa video dati, ung biglang lumakas – meaning nun (+) sya for MG
Nsg Mgt
1. Maintain patent a/w & adequate vent by:
*Assist in mechanical vent – attach to ventilator
*Monitor pulmonary function test.
= kasi decreased vital lung capacity ung pt.
2. Monitor VS, I&O neuro check, muscle strength or motor
grading scale (4/5, 5/5, etc)
3. Siderails
4. Prevent complications of immobility.
Adult - every 2 hrs. // Elderly - every 1 hr.
5. NGT feeding
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4. Assess for movement & sensation of extremeties
Result
1. CSF analysis: a. increase CHON & WBC Content of CSF: CHON, WBC, Glucose
b. Decrease glucose
Confirms meningitis c. increase CSF opening pressure
N 50 – 160 mmHg
d. (+) Culture microorganism
2. Complete blood count CBC – reveals increase WBC
Management:
1. Adm meds
a.) Broad-spectrum antibiotic penicillin
**Side effects:
1.
GIT irritation – take with food
2. Hepatotoxicity, nephrotoxcicity
3. Allergic reaction
4.
Super infection – alteration in normal bacterial flora
Normal flora sa throat – streptococcus
Normal flora sa intestine – e coli
**Sign of superinfection of penicillin = diarrhea
b.) Antipyretic
c.) Mild analgesic
2. Strict respiratory isolation 24h after start of antibiotic therapy
**Side note:
A – Cushing’s synd – reverse isolation - due to increased corticosteroid in body.
B – Aplastic anemia – reverse isolation - due to bone marrow depression.
C – Cancer any type – reverse isolation – immunocompromised.
D – Post liver transplant – reverse isolation – takes steroids lifetime.
E – Prolonged use steroids – reverse isolation
F – Meningitis – strict respiratory isolation – safe after 24h of antibiotic therapy
G – Asthma – not to be isolated
3. Comfy & dark room – due to photophobia & seizure4. Prevent complications of immobility
5. Maintain F & E balance
6. Monitor vs, I&O, neuro check
7. Provide client health teaching & discharge plan
a. Nutrition – increase cal & CHO, CHON-for tissue repair. Small freq feeding
b. Prevent complication hydrocephalus, hearing loss or nerve deafness.
8. Prevent seizure.
Where to bring 2 y/o post meningitis
Audiologist - due to damage to hearing- post repair myelomeningocele
Urologist -Damage to sacral area – spina bifida – controls urination
9. Rehab for neurological deficit. [Can lead to mental retardation or a delay in psychomotor development.]
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CEREBRO VASCULAR ACCIDENT – stroke, brain attack or cerebral thrombosis, apoplexy Partial or complete disruption in the brains blood supply
2 largest & common artery in stroke
Middle cerebral artery
Internal carotid artery
Common to male – 2 – 3x high risk
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