Approach and Management of Delirium, Meniere's, Brain Injury, and Migraines, Exams of Nursing

Download Approach and Management of Delirium, Meniere's, Brain Injury, and Migraines and more Exams Nursing in PDF only on Docsity! THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score Delirium is characterized by a. Disturbance in attention, consciousness, and cognition. The HALLMARK of delirium is a clouding of consciousness, with an inability to focus, sustain, or shift attention, as well as a change in cognition, including impairment in short- term memory, disorientation, and perceptual disturbances. Diagnostic Criteria for Delirium A. A disturbance in attention and awareness B. The disturbance develops over a SHORT period of time (usually hours to a few days), C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). Diagnostics for delirium Chest x-ray study, Other Diagnostics, ECG, Head CT or MRI*, Lumbar puncture* CBC and differential, ESR, Platelet count, Serum electrolytes, Serum glucose, Calcium, Magnesium, Phosphorus, BUN, Creatinine, LFTs, Vitamin B12, Folate, Thiamine, Ammonia, Thyroid function tests Which tool is now the most widely used tool for evaluation of the presence of delirium The Confusion Assessment Method Which medication class has long been implicated as a risk factor for delirium, Anticholinergic medications THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score Treatment of delirium is both- definitive and palliative Definitive care of those with delirium is aimed at identification and treatment of the precipitating causes palliative care of those with delirium is directed toward- the management of symptoms, such as agitation, restlessness, and hallucinations. These medications may be useful in controlling agitation and psychosis, although there is no compelling evidence that demonstrates improvement in the prognosis of delirium with their use Antipsychotic medications such as haloperidol and droperidol These newer medications may be used in small doses for behavior management in the short term when patient or staff safety is compromised. Newer antipsychotics such as risperidone, quetiapine, and olanzapine These medications are useful in the treatment of alcohol and sedative withdrawal. Benzodiazepines. The goals of treatment for the patient with delirium are to, promote recovery, to prevent additional complications, to maintain the patient's safety, maximize function. What is Meniere's disease? Meniere disease is a chronic condition of the inner THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score The Glascow Coma Scale is defined as the measurement tool most frequently used to measure the level of consciousness immediately following an injury The three categories that makes up the GCS eye opening, motor response, verbal response Which GCS score indicates severe Traumatic Brain Injury?8 or less Which GCS score places an individual in the moderate severity Traumatic Brain Injury? 9-12 Which GCS score places an individual in the mild severity Traumatic Brain Injury?13-15 Major leading cause of Traumatic Brain Injury--Falls in both adults and children Two main phases of primary injury that can result in cognitive dysfunction are direct impact & rotational acceleration The two main phases of injury, direct impact and rotational acceleration, give rise to systemic complications and cellular injury mechanisms that result in... cell death, axonal injury, impaired synaptic plasticity 4 categories of s/s of concussion physical, cognitive, emotional, sleep What is the most common symptom of a concussion---headache What is the definition of post concussion syndrome the persistence of post- concussive symptoms beyond the expected timeframe. symptoms occurring 7-10 days after a mild traumatic brain injury that CAN LAST FOR WEEKS TO MONTHS AND UP TO A YEAR Persons experiencing Post concussion syndrome report limitations in functional status, activities of daily living, school or work related activities, leisure and recreational activities, social interactions, financial independence Risk factors for PCS include, comorbid psychiatric illness, advanced age, heightened symptoms, intense emotions (severe anxiety) at the time of injury A patient with a blow to the head with an object, you can expect... damage to underlying tissue/vessels A patient that is thrown against a wall or solid surface, you can expect... focal and diffuse damage A patient that is punched in the face or head, you can expect... THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score contusions/bruising/bleeding A person that experiences violent shaking of the body, you can expect diffuse agonal injuries/torn nerve tissue A patient that falls and hits their head...you can expect focal and diffuse damage A patient that is being strangled, you can expect... diffuse damage (hypoxia) A patient that had a near drowning, you can expect... diffuse damage (hypoxia) A patient that was shot in the face or head, you can expect... disintegration of brain tissue Chronic Traumatic Encephalopathy (CTE) a progressive, degenerative condition involving brain damage resulting from multiple episodes of head trauma 4 stages of chronic traumatic encelopathy THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score Stage 1-patients experience depression, headaches, and short term memory loss Stage 2- difficulty controlling impulses, suicidal thoughts and severe headaches Stage 3-apathy, severe memory problems and impaired judgement Stage 4-paranoia, severe depression, aggression, dementia and suicidal behaviors What is he fifth cranial nerve,--the trigeminal nerve, What is the trigeminal nerve? is a large, mixed sensory and motor nerve that originates in the brainstem and travels in the cervical cord, with the sensory ganglion found in the Meckel cave in the middle cranial fossa What is the he primary feature of Trigeminal Neuralgia===recurrent paroxysms of pain in the distribution of any branch of the trigeminal nerve. The pain is usually described as burning, stabbing, sharp, penetrating, or electric shock-like and usually is on ONE SIDE OF THE FACE patient does not awaken from sleep during a paroxysm. A characteristic feature of trigeminal neuralgia is the trigger zone, a small area of the skin or orobuccal mucosa that the patient can identify as the point that sets off an attack. Criteria for diagnosis of Trigeminal neuralgia include: •Paroxysms of pain lasting from a fraction of a second to 2 minutes and affecting one or more divisions of the trigeminal nerve without radiation of symptoms, Pain characterized as at least three events of intense, sharp, superficial, or stabbing nature and precipitated from trigger areas or trigger factors, No clinically identified neurologic deficit, Not attributable to another disorder Diagnostics include- MRI, CT, Electrophysiology testing THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score factor, CSF cell count, Diagnostic imaging for migraines includes, CT scan, MRI*, CSF, cerebrospinal fluid; Referral for those with migraines should be made when suspected temporal arteritis, change in mental status, nuchal rigidity, neurologic deficit, or new onset of headache-especially over the age of 50. Immediate emergency department referral for one with a migraine is indicated for abrupt onset "THUNDERCLAP HEADACHE," trauma, or headache with associated neurologic abnormalities on physical examination Two areas of pharmacological management of migraines abortive and preventive Preventive pharmacological management is indicated when patients if they are unable to deal with their attacks, they experience MORE THAN FOUR headaches a month, or, the attacks are prolonged and refractory to medicine THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score Abortive therapy is used to treat the intensity and duration of pain during an attack and to manage associated symptoms, such as nausea and vomiting First line treatment of migraines include Simple analgesics, such as acetaminophen and aspirin, can represent first-line treatment in the management of mild to moderate headaches. NSAIDS===if not relieved........Corticosteroids,Triptans When simple analgesics are ineffective in treating migraines, the next step would be to combinine them with a short-acting barbiturate, such as butalbital (Fioricet, Fiorinal, Esgic), Indications for Referral or Hospitalization for those with migraines not easily controlled by routine headache medicines.• Rebound headaches or habituation limits outpatient therapy.• Headache is new and progressively worsening. •Headache is described as the "worse headache of my life."• Headache is affecting the patient's quality of life.• Headache is accompanied by neurologic symptoms that last longer than 30 minutes or is accompanied by numbness or hemiparesis Mild cognitive impairment (MCI) is thought to be a, transitional state between normal aging and dementia Two types of MCI, amnestic, nonamnestic, Amnestic mild cognitive impairment is characterized by deficits in memory; Nonamnestic MCI involves impairments in other cognitive functions Mild cognitive impairment or MCI is a risk factor for dementia Alzheimer disease is characterized by amyloid plaques and neurofibrillary tangles. Examinations of the brains of patients with Alzheimer disease show atrophy of the cerebral cortex that is usually diffuse but may be more pronounced in the frontal, temporal, and parietal lobes. Vascular Dementia is Multiple areas of focal ischemic change characterize vascular dementia, formerly known as multi-infarct dementia the defining lesion is the lacunar infarct. Patients with which history are particularly at risk for developing dementia hypertension, THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score diabetes, hyperlipidemia, peripheral vascular occlusive diseases are at particular risk. Lewy body dementia is characterized by the presence of Lewy bodies in the brain.there is a loss of dopamine-producing neurons, similar to that seen in Parkinson disease, and a loss of acetylcholine, similar to that seen in Alzheimer disease. Pseudodementia--Depression in older adults can lead to memory loss, attention deficits, and problems with initiation Clinical Presentation of a patient with dementia, Memory loss, personality changes, language disturbances, problems with independent activities of daily living Clinical Presentation of a patient with Lewy body dementia visual hallucinations, motor impairments, postural instability, sleep disturbances Patients with Lewy body dementia get worse with which type of medication Haldol Three stages of alzheimers early, middle, and late THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score Benzodiazepines can be utilized in all of the following scenarios except for: Group of answer choices Maria is a 22-year-old woman who has been complaining of headaches, dizziness, and memory problems. In addition, there are bruises on her neck and arms. She mentions that she is in an intimate relationship with someone who has a bad temper. What is NOT an appropriate approach for the screening of traumatic brain injury in this patient? Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT) Which of the following is NOT an overlapping symptom of Post Traumatic Stress Disorder (PTSD) and Persistent Post Concussive Syndrome (PPCS): (TBI) medication cause paradoxical agitation? Different head injuries and what they cause: THE WEEK 1 EXAM REPLY FOCUSES ON THE ASSESSMENT, DIAGNOSIS, AND TREATMENT Q & A. Download to score symptoms, intense emotions (severe anxiety) at the time of injury A patient with a blow to the head with an object, you can expect... damage to underlying tissue/vessels A patient that is thrown against a wall or solid surface, you can expect... focal and diffuse damage A patient that is punched in the face or head, you can expect... contusions/bruising/bleeding A person that experiences violent shaking of the body, you can expect diffuse agonal injuries/torn nerve tissue A patient that falls and hits their head...you can expect focal and diffuse damage A patient that is being strangled, you can expect... diffuse damage (hypoxia) A patient that had a near drowning, you can expect... diffuse damage (hypoxia) A patient that was shot in the face or head, you can expect...