1. Respiratory Assessment
1.1. A&P Review
1.1.1. Functions
1.1.1.1. UR: Warms, filters air
1.1.1.2. LR: Gas exchange
1.1.1.2.1. Oxygen to tissues
1.1.1.2.2. Carbon dioxide out to air
1.1.1.2.3. (works with circulatory)
1.1.2. Structures
1.1.2.1. Lungs
1.1.2.2. Pleura
1.1.2.3. Mediastinum
1.1.2.4. Lobes
1.1.2.4.1. 2 on left
1.1.2.4.2. 3 on right
1.1.2.5. Bronchi/bronchioles
1.1.2.6. Alveoli
1.1.2.6.1. Site of gas exchange
1.1.2.6.2. Lubricated by surfactant
1.1.2.6.3. Three types
1.1.3. Ventilation
1.1.3.1. Inspiration
1.1.3.1.1. 1/3 of cycle
1.1.3.1.2. Contraction
1.1.3.1.3. Increases space of diaphragmatic chamber
1.1.3.1.4. Lowers ITP
1.1.3.1.5. Air enters lungs, inflates them
1.1.3.2. Expiration
1.1.3.2.1. 2/3 of cycle
1.1.3.2.2. Relaxation of diaphragm >>
1.1.3.2.3. UPWARD movement >>
1.1.3.2.4. Increases ITP
1.1.3.2.5. Pushes air out of lungs
1.1.3.3. Inadequate ventilation
1.1.3.3.1. Decreased compliance
1.1.3.3.2. Increased resistence
1.1.4. Perfusion
1.1.4.1. R/T to ventilation
1.1.4.1.1. Oxygen to hemoglobin
1.1.4.1.2. Delivery of oxygen to tissues
1.1.4.1.3. Cellular respiration
1.1.4.2. Signs of hypoxemia
1.1.4.2.1. Cyanotic or darker nail beds or sclera
1.1.4.2.2. Pale and clammy skin
1.1.5. V/Q ratio
1.1.5.1. V = Ventilation
1.1.5.1.1. Movement of air into/out of lungs
1.1.5.2. Q = Perfusion
1.1.5.2.1. Filling pulmonary capillaries w/blood
1.1.5.2.2. Entire output of RV
1.1.5.3. Gas exchange @ alveoli
1.1.5.3.1. Adequate V/Q ratio
1.1.5.3.2. Matched ventilation + perfusion
1.2. Gerontological Differences
1.2.1. Decreased secretions
1.2.2. Weaker lungs
1.2.3. Weaker chest muscles that calcify
1.2.4. Decreased airway diameter
1.2.5. Increased immunosuppression
1.3. Assessment
1.3.1. History
1.3.1.1. Dyspnea
1.3.1.2. Clubbing
1.3.1.3. Cyanosis
1.3.1.4. Accessory muscle use
1.3.1.5. Cough
1.3.1.6. Sputum production
1.3.1.7. Chest pain
1.3.1.8. RR rate per minute
1.3.1.9. WOB
1.3.1.10. Lung sounds
1.3.1.10.1. Normal
1.3.1.10.2. Adventitious
1.3.2. Lung volumes & capacities
1.3.2.1. TV = Air of each breath
1.3.2.1.1. Use spirometer
1.3.2.1.2. Measure several breaths
1.3.2.2. IRV = Max volume inhaled during normal INH
1.3.2.3. ERV = Max volume exhaled during normal EXHL
1.3.2.4. VC: TV + IRV + ERV
1.3.2.5. FEV: Volume exhaled forcefully / sec
1.3.3. Pulse oximetry
1.3.3.1. Non-invasive
1.3.3.2. Oxygen saturation of HgB in blood
1.3.3.3. Normal is 95%+
1.3.3.4. May be unreliable (so still check ABGs)
1.3.3.5. Check machine if running unusually low**
1.4. Diagnostics
1.4.1. Pulmonary function tests
1.4.2. ABGs
1.4.3. Sputum tests
1.4.4. CXR, CT, MRI
1.4.5. Fluroscopic stuies
1.4.6. Radioisotope procedures
1.4.7. Bronchoscopy
1.4.7.1. Scope test
1.4.7.2. Conscious sedation
1.4.7.3. May cough up blood
1.4.7.4. No red juice or soda
1.4.7.4.1. Interferes w/interpretation
1.4.8. Thorascopy
1.4.9. Thoracentesis
1.4.9.1. Pleural effusion
1.4.9.2. Monitor site for excess bleeding or fluid
1.4.9.3. Pain management needed
1.4.10. Biopsies
2. COPD
2.1. Overview
2.1.1. Airflow limitation that isn't fully reversible
2.1.1.1. Progressive decrease of oxygen flow to all tissues
2.1.1.2. R/T abnormal inflammation caused by toxins
2.1.1.3. Airways, lungs, pulmonary vasculature
2.1.1.4. Scar tissue forms
2.1.1.4.1. Airway obstruction
2.1.1.4.2. Lung tissue damage r/t damaging substances
2.1.1.5. Altered vasculature >> vessel damage
2.1.2. Fourth leading COD (12th leading CO disability)
2.1.3. Made of disease(s) that cause airflow obstruction
2.1.3.1. Chronic bronchitis
2.1.3.2. Emphysema
2.1.3.3. (either or)
2.1.4. No longer includes asthma (but may be comorbid)
2.2. Risk Factors
2.2.1. Tobacco smoke
2.2.1.1. 80%+ of ALL cases
2.2.1.1.1. Damages alveoli
2.2.1.1.2. Destroys cilia (defenses)
2.2.1.2. Most important risk factor
2.2.1.2.1. 8 years of smoking or more (especially)
2.2.1.2.2. May also include passive smoking (second-hand)
2.2.1.3. Smoking cessation
2.2.1.4. Ask about pack-year history
2.2.1.5. Confined areas = increased damage
2.2.2. Non-modifiable
2.2.2.1. Ambient air pollution
2.2.2.2. Occupational hazards
2.2.2.3. Genetics
2.2.2.3.1. Alpha-antitrypsin
2.3. Pathophysiology
2.3.1. COPD
2.3.1.1. Defining characteristics
2.3.1.1.1. At least 3 mo over 2 consecutive years
2.3.1.1.2. Aggravating, persistent cough
2.3.1.2. Irritation of airways
2.3.1.2.1. Inflammation, hypersecretion of mucus
2.3.1.2.2. Proliferation of mucus-secreting glands & goblet cells
2.3.1.2.3. >> Clogs the airway
2.3.1.3. Structural changes
2.3.1.3.1. Reduced ciliary fxn
2.3.1.3.2. Thickened bronchial walls
2.3.1.3.3. Narrowed bronchial airways
2.3.1.3.4. Mucus plugging
2.3.1.3.5. Damaged, fibrosed alveoli
2.3.1.3.6. Diminished alveolar macrophage fxn
2.3.2. Emphysema
2.3.2.1. Distension of air spaces beyond terminal bronchioles
2.3.2.2. Destruction of alveolar walls
2.3.2.2.1. Decreased alveolar surface area
2.3.2.2.2. Increased "dead space"
2.3.2.2.3. Impaired oxygen diffusion
2.3.2.2.4. [NO GAS EXCHANGE IS HAPPENING!]
2.3.2.3. Pulmonary capillary bed reduced
2.3.2.3.1. Increased vascular resistence
2.3.2.3.2. Increased pulmonary artery pressure
2.3.2.4. Ultimately causes hypoxemia, cor pulmonale**
2.3.2.5. Other manifestations
2.3.2.5.1. 2:1 AP ratio instead of 1:2
2.3.2.5.2. May not report problems w/breathing b/c feels normal
2.3.2.5.3. Tripod position helps SOB (or Semi-Fowler's position)
2.4. Clinical Manifestations
2.4.1. Appearance
2.4.1.1. Pink puffer
2.4.1.1.1. Severe COPD
2.4.1.1.2. Thin with low muscle mass
2.4.1.1.3. Puffing r/t "air hunger"
2.4.1.1.4. Troubling removing CO2
2.4.1.1.5. Pursed lip breathing
2.4.1.2. Blue bloater
2.4.1.2.1. Appear blue-tinged, dusky
2.4.1.2.2. Bronchitis
2.4.1.2.3. Mucus blocks airway
2.4.1.2.4. Hypoxemia
2.4.2. Slumped over appearance
2.4.2.1. Energy conservation
2.4.2.2. Tripod position for gas exchange
2.4.3. Will appear to be in distress
2.4.3.1. WILL NOT COMPLAIN
2.4.3.1.1. It feels normal
2.4.3.1.2. Monitor frequently
2.4.3.2. r/t increased CO2, low oxygen
2.4.4. Chronic cough w/sputum
2.4.5. Dyspnea
2.4.5.1. Exertion
2.4.5.2. Rest
2.4.5.3. Orthopnea
2.4.6. Weight loss
2.4.7. Large neck muscles
2.4.8. Slow moving
2.4.9. Shallow respiration
2.4.10. Easily tired
2.4.11. Cor pulmonale
2.4.12. Clubbing
2.4.13. Prolonged expiration
2.4.14. Wheezing
2.5. Medications
2.5.1. Bronchodilators
2.5.1.1. e.g. Mucomyst
2.5.1.2. Opens vessels
2.5.2. Corticosteroids
2.5.2.1. Treats inflammation
2.5.2.2. May cause increased blood glucose*
2.5.2.2.1. Monitor diabetics
2.5.3. Others
2.5.4. Oxygen
2.5.4.1. Promote oxygenation w/o hypercapnia
2.5.4.2. Oxygen is still a medication
2.5.5. Nursing care
2.5.5.1. Shake MDI before admin
2.5.5.2. Mouth care after MDI
2.6. Nursing Process
2.6.1. Assessment
2.6.1.1. H&P
2.6.1.2. Diagnostics
2.6.1.2.1. Pulmonary function
2.6.1.2.2. ABGs (precise)
2.6.1.2.3. CXR
2.6.1.2.4. Alpha-antitrypsin screen
2.6.2. Diagnoses
2.6.2.1. Ineffective gas exchange
2.6.2.2. Impaired airway clearance
2.6.2.3. Ineffective breathing pattern
2.6.2.4. Activity intolerance
2.6.2.5. Deficient knowledge
2.6.2.6. Ineffective coping
2.6.3. Collaboration
2.6.3.1. RR failure
2.6.3.1.1. Acidosis
2.6.3.1.2. Hypercapnia
2.6.3.2. Atelectasis
2.6.3.3. Pulmonary infection
2.6.3.4. Pneumonia
2.6.3.5. Pneumothorax
2.6.3.6. Pulmonary HTN
2.6.3.7. Cor pulmonale**
2.6.3.7.1. "R-sided heart failure"
2.6.3.7.2. R/T pulmonary disease
2.6.3.7.3. Changes that occur
2.6.3.8. Dysrhythmias
2.6.4. Planning
2.6.4.1. Smoking cessation
2.6.4.2. Activity tolerance
2.6.4.3. Self-care
2.6.4.4. Coping
2.6.4.5. Adherence
2.6.4.6. Absence of complications
2.6.5. Interventions
2.6.5.1. Gas exchange
2.6.5.1.1. Medications
2.6.5.1.2. Reduce irritants
2.6.5.1.3. Directed coughing or "huff" coughing
2.6.5.1.4. CPT
2.6.5.1.5. Breathing exercises
2.6.5.1.6. Supplemental O2
2.6.5.2. Activity tolerance
2.6.5.2.1. Rehabilitation
2.6.5.2.2. Pacing activities
2.6.5.2.3. Exercises
2.6.5.2.4. Walking aids to conserve energy
2.6.5.2.5. Collaborate approach
2.6.5.3. Nutrition
2.6.5.3.1. Weights
2.6.5.3.2. PO intake & supplements
2.6.5.3.3. Avoid foods that cause bloating
2.6.5.3.4. Don't drink before/during meals
2.6.5.3.5. Mouth care
2.6.5.3.6. Give bronchodilator 30 min before meal
2.6.5.4. Others
2.6.5.4.1. Realistic goals
2.6.5.4.2. Avoid extreme temps
2.6.5.4.3. Coping strategies
2.6.5.4.4. Complications
2.6.5.5. Education
2.6.5.5.1. Patho
2.6.5.5.2. Meds
2.6.5.5.3. Procedures
2.6.5.5.4. When/how to seek help
2.6.5.5.5. Asepsis
2.6.5.5.6. Avoid irritants
2.6.5.5.7. Lifestyle changes*
2.6.5.6. Health promotion
2.6.5.6.1. NO smoking!
2.6.5.6.2. Vaccinations
2.6.5.6.3. Avoid high-exposure areas
2.6.5.6.4. Medication compliance
2.6.6. Evaluation
2.6.6.1. WOB easier?
2.6.6.2. Voice need for meds?
2.6.6.3. Compliant?
2.6.6.4. No complications?
2.6.6.4.1. Acidosis
2.6.6.4.2. Cor pulmonale
2.6.6.4.3. Pneumonia
2.6.6.4.4. Pneumothorax
2.6.6.5. Increase in FEV?
2.6.6.5.1. Usually decreased w/COPD
2.6.6.5.2. R/T fact they can't get rid of air
3. LRT Disorders
3.1. Pneumonia
3.1.1. Classifications
3.1.1.1. CAP
3.1.1.1.1. Late fall and winter
3.1.1.1.2. Influenza
3.1.1.2. HAP
3.1.1.2.1. Preventible
3.1.1.2.2. Costly
3.1.1.3. PCP
3.1.1.3.1. HIV-associated
3.1.1.3.2. Immunosuppression
3.1.1.4. Aspiration
3.1.2. Pathophysiology
3.1.2.1. Microbes enter lungs
3.1.2.1.1. From URT
3.1.2.1.2. From bloodstream
3.1.2.2. Inflammation of lung tissue
3.1.2.2.1. Automatic response to invader
3.1.2.2.2. Creates exudate, increased WBCs
3.1.2.2.3. Impaires adequate V and diffusion of gases
3.1.2.3. V/Q mismatch occurs
3.1.2.3.1. Poorly oxygenated blood returns to heart
3.1.2.3.2. Moves systemically >> hypoxemia
3.1.3. Risk factors
3.1.3.1. Lifestyle
3.1.3.1.1. Smoking
3.1.3.1.2. Alcohol
3.1.3.2. Unsterile equipment
3.1.3.3. HCPs
3.1.3.4. Age
3.1.3.5. Immobility (supine)
3.1.3.6. Post-op
3.1.3.7. Immunosuppression
3.1.3.8. Cough reflex
3.1.3.9. MV/trachs
3.1.4. Clinical manifestations
3.1.4.1. Mucopurulent sputum
3.1.4.2. Congestion
3.1.4.3. Sore throat
3.1.4.4. Orthopnea/SOB
3.1.4.5. Fatigue
3.1.4.6. Poor appetite
3.1.4.7. Cyanosis
3.1.4.8. Cough
3.1.4.9. Diaphoretic
3.1.4.10. "Wet" lung sounds
3.1.4.10.1. Corse
3.1.4.10.2. Rhonchi
3.1.5. Alternative presentations
3.1.5.1. Bacterial
3.1.5.1.1. Chills
3.1.5.1.2. Fever
3.1.5.1.3. Pleuritic pain
3.1.5.1.4. Tachypnea
3.1.5.1.5. Accessory muscles
3.1.5.1.6. Rapid, bounding pulse
3.1.5.2. Viral
3.1.5.2.1. Relative bradycardia
3.1.5.2.2. >> Given elevated temperature
3.1.6. Medical management
3.1.6.1. Antibiotics
3.1.6.1.1. Determined by Gram stain
3.1.6.1.2. Not indicated for viral
3.1.6.1.3. Primary or secondary infection
3.1.6.2. Supportive care
3.1.6.2.1. RR
3.1.6.2.2. Dehydration
3.1.6.2.3. Inflammation
3.1.6.3. O2 + IVF, then antibiotic
3.1.7. Nursing process
3.1.7.1. Assessment
3.1.7.1.1. Findings
3.1.7.1.2. Secretions
3.1.7.1.3. Cough
3.1.7.1.4. Tachypnea
3.1.7.1.5. SOB
3.1.7.1.6. Concomitant Heart failure*
3.1.7.1.7. Risk for shock
3.1.7.2. Diagnoses
3.1.7.2.1. Ineffective airway clearance
3.1.7.2.2. Activity intolerance
3.1.7.2.3. Risk for FVD
3.1.7.2.4. Imbalanced nutrition
3.1.7.2.5. Deficient knowledge
3.1.7.3. Collaborative
3.1.7.3.1. Continuing symptoms after therapy
3.1.7.3.2. Shock
3.1.7.3.3. RR failure
3.1.7.3.4. Atelectasis
3.1.7.3.5. Pleural effusion
3.1.7.3.6. Confusion
3.1.7.3.7. Superinfection
3.1.7.4. Planning
3.1.7.4.1. Airway clearance
3.1.7.4.2. Energy conservation
3.1.7.4.3. Fluid volume
3.1.7.4.4. Nutrition
3.1.7.4.5. Patient understanding
3.1.7.4.6. No complications
3.1.7.5. Interventions
3.1.7.5.1. 2-3L per day*
3.1.7.5.2. Humidified oxygen
3.1.7.5.3. Coughing
3.1.7.5.4. CPT
3.1.7.5.5. Semi-Fowler's
3.1.7.5.6. Rest
3.1.7.5.7. Nutrition
3.2. Tuberculosis
3.2.1. Overview
3.2.1.1. M. tuberculosis (acid-fast bacillus)
3.2.1.2. Affects 1/3 of world
3.2.1.3. Leading COD r/t infection
3.2.1.4. On the rise in USA
3.2.1.4.1. Immigration
3.2.1.4.2. HIV
3.2.1.4.3. Drug resistance*
3.2.1.4.4. Decreased detection by HCPs
3.2.1.4.5. Lack of funding
3.2.2. Pathophysiology
3.2.2.1. Inhale microbe via droplet
3.2.2.2. Travels to lungs, and may enter bloodstream (miliary)
3.2.2.3. Inflammatory response
3.2.2.3.1. Latent TB (infection)
3.2.2.3.2. Active TB (disease
3.2.3. Transmission
3.2.3.1. Person-to-person via droplet
3.2.3.2. 1 cough = 3000 droplets
3.2.3.3. Longer life in darker places
3.2.3.4. Killed via direct sunlight
3.2.3.5. Can remain in air for hours!
3.2.4. Risk factors
3.2.4.1. Close contact
3.2.4.2. Immunocompromised
3.2.4.3. Inadequate health care
3.2.4.4. Comorbidities
3.2.4.5. Immigration
3.2.4.6. Institutionalization
3.2.4.7. Substandard housing
3.2.4.8. HCPs!
3.2.5. Manifestations
3.2.5.1. Low-grade fever
3.2.5.2. Dry cough
3.2.5.3. Night sweats
3.2.5.4. Fatigue
3.2.5.5. Weight loss
3.2.5.6. Anorexia
3.2.5.7. MP sputum or hemoptysis
3.2.6. Diagnostics
3.2.6.1. TB skin test/Mantoux
3.2.6.1.1. Indicator
3.2.6.1.2. Unreliable*
3.2.6.1.3. 0.01cc
3.2.6.1.4. Read w/i 72 hrs
3.2.6.2. Infected if:
3.2.6.2.1. TB skin test +
3.2.6.2.2. CXR = massive consolidation
3.2.6.2.3. Mycobacterium +
3.2.6.2.4. Symptoms +
3.2.7. Medications
3.2.7.1. INH*
3.2.7.2. Rifampin
3.2.7.3. Pyrazinamide
3.2.7.4. Ethambutol
3.2.7.5. Nursing care
3.2.7.5.1. Monitor liver fxn!!
3.2.7.5.2. INH only for infection
3.2.7.5.3. All 4 meds, daily for four weeks
3.2.7.5.4. Then, INH + R for 4-7 months
3.2.8. Nursing Process
3.2.8.1. Assessment
3.2.8.1.1. H&P
3.2.8.1.2. S/S
3.2.8.1.3. Breath sounds
3.2.8.2. Diagnoses
3.2.8.2.1. Ineffective airway clearance
3.2.8.2.2. Deficient knowledge
3.2.8.2.3. Activity intolerance
3.2.8.2.4. Isolation r/t droplet precautions
3.2.8.3. Collaborative
3.2.8.3.1. Malnutrition
3.2.8.3.2. ADRs
3.2.8.3.3. Multidrug resistance
3.2.8.3.4. Spread of infection
3.2.8.4. Planning/Goals
3.2.8.4.1. Patent airway
3.2.8.4.2. Knowledge
3.2.8.4.3. Adherence
3.2.8.4.4. Activity tolerance
3.2.8.4.5. No complications
4. Neurodegenerative
4.1. Overview
4.1.1. CNS & PNS
4.1.2. Progressive neuron loss
4.1.3. Slow, progressive onset
4.1.4. Mostly home-health
4.2. Parkinson's
4.2.1. Decreased dopamine
4.2.1.1. Substantia nigra in basal ganglia
4.2.1.2. Rigidity, bradykinesia, tremors
4.2.1.3. Postural instability
4.2.2. Risk factors
4.2.2.1. Onset @ age 50
4.2.2.2. Males > females
4.2.2.3. Family trend
4.2.2.4. Head trauma
4.2.2.5. Environmental
4.2.2.5.1. Smoking
4.2.2.5.2. Metals
4.2.2.5.3. Herbicides
4.2.2.5.4. Radiation
4.2.2.6. Viral infxn
4.2.2.6.1. Encephalitis
4.2.2.6.2. AIDS
4.2.2.7. Caucasian
4.2.3. Nursing care
4.2.3.1. Assessment
4.2.3.1.1. Degree of disability & function
4.2.3.1.2. Emotional response/coping
4.2.3.1.3. Home health
4.2.3.1.4. Fall risk assessment
4.2.3.1.5. Complications
4.2.3.1.6. Manifestations
4.2.3.1.7. Medications
4.2.3.2. Care plan
4.2.3.2.1. Mobility
4.2.3.2.2. Self-care
4.2.3.2.3. Bowel elimination
4.2.3.2.4. Swallowing/nutrition
4.2.3.2.5. Assistive devices
4.2.3.2.6. Communication
4.2.3.2.7. Coping
4.2.3.3. Diagnoses
4.2.3.3.1. Impaired verbal communication
4.2.3.3.2. Constipation r/t muscle weakness
4.2.3.3.3. Adult FTT r/t depression
4.2.3.3.4. Imbalanced nutrition : <TBR
4.2.3.3.5. Chronic sorrow
4.2.3.3.6. Impaired mobility
4.2.3.3.7. Self-care deficit
4.2.4. Manifestations
4.2.4.1. 4 cardinal signs
4.2.4.1.1. Tremor
4.2.4.1.2. Rigidity
4.2.4.1.3. Bradykinesia
4.2.4.1.4. Postural instability
4.2.4.2. ANS symptoms
4.2.4.3. Psych changes
4.2.4.4. Hypokinesia
4.2.4.5. Micrographia
4.2.4.6. Dysphonia
4.2.4.7. Shoulder pain*
4.2.5. Complications
4.2.5.1. RTIs
4.2.5.2. UTIs
4.2.5.3. Skin rbeakdown
4.2.5.4. MSKT injuries r/t falls
4.2.5.5. Dyskinesia
4.2.5.6. Orthostatic hTN
4.2.6. Diagnostics
4.2.6.1. H&P (at least 2 signs)
4.2.6.2. PET & SPECT
4.2.6.3. Labs, imaging = not useful
4.2.7. Medical care
4.2.7.1. Control symptoms and promote function
4.2.7.2. Cannot prevent progression
4.2.7.3. Individualized care
4.2.7.4. Medications
4.2.7.4.1. Levadopa*
4.2.7.4.2. Anti-cholinergics
4.2.7.4.3. Antivirals (Symmetrel)
4.2.7.4.4. Dopamine agents (Requip)
4.2.7.4.5. MAOIs
4.2.7.4.6. COMI (Comtan)
4.2.7.4.7. Antidepressants
4.2.7.4.8. Antihistamines
4.2.7.5. Surgery
4.2.7.5.1. Stereotactic procedures
4.2.7.5.2. Neural transplant
4.2.7.5.3. Deep brain stimulation
4.3. Alzheimer's
4.3.1. Pathophysiology
4.3.1.1. Neuropathological/biochemical changes
4.3.1.1.1. Tangles: Non-fxn neurons
4.3.1.1.2. Plaques of amyloid protein
4.3.1.2. Shrinkage of cerebral cortex r/t neuronal damage
4.3.1.3. Cells that use ACH (deficiency)
4.3.2. Senile dementia
4.3.3. Confirmed via brain biopsy
4.4. ALS
4.4.1. "Lou Gehrig's disease"
4.4.1.1. Unknown cause
4.4.1.1.1. May be caused by excess glutamate (MSG)
4.4.1.2. Amyotrophic
4.4.1.2.1. Atrophy of muscle fibers
4.4.1.3. Sclerosis
4.4.1.3.1. Hardening
4.4.1.3.2. Anterior and lateral columns
4.4.2. Risk factors
4.4.2.1. Autosomal dominant in 5-10%
4.4.2.2. 40-60 years old
4.4.2.3. Males > females before age 60
4.4.2.4. Environmental toxins
4.4.2.4.1. UV rays
4.4.2.4.2. Carbon monoxide
4.4.3. Nursing process
4.4.3.1. Assessment
4.4.3.1.1. Muscle weakness
4.4.3.1.2. Skin status
4.4.3.1.3. Nutritional status
4.4.3.1.4. RR status
4.4.3.1.5. Support system
4.4.3.1.6. Urinary/bowel status
4.4.3.2. Plan of care
4.4.3.2.1. Support
4.4.3.2.2. Independence
4.4.3.2.3. Communication
4.4.3.2.4. ROM
4.4.3.2.5. Repositioning
4.4.3.2.6. Skin care
4.4.3.2.7. ADLs
4.4.3.2.8. Medications
4.4.3.3. Diagnoses
4.4.3.3.1. Anxiety
4.4.3.3.2. RR-related
4.4.3.3.3. Communication
4.4.3.3.4. Decisional conflict r/t vent
4.4.3.3.5. Impaired resilience
4.4.3.3.6. Risk for aspiration
4.4.4. Manifestations
4.4.4.1. Variable
4.4.4.2. Fatigue
4.4.4.3. Progressive weakness
4.4.4.4. Cramps, twitching
4.4.4.5. Atrophy
4.4.4.6. Spasticity
4.4.4.7. Regurgitation
4.4.4.8. Problems laughing, talking, etc
4.4.5. Complications
4.4.6. Diagnosed by S/S
4.4.6.1. EMG, muscle biopsy
4.4.6.2. MRI
4.4.7. Nursing care
4.4.7.1. Focused at function & QOL
4.4.7.2. One medication: RIlutek
4.4.7.2.1. Baclofen
4.4.7.2.2. Dantrium
4.4.7.2.3. Valium
4.4.7.2.4. (anti-spasmodic)
4.4.7.3. Active & passive ROM
4.5. MD
4.5.1. Incurable, inherited
4.5.2. Pathologic features
4.5.2.1. Degeneration, loss of muscle
4.5.2.2. Variation in muscle fiber size (contractures)
4.5.2.3. Phagocytosis, regeneration
4.5.2.4. Muscle replaced by CT
4.5.2.5. Will also have elevated muscle enzymes
4.5.3. Nursing process
4.5.3.1. Assessment
4.5.3.1.1. MSKT
4.5.3.1.2. Joint mobility
4.5.3.1.3. CV, RR status
4.5.3.2. Plan of care
4.5.3.2.1. Promote function
4.5.3.2.2. Enhance QOL
4.5.3.3. Diagnoses
4.5.3.3.1. Constipation
4.5.3.3.2. Fatigue
4.5.3.3.3. Nutrition
4.5.3.3.4. Skin integrity
4.5.4. Diagnostics
4.5.4.1. Blood or urine
4.5.4.2. Exercise tests
4.5.4.3. EMG, ECG, PFT
4.5.5. Medications
4.5.5.1. Supportive only
4.5.5.2. Muscle relaxants
4.5.5.2.1. Baclofen
4.5.5.2.2. Flexaril
4.5.6. Medical care
4.5.6.1. Supportive
4.5.6.2. Promote activity & QOL
4.5.6.3. Supportive devices
4.5.6.4. Spinal fusion sx
4.6. Huntington's
4.6.1. Premature death of basal ganglia cells
4.6.1.1. Also affects cerebellum, cortex
4.6.1.2. Unknown etiology
4.6.1.2.1. R/T abnormal glutamine in nucleus >>
4.6.1.2.2. Cell death
5. Neurological
5.1. Meningitis
5.1.1. Two forms
5.1.1.1. Septic/bacterial
5.1.1.2. Viral (less common)
5.1.1.2.1. HIV
5.1.1.2.2. Mono
5.1.1.2.3. Immunosuppression
5.1.2. Inflammation with IICP
5.1.2.1. Infected CSF
5.1.2.2. Edema
5.1.2.3. Brain compression
5.1.2.4. IICP
5.1.3. Clinical manifestations
5.1.3.1. Headache & fever (1st)
5.1.3.2. Nuchal rigidity
5.1.3.3. Positive K and B signs
5.1.3.4. Photophobia
5.1.3.5. Rash
5.1.3.6. Change in LOC
5.1.3.7. Acute fulminant infection
5.1.3.7.1. Only 10%
5.1.3.7.2. Death w/i few hours
5.1.3.7.3. High temp w/lesions
5.1.3.8. Dehydration, shock, seizures
5.1.4. A&D
5.1.4.1. CT (brain stem herniation)
5.1.4.2. MRI
5.1.4.3. Lumbar puncture
5.1.4.3.1. Cloudy
5.1.4.3.2. Low glucose
5.1.4.3.3. High protein
5.1.4.3.4. High WBC
5.1.4.4. Bacterial culture
5.1.4.5. Gram stain*
5.1.5. Risk factors
5.1.5.1. Lack of vaccination
5.1.5.2. Close settings
5.1.5.3. Tobacco use
5.1.5.4. URI
5.1.5.5. Otitis media/mastoiditis
5.1.5.6. Immunosuppression
5.1.6. Prevented by vaccination!
5.1.7. Treatment
5.1.7.1. Medications
5.1.7.1.1. IV Vanc + Cephalosporin
5.1.7.1.2. Decadron r/t inflammation
5.1.7.1.3. IV fluids
5.1.7.1.4. Phenytoin r/t seizures
5.1.7.2. Antimicrobial prophlaxis
5.1.7.2.1. Rifampin
5.1.7.2.2. Cipro
5.1.7.2.3. Rocephin
5.1.8. Nursing care
5.1.8.1. Frequent neuro checks
5.1.8.2. Injury
5.1.8.3. Daily weights
5.1.8.4. Labs
5.1.8.4.1. Electrolytes
5.1.8.4.2. Urine labs r/t SIADH
5.1.8.5. Immobility
5.1.8.6. Isolation
5.1.8.7. Support
5.2. Brain abscess
5.2.1. Collection of pus and brain parenchyma
5.2.2. Purulent, usually bacterial
5.2.3. Higher risk w/poor immunity
5.2.3.1. Otitus media
5.2.3.2. Rhinosinusitis
5.2.4. Manifestations
5.2.4.1. Headache esp. in AM
5.2.4.2. Fever
5.2.4.3. Vomiting r/t pressure
5.2.4.4. Neuro efects base on area
5.2.4.5. S/S IICP
5.2.4.6. DLOC, seizures
5.2.5. A&D
5.2.5.1. Neuroimaging
5.2.5.2. MRI or CT aspiration
5.2.5.3. Blood cultures
5.2.5.4. CXR if lung infection
5.2.5.5. EEG for brain activity, blood loss
5.2.6. Risk factors
5.2.6.1. Immunosuppressed
5.2.6.2. Cranial surgery
5.2.6.3. Head injury
5.2.6.4. Tongue piercing
5.2.7. Prevention
5.2.7.1. Prompt treatment of risk factors
5.2.8. Treatment
5.2.8.1. C&S >> antibiotics
5.2.8.2. Corticosteroids for inflammation, edema
5.2.8.3. Antiseizure meds
5.2.9. Nursing care
5.2.9.1. Frequent, ongoing neuro checks
5.2.9.2. Response to treatment
5.2.9.3. Client safety
5.2.9.4. Support
5.3. Encephalopathies
5.3.1. HSV
5.3.1.1. Local necrotizing hemorrhage
5.3.1.1.1. Edema >>
5.3.1.1.2. Nerve body degeneration
5.3.1.2. Most common cause of acute encephalitis
5.3.1.2.1. HSV-1
5.3.1.2.2. HSV-2
5.3.1.3. Clinical manifestations
5.3.1.3.1. Based on location
5.3.1.3.2. HA
5.3.1.3.3. Fever
5.3.1.3.4. Confusion
5.3.1.3.5. Changes in LOC
5.3.1.4. A&D
5.3.1.4.1. EEG shows temporal lobe alteration*
5.3.1.4.2. LP
5.3.1.4.3. MRI
5.3.1.4.4. Viral cultures
5.3.1.4.5. PCR for HSV-1 bands
5.3.1.5. Treatment
5.3.1.5.1. ASAP, for up to 3 weeks
5.3.1.5.2. Antiviral agents
5.3.2. Arthropod-borne
5.3.2.1. Transmission
5.3.2.1.1. Primary (birds)
5.3.2.1.2. Vector (mosquito)
5.3.2.1.3. Secondary (human)
5.3.2.2. Blood tests are slow
5.3.2.3. Manifestations
5.3.2.3.1. Early, flu-like
5.3.2.3.2. Seizures for SL >> WN
5.3.2.3.3. St. Louis
5.3.2.3.4. West Nile
5.3.2.4. A&D
5.3.2.4.1. MRI
5.3.2.4.2. LP
5.3.2.4.3. IgM antibody
5.3.2.4.4. Viral RNA in PCR
5.3.2.5. Treatment
5.3.2.5.1. Manage symptoms
5.3.2.5.2. Siezures
5.3.2.5.3. IICP
5.3.2.5.4. Interferon w/SL
5.3.2.5.5. Experimental for WN
5.3.3. Fungal
5.3.3.1. Immunocompromised usually
5.3.3.2. Certain areas, professions
5.3.3.3. Respiratory risk
5.3.3.4. Manifestations
5.3.3.4.1. F/HA/M**
5.3.3.4.2. Meningeal signs
5.3.3.4.3. Cranial nerve dysfunction
5.3.3.4.4. Skin lesions
5.3.3.4.5. Seizures
5.3.3.4.6. Associated w/stroke
5.3.3.5. A&D
5.3.3.5.1. H/O immunosuppression
5.3.3.5.2. LP
5.3.3.5.3. Serologic test w/antibody
5.3.3.5.4. Blood cultures
5.3.3.5.5. Lung biopsy r/t inhalation
5.3.3.5.6. MRI for secondary
5.3.3.6. Treatment
5.3.3.6.1. Amphotericin B
5.3.3.6.2. Maintenance
5.3.4. CJD
5.3.4.1. Very rare, incurable
5.3.4.2. Caused by prions
5.3.4.3. TSE
5.3.4.4. Manifestations
5.3.4.4.1. Onset around age 50
5.3.4.4.2. Late psych symptoms
5.3.4.4.3. Deterioration
5.3.4.4.4. Ataxia
5.3.4.4.5. Vision changes
5.3.4.4.6. Paralysis
5.3.4.4.7. 6-month survival
5.3.4.5. A&D
5.3.4.5.1. CSF has proteinase inhibitor
5.3.4.5.2. EEG w/specific pattern
5.3.4.5.3. MRI of basal ganglia
5.3.4.5.4. Confirmed only through biopsy/autopsy
5.3.5. VCJD
5.3.5.1. Human variation of BSE
5.3.5.2. Manifestations
5.3.5.2.1. Early psych symptoms
5.3.5.2.2. Lays dormant for ~10yrs
5.3.5.2.3. Onset at age 27
5.3.5.2.4. Affective changes
5.3.5.2.5. S/C impairment
5.3.5.2.6. Limb pain, muscle spasms/rigidity
5.3.5.2.7. Incoordination
5.3.5.2.8. Sleep disturbance
5.3.5.2.9. 22 month survival
5.3.5.3. A&D
5.3.5.3.1. MRI: bilat hyperintensity of posterior thalamus
5.3.5.3.2. Tonsillar biopsy*** shows prions
5.3.5.4. Treatment
5.3.5.4.1. Progressive, fatal
5.3.5.4.2. Opiates for pain
5.3.5.4.3. Meds for myoclonus
5.4. Autoimmune
5.4.1. MS
5.4.1.1. Immune-mediated
5.4.1.1.1. Progressive
5.4.1.1.2. Demyelinating CNS
5.4.1.1.3. Genetic
5.4.1.2. Manifestation
5.4.1.2.1. Relapses, exacerbations
5.4.1.2.2. Parasthesias
5.4.1.2.3. Coordination problems
5.4.1.2.4. LOB
5.4.1.2.5. Pain
5.4.1.2.6. Vision changes
5.4.1.3. A&D
5.4.1.3.1. MRI
5.4.1.3.2. LP
5.4.1.3.3. Urodynamic studies
5.4.1.3.4. Neuropsych testing
5.4.1.4. Treatment
5.4.1.4.1. Interferon
5.4.1.4.2. Glatiramer acetate (Copaxone)
5.4.1.4.3. Methylprednisone IV
5.4.1.4.4. Symptom treatment
5.4.1.5. Nursing care
5.4.1.5.1. Memory aids
5.4.1.5.2. Structured environment
5.4.1.5.3. Relaxation
5.4.1.5.4. Temperature
5.4.1.5.5. Assistive devices
5.4.2. Myasthenia gravis
5.4.2.1. Autoimmune
5.4.2.1.1. Impaired muscle transmission
5.4.2.1.2. Voluntary muscle weakness
5.4.2.2. Manifestations
5.4.2.2.1. Diplopia, ptosis
5.4.2.2.2. Facial muscle weakness
5.4.2.2.3. Swallowing impairment
5.4.2.2.4. Speech
5.4.2.2.5. General weakness
5.4.2.3. A&D
5.4.2.3.1. ACHI test
5.4.2.3.2. MRI scan for enlarged thymus
5.4.2.3.3. SEMG for delay in transmission
5.4.2.4. Treatment
5.4.2.4.1. Cholinesterase inhibitor
5.4.2.4.2. Corticosteroids
5.4.2.4.3. Cytotoxic meds
5.4.2.4.4. Immunomodulating therapy
5.4.2.4.5. Plasmapharesis
5.4.2.4.6. Thymectomy
5.4.2.5. Complications
5.4.2.5.1. MG
5.4.2.5.2. CG
5.4.2.6. Nursing care
5.4.2.6.1. Meds with food, on time
5.4.2.6.2. Ocular strategies
5.4.2.6.3. Maintain temp
5.4.2.6.4. Aspiration
5.4.3. GBS
5.4.3.1. Autoimmune
5.4.3.1.1. Acute PN myelin attack
5.4.3.1.2. Rapid
5.4.3.1.3. Usually after virus
5.4.3.1.4. Recovery phase*
5.4.3.2. Manifestations
5.4.3.2.1. Ascending weakness
5.4.3.2.2. Bulbar weakness
5.4.3.2.3. Tachy or brady
5.4.3.2.4. HTN or htn
5.4.3.2.5. Unaltered LOC
5.4.3.3. A&D
5.4.3.3.1. Symmetric weakness w/upward progression
5.4.3.3.2. History of VI
5.4.3.3.3. Changes in VC, NIF
5.4.3.3.4. LP shows only elevated protein
5.4.3.3.5. Nerve conduction
5.4.3.4. Nursing care
5.4.3.4.1. ICU observation
5.4.3.4.2. High risk for RR distress
5.4.3.4.3. Plasmapheresis
5.4.3.4.4. IVIG**
5.4.3.4.5. Cardiac dysrhythmias