NUR 380: Final Exam Medical Surgical Nursing. Study Guide.

For illnesses & injuries assigned this semester, focus on: 1. Topics: Almost every condition & clinical manifestations will be addressed, with an emphasis on prioritization & a focused assessment, including: Topics Pages Part A: Neurological assessment, head & spinal cord injuries, Multiple Sclerosis, Parkinson’s Disease, CVA, TIAs, epilepsy, meningitis, Myasthenia Gravis, Guillain-Barre’ Syndrome, Alzheimer’s disease 2 Part B: All endocrine disorders 40 Part C: Anemias, hemophilia, blood product therapy, GI bleeding, sickle cell anemia, thrombocytopenia, leukemia, multiple myeloma, aplastic anemia 55 Part D: GI & biliary disorders; i.e. peptic ulcer disease, appendicitis, peritonitis, cirrhosis, hepatic encephalopathy 68 Part E: Renal disorders, i.e. UTIs, cystitis, pyelonephritis, glomerulonephritis, Nephrotic Syndrome, renal injury & failure 82 Part F: Musculoskeletal problems, i.e. traumatic injuries & fractures, potential complications of fractures & of their treatment. 96 2. For all of the above, focus on: a. Normal changes related to aging which impact signs of illness & response to illness. b. Recommended health promotion activities and illness prevention activities. c. Risk factors associated with these conditions. d. Nursing responsibilities for postoperative surgical procedures. e. Nursing responsibilities for orthopedic interventions, i.e. traction, casts, ORIF, prosthetic hip replacement f. Bloodwork results, interpretation based on the patient problem, & nursing implications. g. Nursing responsibilities associated with the assessment & diagnostic procedures frequently performed to diagnose common illnesses and injuries. h. Identify the highest priority nursing diagnoses associated with illnesses and injuries. i. La Charity questions: all topics (Chapter 17 may be excluded). A. Neurological assessment, head & spinal cord injuries, Multiple Sclerosis, Parkinson’s Disease, CVA, TIAs, epilepsy, meningitis, Myasthenia Gravis, Guillain-Barre’ Syndrome, Alzheimer’s disease 1. Neurological Assessment, Head and Spinal Cord Injuries Chapter 65 Structures of the Nervous System 1. Central nervous system: a. Brain b. Spinal cord 2. Peripheral nervous system: a. Cranial nerves b. Spinal nerves c. Autonomic nervous system The Brain 1. Cerebrum: 2 hemispheres, hypothalamus, thalamus, & basal ganglia 2. Brain stem: midbrain, pons, medulla oblongata; the closer to the spinal cord, the more primitive the functions 3. Cerebellum Cerebral Function • Cerebrum: responsible for integration (making sense) of data • Corpus callosum transmits information between hemispheres: sensation, memory, & learned discrimination • Lateralization: right-handed dominant (& some left-handed) have cerebral dominance on left side for verbal, linguistic, arithmetic, calculation & analytic functions • Non-dominant hemisphere: spatial, geometric, visual, pattern, & musical functions • Clinical manifestations depend on which lobe is affected (frontal, parietal, temporal, occipital) Thalamus • Sits above the brain stem • Router: sorts data & sends to other critical areas • Hypothalamus: homeostasis for temperature, osmolarity, circadian rhythms • Posterior pituitary gland: secretion of hormones, maintain water balance, i.e. oxytocin, ADH Basal Ganglia • Sits below the corpus callosum & cerebral cortex • Contains groups of nuclei (ganglia) which share the same function • Motor control, both excitatory & inhibitory • Manifested in Parkinson’s Disease Cerebral Cortex (80% of the Brain) 1. Frontal lobe: executive functions: concentration, abstract thought, planning, analytic processing, storage of information & memory, motor function, judgment, personality, emotional control, inhibitions 2. Parietal: analysis & relay of sensory information from the environment to other critical areas, proprioception, size & shapes 3. Temporal: auditory reception & memory of sound, music, & language 4. Occipital: interpretation & memory of visual imagery, language, hearing Brain Stem Function • Breathing, circulation, & digestion o Midbrain: connects pons & cerebellum with the hemispheres, containing sensory & motor pathways for visual & auditory reflexes o Pons: bridge between 2 halves of cerebellum, & between medulla and midbrain; motor/sensory pathways & respiration o Medulla Oblongata: filters & routs motor fibers brain to spinal cord & sensory fibers from the spinal cord to the brain • Decussation: fibers cross over at this level (implications for stroke) • Cranial nerves 9-12 originate here • Contains reflex centers for respiration, BP, heart rate, cough/gag, vomiting, swallowing, sneezing • Reticular formation for sleep-wake cycles & arousal Cerebellar Function • Cerebellum: sits behind pons & midbrain, & beneath the occipital lobe • Sensory input needed for smooth coordinated movement • Body control & coordination (sports) • Motion memory (how to ride a bike) • Fine motion movements • Proprioception: Awareness of postural body in space (postural) (without looking at body parts) Focused Assessment of the Nervous System • Health history: Critical information 1. History of the present illness: onset, severity, location, fluctuations, aggravating & relieving factors 2. Interview allows the nurse to observe overall appearance, mental status, posture, movement & affect 3. Medical record: previous trauma? 4. Family information: genetics 5. History of falls, alcohol, meds, illicit drugs 6. May need to ask yes/no questions Common Symptoms 1. Pain: usually indicates injury, i.e. hemorrhage, spinal disk disease, tumor 2. Seizures: abnormal electrical discharges resulting in changes in sensation, motor function, perceptions, consciousness; may be brief such as blank stare or full blown, i.e. fever, alcohol/drug withdrawal, hypoglycemia, epilepsy 3. Dizziness or vertigo: sensation of imbalance or movement; sensation of room spinning o Visual disturbances: decreased acuity, blindness, diplopia, nystagmus; due to neurological disease, aging, tumor, stroke o Muscle weakness or rigidity: can cause wide variation in signs & symptoms; can be acute or progressive o Abnormal sensation or absence: may be d/t central or peripheral disease, small or large muscle groups, acute or chronic Physical Assessment • Why is it more challenging to examine the brain & spinal cord? (p. 1921) • 5 parts: 1. Consciousness & cognition 2. Cranial nerves 3. Motor system 4. Sensory system 5. Reflexes Assessment of Consciousness & Cognition • Be specific & concrete; avoid judgements 1. Mental status: orientation to time, person, & place 2. Overall appearance