1/7/24,m12:47mA ATImMed mSurgmStudymgui
M de
ATI mMedmSurg mCMSmStudy mGuide
Ch.m1 mHealth,mWellness,mandmIll
ness m Healthm& mWellness
- Modifiablem(can mbemchanged)mv.mNonmodifiablem(cannot mbemchanged)
- Aspects;mPhysical,mEmotional,mSocial,mIntellectual,mSpiritual,mOccupational,mEnvironmental
- Environment;mSocial m(Crimemvs.msafety,mpoverty mvs.mprosperity,mpeacemvs.msocial munrest,mand mpr
esencemvs.m absencemofmsupport mfrommsocial mnetworksm);mPhysical m(access mto mhealth mcare,msanit
ation,mavailability mofm clean mwater,mand mgeographicmlocation
Ch.m2 mEmergency mNursing mPrinciples mandmManagementm Em
ergency mNursing mPrinciples
• Triage
- Level m1; mResuscitation
- Level m2; mEmergent
- Level m3; mUrgent
- Level m4; mLess mUrgent
- Level m5; mNonurgent
• Primary mSurvey;mrapidmassessment mofmlifemthreateningmconditions; mcompletedmsystematically; mst
andard m precautions; mguided mby mABCDE mprinciple
→mABCDEmPrinciple
- Airway; mmaintain mairway,mhead-tilt/chin-lift mifmunresponsive-
mDO mNOTmperformmis mpotential mcervical m spineminjury;mifmtraumamsuspected musemmodified mja
w mthrust mmaneuver; mbagmvalvemmask mw/ m100% mO2 mw/ m nonrebreathermformspontaneous mbreath
ers
- Breathing; mifmNOTmbreathingmmanual mvent mw.mbagmvalvemmask mormmouth mto mmouth
- Circulation; mHR,mBP,mpulses,mcap mrefill;
To mrestoremcirculation;mCPR,massess mforminternal mbleed,mhemorrhagemcontrol; mIV maccess; m
Isotonicm fluids/blood
To malleviatemshock;mO2,mpressuremto mbleed,melevatemlowermextremities,mIV mfluids m&mblo
od,mVS,m stay mw/ mpt.
- Disability; massess mLOCm; mGCS; mAVPU
- Exposure; mcompletemphysical massessment;mclothing mremoved;mhypothermia mprimary mconcern
• Poisoning; mmedical memergency; mhx,mtypemofmpoison,; mresp msupport,mcirculation,mrestoremfluids,mBP/
EKG,m ingested mpoison musemactivated mcharcoal,mgastricmlavagem(donemw/Im1hr)maspiration; mdiazepam
mifmseizures moccur
• Rapidmresponsemteam; mrespond mto memergency mwhen mpt.mhas mindications mofmrapid mdecline; mearly mr
ecognition m beforemresp/cardiacmarrest mormstrokemoccurs;
• Cardiacmemergency
- Cardiacmarrest;
- Vfib/ mPulseless mVT=mdefibrillate,mCPR,madmin mIV mantidysrhythmicm(epi,mamiodarone,mli
docaine,m magnesiummsulfate)
- Ventricularmasystole
- Pulseless melectrical mactivity m(PEA)m&mAsystole; mCPR,mifmshockablemused mDefib,mIV maccess,mEpi
mIVPmQ3-5 m min
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M de
Emergency mMeds;
• Epi; mstimulatemalpham1 m(vasoconstrict),mbetam1 m( mHR),mbetam2 m(bronchodilator); m→msuperficial mbleeding,m
BP,mAV mblock,mcardiacmarrest,m&masthmam; mA/e; mHTN mcrisis,mdysrhythmias,mangina
• Dopamine; mrenal mblood mvessel mdilation,mbetam1 m( mHR)m→mShock,mHF,mAKI; m A/E; m dysrhythmias,mangina
• Dobutamine; mbetam1 m( mHR)m→HF
NEUROLOGIC
Ch.m3 mNeurologicmDiagnosticmProcedures
Cerebral mAngiography; mvisualization mofmcerebral mblood mvessels,massess mblood mflow min mbrain,mID maneurysms
- Do m NOTmperformmifmpregnant,mNPO mform4-
6hrs mprior,massess mallergy mto mshellfish mormiodine,massess m bleedingmrisk/ musemofmanticoag,ma
ssess mBUN m&mCreat; mmonitormareamformclottingmaftermprocedure; mvoid m immediately mafter; m
may mexperiencemmetallicmtastemormfeelingmofmwarmth m; mmovement mrestricted
CT; m cross msection mimagemofmcranial mcavity
- Supine,mno mjewelry; mifmcontrast mdyemused mtakemprecautions
EEG; mID mbrain mwavemabnormalities,mseizuremactivity m&sleep mdisorder
- Wash m hairmprior,mbemsleep mdeprived,mexposemto mflashingmlights mormhyperventilatemform3-
4 mmin; mavoid m stimulants/sedatives m12-24 mhr.mprior; m45-120 mmin
ICPmMonitoring;mperformed mby mneurosurgeon min moperatingmroom,mused mform mICP,mGCSmscore
mofm8 morm<,m complication mofminfection
• 3 mTypes mICP mMonitoring
- IntraventricularmCatheter;mfluid mfilled mcath mconnected mto msterilemdrainagemsystemminserted m
into mburrm hole,mallows msimultaneous mdrainagem&mmonitoringmby mtransducermconnected mto m
monitor
- Subarachnoidmscrewmormbolt;mhollow mthreaded mscrew mormbolt mconnected mto mtransducer,mplaced mthru mburrmh
ole
- Epidural mormsubdural msensor;mfibermopticmsensorminserted mthru mburrmhole
- S/Sm mICPm(normal m10-
15)=mIRRITABILITY mfirst msign,mseveremheadache,mdecreasemloc,mdilated/mpinpoint m pupils,maltered
mbreathingmpattern m(Cheyne-stokes),mhyperventilation,mapnea,mabnormal mposturing
LumbarmPuncture; mw/draw mCSFmto mdiagnosemMS,msyphilis,mmeningitis
- Void mprior,massumemcannonball mposition,mmonitormpuncturemsite,mremain mlyingmstill mon mb
ack mafterm proceduremformseveral mhours
Complications;mheadachemfrommleakingmCSF,mgivemopioids/pain mmeds,m mfluid mintake
MRI; mNPO m4-
8 mhr.mprior; mremovemjewelry,mnot mclaustrophobic,mgivemearplugs; mw/mcontrastmdyes: massess mform allergies
mformshellfish; mno mmetal mimplants m(IUD,maneurysmmclip,mortho mjoint,martificial mheart mvalve,mpacemaker)
PETm& mSPECTmScan; mPositron memission mtomography mand msingle-
photon memission mcomputed mtomography mscans;m nuclearmmedicinemprocedures mproducem3D mimages mofmhe
ad; mimages mcan mbemstaticm(depictingmvessels)mormfunctional m (depictingmbrain mactivity);mcaptures mreginalm
metabolicmprocesses m(tumormactivity,mdementia)
- Radiation mrisks
X-ray; mreveal mfracturemormcurvature; mno mpregnant mpts,mno mjewelry
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M de
Ch.m4 mPainmManagement
PainmAssessment; mlocation,mquality,mmeasures/intensity/severity,mtiming/onset/duration,msetting/ mhow mit maff
ects m daily mlife,massociated mmanifestations,maggravating/relievingmfactors
Nonpharm mPainmManagement; mtens,mheat,mcold,mmassage,mrelaxation,mimagery
Pharm mmanagement
- Nonopioid; mmild-
moderatempain,m4gmTylenol,mmonitormformsalicylismm(tinnitus,mvertigo,mdecreased m hearing)
,mgi mupset,mbleeding
- Opioid=mmoderate-
severempain,maround mclock madmin,mcausemconstipation,mhypotension,murinary mretention,m n/v,msedati
on,mrespiratory mdepression,mhavemnaloxonemready
Ch.m5 mMeningitis
- Inflammation mofmmeninges,mviral mmost mcommon mand mresolves mw/o mtreatment,mfungal mcommon min m
AIDSmpt.; m bacterial mis mcontagious mw/ mhigh mmortality
Prevention;mHib mvaccine,mPPSV m&mMCV4 mvaccinem(collegemstudents)
s/s:mexcruciatingmconstantmheadache,mstiffmneck,mphotophobia,mfevermand mchills,mn/v,maltered mloc,
mpositivem Kernigmsign m(resistancemand mpain mw/ mextensionmofmpt.mlegmfrommflexed mposition),mpos
itivemBrudzinski msign m (flexion m ofmkneemand mhip mw/ mdeliberatemflexionmofmpt.mneck),mtachycar
dia,mseizure,mred mmacularmrash,m irritable
DX:mCSFmanalysism(cloudy=mbacterial,mclear=mviral; m+m=m mWBC,m mprotein,m mGLU minmb
acterial); m CTmscan/MRImto massess m mICP
Meds
- Ceftriaxonemormcefotaximeminmcombinationmwithmvancomycin:mABX mgiven muntil mculturem&ms
ensitivity m results mavailable; mEffectivemformbacterial minfections
- Phenytoin: mAnticonvulsants mgiven mifmICPmincreases mormexperiences mamseizure.
- Acetaminophen,mibuprofen: mAnalgesics mformheadachemand/ormfever.mNon-
opioid mto mavoid mmaskingm changes min mthemlevel mofmconsciousness.
- Ciprofloxacin,mrifampin,mormceftriaxone: mProphylacticmABX mgiven mifmin mclosemcontact mw/ mpt.
Complications;m mICP; mmonitormloc,mpupillary mchanges,mimpairedmeomm;mSIADH; m monitormformdil
utemblood m and mconcentrated murine; mSepticmemboli
→NURSING: misolation mprecautions,mdroplet mprecautionsmuntil m24 mhrs.maftermantibiotics,m menvironm
ental m stimuli,mquietmenvironment,m bright mlight,mbed mrest,mHOBm30*,mavoidmcoughing/ msneezing,mseizu
remprecautions
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M de
Ch.m6 mSeizures mandmEpilepsy
Seizures;mabrupt,mabnormal,mexcessivemuncontrolled melectrical mdischargemofmneurons mw/Imbrain,maltered ml
oc,m changemin mmotormand msensory mability/ mbehavior
Epilepsy; mchronicmrecurringm abnormalmbrainmelectrical mactivity mw/ m2+mseizures; mnot mcaused mby midentifiablemcause
Risks mFactors;mfebrilemstatemespecially min mchildren m<2,mhead mtrauma, mcer ebral medema, minfection,m
metabolicm disorderm(hypoglycemiamormhyponatremia),mbrain mtumor,mhypoxia,mw/drawl,mstroke,mto
xin mexposure,mheart m disease,mbrain mtumor,mhypoxia,mw/drawl,mfluid/electrolytemimbalances
Triggers; mxs mstress/fatigue/caffeine,mflashingmlights,mhyperventilation,m mphysical mactivity,msubst
ances m (cocaine,maerosols,minhaled mglue)
s/s:mGeneralizedm(aura)
- Tonicmclonicmseizure; mtonicmepisodem(stiffeningmofmmuscles),mclonicmepisodem(r
hythmicm jerking)mpostictal mphasemofmconfusion mand msleepiness
- Tonicmseizure; mstiffeningmofmmuscle,mincreased mmusclemtone,mLOC
- Clonicmseizure; mmusclemcontract mand mrelax
- Myoclonicmseizure; mbriefmjerkingmormstiffeningmofmextremities
- Atonic/akineticmseizure; mmusclemtonemis mlost; mfallingmmay moccur
Partial mormfocal/local
- Complex mpartial mseizure; mautomatisms m(lip msmacking,mpickingmat mclothes,mzonemout); m
may mhavem LOC,mamnesia
- Simplempartial mseizure; mremains mconsciousnessmunusual msensations m(déjàmvu,mchanges
min mHR,m flushing,munilateral mlimb mmovement,mpain,modor)
Unclassified/Idiopathic; mno mknow mreason
DX:mEEG,mMRI,mCT,mCATmscan,mPETmscan,mCSFmanalysis,mskull mXray manalysis
Meds; mAntiepileptics;(phenytoin) mtakemat msamemtimemdaily-
mA/E; mgingival mhyperplasia; mavoid moral mBCm( m effectiveness),mavoid mwarfarin m( mabsorption)
TX:mVagal mnervemstimulatorm(implanted min mleft mchest mwall,mmagnet movermdevicemat monset mofmseiz
ure,mavoid m MRIm&multrasound mand mmicrowaves); mSurgical
Complications; mStatus mEpilepticus; mrepeated mseizuremactivity mw/i m30 mmin; mairway,mO2,mIV maccess,mECG
monitoring,mpulsemox,madmin mdiazepammormlorazepammpush mand mIV mphenytoin
→NURSING: mDURING; mprivacy,mprotect mfromminjury,mpreparemsuction,mdo mnot mrestrain mdo mnotminsert
manythingm in mmouth,mdocument monset m&mduration; mAFTER; mmaintain msidemlying,mVS,massess mneuro
/injuries,mreorient m&m calmmclient,mdeterminemtrigger; mclient mshould mwearmmedical mID
Ch.m7 mParkinson’s mDisease
- Characterized mby mtremor,mmusclemrigidity,mbradykinesiam(slow mmovement),mpostural minstability
- Caused mby moverstimulation mofmbasal mgangliamby mAch mwhich moccurs mduemdegeneration mofmsubsta
ntiamnigram which mresults min mdecreased mdopaminemmakingmAch mdominant
RiskmFactors;m 40-70,mmale,mgenetics,mtoxin/chemical mexposure,mchronicmusemantipsychotics
s/s:mslow,mshufflingmgait,mmasklikemexpression,mdifficulty mchewingmand mswallowing,mdrooling,mdiffi
culty mw/ m ADLs,mmood mswings,mcognitivemimpairment
Meds;mDopaminergicm(Levodopa)m mDopaminemlevels; mDopaminemagonistsm(brocriptine,mropinirol
e,m pramipexole)mactivatemdopaminemrelease; mAnticholinergics m(benztropine)mcontrolmtremors/rigidity;
mCOMTm inhibitors m(entacapone)m mlevodopambreak mdown; mMAO-
Bminhibitorsm(selegiline,mrasagiline)m mwearingmoffm phenomenon mw/ mlevodopa; mAntiviralsm(amanta
dine)mstimulatemdopaminem&mprevent mreuptake
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M de
ATI mMedmSurg mCMSmStudy mGuide
Ch.m1 mHealth,mWellness,mandmIll
ness m Healthm& mWellness
- Modifiablem(can mbemchanged)mv.mNonmodifiablem(cannot mbemchanged)
- Aspects;mPhysical,mEmotional,mSocial,mIntellectual,mSpiritual,mOccupational,mEnvironmental
- Environment;mSocial m(Crimemvs.msafety,mpoverty mvs.mprosperity,mpeacemvs.msocial munrest,mand mpr
esencemvs.m absencemofmsupport mfrommsocial mnetworksm);mPhysical m(access mto mhealth mcare,msanit
ation,mavailability mofm clean mwater,mand mgeographicmlocation
Ch.m2 mEmergency mNursing mPrinciples mandmManagementm Em
ergency mNursing mPrinciples
• Triage
- Level m1; mResuscitation
- Level m2; mEmergent
- Level m3; mUrgent
- Level m4; mLess mUrgent
- Level m5; mNonurgent
• Primary mSurvey;mrapidmassessment mofmlifemthreateningmconditions; mcompletedmsystematically; mst
andard m precautions; mguided mby mABCDE mprinciple
→mABCDEmPrinciple
- Airway; mmaintain mairway,mhead-tilt/chin-lift mifmunresponsive-
mDO mNOTmperformmis mpotential mcervical m spineminjury;mifmtraumamsuspected musemmodified mja
w mthrust mmaneuver; mbagmvalvemmask mw/ m100% mO2 mw/ m nonrebreathermformspontaneous mbreath
ers
- Breathing; mifmNOTmbreathingmmanual mvent mw.mbagmvalvemmask mormmouth mto mmouth
- Circulation; mHR,mBP,mpulses,mcap mrefill;
To mrestoremcirculation;mCPR,massess mforminternal mbleed,mhemorrhagemcontrol; mIV maccess; m
Isotonicm fluids/blood
To malleviatemshock;mO2,mpressuremto mbleed,melevatemlowermextremities,mIV mfluids m&mblo
od,mVS,m stay mw/ mpt.
- Disability; massess mLOCm; mGCS; mAVPU
- Exposure; mcompletemphysical massessment;mclothing mremoved;mhypothermia mprimary mconcern
• Poisoning; mmedical memergency; mhx,mtypemofmpoison,; mresp msupport,mcirculation,mrestoremfluids,mBP/
EKG,m ingested mpoison musemactivated mcharcoal,mgastricmlavagem(donemw/Im1hr)maspiration; mdiazepam
mifmseizures moccur
• Rapidmresponsemteam; mrespond mto memergency mwhen mpt.mhas mindications mofmrapid mdecline; mearly mr
ecognition m beforemresp/cardiacmarrest mormstrokemoccurs;
• Cardiacmemergency
- Cardiacmarrest;
- Vfib/ mPulseless mVT=mdefibrillate,mCPR,madmin mIV mantidysrhythmicm(epi,mamiodarone,mli
docaine,m magnesiummsulfate)
- Ventricularmasystole
- Pulseless melectrical mactivity m(PEA)m&mAsystole; mCPR,mifmshockablemused mDefib,mIV maccess,mEpi
mIVPmQ3-5 m min
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M de
Emergency mMeds;
• Epi; mstimulatemalpham1 m(vasoconstrict),mbetam1 m( mHR),mbetam2 m(bronchodilator); m→msuperficial mbleeding,m
BP,mAV mblock,mcardiacmarrest,m&masthmam; mA/e; mHTN mcrisis,mdysrhythmias,mangina
• Dopamine; mrenal mblood mvessel mdilation,mbetam1 m( mHR)m→mShock,mHF,mAKI; m A/E; m dysrhythmias,mangina
• Dobutamine; mbetam1 m( mHR)m→HF
NEUROLOGIC
Ch.m3 mNeurologicmDiagnosticmProcedures
Cerebral mAngiography; mvisualization mofmcerebral mblood mvessels,massess mblood mflow min mbrain,mID maneurysms
- Do m NOTmperformmifmpregnant,mNPO mform4-
6hrs mprior,massess mallergy mto mshellfish mormiodine,massess m bleedingmrisk/ musemofmanticoag,ma
ssess mBUN m&mCreat; mmonitormareamformclottingmaftermprocedure; mvoid m immediately mafter; m
may mexperiencemmetallicmtastemormfeelingmofmwarmth m; mmovement mrestricted
CT; m cross msection mimagemofmcranial mcavity
- Supine,mno mjewelry; mifmcontrast mdyemused mtakemprecautions
EEG; mID mbrain mwavemabnormalities,mseizuremactivity m&sleep mdisorder
- Wash m hairmprior,mbemsleep mdeprived,mexposemto mflashingmlights mormhyperventilatemform3-
4 mmin; mavoid m stimulants/sedatives m12-24 mhr.mprior; m45-120 mmin
ICPmMonitoring;mperformed mby mneurosurgeon min moperatingmroom,mused mform mICP,mGCSmscore
mofm8 morm<,m complication mofminfection
• 3 mTypes mICP mMonitoring
- IntraventricularmCatheter;mfluid mfilled mcath mconnected mto msterilemdrainagemsystemminserted m
into mburrm hole,mallows msimultaneous mdrainagem&mmonitoringmby mtransducermconnected mto m
monitor
- Subarachnoidmscrewmormbolt;mhollow mthreaded mscrew mormbolt mconnected mto mtransducer,mplaced mthru mburrmh
ole
- Epidural mormsubdural msensor;mfibermopticmsensorminserted mthru mburrmhole
- S/Sm mICPm(normal m10-
15)=mIRRITABILITY mfirst msign,mseveremheadache,mdecreasemloc,mdilated/mpinpoint m pupils,maltered
mbreathingmpattern m(Cheyne-stokes),mhyperventilation,mapnea,mabnormal mposturing
LumbarmPuncture; mw/draw mCSFmto mdiagnosemMS,msyphilis,mmeningitis
- Void mprior,massumemcannonball mposition,mmonitormpuncturemsite,mremain mlyingmstill mon mb
ack mafterm proceduremformseveral mhours
Complications;mheadachemfrommleakingmCSF,mgivemopioids/pain mmeds,m mfluid mintake
MRI; mNPO m4-
8 mhr.mprior; mremovemjewelry,mnot mclaustrophobic,mgivemearplugs; mw/mcontrastmdyes: massess mform allergies
mformshellfish; mno mmetal mimplants m(IUD,maneurysmmclip,mortho mjoint,martificial mheart mvalve,mpacemaker)
PETm& mSPECTmScan; mPositron memission mtomography mand msingle-
photon memission mcomputed mtomography mscans;m nuclearmmedicinemprocedures mproducem3D mimages mofmhe
ad; mimages mcan mbemstaticm(depictingmvessels)mormfunctional m (depictingmbrain mactivity);mcaptures mreginalm
metabolicmprocesses m(tumormactivity,mdementia)
- Radiation mrisks
X-ray; mreveal mfracturemormcurvature; mno mpregnant mpts,mno mjewelry
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M de
Ch.m4 mPainmManagement
PainmAssessment; mlocation,mquality,mmeasures/intensity/severity,mtiming/onset/duration,msetting/ mhow mit maff
ects m daily mlife,massociated mmanifestations,maggravating/relievingmfactors
Nonpharm mPainmManagement; mtens,mheat,mcold,mmassage,mrelaxation,mimagery
Pharm mmanagement
- Nonopioid; mmild-
moderatempain,m4gmTylenol,mmonitormformsalicylismm(tinnitus,mvertigo,mdecreased m hearing)
,mgi mupset,mbleeding
- Opioid=mmoderate-
severempain,maround mclock madmin,mcausemconstipation,mhypotension,murinary mretention,m n/v,msedati
on,mrespiratory mdepression,mhavemnaloxonemready
Ch.m5 mMeningitis
- Inflammation mofmmeninges,mviral mmost mcommon mand mresolves mw/o mtreatment,mfungal mcommon min m
AIDSmpt.; m bacterial mis mcontagious mw/ mhigh mmortality
Prevention;mHib mvaccine,mPPSV m&mMCV4 mvaccinem(collegemstudents)
s/s:mexcruciatingmconstantmheadache,mstiffmneck,mphotophobia,mfevermand mchills,mn/v,maltered mloc,
mpositivem Kernigmsign m(resistancemand mpain mw/ mextensionmofmpt.mlegmfrommflexed mposition),mpos
itivemBrudzinski msign m (flexion m ofmkneemand mhip mw/ mdeliberatemflexionmofmpt.mneck),mtachycar
dia,mseizure,mred mmacularmrash,m irritable
DX:mCSFmanalysism(cloudy=mbacterial,mclear=mviral; m+m=m mWBC,m mprotein,m mGLU minmb
acterial); m CTmscan/MRImto massess m mICP
Meds
- Ceftriaxonemormcefotaximeminmcombinationmwithmvancomycin:mABX mgiven muntil mculturem&ms
ensitivity m results mavailable; mEffectivemformbacterial minfections
- Phenytoin: mAnticonvulsants mgiven mifmICPmincreases mormexperiences mamseizure.
- Acetaminophen,mibuprofen: mAnalgesics mformheadachemand/ormfever.mNon-
opioid mto mavoid mmaskingm changes min mthemlevel mofmconsciousness.
- Ciprofloxacin,mrifampin,mormceftriaxone: mProphylacticmABX mgiven mifmin mclosemcontact mw/ mpt.
Complications;m mICP; mmonitormloc,mpupillary mchanges,mimpairedmeomm;mSIADH; m monitormformdil
utemblood m and mconcentrated murine; mSepticmemboli
→NURSING: misolation mprecautions,mdroplet mprecautionsmuntil m24 mhrs.maftermantibiotics,m menvironm
ental m stimuli,mquietmenvironment,m bright mlight,mbed mrest,mHOBm30*,mavoidmcoughing/ msneezing,mseizu
remprecautions
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M de
Ch.m6 mSeizures mandmEpilepsy
Seizures;mabrupt,mabnormal,mexcessivemuncontrolled melectrical mdischargemofmneurons mw/Imbrain,maltered ml
oc,m changemin mmotormand msensory mability/ mbehavior
Epilepsy; mchronicmrecurringm abnormalmbrainmelectrical mactivity mw/ m2+mseizures; mnot mcaused mby midentifiablemcause
Risks mFactors;mfebrilemstatemespecially min mchildren m<2,mhead mtrauma, mcer ebral medema, minfection,m
metabolicm disorderm(hypoglycemiamormhyponatremia),mbrain mtumor,mhypoxia,mw/drawl,mstroke,mto
xin mexposure,mheart m disease,mbrain mtumor,mhypoxia,mw/drawl,mfluid/electrolytemimbalances
Triggers; mxs mstress/fatigue/caffeine,mflashingmlights,mhyperventilation,m mphysical mactivity,msubst
ances m (cocaine,maerosols,minhaled mglue)
s/s:mGeneralizedm(aura)
- Tonicmclonicmseizure; mtonicmepisodem(stiffeningmofmmuscles),mclonicmepisodem(r
hythmicm jerking)mpostictal mphasemofmconfusion mand msleepiness
- Tonicmseizure; mstiffeningmofmmuscle,mincreased mmusclemtone,mLOC
- Clonicmseizure; mmusclemcontract mand mrelax
- Myoclonicmseizure; mbriefmjerkingmormstiffeningmofmextremities
- Atonic/akineticmseizure; mmusclemtonemis mlost; mfallingmmay moccur
Partial mormfocal/local
- Complex mpartial mseizure; mautomatisms m(lip msmacking,mpickingmat mclothes,mzonemout); m
may mhavem LOC,mamnesia
- Simplempartial mseizure; mremains mconsciousnessmunusual msensations m(déjàmvu,mchanges
min mHR,m flushing,munilateral mlimb mmovement,mpain,modor)
Unclassified/Idiopathic; mno mknow mreason
DX:mEEG,mMRI,mCT,mCATmscan,mPETmscan,mCSFmanalysis,mskull mXray manalysis
Meds; mAntiepileptics;(phenytoin) mtakemat msamemtimemdaily-
mA/E; mgingival mhyperplasia; mavoid moral mBCm( m effectiveness),mavoid mwarfarin m( mabsorption)
TX:mVagal mnervemstimulatorm(implanted min mleft mchest mwall,mmagnet movermdevicemat monset mofmseiz
ure,mavoid m MRIm&multrasound mand mmicrowaves); mSurgical
Complications; mStatus mEpilepticus; mrepeated mseizuremactivity mw/i m30 mmin; mairway,mO2,mIV maccess,mECG
monitoring,mpulsemox,madmin mdiazepammormlorazepammpush mand mIV mphenytoin
→NURSING: mDURING; mprivacy,mprotect mfromminjury,mpreparemsuction,mdo mnot mrestrain mdo mnotminsert
manythingm in mmouth,mdocument monset m&mduration; mAFTER; mmaintain msidemlying,mVS,massess mneuro
/injuries,mreorient m&m calmmclient,mdeterminemtrigger; mclient mshould mwearmmedical mID
Ch.m7 mParkinson’s mDisease
- Characterized mby mtremor,mmusclemrigidity,mbradykinesiam(slow mmovement),mpostural minstability
- Caused mby moverstimulation mofmbasal mgangliamby mAch mwhich moccurs mduemdegeneration mofmsubsta
ntiamnigram which mresults min mdecreased mdopaminemmakingmAch mdominant
RiskmFactors;m 40-70,mmale,mgenetics,mtoxin/chemical mexposure,mchronicmusemantipsychotics
s/s:mslow,mshufflingmgait,mmasklikemexpression,mdifficulty mchewingmand mswallowing,mdrooling,mdiffi
culty mw/ m ADLs,mmood mswings,mcognitivemimpairment
Meds;mDopaminergicm(Levodopa)m mDopaminemlevels; mDopaminemagonistsm(brocriptine,mropinirol
e,m pramipexole)mactivatemdopaminemrelease; mAnticholinergics m(benztropine)mcontrolmtremors/rigidity;
mCOMTm inhibitors m(entacapone)m mlevodopambreak mdown; mMAO-
Bminhibitorsm(selegiline,mrasagiline)m mwearingmoffm phenomenon mw/ mlevodopa; mAntiviralsm(amanta
dine)mstimulatemdopaminem&mprevent mreuptake
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