NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS
NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS
The WEEK 1 QUIZ focuses on the assessment, diagnosis, and treatment
Delirium is characterized by a .
Attention, awareness, and cognition are all disrupted.
a HALLMARK
Delirium is characterized by a clouding of consciousness, as well as a difficulty to focus, sustain, or shift attention, as well as a change in cognition, including short-term memory impairment, disorientation, and perceptual problems NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.
Diagnostic Criteria for Delirium
- A disturbance in attention and awarenessB. 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
NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS
The Confusion Assessment Method
Which medication class has long been implicated as a risk factor for delirium,
Anticholinergic medications
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. NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS
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 NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.
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 ear characterized by recurrent vertigo and hearing loss.
What are the four symptoms characterized by Meniere’s disease?1.dizziness described as spinning vertigo, 2. low-frequency sensorineural hearing loss, 3. tinnitus, 4. a feeling of fullness in the affected ear NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS.
Pathophysiology of Meniere’s Disease
Meniere disease involves excess fluid and pressure in the labyrinth of the inner ear that episodically distends the structures of the labyrinth and damages the vestibular and cochlear hair cells
Causes of Meniere’s Disease–caused by viral infections or immune system-mediated mechanisms
Clinical Presentation of Meniere’s Disease- Early in the disease process-patients have intermittent attacks of vertigo that last from minutes to hours, often associated with nausea and vomiting.These episodes are commonly accompanied by pressure in the ear, low-pitched tinnitus fluctuating in intensity, and unilateral hearing loss
Diagnosis of Meniere disease is based on–clinical criteria and/or response to treatment; however, it is important to differentiate Meniere disease from other causes of vertigo and hearing loss
Physical Examination of Meniere’s disease should include
A thorough head and neck examination to exclude acute otitis media or another infectious process, a comprehensive neurologic examination a, On physical examination, sound will lateralize to the unaffected ear in the Weber test;in the Rinne test, air conduction will be greater than bone conduction.Spontaneous nystagmus occurs during attacks and may not be present between attacks.
Diagnostic criteria for Meniere’s disease include—two episodes of spontaneous vertigo lasting at least 20 minutes each, audiometrically documented hearing loss, tinnitus or aural fullness, and the exclusion of other causes NR 603 WEEK 1 QUIZ QUESTIONS ANSWERS
Diagnostic testing for Meniere’s disease include
an audiogram, and MRI to rule out central nervous system (CNS) lesions
Laboratory testing for Meniere’s disease include: thyroid-stimulating hormone (TSH), rapid plasma reagin (RPR) testing for syphilis, serum glucose, and Lyme serologies
Differential Diagnoses for Meniere’s disease include
Benign Paroxysmal positional vertigo, Vestibular neuritis, Vertebrobasilar insufficiency, Acoustic neuroma, Migraine headache
If Meniere’s disease is suspected a referral to _____________ should be made
otolaryngologist
The goals of care for Meneires Disease includes:managing vertigo, Arresting the disease process
For symptomatic relief of Meneires Disease what medications should be used?
meclizine and antiemetics such as promethazine (Phenergan) may be beneficial for some patients
Patient and family education regarding Menieres Disease includes
Patient safety during acute episodes of vertigo and the sedative side effects of prescribed medications
Traumatic Brain Injury is defined as an alteration in brain function, or other evidence of brain pathology CAUSED BY AN EXTERNAL SOURCE.
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…
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
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