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med surg

neuro- integumentary

Question	Answer
what is meningitis	inflammation of all the meninges, however the organisms predominantly invloved are the arachnoid and subarachnoid spaces
what are the s/s	nuchal rigidity(rigidity of the neck), brudzinskis sign, and kernigs sign, and photophobia
how is meningitis dx	positive kernigs sign and brudzinskis sign, gram stain of the CSF reveals organisms,
viral vs. bacterial	bacterial is contagous, viral manifestations different b/n different organisms.
what lab findings do you expect to see	moderately elevated CSF pressure, elevated CSF protein, decreased glucose, elevated white blood cells count.
what assessment data is critical?	assessment of clinical manifestations,
what meds to treat?	cephalosporins
what is tetanus	caused by the anaerobic spores forming rod clostridium tetani, tetanus may be found in some people wit some form of trauma and no history of tetanus immunization, bacteria enters the bloodstream from the wound and travels to the cns and pns
note:	wounds closer to the head the neurotoxins cause tetanus more quickly.
prevented?	immunization every 10 years,
assessment data	painful muscular spasms, and contractionin the affected extremity. muscular contraction of neck and facial muscles, cheecks and jaws -trismus
risus sardonicus	grotesque grinning expression
prognosis	25%to 50% depending on where
what is gullian barre syndrome	is an inflammatory disease of unknown origin that involves degeneration of the mylein sheath of peripheral nerves
course of the disease	ascending weakness, usually beginning in the lower exteremities and spreading, some times rapidly, to the trunk, upper extremities, and even the face. the weakness evolves over hours to days with maximal deficit by 4 weeks in 90% cases
manifestiations	deep tendon reflexs are lost, paresthesia (tingling)
plateau phase	no longer progresses, does not recover from functions initially lost, deep aching muscle pain in the shoulder girdle and thighs is common,
2 most dangerous features of the disease	respiratory muscle weakness, and autonomic neuropathy involving both the sympathetic and parasympathetic systems.
latter features include	orthostatic hypotension, hypertension, pupillary distrubance, sweating dysfunction, cardiac ysthrimias, parlytic ileus, urinary retention
recovery phase	improvement and recovery occur with remylenation. occurs in a descending pattern, those lost last are restored first. recovery is 6 months,to upto 2 years.
diagnosis	history and physical exam, csf exam, electrophsiologic studies, csf contains increased proteins, with few or no white blood cells, nerve conduction velocity is slowed, conduction block.
prognosis	85% to 90% of clients recover completely
what is trigeminal neuralgia	chronic irritation of the fifth cranial nerve, douloureux, 50 to 70 year olds and 60% of clients are women affecting either the ophthalmic, maxillary, or mandibular division
caused	trinsic or extrinsic lesions within the nerve itself, gross abnormalities of the axon or mylein, with multiple sclerosis,
extrinsic factors	lesions outside trigeminal root and include mechanical compression by tumors, vascular anomalies , dental abscesses or jaw malformation.
characterized by	intermittent episodes of intense pain of sudden onset rarely releived by analgesics. tacticle stimulation may trigger ex. touch facial hygiene, talking
more prevalent	maxillary and mandibular distributions, and on the right side of the face. can be so intese the patient considers suicide.
diagnostic studies find lesions	angiography, CT, and MRI, causative lesions, dx made from basis of an indepth history with attention paid to trigger stimuli and nature of the pain site
meds	anticonvulsants such as tegretol, dampen the reactivity of the neurons, liver impairment may result from carbamazepine, and phenytoin liver enzymes must be monitored during and before therapy
meds cont.	Lioseral is an antispasmotic used alone or with anticonvulsants, opoids are not effective
nx considerations	clients do not usually meet intake requirements. also need emotional support,
surgery includes	nerve blocks with alcohol,or glycerol, peripheral neruectomy, percutaneous radiofrequency wave forms that create lesions that alter pain transmissions.rhizotomy, resection of the root of the nerve
complications	development of facial parathesias and muscular weakness,
assess	aspiration, advance diet slowly, teach patient to use water jet device corneal reflex may be inpaired
what is bells palsy	affects the motor aspect of the facial nerve, the 7th cranial nerve. common type of peripheral facial paralysis, commomly among 20 to 40 yr.
cause	unilateral paralysis of the facial muscles of expression, no pathological cause, paralysis may be central or peripheral in origin,
central facial palsy	upper motor neuron paralysis of paraesis, sometimes causes dissociation of motor function, pt. cannot voluntarily show teeth on the paralyzed side, can show emotional stimulation-sudden laugh.(voluntary emotional dissociation)
manifestaitons	upward movement of the eyeballon closing the eye(bells phenonmenon)
contd	drooping of the mouth, flattening of the nasolabial fold, widening of the palpebral fissure, a slight lag in closing the eye , eating may be difficult
no known cure	care is palative, analgesics for comfort, corticosteroids for edema, physical therapy with moist heat, gentle massage, stimulation of nerve with faradic current, cornea protected with artifical tears, eye patch at night
recovery	within a few weeks without manifestations, if perminant paralysis then surgery may be needed
actinic	ultraviolet light
amelanotic	without pigment
circinate	circular
circumscribed	limited to a certain area by sharply defined border
coalesce	to merge one with another
comedo	plug in skin duct containing keratin (whitehead or blackhead)
cytotoxic	toxic to cells
dermatome	area of skin supplied by a single dorsal nerve root
dermatophyte	fungus that enters the skins surfacec causing infection
desquamation	scaling, peeling of epidermis
discoid	coin like
eczematous	general term for disease process characterized by dxaling, weeping, crusting and inflammation
erythema	redness
exacerbation	worsening of disease state
exfoliative	shedding of skin in fairly large quanities
folliculitis	hair follicle inflammtation
guttate	small, water drop size lesions, usually widespread
hives	spontaneously occuring wheals
hyperkeratosis	thickening of strateum corneaum, usually from repeated pressure or friction
hyperpigmentation	increased or excessive skin pigmentation(melanin) causing a darkening of the skin than the surrounding area
hypopigmentaiton	decreased pigmentation
indurated	hard
intertrigo	irritation of body areas with opposing skinflods that are subject to friction
lesion	detectable change from normal skin structure
maceration	tissue softening or disinteration from excessive moisture
milia	small white papula
perioral	around the mouth
periungual	under the nail bed
pigmentation	degree of skin color, or mucous membrane color
plantar	pertaining to the sole of the foot
polymorphic	existing in many forms
pruritis	itching
punctate	pinpoint
sclerosis	hardening or induration of skin
sebum	lipid excretion produced by sebacous glands
tautness	degree of skin tightness
texture	tactile or visual skin characteristics, coarsenenss or dryness
ultraviolet light	electromagnetic radiaiton from the sun
urticaria	wheals hives
verruca	leasion with surface roughness , wart
macule	skin color change without elevation, flat, described as a patch, if greater than 1 cm. (freckles or petechia)
papule	elevated solid lesion of less than 1 cm varying in color (warts or elevated nevus)
plaque	raised, flat lesion formed from merging papules or nodules
nodule	larger than a papule, raised solid lesion extending deeper into the dermis, a large noduleis referred to as a tumor
wheal	hive, fleeting skin elevation that is irregularly shaped because of edema, mosquito bite
vesicle	blister, elevated, sharply defined lesion containing serous fluid, usually less than 1cm blister, chickenpox, or herpes simplex
bulla	large elevated, fluidfilled lesion greater than 1cm partial thickness burn
CYST	elevated, thick walled lesion containing fluid or semisolid matter.
pustule	elevated lesion less than 1cm contaioning purulent material, lesions larger that 1cm are described as boils, abscesses or furncles, acne or impetigo
physical exam	examine skin thoroughly, use inspection, palpatation, olfaction to asess hair, nails, and skin,
inspection and palpation	hair and scalp, nails- color and shape, texture, integrity, thickness/ skin-color, moisture, temp, tex, turgor, edema, tender, odor,
lesion exam	location, distribution, size, arrangement, color, configuratuion
skin self test	a-asymmerty/ b-border/c-color/d-diameter/
scale	dried fragments of sloughed epidermal cells, irregular in shape and size and white,tan, yellow or silver in color, (dandruff, dry skin or psoriasis)
crust	dried serum, sebum, blood, or pus on skinsurface producing a temporary barrier to the envirionment (impetigo)
erosion	a moist, demarcated depressed area due to loss of partial or full thickness epidermis, basal layer of epidermis reamains intact (ruputured chickenpox vesicle)
ulcer	irregular shaped, exudative, depressed lesion in which entire epidermis and all or part of dermis are lost, results from trauma and tissue destruction (pressure ulcer)
scar	mark left on skin after healing replacement of destroyed tissue by scare tissue
lichenification	epidermal thichening resulting in elevation plaque with accentuated skin markings, usually results from repeated injury through rubbing odr scratiching chronic atopic dermatitis
excoration	superficial, linear abradion of wpidermis, visisble sign of itching caused by rubbing or scratiching atopic dermatisis
fissure	deep linear split through epidermis into dermis tinea pedis
atrophy	wasting of epidermis in whichh skin appears thin and transparant or of dermis in which there is a depressed area arterial insufficiency
atopic dermatitis	a chronic relapsing , pruritic eczema, atiopic refers to familial tendency. for excess inflammation in the skin, linning of teh nose and lungs,
familial	hay fever, asthma, sensitive skin and a hx of eruptions called atiopic dermatitis
patho	immunoregulatory abnormalities have , caused by dysfunction of skin t cells,
Tcell activation	release of cytokines and inflammatory mediatiors, has reduced watere binding capacity, higher rate of transepidermal water loss, decreased water content, water loss leads to further drying and cracking and itching,
manifestations	begins during infantacy, acute onset, red, oozing crusting rash, shows chronic form of dermatitis, thickened dry texture, brownish grey and scales, rash localized to large folds of the extremeties as pt gets older.
contd	found mainly on elbow bends, backs of knees, the neck, eyelids, the backs of hands and feet. pruritis causes great morbidity, provoking scratching which results in severly excoriated lesions, infection, and scarring
contact dermatitis	inflammatory response irritant or allergic, allergic is a delayed hypersensitivity reaction,
management	causative factors, topical meds, wet dressings, antihistamine, topical or systemic steroids,
reconstructive surgery	skin flaps- are sections of skin rotated from their origin to cover a defect. connonuses of skin flaps to reconsrtuct a neck after excision of cancer, occasionally used to close pressur ulcers on the pelvis, blood flow must be protected,
musculocutaneous flaps	comprised of both muscle and skin, used to fill in defects where muscle is missing or where muscle can provide ample blood flow to heal osteomyletiis, named by the muscle of origin,
outcome	pt will maintain effective peripheral tissue perfusion as evidenced by usual color of skin, no pallor or cyanosism, warm and dry skin, blanching no edema or blebs
free flaps	thrombosis is the most common failure of free flaps,
names of flaps	axial skin flap, muscle flap plus skin graft, muocutaneous flap, omental flap

Created by: chevapourfarhadi

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