neuro- integumentary
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| what is meningitis | inflammation of all the meninges, however the organisms predominantly invloved are the arachnoid and subarachnoid spaces
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| what are the s/s | nuchal rigidity(rigidity of the neck), brudzinskis sign, and kernigs sign, and photophobia
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| how is meningitis dx | positive kernigs sign and brudzinskis sign, gram stain of the CSF reveals organisms,
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| viral vs. bacterial | bacterial is contagous, viral manifestations different b/n different organisms.
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| what lab findings do you expect to see | moderately elevated CSF pressure, elevated CSF protein, decreased glucose, elevated white blood cells count.
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| what assessment data is critical? | assessment of clinical manifestations,
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| what meds to treat? | cephalosporins
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| 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
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| note: | wounds closer to the head the neurotoxins cause tetanus more quickly.
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| prevented? | immunization every 10 years,
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| assessment data | painful muscular spasms, and contractionin the affected extremity. muscular contraction of neck and facial muscles, cheecks and jaws -trismus
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| risus sardonicus | grotesque grinning expression
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| prognosis | 25%to 50% depending on where
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| what is gullian barre syndrome | is an inflammatory disease of unknown origin that involves degeneration of the mylein sheath of peripheral nerves
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| 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
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| manifestiations | deep tendon reflexs are lost, paresthesia (tingling)
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| plateau phase | no longer progresses, does not recover from functions initially lost, deep aching muscle pain in the shoulder girdle and thighs is common,
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| 2 most dangerous features of the disease | respiratory muscle weakness, and autonomic neuropathy involving both the sympathetic and parasympathetic systems.
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| latter features include | orthostatic hypotension, hypertension, pupillary distrubance, sweating dysfunction, cardiac ysthrimias, parlytic ileus, urinary retention
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| 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.
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| 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.
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| prognosis | 85% to 90% of clients recover completely
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| 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
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| caused | trinsic or extrinsic lesions within the nerve itself, gross abnormalities of the axon or mylein, with multiple sclerosis,
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| extrinsic factors | lesions outside trigeminal root and include mechanical compression by tumors, vascular anomalies , dental abscesses or jaw malformation.
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| characterized by | intermittent episodes of intense pain of sudden onset rarely releived by analgesics. tacticle stimulation may trigger ex. touch facial hygiene, talking
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| more prevalent | maxillary and mandibular distributions, and on the right side of the face. can be so intese the patient considers suicide.
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| 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
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| 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
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| meds cont. | Lioseral is an antispasmotic used alone or with anticonvulsants, opoids are not effective
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| nx considerations | clients do not usually meet intake requirements. also need emotional support,
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| 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
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| complications | development of facial parathesias and muscular weakness,
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| assess | aspiration, advance diet slowly, teach patient to use water jet device corneal reflex may be inpaired
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| 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.
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| cause | unilateral paralysis of the facial muscles of expression, no pathological cause, paralysis may be central or peripheral in origin,
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| 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)
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| manifestaitons | upward movement of the eyeballon closing the eye(bells phenonmenon)
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| 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
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| 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
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| recovery | within a few weeks without manifestations, if perminant paralysis then surgery may be needed
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| actinic | ultraviolet light
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| amelanotic | without pigment
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| circinate | circular
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| circumscribed | limited to a certain area by sharply defined border
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| coalesce | to merge one with another
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| comedo | plug in skin duct containing keratin (whitehead or blackhead)
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| cytotoxic | toxic to cells
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| dermatome | area of skin supplied by a single dorsal nerve root
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| dermatophyte | fungus that enters the skins surfacec causing infection
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| desquamation | scaling, peeling of epidermis
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| discoid | coin like
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| eczematous | general term for disease process characterized by dxaling, weeping, crusting and inflammation
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| erythema | redness
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| exacerbation | worsening of disease state
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| exfoliative | shedding of skin in fairly large quanities
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| folliculitis | hair follicle inflammtation
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| guttate | small, water drop size lesions, usually widespread
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| hives | spontaneously occuring wheals
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| hyperkeratosis | thickening of strateum corneaum, usually from repeated pressure or friction
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| hyperpigmentation | increased or excessive skin pigmentation(melanin) causing a darkening of the skin than the surrounding area
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| hypopigmentaiton | decreased pigmentation
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| indurated | hard
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| intertrigo | irritation of body areas with opposing skinflods that are subject to friction
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| lesion | detectable change from normal skin structure
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| maceration | tissue softening or disinteration from excessive moisture
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| milia | small white papula
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| perioral | around the mouth
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| periungual | under the nail bed
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| pigmentation | degree of skin color, or mucous membrane color
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| plantar | pertaining to the sole of the foot
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| polymorphic | existing in many forms
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| pruritis | itching
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| punctate | pinpoint
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| sclerosis | hardening or induration of skin
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| sebum | lipid excretion produced by sebacous glands
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| tautness | degree of skin tightness
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| texture | tactile or visual skin characteristics, coarsenenss or dryness
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| ultraviolet light | electromagnetic radiaiton from the sun
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| urticaria | wheals hives
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| verruca | leasion with surface roughness , wart
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| macule | skin color change without elevation, flat, described as a patch, if greater than 1 cm. (freckles or petechia)
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| papule | elevated solid lesion of less than 1 cm varying in color (warts or elevated nevus)
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| plaque | raised, flat lesion formed from merging papules or nodules
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| nodule | larger than a papule, raised solid lesion extending deeper into the dermis, a large noduleis referred to as a tumor
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| wheal | hive, fleeting skin elevation that is irregularly shaped because of edema, mosquito bite
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| vesicle | blister, elevated, sharply defined lesion containing serous fluid, usually less than 1cm blister, chickenpox, or herpes simplex
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| bulla | large elevated, fluidfilled lesion greater than 1cm partial thickness burn
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| CYST | elevated, thick walled lesion containing fluid or semisolid matter.
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| pustule | elevated lesion less than 1cm contaioning purulent material, lesions larger that 1cm are described as boils, abscesses or furncles, acne or impetigo
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| physical exam | examine skin thoroughly, use inspection, palpatation, olfaction to asess hair, nails, and skin,
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| inspection and palpation | hair and scalp, nails- color and shape, texture, integrity, thickness/ skin-color, moisture, temp, tex, turgor, edema, tender, odor,
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| lesion exam | location, distribution, size, arrangement, color, configuratuion
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| skin self test | a-asymmerty/ b-border/c-color/d-diameter/
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| 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)
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| crust | dried serum, sebum, blood, or pus on skinsurface producing a temporary barrier to the envirionment (impetigo)
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| erosion | a moist, demarcated depressed area due to loss of partial or full thickness epidermis, basal layer of epidermis reamains intact (ruputured chickenpox vesicle)
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| 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)
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| scar | mark left on skin after healing replacement of destroyed tissue by scare tissue
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| lichenification | epidermal thichening resulting in elevation plaque with accentuated skin markings, usually results from repeated injury through rubbing odr scratiching chronic atopic dermatitis
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| excoration | superficial, linear abradion of wpidermis, visisble sign of itching caused by rubbing or scratiching atopic dermatisis
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| fissure | deep linear split through epidermis into dermis tinea pedis
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| atrophy | wasting of epidermis in whichh skin appears thin and transparant or of dermis in which there is a depressed area arterial insufficiency
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| atopic dermatitis | a chronic relapsing , pruritic eczema, atiopic refers to familial tendency. for excess inflammation in the skin, linning of teh nose and lungs,
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| familial | hay fever, asthma, sensitive skin and a hx of eruptions called atiopic dermatitis
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| patho | immunoregulatory abnormalities have , caused by dysfunction of skin t cells,
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| 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,
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| 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.
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| 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
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| contact dermatitis | inflammatory response irritant or allergic, allergic is a delayed hypersensitivity reaction,
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| management | causative factors, topical meds, wet dressings, antihistamine, topical or systemic steroids,
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| 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,
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| 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,
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| 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
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| free flaps | thrombosis is the most common failure of free flaps,
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| names of flaps | axial skin flap, muscle flap plus skin graft, muocutaneous flap, omental flap
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