NCLEX RN REVIEW NOTES ==.WELL EXPLAINED AND ILLUSTRATED

Delusion of grandeur (superior) - Delusion of persecution Mgt. Anti-psychosis = Haloperidol (ok-pregnant) WOF: EPS - Dystonia – loss of muscle tone, poor posture Tardive dyskinesia (irreversible) – jaw swinging, involuntary repetitive facial movements, tongue protrusion, lip smacking, Akathisia – feeling of restlessness Pseudoparkinsonism – Mx bradykinesia, rigidity and tremors–tx Benztropine (Cogentin) - Acetylcholine Memory loss/dementia Mgt. Cognex (Tacrine), Aricept (Donepezil), Namenda (Memantine HCL) Chorea – involuntary dance like jerky movement Mgt. Tetrabenazine (Xenazine) CRANIAL NERVES DISORDERS 1. Trigeminal Neuralgia – tic douloureux Cranial nerve #5 Impulse of CNS Triggers Hot/cold food Hard food Facial stimulation Sensory Mx Motor Mx -excruciating pain - facial twitching, grimacing Mgt.DOC: Carbamazepine (Tegretol) – N- 5-12 mcg/ml Surgery: Facial Rhizotomy – electrode inserted face to the skull (base) via foramen ovale, heat current applied to CN5 to partially destroy it & to resolve Mx Health teaching: Avoid triggers 2. Bell’s Palsy Cranial nerve #7 Compress or inflammation due to autoimmune response or infection Herpes simplex/virus Sensory Unilateral facial paralysis Motor facial drooping inability to close the eyelids complete Mgt. Corticosteroids Artificial tears- prevent corneal abrasions Health teaching – encourage facial massage/exercise CNS DISORDERS 1. SEIZURE - sudden surge of electrical impulse of the brain activity - it’s just a manifestation not a dse Seizure disorders a. Epilepsy – a repetitive seizure b. Status epilepticus – seizure episode that last for more than 5 min. - recurrent seizure without going back to the baseline (awake-seizure-unconscious-then seizure again) Causes of seizure High grade fever, brain trauma, tumor, infection, substance abuse or toxicity, severe hypoglycemia, electrolyte imbalance - Na+, idiopathic (unknown) Seizure category a. Generalized – sudden impulse is initiated on the entire brain Type: • Tonic-clonic - Grand mal seizure • Absence seizure – Petit-mal Sudden behavioral arrest commonly 10-15 sec b. Partial – initiated on the specific part of the brain and it may spread Type: • Simplex – patient conscious • Complex – patient unconscious Diagnostic pro.: a. EEG – use H2O soluble adhesive gel prep: -avoid anticonvulsant hair shampoo- to attach electrodes easily avoid stimulants (caffeine) no sleep the night prior to a sleep EEG (test with/without a stressor) Not painful – inform pt, dec anxiety Phases of seizure a. Aura • flashes of lights • smell of a burning wire JITL BRiT KEEP OUR FRIENDLY LITTLE SECRET • metallic taste b. Unconscious - secretions c. Tonic- stiffening – shape of arch common d. Clonic – jerking e. Postictal – sleep phase Secretions Interventions 1. Stay calm 2. Mark the start time – assess seizure duration 3. If the patient is standing, lay the patient on the ground (rush to apply pillows) 4. If lying on the side - to prevent aspiration suction the secretions as needed, then provide O2. If sidelying is contraindicated just turn the head to the side, PRIO - Airway 5. Loosen the tight clothing and remove unnecessary materials near the patient 6. Observe for the duration Do not put anything in the patient’s mouth Do not promote abrupt temperature change, just TSB Side rails up 7. Monitor V/S and level of LOC DOC: Diazepam (Valium) – emergency drug (+) disorder of status epilepticus Maintenance drug Barbiturates – (CNS depressants) A/E – bone marrow depression CBC monitoring Dilantin (Phenytoin) – S/E- gingival hyperplasia 10-20 mcg/ml- therapeutic level Valproic acid (Depakene)- 50-100 mcg/ml therapeutic level Lamictal or Phenobarbital 2. MENINGITIS Meninges – covering of the brain Causes: Bacteria (streptococcus pneumonia or Neisseria meningitidis), deadly even an hour < 20 y.o. Virus- entero/coxsackie virus- common <5 y.o. Fungal – cryptococcal meningitis Mx: Fever Rigidity/nuchal rigid Brudzinski’s sign (back of neck)– patient lie flat, flex the neck (outcome hips and neck flexion) Kernig’s sign (Hamst