Anybody interested in an online NCLEX study group

Great!! I am planning on breaking down the review into sections. We can just use this forum to share our (personal) notes on each systems/sections. I want to begin with the Neuro System : )

Here are some of My NOTES:

Quick Overview of the Cranial Nerves[h=3]1 The Olfactory Nerve[/h]- Transmits the sense of smell from the nose

2 The Optic NerveThe optic nerve is a sensory nerve responsible for vision. [h=3]3 The Oculomotor Nerve[/h]-Transmits signals from the brain that result in eye movements.

[h=3]4 The Trochlear Nerve[/h]- Causes the eye to move in the downward and inward directions.

[h=3]5 The Trigeminal Nerve[/h]- The motor portion of the trigeminal nerve is responsible for jaw movement and chewing, while the sensory portion of the nerve provides the sensation of touch over the face.

6 The Abducens NerveThe abducens nerve is a motor nerve that is responsible for lateral or outward eye movement.[h=3]7 The Facial Nerve[/h]- Responsible for facial movements and expression, as well as some muscles deep in the neck.

8 The Auditory Nerve

- Responsible for hearing.

[h=3]9 The Glossopharyngeal Nerve[/h]- Innervates muscles of the neck responsible for swallowing and speech. A portion also transmits taste and touch as well as sensation of a portion of the ear.

[h=3]10 The Vagus Nerve[/h]-. Responsible for the gag reflex.

[h=3]11 The Spinal Accessory Nerve[/h]- Responsible for the movement of the sternocleidomastoid muscle in the neck and the trapezius muscle in the upper back resulting in shrugging.

12 The Hypoglossal Nerve- Innervates the muscles of the tongue responsible for tongue movement. It traverses the skull through the hypoglossal canal.

GLASCOW COMA SCALE

• SCALE METHOD OF ASSESSING A CLIENT'S NEUROLOGICAL CONDITION
  
  
• THE SCORING SYSTEM (ONE TO FIFTEEN (1-15) PTS.)
  
  
• LOWER THAN EIGHT INDICATES COMA.
  

It is based on:1. Eye Opening2. Motor Response3. Verbal Response

NEURO DIAGNOSTIC TESTS

These are some of the diagnostic tests that helps in diagnosing Neurological Diseases.

• COMPUTED TOMOGRAPHY (CT) SCAN 
  
  
• CEREBRAL ANGIOGRAPHY
  
  
• MAGNETIC RESONANCE IMAGING (MRI)
  
  
• LUMBAR PUNCTURE
  
  
• ELECTROENCEPHALOGRAPHY (EEG)
  
  
• MYELOGRAPHY
  

INCREASED INTRACRANIAL PRESSURE

- Increase in pressure within the cranium.

CAUSES:EdemaTraumaHemorrhage

Normal ICP: 5- 15 mm Hg.

INTERVENTIONS:

• * NO VAGAL STIMULATION W/ PATIENT
  
  
• IMPLEMENT SEIZURE PRECAUTIONS
  
  
• MAINTAIN PATENT AIRWAY
  

ASSESSMENT

• EARLIEST SIGN: DECREASE IN LOC, RESTLESSNESS AND CONFUSION
  
  
• PROJECTILE VOMITING
  
  
• CHANGES IN VITAL SIGNS (MAY BE A LATE SIGN).
  
  
• SYSTOLIC BLOOD RISES WHILE DIASTOLIC PRESSURE REMAINS THE SAME.
  
  
• ELEVATED TEMPERATURE
  

Remember: PATIENT WOULD HAVE:

• HIGH blood pressure,
  
  
• LOW respiration and pulse,
  
  
• HIGH temp.
  

Nursing Care

• MAINTAIN FLUID BALANCE: FLUID RESTRICTION (if possible)
  
  
• POSITION CLIENT: BED ELEVATED 30-45 DEGREES
  
  
• MAINTAIN A PATENT AIRWAY.
  
  
• HYPEROSMOTIC AGENTS (MANNITOL, OSMITROL)
  
  
• CORTICOSTEROIDS (DEXAMETHASONE)
  
  
• DIURETICS (FUROSEMIDE, LASIX): REDUCE CEREBRAL EDEMA
  
  
• ANTICONVULSANTS (PHENYTOIN, DILANTIN): PREVENT SEIZURES.
  

HEAD POSITION:MIDLINE OR NEUTRAL POSITIONAVOID FLEXING OR EXTENDING.

IMPORTANT:

• PATIENT CAN ALSO MANIFEST THE CUSHING'S TRIAD) WHICH ARE VITAL SIGN CHANGES THAT WILL SHOW A DECREASE IN RESPIRATIONS AND PULSE RATE BUT INCREASE IN BP.
  

FOR AN INFANT*(SYMPTOMS*)

• BULGING FONTANELS
  
  
• RESTLESSNESS & IRRITABILITY
  
  
• HIGH PITCHED CRY
  

ANEURYSM

- outpouching of a vessel

Types of Cerebral Aneurysm:

• SACULAR (BERRY)
  
  
• FUSIFORM
  
  
• MYCOTIC
  

CAUSES OF ANERYSM INCLUDES:Congenital, Atherosclerosis, Trauma

• PERSON CAN BE ASYMPTOMATIC, UNI ANEURYSM, RUPTURES.
  
  
• HEMORRHAGIC STROKE.- Aneurysm does not rupture, but bleeds.
  

ASSESSMENT FOR PATIENTS:

• HEADACHES *(SEVERE SUDDEN HEADACHES)
  
  
• VOMITING
  
  
• PTOSIS
  
  
• DIPLOPIA
  
  
• DECREASED LOC
  

INTERVENTIONS:

• SEIZURE PRECAUTIONS
  
  
• ASSESS LOC AND NEUROLOGICAL STATUS
  
  
• CORTICOSTEROIDS (DEXAMETHASONE) reduce inflammation
  
  
• ANTICONVULSANTS (reduce risk of seizures)
  
  
• STOOL SOFTENER (reduce straining)
  

SEIZURES

- abnormal chaotic electrical discharge within the neuron system of the brain.

Types of Seizures:

• GENERALIZED SEIZURES (TONIC CLONIC, ABSENT SEIZURES)
  
  
• PARTIAL SEIZURES (SIMPLE, COMPLEX)
  

*Never use a tongue blade. Do not restrain the patient.*Pad the siderails.

Dilantin (Phenytoin): (Anticonvulsant Drug)- Side Effects includes: Ataxia, slurred speech, blurred vision, mental confusion.- DO NOT WITHDRAW SUDDENLY (SEIZURES CAN OCCUR).- Administer this drug with Nornal Saline- Therapeutic Level: 10- 20 mcg/ ml.- When taking Dilantin, teach pt. to have good dental hygiene (can cause gingival hyperplasia)

Phenobarbital (Barbituate)- Side Effects: Lethargy, Drowsiness & Respiratory depressionTegretol (Carbamazepine)

MENINGITIS

- inflammation of the brain and the spinal meninges.

Note: Droplet precaution have to be maintained until antibiotic therapy is given.

Causes:- Head Trauma- Skull Fracture- Bacteria: Haemophilus Influenzae, Neissria Meningitidis- Viruses

DIAGNOSIS:Lumbar Puncture Procedure - (increased CSF pressure and increase in WBC count .POSITION: SIDElying with head down to the chest w/ legs pulled up.Needle is inserted at Lubar area (L4-L5)

Pre-Op- Let pt. empty bladder- Position: Lateral recumbant w/ knees flexed

ASSESSMENT (Meningitis):- Confusion- Lethargy- Fever- Nuchal Rigidity/ Stiff Neck

Tests for MeningitisBrudzinski's Sign

• INVOLUNTARY FLEXION OF THE HIP AND KNEE WHEN THE NECK IS FLEXED.
  

Kernig's Sign

• LOSS OF THE ABILITY OF A SUPINE CLIENT TO STRAIGHTEN THE LEG WHEN FLEXED AT THE KNEE AND HIP.
  

TREATMENT:- Bed Rest- Antibiotics- Diuretics- Corticosteroids

Lou Gehrig's Disease/ Amyothropic Lateral Sclerosis (ALS)

Degeneration of the nerves that controls the voluntary muscles.

ASSESSMENT:Muscle Weakness and TwitchingFatigue- Lowe extremities are usually involved late in the disease.

Treatment:Riluzole (Rilutek)

Interventions:Conserve energy by spacing activities.Small frequent feedings.

STROKE

• CEREBROVASCULAR ACCIDENT (CVA) CAN BE A REDUCTION IN CEREBRAL BLOOD FLOW AND OXYGEN OR A BLEEDING OR HEMORRHAGING OF A BLOOD VESSEL.
  

TWO TYPES OF STROKE:* ISCHEMIA

When a patient has HEMIPARESIS (one side is paralyzed): Place the patient in the affected side in order to prevent airway obstruction and reduce the risk of aspiration.

HOMONYMOUS HEMIANOPSIA- loss of vision in half of the visual field can occur following a stroke.

DIAGNOSIS:

• DIAGNOSIS CAN BE DETERMINED BY A CT SCAN, CEREBRAL ARTERIOGRAPHY, ELECTROENCEPHALOGRAPHY, AND MRI.
  
  
• CAROTID ENDARTERECTOMY
  
  
• A SURGICAL INTERVENTION USED IN A STROKE MANAGEMENT AND CAN BE USED AS A STROKE PREVENTION.
  

Important Assessments:

• HEADACHE, NAUSEA, VOMITING
  
  
• FACIAL DROOPING
  
  
• APHASIA, SPEECH CHANGES
  
  
• NUCHAL RIGIDITY
  

ENCEPHALITIS

Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.

- Enchephalitis is usually caused by a viral agent.- Does not respond to antibIotic therapy.

ASSESSMENT:

• FEVER
  
  
• HEADACHE
  
  
• LOW APPETITE
  
  
• LOW ENERGY
  

Diagnosis:- A CSF examination- Blood Tests

Treatment- Decrease ICP- Anticonvulsants

MULTIPLE SCLEROSIS

- a chronic degenerative disease of the CNS- demineralization of the neurons.- exacerbation and remissions.

Causes:- An autoimmune response- Virus infection- Stress related that can precede an onset.

Assessment for patients with MS

• FATIGUE AND WEAKNESS
  
  
• BLADDER AND BOWEL DISTURBANCES (LATER STAGE)
  
  
• RESPIRATORY PARALYSIS AND FAILURE (LATER STAGE)
  
  
• * POSITIVE BABINSKI REFLEX.
  

Meds:Cholinergic Drug: Bethanechol (Urecholine)Glucoccorticoides: Demathesone, PrednisoneMuscle Relaxants: Baclofen

INTERVENTIONS

- Assess the patient's Neurological Status.- Make sure to assess gag reflex before feeding.

MYASTHENIA GRAVIS

- Neuromuscular disease: weakness and fatigue of the voluntary muscles.- Is usually due to insufficient amount of Acetycholine.

CAUSES:- An autoimmune response- Inadequate release of Ach.

ASSESSMENT

• WEAKNESS AND FATIGUE
  
  
• DIFFICULTY CHEWING
  
  
• DYSPHAGIA, PTOSIS
  
  
• DIFFICULTY BREATHING (RESPIRATORY)
  

Diagnostics;Tensilon Test- used for diagnosing Myasthenia Gravis.- used to defferntiate cholinergic crisis from myasthenic crisis.

How the test is done:An IV injection of edrophonium or neostigmine causes some quick relief of muscle weakness.

Cholinesterase Inhibitor is used for Myasthenia Gravis- Cholinesterase Inhibitor can intensify transmission at muscarinic and neuromuscular junctions.

Atropine- antidote for cholinergic crisis.

TREATMENT:Cholinergic Medications (Anticholinesterase.

• Neostigmine (Prostigmin)
  
  
• Pyridostigmine (Mestinon)
  

Side effects of Medications:- increase GI motilioty- bradycardia

- increased salivation

TRIGEMINAL NEURALGIA (Tic Douloureux)

Painful disorder of the fifth cranial (trigeminal nerve)Extreme and excruciating facal pain.Pain is stimulated by pressure and temperature.

TREATMENTAnticonvulsants (Tegretol)Phenytoin (Dilantin)* watch out for gingival hyperplasia, hypotension

Surgical InterventionSevering of the sensory root in the nerve.

Bells Palsy (Facial Paralysis)

A paralysis that usually occurs in one side of the face.There is an inflammation in the seventh (facial) nerve.* Affects the facial Nerve (Cranial nerve VII)

ASSESSMENT

Difficulty ChewingFacial PainIncreased lacrimation

Medications:PrednisoneAntivirals

BRAIN TUMORS

- a brain tumor is an abnormal mass found in the brain that results from unregulated cell growth and division.

The presence of lesions can cause:

• compression of blood vessels
  
  
• producing edema
  
  
• ischemia
  
  
• increase in intracranial pressure
  

GENERAL ASSESSMENT:

• SEIZURES
  
  
• VISUAL CHANGES
  
  
• SYMPTOMS OF ICP
  

SURGICAL PROCEDURES:

• CRANIOTOMY
  
  
• GAMMA KNIFE SURGERY
  

Diagnostic Evaluation:CT Scanning and MRI can show the location and the size of the tumor.

Intervention*Post-op, position a pt. after a supratentorial surgery in a semi to low fowlers position.

PARKINSONS DISEASE

- degenerative disease caused by the decrease and lack of dopamine in the brain.Assessment:

• TREMORS IN HANDS AND FINGERS (PILL ROLLING)
  
  
• AKINESIA
  
  
• BRADYKINESIA
  
  
• BLANK FACIAL EXPRESSION
  
  
• SHUFFLING STEPS AND GAIT
  
  
• RESTLESSNESS
  

Antiparkinsonian Agents

Cholinergic Medications (Anticholinesterase)

• Pyridostigmine (Mestinon)
  
  
• Neostigmine (Prostigmine)
  
  
• Edrophonium Chloride (Tensilon)
  
  
• - Used for Myasthenia Gravis
  

DopaminergicsLevodopaCarbidopa/ Levodopa

SPINAL CORD INJURY

- a trauma in the spinal cord (partial or complete) that traumatize and disrupt the nerve tracts and neurons within our system. A spinal cord injury can be classified as either complete or incomplete

PATIENT WITH SPINAL CORD INJURY ASSESSMENT:ACUTE RESPIRATORY FAILURECOMPROMISED RESPIRATORY FUNCTIONSENSORY AND MOTOR PARALYSIS WITHIN OR BELOW LEVEL OF INJURY.

Spinal Shock- is also called a neurogenic shock.

Assessment includes:

• DECREASE OR LOSS OF REFLEX ACTIVITY, FLACCID PARALYSIS, BRADYCARDIA.
  
  
• USUALLY OCCURS WITHIN SEVERAL HOURS RIGHT AFTER INJURY.
  
  
• LOSS MOVEMENTS OF MUSCLES (FLACCID PARALAYSIS), BOWEL AND BLADDER.
  

Autonomic Dysreflexia

- also known as autonomic hyperrefelexia.- caused by stimulus to the bladder or bowel- Try to limit the catheterization of spinal cord patients to once every 12-14 hrs.

Asessment includes:

• HYPERTENSION (SEVERE)
  
  
• HEADACHE (THROBBING)
  

- also known as autonomic hyperrefelexia.

HEAD FRACTURES

Basillar Fracture- A leakage of CSF or cerebrospinal fluid can accompany a basillar fracture. CSF will show yellow ring called the halo sign and it will test positive for glucose.

SIDE NOTE: REMEMBER FOR THE NCLEX- Guillain–Barré syndrome: Patient will have an increase in protien but a normal cell count.- Guillain–Barré patient: usually has a previous virus illness.- With Meningitis: There is an increase in WBC. And with bacterial meningitis, there is an increased protien & decreased glucose.- For pt. with a stroke and has a fever: Tylenol can be givin. Not Aspirin or Advil.- Patients w/ Multiple Sclerosis: give Biological Response Modifiers, Steroids, Immunosupressants and Muscle Relaxers

• BIOLOGICAL RESPONSE MODIFIERS: AVONEX, BETASERON, COPAXONE.
  

- Earliest indication of Increased Intracranial Pressure: RESTLESSNESS.

- ANTIPARKINSONIAN MEDICATIONS:

• RESTORES THE PRODUCTION OF DOPAMINE AND SUPPRESSION OF ACETYLCHOLINE.
  

♣ Dopaminergic Medications:

• CARBIDOPA (SINEMET)
  
  
• BROMOCRIPTINE (PARLODEL)
  
  
• (MIRAPEX), (CARBEX)
  

Â¥ Anticholinergic Medications:

• BENZTROPINE MESYLATE (COGENTIN)
  
  
• TRIHEXYPHENIDYL HYDROCHLORIDE
  

♣ ANTICONVULSANTS

♦OSMOTIC DIURETICS♥ CHOLINESTERASE INHIBITOR♣ SKELETAL MUSCLE RELAXANTS♦ ANTIGOUT MEDICATIONS

ScoliosisA lateral curvature of the spine that usually occurs more often in girls than in boys.

There are two types:- Nonstructural Scoliosis- Structural Scoliosis

Nonstructural Scoliosis - The curve in the spinal column disappears when the child tries to bends at the waist and touches the toes. On the other hand when you assess a child with structural scoliosis, you will see a failure of the spinal curve to straighten when the child tries to bend forward with the knees straight. For these patients, bracing can help slow the progression of the condition.

Note: If a child is wearing a brace. Inform and educate the parents that the brace must be worn 16 to 23 hours each day. Examine the skin daily to evaluate for any skin breakdowns.

Diagnosis:X- Ray

Guillian Barre Syndrome

ASSESSMENT:- ascending weakness, beggining with the legs- paresthesia with the limbs

PATIENT WILL BE AT RISK FOR RESPIRATORY (Make sure intubation tray is at hand)

More NERVOUS SYSTEM DRUGS

Cholinergic Medications- Stimulates the parasymphatetic SystemInitiates action of Ach and stimulates cholinergic receptors

Used to treat:Bladder functionsGlaucomaMyasthenia GravisAlzheimer's Disease

Medications

Pilocarpine (Pilocar)Bethanicol Chloride (Duvoid)

Adverse ReactionAs a result of (overstimulation of the parsympahtetic Nervous system)HeadacheHypotensionFlushingBradycardia

Notify if patient has shortness of breath

ANTICHOLINERGIC MEDICATIONS- Prevents the cholinergic effects by blocking the action of the Ach

Used For:decreases GI spasmshelps alleviate symtpoms of Parkinson's Disease.Reducces gastric and ssalivary secretions

MedicationsAtropineBenztropine (Cogentin)Scopolamine

Interventions

Contranindicated with:narrow angle glaucomamyasthenia gravis

Glaucoma

Glaucoma: there is an increased of intraocular pressure in the eye.

There are two types:

1. Open Angle Glaucoma or Primary” Glaucoma
   
   
2. Primary Angle Glaucoma.
   

Open angle glaucoma is slow in onset and chronic, while the primary angle glaucoma needs immediate treatment.

Open Angle GlaucomaBilateral

Acute Angle-closure GlaucomaUnilateral

TREATMENTBeta Adrenergic BlockersCholinergic Agents (Pilocarpine)AVOID ANTICHOLINERGICS (Atropine)

Cataracts

Complete or partial opacity of the eye lens.

Types of Cataracts:Senile: associates with agingTraumatic: associates with injurySecondary: Those that followed after othe reye diseases.

Assessment:PainlessDecrease in visual acuity

Remember:If there is severe pain, its a sign of increased occular pressure (call physician)

Cataract Surgery:Removal of the opacified lens.DO NOT ADMINISTER MORPHINE (causes miosis)

Detachment of RetinaUsually no painPerson feel like there is a curtain or shadowPerson might complain of floating spots.

Opthalmic, otic and nasal agents treat, prevent and inhibitconditions affecting the eyes, ears and the nose.

Miotics causes the pupit to contract (constrict)Miotics include:Carbachol (intraocular) (Miostat)Pilocarpine (Piloptic)

Conditions treated with miotics includes:Primary Open- Angle glacaumaMiotics are also administered to create pupillary miosis (contraction) during ocular surgery

MydriaticsMydriatics dilate the pupil. Sometimes the pupil must be dilated during treatment to prevent adhesion of the pupils.

Mydriatics includes:

• Atropine Sulfate
  
  
• Cyclopentolate hydrochloride (mydrilate)
  
  
• Epinephrine hydrochloride (glaucon
  

Conditions used treated with mydriaticsOpen angle glacauma

Opthalmic Vasoconstricorsconstrict the blood vessels of the pupil in the eyes

• Naphazoline Hydrochloride (Allerest)
  
  
• Oxymetazoline Hydrochloride (Visine)
  

Conditions treated with opthalmic vasoconstricorsAllergiesEye irritations

Otitis MediaInfection of the middle ear.Infants and children is common (eustachian tube is shorter)

AssessmentPain from pressureFever

MEDICATIONSAntypyreticAnalgesic

Menierre's Disease

Ear disease that affects the vestibular and semicircular canals.Produces severe vertigo.

ASSESSMENT:HeadacheVertigoNauseaTinnitis

DIAGNOSTICSAuditory TestWeber Test

TREATMENT:Antihistamine

Otics are used and administered to treat conditions of the ear.

Examples:Carbamide Peroxide (Murine Ear)Boric Acid Solution (Ear dry)

How confident are you guys with you Neuro Pharmacology