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Ƒ rehabilitation for residual deficits mental

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ƒRehabilitation for residual deficits: mental retardation or delay in psychomotor developmentLIVING SPRING INSTITUTELIVING SPRING INSTITUTE
During the acute stage of meningitis, a 3-year old patient is restless and irritable. Whichnursing intervention is most appropriate?LIVING SPRING INSTITUTE
Myasthenia GravisƒA neurovascular disorder characterized by a disturbance in the transmission of impulse fronerve to muscle cells at the neuromuscular junction leading to DESCENDING MUSCLEPARALYSIS.ƒMore common in women aged 20 to 40.ƒEtiology: idiopathic, related to autoimmuneFor unknown reasons, the body is producing cholinesterase which destroys acetylcholine,the neurotransmitter for muscle movement, leading to muscle weakness.ƒSSx:Initial Sign: PTOSIS (drooping of upper eyelid)DiplopiaMasklike facial expressionDysphagiaHoarsenessRespiratory muscle weaknessrespiratory arrest (Prepare tracheostomy set at bedside)Extreme muscle weakness especially during activity or exertionƒDx test:TENSILON TESTTensilon (Edrophonium HCl) is a short acting anti-cholinesteraseTensilon is administered via IV pushIf patient has MG, symptoms will be temporarily relieved (for 5 to 10 minutes)CSF analysis reveals elevated cholinesterase levelsLIVING SPRING INSTITUTE 2011NCLEX PHARM MADE EASY1. phenytoin(Dilantin):anti-seizure, neuropathic pain, mood-stabilizer (bipolar). Start small and titratelike a cook. Folate deficiency(eat fresh leafy veggies; watch out for spina bifida), gingival hyperplasia(gum massage; see a dentist often),blood dyscrasias(anemia,agranulocytosis,thrombocytopenia), sedation(no machines for 24hrs, avoid sedatives like alcohol, sleeping meds).hypotension = change slowly.Aimis to get seizure free yrs. Rememberquiet environ, dimmed lighting,helmet, avoid alcohol, ketogenicdiet(low carb, high fat in intractable seizures)Others are:carbamazepine, valproate, ethosuximide,lamotrigine2.furosemide(Lasix) and hydrochlorothiazide--eat food high in potassium(fruits/foods likewatermelon, cantaloupe, banana, tomatoes, potatoes). Watch out when mixed with digoxin/digitalisbecause hypoK+LIVING SPRING INSTITUTE
will cause digoxin toxicity,alkalosis, muscle weakness, muscle cramps, u-wave on ECG, dysrhythmia,constipation. Thiazides are sulfa meds, so photophobia, Steven Johnson syndrome, kidney damage,gout,interference with some oral hypoglycemic,are our concern. NSAIDS make loop ineffective. Avoid thesemeds at bed time, Weigh same time, I&O, BP, reduce sodium in diet. Others areethacrynic acid,bumetanide, chlorothiazide3. ampicillin, amoxycillin, cloxacillin, dicloxacillin= photosensitivity, makes OCP ineffective, finishthe entire course, may cause pseudomembraneous colitis(C.diff, contact isolation, vancomycin /metronidazole,fluid), may cause oral thrush(give yogurt to replenish lactobacillus acidophilus). Treatmentfor impetigo. Others are,gentamicin-aminoglycoside(ototoxicity, nephrotoxicity, neuromuscularparalysis),tetracycline-tetracyclines(photosensitivity, avoid from conception to age 12yr because ofteeth/bone effect, avoid antacids/calcium-containing food),ciprofloxacin-fluoroquinolones4. Clozapine, fluphenazine, haloperidol, chlorpromazine, olanzepine, riseperidone

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