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NCLEX Review: Neurological System

[youtube http://youtu.be/5AHvjKjCJhA w=400&h=300]

nclexrevneuro

Show Notes:

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

Degeneration of the nerves that controls the voluntary muscles.

ASSESSMENT:

  • Muscle Weakness and Twitching
  • Fatigue
  • dysphagia
  • dysarthia (difficulty swallowing)
  • cramping

– Lowe extremities are usually involved late in the disease.

Treatment:

Riluzole (Rilutek)

Side Effects:

  • nausea, stomach pain, low fever, loss of appetite
  • dark urine, clay-colored stools, jaundice
  • fever, chills, body aches, flu symptoms

Antispasmodics

  • baclofen
  • diazepam

Interventions:

Conserve energy by spacing activities.

Small frequent feedings.

The Nervous System

NCLEX Review on the Neurological System

Time Management:

  • Make sure to read and understand the overview of the Nervous System:
  • Focus in understanding the causes and logic behind each disease.
  • Have an understanding of the signs and symptoms of the disease.
  • Know the medications and the rationale behind using those meds.

Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).

When I say the CENTRAL NERVOUS SYSTEM, We can simplify at as the BRAIN and the SPINAL CORD.

The PERIPHERAL NERVOUS SYSTEM on the other hand, contains the Cranial NERVES and the SPINAL NERVES.

  • WHEN WE TALK ABOUT THE AUTONOMIC NERVOUS SYSTEM, WE ARE BASICALLY TALKING ABOUT THE “SYMPATHETIC” (FIGHT OR FLIGHT) SYSTEM OR THE “PARASYMPATHETIC” SYSTEM.
  • .THE BASIC COMPONENT OF THE NERVOUS SYSTEM IS THE NERVE CELL OR NEURON

NEURON

– is the primary component of the nervous system.

– it is composed of cell body (gray matter), axon and dendrites.

BRAIN (Central Nervous System: Brain and Spinal Cord).

CEREBRUM- Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter

  • TWO HEMISPHERES: LEFT AND RIGHT AND EACH HEMISPHERE IS DIVIDED INTO TWO LOBES.

FRONTAL LOBE

  • PERSONALITY, BEHAVIOR
  • HIGHER INTELLECTUAL FUNCTIONING
  • BROCA’S AREA: (MOTOR SPEECH AREA)

PARIETAL LOBE

  • POSTCENTRAL GYRUS: REGISTERS SENSATION (TOUCH, PRESSURE)
  • INTEGRATES SENSORY INFORMATION

TEMPORAL LOBE

  • HEARING, TASTE, SMELL (hint: location of ears – close the temples)
  • WERNICKE’S AREA: SENSORY SPEECH AREA
  • (UNDERSTANDING, FORMATION OF LANGUAGE)

OCCIPITAL LOBE

  • VISION

Peripheral Nervous System- composed of Spinal Nerves (31)

Autonomic Nervous System- part of the Peripheral Nervous System

  • REGULATES FUNCTIONS OCCURRING AUTOMATICALLY IN THE BODY.
  • ANS REGULATES SMOOTH MUSCLE, CARDIAC MUSCLE AND GLANDS.

IT IS NOT NECESSARY TO KNOW EVERY PHYSIOLOGY FOR EVERY SINGLE PART OF THE BRAIN. BUT JUST IN CASE WE GO END UP GETTING LOW LEVEL QUESTIONS ON THE EXAM, THEN IT IS IMPORTANT THAT WE UNDERSTAND THE BASIC CONCEPT AND FUNCTION OF EACH AREA. IT WOULD ALSO BE A GREAT IDEA TO KNOW THE CRANIAL NERVES.

The CRANIAL NERVES

GLASCOW COMA SCALE

INCREASED INTRACRANIAL PRESSURE

MENINGITIS

ENCEPHALITIS

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Infection Control NCLEX Review

Everyone taking the NCLEX or is about to take the NCLEX  has realized that the NCSBN had change some of the content format of the NCLEX.  One of the big changes includes the percent amount of Safety and Infection Control that will be on the NCLEX.  The “Safety and Infection Control” now makes up about 8-14% of the questions in the NCLEX, I believe that it only previously composed of about 9-12% prior (or I could be wrong).

Infection Control

Recently Infection Control makes up about 10- 13% of the NCLEX.  That means that if you are able to get the average of about 130-150 questions, then you are guaranteed to recieved between 15- 20 questions that is related to Infection Control.  Even if we get the least (75) amount of questions, we can still receive about 7-9 questions that is related to infection control, that is a HUGE help, if we do well on these questions.  I personally dont think that Infection control is a difficult area.  I believe that most of the nursing students never really studied “Infection Control,” when they were in Nursing School.  Therefore, this lack of knowledge did not prepare the majority of the Nursing Student for the NCLEX.

Standard Precautions

– is always done in congruent with the other types of precautions.

Transmission-based Precautions includes:

A – Airborne
D – Droplet
C – Contact

Airborne Precaution

  • is done when small droplets of infected pathogens are about ( 5 um) are suspended in the air over time and travels a distance of more than (3) three feet.

AIRBORNE PRECAUTION is used with these diseases:

My – Measles

  • Measles- or rubeola
  • Can be transmitted through blood urine and droplets
  • Communicable about 4-5 days after the rash
  • Treatment: Bedrest and antibiotics

Chicken – Chickenpox

  • Chickenpox (Varicella)
  • Pt. will have a slight fever
  • macular rash appears on trunk and eventually turn to crust.

Hez – Herpes Zoster (Disseminated)

TB – Tuberculosis

  • Private room
  • Negative pressure with 6-12 air exchanges per hour
  • UV
  • Mask
  • N95 Mask for TB

DROPLET PRECAUTION

S – Sepsis
S – Scarlet fever
S – Streptococcal pharyngitis
P – Pneumonia
I – Influenza
D – Diptheria (Pharyngeal)
E – Epiglottitis

What is necesary: Private room and Mask

Contact Precation
M – Multidrug resistant organism
R – Respiratory infection – RSV
E – Enteric infections – clostridium defficile
E – Eye infections

Skin Infections:
V – Varicella zoster
C – Cutaneous diptheria
H – Herpes simplex
I – Impetigo
S – Scabies, Staphylococcus

Private room
Gloves
Gowns

NCLEX Review on Infection Control

It is really important to study and understand Infection Control for the NCLEX Exam.

Lets look at Infection Control more closely for the NCLEX:

INFECTION CONTROL: NCLEX REVIEW

 

Nclex Infection Control Review on Contact Precautions 
Contact Precautions -Any Physical Skin-Skin Contact
-Contact with contaminated inanimate objects
*Clean (non-sterile) gloves must be used.
*Change gloves after contact with feces, and/or wound drainage
*Remove gloves & wash hands w/antimicrobial cleanser
* Use gown if RN will have contact with, or if client is incontinent, has an iliostomy/colostomy, wound drainage.
* Remove gown before leaving client’s room

Infection Control NCLEX Diseases
Contact Precautions Diseases:
* MRSA
* Vancomycin resistant organisms
* Herpes simplex & zoster
* Hep A
* GI, Wound, & UTIs
* Pediculosis
* Scabies
* C. diff
* RSV
* Hep A if patient is diapered or incontinent
Lyme Disease Stage 1 = rash/papule at area of tick bite (2-30 days), concentric rings/bull’s eye, lesion enlarges quickly. Regional lymphadenopathy. Flu-like symptoms (malaise, fever, HA, myalgia, arthralgia, conjunctivitis) within one to several months.

Stage 2 (if untreated for 1-6 mo.) = Cardiac conduction defects. Neurological disorders: facial paralysis, paralysis that is not permanent.

Stage 3 = Arthralgias, enlarged or inflamed joints, chronic fatigue, cognitive disorders.

 

 

♦ NCLEX DISEASES: Airborne Precautions 

Airborne Precautions < 5 Microns

Make sure that these patients would require:

  1. PRIVATE ROOM
  2. CLOSED DOOR
  3. FILTERED MASK
    Client requires a private room w/ neg air pressure and 6-12 air exchanges per hour.
    Door must remain closed
    N-95 Hepa filter mask

NCLEX DISEASES: Airborne Precautions
Diseases:
* TB (m. Tuberculosis) MUST WEAR FIT TESTED MASK
* Measles (rubeola)
* Chicken Pox (varicella)
* Shingles (disseminated zoster)

 

 

 Nclex Infection Control Review on Droplet Precautions 
Droplet Precautions > 5 Microns
Client requires a private room
Room door may remain open
Any contact with conjunctiva or mucous membranes (nose or mouth), coughing, sneezing, talking or procedures such as suctioning or bronchoscopy
Must maintain spatial separation of 3 feet
If < 3 feet, staff or visitors must wear a mask (i.e. staff giving direct care)

* When transporting client, s/he must wear a mask
Diseases:
* Diptheria
* Streptococcal pharyngitis/tonsillitis
* certain pneumonias
* Meningitis -If caused by H. influenzae Type B or N. meningitidis
* Mumps
* Pertussis
* Scarlet fever

 

Nclex Infection Control Review on Aids

AIDS — opportunistic infections

  • TB
  • PCP (P. carinii – pneumonia)
  • C. albicans
  •  C. neoformans (debilitating meningitis)
  • CMV, Kaposi’s sarcoma (most common malignancy)

AIDS Syndrome +ve for HIV in blood (+ve ELISA with a Western Blot or indirect immunoflourescence assay (IFA) follow up) and CD4/TC counts below 200

NCLEX Infection Control: Transmission of Hepatitis

  • Hep A transmission Fecal/Oral (shellfish in contaminated water, contaminated food handlers etc.)
    Hep B transmission Parenteral (blood). maternal – fetal, sexual contact
    Hep C transmission Parenteral (blood), sexual contact
    Hep D transmission co-infects w/ Hep B

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