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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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It has happend to the majority of us.  It has happened to us in Nursing School, but we didn’t expect it to happen now, after we graduate from Nursing.  But it does, it is just part of the JOURNEY towards our Nursing Career.  For you, maybe its your first time taking the NCLEX, for others maybe the second time, or even maybe the third or fourth.  And you have now reached the epitome of stress, you felt like you have poured everything into passing this oh so “dreaded” exam that they call NCLEX.  And for the unfortunate one’s who have worked so hard, gave it their all but still come a little short and still FAIL, it is so tough to a point that you reach the point of…. BURNOUT. 

Now I am going to talk a little about STRESS, and how our AWARENESS and PRACTICE can help.  This is not only directed towards Nursing School and the NCLEX, but in the general sense of living a more happy fulfilled life.

I personally don’t believe that a stress-free life is possible. Stress is a response to challenges in life, and a life without challenges is too boring to contemplate. However, I do believe that most of the stress in our lives is unnecessary, and that it can be eliminated by taking some simple (and some not-so-simple) steps. It can’t be accomplished overnight — I’ve been eliminating stressors in my life for awhile now, and I’m still not done. But I think it’s a worthwhile goal.  I remember how stressful NURSING SCHOOL was.  As a matter of fact, it was at some point a “HELL” kind of experience for me.  The journey was tough, one in which it has affected my life: physically, emotionally, mentally and spiritually…. but in one sense, it has also made me become a stronger person.

 

Especially living in this Country, and the economic turmoil that we just had experienced, it can become overwhelming.  I think overcoming and understanding the stress involved with being in Nursing School and NOW… taking the NCLEX is more than just this experience.  Because I believe that as we start JOB HUNTING and start working as a nurse, there will be new stressors that we will encouter.  But these sources of stress can be eliminated with a little thought. Here’s how:

  1. Identify stressors. This is the most important step of all, as identifying the things that stress you out in your life is the first step towards eliminating them. Take 10 minutes to think about what stresses you out during the day. What weekly occurrences stress you out? What people, activities, things cause stress in your life? Make a Top 10 list, and see which of them can be eliminated, and start to weed them out. For those that can’t, find ways to make them less stressful.
  2. Procrastination. We all do this, of course. But allowing stuff to pile up will stress us out. Find ways to take care of stuff now (form a Do It Now habit) and keep your inbox and desk clear.
  3. Controlling. We are not the Master of this Universe. I know we sometimes wish we were, but acting as if we are is a sure way to get stressed out. Trying to control situations and people cannot work, and only serves to increase our anxiety when it doesn’t work. Learn to let go, and accept the way that other people do things, and accept what happens in different situations. The only thing you can control is yourself — work on that before you consider trying to control the world. Also learn to separate yourself from tasks and to delegate them. Learning to let go of our need to control others and the situations around us is a major step towards eliminating stress.
  4. Multitasking. Having multiple tasks going on at the same time might seem productive, but in actuality it slows us down from actually focusing on a task and completing it — and it stresses us out in the meantime.
  5. Avoid difficult people. You know who they are. If you take a minute to think about it, you can identify all the people in your life — bosses, coworkers, customers, friends, family, etc. — who make your life more difficult. Now, you could confront them and do battle with them, but that will most certainly be difficult. Just cut them out of your life.
  6. Simplify life. Simplifying, of course, is very important, at least to me personally. Simplify your routines, your commitments, your information intake, your cluttered rooms, the mass of stuff going on in your life … and have less stress as a result.
  7. Slow down. Instead of rushing through life, learn to take things slow. Enjoy your food, enjoy the people around you, enjoy nature. This step alone can save tons of stress.
  8. Help others. It may sound contradictory to add more tasks to your life by trying to help other people (you’ve got enough to do), but if you were to add anything to your life, this should be it. Helping others, whether volunteering for a charity organization or just making an effort to be compassionate towards people you meet, not only gives you a very good feeling, it somehow lowers your stress level. Of course, this doesn’t work if you try to control others, or help others in a very rushed and frenetic way — learn to take it easy, enjoy yourself, and let things happen, as you work to make the lives of others better.
  9. Relax throughout the day. It’s important to take mini-breaks during your work day. Stop what you’re doing, massage your shoulders and neck and head and hands and arms, get up and stretch, walk around, drink some water. Go outside and appreciate the fresh air and the beautiful sky. Talk to someone you like. Life doesn’t have to be all about productivity. You should also avoid using online activity too much as your de-stressing activity — get away from the computer to relax.
  10. Exercise. This is common advice for stress relief, and that’s because it works … but it’s also a stress prevention method. Exercising helps relieve the stress buildup, it gives you some quiet time to contemplate and relax, and just as importantly, it makes you more fit. A fitter person is better equipped to handle stress. Another important factor: being unhealthy can be a major stressor (especially once you have to go to the hospital), and exercise can help prevent that.
  11. Eat healthy. This goes hand-in-hand with exercise as a stress prevention method, of course. Become healthier and a major source of stress will disappear. Also, I’ve found that greasy food, for me, puts me in a worse mood and can contribute to stress levels immediately

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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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