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Considerations for Epilepsy and Thyroid Disorders in Women, Exams of Health sciences

This document covers various medical considerations for women with epilepsy and thyroid disorders. It provides information on seizure activity during menses, the impact of medications on contraceptives, fetal risks in pregnant women, and monitoring during pregnancy. It also discusses non-pharmacological treatments for refractory seizures, causes and management of hypothyroidism, and aspects of diabetes. Additionally, it covers nursing interventions for Parkinson's and dementia, as well as seizure classifications and management.

Typology: Exams

2024/2025

Available from 09/13/2024

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NSG123/ NSG 123 Exam 4: (New 2024/ 2025
Update) Med Surg 1 Review| Questions and
Verified Answers| 100% Correct|All Units
Covered| A Grade Herzing
QUESTION
considerations for epilepsy in women
Answer:
- increased seizure activity during menses
- anticonvulsant medication decreases effectiveness of oral contraceptives
- diagnosis of epilepsy puts fetus at 3x higher risk for malformations
- careful monitoring required during pregnancy
QUESTION
non-pharmacological treatment options for refractory seizures
Answer:
- vagal nerve stimulator (implanted under clavicle, patient controls when they feel an aura,
diminishes the severity and duration of seizure, DOES NOT prevent seizures)
- responsive neurostimulation system (electrodes implanted in brain, interrupts brain activity,
prevents seizures)
QUESTION
medications for seizures
Answer:
- carbamazepine/Tegretol (grand mal/tonic-clonic)
- clonazepam/Klonopin (children)
- phenytoin/Dilantin (multiple types)
- valproate/Depakote (tonic-clonic)
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Download Considerations for Epilepsy and Thyroid Disorders in Women and more Exams Health sciences in PDF only on Docsity!

NSG123/ NSG 123 Exam 4: (New 2024/ 2025

Update) Med Surg 1 Review| Questions and

Verified Answers| 100% Correct|All Units

Covered| A Grade – Herzing

QUESTION

considerations for epilepsy in women Answer:

  • increased seizure activity during menses
  • anticonvulsant medication decreases effectiveness of oral contraceptives
  • diagnosis of epilepsy puts fetus at 3x higher risk for malformations
  • careful monitoring required during pregnancy

QUESTION

non-pharmacological treatment options for refractory seizures Answer:

  • vagal nerve stimulator (implanted under clavicle, patient controls when they feel an aura, diminishes the severity and duration of seizure, DOES NOT prevent seizures)
  • responsive neurostimulation system (electrodes implanted in brain, interrupts brain activity, prevents seizures)

QUESTION

medications for seizures Answer:

  • carbamazepine/Tegretol (grand mal/tonic-clonic)
  • clonazepam/Klonopin (children)
  • phenytoin/Dilantin (multiple types)
  • valproate/Depakote (tonic-clonic)

QUESTION

Phenytoin (Dilantin) information Answer:

  • 10 - 20mcg/mL therapeutic level
  • must be given on time
  • increases risk for osteoporosis (take calcium and vitamin D)
  • causes gingival hyperplasia (expected side effect, do not stop medication)
  • encourage good dental hygiene
  • do not take oral contraceptives
  • do not stop abruptly

QUESTION

status epilepticus Answer:

  • prolonged seizure activity
  • medical emergency
  • goal is to stop the seizures ASAP
  • give IV medications (diazepam/Valium, lorazepam/Ativan, fosphenytoin/Cerebyx)

QUESTION

thyroid hormones Answer: T3, T4, calcitonin

QUESTION

diagnosis of hyperthyroidism Answer:

  • physical assessment is done from behind patient, feeling for structures moving up and down as the patient swallows
  • TSH, T3, T4 blood tests (affected by oral contraceptives, corticosteroids, aspirin, carbamazepine, Lasix, heparin)

QUESTION

What is the priority action for a thyroid storm? Answer:

  • decrease the fever (passive cooling, Tylenol)
  • IV fluid with glucose
  • betabolcker
  • hydrocortisone

QUESTION

causes for thyroid storm Answer:

  • stressful event (surgery, illness, trauma)
  • patient did not seek treatment for hyperthyroidism
  • patient did not take thyroid medication

QUESTION

management of hyperthyroidism Answer:

  • radiation treatment (may increase T3 & T4 levels)
  • medications (PTU, methimazole, sodium or potassium iodine solution)
  • surgery (subtotal thyroidectomy)

QUESTION

nursing considerations for PTU and methimazole Answer:

  • lab values must be checked before administration due to agranulocytosis
  • sore throat
  • ecchymosis
  • rash
  • nausea
  • gastric irritation

QUESTION

nursing considerations for sodium or potassium iodine solutions Answer:

  • give with fruit juice or milk
  • use a straw to avoid staining teeth
  • watch for cardiac symptoms

QUESTION

nursing considerations for thyroid surgery Answer:

  • monitor airway
  • monitor calcium levels/hypocalcemia

QUESTION

signs and symptoms of hypocalcemia Answer:

  • tingling in toes, fingers, around mouth
  • difficulty speaking
  • Chvostek and Trousseau's signs
  • life-threatening condition

QUESTION

treatment for hypocalcemia Answer:

  • IV calcium gluconate
  • IV isotonic saline
  • calcium & vitamin D tablets (short and long-term)
  • cardiac system slows down (increased risk for heart disease)

QUESTION

myxedema Answer:

  • life-threatening complication of hypothyroidism
  • mask-like face
  • facial edema
  • constipation
  • confusion
  • coma

QUESTION

treatment of myxedema Answer:

  • IV T3 and T4 hormone replacement (STOP med if patient has chest pain or cardiac symptoms)
  • passive warming
  • turn and reposition frequently

QUESTION

patient education for Synthroid Answer:

  • lifelong treatment
  • take on empty stomach 2 hours before meal
  • interacts with other medications (antacids, Maalox)
  • always pack in carry-on when traveling
  • avoid sedatives
  • minimize constipation

QUESTION

treatment for hypothyroidism Answer: Hormone replacement - Levothyroxine (Syn- throid)

QUESTION

diabetes Answer: hyperglycemia caused by not enough insulin in the body or there is insufficient insulin action or a combination of both

QUESTION

types of diabetes Answer:

  • type 1 (early onset) - autoimmune disease, body attacks the pancreas where insulin is produced
  • results in lack of insulin
  • type 2 (later onset) - body does not make enough insulin
  • latent autoimmune (mimics type 2 at first but then starts to look like type 1)
  • gestational - occurs during pregnancy, greater chance of type 2 later in life

QUESTION

complications of diabetes Answer:

  • diabetic ketoacidosis - type 1 complication
  • hyperglycemic hyperosmolar syndrome (HHS) - type 2 complication

QUESTION

type 1 diabetes information Answer:

  • usually early onset (8- 11 years of age)
  • autoimmune disease (pancreas does not make insulin)

QUESTION

medical management of diabetes Answer:

  • nutritional therapy
  • exercise
  • monitoring
  • pharmacological therapy
  • education

QUESTION

nutritional recommendations for diabetes Answer:

  • carbohydrates 50 - 60%
  • fat 30% (saturated fats <10%)
  • non-animal sources for protein
  • increase fiber
  • do not skip meals
  • maintain consistent caloric & carbohydrate intake
  • eat foods with lower glycemic index (raw, whole rather than juice)
  • combine starchy foods with protein and fat to slow absorption and glycemic response

QUESTION

What medication should be avoided when taking levodopa/carbidopa (SInemet)? Answer: MAOIs (Nardil, Emsam)

QUESTION

non-pharmacological treatment for Parkinson's disease Answer:

  • deep brain stimulation (most common) - improves tremors and rigidity, will not cure Parkinson's
  • ablation of brain cells in specific areas
  • transplantation of neural stem cells

QUESTION

nursing interventions for Parkinson's disease Answer:

  • maintain good health
  • encourage independence
  • avoid complications (aspiration, falls)***
  • promote physical activity (swimming, stationary bike, stretching, gardening, NO JOGGING/RUNNING)
  • exaggerate steps as if they are stepping over something
  • walk to a beat
  • good sleep hygiene
  • manage speech problems (face person, short sentences)
  • dietary considerations (nutrient dense, avoid constipation)
  • provide support for caregivers

QUESTION

delerium Answer:

  • temporary acute mental confusion
  • due to acute injury (SURGERY, dehydration, medication reaction, UTI) ex: patient returns to med/surg floor after hip replacement surgery and cannot focus on anything, cannot follow directions

QUESTION

nursing intervention for delerium Answer:

  • fall prevention
  • hydration
  • watch patient cues (if getting up, they may need to use the bathroom)

Alzheimer's disease Answer:

  • progressive degeneration of the brain
  • cause is unknown
  • not a normal aging process
  • familial (early onset) or sporadic (late onset)

QUESTION

signs of Alzheimer's disease Answer:

  • forgetfulness
  • decreased memory function
  • decreased orientation
  • personality changes
  • loss of ability to do activities of daily living
  • unable to recognize family members

QUESTION

diagnostic studies for dementia/Alzheimer's Answer:

  • CBC
  • electrolytes
  • vitamin B12***
  • thyroid levels***
  • MRI
  • CT scan
  • cerebrospinal fluid
  • definitive diagnosis can only be made with autopsy

QUESTION

management options for dementia/Alzheimer's Answer:

  • donepezil hydrochloride

(Aricept) (interferes with acetylcholine uptake) - watch for liver disease***

  • memantine (Namenda) (calms the brain) - watch for renal disease***
  • behavioral therapy
  • frequent re-evaluation as symptoms change

QUESTION

classifications of seizures Answer:

  • focal/partial (one hemisphere)
  • generalized (both hemispheres)
  • provoked (related to reversible condition - high fever, brain injury, hypoglycemia)

QUESTION

signs of seizure Answer:

  • staring off into space
  • tremor of one arm/leg or both arms/legs
  • falling to the floor and shaking
  • foaming at the mouth

QUESTION

causes of seizures Answer:

  • head injury
  • alcohol withdrawal
  • fever (childhood)
  • hypertension
  • stroke
  • hypoxemia
  • CNS infection
  • brain tumor
  • bed in low position
  • pillow for patient's head
  • side lying position
  • curtain for privacy
  • have suction and oxygen available

QUESTION

When will a nurse check blood glucose levels? Answer: peak time of insulin medica- tion

QUESTION

insulin preparation steps Answer:

  • agitate cloudy insulin
  • scrub top of insulin vial with alcohol
  • inject air equal to dosage into cloudy (NPH) (do not touch solution with needle)
  • inject air equal to dosage into clear (regular)
  • invert clear insulin vial and draw up clear
  • invert cloudy insulin vial and draw up cloudy (do not push plunger while in the vial)

QUESTION

patient education for blood glucose monitoring Answer:

  • wash hands
  • engage needle
  • insert test strip in machine
  • clean finger with alcohol and let dry
  • prick finger, wipe away blood
  • obtain blood sample

QUESTION

patient education for self-injection of insulin Answer:

  • stabilize skin
  • use 90 degree angle
  • rotate injection sites
  • do not rub injection site

QUESTION

patient education for insulin pumps Answer:

  • only use rapid acting insulin
  • needle will be subcutaneous
  • rotate sites every 3 days
  • check glucose level several times per day
  • may disconnect from pump when needed
  • cannot be used on patients with decreased mental status

QUESTION

rapid acting insulin, onset, peak, duration Answer: Onset: 10-30 min Peak: 30 min-3 hr Duration: 3 - 5 hr 15 minutes feels like an hour after 3 rapid responses.

QUESTION

short acting (regular) insulin onset, peak, duration Answer: Onset: 30 min-1 hr Peak: 2 - 5 hr Duration: 5 - 8 hr

Answer:

  • polyuria
  • polydipsia
  • polyphagia
  • fruity smell to breath

QUESTION

patient education for sulfonylureas (glipizide) Answer:

  • monitor for hypoglycemia
  • watch for GI symptoms
  • avoid alcohol

QUESTION

patient education for biguanides (metformin) Answer:

  • monitor for hypoglycemia
  • watch for GI symptoms
  • stop 48 hours prior to contrast dye

QUESTION

treatment for hypoglycemia Answer: rules of 15

  • give 15g of concentrated carbohydrate (juice or soda)
  • retest blood glucose in 15 minutes
  • repeat if <70 mg/dL if unable to swallow

QUESTION

cranial arteritis Answer:

  • common cause for headache in the older population
  • inflammation of the temporal artery (pain in the temple area)
  • treated with corticosteroids

QUESTION

primary headache Answer: a headache for which no specific organic cause can be found (ex: migraine, cluster, tension)

QUESTION

secondary headache Answer: headache identified as a symptom of another organic disorder (ex: brain tumor, hypertension)

QUESTION

Phases of migraines Answer:

  • premonitory (days before - depression, feeling cold, no appetite)
  • aura (visual disturbances, hand tingling)
  • headache (nausea, vomiting, light & sound sensitivity)
  • post drome (pain subsides, weakness, tiredness)

QUESTION

cluster headache Answer:

  • unilateral (one side of the head)
  • rapid onset
  • can occur 1 - 8 times per day