The Future

It seems as though something is missing - no studying no goal..oh-oh....maybe after I do a bit of housekeeping I may set my next venture on combining my RN with my Computer Degree and get something in healthcare informatics. After all it was the RN requirement that made me go back. hummmmmm, never know - Life is adventure, knowledge is key.

$7.95

Well worth it, the best $7.95 I ever spent - the price of knowing if you passed the NCLEX-RN (unofficial) is $7.75. I was so afraid to look, but to curious not to. I had only 75 questions, I don't remember any on drug calculations or OB questions, so I thought I must have bombed so bad it was not worth testing me any more. This was one time I was glad to be wrong! The only study books I used were - 

Neurosensory Disorders

• Acute Head Injury
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease) - progressive degenerative disorder; nerve cells degenerate and die, muscle fibers atrophy - 3 times more prevalent in males. cause is unknown, ? genetic
• Bell's Palsy - inflammation around 7th cranial nerve (facial). unilateral facial weakness or paralysis, rapid onset; more common before 60, complete recovery in 1-8 weeks but longer in older adults, may reoccur, may result in contractures. caused from viral infection, hemorrhage, tumor, or trauma
• Brain Abscess - free or encapsulated collection of pus usually in the temporal love, cerebellum or frontal lobe, rare, can occur at any age, most common 10 - 35.prognosis is fatal or fair. causes - infection of ears, sinuses, or dental abscess and mastoiditis, subdural empyema or trauma.
• location of abscess
• temporal -
• auditory receptive dysphasia
• central facial wekness
• hemiparresis
• cerebrallar abscess -
• dixxiness
• coarse nystagmus
• gaxe weakness on lesion side
• tremor
• ataxia
• frontal
• expressive dysphasia
• hemiparesis with unilateral motor seizure
• drowsiness
• inattention
• mental function impairment
• seizures
• Brain tumor - causes - environmental, genetic
• frontal - aphasia, memory loss, personality changes
• temporal - aphasia, seizures
• parietal - motor seizures, sensory impairment
• occipital - homonymous hemianopsia (blindness or defective vision affecting the right halves or left halves of the visual field of the 2 eyes), visual hallucunation, visual impairment
• cerebellum - impaired coordination, impaired equilibrim
• Cartaract -
• Cerebral aneurysm - classified by size or shape, causes - atherosclerosis, congnital weakness, head trauma, keep lights low and no stress
• saccular - most common occur at the base of the brain at he juncture where the large arteries bifurcate, others include berry and dissecting.
• Crushing's triad (bradicardia, high sBP, wide pulse pressure, precussor to hemmorhage
• subarachnoid hemorrage - result of rupture, high motality rate, keep low lights, avoid overstimulation, HOB elevate 0 - 30 degrees, frequent neuro checks
• Conjuctivitis - inflammation of the conjucntiva, may be from infection (highly contagious), chemical, or allery
• causes -
• bacterial -
• staphylococcus aureus
• strptococcus pneumoniae
• neisseria gonorrhoeae
• n. meningitidis
• Chlamydial
• chlamydia trachomatis
• Viral
• Adenovirus types 3,7, and 8
• herpes simplex virus, type 1
• other causes -
• allergic -
• pollen
• grass,
• topidal medications,
• air pollution
• smoke
• fungal infections (rare)
• Occupationa irritans (acids and slkalies)
• parasitic diseases caused by phthirus pubis, or schistosoma haematobium
• tickettsial diseases (Rochy Mountain spotted fever)
• Corneal abrasion
• Encephalitis  severe inflammation and swelling of the brain, damages optic nerve.  usually caused by misquito or tick borne virus; may also occur by drinking infected goat milk, may cause permanent neurologic damage and is commonly fatal. Keep room cool and dark
• Glaucoma - increased intraocular pressure
• causes -
• diabetes mellitus
• long term steroid treatment
• previous eye trauma or surgeru
• Uveitis
• fisk factorw
• family history of glaucoma
• race - more prevailent in african-american
• Gukllain-Barre syndrome
• causes -
• cell mediated immune response with an attach on peripheral nerves in response to a virus
•  demyelination of the peripheral nerves
• respiratory infection
• test
•  history of preceding febrile illness (usually from a respiratory infection)
• CSF protein level begins to rise
• EMG shows repeated firing of the motr unit reather than widespread sectional stimulation
• nerve conduction velocities are slowed after paralysis
• potential complication
• mechanical ventilatory failure
• aspiration pneumonia
• sepsis
• joint contractions
• DVT
• Hearing Loss  3 major types of hearing loss
• conductive loss
• sensorineural loss
• mixed loss

Neurosensory Systems and Tests

• Neuron - nerve cell -
• axons carry away
• dentrites bring to
• neurotransmitters - help conduct impulses across the synapse
• acetylcholine
• seotonin
• dopamine
• endorphins
• gamma-aminobutyric acid
• norepinephrine
• CNS - central nervous system - brain and spinal cord
• Cerebrum - largest part of the brain 
• hemispheres - right and left opposite control because motor impulses cross in the deulla
• fissures divide cerebrum into 4 lobes
• frontal - personality, memory, reasoning, concetration and motor control of speech
• parietal  - sensation, integration of sensory information and spatial relationships
• temporal  - hearing, speech, memory, and emotion
• occipital - vision and involuntary eye movements
• Thalamus - 2 oval shaped parts deep in the brain, the relay station - recieves input form all senses except smell, analyses input and transmits to other parts of the brain.
• Hypothalamus - beneath the thalamus - control sleep and wakefulness, temperature, respiration, BP, sexual arousal , fluid balance, and emotioal response.
• Cerebellum - base of the brain - coordinates muscle movements, maintains balance and controls posture
• Brain Stem - connects brain and spinal cord has 3 sections
• midbrain - pupillary relexes and eye movements; relfex center of the 3rd and 4th cranial nerves
• pons - helps regulate respiration, mediates chewing, tasting, saliva and equilibruim; reflex center for the 5th, 6th, 7th and 8th cranial nerve
• medulla oblongata - vomiting, vasomotor, respiratory and cardiac centers
• Spinal cord - 2 way conduction system between brain and peripheral nervous system (PNS)
• gray matter - cell bodies and dendrites and axons
• white matter ascending (sensory) sends signalsto the brain and desending (motor) tracts send signals out to the muscles
• PNS - Periperal Nervous System - delivers messages (like the post office) main nerves grouped
• 31 pairs of spinal nerves - carry mixed impulses (motor and sensory)
• 12  pairs of cranial nerves -
1. olfactory
2. optic
3. oculomotor
4. trochlear
5. trigeminal
6. abducen
7. facial
8. acoustic
9. glossopharyngeal
10. vagus
11. spinal accessory
12. hypoglossal
• Autonomic nervous system - subdividsion of PNS - controls involuntary body functions
• digestion
• respiration
• cardiovascular
• 2 cooperating systems
• sypathetic - fight or flight
• parasympathetic - conserves and restores energy
• Eyes -
• external -
• eyelids
• conjuctivae (thin transparent membrane that line the lids)
• lacrimal apparatuses,extraocular muscles, and the eyeballs
• internal -
• iris
• cornea
• pupil
• lens
• vitreous humor
• retina
• retinal cones - visual acuity and color discrimination under bright lights
• retinal rods - peripheral vision under decreased light conditions
• optic nerve - 2nd cranial nerve
• Ears
• External -  pinna (auricle) and external auditory canal separated by the tympanic membrane
• Middle -  AKA tympanum - air filled cavity in the temporal bone - 3 small bones - malleus, incus, and stapes
• Inner - AKA Labyrinth - cochlea, vestibule and semicircular canals

Most Important Tests

• Electroencephalogram (EEG) electrical graph of brain activty
• Computer tomography (CT) - cross scetion veiws of brain images
• Magnetic Resonance Imaging (MRI) - magnetic snapshot - contraindications - pacemaker
• Cerebral Angiogram - upstairs artery exam blood flow using dye
• check site for bleeding
• assess distal pulses
• assess neuro status
• encourage fluids
• Lumbar Puncture L(P) - reveals pressure also used to inject dye for myelogram *contra indicated with increase intracranial pressur (ICP)
• keep flat
• monitor neuro status
• monitor site for leakage or bleeding
• encourage fluids
• Cerebrospinal fluid (CFS) analysis - LAB
• Electromypgraphy (EMG) - electrical acitivity of a muscle at rest and contraction
• Myelography - see the spine - subarachnoid space, spinal cord and verebrae contraindicated with seafood or iodine allergies
• keep flat after
• check site for leakage or bleeding
• encourage fluids
• Skull x-ray
• Positron emission tomography (PET) injection of radioisotope after visulaization of the brain's oxygen uptake, blood flow and glucose metabolism
• no tobacco, alcohol,  or caffeine 24 hours before
• Blood Chemestry Test - checking levels of potassium, sodium, calcium, phoshorus, protein, osmolality, glucose, bicarbonate, blood urea nitrogen and creatinine
• Hematologic study - WBCs, RBCs, erythrocyte sedimentation rate, platelets, hemoglobin, hematocrit.
• Coagulation study
• Visual Acuity
• Extraocular eye muscle testing - checks for parallet alignment of the eyes, muscle strength and cranial nerve function
• Visual field examinaitn
• Tonometry test - measures intra ocular pressure
• Tick-tock test is an auditory acuity test checking ability to hear a whispered phrase or a ticking watch
• Otoscopic examination to visulize the tympanic membrane
• Audiometry - measures degree of deafness

Chvostek's sign, Amin&Shwani 2010

Trausseau's sign

Hematologic and Immune System

• Serum Magnesium if less than 1.5mEq/l confirms hypomagnesemia; if greater than 2.5 mEq/l confirms hypermagnesemia.
• CD4=T cell count less than 200 cells/ul indicative of AIDS
• Serum ionized calcium leve less than 4.5 mEq/L confirms hypocalcemia; if greater than 5.5 confirms hypercalcemia
• Trousseau's  and Chvostek's signs
• Serum chloride level less than 98mEq/L confirms hypochloremia
• supportive values with metabolic alkalosis include a serum pH greater than 7.45 and a serum carbon dioxide level greater than 32 mEq/L
• Serum chloride level greater than 108 mEq/L confirms hyperchloremia
• supportive values with metabolic acidosios include a serum pH less than 7.35 and a serum carbon dioxide level less than 22 mEq/L
• Serum Phosphorus level less than 1.7 mEq/L (or 2.5 mg/dl) confirms hypophosphatemia, urine phosphorus level more than 1.3 g/24/hrs supports this
• Serum Phosphorus level greater than 2.6 mEq/L (or 4.5 mg/dl) confirms hyperphosphatemia, urine phosphorus level less than 0.9 g/24/hrs supports this
• Sodium - hyponatremia less than 135 mEq/;L hypernatremia greater than 145 mEq/L

• Disseminated Intravascular Coagulation - PT greater than 15 seconds; PTT greater than 60 to 80 seconds; fibrinogen levels less than 150 mg/sl; platelets less than 100,000; fibrin degradation products typically greater than 100 mcg/ml; and a positive D-dimer test specific for DIC
• Hemophilia Factor VIII assay reveals 0% to 25% of normal factor VIII (hemophilia A)
• hemophilia B factor IX assay shows deficiency in addition to baseline coagulation results similar to that of A
• Idiopathic Thrombocytopenic Purpura (ITP)  platelet count is less than 20,000/ul; prolonged bleeding time
• Iron Deficiency Anemia decreased Hb, HCT, iron, ferritin, reticulocytes, red cell indices, transferring and saturation; absent hemosiderin, and increased iron biding capacity.
• Aplastic Anemia - bone marrow biopsy shows fatty marrow with reduction of stem cells, Fecal occult blood test is positive, decreased granulocytes, thromobocytes, and RBCs, hematuria
• Pernicious Anemia - from vitamin B mal-absorption
• Polycythemia vera - chronic myeloproliferateve disorder characterized by increased RBC mass, leukocytosis, thrombocytosis and increased Hb, common with jewish males age 40 - 60
• Rheumatoid Arthritis -  antibodies attack the synnovium of the joint , then the articular cartilage and surrounding tendons and ligaments. ANA positive, elevated ESR, WBC, platelets and anemia, Rheumatoid factor test is positive
• Scleroderma - connective tissue disease, more women 30 -50 elevated ESR, positive rheumatoid factor 25% - 35% of the time, positive antinuclear antibody test. CXR - bilateral basilar pulmonary fibrosis, UA - proteinuria, microscopic hematuria, and casts
• Sickle Cell Anemia - congenital hematologic disease, inherited
• Systemic lupus erythematosus (SLE) - ANA test positive, decreased HB, HCT, WBC and platelets and an increased ESR, rheumatoid factor is positive, UA - proteinuria and heaturia. Lupus Erythematosus cell positive
• Vasculitis - inflammation and necrosis of blood vessels
• Wegener's Granulomatosis - affects medium to large vessels of upper and lower respiratory tract and kidney
• positive leukocytosis, elevated ESR, IgA, IgG; low titer rheumatoid factor; tissue biopsy shows narcotizing vasculitis with granulomatous inflammation
• Temporal arteritis - affects medium to large arteries, most connonly branches of th ecarotid artery
• decreased Hb and elevated ESR, tissue biopsy shows panarteritis with infiltration of mononucliar cells, giant cells within vessel wall, fragmentation of internal elastic lamina and proliferation of intima
• Takayasu's arteritis - AKA aortic arch syndrome 
• decreased HB, leukocytosis, positive lupus erythematosus cell preparation and elevated ESR; Arteriography shows calcification and obstruction of affected vessels; tissue biopsy shows inflammation of adventita and intima of vessels and thickening of vessel wall

PLATE = key blood components:
Plasma - liquid portion - water, protein (albumin and globulin), glucose, and electrolytes
Leucocytes- white blood cells
AB antigens - blood type
Thrombocytes - platelets clotting - contributors
Erythocytes - red blood cells - oxygen carrier

T-Cells -
killer, helper or suppressor
B-Cells -
 responsible for humeral or immunoglobulin-mediated immunity
Immunoglobulin -
Immunoglobulin G (IgG) - major antibacterial and antiviral antibody
Immunoglobulin M (IgM) - first Immunoglobulin produced too large to cross membrane barriers, usually only in vascular system
Immunoglobulin  A (IgA) - mainly found in body secretions, defends against pathogens on body surfaces, especially respiratory and GI tract
Immunoglobulin D (IgD) - in plasma, dominant antibody on surface of B cells mainly an antigen receptor.
Immunoglobulin E (IgE) - antibody involved in immediate hypersensitivity or allergic reactions, stimulates the release of mast cell granules which contain histamine and heparin.

• Lymphangiography - radiographic picture of lymphatic system -
• note allergies to iodine, seafood and radiopaque dyes
• possible throat irritation and flushing after dye
• NPO
• After procedure
• monitor V/S
• encourage fluids
• may have blue discolored skin, stool, and urine for about 48 hours

Schilling Test - oral radioactive cyanocobalamin then 24 hour urine (all urine, room temp) for vitamin B 12

Hodgkin's progress - 4 stages

• Stage I  - single lymph node region or single extralymphatic organ
• Stage II  - two or more nodes on same side of diaphragm or in an extralymphatic organ
• Stage III - spreads to both sides of the diaphragm or in an extralymphatic organ, the spleen or both
• Stage IV -  disease disseminates

*all review material was taken from - NCLEX-RN Review made Incredibly Easy 5th Edition Lippincott, Williams & Wilkins