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NU-665 |! Neurology |! exam |! with |!
precise |! answers
hospice |! care holistic, |! compassionate |! care |! given |! to |! dying |! people |! and |! their |! families. utilizes |! Medicare |! Benefit |! with |! qualifying |! factor |! of |! 6 |! months |! or |! less palliative |! care multi-disciplinary |! approach |! to |! relief |! of |! sufferring |! that |! can |! be |! provided |! at |! any |! point |! in |! a |! patient's |! illness. Palliative |! Performance |! Scale |! (PPS) scale |! sued |! to |! determine |! functionality |! sauce |! as |! ambulation, |! activity |! level, |! selfceare |! and |! conscious |! level terminal |! illness a |! disease |! or |! condition |! that |! will |! eventually |! cause |! death end-stage |! heart |! disease EF |! less |! than |! or |! equal |! to |! 20% dyspnea |! and |! or |! symptoms |! at |! rets |! or |! with |! minimal |! exertion NYHA |! classes |! 3 |! and |! 4 |! with |! symptoms. FAST |! scale scale |! utilized |! to |! qualify |! dementia |! patients |! for |! hospice End |! stage |! dementia Fast |! scale |! of |! 7E |! or |! above hospice |! referral
Bell's |! Palsy temporary |! paralysis |! of |! the |! seventh |! cranial |! nerve |! that |! causes |! paralysis |! only |! on |! the |! affected |! side |! of |! the |! face |! with |! onset |! within |! 72 |! hours |! and |! unknown |! causes |!. -differential |! diagnosis: |! Herpes |! Zoster, |! Otitis |! media, |! Lyme |! disease, |! ischemic |! stroke. -imaging |! not |! necessary |! but |! can |! be |! considered |! if |! symptoms |! not |! improving |! or |! atypical |! presentation. Migraines intense |! headaches, |! typically |! perceived |! from |! one |! half |! of |! the |! head, |! that |! recur |! regularly |! and |! can |! be |! difficult |! to |! treat headaches a |! diffuse |! pain |! in |! different |! portions |! of |! the |! head |! and |! not |! confined |! to |! any |! nerve |! distribution |! area tension |! headache pain |! is |! like |! a |! band |! squeezing |! the |! head, |! linked |! to |! stress cluster |! headache excruciating |! stabbing |! or |! burning |! sensations |! located |! in |! the |! eye |! or |! cheek.
- |! Most |! common |! among |! men -assocaiaited |! symptoms |! include |! ptosis, |! facial |! swelling, |! tearing-up. -may |! wake |! patient |! up |! from |! sleep. -patient |! is |! restless multiple |! sclerosis myelin |! sheath |! destruction. |! disruptions |! in |! nerve |! impulse |! conduction multiple |! sclerosis |! diagnosis
medicare |! hospice |! eligibility |! criteria To |! be |! eligible, |! a |! patient |! has |! to |! be |! BOTH |! entitle |! to |! MEDICARE |! PART |! A |! and |! certified |! as |! terminally |! ill Migraine |! Medications
- |! Ergot |! Alkaloids |! Ergotamine |! (Ergostat)
- |! Serotonin |! Receptor |! Agonists |! Sumatriptan |! (Imitrex)
- |! Beta-Blockers |! Propanolol, |! Atenolol
- |! Anticonvulsants |! Divalproex |! (Depakote)
- |! Tricyclic |! Antidepressants |! Amitriptyline |! (Elavil)
- |! Calcium |! Channel |! Blockers |! Verapamil
- |! Estrogens |! Alora, |! Climara
- |! Triptans |! Almotriptan, |! Naratriptan, |! etc Migraine |! Diagnosis Two |! of |! the |! Four: -Headache |! (unilateral) -Headache |! (pulsating) -Nausea |! -Photophobia/phonophobia or |! Two |! Major |! and |! One |! Minor: -Major: |! Unilateral |! Pain, |! Worsening |! by |! movement, |! Moderate/severe |! pain -Minor: |! Nausea/vomiting, |! Photophobia/phonophobia Migraine |! with |! aura Above |! plus |! scotoma, |! scintillating |! lights |! halos, |! etc. Aggravating |! Factors: |! Foods |! high |! in |! tryptans Teenage |! to |! middle-age |! females Migraines |! without |! aura |! diagnostic |! criteria
migraine |! abortive |! therapy Migraine |! prophylaxis Propranolol, |! topiramate, |! CCBs, |! amitriptyline Migraine |! Patient |! Education Temporal |! arteritis |! diagnosis Screen |! with |! ESR, |! but |! need |! biopsy |! to |! diagnose. Global |! Deterioration |! Scale Measures |! clinical |! characteristics |! at |! seven |! levels |! based |! on |! the |! progressive |! stages |! of |! AD FAST |! scale |! for |! dementia Stage |! 7 |! is |! eligible |! for |! hospice What |! does |! FAST |! mean? Functional |! Assessment |! staging advanced |! COPD -hypoxemia |! increases |! less |! than |! 88% |! on |! room |! air; |! oxygen |! supply |! to |! brain |! inadequate; |! impaired |! judgement, |! confusion, |! motor |! incoordination -Poor |! response |! to |! treatments -frequent |! hospitalizations |! due |! to |! exercerbations |! or |! infections. -Right |! sided |! Heart |! failure -unintentional |! weight |! loss |! is |! less |! than |! 10 |! pounds |! in |! 6 |! months -resting |! tachycardia conversation |! project |! concepts |! covered 1- |! what |! matters |! to |! the |! person 2-what |! supports |! they |! have |! or |! will |! need 3-how |! much |! knowledge |! /participation |! about |! the |! disease |! process |! they |! desire advanced |! care |! planning
1- |! discontinuation |! of |! dialisis |! or |! transplant 2-creatinine |! clearance |! less |! than |! 10 |! cc/min 3-Serum |! creatine |! less |! than |! 8.0 |! mg/dl 4- |! s/s |! of |! kidney |! failure |! e.g |! uremia, |! oliguria, |! fluid |! overload |! and |! hyperkalemia |! ( |! that |! are |! unresponsive |! to |! tx) Bell's |! palsy |! treatment |! and |! management If |! from |! a |! Lyme-endemic |! area |! do |! Lyme |! serology Treat |! with |! corticosteroids |! (best |! chance |! of |! full |! recovery, |! takes |! 1-3 |! months |! to |! fully |! recover). Anti-viral |! co-admin |! if |! suspected |! Herpes |! Zoster NSAIDs |! for |! pain For |! Bell's |! palsy |! look |! for |! facial |! signs |! in |! both |! upper |! and |! lower |! which |! indicates |! a |! peripheral |! cause amyotrophic |! lateral |! sclerosis |! (ALS) condition |! of |! progressive |! deterioration |! of |! motor |! nerve |! cells |! resulting |! in |! total |! loss |! of |! voluntary |! muscle |! control; |! symptoms |! advance |! from |! muscle |! weakness |! in |! the |! arms |! and |! legs, |! to |! the |! muscles |! of |! speech, |! swallowing, |! and |! breathing, |! to |! total |! paralysis |! and |! death; |! also |! known |! as |! Lou |! Gehrig |! disease ALS |! diagnosis
- |! Onset |! insidious-gradual, |! not |! aware |! until |! clinical |! signs |! and |! symptoms |! increase
- |! Difficult |! to |! dx |! ALS- |! mimics |! MS |! and |! HIV
- |! ABSENCE |! OF |! SENSORY |! INVOLVEMENT
- |! Lab |! Values- |! 70% |! elevated |! creatine |! phosphokinase |! (associated |! with |! destruction |! of |! muscle |! tissue)
- |! Electromyographic |! studies- |! decreased |! muscle |! activity
- |! Nerve |! conduction |! velocity |! (NCV)- |! Distinguish |! LMN
- |! MRI- |! (grey |! matter) |! may |! be |! normal
- |! CSF- |! normal |! in |! ALS |! patients |! (elevated |! proteins) Mysethenia |! Gravis
Medicare |! levels |! of |! hospice |! care 1-Routine |! home |! care 2-Continous |! home |! care 3-Inpatint |! respite |! care 4-General |! inpatient |! care insomnia recurring |! problems |! in |! falling |! or |! staying |! asleep Insomnia |! management obtain |! sleep |! and |! social |! history |! to |! look |! for |! associations |! (ex. |! meds, |! caffeine |! intake)
- |! behavioral |! therapy
- |! pharmacological |! therapy Parkinson's |! disease A |! disorder |! of |! the |! central |! nervous |! system |! that |! affects |! movement, |! often |! including |! tremors. -1st |! line |! TX: |! SINEMET |! (Levodopa-cardidopa). -2nd |! line: |! Dopamine |! agonists |! e.g Bridzinski's |! Sign Babinsky |! sign Tension-type |! headache |! tx NSAIDS, |! excedrin. note- |! does |! not |! have |! associated |! symptoms |! e.g |! n/v/dizzinness Thunderclap |! headache A |! severe |! HA |! of |! sudden |! onset. |! Concerning |! for |! subarachnoid |! hemorrhage migraine |! evaluation |! mnemonic
- |! visual |! disturbances |! including |! complaints |! of |! painless |! "falling |! curtain". -langauge/speech |! difficulties -ataxia |! = |! balance |! problems -positive |! babinski |! sign Hypertensive |! intracerebral |! hemorrhage pt |! c/o |! headache, |! arm/leg |! weakness, |! noted |! eye |! deviation, |! stupor-coma. |! happens |! quickly |! and |! ma |! lead |! to |! death. ABCD |! score Age, |! Blood |! Pressure, |! Clinical |! Features, |! Duration |! of |! Symptoms |! and |! Diabetes Age |! > |! 60 |! = |! 1 |! Point Blood |! Pressure |! >140/>90 |! = |! 1 |! Point Clinical |! Features |! - |! Unilateral |! Weakness |! - |! 2 |! Points, |! Speech |! Disturbances |! - |! 1 |! Point Neuro |! Sx |! > |! 60 |! Mins |! = |! 2 |! Points, |! and |! 10 |! Mins |! to |! 60 |! Mins |! = |! 1 |! Point DM |! = |! 1 |! Point Score|! 0 |! to|! 3 : |! Low |! Stroke |! Risk Score|! 4 |! to|! 5 : |! Moderate |! Stroke |! Risk Score|! 6 |! to|! 7 : |! High |! Risk Insomnia |! Treatment |! Goals barriers |! to |! advanced |! care |! planning Benefits |! of |! Palliative |! Care respite |! care planned |! short-term |! care, |! usually |! for |! the |! purpose |! of |! relieving |! a |! full-time |! informal |! caregiver Seizures
- |! The |! sudden |! attack |! or |! recurrence |! of |! a |! disease
- |! A |! single |! episode |! of |! epilepsy, |! often |! named |! for |! the |! type |! it |! represents ALS |! treatment No |! effective |! medical |! management Riluzole |! (glutamate |! agonis) |! may |! slow |! progression/prolong |! survival |! (esp |! with |! bulbar |! onset) Symptomatic |! relief |! (spasticity, |! pain, |! respiratory |! failure |! etc) PT: Maintain |! respiratory |! function Manage |! dysphagia Prevent |! indirect |! impairments |! (PROM, |! skin |! care, |! positions) Moderate |! exercise |! (prevent |! further |! deconditioning) EXERCISE |! PRECAUTIONS: Monitor |! fatigue, |! avoid |! overwork |! injury, |! NO |! EXERCISE |! IF |! LESS |! THAN |! 1/3 |! MU |! FUNCTIONING As |! disease |! progresses |! replace |! resistance |! exercise |! with |! functional |! activities. Energy |! conservation |! techniques/pacing/balance |! activity |! with |! rest Maintain |! max |! functional |! independence Provide |! assistive |! devices Treat |! symptoms Educations CHF |! hospice |! eligibility end-stage |! is |! class |! IV |! (FOUR). i.e |! inability |! to |! carry |! out |! any |! activity |! without |! symptoms |! and |! presence |! of |! symptoms |! at |! rest. Parkinson's |! disease |! symptoms
