NCLEX- Neurosensory Nursing – Flashcards
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Todd's Paralysis
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Motor Paralysis in Post Ictal Phase in Seizure focal weakness <24 hrs
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Electro Encephalo Graphy
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confirmatory of seizure check brain activity, electrical activity and brain waves
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Phenytoin (Dilantin)
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Antiepileptic drugs AE: Gingival Hyperplasia ataxia nystagmus BMS Agranulocytosis --Hydantoin--
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Carbamazepine (Tegretol)
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--Phenytoin like-- AE: Hepatotoxic BMS
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Valproic Acid (Depakote)
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--Phenytoin like-- AE: Hepatotoxic
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Phenobarbital (Luminal)
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--Barbiturates-- neonatal seizure potentiates GABA effect inhibitory neurotransmitter decrease nerve impulse transmission AE: drowsiness dizziness CNS depressant
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Diazepam (Valium) Lorazepam (Ativan)
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--Benzodiazepine-- potentiates GABA effect inhibitory neurotransmitter decrease nerve impulse transmission AE: CNS depressant dependency
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Ethosuximide
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--Succinimide-- Suppression of Ca influx AE: drowsiness dizziness
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Status epilepticus
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rebound seizure sustained seizure >5 mins Tx: Benzodiazepines
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myelin sheath
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increase impulse nerve transmission CNS=oligodendrocytes
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Multiple Sclerosis
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demyelination of myelin sheath in CNS scar formation--gliosis destruction of oligodendrocytes autoimmune
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Multiple Sclerosis
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Lhermitte's Sign
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Lhermitte's Sign
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electric shock like pain with neck flexion
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Multiple Sclerosis
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Optic Neuritis Blurring of Vision Numbness, paresthesia
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Multiple Sclerosis
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spasticity -shorten and harden due to decreased stimulation
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Multiple Sclerosis
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Uthoff's Sign
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Uthoff's Sign
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weakness and diplopia due to fatigue and extreme temp
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Multiple Sclerosis
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Urinary Incontinence
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Multiple Sclerosis
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Charcot's Triad
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Charcot's Triad
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Scanning Speech Intentional Tremors- tremors in motion Nystagmus
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MS Dx
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MRI -plaque formation, gliosis CSF Analysis- oligoclonal antibody
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Methotrexate
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MS Immunosuppresant AE: hepatotoxic BMS
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Methylprednisolone
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MS (exacerbation) Steroid anti inflammatory
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Beta-interferon (Avonex)
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MS Immunomodulators AE: flu-like symptoms teach patient self injection 1st line drug
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Baclofen (Lioresal)
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MS Muscle relaxant relieve spasticity centrally acting acts on CNS suppresses reflex in spinal cord AE: BMS drowsiness
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Dantrolene (Dantriom)
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MS muscle relaxant direct acting acts on muscle fibers prevent Ca influx AE: hepatotoxic
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Guillain Barre Syndrome
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demyelination of PNS decreased stimulation autoimmune ascending paralysis
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GBS Predisposing factors
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viral infection-3 wks after infection CMV Campilobacter jejuni-bacterial
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GBS early s/sx
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leg weakness
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GBS late s/sx
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complete paralysis
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GBS
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areflexia
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GBS
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Autonomic Signs: -heartblock- bradycardia, hypotension, cardiac arrest, respiratory paralysis
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IVIg
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GBS Tx Immunotherapy also used in kawasaki dse started 2 wks upon dx
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NSAIDs
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GBS Analgesics
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Narcotics
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GBS Analgesics can lead to resp depression
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Plasmapheresis
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GBS Tx removal of pathologic Ab (antibody)
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Parkinson's Dse/ Paralysis Agitans
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destruction of basal ganglia decreased dopa, increased Ach
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Parkinson's Predisposing factors
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hereditary CNS trauma chemical-lead CVD- bv -stroke
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Parkinson's s/sx
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mask like facial expresion
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Parkinson's s/sx
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Drooling of saliva
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Parkinson's s/sx
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resting tremors (pill rolling)
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Parkinson's s/sx
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rigidity akinesia postural problem
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Levodopa
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Diagnosis of Parkinson's but not confirmatory
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Entacapone
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Adjunct Agents for Parkinson's COMT Inhibitor AE: hallucinations psychosis confusion
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Selegiline (Eldepryl)
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Adjunct Agents for Parkinson's MAOI B AE: hallucinations psychosis confusion
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Levodopa
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Parkinson's dopaminergics precursor of dopa
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Sinemet
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Levo+carbidopa DOC for Parkinson's dopaminergics
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Sinemet precautions
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low CHON diet- decrease l-dopa absorption avoid B6- pork, oat-enhances dopadecarboxylase enzyme activity
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Amantadine (Symmetrel)
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Dopaminergics increase endogenous production of dopa anti-viral
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Bromocriptine (Parlodel)
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Dopamine agonists enhance DA receptor CI: lactating mom-inhibits prolactin synthesis
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Artane Cogentin Akineton
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Parkinson's Anticholinergic agents block AcH treat tremors and rigidity SE: SNS
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ALS
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destruction of motor neurons progressive, head to toe paralysis
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ALS Causes
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hereditary
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Myasthenia Gravis
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decreased AcH decreased muscle stimulation descending paralysis serious muscle weakness destruction of neuromuscular junction
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MG Causes
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autoimmune Thymoma- benign tumor of thymus gland -maturation of T-lymphocyte
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Triad Sign of MG
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Ptosis Diplopia Dysphagia
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Tensilon Test
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MG Diagnosis short acting <5 mins (-) ptosis (+) tensilon test
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Single Fiber EMG
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confirmatory test of MG (-) electrical activity of muscle paralysis
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CT Scan
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MG Dx thymus gland tumor thymoma
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Cognex
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MG Tx Cholinergic Agonist/Parasympathomimetic Direct acting on AcH receptor Alzheimer's, Dementia
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Pyridostigmine (Mestinon)
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MG DOC acts on acetylcholinesterase given before meal
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Pyridostigmine (Mestinon)
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AE: N & V Diarrhea Bradycardia
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Myasthenic Crisis
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undermedication
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Myasthenic Crisis
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S/Sx: dysphagia, tachycardia
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Myasthenic Crisis
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Tx: Mestinon
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Cholinergic Crisis
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overmedication
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Cholinergic Crisis
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S/Sx: hypersalivation, bradycardia
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Cholinergic Crisis
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Tx: Atropine SO4
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CNs
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12 pairs
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SNs
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31 pairs
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I-II
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CN
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III-XII
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brainstem
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I
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Olfactory
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II
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Optic
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III
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Oculomotor
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IV
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Trochlear
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V
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Trigeminal
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VIII
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Vestibulocochlear
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X
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Vagal
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Oculomotor
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Pupillary constriction
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Trochlear
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superior
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Trigeminal
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mastication
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Abducens
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lateral rectus
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Vestibulocochlear
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Romberg's Test
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Glossopharyngeal
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posterior 1/3 bitter mov't of tongue
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Vagal
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gag reflex PNS
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Spinal
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neck and shoulder
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Hypoglossal
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tongue
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Trigeminal Neuralgia
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Nerve pain destruction of CN V
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Trigeminal Neuralgia
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Causes: compression -tumor -superior cerebral artery
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Trigeminal Neuralgia
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S/Sx: paroxysmal (on and off) facial pain unilateral, sudden
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Pain triggers Trigeminal Neuralgia
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chewing, shaving, brushing, facial massage
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Carbamazepine (Tegretol)
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Trigeminal Neuralgia Tx decrease nerve sensitivity
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Nerve block
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Surgery Trigeminal Neuralgia injection of alcohol or anesthesia to nerve root
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Rhizotomy
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Surgery Trigeminal Neuralgia resection/cutting of nerve Cx: unilateral facial numbness
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Trigeminal Neuralgia Care
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soft diet, room temp, minimal chewing, increase calorie, avoid hot and cold, eat on unaffected side, soft bristled brush, mouthwash, electric razor, avoid brushing hair
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Bell's Palsy/Facial Palsy
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destruction of CN VII, facial paralysis
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Bell's Palsy/Facial Palsy
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Causes: trauma, viral infection- herpes skin lesion (linear)
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Bell's Palsy/Facial Palsy
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S/sx: Facial paralysis unilateral nasolabial fold
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Bell's Palsy/Facial Palsy
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s/sx: Ageusia - absence of taste anterior 2/3 sweet, sour, salty
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Bell's Palsy/Facial Palsy
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s/sx: corneal irritation (-)blinking
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Bell's Palsy/Facial Palsy
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s/sx: ear pain -back of ear (hyperacusis) -sensitivity to nose
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Methylprednisolone
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Bell's Palsy/Facial Palsy Tx steroid, 1st line, DOC
