Chapter 42

Question 1

Intracranial pressure

Answer 1

Normal 10-15 above 20 can be hypoxic and death
Lying down can decrease ICP
Increase CO2 causes vessels to dilate and decreased O2 causes edema which can increase ICP

Question 2

Cushing Triad with ICP

Answer 2

Increased pulse pressure
Decreased pulse
Irregular respirations- Biots

Question 3

Cerebral perfusion pressure

Answer 3

Blood flow to the brain
70-100 normal
Less than 55 is associated with ischemia and neuronal death

Question 4

Migraine

Answer 4

Aura occurs
Unilateral
Frontotemporal 
Throbbing pain behind ear or eye 
Photophobia, phonophobia, nausea
Women with migraines have increased risk for stroke
Drugs: Tylenol, ibuprofen, BB, CCB, Triptans- report angina, may have rebound HA, avoid triggers such as alcohol, chocolate, thyramine
Avoid opioids and barbiturates

Question 5

Cluster HA

Answer 5

Occurs for 30 min to 2 hrs at same time of day
Unilateral, excruciating, nonthrobbing pain
May radiate to forehead, temple, cheek
Often pace, walk, sit/Rock
Common in spring and fall
Avoid triggers
Intervene:’consistent sleep wake cycle, lithium, corticosteroids, oxygen, surgery

Question 6

Generalized seizure

Answer 6

Involves both hemispheres
Tonic clonic: 2-5 min, unconscious, full out seizure
Tonic: unconscious, autonomic changes, 30sec- minutes
Clonic: several minutes, muscles contract
Atonic:’loss muscle tone, few seconds, risk for falls, resistant to drug therapy

Question 7

Partial seizure

Answer 7

One hemisphere
Less responsive to Meds
Complex: lose consciousness, 1-3 minutes, prior wander, after amnesia, most common
Simple: conscious, aura, one sided movements, autonomic changes- change in HR, flushed, epigastric discomfort

Question 8

Epilepsy

Answer 8

2+ seizures
Primary- seizure expected
Idiopathic- unsure of reasoning

Question 9

Seizure precautions

Answer 9

Oxygen
Suction in buccal space
Airway
IV access
Padded side raises per protocol

Question 10

Seizure management

Answer 10

Depends on type
Pt safety
Side lying position to protect airway 
No restraints 
Nothing in mouth

Question 11

Status epilepticus

Answer 11

Seizure lasting longer than 5 minutes 
Longer than 10 min could cause death
Medical emergency 
Assess airway, ABGs
IV push lorazepam, diazepam 
Prevention is IV Dilantin 
Check serum drug levels

Question 12

Drug therapy

Answer 12

Use combination
Monitor therapeutic blood levels Q6-12 hours then every 2 weeks
Can build up sensitivity
DONT give Warfarin with Dilantin
NO grapefruit juice, can increase toxicity
DONT abruptly stop

Question 13

Meningitis

Answer 13

Inflamed meninges 
Droplet precautions
Caused by viral, bacterial, fungal, Protozoa, CA, NSAIDs, ABT, IV IG
Occurs in high populated areas
Increase risk at age 16-21
Prevention = Vaccination

Question 14

Caring for pt with Meningitis

Answer 14

Sx: decreased LOC, disoriented, nuchal rigidity, photophobia, HA, myalgia, N/V, increased ICP, macular rash
Labs: CSF, CIE, CT, Xray, gram stain, CBC
Intervene: ABCs, prevention, neurons Q4H, broad spectrum ABT, mannitol, prophylaxis tx- Rifampin, vascular assessment Q4H, v.s, private room, 3 ft away unless mask on, manage pain, monitor labs

Question 15

Bacterial vs. Viral CSF

Answer 15

Bacterial- cloudy, decreased glucose

Viral- clear

Question 16

Encephalitis

Answer 16

Inflamed brain tissue
Caused by viral, bacteria, fungi, parasites
Death from herniation or increased ICP

Question 17

Care for pt with Encephalitis

Answer 17

Assessment- fever, N/V, change LOC, fatigue, joint pain, HA, vertigo
Labs- LP, PCR, EEG, CT
Interventions- prevention, Acyclovir, resp support, TCDB, v.s and neuro Q2H, elevate HOB, quiet env

Question 18

Changes in v.s. That require immediate attn with encephalitis

Answer 18

Widened pulse pressure
New Bradycardia
Irreg resp effort
Dilated pupils and less responsive to light

Question 19

Parkinson’s disease

Answer 19

Progressive neuro degenerative disease
PNS- changes muscle action
Autonomic- changes in BP, HR
Affects motor ability

Question 20

Care for PD

Answer 20

Assessment- stooped posture, shuffled gait, a/bradykinesia, pill rolling motion, slurred speech, masklike face
Labs-CSF: decreased dopamine, MRI, PET
Interventions- preserve mobility, cognition, QOL, with end stage manage airways, sleep pattern, small frequent meals, weekly wt, allow time to respond, admin med on schedule, monitor for s/e, keep pt as independent as possible

Question 21

Drugs with PD

Answer 21

Tx symptoms
Dopamine agonists- minim dopamine, effective for 3-5 years, Requip
Neupro- dopamine agonists transdermal patch
Sinemet- before meals, long term use for dyskinesia
Parlodel when others aren’t effective
Drug holiday

Question 22

Alzheimer’s disease

Answer 22

Loss of brain fxn
Impairs language, judgment, behavior
Age, women, family hx are risk
Af Am increased risk, Hispanics diagnosed early
Intervene- memory training, structured env, self management, B&B
Drugs- Aricept, Namenda, SSRI- Zoloft

Question 23

Huntington disease

Answer 23

Hereditary, autosomal dominant
Onset 30-50 y.o.
Die from other complication such as PNA, heart failure
Progressive mental status change and rapid, jerky movements
Triad: dominant inheritance, choreoathetosis, dementia
Maintain ADLs

Question 24

Tegretol

Answer 24

Monitor CBC

Don’t crush

Question 25

Klonopin

Answer 25

Monitor results of liver fxn test

Question 26

Depakote

Answer 26

Monitor CBC, PT, PTT, AST

Question 27

Lamictal

Answer 27

Life threatening rash when given with valproic acid

Question 28

Keppra

Answer 28

Monitor renal fxn

Notify PCP for gait or coordination problems

Question 29

Phenobarbital

Answer 29

Overdoses can be fatal

Question 30

Dilantin

Answer 30

Cause gingival hyperplasia
Check CBC and Ca levels
Therapeutic levels 10-20, toxic >30