Alterations in Neuro [seizure + LOC]

Question 1

myelination proceeds in ____ direction

Answer 1

cephalocaudal direction

head to fingers/toes

newborn reflex is fr lack of myelination

Question 2

cerebral BF is maintained thru…

Answer 2

autoregulation

Question 3

most important indicator of neuro dysfunction

Answer 3

states of consciousness

Question 4

5 types of aletered levels of consciousness

Answer 4

1 confusion
2 delirium
3 lethargy
4 stupor
5 coma

Question 5

confusion

Answer 5

disoriented to person, place, time

-may still be able to answer simple questions

Question 6

delirium

Answer 6

• disoriented
• fear, irritable, agitated
• mental or motor excitement

Question 7

lethargy

Answer 7

• profound slumber

- limited speech + movement

Question 8

stupor

Answer 8

deep sleep or unresponsiveness

-only aroused by vigorous stimuli

Question 9

coma

Answer 9

unconscious

-cannot be aroused

Question 10

altered states of consciousness often follows a predictable sequence

Answer 10

1 slight disorentatn
2restlss + irrtbl
3 drowsy
4 non-purposeful response to pain
5 posturing, siezures, fixd pupils
***6*** crushing triad

Question 11

cushing triad of altered states of consciousness

Answer 11

• incr SBP w widened pulse pressure
• bradycardia
• irregular respirations

Question 12

early signs of ICP

Answer 12

• headache
• slow reacting pupils
• slight change in LOC
• restlessness

Question 13

early signs of ICP in infants are similar but with…

Answer 13

• bulging fontanelle
• high pitched cry

nonspecific to infants

• headache
• slow reacting pupils
• slight change in LOC
• restlessness

Question 14

late signs of ICP

Answer 14

-significant change in LOC
-cushing triad
»incr SBP w widened pulse pressure
»bradycardia
»irreg RR

Question 15

altered states of consciousness

treatment

Answer 15

AIRWAY> positioningm, intubation, bag-valve mask
BREATH>O2
CIRC> IV fluids, blood products

Question 16

altered states of consciousness

is assessed with..

Answer 16

Glasgow Coma Scale
>eye opening
>verbal response
>motor response

Question 17

altered states of consciousness

nursing mgmt

Answer 17

provide sensory stimultn
»encourage family to stroke + touch in soothing manner
repeated orientation
»bring familiar toys to bedside

Question 18

Seizure Disorders

Answer 18

excessive neurons becoming overexcited

Question 19

highest rate of onset of seizures

Answer 19

during first 12 months of life

Question 20

possible causes of seizures

Answer 20

wide variety; many are unknown

• brain injury
• infection
• electrolyte disturbance
• toxins

Question 21

Status Epilepticus

Answer 21

prolonged continuous seuzire lasting longer than 15 min
or
intermittent seizures longer than 15 min w/o full recovery bw each seizure

Question 22

seizures use up a lot of ___ +___

Answer 22

glucose + oxygen

Question 23

generalized seizures aka

Answer 23

tonic clonic

Question 24

generalized seizures/tonic clonic

manifestations

Answer 24

body becomes stiff + rigid

>followed by rhythmic jerking motions

Question 25

childhood absence epilepsy is caused by genetic predispotiion

Answer 25

touch does not interrupt seizures

Question 26

infantile spasms - genetic

Answer 26

abrupt spasms | >involves head nods + jackknife body contractions

Question 27

Phases of Seizure Disorders

Answer 27

Tonic Clonic Postictal

Question 28

Tonic

Answer 28

- unconscious - continuous muscular contraction - sustained stiffness

Question 29

Clonic

Answer 29

- alternating muscular contraction | - relaxation or rhythmic jerking

Question 30

Postictal

Answer 30

decreased LOC

Question 31

NEONATAL SEIZURES | findings

Answer 31

* *subtle** - roving eye mvmt - repetitive blinking - sucking, lip smacking, tongue thrusting - leg pedaling mvmt - swimming mvmt of arms - apnea + tachycardia

Question 32

seizure disorder | maintaining safety

Answer 32

- nothing in mouth - side-lying position - ensure rails have pads - move objects away

Question 33

seizure disorder | ABC's

Answer 33

airway suctioning supplt O2 bolus

Question 34

how to stop seizure

Answer 34

anticonvulsant + tx of cause

Question 35

post-seizure care

Answer 35

monitor postictal period (30 min-2hr) | get glucose + abg levels

Question 36

when starting new antiepileptic drugs, adolescents....

Answer 36

should NOT drive or do anything risky | -avoid ETOH

Question 37

MEDS for seizures

Answer 37

``` benzos [diazepam, lorazepam/ativan] fosphenytoin/cerebryx levetiracetam/keppra phenobarbital valcroic acid/depakote ```

Question 38

benzos [diazepam, lorazepam/ativan]

Answer 38

monitor for >hypotension >tachycardia >resp dprssn *rectal or nasal form for home admin

Question 39

fosphenytoin/cerebryx

Answer 39

monitor for resp dprssn

Question 40

levetiracetam/keppra

Answer 40

monitor gait/coordinatn problems

Question 41

phenobarbital

Answer 41

monitor for excess sedation

Question 42

valcroic acid/depakote

Answer 42

can be given in sprinkle form

Question 43

Seizure Disorder | treatments

Answer 43

- vagal nerve stimulator | - ketogenic diet

Question 44

vagal nerve stimulator

Answer 44

activated vagal nerve after AURA | -to reduce spread of seizure

Question 45

ketogenic diets must cut out

Answer 45

all glucose fr all sources

Question 46

a trial of antiseizure medication withdrawal

Answer 46

attempted after 2 years of no seizures

Question 47

seizure/anti epileptic meds are at risk for..

Answer 47

-depression -anxiety -behavioral problems ADHD

Question 48

seizure education

Answer 48

nonadherence is common (esp w alcohol) safety measures includes no bath, may need helmet, no playing around open flames, medical alert ID *teach parents to focus on what they CAN do

Question 49

Febrile Seizures

Answer 49

usually w temp >39C in first 24 hr of illness

Question 50

SIMPLE Febrile Seizures duration

Answer 50

last less than 15 min | do no recur during the same illness

Question 51

SIMPLE Febrile Seizure | manifestations

Answer 51

- generalized w tonic-clonic mvmt + eye rolling - brief postictal period - not tx w anticonvulsant - give antipyretic + education