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Med Surg 2 > Chronic Neurologic Problems > Flashcards

Chronic Neurologic Problems Flashcards

1
Q

HA
Primary vs sexonday

A

Primary: not caused by disease
-tension
-migraine
-cluster

Secondary: caused by other medical things
-infection
-tumor

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2
Q

Interventions simmilar across all 3 types of HA

A

Diary
Avoid triggers
Education on meds and SE
Stress management
Exercise

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3
Q

HA diagnostic test

A

H&P

Test to r/o other causes:
-neuro
M/S
Infections

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4
Q

Tension HA
Aka
S/s

A

Stress HA
S/s:
-band-like
-dull, constant pressure
-light and sound sensitivity

Does not have N/V or warning aura

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5
Q

Tension HA
Meds and other tx

A

Meds:
Tylenol, Nsaids

Others:
Remove stress
Hydration

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6
Q

Migraine HA
S/s
Associated with 5 things
Triggers
Has what

A

S/s:
Unilaterl
Throbbing pain
Light, sound, smell sensitivity

Associated w/ seizure disorders:
-asthma, depression, anxiety, IBS, raynauds

Triggers: a bunch: food, alcohol, stress, weather

Has an aura (feeling)

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7
Q

Migraine HA
Meds

A

Nsaids
ASA w/ caffeine

Need provider for:
Sumatriptan (abortive) (causes vasoconstriction systemic)
Topiramate (preventative)
Botulinum toxin A (prophylactic) (last months)

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8
Q

Cluster HA
Involves what and how bad is it
Irregularities in what 2 things
Up to how may times in a day
S/s
Triggers

A

Most severe HA
Involves hypothalamus
Irregularities in melatonin and cortisol
Occures up to 8 times a day

S/s:
Sharp stabbing pain around eye
Radiating to other parts of face

Triggers: same as others

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9
Q

Cluster HA
Meds
Other tx

A

Meds:
Sumatriptan: gold standard
-causes vasoconstriction (cant take with CAD)

Other tx:
Oxygen- high flow for 10 mins
-causes vasoconstiction

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10
Q

Epilepsy and seziure disorders
What is happening
Etiology
Epilepsy definition

A

Uncontrolled electrical activity in the brain

Etiology:
Trauma, tumors
Overdose/withdrawal
Metabolic issues: F&E
Congenital, genetics
Infection
Idiopathic

Epilepsy=reoccurring seizures

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11
Q

Epilepsy and seizure disorders CM
2 classifications
Phases

A

Generlized: both hemispheres

Partial: one hemisphere

Phases:
Prodromal: sensation or behavior prior to seizure
Aural: sensory warning
Ictal: beginning to end of seizure
Post-ictal: recovery after seizure

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12
Q

Generalized seizures
Name
S/s

A

Tonic clonic sz (grnad mal)

S/s:
LOC
Stiff body (tonic)
Jerking (clonic)
Cyanosis, salivation, tongue/cheek biting, incontinence

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13
Q

Other generalized seizures
Names and what they look like
If not sure what type what should you do?

A

Myoclonic:
sudden excessive jerking, twitching

Atonic:
Drop attack, tonic or loss of tone, pt conscious

Tonic:
Increased tone, remains conscious

Clonic:
LOC, loss of tone followed by rhythmic jerking

If not sure: observe and report behaviors, movements, tone to HCP

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14
Q

Partial seizures
Names and what they look like

A

Simple focal seizure:
Remains conscious, experience unusual sensations:
Ex:joy, happiness, anger, taste, smells, visions

Complex focal seizures:
Unconscious (dream-like state)
Automatisms: lip smacking, chewing, strange behavior

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15
Q

Psychogenic seizures
Not what
Diagnose how
Check what

A

Non-epileptic although mimic symptoms

Diagnose: video EEG monitoring

HX emotional, physical abuse or traumatic event

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16
Q

Complications
Name of it
Med emergency what to do/what you see
Meds if dont work then give what meds

A

Status epilepticus:
Continuous sz or rapid succession w/o. Return of LOC lasting longer than 5 mins

Med emergency: brain using more energy than supply
-permanent brain damage
Oxygenations/ventilation impaired
Hyperthermia (increase metabolic rate)
Cardiac dysrhythmias

Med:
IV benzos(ativan, diazepam) if dont work give IV phenytoin or fosphenytoin

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17
Q

SUDEP

A

Sudden unexplained death in epilepsy

Due to impaired resp and cardiac

Were also worried about these patients falling

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18
Q

Pschogenic seizures/ status epilepticus
Diagnostic test

A

H&P, presentation, length of time

EEG: GOLD STANDARD

R/o other causes w/:
CT, MRI, CBC, LP, BMP

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19
Q

seizure medications

A

phenobarbital
phenytoin (Dilantin)
Gabapentin
valporic acid
fospenytoin Na
primodon
levetriacetam (Kappra)

administer during sz:
lorazepam
diazepam

20
Q

Common side effects of sz meds

A

Resp despression
dysrhythmias
Sucididal ideations
Gum hypertrophy
Wt gain
Liver damage

21
Q

Sz meds
Which med should we check therapeutic levels?
What diagnostic test should be done

A

Check therapeutic levels: phenytoin

CBC: risk of blood dyscrasias

22
Q

Give sz meds IV with what fluid, not what fluid
how to give it and monitor what
PH of phenytoin
What to do with valium
Issues with valporic acid (so get what test)
Phenobarbital & phenytoin cause what
Dilantin causes what
Tell pt to take what if on sz meds
What decreases sz threshold
What do many sz meds cause in pregnancy

A

Give in NS only, no D5W
Give slowly and monitor for phlebitis
Phenytoin PH 12 same as bleach
Valium adheres to plastic so flush well
Valporic acid: bleeding/bruising (get CBC)
Phenobarbital/phenytoin: vit D, folic acid deficiency
Phenytoin: hypertrophy of gums
Tell pt to take birth control
Drugs and alcohol decrease sz threshold
Sz meds are tertogenic

23
Q

Sz management
Sx
Others

A

Sx: remove the epileptic focus:
Only if failure to respond to meds

Vagal nerve stimulator:
Disrupt excessive neron firing

Ketogenic diet:
High fat, low carbs

24
Q

Sz assessment and what to take note of

A

-Event leading to it
-When it occured
-Length of phases (aural, ictal, postictal)
-Body reaction
-Eye reaction
-What pt does after
-Long does it take until next one
-Autonomic signs: pupil dilate, salivation, alterted breathing, cyanosis, flushing, diaphoresis
-describe it (tonic, clinic, staring, blinking)

25
Q

At home instructions for sz
Adhere to what
Wear what
When to call ambulance

A

Adhere to drug regimen
Alert bracelet

Call ambulance if:
-1st sz ever
-prolonged or recurrent sz
-injury with seizure

26
Q

multiple sclerosis (MS)
What type of disorder
Possible causes (really dont know)

A

Degenerative disorder (demyelenation in brain/spinal cord)

Autoimmune
Genetic link
Environment exposure

27
Q

MS patho
Happens, causes what
1st then possibly
Effects what usually

A

Inflammation, edema, scarring (damages myelin)

Slowed nerve conduction 1st
Then
Possible permanent loss of nerve function

Effects usually: optic, cerebrum, cervical

28
Q

MS CM

A

Blurred/double vision
Red/green color distortion
Muscle weakness, coordination/balance
Paresthesia
Speech/cognitive diffculties
Bowel/bladder problems
Depression/sexual dysfunction

29
Q

MS diagnostic test

A

LP (elevated protein and WBCs)

MRI (brain and SC for plaques)

Auditory and visual pathway evoked potentials

30
Q

MS meds
Is there a cure?
Acute relapse(3)
Vs
Disease modifying meds (4)
Nd
Pt teaching (3)

A

No cure

Relapse:
Steroids
Plasmapheresis
Iv immunoglobulin

Disease modifiers:
Interferon beta 1a Avonex (IM), Rebif (SQ)
Interferon beta 1b Betaseron (SQ)
Copaxone (SQ) (helps inflammation/protects myelin)

Teach pt:
Rotate injection site
Protect skin from sun
May get flu-like s/s with meds that okay

31
Q

MS management
Mobility
Bladder control
Constipation

A

Mobility:
Goal to decrease spasticity, increase coordination
-pt
-excercise
-muscle relaxants

Bladder control:
-meds for bladder spasms
-self catheterization

Constipation:
-Increase fiber
-bowel regimen

32
Q

Parkinsons disease
Type of disorder
Characterized by:
Patho: lack of what

A

Neurogenerative disorder

Characterized by slowed movements:
TRAP

Patho: lack of dopamine

33
Q

Parkinsons CM
main one
Other s/s
Complications

A

TRAP:
Tremors: 1st symptoms
Rigidity: jerky (muscle contractions)
Akinesia: loss of control of voluntary muscle movement
-stooped posute, masked face, drooling, shuffling gait
Postural instability: difficulty stopping

Other s/s: depression, anxiety, sleep disturbances

Complications:
-frozen, psychosis, dementia
-dysphagia

34
Q

Parkinsons tx
MEDS: main ones then others
Sx (use only if)

A

Meds:
Levodopa: precursor of dopamine
Sinemet: L/C (prevent breakdown of l-dop)
*effects decline with use

Others:
Pramipexole (receptor agonist)
Amatadine (agonist)
Anticholinergic meds: limit use (increases confusion)

Sx:
Deep brain stimulator (decreases neuronal activity
*use only when meds dont work

35
Q

Parkinsons diagnostic test

A

S/s of TRAP

HX

Positive response to meds confirm diagnosis

36
Q

Parkinsons management
Risk of what
Deficit of what
Who else can help
Nurtition

A

Risk of falls
Self care deficit
PT/OT/ST

Nutrition:
-Increase fiber
-Easy to chew and swallow
-6 small meals
-Decrease protein and Vit B6 (impairs absorption of levodopa)

37
Q

Myasthenia gravis (MG)
Type of disease
Antibodies affect what receptors
Muscle weakness/fatigue worse when

A

Autoimmune disease

Affect acetylcholine recptors (decrease muscle contraction)

Worse with activity

38
Q

MG CM
Primarily
What unefffected
What happens as the day goes on
What improves it

A

Primarily facial muscle early AM
Diplopia
Ptosis
Impaired swallowing/chewing
Speech impaired

Trunk/limb/sensation/reflexes remain normal

Morexhausted as day goes on

Improves with rest

39
Q

MG complications
Cause of exacerbation:
Myasthenia crisis (what does that mean with medication)
Acute exacerbation affects water putting you at risk of?

A

Causes:
-stress, pregnancy, temperature
Meds causes:
-Anesthesia, opioids, neuromuscular blockade
-betablockers, phenytoin
-benzodiasepines, muscle relaxers

MG crisis:under medicated
Acute exacerbation may affect swallowing and breathing:
Risk of aspiration,
Risk of Ineffective breathing patterns
Risk of imparied airway clearance

40
Q

MG diagnostic test

A

H&P

EMG

Tensilon test (admin Edrophonium(Tensilon):
-injected, expect muscle contractility to improve)
-imporvement rapidly

41
Q

MG meds

A

Mestinon (pyridostigmine)

Steroids
Immunosuppressants
Plasmapheresis

42
Q

MG sx

A

Sx removal of thymus gland
-(CT to confirm thymus is an issue)

43
Q

Distinguishing between MG crisi or cholinergic crisis

MG crisis: s/s, triggers, cause
Cholinergic crisis: cause, s/s, TX

How to distinguish

A

MG crisis: exacerbation of muscle weakness
Triggered by: stress, illness, meds
Under medicated anticholinesterase meds

Cholinergic crisis: over medicated anticholinesterase meds
-muscle stop reacting to acetylcholine
S/s: SLUD (salivation, lacrimation, urination, defecation)
Tx:
support ventilation until symptoms subside
Atropine help w/ secretions

Distinguish by giving Edrophonium:
MG crisis will get better, Cholinergic crisis worse

44
Q

Amyotrophic lateral sclerosis: ALS

What happens
What is still intact

A

Loss of both upper & lower motor neuron

Sensory and cognitive function intact

45
Q

ALS CM
What is effected, what does to muscle
Classic sign
What is effected 1st then later
Early CM

A

Dead neurons
No signal to muscles

Classic sign: progressive muscle weakness
Upper body weakness affected 1st, lower later

EARLY:
Dropping things
Tripping
Slurred speech
Muscle fatigue, cramps, twitching

46
Q

ALS other CM

A

Sleep disorders
Pain
Drooling
Consitpation
GERD
Muscle wasting

COGNITIVE FUNCTION IS INTACT

47
Q

ALS management
Is there a cure?
Med
Supportive care
Risk of
Control what

A

No cure

Med: Riluzole: slows progression

Supportive care

Risk of aspiration, injury, falls

Control pain

Med Surg 2 (5 decks)

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