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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
At home instructions for sz Adhere to what Wear what When to call ambulance
Adhere to drug regimen Alert bracelet Call ambulance if: -1st sz ever -prolonged or recurrent sz -injury with seizure
26
multiple sclerosis (MS) What type of disorder Possible causes (really dont know)
Degenerative disorder (demyelenation in brain/spinal cord) Autoimmune Genetic link Environment exposure
27
MS patho Happens, causes what 1st then possibly Effects what usually
Inflammation, edema, scarring (damages myelin) Slowed nerve conduction 1st Then Possible permanent loss of nerve function Effects usually: optic, cerebrum, cervical
28
MS CM
Blurred/double vision Red/green color distortion Muscle weakness, coordination/balance Paresthesia Speech/cognitive diffculties Bowel/bladder problems Depression/sexual dysfunction
29
MS diagnostic test
LP (elevated protein and WBCs) MRI (brain and SC for plaques) Auditory and visual pathway evoked potentials
30
MS meds Is there a cure? Acute relapse(3) Vs Disease modifying meds (4) Nd Pt teaching (3)
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
MS management Mobility Bladder control Constipation
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
Parkinsons disease Type of disorder Characterized by: Patho: lack of what
Neurogenerative disorder Characterized by slowed movements: TRAP Patho: lack of dopamine
33
Parkinsons CM main one Other s/s Complications
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
Parkinsons tx MEDS: main ones then others Sx (use only if)
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
Parkinsons diagnostic test
S/s of TRAP HX Positive response to meds confirm diagnosis
36
Parkinsons management Risk of what Deficit of what Who else can help Nurtition
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
Myasthenia gravis (MG) Type of disease Antibodies affect what receptors Muscle weakness/fatigue worse when
Autoimmune disease Affect acetylcholine recptors (decrease muscle contraction) Worse with activity
38
MG CM Primarily What unefffected What happens as the day goes on What improves it
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
MG complications Cause of exacerbation: Myasthenia crisis (what does that mean with medication) Acute exacerbation affects water putting you at risk of?
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
MG diagnostic test
H&P EMG Tensilon test (admin Edrophonium(Tensilon): -injected, expect muscle contractility to improve) -imporvement rapidly
41
MG meds
Mestinon (pyridostigmine) Steroids Immunosuppressants Plasmapheresis
42
MG sx
Sx removal of thymus gland -(CT to confirm thymus is an issue)
43
Distinguishing between MG crisi or cholinergic crisis MG crisis: s/s, triggers, cause Cholinergic crisis: cause, s/s, TX How to distinguish
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
Amyotrophic lateral sclerosis: ALS What happens What is still intact
Loss of both upper & lower motor neuron Sensory and cognitive function intact
45
ALS CM What is effected, what does to muscle Classic sign What is effected 1st then later Early CM
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
ALS other CM
Sleep disorders Pain Drooling Consitpation GERD Muscle wasting COGNITIVE FUNCTION IS INTACT
47
ALS management Is there a cure? Med Supportive care Risk of Control what
No cure Med: Riluzole: slows progression Supportive care Risk of aspiration, injury, falls Control pain

Med Surg 2 (5 decks)

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