Chronic Neurological Problems

Question 1

Tension-Type Headache

Answer 1

Bilateral, pressing/tightening

mild to moderate
no prodrome (aura)

may have photophobia

Question 2

Migraine headache

Answer 2

unilateral or bilateral throbbing pain

May have prodrome

Females more likely to have
peak incidence between 20-30y.o

“Hibernate”

Question 3

Migraine triggers

Answer 3

foods, stress, hormone, meds,fatigue

Question 4

Migraine s/s

Answer 4

irritable, generalized edema, pallor, N/C, photophobia

Question 5

Cluster Headaches

Answer 5

Rare
Sharp, stabbing pain, usually around the eyes radiating to forehead, temple, cheeks, nose, gums

Agitated/restless
May last 4-8wks = get them and then they go away for a period before coming back

Question 6

Prodrome

Answer 6

“Aura” - sensory input

Smell, taste, vision that happens before a headache

Question 7

Headache Dx

Answer 7

Dx by exception - r/o other causes (brain tumor, injury)

HPI, headache hx
EMG (Tension-Type)
CT/MRI if headache is abnormal

Question 8

Headache Tx

Answer 8

NSAIDS/Acetaminophen – NO OPIOIDS

Muscle relaxants = Tension Type
Serotonin receptor agonist = migraines
100% O2 = acute clusters

Question 9

Overall goals for headaches

Answer 9

reduced or no pain
increased comfort/decrease anxiety
demonstrate an understanding of triggering events and tx strategies
positive coping strategies to deal with chronic pain
increased quality of life and decreased disability

Question 10

Nursing Management/Teaching for Headaches

Answer 10

headache diary
quiet, dim environment
moist head and massage to the neck

Question 11

Seizure

Answer 11

Paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function

abnormal firing of brain; location determines presentation (not every seizure is the same)

May be idiopathic
Most stop on their own

Question 12

Idiopathic

Answer 12

symptoms of another disease/disorder/ or without apparent cause

Question 13

Epilepsy

Answer 13

spontaneous recurring seizures from a chronic cause

75% are idiopathic – don’t know the etiology

Question 14

Non-neurological reasons for seizures

Answer 14

alcohol withdrawal, extreme temp. changes, brain tumors, hypo/hypernatremia, hypoglycemia, excessive amounts of toxins in the body (ecstasy)

Question 15

Seizure Disorder/Epilepsy Clinical manifestations

Answer 15

Prodromal phase
Aural phase
Ictal phase
Postictal phase

Question 16

Prodromal phase

Answer 16

sensation of a seizure coming

Question 17

Aural phase

Answer 17

sensory input

Question 18

Ictal phase

Answer 18

during seizure

Question 19

Postictal phase

Answer 19

immediately after seizure

confused, can be combative

Question 20

Generalized Seizures

Answer 20

loss of consciousness

Tonic clonic, atypical and typical absence (in children)

Question 21

Tonic Clonic (grand mal)

Answer 21

loss of consciousness and falling to the ground

Stiffness of the body (tonic) - cannot breathe, excessive salivation, tongue or cheek biting, incontinence

jerking of the extremities when the brain relaxes (clonic)

Question 22

Partial aka Focal Seizures

Answer 22

one areas of the brain is affected

Simple or Complex partial

Question 23

Status Epilepticus

Answer 23

continuous tonic clonic seizures

at risk for brain damage, hyperthermia, muscle breakdown, death if left untreated

Question 24

Seizure disorders/Epilepsy complications

Answer 24

Status epilepticus
Physical injury
psychosocial

Question 25

Seizure disorders/Epilepsy Dx

Answer 25

CBC/Chemistries/LFT/UA to r/o metabolic disease CT or MRI EEG - electrical activity in the brain

Question 26

Seizure Disorder/Epilepsy Tx

Answer 26

treat underlying disease if possible Client Safety Ativan - tops active seizures surgical therapy O2 in the room, Padded bedside rails, suction kit, nasal cannula

Question 27

seizure disorder/epilepsy teaching

Answer 27

monitor serum levels med teaching: side effects, don't stop taking them adequate rest, proper diet, exercise avoid excessive alcohol intake Medical alert bracelet Driving considerations

Question 28

Multiple Sclerosis

Answer 28

chronic, progressive, degenerative d/o of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord slow onset; chronic w/ periods of remission and exacerbations onset between 20-50y.o mostly in females cause unknown: viral, immunologic,genetic

Question 29

Multiple Sclerosis clinical manifestations

Answer 29

``` weakness, paralysis of limbs, trunk, head diplopis scanning speech pasasthesia scotomas (patchy blindness) decreased hearing fatigue spasticity constipation urinary urgency/freqeuncy/ dribbling/ incontinence decreased libido erectile dysfunction remission or improvement with pregnancy but high risk of exacerbation during postpartum emotional lability intellectual functioning unaffected ```

Question 30

multiple sclerosis dx

Answer 30

MRI | LP for analysis of CSF

Question 31

multiple sclerosis tx

Answer 31

``` no cure corticosteroids immunomodulator - interferons immunosuppressants anticholinergics - bladder symptoms muscle relaxations - for spasticity CNS stimulants - for fatigue PT, OT, speech therapy ``` Nutrition: Vit. B12, C, low fat, gluten free; high roughage Be aware for triggers Life expectance >25 yrs after onset Death usually from infection r/t immobility or unrelated disease

Question 32

Myasthenia Gravis

Answer 32

autoimmune disease Antibodies attack acetylcholine receptors exacerbations: stress, secondary illness, menses, pregnancy, trauma, temp. extremes, hypokalemia, certain meds

Question 33

Myasthenia Gravis clinical manifestations

Answer 33

fluctuating weakness of skeletal muscle strength restored with rest muscles used for movement of eyes, eyelids, chewing, swallowing, speaking, and breathing most commonly involved muscles are strongest in the morning with weakness most prominent at night no sensory loss, reflexes are normal muscle atrophy is rare

Question 34

Myasthenia Crisis

Answer 34

acute exacerbations of weakness affects swallowing and breathing

Question 35

Myasthenia Gravis Dx

Answer 35

Hx and PE EMG Anti-achr antibodies anticholinesterase agent (Tensilon Test) - dx and therapeutic --> ATROPINE at bedside!!!

Question 36

Myasthenia Gravis tx

Answer 36

``` anti cholinesterase drugs alternate day corticosteroids immunosuppressants Thymectomy (if thymoma present) Plasmapheresis - short term for crisis Immunoglobulin G - second line tx ```

Question 37

Amyotrophic Lateral Sclerosis

Answer 37

rare - degeneration of motor neurons in the brainstem and spinal cord mostly in med usually 40-70y.o dx w/ HPI no specific tests

Question 38

Amyotrophic Lateral Sclerosis manifestations

Answer 38

``` weakness in upper extremities dysarthria dysphagia muscle wasting no cognitive impairments death usually occurs from respiratory infection or compromised respiratory function ```

Question 39

ALS collaborative Care

Answer 39

no cure Riluozle - delays need for tach and death ``` moderate exercise supportive cognitive and emotional functioning reduce risk of aspiration treat pain reduce risk of injury diversional activities support family/friends ```

Question 40

Huntington's Disease

Answer 40

genetically transmitted autosomal dominant disorder in men and women offspring client have 50% chance of getting disease onset between 30-50 y.o Deficiency of Ach and GABA, excess Dopamine

Question 41

Huntington's Disease minifestations

Answer 41

``` abnormal and excessive involuntary movements (chorea) twisting movement of face, limbs, body speech impairment loss of cognitive ability emotional lability psychotic behavior difficulty swallowing, chewing ```

Question 42

Huntington's Disease Dx

Answer 42

HPI, presence of gene No cure death usually 10-20ys after onset due to infection, choking, pneumonia palliative care: antipsychotic meds, maintain safety, reduce risk of aspiration, high calorie diet due to chorea (4-5000 calories), provide family support