Nervous System Disorders Flashcards
0
Q
Inhibit neural pathways. Local anesthetic capable of inhibiting impulse pathways.
A
Therapeutic nerve blocks
1
Q
Instituted for those who suffer from chronic headaches. Acquired skill to control bodily functions: HR, BP. Teaching sessions are needed.
A
Biofeedback
2
Q
What neuron recovers first?
A
Motor recovers sooner than sensation
3
Q
This block is considered a regional anesthesia because the nerve block occurs distal to where the med is administered.
A
Nerve block
4
Q
What medication is used for a nerve block?
A
Lidocaine benzopine
5
Q
What contains side effects of dysrythmias, tachycardia, confusion, tinnitus, blurred vision, N/V, or metallic taste.
A
Nerve block
6
Q
A permanent change or destruction of nerve fibers.
A
Neuroablation
7
Q
Permanent destruction from administration of a chemical agent
A
Chemical ablation
8
Q
Radio frequency (heat) to nerve to cause destruction
A
Thermal ablation
9
Q
Surgical ablation of a nerve route
A
Rhizotomies
10
Q
Extreme cold to nerves to cause destruction
A
Cryoablation
11
Q
Severing of the spinothalamic tract
A
Cordotomies
12
Q
Severing at the level of the brain stem
A
Tractotomies
13
Q
Severing of only sensory fibers. Motor should still be intact.
A
Dorsal route
14
Q
Produced by a better powered implant when it sends electrical impulses it blocks nerve pathways
A
Electrical stimulation
15
Q
Implant into the chest wall for the spinal cord and vagal nerve (rarely used for pain, but used for Parkinson’s)
A
Deep brain stimulation
16
Q
Standard with chronic low back pain
A
Spinal cord stimulation
17
Q
Electrodes are wrapped around the vagal nerve used for treating seizures with varying frequencies and strengths to the vagus nerve
A
Vagal nerve stimulation
18
Q
Where do most inflammatory conditions of the nervous system begin?
A
In the bloodstream
19
Q
Acute inflammation of the meninges and infection of CSF and arachnoid Mater
A
Meningitis
20
Q
Meningitis is usually associated with what disease?
A
Upper respiratory infection
21
Q
What are the causes of meningitis?
A
Viral, bacterial, fungal, and Protozoa
22
Q
What causes a thickened viscosity of the CSF fluid?
A
When proteins spills because the blood brain barrier is no longer intact
23
Q
Why does less glucose pass?
A
When the blood brain barrier is damaged glucose levels decrease
24
This type of meningitis caused purulent secretions
Bacterial
25
What pathogen cause streptococcal meningitis?
Hemophilius influenza
26
What is the percentage of cases of streptococcal pneumonia/neisseria menigitides
80%
27
The mortality rate is
25% treated and 100% untreated
28
What is the first sign of bacteria meningitis?
Severe HA
29
What are the signs and symptoms of bacteria meningitis?
```
HA
N/V
Fever
Stiff neck
Skin rash/petechiae
```
30
What is nuchal rigidity?
Stiff neck
31
Flexion of the neck; knees automatically flex
Positive brudzinskis sign
32
Lying down and hips flexed and cannot extend the knee
Positive kernig
33
What is a common complication of bacterial meningitis?
IICP
34
What cranial nerves are involved with IICP?
2,3,4,6,8
35
1/3 of the patients with bacterial meningitis will have?
Seizures
36
What is a common cranial nerve issue with bacterial meningitis?
Photophobia
37
What Could be a permanent complication of bacterial meningitis?
Deafness
38
A pathological process caused by numerous small clots (countless amounts)
DIC- disseminated intravascular coagulation
39
How is bacterial meningitis diagnosed?
C&S (blood, sputum, nasal)
Imaging (X-ray, CT, or MRI)
Lumbar Puncture (DEFINITIVE TOOL)
40
How is bacterial meningitis treated?
Broad spectrum antibiotics until the pathogen is identified. Given in large, rapid doses of IV and PO.
41
What is Waterhouse-Friderichsen syndrome?
Severe vascular dysfunction
42
Why is decadron used?
It decreases cerebral edema. It also reduces mortality rate and hearing loss.
43
What precautions will a bacterial meningitis patient be on?
Droplet precautions
44
Meningococcal meningitis is
HIGHLY CONTAGIOUS
45
What is key in bacterial meningitis?
Prevention
46
What is critical to manage with a patient positive for bacterial meningitis due to increased risk of seizures?
Fever
47
What is viral meningitis usually caused by?
Measles, mumps, herpes, HIV
48
This disease is not as severe as bacterial meningitis and usually resolves within
2 weeks
49
What is different about viral and bacterial meningitis?
Viral doesn't have purulent secretions and may have a normal or low glucose level.
50
How is viral meningitis diagnosed?
CSF sample (clear or cloudy)
PCR (blood test)
Stains and grams (negative for organisms)
51
What is the treatment for viral meningitis?
Treat symptoms only
52
Acute inflammation of the brain usually caused by a virus
Encephalitis
53
Mosquitoes and ticks can transmit the virus to a human via an insect bite
Encephalitis
54
The onset of encephalitis is
2-3 days
55
Encephalitis is a mild to severe manifestation that has what type of symptoms?
Flu-like symptoms
56
Encephalitis needs to be diagnosed when to have a favorable outcome?
Early
57
How is encephalitis treated?
Acyclovir (antivirals) and decadron
58
What else is treated with encephalitis?
Symptoms
59
Localized collections of pus within the brain tissue
Brain abscess
60
The infection is usually by a direct extension by
The ear, mastoid, tooth, and sinuses
61
Trauma or neurosurgery including tongue piercing and chipped teeth can cause
Brain abscess
62
Brain abscesses can be because of the bloodstream and septic emboli because it
Travels to the CNS from somewhere else
63
What organisms are usually associated with brain abscesses?
Streptococci
| Staph aureus
64
What side of the brain does the abscess occur on?
The same side as the primary infection
65
Liquid necrotic tissue is encapsulated in a thick fibrous wall within
2 weeks
66
What are the systemic signs and symptoms of brain abscess
```
HA
Fever
Chills
N/V
Malaise
```
67
How does the brain abscess affect the temporal lobe?
Visual changes and receptive aphasia
68
How does the brain abscess affect the occipital lobe?
Visual impairment
69
How does the brain abscess affect the frontal lobe?
Expressive aphasia and motor weakness
70
How does the brain abscess affect the cerebellar region?
Ataxia
71
How do we diagnose brain abscesses?
WBC and ESR (to determine infection)
Cultures (ear,nose, and throat)
Imaging (to actually see the abscess)
72
How do we treat the brain abscess?
IV antibiotics administered in large doses to cross the blood brain barrier
73
What surgery is performed to remove and drain the abscess?
Craniotomy
74
Infection of ANY part of the nervous system
Neurosyphilis
75
Tertiary syphilis "treponema pallidum" can invade the CNS in a few months of original infection and can lay dormant for
10 years
76
Neurosyphilis is not contagious but can be fatal and Neuro deficits are
Permanent
77
Neurosyphilis is diagnosed by
RPR (rapid plasma regain)
| A specific syphilis test
78
Signs and symptoms of Neurosyphilis are
```
Progressive ataxia
Lightening pain (shooting)
Slapping gait (toes slap the ground)
Loss of DTR and proprioception (deep tendon reflexes) (walking into the table)
Charcots joints (enlarged with instability and loss of sensation)
```
79
Treatment for Neurosyphilis
PCN
80
Most common type of pain
Headache
81
Primary or functional problem of a headache is
The actual headache
82
The secondary or organic problem of a headache is
The headache is a result of another medical condition
83
What are the three types of headaches
Tension
Migraine
Cluster
84
This headache is mainly caused by stress
Tension Headache
85
This is the most common type of headache
Tension headache
86
Tension headaches occur
Intermittently (weeks to years)
87
The duration of a tension headache is
Minutes to days
88
Migraines are more prevalent in
Women
89
The onset of migraines usually occur at what age?
20-30 years old
90
The cause of migraines is
Unknown
91
What are the triggers of a migraine?
Food, medications, hormones
92
What kind of foods contain tyramine?
Chocolate, smoked fish, aged cheese, hot dogs, pickles, yeast, coffee, and wine.
93
How long does a migraine typically last?
4-72 hours
94
What are the symptoms of a migraine
```
Unilateral pain
Throbbing
Photophobia
Phonophobia
N/V
```
95
What are some factors that contribute to migraines?
```
Stress
Menses
Sleep problems
Bright lights
Missed meals
Smells
```
96
What is the most common type of migraine?
Migraine without an Aura
97
What is an aura?
Sensation that immediately perceives a HA, paralysis of limbs, abnormal feeling, blurred vision, spots in the eyes.
98
Hours to days prior to preceding migraine including mood and food craving
Prodromal period
99
When the HA begins and intensifies over hours with a tendency to hibernate
Second phase or headache phase
100
Pain is improving with residual effects of scalp tenderness and neck tenderness
Third phase and gradual subsiding
101
What is the first line of defense for migraines and is highly effective?
Triptans
102
What is the anti-inflammatory to take with Triptans?
Treximet
103
Affects serotonin receptors to inhibit neurogenic inflammation and cause cranial vasoconstriction
Triptans
104
What are side effects of Triptans
Flush
Tingling
Hot sensation
105
Who is contraindicated to take Triptans?
Someone with vascular conditions, HTN, and CVD
106
Tripten vs. Ergotamine
Can't be taken together because it causes too much constriction
107
This type of medication is used to treat migraines. It causes constriction by affecting vascular smooth muscle.
Ergotamine
108
What are 4 treatments that are used prophylactically for migraines?
Antihypertensives
Anticonvulsants
Antidepressants
Botox
109
With topamax it is recommended to increase fluids. Why?
It increases the risk of kidney stones
110
When taking anticonvulsants what is important about treatment?
Do not abruptly discontinue treatment. Can trigger rebound seizure activity.
111
A rare form of headache that occurs usually in males age 20-40 years old and tends to precede over the eye.
Cluster headaches
112
What is the thought cause of cluster headaches?
Hypothalamic dysfunction
113
What are the signs and symptoms of a cluster migraine?
Extremely severe
Unilateral burning or stabbing pain
Lasts 45 minutes
1-8 times a day
114
What is unique about cluster headaches?
They come back at the same time of year and season
115
What symptoms are present on the affected side of the cluster headache?
```
Ipsilateral tearing
Rhinorrhea (nasal congestion)
Facial flushing/pallor
Miosis (constricted pupil-one sided)
Periorbital edema
```
116
What are some triggers of cluster headaches?
```
ETOH
Smoke
Strong odors
Vasodilators
Napping
```
117
What treatment is used prophylactically for cluster headaches?
Migraine medications
118
What is abortive treatment for cluster headaches?
Oxygen 100% by face mask
6-8L for 10 minutes AND
Triptans
119
Two different types of surgery that can be performed for cluster headaches?
Ablation with percutaneous radio frequency
| Deep brain stimulation to the hypothalamus
120
Paroxysmal uncontrolled electrical discharge of neurons; interrupts normal function caused by abnormal motor and sensory autonomic activity.
Seizures
121
Tumors may be a symptom of a disease. What is the primary reason for seizures.
Tumor
122
Seizures may also spontaneously. What is the percentage of cases not related to a source?
75%
123
A chronic condition of abnormal spontaneous depolarization or uncontrolled electrical discharge affecting 3 million people.
Epilepsy
124
Is believed to start at the foci and is thought to be involved with gliosis or Astrocyte involvement.
Epilepsy
125
Males, Alzheimer's/stroke, AA, family history and socially disadvantaged are all what?
Risk factors
126
20-30 years of age diagnosed with a seizure is usually related to
Tumor or trauma
127
A diagnosis of seizure often due to a noxic event or inadequate oxygen is found in who?
Infants
128
Seizures diagnosed in patients over the age of 50 are usually caused by
Stroke or tumor
129
EEG is
Not a definitive test for seizures
130
How is a seizure diagnosed?
CT scan
MRI
Cerebral angiography
MRA
131
What test can look for seizures but only indicates abnormalities predisposing of seizures?
Serum labs
132
Behavioral changes that precede the seizure
1st phase: Prodromal phase
133
Sensory warning (smell, sound, heard)
2nd phase: aural phase
134
During the seizure
3rd phase - ictal phase
135
After the seizure
4th phase - post ictal phase
136
Tingling or cheek biting, incontinence, excessive salivation and cyanosis are symptoms of what seizure?
Grand mal
137
During what phase will a patient sleep for hours with no memory and soreness?
Post ictal
138
In general seizures what part of the brain is involved?
Entire brain
139
What is the most common type of seizure and results in loss of consciousness?
Tonic-clonic
140
Medical term for stiffness during a seizure
Tonic
141
Medical term for jerking during a seizure
Clonic
142
How long does jerking last?
2-5 minutes
143
Medical management is based on stabilizing the nerve cell membrane by what?
Administering anti-seizure medications
144
What medication still needs to be monitored by blood serum labs?
Dilantin
145
What is important about anti-seizure meds?
Start with a low dose and if inadequate add more. Give minimal dose necessary.
146
What meds have numerous side effects?
Anti-epileptic drugs
147
What patient teaching is pertinent to the medication regime?
Take med at the same time everyday and do not abruptly discontinue.
148
Removing the epileptic focus to prevent the spread of abnormal firing. Must meet 3 criteria points:
Confirm diagnosis
Failed drug trial
Identify type of seizure
Surgical intervention
149
A device that can be used to stop abnormal firing and is attached around the nerve with a battery and the electrode has varied strength and frequencies.
Vagal nerve stimulation
150
A specific diet that has extremely low carbs and alters brain metabolism and prevent seizures is called
Ketogenic diet
151
The state of continuous seizures and is 2x more of risk for death
Status epilepticus
152
Status epilepticus is considered
A medical emergency and can cause brain damage
153
What is the two priority treatments for emergency complications of seizures?
IV access
| Airway
154
When a patient is at risk for aspiration what does the nursing care include during a seizure?
Turn the head to the side to prevent swallowing the tongue and aspirating saliva contents.
155
This type of seizure is unilateral due to local focal abnormality
Partial seizure
156
This type of seizure is bilateral
Generalized seizure
157
A partial seizure does NOT precede a loss of
Consciousness
158
A generalized seizure DOES precede
Complete loss or alteration of consciousness
159
This type of seizure manifests as intact consciousness, they tend to last less than a minute, will be one sided, and el have motor, sensory, and autonomic manifestations.
Simple partial seizure
160
This seizure will manifest as altered consciousness with confusion or clouding, last longer than a minute, behavior changes, emotional changes, altered memory, and repetitive movement.
Complex partial seizures
161
The medical term for repetitive movement
Automateisms
162
What seizure usually involves the temporal lobe
Complex partial seizures
163
The confused state is called
Post ictal
164
Atypical absence associated with staring spells and peculiar behavior and post ictal confusion
Absence seizures
165
What is the worst seizure?
Tonic-Clonic seizure
166
This type of seizure can last seconds an is associated with forceful jerking and tends to occur in clusters
Myoclonic seizures
167
This type of seizure is associated with stiffness abruptly with possible loss of consciousness
Tonic seizure
168
This seizure is classified as abrupt jerking occurs with muscle flaccidity; seen on childhood and usually resolves or progresses to another type of seizure
Clonic seizure
169
A seizure classified as a "drop attack" with sudden flaccidity and regains consciousness by the time they hit the floor. High risk for injury.
Atonic seizures
170
Partial seizures usually progress to
Generalized seizures
