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Flashcards in Neuro Deck (156)
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1

Headache

Priority is to determine underlying cause of headache prior to treatment
Thorough history and physical
*Distinguish what causes it; is there an aura?

2

Headache: Nursing Assessment

Health History
Seizures, cancer, stroke, trauma, asthma or allergies, mental illness, stress, menstruation (where are they in their menstruation/pregnancy?), exercise, food (nuts, chocolates, wines, MSG), bright lights (low light: not enough lighting; eyes could be straining), noxious stimuli
Medications (What are they using?)
Surgery and other treatments (cranial/facial could be manifestation)

3

Headache: Nursing Assessment

Objective Data
Anxiety or apprehension
Diaphoresis, pallor, unilateral flushing with cheek edema, conjunctivitis
*Migraines can often mean something more severe

4

Migraine Headache

Recurring
Characterized by unilateral or bilateral throbbing pain
Triggering event or factor
Family history

5

Migraine Headache: Drug Therapy

Goal is to terminate or decrease symptoms
Mild to moderate headache can obtain relief with aspirin or acetaminophen
One in progress may need narcotics (narcotics can cause onset; stopping treatment can result in withdrawal)
Antiemetics

6

Migraine Headache: Drug THerapy

Serotonin receptor agonists
Alpha- and beta-adrenergic blockers
Tricyclic antidepressants
Calcium channel blockers (common)
Antiseizure drugs

7

Migraine Headache: Drug Therapy

Propanolol (prevents dilation of cerebral blood vessels)
Verapamil (controls cerebral vasospams)
Amitriptyline (blocks uptake of serotonin and catecholamines)
Methysergide maleate (dec. serotonin action)
Ergomar or Cafergot (helps to dec. severity; Can be given by supp.)
Imitrex and Zomig (act rapidly to stop migraine; Self-injection)

8

Tension-Type Headache: Drug Therapy

Non-narcotic analgesic used alone or in combination with a sedative, muscle relaxant, tranquilizer, or codeine
*Tylenol, Ibuprofen. Combine with muscle relaxant. Heat and cold therapy may help

9

Cluster Headache: Treatment

Similar meds as migraines may control these
Oxygen (10-20 min. continuous flow)
Ergotamine tartrate give HS rectally)
*Look at changing the triggers - Fall (season) and alcohol intake

10

Tension-Type Headache: Diagnostic Studies

Careful history taking
Electromyography may be performed (may reveal sustained contraction of neck, scalp, or facial muscles)

11

Tension Headache: Drug Therapy

Nonnarcotic analgesics (Aspirin/ Tylenol)
Elavil may be given at bedtime

12

Cluster Headavhe: Diagnostic Studies

Primarily history
CT, MRI, or MRA may be performed to rule out aneurysm, tumor, or infection

13

Cluster Headache: Drug Therapy

Alpha-adrenergic blockers
Vasoconstrictors
Acute treatment is inhalation of 100% oxygen delivered at a rate of 7-9L/min for 15-20 minutes

14

Headache

Can be first symptom of a more serious illness
Can accompany subarachnoid hemorrhage; brain tumours; other intracranial masses; arteritis; vascular abnormalities; trigeminal neuralgia; diseases of the eyes, nose, and teeth; and systemic illness

15

Headache: Collaborative Care

If no systemic underlying disease is found, therapy is directed toward functional type of headache
Includes drugs, medication, yoga, biofeedback, cognitive-behavioural therapy, and relaxation training

16

Headache: Nursing Diagnoses

Acute pain
Anxiety
Hoplessness

17

Headache: Planning

Have reduced or no pain
Experience increased comfort and decreased anxiety
Demonstrate understanding of triggering events and treatment strategies
Use positive coping strategies to deal with chronic pain
Experience increased quality of life

18

Headache: Nursing Implementation

Daily exercise, relaxation periods, and socializing help decrease recurrence and should be encouraged
Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis
Help client examine lifestyle, recognize stressful situations, and learn to cope with them more appropriately

19

Headache: Nursing Iplementation

Massage and heat packs can help with tension-type
Client should make a written note to prevent accidental overdose
Teach client about prophylactic treatment
Dietary counselling for food triggers
Avoid smoking and smoke exposure and other environmental triggers

20

Meningitis

Inflammation of the meninges: brain and spinal cord
Bacterial: 100 cases a year in Canada - 21% due to pneumococcal
Viral: Less severe, shorter course

21

Meningitis: Clinical Manifestations (Assessment)

Nuchal rigidity
Positive Kernig's sign
Positive Brudzinski's sign
Photophobia
Seizures & Increased ICP
Rash

22

Meningitis: Management

Diagnosis: Lumbar puncture culture CSF & blood
Pharmacological Treatment: Antibiotics that cross blood brain barrier (BBB); Dexamethasone (corticosteroid)

23

Meningococcemia

Spread airborne droplets
Highly contagious
Death can occur 10-12 hours after fever and petechial rash
Due to overwhelming septicaemia, vascular collapse and adrenal hemorrhage

24

Public Health Issues

Since highly contagious individuals exposed are placed on prophylactic antibiotics
Rifampin and ciprofloxacin
Must be reported to health dept.
Preventative vaccination program

25

Meningitis: Treatment

Viral: Focuses on relieving symptoms. Antipyretics and analgesics. No need for isolation
Bacterial: Rapid diagnosis. Antibiotic therapy immediately; IV penicillin, cephalosporins, more specific with C&S- high doses to cross BBB. Airborne isolation precautions

26

Encephalitis: Treatment

Antiviral medications (Vudarabine and acyclovir)
No need for isolation as not transmitted from person to person

27

Brain Abscess

Treatment focuses on prompt antibiotic therapy
Treatment of symptoms
Surgical interventions (when antibiotics not effective): Drainage of abscess, craniotomy to remove encapsulated abscess

28

Brain Infections: Nursing Care

Assessment:
VS/LOC
Changes in vision/hearing
Brudzinski's and Kernig's signs
Seizures/restlessness or agitation
Petechial rash
Exposure to mosquitoes or ticks
Hx of head injury, brain surgery, otitis media or bacterial endocarditis

29

Brain Infections: Nursing Care

Diagnoses: Risk for Ineffective Tissue Persion: Cerebral; Hyperthermia; Acute pain
Evaluation: Afebrile; Absence of headache/ signs of IICP; Knowledge of anti-infective therapy

30

Relief of other symptoms

Anticonvulsants
Antipyretics
Analgesics
Osmotic diuretics
Corticosteroids
Antiemetics
IV fluids