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Term 5: MS lll > Neuro > Flashcards

Neuro Flashcards

(61 cards)

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1
Q

What are seizures?

A

Disorders that involve periodic disturbances in the brains electrical activity, resulting in some degree of temporary brain dysfunction.

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2
Q

Etiology of seizures

A
  • High fevers
  • Brain infections
  • Metabolic disorders - diabetes
  • Inadequate brain oxygenation
  • Structural damage
  • Fluid accumulation
  • Toxic drugs/substance
  • Withdrawal
  • Certain drugs
  • Heart problem
  • Sleep deprivation
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3
Q

Where do partial seizures take place in the brain?

A
  • Begin in 1 Part of brain

- Simple partial & complex partial

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4
Q

Generalized seizures

A

Involve electrical discharges in whole brain

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5
Q

Aura

A

Certain smell, taste before seizure

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6
Q

Types of generalized seizures

A
  • Tonic Clonic
  • Tonic
  • Clonic
  • Absence
  • Atonic (fall down)
  • Myoclonic (one muscle)
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7
Q

Tonic phase

A
  • Neuronal hyperexcitation
  • Loss of consciousness
  • Apnea
  • Dilated pupils
  • Duration = 15-60 seconds
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8
Q

Clonic Phase

A
  • Inhibitory neurons interrupt seizure discharge
  • Hyperventilation - irregular breathing
  • Rhythmic jerking of extremities
  • Duration = 60-90 seconds
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9
Q

Postictal

A
  • Deep sleep
  • Muscle soreness
  • Headache
  • Amnesia
  • Visual disturbances
  • Dysphagia
  • Aphasia
  • Duration = variable
  • Confusion
  • Soreness
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10
Q

Todd’s Paralysis

A

temporary motor deficit of arm or leg that can last up to 24 hours

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11
Q

Diagnosis of seizure

A

Two witnesses of seizure, EEG

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12
Q

EEG

A
  • Deprive pt of 18-24 hr of sleep than do EEG test

- Check electrolytes, blood sugar, anemia,kidney/liver function, the cause of low O2

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13
Q

How to prevent injury during seizure?

A
  • side/lying position
  • suction available (around mouth not in)
  • bed in lowest position
  • side rails up
  • padded

(Pt is at risk for injury)

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14
Q

Nurses role during seizure?

A
  • Time the seizure
  • Speak calmly
  • Don’t grab or hold
  • Explain to others
  • Block hazards
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15
Q

What is Epilepsy?

A

A condition in which a patient has spontaneous unprovoked recurring seizures caused by a chronic underlying condition

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16
Q

Etiology of Epilepsy

A

Attributes to a group of abn neurons (seizure focus) that undergo spontaneous firing- possibly due to scarring (gliosis)

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17
Q

Incidence rate of Epilepsy

A

New onset high in 1st year of life declining in childhood and teens, plateauing in middle age and sharp rise in elderly

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18
Q

Causes of Epilepsy

A
  • idiopathic - genetic/developmental defect

- acquired - hypoxemia

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19
Q

Medical management of Epilepsy

A
  • Individualized due to varied forms of the condition

- Management is aimed at prevention and management of seizures

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20
Q

Tests for epilepsy

A
  • EEG
  • CT
  • MRI
  • SPECT
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21
Q

Pharmaceutical therapy for Epilepsy

A
  • Control w/o side effects
  • Start with single med with increasing dose
  • Monitor levels
  • May need to switch if not working
  • When sick or with weight change/stress may need dose adjustment
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22
Q

Medication for Epilepsy

A
  • Dilantin (no ETOH, take on empty stomach)

- Gain or lose wt is sign of OD or UD of med

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23
Q

Nursing management of Epilepsy

A
  • Preventing Injury
  • Reducing fear
  • Improving coping
  • Monitoring and managing potential complications

PC Status Epilepticus, toxcity

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24
Q

Newly diagnosed pt of Epilepsy

A
  • Teach about aura
    • Keep seizure diary
    • Med compliance
    • Stress relief
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25
Sub therapeutic and toxic drug levels can cause:
-Breakthrough seizures -Adverse effects Lethargy Nystagmus Ataxia, dysarthria
26
Food and drug interactions
- Delayed absorption - Potentiated - Inactivated
27
Ataxia
Complete body weakness
28
Dysarthria
Slurred speech
29
Ketogenic Diet
-4:1 fats to protein and carbohydrates -May be useful in children -Difficulty with compliance In adults
30
Subdural grids
This figures out where the problem is on the brain
31
Vagal nerve stimulator
- for partial seizures | - stimulates brain
32
Series of generalized seizures (status epilepticus)
-Clinical/electrical > 30 minutes -Medical emergency -Heavy metabolic load -Respiration interruption and even arrest at peak, producing hypoxia -Can lead to anoxia, cerebral edema, possible irreversible brain damage and death -Precipitating factors – drug withdrawal, fever, infection
33
Medical management of status epilepticus
-Stop seizures to promote adequate cerebral oxygenation -Airway, ET tube, O2 -Meds IV - lorazepam, dilantin,barbiturates -Monitored EEG,VS, labs to include lytes, glucose, med levels
34
Nursing management of status epilepticus
- Monitor respiratory and cardiac function - Prevent injury to patient and self - Suction/positioning
35
What is Parkinson's Disease?
Slow progressive disabling neurologic moving disorder with gradual onset
36
parkinsons s/s
powerpoint
37
Parkinson’s etiology
- Mostly men in 50’s - s/s increase with stress/fatigue - Runs in family but not genetic - Exposure to toxins - “Slow grower” - Body attacking nervous system
38
Parkinson’s Diagnosis
-Based on S/S •aging can cause some of the same symptoms -Give significant dose of carbidopa-levodopa •If improved then positive for Parkinsons •CT & MRI can be done to rule out any structural disorders -PET scan to evaluate levodopa uptake and conversion
39
Medical management of Parkinson’s
- No cure - Controlling symptoms and keep function is goal - Care individualized - S/S of meds: - Surgery
40
Reason for Parkinson’s medication?
- Pt is lacking in dopamine and it needs to be replaced | - Take medication 30min-1hr prior to eating
41
Nursing role for Parkinson’s
To enhance: - Mobility - Maintain self care independence - Adequate bowel elim - Maintaining nutrition - Effective communication - Develop positive coping - Have pt walk wide - Increase fiber in diet (they may not be too hungry) - Have hard time swallowing, sense of smell down (cause of decreased appetite) - Need high calorie, stuff they like (flavorful), 6 meals/day - Massage, acupuncture, music, - Goal:pt does own ADL - Pt will talk quietly (may need clipboard to write)
42
What is a Parkinson’s pt is at risk for?
- Aspiration | - Falls
43
First sign of multiple sclerosis (MS)?
-Eye sight gets worse
44
What can flareups of MS be triggered by?
Flu
45
Patterns of MS
- Relapsing remitting clearly defined flare-ups - Primary progressive –gradual decline - Secondary progressive – second step of relapsing remitting - Progressive relapsing – primary progressive with sudden worsening
46
Risk factors of MS
- Mostly in woman 20-40 | - Having one autoimmune disease puts you at risk for another one
47
Clinical manifestations of MS
- Numbness/weakness in limbs usually one side or bottom half of body - Loss of vision partial or complete - Double vision/blurring - Tingling or pain in parts of body - Electric shock sensation that occurs with certain head movements - Fatigue (ataxia) - Dizziness - Musc stiffness and spasticity - Slurred speech, dydphagia - Paralysis problems with elimination and sexual function - Mental changes - Abn reflexes - Seizures - Depression - Personality labile (up and down)
48
Individualized diagnostics of MS
- Pulmonary function - Spinal tap (increased WBC and protein) - MRI - Electrical studies
49
Goal of MS
-ADLs without fatigue | Doesn’t get better- degenerative
50
Medications for MS
- Virus fighters - Immune suppressors/steroids - Muscle relaxants - Drugs to decrease relapse - Pain meds - Meds to rectify sexual, bowel, and bladder problems
51
Specific medications for MS
-Refer to recording
52
MS and temperature
- You don’t want hem to get too hot - Need to stay cool, use air conditioner - Avoid extreme temps
53
Nursing role for MS patient
- Encourage rest, exercise, heat avoidance and a well-balanced diet - Enhance bladder/bowel control, sexual function - Improve cognitive and sensory function - Promote self-care
54
Weight management in MS
- Do not want pt to gain wt - High carbs, low fat, low gluten - Relaxing exercises (no hardcore gym exercises) (Push fluids & oral marijuana)
55
What is Myasthenia Gravis?
- A breakdown in the normal communication between muscles and nerves - Results in muscular weakness
56
Causes of Myasthenia Gravis?
- Blockage and/or destruction of the receptor site for the Ach pathway - Thymus tumor (can remove) - A different antibody causing a different autoimmune problem - Can be genetic
57
Triggers of Myasthenia Gravis?
- Fatigue - Stress - Meds
58
Clinical manifestations of myasthenia gravis
- Muscle weakness escalating with continued use – strongest in AM - Initially ocular – ptosis, double vision - Facial and throat weakness - Expression impaired - Speech impaired and voice fades - Chewing and swallowing impaired - Neck, shoulders & hips affected more than distal area - Generalized weakness to include respiratory - No effect on sensation or reflexes - 15% of pt face and throat - Tired all the time - Muscle weakness will work its way down body
59
Diagnosis tests for Myasthenia gravis
- Routine PE - Tensilon test - administer to see increased strength (eyeballs open wide) - Blood testing for antibodies - Ice bag – to open eyes - Nerve testing - Scans for tumors - Pulmonary Function Tests
60
MG Crisis
- Acute exacerbation of the disease with weakness in the chest muscles - Patient will probable need ventilation - Blood filtering to get rid of some of the antibodies - Aspiration!! - All respiratory problems - Shallow big breaths
61
Self care with MG
- Frequent breaks in am care - When to take meds - PCS: respiratory, teach about recognition - Electric devices: jar opener, etc - May have double vision (eye patches) - Support groups: find out how pt can get support (More on pp slide 60)

Term 5: MS lll (3 decks)

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