Nurb test 3: chronic neuro Flashcards by katie boone

cause is not from an illness or another condition Ex: cluster, tension, migraine

primary headache

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most common type of pain experienced
can have more than one type
history will help a lot in determining which or what kind they are experiencing

Headaches

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caused by another illness or infection Ex: sinus infection, neck injury, or a stroke

secondary headache

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-four most common types of headache

tension, cluster, sinus, and migraine

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lateral location, tightening or pressing quality, mild or moderate, not worsened with physical activity

Tension HA

1a. Characterized by:

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episodic or chronic, come and go or be there a long time, can last 30 min up to 7 days, can occur intermittently for weeks months or even a year
-caused by neurovascular factors very similar to migraines

1b. Duration:

tension ha

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sensitivity to light or sound, stiff neck

1c. Clinical Manifestations:

tension ha

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(emg) electromyography= shows the contraction of neck, scalp, and facial muscles

1d. Diagnostic Testing:

tension ha

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reoccurring, unilateral, can be bilateral sometimes, described as a throbbing pain
- Usually caused by a triggering event Ex: certain type of food or hormone levels
Age for onset-years old ___

Migraine HA
2a. Defined by:
20-30

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very strong family history, low socioeconomic status, and increase workload

risk factors

migraine ha

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(early signs and symptoms before the headache) = sensitivity to light, irritability, possibly food cravings,

Clinical Manifestations:
A. protodon
migraine ha

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= immediate precedes headache= patchy blindness, hearing sounds

sx
ora
migraine ha

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generalized edema, become very pallor, n/v = common

sx C. With headache:

migraine ha

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70% have a first degree relative that has as well
can be associated with seizures, asthma, turrets, and anxiety
2c. Duration: hours , improvement with sleep

migraine ha

4-72

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Really rare less than .1 percent of pop
Repeated headache that can last weeks to months that is followed by periods of remission
Attacks occur in clusters can last 2-3 weeks
Happens typically same time of day or same time (season) of year
Cause is unknown

Cluster HA

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sharp stabbing pain, usually around the eye, can radiate to temple forehead, cheeks, nose, and gums
-can even have swelling around your eyes
During an attack you get restless and agitated

3a. Characterized by:

cluster ha

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3c. Triggers: alcohol, strong odors, napping

cluster ha

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–sudden and happen at night, not a lot of drug therapy useful

Collaborative Care Cluster

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vasoconstrictor, 100 percent at 6-8 liters for 10 minutes also increases serotonin synthesis

Oxygen-

symptomatic tx cluster a

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chronic progressive degenerative disorder of the central nervous system
- demyelination of the nerve fibers of brain and spinal cord, messes up flow of information between the brain and the body
Autoimmune disease

Multiple Sclerosis-

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Characterized by: Chronic inflammation, Demyelination, Gliosis (scarring)

multiple sclerosis

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Onset: __year olds
Risk factors: women, climate between 45-65 degrees= us, Canada, and Europe
Cause is unknown

multiple sclerosis

20-50

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Susceptibility is inherited
Precipitating Factors: controversial may not be a cause and effect relationship
- possible precipitating factors= physical injury, stress, infection, fatigue, pregnancy, and poor state of health

multiple sclerosis

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Trigger (virus) then Lymphocytes (T cells) to central nervous system, inflammation starts, then Demyelination, n then Plaque formation.
Then Glial scar tissue, Destruction of nerve axons, Impulses blocked, Permanent loss of function

MS Pathophysiology

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- gradual onset with vague symptoms -occurs intermittently over months to years - progressive deterioration in neurological function from demyelination signs and sx different form person to person, makes it even more difficult Ex: some could have severe at first and others could be mild for years

Clinical Manifestations: Multiple Sclerosis

- motor: weakness and paralysis - sensory: numbness, blurred vision, - cerebral: dysphasia, ataxia - fatigue - depression - bowl and bladder function

sx multiple sclerosis

no definitive test, based on pt history*, as well as Sx and signs, presence of multiple lesions or plaques in brain -csf= shows increase immunoglobulin g and increase in lymphocytes = rushing to help

Dx MS:

A. Educate on triggers or causes that worsen the disease B. Prevent complications from immobility even bed rest C. Resistance building- avoid fatigue, extreme hot cold D. Bladder/bowel function- self cath maybe, bowl constipation to increase fiber

Nursing Implementation: MS

chronic progressive neurodegenerative disorder char by: slowness of movement, rigidity, trimmers at rest, gate disturbance - dev gradually -dx increases with age, strong familial link

Parkinson’s Disease-

-Degeneration of neurons that produce dopamine in the mid brain, bc neurons are dying the affects dopamine needed for function of extrapyramidal motor system=which control your movements

Pathophysiology PD

- don’t start till 80 percent of neurons are gone, by time your are having symptom it progressed - Gradual onset and prolonged course - can start with one side of the body classic signs is the triad

Sx PD

- first sign, more promoinate at rest, aggravated by stress - second sign, jerky quality to movements - slowness in movement: stoop posture, drooling, shuffling

Parkinson’s Disease: Clinical Manifestations of Triad of symptoms tremor rigidity bradykinesia

Triad: trimmer, rigidity, and bradykinesia

Classic Signs: parkinson

shuffle, posture issues=stoop over | -Pulpsaive gate- stooped, head is pointed down and out, very stiff

Later Stages: | parkinsons

little or no facial expression, arm may not swing with walk

Beginning Stages: | Parkinson

first used, monitor for signs of dyskinesia/ very common drug used - : med brain converts to dopamine - : what makes sure dopamine reaches brain before broke down

Levodopa+carbidopa = (Sinemet)= - Levodopa - carbidopa Antiparkinsonian/Dopaminergics

Promote physical exercise- help body to prevent muscle atrophy Well balanced diet- prevent malnutrition and constipation Dysphasia and Bradykinesa- soft food easy to chew Encourage independence- as much as possible, alter enviro to needs Ex: shoes that slip on, velcro, no buttons hard for them, elevated toilet seat - anything that makes life easier to do on own Medication regimen -Assess for improvement or lack of -Levadopa assess for freezing= overdose

Parkinson’s Disease: Nursing Mgt

autoimmune disease of the neuromuscular junction - char by weakness of certain musculoskeletal groups - commonly occurs between ages __years old - women peak age is child bearing years

Myasthenia Gravis- | 10-75

- Antibodies attack acetylcholine receptors which decrease the receptor sites and prevents muscle from contracting which can lead to muscle weakness

Patho MG

primary = fluctuating weakness in skeletal muscles (strength can come back after period of rest and gone again, comes and goes) - muscles involved those that make moving your eyes possible, eye lids, chewing, swallowing, speaking, and breathing - Muscles strongest in morning progressively weaker throughout the day - Exacerbations can be caused by stress, pregnancy, temperature extremes, trauma, other illnesses - Exacerbation can lead to a myasthenic crisis: acute exacerbation

Clinical Manifestations MG

- hx of patient 1. EMG- shows decreased response to stimulation=muscle fatigue 2. - improvement in contractility after injection of stuff= anticholinesterase - useful to dx cholinergic crisis= overdose of anticholinesterase drugs

Myasthenia Gravis Diagnostic Studies 1. emg 2. tensilon test

- rare progressive neurologic disorder char by loss of motor neurons - death 2-6 years after diagnosed, some can live 10 years - more common in men onset 40-70 years old unknown why brainstem and spinal cord generate, dead motor neurons can’t transmit to muscle you then have wasted muscle AKA: Lou Gehrig’s Disease

Amyotrophic Lateral Sclerosis (ALS)

Muscle wasting, Drooling, Depression, Foot drop, Weakness in legs, Hand weakness, Slurring speech, Difficulty swallowing, Fatigue * Death usually is a result of resp infection - Important to know cognitive function is perfectly fine, but body is just wasting away

ALS: Clinical Manifestations

Facilitate communication-computer assisted communication device, hard to talk when whole body won’t do anything Reduce risk of aspiration- difficulty swallowing Comfort- treat pain Safety-assess risk for fall, do some altered enviro Support- bc they can still function cognitively, try to find ways to help them communicate= can be frustrating -emotionally Exercises important to prevent spasticity Pay attention to resp issues identify asap

Nursing Mgt ALS

cranial nerve disorder - very sudden - typically unilateral - severe stabbing recurrent pain - most commonly dx neuralgic condition - more common in women - 5th cranial nerve, three branches does motor and sensory,only focus on sensory - affects mandibular and axillary not ophthalmic

Trigeminal Neuralgia-

not fully understood, studies : blood vessels become compressed and leads to irrigating the nerve, keeps firing off sensory fibers Risk factors- multiple sclerosis, hypertension

Patho TN :

feature is abrupt onset of pain in lips, gum, forehead, side of nose, cheek Reoccurrences are very unpredictable -can last seconds to a few minutes Sx: Pain, Twitching, Decreased facial sensation, Grimacing, frequent blinking or tearing with attacks

Clinical Manifestations TN | Classic:

stimulation at trigger site | Chewing, Tooth brushing, Hot/cold, Yawning, Talking

Triggers TN

Outpatient, assess for triggers, Comfort, response to drug therapy Education: nutrition, oral hygiene -Environmental management, Decrease stimuli, prevent acute attacks Oral hygiene- decreased stimulation= soft tooth brush, chew soft food Nutrient: luke warm foods, not hot or cold extreme food Communication

Trigeminal Neuralgia: Nursing Mgt

- acute peripheral facial paralysis - inflammation of cranial nerve 7 on one side of the face - affects ___ year olds - Disruption of CN VII on one side of face - Unknown cause, herpes simplex virus may be related because it cause inflammation, demyelination, - Can recover fully in 6 months

. Bell’s Palsy 20-60

- Onset comes with an outbreak of herpes in and around the ear - often have Fever - Tinitis - drooping mouth on one side

Bell’s Palsy: Clinical Manifestations

relief of sx and prevent complication | - protect eye on the affected side

Collaborative Care BP-

Moist heat, Gentle massage, Prescribed exercises, Electrical stimulation, Protective measures

Conservative Therapy BP

Early recognition is key*, outpatient Comfort- mild analgesic for pain Protect from drafts- don’t want cold air hot wet packs for lesions helps promote circulation and decrease pain Promote adequate nutrition- chew on unaffected side Eye protection- artificial tears, wear dark sunglasses Support- reassure it won’t last, will make a full recovery

Bell’s Palsy: Nursing Mgt

- acute rapidly progressing and potentially fatal form of polyneuritis char= by ascending symmetric paralysis - affecting cranial nerves and peripheral nervous system - complete recovery 85-95% cause- unknown

Guillain-Barre Syndrome

Loss of myelin causing loss of nerve transmission

patho guillain- barre syndrome

Preceded by: Viral infection, Viral immunizations, Trauma, Surgery, HIV

guillain-barre syndrome

1-3 weeks after an upper respiratory or Gi infections Weakness of lower extremities peaks about day 14 distal muscles have numbness and tingling followed by paralysis *Most dangerous autonomic nervous system dysfunction= Orthostatic Hypotension Pain- most worse at night *Most serious complication difficult breathing which could lead to respiratory failure

Guillain-Barre Syndrome: Clinical Manifestations

- based on history and sx 1. and 2. -show abnormal 3. - show increase in protein but not till after 7-10 days

Guillain-Barre Syndrome Diagnostics 1. emg 2. nerve conduction 3. csf

- supportive care - IV, can be just as effective as plasma exchange, immediately available, increases safety , better option, *but pt has to be hydrated and have to have good renal function

Guillain-Barre Syndrome Collaborative Care 1. Immunoglobulin (Sandoglobulin)

- 1st two weeks, decrease hospital stay, decrease time on vent, and decrease recovery time

Guillain-Barre Syndrome Collaborative Care | 2. Plasmapheresis

Respiratory support Encourage nutrition- may have difficulty swallowing= upright position* don’t want to aspiration Communication- dwindles as syndrome progresses, think of other ways Urinary retention -very common for a few days, I and O cath preferred to decrease chances of uti Goal= full recovery Support and encouragement for the pt and the family

Guillain-Barre Syndrome: Nursing Mgt

Nurb test 3: chronic neuro Flashcards

(62 cards)