Problems of the CNS: The Brain Flashcards
(77 cards)
1
Q
Risk factors for headaches
A
Alcohol Environmental allergies Medication Intense odors, bright lights Fatigue, sleep deprivation Depression Emotional/physical stress, anxiety Menstrual cycle, oral contraceptive use Foods (Tyramine, caffeine, MSG, nitrites, milk products)
2
Q
Multifaceted (vascular,genetic,neurologic, hormonal,environmental) headaches
A
migraines
3
Q
Symptoms of migraines
A
Intense pain, unilateral
Throbbing
Worsens with movement,
Photophobia or phonophobia
4
Q
Types of migraine headaches
A
aura, no aura, atypical
5
Q
Classic migraine
A
aura
6
Q
4-72 hours duration (common)
A
no aura
7
Q
Longer than 72 hours, unclassified
A
atypical
8
Q
3 R’s
A
Recognize migraine symptoms
Respond and health care provider
Relieve pain and associated symptoms
9
Q
Mild abortive therapy
A
Acetaminophen
NSAIDS (Ibuprofen, naproxen)
Migraine specific OTC formulations
Antiemetics
10
Q
Severe abortive therapy
A
Triptan preparations
Ergotamine preparations
Isometheptine combination
11
Q
Preventative therapy
A
NSAID Beta blocker (Propranolol, timolol) Calcium channel blocker (verapamil) Antiepileptic drugs (Topiramate) Avoid triggers
12
Q
Migraine trigger foods
A
chocolate, alcoholic beverages, aged cheese, caffeine, caffeine withdrawals, foods with yeast (bread/pastry), MSG, nitrates (meats), nuts, artificial sweeteners, smoked fish
13
Q
Migraine trigger drugs
A
cimetidine, estrogens, nitroglycerin, nifedipine
14
Q
Migraine trigger (other)
A
anger, fatigue, hormonal, light glare, missed meals, hypoglycemia, psychological stress, sleep problems, smells (tobacco), traveling at different altitudes
15
Q
Complementary & Alternative therapy
A
Yoga Meditation therapy Massage Exercise Biofeedback Accupuncture Herbal remedies (always review with provider first)
16
Q
Trigeminal autonomic cephalgia Brief, intense, unilateral pain Described as non-throbbing or “boring” 30 min to 2 hours Occurring daily for 4 to 12 weeks No warning
A
cluster headache
17
Q
Vasoreactivity & neurogenic inflammation
A
cluster headache
18
Q
Symptoms of cluster headaches
A
Tearing of eye with nasal congestion Facial sweating Drooping eyelid (ptosis) and eyelid edema Miosis Facial pallor Nausea & vomiting Pacing, walking, and rocking activities
19
Q
Treatment of cluster headaches
A
Triptans, ergotamine, anti epileptics, CCB, lithium, corticosteroids, melatonin, glucosamine
Oxygen therapy (100% for short period during HA, then d/c)
Consistent sleep-wake cycle
Review triggers such as bursts of anger, excessive physical activity
Deep brain stimulation or surgery as last resort
20
Q
Types of seizures
A
generalized, partial, unclassified, secondary
21
Q
Types of epilepsy
A
primary or idiopathic
22
Q
Generalized seizures
A
tonic-clonic, tonic, clonic, absence, myoclonic, atonic
23
Q
Both cerebral hemispheres 2 -5 minutes Loss of consciousness Incontinent Biting of tongue Post-ictal period with fatigue, lethargy, confusion
A
tonic-clonic
24
Q
Abrupt increase in muscle tone
LOC
A
tonic
25
Muscle contraction and relaxation
clonic
26
Brief jerking or stiffening of extremities
myoclonic
27
Sudden loss of muscle tone
atonic
28
Parietal seizures
local or focal
29
LOC 1-3 minutes
Automatisms (an action performed unconsciously or involuntarily) can occur
Amnesia post seizure
Also called psychomotor or temporal lobe seizures
More common in older adults
complex partial
30
```
Remains conscious
Aura may occur
One sided movement
Unusual sensations
Can have autonomic symptoms
```
simple partial
31
Seizure risks
```
Metabolic disorders
Acute alcohol withdrawal
Electrolyte disturbances
Heart disease
High fever
Stroke
Substance abuse
```
32
Seizure precautions
```
Oxygen
Suction equipment
Airway
IV access
Siderails up
No tongue blades
```
33
Seizure management
```
Depends on type of seizure
Patient safety
Observation and documentation
Side-lying position (recovery position)
No restraints
```
34
Acute seizure management
Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
35
Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency
status epilepticus
36
Status Epilepticus management
```
Establish airway
ABGs
IV push lorazepam, diazepam
Rectal diazepam
Loading dose IV phenytoin
```
37
Drug therapy of status epileptics
Evaluate most current blood level of medication, if appropriate
Be aware of drug-drug/drug-food interactions
Maintain therapeutic blood levels for maximal effectiveness
Do not administer warfarin with phenytoin (therapeutic level 10-20)
Document and report side/adverse effects
38
Education of status epileptics
Compliance with AEDs
Social service resources to assist with medication costs
Discrimination prohibited
Alternative employment may be needed
Vocational rehabilitation may be subsidized
39
Surgical management of status epileptics
Vagal nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Partial corpus callosotomy
40
inflammation of meninges
meningitis
41
Risk factors of meningitis
Viral (mumps, measles, herpes, West Nile)
Fungal (AIDS)
Bacterial (Otitis media, pneumonia, sinusitis, immunosuppression, invasive procedures,overcrowded living conditions, Streptococcus pneumoniae & Neisseria meningitidis, Haemophilus influenzae)
42
General symptoms of meningitis
fever
43
Neurological symptoms of meningitis
```
Headache
Photophobia
Indications of increased ICP
Nuchal rigidity
Positive Kernig’s, Brudzinski’s signs
Decreased mental status
Focal neurological deficits
```
44
GI symptoms of meningitis
Nausea and vomiting
45
Reflex contraction & pain in hamstring when extend leg after flexion at hip.
Kernig’s sign
46
Involuntary flexion of knee when neck flexed
Brudzinski’s sign
47
Laboratory Assessment of Meningitis
CSF analysis (elevated protein >25, WBC, CSF pressure >200 or >15, decreased glucose
48
Nursing care of meningitis
```
Bacterial (isolation: droplet precautions)
Fever reduction
Dark, quiet environment
Bedrest, HOB elevated
Seizure precautions
Neuro checks q 2-4 hours
Cranial nerves III, IV, VI, VII, VIII
```
49
Drug therapy of meningitis
Broad-spectrum antibiotic
Fever-reducing agents (acetaminophen, ibuprofen)
Hyperosmolar agents
Anticonvulsants
Phenytoin
Steroids (controversial)
Prophylaxis treatment for those in close contact with meningitis-infected patient
50
Inflammation of brain tissue
Cerebrum, brain stem, cerebellum
No exudate formation
Degeneration of neurons, demyelination of axons
Encephalitis
51
Causes of encephalitis
Arboviruses spread by infected mosquitoes or ticks
Enteroviruses such as herpes zoster
Amebic meningoencephalitis
52
Symptoms of encephalitis
```
High fever
Changes in mental status
Motor dysfunction
Focal neuro deficits
Photophobia
Fatigue
Joint pain
Headache
Signs of increased ICP
```
53
How to diagnose encephalitis
Lumbar puncture (PCR)
EEG
CT scan
54
Preventative measures for encephalitis
protection from mosquitoes
55
Nursing care of encephalitis
similar to meningitis
56
Treatment of encephalitis
supportive and acyclovir if it is herpes
57
What can result from herpes simplex encephalitis
hemorrhagic necrosis
58
Degeneration of the substantia nigra results on decreased production of dopamine
Overstimulation of the basal ganglia by acetylcholine
Parkinson disease
59
Risk factor of Parkinson disease
```
Age 40 to 70
Gender: men
Genetic predisposition
Exposure to environmental toxins
Chronic use of antipsychotic medication
```
60
Symptoms of Parkinson disease
```
Tremor
Muscle rigidity
Bradykinesia
Postural instability
Mask like facial expression
Shuffling gait
Reduced arm swinging
```
61
Physical assessment of Parkinson disease
Autonomic dysfunction (orthostatic hypotension, Flushing)
Emotionally labile
Depressed, paranoid
62
Drug therapy of Parkinson disease
```
Dopamine agonists (levodopa)
Anticholinergics
Catechol O-methyltransferase inhibitors
Most effective in the first 3 to 5 years of use
Therapeutic levels
Drug toxicity interventions
Drug holiday
```
63
Nursing care of Parkinson disease
Mobility
Nutrition
Psychological
Speech therapy
64
Chronic progressive
Structural changes in brain
(Neuritic plaques, granulovascular degeneration,
Neurofibrillary tangles)
Alzheimer’s Disease
65
Stages of Alzheimer's disease
Early or Mild
Middle or Moderate
Late or Severe
66
Risk factors of Alzheimer's disease
```
Gender
Family history
African Americans more than Euro-Americans
Environmental agents
(Viruses, Toxic metals)
Head trauma
Age
```
67
Health promotion of Alzheimer's disease
Walking, swimming, exercise
Balanced diet (Dark colored fruits & vegetables
Folate, vitamins B12, C and E)
68
Symptoms of Alzheimer's disease
Gradual memory loss, short term first
Changes in behavior & personality
Eventual language, motor skills lost
69
Diagnostic testing of Alzheimer's disease
MMSE (Orientation, registration, attention & calculation, recall, speech-language)
CT scan, Lab studies, EEG
70
Priority care of Alzheimer's disease
```
Interventions and support (patient and caregiver)
Cognitive stimulation and memory training
Structuring the environment
Orientation and validation therapy
Promoting self-management
Promoting bowel and bladder continence
Promoting communication
Traumatic relocation syndrome
```
71
Medication therapy of Alzheimer's disease
```
Cholinesterase inhibitors
(Donepezil (Aricept); galantamine (Reminyl)
N-methyl-D-aspartate receptor antagonist
(Memantine (Namenda)
Antidepressants
(SSRIs)
```
72
Hereditary disorder
Autosomal dominant
Decrease in the GABA (inhibitory transmitter in the basal ganglia
Increase in glutamate
Huntington Disease
73
When does Huntington disease begins
30 to 50 years
74
Stages of Huntington disease
Stage 1: onset
Stage 2: increasing dependence on others
Stage 3: loss of independent function
75
Physical assessment of Huntington disease
```
Progressive mental status changes
Choreiform movements (brisk, jerky, purposeless movements)
```
76
Drug therapy for Huntington disease
tetrabenazine
77
Teaching for Huntington disease
include psychosocial support resources
