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Flashcards in T3 - Probs of CNS (Brain) (Josh) Deck (64):
1

Risk factors for Headaches

ETOH

Environmental allergies

Meds

Intense odors / bright lights

Fatigue / Sleep Depr.

Depression

Emotional/Physical Stress; Anxiety

Menstrual Cycle; Oral Contraceptive use

Foods

2

Which foods increase risk for headaches?

Tyramine
- aged cheese, meats, etc

Caffiene

MSG

Nitrites

Milk products

3

Describe the characteristics of a Migraine Headache.

Intense, UNILATERAL pain

Worsens w/ mvmt

Photophobia or Phonophobia

4

What are the categories of a Migraine?

Aura (classic migraine)

No Aura (most common)

Atypical

5

What are the Phases of an Aura Migraine?

Prodrome

Aura

Termination

6

How long does a No Aura Migraine last?

How long does an Atypical Migraine last?

4-72 hrs

longer than 72 hrs

7

What are characteristics of a Cluster Headache?

Trigeminal Autonomic Cephalalgia

Brief, Intense, UNILATERAL pain

Non-throbbing or BORING pain

30 mins to 2 hrs in length

Occurs daily for 4-12 wks

No warning

8

What is the patho of a Cluster Headache?

vasoreactivity and neruogenic inflammation

9

Which headache?

- Tearing of eye w/ nasal congestion

- Facial sweating

Drooping eyelid (ptosis) and eyelid edema

- Miosis

- Facial pallor

- N/V

- Pacing, walking, and rocking activities

Cluster Headache

10

What meds for Abortive treatment for Migraine?

Mild
- Acetaminophen
- NSAIDs (ibuprofen; naproxen)
- Migraine specific OTC formulations
- Antiemetics

Severe
- Triptans
- Ergotamines
- Isometheptenes

11

Which meds for Preventive treatment for Migraine?

NSAIDs

Beta Blockers (propanolol; timolol)

CCBs (verapamil)

Antiepileptics (topiramate

Avoiding triggers

12

What non-pharmacological treatments for Migraines?

O2 Therapy (100% for short time)

Complimentary and Alternative Therapy (yoga, etc)

Consistent sleep/wake cycle

Review triggers such as bursts of anger or excessive physical activity

Deep brain stimulation or surgery as last resort

13

Triggers for Migraines.

Tyramine foods (pickles, caffeine, ETOH, aged cheese, artificial sweeteners, NUTS)

MSGs

Meds
- Ranitidine
- Estrogen
- Nitro
- Nifedipine

Anger

Lack of sleep/rest

14

Triggers for Cluster Headaches.

Anger outburst

Anxiety w/ prolonged anticipation

Excessive physical activity; fatigue

Altered sleep-wake cycles

15

What are the different types of Generalized Seizures?

Tonic-Clonic

Tonic

Clonic

Absence

Myoclonic

Atonic

16

Characteristics of a Tonic-Clonic Seizure.

Both cerebral hemispheres

2-5 mins

Loss of consciousness

Incontinent

Biting of Tongue

Post-ictal period with fatigue, lethargy, and confusion

17

What is the Tonic stage and what is the Clonic stage?

Tonic = abrupt increase in muscle tone with loss of consciousness

Clonic = muscle contraction and relaxation

18

Which seizure involves staring off in space (looks like day-dreaming) and happens in kids?

Absence

19

Which seizure involves brief jerking or stiffening of extremities?

Myoclonic

20

Which seizure involves a sudden loss of muscle tone?

Atonic

21

What are the two classifications of Partial Seizures?

Complex Partial

Simple Partial

22

Characteristics of a Complex Partial Seizure?

Loss of consciousness for 1-3 mins

Automatisms can occur

Amnesia post seizure

AKA: Psychomotor or Temporal Lobe Seizures

***more common in older adults

23

Characteristics of Simple Partial Seizure?

Remains CONSCIOUS throughout

Aura may occur

One sided mvmt in extremities

Unusual sensations (DEJA VU)

Can have autonomic symptoms

Pain or offensive smell

24

Risk factors for Seizures

Metabolic Disorders

Acute ETOH withdrawal

Electrolyte disturbances

Heart Disease

High Fever

Stroke

Substance Abuse

25

What are some meds we can give for an Acute Seizure?

Lorazepam (ativan)

Diazepam (valium)

Diastat

IV Phenytoin or Fophenytoin

26

Which med is the DOC for acute Seizure treatment?

Lorazepam (Ativan)

***can be given IV
***few s/e than Diazepam

27

What do we need to remember about Phenytoin?

don't administer w/ Warfarin

28

What is Status Epilepticus?

prolonged seizure (5-30 mins) or repeated seizures over course of 30 mins

29

What is emergency treatment for Status Epilepticus?

Establish Airway

ABGs

IV push of lorazepam (or diazepam)

Rectal diazepam

Loading dose of IV Phenytoin

30

Which type of Meningitis is most common?

Bacterial (due to overcrowded living conditions)

31

What are some risk factors for Viral Meningitis?

Mumps

Measles

Herpes

West Nile

32

What are some risk factors for Bacterial Meningitis?

Otitis Media; Pneumonia; Sinusitis

Immunosuppression

Invasive Procedures

Overcrowded living conditions

Step. pneumoniae; Neisseria meningitidis

Haemophilus influenzae

33

Fungal Meningitis is the least common type. Who is most at risk?

AIDS patient

34

S/S of Meningitis

Fever

Headache

Photophobia

Increased ICP

Nuchal ridigity

Positive Kernigs and Brudzinskis

Decreased Mental Status

Focal Neuro Deficits

N/V

35

What is Kernig's Sign?

Brudzinskis?

Kernigs = pain when leg extended and flexed at hip

Brudzinskis = involuntary flexion of knee when neck is flexed

36

Nursing Care for Meningitis

Isolation and Droplet precautions (w/ bacterial)

Fever reduction

Dark, quiet environment

Bedrest; HOB elevated

Seizure precautions

Neuro Checks q 2-4 hrs

37

When doing neuro checks for Meningitis, which Cranial Nerves are we focusing on?

III: Oculomotor

IV: Trochlear

VI: Abducens

VII: Facial

VIII: Vesibulocochlear

38

Medications for Meningitis

Broad spectrum antibiotic (bacterial)

Fever reducing agents (Acetaminophen; Ibuprofen)

Hyperosmolar Agents

Anticonvulsants (Phenytoin)

Steroids (CONTROVERSIAL)

Prophylaxis treatment for those in close contact w/ meningitis infected client

39

S/S of Encephalitis

High Fever

Changes in Mental Status

Motor Dysfunction

Focal neuro deficits

Photophobia

Fatigue

Joint Pain

Headache

Increased ICP

40

Encephalitis can be caused by ---

mosquitoes and ticks

***Caused by arbovirus spread by mosquitoes and ticks

41

If Encephalitis is caused by Herpes, what do you treat it with?

Acyclovir

42

Parkinson's is a degeneration in which area of the brain?

What does it result in?

substantia nigra

results in decreased production of DA

43

In Parkinson's, there is a decrease in --- and an increase in ---

DA

ACh

44

What are risk factors for Parkinson's Disease?

Age 40-70

Men

Genetic predisposition

Exposure to environmental toxins

Chronic use of antipsychotic meds

45

S/S of Parkinson's Disease

Tremor

Muscle Rigidity

Postural Instability

46

What will posture of Parkinson's patient look like?

Fwd tilt of trunk

Rigidity and trembling of head

Reduced arm swinging

Shuffling gait w/ short steps

47

What will the face of a Parkinson's client look like?

mask-like facial expression

48

Medications used to treat Parkinson's

DA agonists

Anticholinergics

Catechol O-methyltransferase Inhibitors

49

What should we remmber about Parkinson's Meds?

most effective first 3-5 years

Need drug holidays

50

What are the structural changes in brain associated with Alzheimers?

Neuritic Plaques

Granulovascular Degenerations

Neurofibrillary Tangles

51

Symptoms of Alzheimers

Gradual memory loss (short term first)

Behavior/Personality changes

Eventually lose language and motor skills

52

Medication classes for Alzheimers

Cholinisterase Inhibitors

NMDA Receptor Antagonists

SSRIs

53

What are the Cholinisterase Inhibitors used for Alzheimers?

Donepezil

Galatamine

54

What are the NMDA Receptor Antagonists used for Alzheimer's?

Memantine

***usually for late stages
***can be taken w/ one of the other classifications

55

Why do we take Cholinisterase Inhibitors with Alzheimer's?

prevent the breakdown of ACh, which increases the amount available for nerve impulses

56

Alzheimers:

Nursing Considerations for Donepezil (Cholinisterase Inhibitor)

Observe for frequent stools or upset stomach

Monitor for dizziness or headache

Use caution if they have COPD or Asthma

57

When does Huntington's Disease usually begin?

30-50 years old

58

What is the patho behind Huntington's?

decrease in GABA and increase in Glutamate

59

S/S of Huntington's

Progressive mental status change

Choreiform movements
***Brisk, jerky, purposeless mvmts

60

What medication for Huntington's

tetrabenazine

61

Which type of headache is familial?

Which type of headache can occur at same time every day?

Migraine

Cluster

62

Which medications can trigger migraines?

Ranitidine

Estrogen

Nitro

Nifedipine

63

What are the Autonomic Symptoms of Simple Partial Seizures?

Changes in HR and abnormal flushing

64

Meningitis:

Which type has CLEAR CSF and which type has CLOUDY CSF?

Clear = Viral

Cloudy = Bacterial