T3 - Probs of CNS (Brain) (Josh) Flashcards by Faiza Dang

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

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Which foods increase risk for headaches?

Tyramine
- aged cheese, meats, etc

Caffiene

MSG

Nitrites

Milk products

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Describe the characteristics of a Migraine Headache.

Intense, UNILATERAL pain

Worsens w/ mvmt

Photophobia or Phonophobia

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What are the categories of a Migraine?

Aura (classic migraine)

No Aura (most common)

Atypical

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What are the Phases of an Aura Migraine?

Prodrome

Aura

Termination

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How long does a No Aura Migraine last?

How long does an Atypical Migraine last?

4-72 hrs

longer than 72 hrs

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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

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What is the patho of a Cluster Headache?

vasoreactivity and neruogenic inflammation

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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

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What meds for Abortive treatment for Migraine?

Mild

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

Severe

Triptans
Ergotamines
Isometheptenes

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Which meds for Preventive treatment for Migraine?

NSAIDs

Beta Blockers (propanolol; timolol)

CCBs (verapamil)

Antiepileptics (topiramate

Avoiding triggers

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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

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Triggers for Migraines.

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

MSGs

Meds

Ranitidine
Estrogen
Nitro
Nifedipine

Anger

Lack of sleep/rest

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Triggers for Cluster Headaches.

Anger outburst

Anxiety w/ prolonged anticipation

Excessive physical activity; fatigue

Altered sleep-wake cycles

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What are the different types of Generalized Seizures?

Tonic-Clonic

Tonic

Clonic

Absence

Myoclonic

Atonic

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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

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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

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

Absence

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Which seizure involves brief jerking or stiffening of extremities?

Myoclonic

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Which seizure involves a sudden loss of muscle tone?

Atonic

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What are the two classifications of Partial Seizures?

Complex Partial

Simple Partial

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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

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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

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Risk factors for Seizures

Metabolic Disorders

Acute ETOH withdrawal

Electrolyte disturbances

Heart Disease

High Fever

Stroke

Substance Abuse

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

Lorazepam (ativan) Diazepam (valium) Diastat IV Phenytoin or Fophenytoin

Which med is the DOC for acute Seizure treatment?

Lorazepam (Ativan) * **can be given IV * **few s/e than Diazepam

What do we need to remember about Phenytoin?

don't administer w/ Warfarin

What is Status Epilepticus?

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

What is emergency treatment for Status Epilepticus?

Establish Airway ABGs IV push of lorazepam (or diazepam) Rectal diazepam Loading dose of IV Phenytoin

Which type of Meningitis is most common?

Bacterial (due to overcrowded living conditions)

What are some risk factors for Viral Meningitis?

Mumps Measles Herpes West Nile

What are some risk factors for Bacterial Meningitis?

Otitis Media; Pneumonia; Sinusitis Immunosuppression Invasive Procedures Overcrowded living conditions Step. pneumoniae; Neisseria meningitidis Haemophilus influenzae

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

AIDS patient

S/S of Meningitis

Fever Headache Photophobia Increased ICP Nuchal ridigity Positive Kernigs and Brudzinskis Decreased Mental Status Focal Neuro Deficits N/V

What is Kernig's Sign? Brudzinskis?

Kernigs = pain when leg extended and flexed at hip Brudzinskis = involuntary flexion of knee when neck is flexed

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

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

III: Oculomotor IV: Trochlear VI: Abducens VII: Facial VIII: Vesibulocochlear

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

S/S of Encephalitis

High Fever Changes in Mental Status Motor Dysfunction Focal neuro deficits Photophobia Fatigue Joint Pain Headache Increased ICP

Encephalitis can be caused by ---

mosquitoes and ticks ***Caused by arbovirus spread by mosquitoes and ticks

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

Acyclovir

Parkinson's is a degeneration in which area of the brain? What does it result in?

substantia nigra results in decreased production of DA

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

DA ACh

What are risk factors for Parkinson's Disease?

Age 40-70 Men Genetic predisposition Exposure to environmental toxins Chronic use of antipsychotic meds

S/S of Parkinson's Disease

Tremor Muscle Rigidity Postural Instability

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

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

mask-like facial expression

Medications used to treat Parkinson's

DA agonists Anticholinergics Catechol O-methyltransferase Inhibitors

What should we remmber about Parkinson's Meds?

most effective first 3-5 years Need drug holidays

What are the structural changes in brain associated with Alzheimers?

Neuritic Plaques Granulovascular Degenerations Neurofibrillary Tangles

Symptoms of Alzheimers

Gradual memory loss (short term first) Behavior/Personality changes Eventually lose language and motor skills

Medication classes for Alzheimers

Cholinisterase Inhibitors NMDA Receptor Antagonists SSRIs

What are the Cholinisterase Inhibitors used for Alzheimers?

Donepezil Galatamine

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

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

Why do we take Cholinisterase Inhibitors with Alzheimer's?

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

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

When does Huntington's Disease usually begin?

30-50 years old

What is the patho behind Huntington's?

decrease in GABA and increase in Glutamate

S/S of Huntington's

Progressive mental status change Choreiform movements ***Brisk, jerky, purposeless mvmts

What medication for Huntington's

tetrabenazine

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

Migraine Cluster

Which medications can trigger migraines?

Ranitidine Estrogen Nitro Nifedipine

What are the Autonomic Symptoms of Simple Partial Seizures?

Changes in HR and abnormal flushing

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

Clear = Viral Cloudy = Bacterial