Test Number 3 Flashcards
Musculoskeletal Cognitive/Perceptual Neurological Disorders (177 cards)
1
Q
What is a contusion?
A
Bleeding into the soft tissue; r/t blunt force “Bruise”
2
Q
What is a hematoma?
A
Contusion with large amount of bleeding “Raised bruise”
3
Q
What is a strain?
A
Stretching injury to a muscle or muscle-tendon unit caused by mechanical overloading. ***Remember the “T” in sTrain…TENDON***
4
Q
What is the most common strain?
A
Lower back or cervical region.
5
Q
What is a sprain?
A
Injury to a ligament surrounding a joint. Forces go in opposite directions. Loss of ability to move/use joint. Usually makes a “pop” noise when it happens. (Stretch/Tear) Manifestations: Rapid swelling, pain, discoloration.
6
Q
What is the most common sprain?
A
Ankle or knee.
7
Q
What does “RICE” stand for?
A
Rest-Ice-Compression-Elevation!
8
Q
What is tx for strains and sprains?
A
RICE! Ice for first 24 hours. Compression dressing to reduce swelling. Elevate above the heart. More severe injuries: may require surgery, PT. Torn ACL= surgery sometimes. PT has shown to be just as helpful according to new research.
9
Q
What will an x-ray show?
A
Fractures—BONES! Will not show soft tissue injuries.
10
Q
What will an MRI show?
A
Shows details of SOFT TISSUE injuries. (Ligaments, tendons, ect)
11
Q
What is a ligament?
A
Connects bone to bone.
12
Q
What is a tendon?
A
Connects muscle to bone.
13
Q
What meds are used for contusions, strains, and sprains?
A
-Analgesics -NSAIDs (r/t inflammation) -Muscle relaxants (Flexeril, Valium)
14
Q
What NSG DX would work for contusions, strains, and sprains?
A
-Acute pain (RICE) -Impaired physical mobility (use of correct assistive devices) -Self care deficit (requires assistance) -Risk for impaired skin integrity (Elderly)
15
Q
When wrapping an injury with ACE wrap how would you wrap it?
A
Start distal and wrap proximal to help with blood return to the heart.
16
Q
What is a dislocation?
A
Loss of articulation of bone ends in the joint capsule following severe trauma.
17
Q
What is the most common dislocation?
A
Shoulder
18
Q
In assessing for a dislocation, what would you assess?
A
The 5 P’s! Pain, pallor, paresthesias, pulse, paralysis.
19
Q
What do you want to do after a dislocation?
A
Immobilize! Do NOT move until relocated. Provide pain relief with medication and ICE! Pt will most likely need PT and education about injury.
20
Q
What is a sublaxation?
A
Dislocation where bone ends are still partially intact. (Partial dislocation) Very painful, limited motion. ***Common after stroke!*
21
Q
What is a fracture?
A
Break in continuity of the bone. Happens when the bone is subjected to more kinetic energy than it can absorb.
22
Q
What are the 9 ways to classify a fx?
A
- Simple 2.Compound 3. Complete 4. Incomplete 5. Comminuted 6. Compressed 7. Stable/Non-Displaced 8. Unstable/Displaced 9. Stress/Pathologic
23
Q
What is a simple fx? What is a compound fx?
A
Simple= closed, skin intact. Compound= skin is open over fx. (Problem r/t bacteria!)
24
Q
What is complete fx? What is incomplete fx?
A
Complete= fx entire width of bone Incomplete= partial width of bone
25
What is comminuted fx? What is compressed fx?
Comminuted= broken in many places Compressed=bone is crushed
26
What is stable/non-displaced fx? What is unstable/displaced fx?
Stable/non-displaced=bones maintain alignment (good!) Unstable/displaced= bones move out of correct alignment. (Usually have muscle spasms because of it) may need surgery, traction, or manipulation.
27
What is stress/pathologic fx?
Disrupted bone homeostasis and inadequate repair. (Fx that would not usually happen. Probably related to cancer, or osteoporosis)
28
What things can happen as a result to a fx? (4)
1. Soft tissue damage/injuries (muscles, tendons, ligaments) 2. May have issue with circulation. (Check 5P's, sensation, swelling) 3. May have obvious deformity (Ex: Hip fx= fx leg shorter and rotated outward) 4. May have felt the breakage of the bone at the time of fx (Crack or pop)
29
What are the fx healing phases?
1. Inflammatory (bone injury)- bleeding at the site. May not see bruising right away, depends on how deep the bone is. 2. Reparative callus forms (fibrocartilaginous callus) 2-3wks soft callus, 4-8wks hard callus. 3. Remodeling of new bone is laid down (Osteoblasts continue to form new woven bone \*compact bone\* which can take up to a year. Osteoclasts continue to dissolve away callous as it is replaced by mature bone) \*\*\*May not be completely healed when cast comes off. Can take up to a year\*\*\*\*
30
What is healing of fx influenced by?
Age, health (DM, malnutrition, elderly), tx sought, physical activity, type and location of fx.
31
What is the normal healing time of a arm/foot fx? What is the normal healing time of a hip?
Arm/foot= 6-8 weeks. Hip= 12-16 weeks.
32
What are complications of a hip fx?
BIG DEAL! Pressure ulcer, pneumonia, anesthesia side effects
33
What is emergency care of fx/dislocation?
1. Immobilization- above/below joint. Maintain alignment (be creative) Splint! 2. Maintain tissue perfusion- elevate before/after splinting (do not wrap too tight) 3. Open wounds- use sterile dressings
34
What are DX tests for fx/dislocations?
1. hx of incident and assessment. 2. X-ray of bones 3. additional tests if needed, depending on how fx happened. To look for cancer, osteoporosis, bone disease. (Ex. Fibula fx very uncommon without tibia fx as well)
35
What meds are used for fx/dislocations?
1. Pain meds (Narcs) 2. NSAIDs (beware of bleeding! may interfere with healing time) 3. Antibiotics (open fxs) 4. Others r/t complications (Anticoagulants, stool softner, MVI, Ca++, Vit D, anti-ulcer r/t meds used to decrease pain)
36
Tx for fx/dislocations?
1. Surgery (usually within 6 hrs) 2. Traction 3. Casting 4. Electrical Bone Stimulation
37
What are indications for needing surgery for fx?
Displaced fx, damage involving blood supply or nerves (soft tissue damage)
38
What is external fixation?
Pins surgically placed above and below fx, then attached to external device to hold bone in place.
39
What is ORIF?
Open reduction internal fixation. Stabilize with hardware. (permanent) (Most hardware is MRI compatible...but always ask)
40
What is traction?
Application of straightening or pulling force to maintain or return fx bones in normal alignment, and prevent muscle spasms. Weights maintain necessary force! (NEVER remove weights without DR permission)
41
What are the two types of traction?
1. Straight/Skin/Buck's 2. Skeletal
42
What is straight traction?
Pulling force in a straight line. (Buck's extension) On the skin. (Hips)
43
What is skeletal traction?
Involves one or more forces of pull. ( Don't remove weights)
44
When caring for a pt in traction...what does T-R-A-C-T-I-O-N stand for?
Temperature (in extremity) Ropes hang freely Alignment Circulation (check 5Ps) Type/location of fx Increase fluid intake Overhead trapeze No weights on bed/floor
45
What complications come with immobility?
-Friction -Moisture -Skin break down -Problems urinating -Constipation -Kidney stones r/t Ca++ deposits
46
What is casting?
Rigid device applied to immobilize bones and promote healing. Extends above and below the fx
47
What are the two types of castings? What should be taught about casts in general?
1. Plaster 2. Fiberglass \*\*\*NEVER stick anything in casts for ANY reason\*\*\*
48
What to remember about plaster casts?
-Needs 48 hrs to dry. Do not press on it/move while drying. -Cant weight bear until dry -May need new cast if fx swells after it is placed -Can not get wet! It will disintegrate/crumble
49
What to remember about fiberglass casts?
-Used in ER for non displaced fx -Hardens in 1 hr -Can get wet
50
What is electrical bone stimulation?
Promotes healing on fx. Increases osteoclast/osteoblast activity!
51
What is compartment syndrome?
A condition resulting from increased pressure within a confined body space (like muscle), constricting structures within it and reducing circulation to the muscles, blood vessels, and nerves. May lead to ischemia\*\*\*\*EMERGENCY\*\*\*\*MUST MOVE FAST ELEVATE LIMB & CALL DR IMMEDIATELY
52
S/S of compartment syndrome?
Bruising, swelling, compression, decreased sensation, loss of movement, decreased distal pulses, cyanosis. Increasing pain distally (because lack of O2 to area) Not relieved by pain meds.
53
When does compartment syndrome develop?
Within 24-72 hours of fx or injury
54
What does compartment syndrome result from?
Hemorrhage, edema from injury, or swelling with too tight of a cast. Could also happen from a crushing injury
55
What two things can help compartment syndrome?
1. Bivalve cast (leave cast of but spread both sides)...if cast is too tight. 2. Fasciotomy- cut the muscle fascia to relieve pressure and increase blood flow (leave open and suture later) \*\*\*\*MAY RESULT IN AMPUTATION
56
What is fat embolism syndrome? (FES)
Fat globules lodge in pulmonary capillaries or peripheral circulation usually after a long bone or pelvis fracture. Happens within 24 hours of a fx.
57
S/S of FES?
1. Respiratory changes (cyanosis 2. Neurological abnormalities (confusion, restlessness) 3. Petechial rash on chest, axilla, arms, mouth. (pin point rash from erythrocyte extravasation (leaking of RBC)
58
What can FES result in? How is it prevented?
-ARDS Acute respiratory distress syndrome (1/2 will require mechanical ventilation) -Prevented by stabilizing the fx, steroids to decrease inflammation and close monitoring
59
What is VTE?
Venous thromboembolism -Blood clot forms in intimal lining of large vein (legs or pelvis-ileac vein) and can lead to PE.
60
What are the 3 precursors/risk factors for post-op trauma pts?
1. Venous stasis 2. Injury to blood vessels 3. Altered blood coagulation
61
S/S of VTE?
Swelling, tenderness, and sometimes pain.
62
How is VTE DX?
Thru doppler or venogram
63
Prevention of VTE?
\*\*\*\*Prevention is the BEST TX! -Early immobility of fx, anticoagulants, TEDS, SCDs, early amputation.
64
What is TX of VTE?
-Bed rest for 5-7 days to prevent dislodging of clot. -Thrombolytics -Heparin IV to prevent more clots -Then switching them to Coumadin (PO) before going D/C.
65
When is infection a potential complication for a fx?
When it is a compound/open fx. It may lead to osteomyelitis (infection in the bone), very slow healing process. Needs long-term antibiotics (can be lifelong)
66
What is delayed/non-union fx?
Prolonged healing of the bones beyond usual time period for healing, or not healing at all.
67
Risk factors that can lead to delayed/non-union fx? (8)
1. Nutrition (delays healing) 2. Inadequate immobilization (if cast isn't on correctly-refracture) 3. Poor alignment of fx (i.e. multiple fx or crushed bones) 4. Prolonged reduction time (not seeking tx immediately) 5. Infection or necrosis (d/t poor blood supply...make need to be recasted) 6. Age (younger heal faster) 7. Immunosuppression (won't have the rapid response for inflammation which is the 1st phase of the healing process for fx) 8. Severe bone trauma
68
How are delayed/non-union fx TX?
1. Surgery (Bone grafting) 2. Electrical stimulation (TENS unit and put on both sides of fx to stimulate bone to grow faster and heal 3. Debridement (if infection present)
69
What is RDS?
Reflex sympathetic dystrophy (complex regional pain syndrome) It is a poorly understood condition. Occurs post fx/injury
70
S/S of RSD?
Persistent pain, hyperesthesia (increased sensitivity), swelling, changes in skin color, decreased muscle movement, muscle wasting, skin and nail changes.
71
What is the TX for RSD?
Adjuvant meds, nerve blocks
72
What 5 main things to manage when providing care to oath injuries?
1. Pain (and asking details about it) and elevating limb 2. Impaired physical mobility (keep assistive devices next to bed) and get them things to take come at D/C 3. Impaired tissue perfusion (Check 5 Ps) 4. Neurovascular compromise (Check extremity for 5 Ps each time you are in the room) 5. Assessment of pts response to trauma (will they have changes in ADLs, at home), psych-social needs...coping,etc)
73
Health promotion for bone injuries?
Maintain good bone health! Take in Ca++ when young. Others: Weight bearing exercises, weight loss, maintain bone density.
74
NUR DX for fx?
1. Acute pain 2. Risk for peripheral neurovascular dysfunction (so you always check to prevent!) 3. Risk for infection 4. Impaired physical mobility
75
What things need to be taught to the pt before D/C for home care of fx?
1. Care care (checking edges, how to shower with it) 2. Following Dr. orders about weight bearing (LE injuries) 3. Doing ROM to unaffected joints to keep them strong when not being used d/t injury 4. Elevate 5. D/C planning (Home PT, equipment and assistive devices needed)
76
What is an amputation?
Partial or total removal of a body part d/t trauma or disease
77
What are poss causes of amputations?
1.Peripheral vascular/arterial disease (PVD,PAD) such as; -DM -Hypertension -Smoking 2. Trauma (especially UE) 3. Other traumatic events (i.e. frostbite, burns, compartment syndrome \*\*\*\*Underlying cause is interruption of blood flow (can be acute or chronic)
78
What are the goals for amputees?
1. To alleviate symptoms (pain, ulcerations) 2. Maintain healthy tissue (open "Guillotine" or closed stump 3. Increase functional outcome
79
What things should be done for amputees to ensure site healing?
1. Assess circulation 2. Stump is wrapped in rigid or compression dressing (to prevent infection, minimize edema) usually ACE wrap used distal to proximal extremity to allow a conical shape to form stump (so prosthesis fits) 3. Limb is only elevated for first 24 hours d/t risk of contracture in limbs (especially with legs...hip flexor) should only sit for a limited amount of time, and should spend some time laying prone (if able) to stretch hip flexor 4. Have get up and ambulate as soon as possible with prosthesis so they don't lose ability to walk
80
Poss complications with amputations?
1. Infection 2. Delayed healing time if not good circulation 3. Chronic stump pain (may never be able to manage) 4. Phantom limb pain/phantom sensation is very difficult to tx d/t nerves being cut off at stump and they are still receiving pain signals and sending them to the brain so it feels like the rest of the leg is still there (Neurontin, Lyrica 5. Contractures
81
NUR DX for amputations?
Lots of pysch-social needs, pain, grief, body image, mobility, risk for infection, impaired skin integrity
82
What is carpal tunnel syndrome?
Compression of the MEDIAN nerve in the wrist. (Radial side)
83
S/S of carpal tunnel syndrome?
N/T in thumb and index finger, pain
84
TX of carpal tunnel syndrome?
-Surgery to increase the size of tunnel, although not very effective, because syndrome is caused by repetitive use. -Splinting the wrist -Increasing mobility -Meds: NSAIDs to decrease inflammation, and steroid injections to inflamed areas ( can only be done 1-2x per year, quick relief but doesn't last long) -Rehab -Avoiding activities that make pain worse (as much as poss)
85
What is bursitis?
Inflammation of the bursa (fluid sac by joints) Common in the shoulder, hip, knee, and elbow
86
S/S of bursitis?
Tender, hot, red, swollen joint with pain on flexion
87
TX of bursitis?
-Splinting/sling (shoulder) -Increasing mobility -Meds: NSAIDs to decrease inflammation, and steroid injections to inflamed areas ( can only be done 1-2x per year, quick relief but doesn't last long) -Heat and ice -Rehab -Avoiding activities that make pain worse (as much as poss)
88
NUR DX for repetitive use injuries (carpal tunnel syndrome and bursitis)
-Pain -Physical mobility
89
What is osteoarthritis (OA)/degenerative joint disease (DJD)?
Loss of cartilage and hypertrophy of bones at articular margins -No inflammation -Most common form of all arthritis -More common in males until 55, then twice as high for females
90
Risk factors that can lead to OA/DJD?
-Age (if family genetics has is young, increased risk for the pt to get it young as well) -Excessive weight -Inactivity (sedentary lifestyle) -Strenuous, repetitive exercise -Hormonal factors (low estrogen and Ca++)
91
How does OA/DJD (pathophys) occur?
1. Cartilage lining joints degenerates, falls apart (Wear and tear on joints) 2.Osteophytes (bone spurs) form along edges of joints causing pain and limited mobility (bumpy knuckles on elderly)
92
S/S of OA/DJD?
1. Gradual, progressive onset 2. Pain and stiffness in one or more joints (worse in the morning, better as they move around) 3. Pain may be referred to other areas 4. Immobility and stiffness 5. Decreased ROM and crepitis 6. Boney overgrowth (osteophytes on joint line)
93
What do you want to do for pt with OA/DJD?
1. Relieve pain 2. Maintain function and mobility (household chores, etc)
94
What meds are used for OA/DJD?
1. Tylenol first! Its the safest! 2. NSAIDs (when it gets to the point of inflammation later on in the disease) 3. Corticosteroid joint injections (can cause cartilage disfunction) 4. Injections to maintain/build cartilage/lubricate joint (longer onset to relief, may need more than 1 injection later)
95
TX to control/reduce effects of OA/DJD?
-PT to strengthen muscles around the joint -Rest to the involved joints. But mobility is still important -Usually ambulation devices (cane, walker) -Weight loss if overweight can help joints, but may not be realistic for the pt to do so -Analgesics and anti-inflammatory meds
96
What is a joint arthroplasty for OA/DJD?
Surgery for a total joint replacement. Most common in knees. Sometimes shoulders and elbows.
97
Other therapies for OA/DJD?
-Bioelectromagnetic therapy (Tommy Copper) -Anti-inflammatory diet ( removing potatoes, tomatoes, eggplants, peppers, tobacco) -Nutritional supplements like glucosamine and chondritic -Osteopathic manipulation (to increase ROM) -Yoga (stretching promotes better joint mobility)
98
Things to do when providing nursing care to OA/DJD pt?
-Promote comfort (meds, maintaining ADLs, assist with adaption to maintain life roles) -Maintaining mobility (OT, exercise within limits) -Assist with adaptation of lifestyle (may need help at home with devices....grabber)
99
NUR DX for pt with OA/DJD?
-Impaired physical mobility -Pain -Self-care deficit
100
What is back pain most often d/t?
Strain of muscles and tendons of back caused by abnormal stress or overuse (must r/o other causes such as herniated discs)
101
What is local back pain?
figure out the cause, compression vs arthritis? Sensory nerve
102
What is radicular pain?
Happens with herniated disc and is aggravated by movement/activity like coughing, moving, sitting. (Sciatica) Kind of like referred pain
103
What is muscle spasm pain?
Cramped muscle. May be accompanied by poor posture.
104
What are some clinical manifestations from low back pain?
-Mild discomfort to chronically debilitating -Gait, neuro involvement- depending on where the problem is occurring (may have loss of bowel or bladder control with neuro problems)
105
How is lower back pain DX?
-Usually conservative tx for 4 weeks and continue to move first before xray/MRI is done. -Then X-ray, possibly CT and/or MRI
106
What meds are used for lower back pain?
-NSAIDs -Steroids -Muscle relaxants (Typically avoid narcotics because they are just working as a bandaid...not really fixing the problem but just covering it up, although pt with chronic back pain may be on narcs) -Pain clinic for injections
107
What things are done to minimize lower back pain?
-Limited rest, early mobilization -When laying down, bend knees to decrease pain -Application of heat/ice alternating (15-30 min/time) -PT; massage and gentle stretching at first, then work on core strengthening to build up muscle to support back.
108
NUR DX for lower back pain?
-Acute pain -Knowledge deficit -Risk for impaired adjustment
109
What is back pain with herniated disc?
Rupture of cartilage surrounding disc with protrusion of nucleus pulposus (fluid inside disc escapes), pain radiates (radicular pain) \*\*\*Happens with normal aging d/t decreased water content\*\*\*\* \*\*Common sites are Lumbar to sacral area: L4, L5, and Neck: C5-6 (A dermatome map used to match pain with certain nerve area)
110
How does back pain with herniated disc occur (pathophys)?
1. Protrusion occurs spontaneously or as a result of trauma (good body mechanics should be used to prevent), may or may not herniate...may just bulge. 2. Abrupt herniation (usually from an injury) causes intense pain and muscle spasms. 3. Gradual herniation occurs with degenerative changes, osteoarthritis (position change with posture)
111
Manifestations of lumbar disc herniation:
-Pain going down back and radiating down butt, LEs -If nerve compression...bladder dysfunction (makes this pt a more urgent priority) -Sciatica -Absent lumbar lordosis (60%) -Motor deficits like foot drop, can't lift foot, and one limb losing more muscle tone than other -Sensory deficits like paresthesias and numbness, odd sensations
112
Manifestations of cervical disc herniation:
-Pain in shoulder, arm, neck -Paresthesias and muscles spasms in UEs, sometimes odd sensations
113
Clues that a cervical disc herniation is lateral?
-Pain in shoulder, back, neck, spasms, and paresthesias
114
Clues that a cervical disc herniation is central?
-LE weakness, unsteady gait, spasms
115
How is back pain with herniated disc DX?
-Usually MRI, CT scan -Plain x-ray if not done prior -May do EMG to check electrical activity of muscles at rest and with voluntary contractions (needles in to muscle) -May do myelogram \*\*\*MRI is the best DX tool
116
What kinds of meds are given for back pain with herniated disc?
Meds for pain(analgesics), inflammation(NSAIDs), spasms(muscle relaxants), and anxiety(valium)
117
What is spondylolistesis?
Bones in spine slip on each other (most common L4-L5)
118
What is spondylosis?
Small fx in back of spine (most common L5-S1)
119
What is spinal stenosis?
Narrowing of spinal canal due to enlarged facet joints and thickening of ligaments
120
TX for back pain with herniated disc?
-Conservative tx first (take meds as prescribed, stay active, etc) -Then alternative therapies like acupuncture (to release endorphins), acupressure, and massage (could be pseudoscience or placebo...but if it works its beneficial!) -Surgery
121
What is a laminectomy?
Removal of part of vertebral lamina (24 stay in hospital)
122
What is a discectomy?
Removal of herniated nucleus polposus (just fluid squeezed out and not the entire disc because then it will result in bone on bone)
123
What is decompressive laminectomy?
laminectomy with removal of arthritic bone spurs. Sometimes requires spinal fusion. (For cervical laminectomy they go in through the front of neck)
Hopsital stay=2-3 days
124
What is a cervical fusion?
Fuse cervical discs. Can use a cadaver (allograft) bone or own bone (autograft) from iliac crest. Using own bone means no problems with rejection \*Home in 24 hours \*Smoking cessation for 4-6 weeks before surgery otherwise bones will not heal properly
125
What are poss NUR DX for back pain with herniated disc?
-Acute pain, Chronic pain, constipation, limited mobility, self care deficit, risk for impaired skin integrity
126
What is shingles?
Neurological disorder caused by the virus Varicella Zoster, which is initially chicken pox. Virus lays dormant in sensory dorsal ganglia (nerve roots) and skin lesions flares up along the path of dermatome.
- Usually affects people over 50, especially if immune compromised or stressed
- Skin lesions very painful. Erupt for 3-5 days, crust over, and recover in 3-6 weeks.
127
TX for shingles?
1st line- antiviral agents (more effective if taken in the beginning of outbreak) ie: Acyclovir
Pain relief: pain med for acute pain, even after shingles disappear, pain can be chronic
Infection control: Limit contact
128
Prevention for shingles?
Zostavax vaccine. Certain criteria to get it though. Age, immunocompromised, cancer, ect.
129
NUR DX for shingles:
Acute pain, disturbed sleep pattern, risk for secondary bacterial infection
130
What are migraine headaches?
Involves dilation and inflammation of intracranial arteries (decreases brain activity, increases the release of serotonin...too much can lead to headaches)
\*10-15% of the population has them
131
What are triggers for migraines?
Stress, BS levels, smells, hormones, foods, fatigue, bright light, irregular sleep pattern
132
S/S of migraines?
- Usually one sided throbbing/ pulsing
- Hypersensitivity to light/sound/smells
- Pain
- N/V
- Aura (20% of people)
133
Med tx for migraines?
(Abortive, migraine specific, prophylactic)
Abortive meds: NSAIDs, narcs, ASA, caffeine containing meds
Migraine specific meds: Imitrex, frova
Prophylactic: Beta blockers in small doses (Inderal), anticonvulsants (Topamax, Depakote), antidepressants (Elavil)
134
Nursing care for pt with migraines?
- Pain meds
- Minimize light, nose, activity
- App of heat/cold
- Education on meds/keeping headache diary
135
What is a seizure?
Episodes of abnormal, sudden, excessive discharge of electrical activity within the brain resulting in abrupt and temporary altered state of cerebral function.
136
What are poss causes of seizures?
- Head injury
- CNS infection
- Brain tumor
- Birth trauma
- Lyte disturbance
- ETOH withdrawal
\*Can be idiopathic/primary (epilepsy) or acquired/secondary (from cancer, ETOH)
137
What is the goal?!
TO CONTROL SEIZURES
138
How can seizures be prevented?
Preventing head injuries, lead poisoning, childhood injections, giving immunizations, not drinking. (can also be caused by high risk pregnancies)
139
What two seizures are generalized?
\*Tonic-clonic/grand mal
\*Absense/petit mal
140
What is a tonic-clonic/grand mal seizure?
LOC, full blown, stereotypical seizure. Lasts 2-5 minutes. More common in adults. Confusion can last up to an hour after the seizure
\*MAY have AURA
141
What is absense/petit mal seizure?
Brief LOC/staring. More common in children. Lasting only seconds. "Day dreaming" look
142
What are the two partial seizures?
- Complex
- Simple
143
What is complex partial seizure?
Memory, awareness, or conciousness impaired. (LOC) Repetitive non-purposeful movements or phrases. Lasts 1-3 minutes. They will not remember anything afterwards.
\*Sometimes AURA
144
What is simple partial seizure?
Memory, awareness, and consciousness preserved. No LOC. Movement of 1 extremity, unusual sensations.
\*AURA
145
What is status epilepticus?
An EMERGENCY! What seizure activity lasts longer than 30 minutes (1 seizure lasting that long or multiple)
146
What things do you need to do in a status epilepticus situation?
- Airway
- Assessment
- Prevent injury
- Emergency meds (IV Valium, Ativan) give IVP, then anti convulsant meds
147
What are seizure attacks precipitated by?
Anger, menses, excitement, fatigue
(Make journal or log to look for potential triggers)
148
Tx during seizure attacks?
1. Prevent from injury!
- Do not restrain, put anything in mouth, and place on side)
2. Observe and record
- When did it start, and where? Did they LOC? Where they disorientated?
3. Maintain privacy as much as possible
149
NUR DX for seizures?
- Altered cerebral tissue perfusion
- Risk for injury
- Risk for aspiration
- Altered self image
- Decrease in self esteem
- Anxiety
- Social isolation
- Risk for ineffective airway clearance
150
What are some life style adjustments and concerns for seizures?
1. Eliminate factors that may trigger seizures (have reg routine and sleep, foods, no etoh, wear ID bracelet)
2. Employement concerns (transportation---one driving for 6 months after a seizure)
3. Meds will control 50-60% if properly prescribed and taken, may need a combo (usually continue for life)
151
Important things about Dilantin (anticonvulsant):
\*\*\*Most widely used\*\*\*
- Decreased absorption with Ca++ and enteral feedings (hold 2 hrs before/after)
- Must give on empty stomach
- S/E: Gingival hyperplasia
- Must maintain therapeutic blood level by consistantly taking their meds
- Measle-like rash (D/C if this happens)
- Purple glove syndrome (Usually IV)
152
Important things to remember about Phenobarbital (anticonvulsant):
MANY CNS S/E!
Better drugs available
153
Important things to remember about Tegretol (anticonvulsant):
- Preferred d/t lower S/E
- Requires increasing doses overtime
- Grapefruit juice increases absorption
- S/E: rash, photosensitivity
154
Important things to remember with Depakote (anticonvulsant):
- ALWAYS give with food!
- Enteric coated
- S/E: Rare (some GI side effects)
- Potential liver toxicity, pancreatitis
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Important things to remember about Zarontin (anticonvulsant):
\*\*\*\*Very effective for absense of seizures
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What is Trigeminal neuralgia? What is the cause?
\*\*\*Called suicide disease\*\*\*
Chronic disease involving cranial nerve 5.
Caused by flu, infection, pressure on the nerve (causes pain)
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What are S/S of trigeminal neuralgia?
Sudden, severe, unilateral, facial pain; frequent or remission. (No visual pain, no change in facial movement)
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What are possible triggers of trigeminal neuralgia?
- Light
- Touch
- Wind
- Sneezing
- Changes in temp
- Talking
- Shaving face
- Chewing
- Swallowing
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What meds are used for trigeminal neuralgia?
1. Anticonvulsants (Tegretol, Dilantin)
2. Gabapentin (Neurontin)
3. Skeletal muscle relaxants
4. Lyrica
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What surgical tx can be done for trigeminal neuralgia?
1. Microvascular decompression (MVD)
2. Steriotactic radiosurgery/gamma knife surgery
3. Rhizotomy
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What is microvascular decompression (MVD)?
Surgical procedure to tx trigeminal neuralgia.
Done on young, healthy people.
Small incision, and teflon pad is placed when the nerve is compressing. Quick pain relief
(65% still have pain relief after 10 years)
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What is Steriotactic radiosurgery/gamma knife surgery?
Procedure done to tx trigeminal neuralgia.
No incision is made. Radiation aimed at TGN at spot of compression, which stimulates healing of the nerve. Relief in 3-4 weeks.
Good for elderly and those who are not anesthesia canidates.
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What is a rhizotomy?
Procedure done to tx trigeminal nerve neuralgia by severing nerve root by injection, compression, or radiofrequency.
\*\*\*NOT very effective. 50% still have pain afterwards
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NUR DX for trigeminal neuralgia:
- Pain
- Risk for altered nutrition
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What is Bell's Palsy?
7th cranial nerve disorder. Unilateral weakness of facial muscles. Paralysis of unilateral face.
- Can occur at any age
- Can accompany another condition or by it self
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S/S of Bell's Palsy:
- Can be minimal to severe.
- Sudden onset pain behind ear or along jaw preceding paralysis, N/T on affected side, impaired taste, facial droop can be mild to severe with time (mouth and eyelid)
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Meds for Bell's Palsy:
1. Acyclovir (antiviral)
2. Steroids (prednisone)
\*\*\*\*80% recover from Bell's\*\*\*\*\*
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Nursing care for pt with Bell's Palsy:
- Self care
- Prevent injuries
- Maintain nutrition
- Artificial tears if they cant close their eye completely. And possibly an eye patch to prevent dry eye.
- Massage for pain
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What two ways can neuropathy be?
Peripheral (limbs) or autonomic-visceral (organs)
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What neuropathy is most common?
Diabetic neuropathy
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What is polyneuropathy?
- More than one area affected, multiple nerves (DM)
- Like in bed 10
- Progressive slowly over months to years
- Bilat sensory disorders
- Starts with N/V in toes and works its way up legs to torso.
- Ex: Diabetic neuropathy, GBS, from radiation/chemo after cancer
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What is mononeuropathy?
Single nerve.
-Ex: carpal tunnel, shingles
(Focal peripheral neuropathy)
-Usually from trauma, compression (like leg falling asleep), or entrapment
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What is visceral (autonomic) neuropathy?
S/S depend on area of ANS involvement
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What is CV visceral neuropathy?
No increase in heart rate with exercise=light headed
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What is GI visceral neuropathy?
Gastroporesis=change in motility
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What is GU visceral neuropathy?
Sexual dysfunction (includes erectile dysfunction)
\*\*With DM you can have both neuro and vascular problems
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What is
