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MED SURG > TOPIC 11 - neuro part 2 > Flashcards

TOPIC 11 - neuro part 2 Flashcards

1
Q

types of headaches

A

primary
tension
migraine
cluster
secondary

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2
Q

primary vs secondary headaches

A

primary are not caused by disease or another medical condition (ex: tension, migraine, cluster)

secondary are caused by another condition or disorder (ex: sinus infection, neck injury, brain tumor)

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3
Q

pain location of tension headaches

A

Tension headache is often described as a feeling of a weight in or on the head and/or a band squeezing the head.

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4
Q

pain location of migraine headaches

A

Migraine headache is described as an intense, throbbing or pounding pain that involves one temple. The pain usually is unilateral (on one side of the head), although it can be bilateral.

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5
Q

pain location of cluster headaches

A

Cluster headache pain is focused in and around one eye and is often described as sharp, penetrating, or burning.

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6
Q

tension headaches

A

most common
bilateral location : pressing/tightening quality
mild or moderate
episodic or chronic
bilateral frontal-occipital : contant, dull, bandlike

NO warning symptoms, NO nausea or vomiting, NO trouble with physical activity
SENSITIVITY to light or sound

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7
Q

migraine headaches

A

unilateral throbbing pain, premonitory symptoms or triggers, onset between 20-30, affects more females than males, state of neuronal hyper-excitability in occipital cortex of the cerebral cortex, may or may not have known precipitating factors

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8
Q

what medical issues are migraine headaches associated with

A

seizure disorders, ischemic stroke, asthma, depression, anxiety, myocardial infarction, Raynaud’s syndrome, and irritable bowel syndrome.

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9
Q

precipitating factors for migraine headaches

A

include foods, menstruation, head trauma, physical exertion, fatigue, stress, missed meals, weather, and drugs. Food triggers include chocolate, cheese, oranges, tomatoes, onions, monosodium glutamate, aspartame, and alcohol (particularly red wine).

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10
Q

risk factors for migraine headaches

A

Family history
Low level of education
Low socioeconomic status
High workload
Frequent tension-type headaches

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11
Q

clinical manifestations of migraine headaches

A

neurologic, psychologic, or other premonitory manifestations
aura
steady, throbbing
synchronous with pulse
may last 4-72 hrs
vary in severity

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12
Q

cluster headaches

A

generally occur at same time of day or night
onset between 20-45
men more affected

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13
Q

what is the most common type of headache

A

tension

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14
Q

what is the most severe primary headache

A

cluster

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15
Q

triggers for cluster headaches

A

alcohol
strong odor
weather changes

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16
Q

what part of the brain is affected in cluster headaches

A

ophthalmic branch of trigeminal nerve
hypothalmus
irregularities with melatonin and cortisol

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17
Q

manifestations of cluster headaches

A

Sharp, stabbing, intense pain lasts minutes to 3 hours
May occur every other day and as often as 8x/day
Can occur in cycles with remission periods in between
Pain is generally located around the eye, radiating to the temple, forehead, cheek, nose, or gums
Swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and miosis (constriction of the pupil).
often agitated and restless, unable to sit still or relax
aura similar to migraine may occur in 14% of patients up to 60 minutes before an attack.
Cluster headaches can occur every other day and as often as eight times a day.
Because cluster periods often occur seasonally, headaches may be mistaken for symptoms of allergies.

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18
Q

health history for assessment of headaches

A

Seizures, cancer, stroke, trauma, asthma or allergies, mental illness, stress, menstruation, exercise, food, bright lights, noxious stimuli
Medications
Surgery and other treatments

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19
Q

objective data for assessment of headaches

A

Anxiety or apprehension
Diaphoresis, pallor, unilateral flushing with cheek edema, conjunctivitis

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20
Q

details about the headache in assessment

A

Location, Type of pain
Onset, Frequency, Duration, time of day
Relation to outside events

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21
Q

if no systemic underlying disease is the cause of the headache, what guides therapy

A

the type of headaches

types of therapies: Drugs, medications, yoga, biofeedback, cognitive-behavioral therapy, and relaxation training

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22
Q

symptomatic drug therapy for tension headaches

A

Mild-moderate headache treated with aspirin, acetaminophen, or an NSAID alone or in combination with a sedative, muscle relaxant, or tranquilizer

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23
Q

preventative drug therapy for tension headaches

A

Tricyclic antidepressants
Antiseizure medications

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24
Q

preventative drug therapy for migraine headaches

A

Antiseizure drugs - GABA, topiramate
Botox
SSRIs

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25
symptomatic drug therapy for migraine headachces
Mild to moderate headache can obtain relief with NSAID, aspirin, or caffeine-containing combination analgesics
26
skin patch for migraine headaches
zecuity
27
first line therapy for moderate to severe headaches
triptans - vasoconstrict : caution to pt with heart disease or stroke
28
preventative drug therapy for cluster headaches
High-dose verapamil Varied other options : lithium, ergotamine, antiseizure drugs (e.g., topiramate), and melatonin. Invasive nerve blocks, deep brain stimulation, and ablative neurosurgical procedures have been used for refractory cluster headaches
29
symptomatic drug therapy for cluster headaches
triptans (dont give to pt with vascular risk factors) 100% oxygen at 6-8 L/min for 10 min non rebreather (repeat after 5 min rest)
30
headache nursing implementation
Teach patient about preventive treatment Dietary counseling for food triggers Avoid smoking and other environmental triggers An inability to cope with daily stresses can cause headaches Daily exercise, relaxation periods, and socializing help reduce recurrence and should be encouraged Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis Encourage a quiet, dim environment Massage and heat packs can help with tension-type Patient should make a written note of medications to prevent accidental overdose
31
headache provoking foods
chocolate, cheese, oranges, tomatoes, onions, monosodium glutamate, aspartame, alcohol, excessive caffeine, fermented or marinated foods
32
what med is prescribed to be taken before planes take off to decrease likelihood of attacks that occur at high altitudes
ergotamine
33
dementia causes dysfunction of loss of :
Memory Orientation Attention Language Judgment Reasoning Behavior or personality
34
what factors does dementia interrupt
Work Social responsibilities Family responsibilities Ability to perform ADLs
35
what are the most common causes of dementia
neurodegenerative conditions (alzheimers) vascular conditions
36
vascular dementia results from what
ischemic or hemorrhagic brain lesions caused by cardiovascular disease
37
mixed dementia
2 or more types of dementia at the same time usually alzheimers with vascular dementia
38
lewy bodies dementia
neurodegenerative dementia presence of lewy bodies in brainstem and cortex (intraneural cytoplasmic inclusions) includes features of parkinsons
39
normal pressure hydrocephalus
uncommon caused by obstruction of CSF flow : meningitis, encephalitis, head injury (manifestations = dementia, urinary incontinence, difficulty walking) treatable if diagnosed early
40
what ethnicity is alzhemiers most common in
african americans and hispanics lower socioeconomic status / poor access to healthcare
41
alzheimers disease
chronic, progressive, neurodegenerative brain disease cannot be prevented, cured, or slowed
42
patho of alzheimers
Abnormal amounts of β-amyloid are cleaved from the amyloid precursor protein (APP) and released into the circulation. The β-amyloid fragments come together in clumps to form plaques that attach to the neuron. Microglia react to the plaque, and an inflammatory response results.
43
early warning signs of alzheimers
Memory loss that affects job skills Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or ↓ judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative
44
diagnostics of alzheimers
patient evaluation : Complete health history Physical examination Neurologic assessment Mental status assessment labs imaging : CT, MRI, PET
45
examples of neuropsychologic testing for alzheimers
Mini-Cog Mini-Mental State Examination (MMSE) -- Used to determine a baseline from which to evaluate change over time
46
mini mental state vs mini cog
mini cog : draw a clock MMSE : oriented to time, registration, naming, reading
47
confusion assessment method
BEST PRACTICE FOR ASSESSING CONFUSION IN OLDER ADULTS Assess onset, attention level, type of thinking, LOC, disorientation, memory impairment, perceptual disturbance, psychomotor agitation, psychomotor retardation, and the sleep-wake cyle
48
subjective and objective data for alzheimers assessment
subjective = Past health history Medications Health perception–health management Nutritional-metabolic Elimination (incontinence) Activity-exercise Sleep–rest pattern Cognitive-perceptual objective = Disheveled appearance Neurologic Early, middle, late changes
49
gradual vs abrupt onset of dementia
gradual and progressive = neurologic degeneration abrupt = vascular dementia
50
what can you do to treat and prevent vascular dementia
treat risk factors : Hypertension, diabetes, smoking, hypercholesterolemia, cardiac dysrhythmias
51
care for alzheimers
NO CURE care is aimed at : Delaying onset of symptoms Controlling undesirable behavioral manifestations Providing support for family caregiver
52
drug therapy for alzheimers
memantine - protects nerve cells against excess amounts of glutamate SSRI's antidepressants - trazodone may help with problems with sleep antipsychotic drugs - managing behavioral problems
53
health promotion for alzheimers
Avoid harmful substances Challenge your mind Exercise regularly Stay socially active Avoid trauma to the brain Take care of mental health Treat diabetes Take care of your heart Get enough sleep Get the right fuel
54
patient responses to alzheimers diagnosis
Depression Denial Anxiety and fear Withdrawal Feelings of loss
55
when there is an inability to communicate symptoms who is in charge of communicating for the pt
caregiver or health care professionals
56
behavioral problems with AD
Repetitiveness Delusions Hallucinations Agitation Aggression Altered sleep patterns Wandering Hoarding Resisting care
57
interventions of behavioral problems
assess physical status before environment remove stimulus reassure about safety rely on mood and behavior rather than verbal communication
58
nursing strategies for behavioral problems
redirection distraction reassurance
59
sundowning
Specific type of agitation Patient becomes more confused and agitated in late afternoon or evening May be due to disruption of circadian rhythms
60
nursing interventions for sundowning
Create a quiet, calm environment Maximize exposure to daylight Evaluate medications Limit naps and caffeine Consult health care provider on drug therapy
61
safety risks with alzheimers
Injury from falls Ingesting dangerous substances Wandering Injury to others and self with sharps Burns Inability to respond to crisis
62
manifestations of infection
change in behavior, fever, cough (pneumonia), pain, urination (bladder problems)
63
caregiver support
Work with the caregiver to assess stressors and to identify coping strategies to reduce the burden of caregiving. Determining what the caregiver views as most disruptive or distressful can help to establish priorities for care.
64
expected outcomes for alzheimers disease
Functions at highest level of cognitive ability Experiences no injury Remains in restricted area during ambulation and activity Performs basic personal care activities of daily living including
65
delirium
state of temporary but acute mental confusion often preventable or reversible can be life threatening
66
contributing factors to delirium
Impairment of cerebral oxidative metabolism Cholinergic deficiency Excess release of dopamine Change in serotonin Stress, surgery, sleep deprivation COGNITIVE Dementia Cognitive impairment Depression History of delirium ENVIRONMENT Admission to ICU Use of physical restraints Pain (especially untreated) Emotional stress Prolonged sleep deprivation FUNCTION Functional dependence Immobility History of falls SENSORY Sensory deprivation Sensory overload Visual or hearing impairment
67
DELIRIUM MNEUMONIC CAUSES
Dementia, dehydration Electrolyte imbalances, emotional stress Lung, liver, heart, kidney, brain Infection, ICU Rx Drugs Injury, immobility Untreated pain, unfamiliar environment Metabolic disorders
68
when does delirium develop
over 2-3 day period can develop within hours
69
early manifestations of delirium
Inability to concentrate Disorganized thinking Irritability Insomnia Loss of appetite Restlessness Confusion
70
later manifestations of delirium
Agitation Misperception Misinterpretation Hallucinations
71
how long do delirium symptoms last
1-7 days can be years can never recover
72
distinctions of delirium rather than dementia
Sudden cognitive impairment Disorientation Clouded sensorium
73
diagnostic studies for delirium
Medical history Psychologic history Physical examination Careful attention to medications Cognitive measures Confusion Assessment Method (CAM)
74
lab tests to look at for delirium
Serum electrolytes Blood urea nitrogen level Creatinine level Complete blood count (CBC) Drug and alcohol levels Electrocardiogram (ECG) Urinalysis Liver and thyroid function tests Oxygen saturation level Lumbar puncture
75
role as nurse for delirium
Prevention Early recognition Treatment Focus on eliminating precipitating factors Protect patient from harm Encourage family members to stay at bedside If delirium is secondary to infection, antibiotic therapy is started Reorientation and behavioral interventions Create a calm and safe environment Provide reassurance Pay attention to environmental stimuli
76
Other risks for people with delirium
Immobility Skin breakdwon
77
Drug therapy for delirium
reserved for those with severe agitation puts patients more at risk for falls and injury Dexmedetomidine (Precedex) for sedation Neuroleptics Haloperidol (Haldol) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Short acting benzos

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