ch 58 chronic neurologic problems Flashcards
1
Q
three types primary headaches
A
- tension
- migraine
- cluster
2
Q
S+S tension headache (3)
A
- bilateral
- band like pressure
- intermittent, episodic
3
Q
red flags that would warrant imaging for headaches (7)
A
- fever
- recent weight loss
- h/o cancer
- waking from sleep with headache
- headache first thing in morning
- vomiting
- new onset >50 yo
4
Q
abortive meds for tension headache
A
tylenol
NSAIDs
5
Q
preventative meds for tension headache (3)
A
- tricyclic antidepressant (amitriptyline)
- SSRIs (fluoxetine)
- antiseizure (topiramate)
6
Q
what is important to remember about topiramate (antiseizure med)
A
don’t stop abruptly
causes weight loss
7
Q
S+S migraine headache (4)
A
- unilateral throbbing pain
- w/ or w/o aura
- N/V
- light/sound sensitivity
8
Q
if someone has aura with migraines, what med should they not take that would put them at increased risk for DVTs
A
birth control pills
9
Q
abortive meds for migraines (3)
A
- NSAIDs
- tylenol with caffeine
- triptans (take at 1st sign migraine)
10
Q
preventative meds for migraines (6)
A
- topirimate (antiseizure)
- b blocker
- botox
- SSRIs
- calcium channel blocker
- divalproex, clonidine, thiazides
11
Q
contraindication to triptans for migraine treatment
A
uncontrolled HTN
12
Q
S+S cluster headache (6)
A
- unilateral
- pain around eye
- eye swelling
- rhinitis
- constricted pupil
- periods of remission
13
Q
risk factor for cluster headache (2)
A
- heavy drinking
- smoking
14
Q
treatment cluster headache (3)
A
- give 100% O2 through nonrebreather mask
- preventative meds
- triptans
15
Q
diagnostic for seizures
A
EEG
16
Q
2 big categories of seizures
A
partial
generalized
17
Q
2 types partial seizures
A
simple focal seizure
complex focal seizure
18
Q
S+S simple focal seizure
A
vision changes
19
Q
S+S complex focal seizure
A
- altered LOC
- period of confusion
- vision changes
20
Q
state of constant seizure
A
status epilepticus
21
Q
S+S tonic seizures
A
- stiffness
- fall backward
22
Q
S+S atonic seizures
A
“drop attack”
fall forward
23
Q
S+S absence seizures
A
spaced out
24
Q
S+S myoclonic seizures
A
muscle jerks
often in clusters and in a.m.
25
S+S tonic clonic seizures
```
stiff
unconscious
fall
shaking
foamy mouth
```
26
types generalized seizures (5)
- tonic
- atonic
- absence
- myoclonic
- tonic clonic
27
how to stop status epilepticus
rectal suppository of benzodiazepine
28
common side effect phenobarbital
drowsiness 2-3 weeks
29
therapeutic level phenytoin
10-20
30
nursing considerations for gabapentin (2)
- assess for suicidal thoughts
| - high fall risk
31
common side effect topiramate
weight loss
32
teaching for pt with phenytoin
use soft toothbrush
33
what diet might seizure pt be put on before surgery
keto diet
34
autoimmune CNS disorder in which antibodies attack acetylcholine receptors
myasthenia gravis
35
S+S myasthenia gravis (3)
- worsen throughout day
- fluctuating weakness of head, neck, and resp muscles
- ptosis
36
what can myasthenia gravis cause that results in airway emergency
paralysis of diaphragm
37
treatment myasthenia gravis (3)
- anticholinesterase meds
- corticosteroids
- immunosuppressants
38
treatment myasthenic crisis (2)
- plasmapheresis
| - stress dose steroids
39
S+S restless leg syndrome
- pain at night
| - need to keep moving legs
40
treatment restless leg syndrome
- regular sleep habits
| - meds: opioids, benzos, dopaminergic
41
treatment for amyotrophic lateral sclerosis (ALS)
no treatment
| palliative: riluzole slows progression of disease
42
S+S ALS (3)
- dysphagia
- dysarthria (speaking)
- weakness of upper extremities
43
S+S huntingtons disease
-abnormal and excessive involuntary movements of face, limbs, and body (chorea)
44
treatment huntingtons disease
no treatment
| palliative: antipsychotic, antidepressant, antichorea meds
45
CNS disorder more prevalent with increased age, slow onset, disrupts muscle response to dopamine
parkinsons disease
46
S+S parkinsons disease (7)
- tremor
- joint rigidity (cogwheeling in passive ROM)
- bradykinesia
- shuffling gait
- memory impairment
- dysphagia
- blank affect
47
complications parkinsons disease (4)
- constipation
- insomnia
- parkinsonian dementia
- orthostatic hypoTN
48
treatment parkinsons disease (4)
- levodopa with carbidopa
- dopamine receptor agonists
- anticholinergics
- surgery (deep brain stimulation)
49
how does levodopa with carbidopa help treat parkisons
increase dopamine levels
50
side effects levodopa with carbidopa (2)
- orthostatic hypoTN
| - nausea
51
side effects anticholinergics (amantidine) (3)
- dryness
- urinary retention
- constipation
52
contraindication for deep brain stimulation for parkinsons
parkinsonian dementia
53
nutrition considerations for parkinsons pt
- combat malnutrition and constipation
| - small frequent meals
54
autoimmune degenerative CNS disease characterized by disseminated demyelination of nerve fibers of brain and spinal cord
multiple sclerosis (MS)
55
S+S multiple sclerosis (5)
- vague, relapsing remitting pattern
- progressive muscle weakness/paralysis
- difficulty with speech
- decreased hearing and vision
- spastic bladder and incontinence
56
Dx MS
MRI of spine (shows multiple lesions)
57
treatment for MS that slows progression of disease
- corticosteroids
- immunosuppressants
- immunomodulators
- anticholinergics
- muscle relaxants
58
two surgery options for MS
- dorsal column stimulation
| - intrathecal baclofen pump (muscle relaxant)
59
nutrition considerations for pt with MS (2)
- multivitamins
| - low fat diet
60
what can the UAP help with for seizures (4)
- have emergency O2 equipment at bedside
- pad side rails, remove potentially harmful objects
- report any seizure activity to RN
- obtain VS after seizure
61
important admin teaching with levodopa
don't take with food
