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