CH 65 Misc Neuro Flashcards
This flashcard is going to talk about cranial nerve problems and will follow the recording on blackboard
what is trigeminal neuralgia ?
benign condition that is characterized by sudden, unilateral severe, brief stabbing, recurrent episodes of pain along trigeminal nerve
trigeminal neuralgia is a bengin condition but has considerable amount of what ?
pain and life style disruption from physical and psychologic dysfunction
trigeminal neuralgia may be related to underlying conditions like ?
shingles
multiple sclerosis
cerebellar
brainstem masses
there are two types of classifications of trigeminal neuralgia which are ?
tn1(classic) and tn2(atypical)
what are the clinical manifestation
what is the first episode ?
sudden onset of abrupt waves of excruciating pain
(burning, knifelike or lightning-like shock in the lips,gumes,cheek, forehead, side of the nose)
in an acute attack of tn1, most of the time they will have what?
facial twitching
grimacing
frequent blinking and tearing
facial sensory loss
how long are attacks
how frequent are attacks ?
seconds to 2-3mins
1 to over 50x a day
how does the pain or gets triggered with TN?
light touch at trigger zone along distribution of nerve branches
(chewing, brushing teeth, hot or cold blast of air, washing the face, yawning, talking)
the pain can be so intense that patients will tend to do what ?
think of some triggers and patients will try to avoid doing these things to avoid being triggered
neglect nutrition, hygiene, cloth over face, social withdrawal
excessive sleeping
TN2 usually symptoms are what ?
constant aching, burning, crushing, or stabbing pain
(lower intensity, does not completely subside)
lower intensity pain but there all the time
what are some diagnostic studies for TN?
kinda rule out other disorders causing facial pain
MRI, neurologic, dentistry, pain management, reconstruction possible
what is the main goal for TN?
notes
half of patients may have recurrent pain for up to 15 years!
pain relief
what are the 3 types of drug therapy we can use to help aid patients with TN?
anti-seizure drugs
tca
local nerve block with anesthetic or botulinum toxin
( or surgery to help aid the nerve )
TN nursing assessment notes
Assess attacks
- Triggering factors
- Characteristics
- Frequency
- Pain management techniques
Assess:
- Hygiene; include oral hygiene
- Nutrition
- Behavior (withdrawal)
- Lifestyle disruption
Emotional state, drug use or other coping mechanisms, suicidal tendicies
TN nursing management
Monitor response to drug therapy and side effects
- Complimentary pain management options
- Acupuncture, biofeedback, and yoga
- Environmental assessment to reduce triggers
- Protect face from temperature extremes
- Use electric razor
how are we going to help with nutrition with TN?
if they can’t eat, where do we place the ng tube ?
luke warm and high protein
unaffected side with enteral feedings
when do we start oral care if they are on medications/analgesia ?
take their med first then start brushing teeth to aid with avoiding triggers
how often should these patients visit the dentist ?
semi-annually
The section we are talking about is
Bell’s Palsy
what is this ?
acute, usually temporary facial paresis (or palsy) from damage to facial nerve (CN VII (7)) ; usually unilateral but can be bilateral
the exact cause of Bell’s palsy is unknown but often occurs with pregnancy, upper respiratory conditions, hypertension, 15-60 years old and affect both genders equally.
how long do you think it takes to recover from Bell’s palsy since it is typically an acute condition ?
2weeks-6months and residual effects are possible even after recovery
what are facial characteristics of bell’s palsy ?
inability to wrinkle brow
drooping eyelid
inability to smile/pucker
inability to puff cheeks/ no muscle tone
usually one side only
what cranial nerve does Bell’s palsy affect?
7
what is the key feature of Bell’s palsy ?
unilateral lower motor facial weakness
notes
bells palsy clinical manifestations
50-60% have pain behind the ear and neck
drooping eyelid and corner of the mouth, facial twitching, dryness of eye or mouth, facial numbness, altered taste, hearing loss, excessive tearing in one eye
how do symptoms appear and what is the peak for Bell’s palsy?
onset is sudden
peak is 48-72 Hours
bells palsy patients usually will have problems eating, swallowing, taste and speech why ?
because literally one side is paralysis, they won’t be able to move or anything
what are diagnostic studies for Bell’s palsy?
rules out other possibilities
( especially stroke)
how can we rule out stroke from diagnosing Bell’s palsy ?
just the face paralysis for bells
entire side of the body for stroke
what are medications we can aid with Bell’s palsy? (3)
corticosteroids
antivcials
lubricating drops/cream for eye
how can we help with pain for Bell’s palsy ?
how can we help with nutrition?
how can we help protect their eye ?
any other information to tell bells?
mild analgesia
chew on unaffected side
orla hygiene after meals
dark glasses, ointment, shields
protect face from cold, exercise facial muscles, facial sling to support
Guillain-Barre Syndrome (GBS)
what is it ?
what causes it ?
nerve transmission is slowed or stopped, leading to flaccid paralysis with muscle denervation and atrophy
vital or bacterial causes
( campylobacter jejuni )
what is the clinical manifestation for GBS?
acute, ascending, rapidly progressive, symmetric weakness of limbs
pins and needles feelings
notes
we also have an GBS autonomic nervous system dysfunction
- orthostatic hypotension
- hypertension
- abnormal vagal respones
(bradycardia, heart block, systole)
- bowel and bladder dysfunction
-facial flushing
- diaphoresis
CN involvement
- facial weakness, paresthesia, emo movement problems, dysphagia
pain
- worst at night
- sleep disruption
what is the biggest concern for GBS?
why is it^
and what do we do if it happens^
respiratory failure
paralysis progressive to nerves in thorax
- frequent assessment of RR and depth
may need intubation and mechanical ventilation
how do we help patient with respiratory compromise with GBS?
ventilatory support
what are the 2 medications that we are going to use to help aid with GBS?
plasma exchange (plasmapheresis)
high-dose iv immunoglobim (ivig)
high does of iv immunoglobulin for gbs is most effective during when ?
first 2 weeks on symptom onset
we are doing neurologic assessment
like their motor reflex
- remember its ascending paralysis
respiratory assessment
- pulse ox
- monitor depth and rate
cardiac assessment
- monitor bp and hr
fever
- suptum and blood cultures; antibiotics
nutriton
- delayed gastric emptying - risk for aspiration and develop paralytic ileus -> obstruction
may need enteral (ng tube)
sitting up, semi fowlers ! no laying flat cause of aspiration
limit the amount of muscle atrophy
ot and pt therapy
recovery stats within 28days
80% walk independently at ____months
60% have full recovery in ___year
6
1
what is chronic inflammatory demyelinating polyneuropathy (CIDP)?
affects motor and sensory functions of your nerves
when do CIDP symptoms occur ?
symptoms gradually over 8 weeks - no acute onset
no self-limited ( no ending point )
the biggest concern we are talking about CIDP, its because it looks like GBS, so we want to be able to differentiate and properly treat.
what is the classic presentation of CIDP?
progressive symptoms lasting longer than 2 moths
symmetrical weakness in arms and legs
distal to proximal
numbness tingling
decreased absent reflexes
papilledema
pin prick sensations issue
what’s the goal for CIDP?
stop immune response, nerve inflammation and deymeylination
what are the 3 medications we use for CIDP?
IVIG
high-dose corticosteroids
plasma exchange
how do we help with rehab with CIDP?
improve muscle strength, function and mobility
reduce atrophy and joint distortion
what is tetanus caused by ?
clostridium tetani
(anaerobic bacillus release potent neurotoxin, tetanospasmin )
what is tetanospasmin ?
binds to motor nervres and enters axons in the brain and spinal cord, stopping release of inhibitory neurotransmitters and causing sustained muscle contractions
how long is the incubation of tetanus and how does it enter the body ?
4-14days
enters body through wound
what is the hallmark features of tetanus ?(3)
muscle rigidity and spams
trismus - jaw stiffness
risks sardonicous - sardonic smile
what are severe forms of tetanus ?
tonic seizure
any noise, light they can have painful Spams
respiratory spams = respiratory concern
prevention is key!
get your shot every what ?
10 years
the general rule is if a patient comes with a dirty wound, you give the booster shot!
- more than 5 years, you get another one
wound care - cleaning it
tetanus is a medical emergency, why so ?
because of the respiratory spams that can occur
what do we give during a tetanus emergency ?
tetanus immune globulin (TIG) provides temporary immunity by antitoxin
how can we help with pain management and overall drug medication for tetanus ?
skeletal muscle relaxants
sedative
neuromuscular blocking agents
after the medications, they are often put on antibiotics for ____days
examples like
tetracycline, doxycycline
10-14days
if a patient with having respiratory spams, they are going to be on a mechanical ventilation
- given neuromuscular blocking agents
(sedative and opioids)
hydration - iv fluids
wounds
- debride or drain abscess
- antibiotics to prevent secondary infection
