Chapter 42 Flashcards
Intracranial pressure
Normal 10-15 above 20 can be hypoxic and death
Lying down can decrease ICP
Increase CO2 causes vessels to dilate and decreased O2 causes edema which can increase ICP
Cushing Triad with ICP
Increased pulse pressure
Decreased pulse
Irregular respirations- Biots
Cerebral perfusion pressure
Blood flow to the brain
70-100 normal
Less than 55 is associated with ischemia and neuronal death
Migraine
Aura occurs Unilateral Frontotemporal Throbbing pain behind ear or eye Photophobia, phonophobia, nausea Women with migraines have increased risk for stroke Drugs: Tylenol, ibuprofen, BB, CCB, Triptans- report angina, may have rebound HA, avoid triggers such as alcohol, chocolate, thyramine Avoid opioids and barbiturates
Cluster HA
Occurs for 30 min to 2 hrs at same time of day
Unilateral, excruciating, nonthrobbing pain
May radiate to forehead, temple, cheek
Often pace, walk, sit/Rock
Common in spring and fall
Avoid triggers
Intervene:’consistent sleep wake cycle, lithium, corticosteroids, oxygen, surgery
Generalized seizure
Involves both hemispheres
Tonic clonic: 2-5 min, unconscious, full out seizure
Tonic: unconscious, autonomic changes, 30sec- minutes
Clonic: several minutes, muscles contract
Atonic:’loss muscle tone, few seconds, risk for falls, resistant to drug therapy
Partial seizure
One hemisphere
Less responsive to Meds
Complex: lose consciousness, 1-3 minutes, prior wander, after amnesia, most common
Simple: conscious, aura, one sided movements, autonomic changes- change in HR, flushed, epigastric discomfort
Epilepsy
2+ seizures
Primary- seizure expected
Idiopathic- unsure of reasoning
Seizure precautions
Oxygen Suction in buccal space Airway IV access Padded side raises per protocol
Seizure management
Depends on type Pt safety Side lying position to protect airway No restraints Nothing in mouth
Status epilepticus
Seizure lasting longer than 5 minutes Longer than 10 min could cause death Medical emergency Assess airway, ABGs IV push lorazepam, diazepam Prevention is IV Dilantin Check serum drug levels
Drug therapy
Use combination
Monitor therapeutic blood levels Q6-12 hours then every 2 weeks
Can build up sensitivity
DONT give Warfarin with Dilantin
NO grapefruit juice, can increase toxicity
DONT abruptly stop
Meningitis
Inflamed meninges Droplet precautions Caused by viral, bacterial, fungal, Protozoa, CA, NSAIDs, ABT, IV IG Occurs in high populated areas Increase risk at age 16-21 Prevention = Vaccination
Caring for pt with Meningitis
Sx: decreased LOC, disoriented, nuchal rigidity, photophobia, HA, myalgia, N/V, increased ICP, macular rash
Labs: CSF, CIE, CT, Xray, gram stain, CBC
Intervene: ABCs, prevention, neurons Q4H, broad spectrum ABT, mannitol, prophylaxis tx- Rifampin, vascular assessment Q4H, v.s, private room, 3 ft away unless mask on, manage pain, monitor labs
Bacterial vs. Viral CSF
Bacterial- cloudy, decreased glucose
Viral- clear
Encephalitis
Inflamed brain tissue
Caused by viral, bacteria, fungi, parasites
Death from herniation or increased ICP
Care for pt with Encephalitis
Assessment- fever, N/V, change LOC, fatigue, joint pain, HA, vertigo
Labs- LP, PCR, EEG, CT
Interventions- prevention, Acyclovir, resp support, TCDB, v.s and neuro Q2H, elevate HOB, quiet env
Changes in v.s. That require immediate attn with encephalitis
Widened pulse pressure
New Bradycardia
Irreg resp effort
Dilated pupils and less responsive to light
Parkinson’s disease
Progressive neuro degenerative disease
PNS- changes muscle action
Autonomic- changes in BP, HR
Affects motor ability
Care for PD
Assessment- stooped posture, shuffled gait, a/bradykinesia, pill rolling motion, slurred speech, masklike face
Labs-CSF: decreased dopamine, MRI, PET
Interventions- preserve mobility, cognition, QOL, with end stage manage airways, sleep pattern, small frequent meals, weekly wt, allow time to respond, admin med on schedule, monitor for s/e, keep pt as independent as possible
Drugs with PD
Tx symptoms
Dopamine agonists- minim dopamine, effective for 3-5 years, Requip
Neupro- dopamine agonists transdermal patch
Sinemet- before meals, long term use for dyskinesia
Parlodel when others aren’t effective
Drug holiday
Alzheimer’s disease
Loss of brain fxn
Impairs language, judgment, behavior
Age, women, family hx are risk
Af Am increased risk, Hispanics diagnosed early
Intervene- memory training, structured env, self management, B&B
Drugs- Aricept, Namenda, SSRI- Zoloft
Huntington disease
Hereditary, autosomal dominant
Onset 30-50 y.o.
Die from other complication such as PNA, heart failure
Progressive mental status change and rapid, jerky movements
Triad: dominant inheritance, choreoathetosis, dementia
Maintain ADLs
Tegretol
Monitor CBC
Don’t crush
Klonopin
Monitor results of liver fxn test
Depakote
Monitor CBC, PT, PTT, AST
Lamictal
Life threatening rash when given with valproic acid
Keppra
Monitor renal fxn
Notify PCP for gait or coordination problems
Phenobarbital
Overdoses can be fatal
Dilantin
Cause gingival hyperplasia
Check CBC and Ca levels
Therapeutic levels 10-20, toxic >30
