Chapter 44: Care Of Patients With Priblems Of The CNS: Brain

Question 0

Migraine headache

Answer 0

Typical migraine is described as unilateral, fronto-temporal, throbbing pain in the head that is often worse behind one eye or ear, often accompanied by a sensitive scalp, anorexia, photophobia (sensitivity to light and noise), and nausea with or without

˜A Migraine headache—chronic, episodic disorder with multiple subtypes
˜Classified as a long-duration headache because it usually lasts longer than 4 hours

Question 1

Stages of a Migraine

Answer 1

ØProdrome: the patient has specific symptoms such as food cravings or mood changes
ØAura phase: (if present) involves visual changes, flashing lights, or diplobia (double vision)
ØHeadache phase: may last several hours to a few days
ØPostprodrome: patient is fatigued, irritable, and has muscle pain

Question 2

Medication for migraines

Answer 2

˜Abortive therapy—alleviating pain during the early aura phase or soon after the headache has started:
ØDrug therapy to manage migraine HA’s
•Mild HA’s nonspecific analgesics Acetaminophen
•Mild HA’s nonsteroidal anti-inflammatory (NSAIDs) Ibuprofen or Naproxen, beta blockers Propranolol or Timolol
•Severe HA’s ergotamine preparations Cafergot, triptan preparataions Imitrex, isometheptene combinatiaon Midrin and antiepileptic drugs Epakote
•Triptan preparations such as Imitrex instruct patients to report chest pain or tightness immediately. They may also cause rebound HA
•Contraindicated in patients with actual or suspected ischemic heart disease, cerebrovascular ischemia, hypertension, peripheral vascular disease and those with Prinzmetal’s angina due to potential coronary vascular spasm

˜Preventive therapy: when migraine HA’s occur more than 2x/week, interfere with ADLs or not relieved with acute treatment

Question 3

Interventions for migraine

Answer 3

The 3 R’s (National Headache Foundation):
ØRecognize migraine symptoms
ØRespond and see health care provider
ØRelieve pain and associated symptoms

˜The priority for care of the patient having migraines is pain management

Question 4

Cluster headache

Answer 4

˜Cluster HA’s are manifested by brief intense unilateral pain that generally occurs in the spring and fall.
˜It is the most common chronic short-term HA with pain lasting less than 4 hours.
˜Men are affected 3-4 times more than women.
˜Histamine cephalalgia less common than migraines.
˜Cause unknown; attributed to vasoreactivity and oxyhemoglobin desaturation.
˜Unilateral, radiating to forehead, temple, or cheek, NONthrobbing
˜Ipsilateral tearing of the eye, rhinorrhea, ptosis, and miosis (pupil constriction)

They occur at the same time every day for about 4 to 12 weeks which is why they’re called cluster. You may have a period of remission for nine months afterwards.

Question 5

Cluster headache treatment

Answer 5

˜Same types of drugs used for migraines
˜Patient to wear sunglasses and avoid sunlight
˜Oxygen via mask 7-10L for 15-30min
˜Avoidance of precipitating factors, such as anger, excitement
˜Surgical management if drug resistant

Question 6

CAM for migraines

Answer 6

Yoga, meditation, massage, exercise, biofeedback, relaxation techniques
˜Acupuncture, use of herbs and nutritional therapies with approval
ØTriptan drugs should not be taken with selective serotonin reuptake inhibitor (SSRI) antidepressants or St. John’s wort, an herb used commonly for depression.
˜Avoidance of trigger events that may result in migraine episodes, such as tension and stress

˜Recommend at beginning of a migraine HA to reduce pain by lying down and darkening the room. Close or cover eyes and apply cool cloth to forehead.
˜If patient falls asleep, he/she should remain undisturbed until awakening.
˜Instruct patient to take preventive drugs regularly, avoid triggers and use complimentary alternative therapies to help them relax and avoid HA.
˜Emphasize a healthy lifestyle and avoid smoking, exercise regularly, eat a balanced diet, and get adequate rest and sleep.

Question 7

Tension headache treatment

Answer 7

Tension HA’s are the most common type of chronic long-duration HA lasting more than 4 hours
˜Neck and shoulder muscle tenderness and bilateral pain at the base of the skull and in the forehead
˜Head pain without associated symptoms
˜Treatment—non-opioid analgesics, muscle relaxants, occasional opioids
˜Ibuprofen plus caffeine
˜Prophylactic treatment similar to that used in treating migraine headaches

˜Health teaching aides:
˜Lifestyle changes to include routine sleeping pattern, exercise, massage, yoga to reduce stress, and a healthy diet to include fruits and vegetables and to avoid fasting and triggers for headaches that include caffeine, smoking, pickled foods, and red wine.

Peppermint oil may halp

Question 8

Seizure

Answer 8

Seizure—abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain; may result in alteration in consciousness, motor or sensory ability, and/or behavior

Secondary seizures—result from an underlying brain lesion, most commonly a tumor or trauma

Question 9

Tension headaches

Answer 9

˜Tension HA’s are the most common type of chronic long-duration HA lasting more than 4 hours
˜Neck and shoulder muscle tenderness and bilateral pain at the base of the skull and in the forehead
˜Head pain without associated symptoms

Question 10

Tonic-clonic seizure

Answer 10

˜Generalized seizures occur and involve both cerebral hemisipheres. There are 6 types and will discuss 2 types:
ØTonic-clonic last 2-5 minutes. Tonic phase is stiffening and rigidity of muscles and immediate loss of consciousness (LOC). Clonic is a rhythmic jerking of all extremities follows the tonic phase. May bite tongue, incontinent of urine or feces. Fatigue, confusion, and lethargy may last up to an hour after the seizure. Refer to Memory Notebook Vol. 2, 4th Ed, p. 130

Question 11

Absence seizure

Answer 11

ØAbsence seizure common in children with LOC and blank staring may last for a few seconds with automatisms (involuntary behaviors) such as lip smacking and picking at clothes

Question 12

Epilepsy

Answer 12

˜Epilepsy— defined by the National Institute of Neurological Disorders and Stroke as “two or more seizures experienced by a person”; chronic disorder with recurrent, unprovoked seizure activity, may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters (e.g., GABA)

Primary or idiopathic epilepsy is not associated with any identifiable brain lesion or other specific cause.

Question 13

Seizure treatment with meds

Answer 13

˜Antiepileptic drugs (AEDs)
ØBe aware of drug-drug and drug-food interactions. Instruct patient to avoid drugs and foods that might interfere with the absorption or metabolism of the AED. For instance warfarin (Coumadin, Warfilone) should not be given with phenytoin (Dilantin)
˜Importance of compliance
ØTeach and emphasize patients to take their drugs on time and not to miss a dose to maintain therapeutic blood levels and maximum effectiveness
˜Health teaching
ØEmphasize that AEDs must not be stopped even if the seizures have stopped can lead to life threatening complication of status epilepticus
ØTeach importance of having serum drug levels monitored to ensure a therapeutic level, and assess for high levels that could indicate toxicity

Question 14

Seizure precautions

Answer 14

Precautions are taken to prevent the patient from injury if a seizure occurs. Have to following:
˜Oxygen
˜Suction equipment
˜Airway
˜IV access, insert saline lock
˜Siderails up: Should be up and side rails are rarely the source of significant injury, follow hospital policy about use of side rails because now classified at a restraint
˜No tongue blades: padded tongue blades do not belong at the bedside and should NEVER be inserted into the patient’s mouth because the jaw may clench down as soon as the seizure begins. Forcing a tongue blade or airway into the mouth is more likely to chip the teeth and increase the risk of aspirating tooth fragments than prevent the patient from biting the tongue. Furthermore, improper placement of a padded tongue blade can obstruct the airway

Question 15

Risk for seizure

Answer 15

˜Seizures may result from:
ØMetabolic disorders
ØAcute alcohol withdrawal
ØElectrolyte disturbances. Such as      
     hyperkalemia, water intoxication, and   
     hypoglycemia
ØHeart disease
ØHigh fever
ØStroke
ØSubstance abuse

These are not considered epilepsy. Increased physical activity, emotional stress, excessive fatigue, alcohol, caffeine, foods or chemical can trigger a seizure

Question 16

Acute seizure management

Answer 16

˜Lorazepam (Ativan)
˜Diazepam (Valium)
˜Diastat (Diazepam rectal gel)
˜IV phenytoin (Dilantin) or fosphenytoin (Cerebrex) causes fewer cardiac problems than Dilantin and can be given in an IV dextrose solution

Question 17

Status epilepticus

Answer 17

˜Medical emergency!
˜Prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes
˜It is a potential complication of all types of seizures!
˜Seizures lasting longer than 10 minutes can cause death!
˜Common causes: sudden withdrawal from AED’s, infections, acute alcohol or drug withdrawal, head trauma, cerebra edema, metabolic disturbances
˜Establish an airway is the top priority! Intubation by respiratory therapy (RT) or anesthesia may be necessary
˜ABGs
˜IV push drugs of choice lorazepam (Ativan), diazepam (Valium); rectal diazepam gel (Diastat)
˜Loading dose IV phenytoin to prevent additional tonic-clonic seizures or cardiac arrest

Question 18

Seizure management

Answer 18

Precautions are taken to prevent the patient from injury if a seizure occurs. Have to following:
˜Oxygen
˜Suction equipment
˜Airway
˜IV access
˜Siderails up: Should be up and side rails are rarely the source of significant injury, follow hospital policy about use of side rails because now classified at a restraint
˜No tongue blades: padded tongue blades do not belong at the bedside and should NEVER be inserted into the patient’s mouth because the jaw may clench down as soon as the seizure begins. Forcing a tongue blade or airway into the mouth is more likely to chip the teeth and increase the risk of aspirating tooth fragments than prevent the patient from biting the tongue. Furthermore, improper placement of a padded tongue blade can obstruct the airway

Question 19

Surgical management of seizures

Answer 19

˜Vagal nerve stimulation (VNS)
˜Conventional surgical procedures
˜Anterior temporal lobe resection
˜Partial corpus callosotomy

Question 20

Care during a seizure

Answer 20

Protect from injury, do not put anything in mouth, turn to side, loosen restrictive clothing, maintain airway and suction, do not restrain, record the time seizure began and ended.

After take the patient’s vital signs, performed neurological checks, keep patient on side, allow patient to rest, document seizure

Question 21

Meningitis

Answer 21

˜Meningitis—inflammation of the meninges that surround the brain and spinal cord
˜Viral meningitis—usually self-limiting and the patient has a complete recovery
˜Bacterial meningitis—potentially life-threatening
˜Regardless of the causative organism, symptoms are the same
˜The organisms responsible for meningitis enter the CNS via the bloodstream at the blood brain barrier (BBB). Direct routes of entry occur as a result of penetrating trauma, surgical procedures, or a ruptured cerebral abscess. Example, a basilar skull fracture can lead to meningitis as a result of the direct communication of CSF with the environment

Question 22

Viral meningitis

Answer 22

˜Most common type
˜Results from a variety of viral illnesses including measles, mumps, herpes simplex and herpes zoster
˜No exudate and no organisms are obtained from the CSF.
˜Clinical manifestation of viral meningitis include fever, photophobia (light sensitivity), headache, myalgias (muscle aches), and nausea.

Question 23

Bacterial meningitis

Answer 23

˜A medical emergency with a mortality rate of about 25%.
˜Occurs most often in the fall and winter when URIs commonly occur
˜Most frequent involved organism is Streptococcus pneumoniae (pneumococcal disease) and Nisseria meningitidis (meningococcal)
˜Meningococcal meningitis is the only type of bacterial meningitis that occurs in outbreaks. It is most likely to occur in areas of high population density, such as college dormitories, military barracks, and crowded living areas

˜The number of outbreaks on college campuses has been declining over the past few years because many states require students to be vaccinated against meningitis.
˜Teach people who live in highly populated areas the importance of getting the meningitis polysaccharide vaccine to prevent infection by certain groups of meningococcal bacteria.

Question 24

Dilantin contraindication

Answer 24

˜Do not administer warfarin (Coumadin, Warfilone) with phenytoin (Dilantin) as this can interfere with the absorption or metabolism of antiepeliptic drugs (AEDs)
˜Document and report side and adverse effects and report to health care provider.

Question 25

Meningitis labs

Answer 25

˜Cerebrospinal fluid analysis is the most significant laboratory test used to diagnose meningitis
˜CT or MRI scan to identify increased intracranial pressure, the presence of a brain abscess, or developing hydrocephalus
˜Blood cultures
˜Counterimmunoelectrophoresis to determine the presence of viruses or protozoa
˜Complete blood count (WBC is elevated)

Question 26

Meningitis meds

Answer 26

˜Broad-spectrum antibiotics until results of culture and Gram stain are available. After available, the appropriate anti-infective drug to treat the specific type of meningitis is given. 2 weeks IV antibiotics is usually needed.
˜Hyperosmolar agents
˜Anticonvulsants
˜Steroids (controversial if they help)
˜Prophylaxis treatment for those who have been in close contact with the meningitis-infected patient

Question 27

Bacterial meningitis CSF

Answer 27

ØAppearance cloudy, turbid
ØWhite cells increased
ØProtein increased
ØGlucose decreased
ØCSF pressure elevated

Question 28

Viral meningitis CSF

Answer 28

ØAppearance clear
ØWhite cells increased
ØProtein increased slightly elevated
ØGlucose most often normal may be decreased
ØCSF pressure varies

Question 29

Meningitis interventions

Answer 29

˜The most important nursing intervention for patients with meningitis is the accurate monitoring and recording of their neurologic status, vital signs, and vascular assessment.
˜Standard Precautions are appropriate for all patients with meningitis unless the patient has a bacterial type that is transmitted by droplets, such as Neisseria meningitides and Haemophilus influenzae. Patients with these infections should be placed on respiratory droplet precautions as well as Standard Precautions

See pic 44-8

Question 30

Meningitis assessment

Answer 30

˜ Perform a complete neurological and neurovascular assessment. Signs and symptoms of meningitis—headache, nausea, vomiting, and fever
˜Photophobia and indications of increased intracranial pressure
˜Nuchal rigidity (stiff neck) and positive Kernig’s (flexing the patient’s hip 90 degrees then extending the patient’s knee causes pain, and Brudzinski’s sign (flexing the patient’s neck causes flexion of the patient’s hips and knees)
˜Assess and monitor for early neurologic changes that may indicated increased intracranial pressure, such as a decrease in mental status or LOC. At risk for seizure, and hydrocephalus.

Excessive amounts of ADH are produced resulting in water retention

See picture 44-7

Question 31

Encephalitis

Answer 31

˜Inflammation of the brain tissue and surrounding meninges; affects the cerebrum, the brain stem, and cerebellum
˜Caused by viral agents, bacteria, fungi, or parasites (malaria, West Nile virus mosquitoes; echovirus herpes virus, measles and mumps)
˜Degeneration of neurons of the cortex and demyelination of axons and destroys white matter and leads to hemorrhage, edema, necrosis, small lacunae develop in cerebral hemispheres

Viral encephalitis can be life-threatening and lead to learning disabilities, epilepsy, memory, or find motor deficits

Question 32

Encephalitis interventions

Answer 32

˜Prompt recognition and treatment of signs of cerebral edema, hemorrhage, and necrosis of brain tissue
˜Establishment of patent airway to prevent development of atelectasis or pneumonia, which can lead to further brain hypoxia (lack of oxygen)
˜Assessment of vital signs
˜Continuous supportive care and assessment
˜Teach people who live in mosquito-infested areas to protect themselves and families from West Nile viral infections.

Treat with Acyclovir for herpes. None for other viruses.

Question 33

Parkinson’s disease

Answer 33

˜Progressive neurodegenerative disease that is the third most common neurologic disorder of older adults
˜Tremor, rigidity, bradykinesia (slow movement), or akinesia (no movement). Cause unknown, may be due to environmental and genetic factors. Exposure to pesticides, herbicides, industrial chemicals or metals, drinking well water, over the age of 40 and reduced estrogen levels may contribute.
˜Neurotransmitters Dopamine (inhibit) and acetylcholine (ACh) checks and balances to excite muscles allowing voluntary control movement such a picking up a pencil and writing
˜A decrease in the amount of dopamine in the brain leads to a person’s ability to refine voluntary movement, and reduces the sympathetic nervous system influence to heart and blood vessels resulting in orthostatic hypotension

Question 34

Assessment Parkinson’s disease

Answer 34

˜Fatigue, slight tremor, problems with manual dexterity
˜Rigidity is present early in the disease process
˜ Changes in facial expression or a masklike facies with wide-open, fixed staring eyes are caused by rigidity of the facial muscles
˜Facial rigidity can cause uncontrolled drooling, difficulty in chewing and swallowing, and inadequate nutrition
˜Dementia as the disease progresses
˜ Changes in voluntary movement, autonomic nervous system symptoms such as excessive perspiration, orthostatic hypotension
˜No specific diagnostic tests

Question 35

Parkinson’s disease med therapy

Answer 35

Most important desired outcome is to improve mobility.
Dopamine agonists most effective the first 3-5 years of use. Fewer incidents of duskinesias (problem with movement) and “wearing off” phenomenon.
Catechol O-methyltransferases (COMTs) prolong the action of Levodopa.
Monoamine oxidase type B (MAO-B) inhibitors
Dopamine receptor antagonists for early and mild symptoms.

Question 36

Neuro assessment meningitis

Answer 36

˜The priority for care is to monitor for early neurologic changes that my indicate increased ICP, such as decreased LOC.
˜The patient is also at risk for seizure activity
˜Assess cranial nerves III, IV, VI, VII, and VIII. A sixth cranial nerve defect (inability to move the eyes laterally) may indicate the development of hydrocephalus (excessive accumulation of CSF within the brain’s ventricles).
˜Other indicators of hydrocephalus include signs of increased ICP and urinary incontinence. Urinary incontinence results from decreasing LOC

Question 37

Encephalitis assessment

Answer 37

Fever, nausea and vomiting, stiff neck, changes in mental status such as agitation, motor dysfunction such as dysphasia, focal neurological deficits, photophobia and phonophobia, fatigue, symptoms of increased pressure

Use the Glasgow coma scale to assess level of consciousness. Mental status changes are more extensive than with meningitis. The patient may have muscle tremors and jerks, increased deep tendon reflexes, seizures, vertigo,

Monitor for increased ICP such as a widened pulse pressure, bradycardia, irregular respirations, dilated pupils becoming less responsive,

Question 38

Parkinson’s management

Answer 38

˜Exercise and ambulation to maintain strength, mobility and flexibility, and to prevent falls. Remind patient to avoid concentrating on his/her feet when walking to prevent falls
˜Self-management participate as much as possible
˜Injury prevention patient with PD tend to not sleep well at night due to drug therapy. Prone to injury and may fall asleep during the day. Avoid driving and operating machinery
˜Nutrition difficulty swallowing use small frequent meals or a commercial powder such as Thick-it, soft diet or thick, cold fluids, such as milk shakes are more easily tolerated
˜Communication speak slowly, pause, may need alternative methods such as voice synthesizer or personal digital assistant
˜Psychosocial support changes in gait and tremors incontrollable, assistance with movement, difficulty talking, drooling. Encourage to undertake activities large muscle activities

Question 39

Surgical management Parkinson’s

Answer 39

ØStereotactic pallidotomy/thalamotomy
ØDeep brain stimulation
ØFetal tissue transplantation

Question 40

Alzheimer’s

Answer 40

˜Chronic, progressive, degenerative disease that accounts for 60% of dementias occurring in people older than 65 years
˜Loss of memory, judgment, and visuospatial perception and change in personality
˜Increasing cognitive impairment, severe physical deterioration, death from complications of immobility
˜Age, gender (women more than men), and family history are important risk factors
˜Environmental agents, certain viruses such as herpes zoster and herpes simplex, and metals such as copper or zinc
˜Head injury or repeated head trauma (e.g., boxers)

Question 41

Alzheimer’s changes in brain

Answer 41

˜Alzheimer’s disease creates changes that include:
ØNeurofibrillary tangles
ØNeuritic plaques
ØVascular degeneration
ØChanges in neurotransmitters
ØIncreased amounts of an abnormal protein, beta amyloid

Question 42

Manifestations Alzheimer’s

Answer 42

˜Changes in cognition
ØOne of the first symptoms of AD is short-term memory
ØThere is increasing evidence that altered smell is associated with the development of AD
˜Alterations in communication and language abilities (inability to use objects correctly, inability to find words, and loss of sensory comprehension)
˜Changes in behavior, personality, and judgment (aggressiveness, especially verbal and physical abusive tendencies, rapid mood swings, and increased confusion)
˜Changes in self-care skills (decreased interest in personal appearance, loss of bowel and bladder control, decreased interest or ability to eat)
˜Psychosocial assessment, especially patient’s reaction to changes in routine

Question 43

Alzheimer’s interventions

Answer 43

Answer patient’s questions truthfully.
˜Assess and treat other medical problems.
˜Provide cognitive stimulation and memory training.
ØIn later stages of AD, reality orientation does not work and often increases agitation. Use validation therapy that acknowledges the patient’s concerns and feelings. This does not argue with the patient and does not reinforce the patients wrong perception
˜Structure the environment to increase patient’s ability to function.
˜Prevent overstimulation and provide as much undisturbed sleep as possible
˜Orientation and validation therapy.
˜Promote self-management.
˜Promote bowel and bladder continence.
˜Assist with facial recognition.
˜Promote communication.

Question 44

Parkinson’s disease drug toxicity

Answer 44

˜Long-term drug therapy regimens often cause delirium, cognitive impairment, decreased effectiveness of the drug (wearing off or loss of response to the drug), or hallucinations.
˜Reduce medication dose.
˜Change medications or frequency of administration.
˜Take “drug holiday,” especially in the use of levodopa therapy.
˜Monamine oxidase type B (MAO-B) inhibitors (MAOIs) are use in the early stage of Parkinson disease. Teach patients about the need to avoid foods, beverages, and drugs that contain tyramine, including aged, smoked, or cured foods and sausage. Avoid red wine and beer (not all alcohol) to prevent severe headache and life threatening hypertension. Continue these restrictions for 14 days after the drug is discontinued.

Question 45

Parkinson’s disease nursing diagnoses

Answer 45

Impaired physical mobility, risk for falls, risk for self-care deficit, risk for impaired verbal communication, chronic confusion, risk for imbalance nutrition

Question 46

Alzheimer’s rf injury

Answer 46

Interventions for the patient with Alzheimer’s disease include:
ØCoping with restlessness and wandering; ensuring patient wears identification bracelet; consider registering patient in Safe Return Program; may need to install alarms and deadbolts on outside doors, providing frequent walks and structured activities
ØEnsuring safety by removing all potentially dangerous objects, particularly in case seizures occur
ØMinimizing agitation by talking calmly and softly; displaying positive affect; making calm movements; offering diversion

Question 47

Stages of Alzheimer’s

Answer 47

See 44-12

Question 48

Family coping with Alzheimer’s

Answer 48

˜Interventions for the caregiver role:
ØEncourage family to seek legal counsel regarding patient’s competency, need to obtain guardianship, or durable medical power of attorney, when necessary.
ØMake caregivers and family aware of their own health and stress resulting from new responsibilities for care.

Question 49

Disturbed sleep Alzheimer’s

Answer 49

Disturbed Sleep Pattern
˜Difficulty sleeping at night with frequent naps in the day
˜Interventions for establishing sleep pattern:
ØRe-establish the usual day-night pattern by providing activity and exercise during the day.
ØEstablish before-bedtime ritual.
ØAdjust treatment and medication schedule to provide for uninterrupted sleep.
ØGive mild antianxiety agent or hypnotic.

Question 50

Alzheimer’s psychosocial assessment

Answer 50

Affects personality and behavioral changes. They often recognize it in the early stages and begin to grieve. Assess the patient’s reactions to changes which can be very traumatic. They may overreact to any change becoming excessively aggressive. They are often unaware of their behavior and the assessment shifts to the family. Assess the ability to cope with it.

Question 51

Huntington disease

Answer 51

˜Hereditary disorder transmitted as an autosomal dominant gene (is from one parent in order for you to inherit the disease) trait at the time of conception
˜Movement disorder characterized by both neurologic and behavioral symptoms
˜Men and women affected equally and symptoms begin between 35 and 50 years of age.. Men often have more severe form.
˜Gradual clinical onset of progressive mental status changes, leading to dementia and choreiform jerky movements in the limbs, trunk, and facial muscles
˜Three stages, each lasting about 5 years over an average 15 years of the disease
˜People who inherit the mutation from fathers have an earlier onset and a shorter life expectancy

Question 52

Management of huntingtons

Answer 52

˜No known cure or treatment
˜Genetic counseling (autosomal dominant)
˜Antipsychotic agents or monoamine-depleting agents used to manage movement abnormalities that are disabling or interfere with ADLs
˜Medications to treat depression, anxiety, and obsessive-compulsive behaviors

Question 53

Imitrex/ sumatriptan

Triptan preparation

Answer 53

Contraindicated in patients with ischemic heart disease, cerebrovascular ischemia, hypertension, and peripheral

Take this medication as soon as migraine symptoms develop. Report chest pain or tightness to the doctor immediately. Use birth control while on this. Common side effects include flushing, tingling, and a hot sensation. These go away after you are used to the medicine. Do not take with an SSRI antidepressants or St. John’s wort.

Question 54

Triggers for a headache

Answer 54

Caffeine, red wine, tyramine containing products such as pickled products, caffeine, beer, wine, preservatives, artificial sweeteners.

Aged cheese, chocolate, foods with yeast, monosodium glutamate, nitrates, nuts, smoked fish,

medications such as Tagamet, estrogens, nitroglycerin,

other factors such as anger, fatigue, menstruation, Light glare, missed meals, stress, sleep problems, smells, travel to different altitudes

Question 55

Seizure nursing diagnosis

Answer 55

Risk for injury. Ineffective coping. Risk for ineffective breathing pattern. Potential for status epilepticus

Question 56

Alzheimer’s health promotion

Answer 56

There are no ways to prevent Alzheimer’s. Eat a balanced diet, dark colored fruits and vegetables, use soy products, and get folate, vitamins B12, C, and E. They have been associated with a less risk of developing Alzheimer’s. Walking, swimming, exercising help decrease mental decline and dementia.

Question 57

Dilantin phenytoin

Answer 57

Warfarin should never be given with Dilantin.
Always take the medication at the same time every day to maintain a therapeutic level.

Monitor for gastric distress, gingival hyperplasia, anemia, ataxia, and nystagmus. Check CBC and calcium levels. Monitor for therapeutic drug levels between 10 to 20 µg a toxic level is greater than 30. For IV Dilantin, flesh catheter with saline before and after.

Question 58

Alzheimer’s med therapy

Answer 58

˜Donepezil, galantamine, rivastigmine
˜Memantine
˜Antidepressants
˜Psychotropic drugs
˜Drugs will not cure or improve AD but will help control emotional responses