Chp. 59 - Chronic Neurologic Problems Flashcards
Tension-type headache
characterized by its bilateral location and pressing/tightening quality. They are usually of mild or moderate intensity and not aggravated by physical activity
Migraine headache
recurring headache characterized by unilateral or bilateral throbbing pain, a triggering event or factor, strong family history, and manifestations associated with neurologic and autonomic nervous system dysfunction
Migraines may be preceded by…
prodrome - something happens before a migraine (about 24 hrs) that warns a person that it is coming aura - immediately precedes migraine (not common)
What medication to take at onset of migraine (abortive)
Triptan (sumatriptan) Abortive medication Shrinks blood vessels that are causing pain
Example of prophylactic medication for migraine
Topamax
Cluster headache
rare form of headache with a sharp stabbing pain. They involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission
Tension headache Site Quality Frequency Duration Associated Symptoms
Site: bilateral, bandlike pressure at base of skull Quality: constant, squeezing tightness Frequency: cycles for many years Duration: 30 min - 7 days Associated symptoms: stiff neck/shoulders, tenderness
Migraine headache Site Quality Frequency Duration Time/mode of onset Associated symptoms
Site: unilateral (60%), commonly anterior Quality: throbbing, synchronous with pulse Frequency: periodic; cycles of several mos to yrs Duration: 4-72 hours Time/mode of onset: may be prodrome; onset after wake; improves w/ sleep Associated symptoms: N/V irritability, sweating, photo/phonophobia, family Hx
Cluster headache Site Quality Frequency Duration Time/mode of onset Assoicated symptoms
Site: unilateral, radiating from 1 eye Quality: severe, bone-crushing Frequency: may have mos or yrs between attacks Duration: 5 min - 3 hrs Time/mode of onset: nocturnal; commonly awakens pt from sleep Associated symptoms: facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis
Seizure
A paroxyxmal, uncoltrolled electrical discharge of neurons in the brain that interrupts normal function
4 phases of seizure
- Prodromal - signs/activity that precede sz 2. Aural - sensory warning of impending sz 3. Ictal - full sz 4. Postical - period of recovery after sz
Generalized seizure
involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain from the onset of the seizure (no warning or aura)
Tonic-clonic seizure
sz characterized by loss of consciousness and falling followed by stiffening of the body (tonic) and subsequent jerking of the extremities (clonic) Generalized
Absence (petit mal) seizure
sz w/ brief starting spell lasting only a few seconds (many go unnoticed); rarely continues beyond adolescence Generalized
Myoclonic seizure
sz characterized by a sudden, excessive jerk of the body or extremities Generalized
atonic seizure
sz characterized by loss of muscle tone and begins suddenly with the person falling to the ground Generalized
Tonic seizure
sz involves a sudden onset of maintained increased tone in extensor muscles (increased tone in muscles) Generalized
Clonic seizure
sz begins with loss of consciousness and sudden loss of muscle tone, followed by limb jerking Generalized
Simple partial seizure
sz do not involve loss of consciousness and rarely last longer than 1 minute
Complex partial seizure
sz usually last longer than 1 minute, frequently followed by a period of postictal confusion (amnesia of event), involve alteration in consciousness
Status epilepticus
a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures
Primary drugs to treat generalized tonic-clonic and partial seizures
phenytoin (Dilantin) ***** carbamazepine (Tegretol) phenobarbital divalproex (Depakote)
Drugs used to treat absence and myoclonic sz
divalproex (Depakote) clonazepam (Klonopin)
Drug to treat status epilepticus
diazepam (Valium)
SE for antiseizure drugs
involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing
Multiple Sclerosis (MS)
a chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord
Parkinson’s Disease
a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance
Parkinson’s Triad
1) bradykinesia - slowness in the initiation of movement 2) rigidity - increased muscle tone 3) tremor at rest
Priority Pt teaching for Parkinsons *
Avoid taking other drugs without HCP approval Take meds ON TIME!
Myasthenia Gravis (MG)
an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain muscle groups
Myasthenic crisis
an acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs
1 NDx for pt with Myashtenia Gravis
Activity intolerance ( get more tired as the day goes on)
Restless legs syndrome (RLS)
a relatively common condition characterized by unpleasant sensory (paresthesias) and motor abnormalities of one or both legs
Amyotrophic Lateral Sclerosis (ALS)
a rare progressive neurologic disorder characterized by loss of motor neurons
What happens with ALS? (progress of disease)
motor neurons in the brainstem gradually degenerate -> electrical and chemical messages from the brain do not reach muscles; ‘cognitively intact, trapped inside a dying body’
True or False: A person with Huntington’s Disease is hyperactive.
True
reverse
characterized by its bilateral location and pressing/tightening quality. They are usually of mild or moderate intensity and not aggravated by physical activity
Tension-type headache
reverse
recurring headache characterized by unilateral or bilateral throbbing pain, a triggering event or factor, strong family history, and manifestations associated with neurologic and autonomic nervous system dysfunction
Migraine headache
reverse
prodrome - something happens before a migraine (about 24 hrs) that warns a person that it is coming aura - immediately precedes migraine (not common)
Migraines may be preceded by…
reverse
Triptan (sumatriptan) Abortive medication Shrinks blood vessels that are causing pain
What medication to take at onset of migraine (abortive)
reverse
Topamax
Example of prophylactic medication for migraine
reverse
rare form of headache with a sharp stabbing pain. They involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission
Cluster headache
reverse
Site: bilateral, bandlike pressure at base of skull Quality: constant, squeezing tightness Frequency: cycles for many years Duration: 30 min - 7 days Associated symptoms: stiff neck/shoulders, tenderness
Tension headache Site Quality Frequency Duration Associated Symptoms
reverse
Site: unilateral (60%), commonly anterior Quality: throbbing, synchronous with pulse Frequency: periodic; cycles of several mos to yrs Duration: 4-72 hours Time/mode of onset: may be prodrome; onset after wake; improves w/ sleep Associated symptoms: N/V irritability, sweating, photo/phonophobia, family Hx
Migraine headache Site Quality Frequency Duration Time/mode of onset Associated symptoms
reverse
Site: unilateral, radiating from 1 eye Quality: severe, bone-crushing Frequency: may have mos or yrs between attacks Duration: 5 min - 3 hrs Time/mode of onset: nocturnal; commonly awakens pt from sleep Associated symptoms: facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis
Cluster headache Site Quality Frequency Duration Time/mode of onset Assoicated symptoms
reverse
A paroxyxmal, uncoltrolled electrical discharge of neurons in the brain that interrupts normal function
Seizure
reverse
- Prodromal - signs/activity that precede sz 2. Aural - sensory warning of impending sz 3. Ictal - full sz 4. Postical - period of recovery after sz
4 phases of seizure
reverse
involve both sides of the brain and are characterized by bilateral synchronous epileptic discharges in the brain from the onset of the seizure (no warning or aura)
Generalized seizure
reverse
sz characterized by loss of consciousness and falling followed by stiffening of the body (tonic) and subsequent jerking of the extremities (clonic) Generalized
Tonic-clonic seizure
reverse
sz w/ brief starting spell lasting only a few seconds (many go unnoticed); rarely continues beyond adolescence Generalized
Absence (petit mal) seizure
reverse
sz characterized by a sudden, excessive jerk of the body or extremities Generalized
Myoclonic seizure
reverse
sz characterized by loss of muscle tone and begins suddenly with the person falling to the ground Generalized
atonic seizure
reverse
sz involves a sudden onset of maintained increased tone in extensor muscles (increased tone in muscles) Generalized
Tonic seizure
reverse
sz begins with loss of consciousness and sudden loss of muscle tone, followed by limb jerking Generalized
Clonic seizure
reverse
sz do not involve loss of consciousness and rarely last longer than 1 minute
Simple partial seizure
reverse
sz usually last longer than 1 minute, frequently followed by a period of postictal confusion (amnesia of event), involve alteration in consciousness
Complex partial seizure
reverse
a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures
Status epilepticus
reverse
phenytoin (Dilantin) ***** carbamazepine (Tegretol) phenobarbital divalproex (Depakote)
Primary drugs to treat generalized tonic-clonic and partial seizures
reverse
divalproex (Depakote) clonazepam (Klonopin)
Drugs used to treat absence and myoclonic sz
reverse
diazepam (Valium)
Drug to treat status epilepticus
reverse
involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing
SE for antiseizure drugs
reverse
a chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord
Multiple Sclerosis (MS)
reverse
a chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor at rest, and gait disturbance
Parkinson’s Disease
reverse
1) bradykinesia - slowness in the initiation of movement 2) rigidity - increased muscle tone 3) tremor at rest
Parkinson’s Triad
reverse
Avoid taking other drugs without HCP approval Take meds ON TIME!
Priority Pt teaching for Parkinsons *
reverse
an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain muscle groups
Myasthenia Gravis (MG)
reverse
an acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs
Myasthenic crisis
reverse
Activity intolerance ( get more tired as the day goes on)
1 NDx for pt with Myashtenia Gravis
reverse
a relatively common condition characterized by unpleasant sensory (paresthesias) and motor abnormalities of one or both legs
Restless legs syndrome (RLS)
reverse
a rare progressive neurologic disorder characterized by loss of motor neurons
Amyotrophic Lateral Sclerosis (ALS)
reverse
motor neurons in the brainstem gradually degenerate -> electrical and chemical messages from the brain do not reach muscles; ‘cognitively intact, trapped inside a dying body’
What happens with ALS? (progress of disease)
reverse
True
True or False: A person with Huntington’s Disease is hyperactive.