Chronic Neuro Flashcards
This type of a headache is often described as a feeling of a weight in or on the head and/or a band squeezing the head.
Tension headache
This type of a headache is described as an intense, throbbing or pounding pain that involves one temple. The pain usually is unilateral (on one side of the head), although it can be bilateral.
Migraine headache
headache pain is focused in and around one eye, and is often described as sharp, penetrating, or burning.
Cluster headache
General management of headaches?
- Daily exercise, relaxation periods, and socializing help reduce recurrence
- Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis
- Massage and heat packs can help with tension-type
Written tracking of medications - Teach patient about prophylactic treatment
- Avoid triggers – dietary counseling
Specific Management of a tension-type headache?
Nonopioid analgesic, massage and hot packs
Specific Management of a mild/moderate migraine headache?
aspirin, acetaminophen, caffeine combination
Specific Management of a moderate/severe migraine headache?
triptans (sumatriptan)
Preventive treatment for migraine headaches?
anti-seizure meds
Specific Management of a cluster headache?
oxygen
prophylactic tx
Seizure classification flowchart: Partial Seizures
Alert = Simple partial seizures
Altered consciousness = complex partial seizures
Nursing considerations for antisizure drugs?
- don’t d/c abruptly, may precipitate seizures
- monitor drug serum levels
Side effects of antiseizure meds?
- CNS: diplopia, drowsiness, ataxia and mental slowing
- Non-CNS: rashes, hyperplasia of gingiva
Drug therapy for generalized tonic/focal seizures?
phenytoin, carbamazepine, phenobarbital, divalproex, primidone
Drug therapy for absence/myoclonic seizure?
ethosuximide, divalproex, clonazepam
What is Status Epilepticus?
Constant or rapid succession seizures without return to consciousness
Tonic-clonic status epilepticus complications?
ventilatory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, and systemic acidosis
Medications for status epilepticus?
- IV lorazepam (ativan) and diazepam (valium)
- follow with long-acting drugs
Nursing Implementation: Prevention
- Wear helmet if risk for head injury
- Assist to identify events or situations precipitating seizures, and avoid if possible
- Instruct to avoid excessive alcohol, fatigue, and loss of sleep
Observation and treatment of seizure?
- Maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor
- Patient may require suctioning or oxygen after seizure
T/F: Newer antiseizure medications offer better treatment for older adults?`
True
What are the branches of the trigeminal nerve?
opthalmic, maxillary and mandibular
Meds to treat trigeminal neuralgia?
Antiseizure& Tricyclic antidepressants
Trigeminal Neuralgia Interprofessional/Nursing Care?
- Avoid stimuli that worsen
- Meds:
- Antiseizure
- Tricyclic antidepressants
- Good oral care
- Nutrition
- Easy to chew
Bell’s Palsy Interprofessional/Nursing Care?
- Moist heat, massage, exercise
- Meds:
- Corticosteroids – prednisone
- Anitiviral may be used – acyclovir
- Avoid cold and drafts-hypersensitivity
- Chew on unaffected side
- May use artificial tears
- Reassure patient will likely improve
Guillain-Barre Syndrome Interprofessional/Nursing Care?
- Supportive care:
- Ventilatory support – may need
- Nutrition-may need supplemental, watch hypomotility
- Urinary retention may occur
- Plasmapheresis
- Immunoglobiulin therapy
How is Bell’s Palsy Diagnoses?
by pattern/onset of symptoms
Bells’s Palsy S/S?
- inability to wrinkle brow, close eye, puff cheeks, smile or pucker
- drooping eyelid and mouth, no muscle tone
Symptoms of Guillain-Barre Syndrome?
- fast onset, resolves quickly
- develops weakness in the LE from distal to proximal
- may have residual weakness
What is the most common site for lesion formation in patients with multiple sclerosis?
optic nerve, causing diplopia and nystagmis
Common symptoms of MS?
- speech & swallowing difficulties
- numbness, paresthesia
- pain
- bladder/bowel issues
- sexual dysfunction
Initial tx of MS?
- Immunomodulators
- Interferon B-1b (Betaseron)
- Interferon B-1a (Avonex, Rebif)
- Glatiramer (Copaxone)
- immunosupressants
Tx for an acute exacerbation of MS?
corticosteroids
Symptomatic management of MS: drugs?
- Anticholinergic (oxybutynin)
- Muscle relaxants (baclofen)
(1) What is baclofen and (2) why is it given to tx MS?
1) a muscle relaxant
2) used to treat secondary muscle spasms
Ways to avoid/minimize the effects of MS?
Avoid fatigue, extremes of hot and cold, exposure to infection
Patient teaching for MS?
- balance of exercise and rest
- nutrition, include dietary fiber
- avoiding the hazards of immobility
- self-catheterization if necessary
S/S of Parknison’s disease?
- resting tremors
- cogwheel rigidity
- bradykinesia
- postural instability
- blank facial expression
- short shuffling gait
Tx for Parkinson’s disease?
- dopamine (DA) precursor
- Levodopa-Carbidopa
Where are dopamine precursors converted to DA within the body?
in the basal ganglia
What decreases the absorption of levodopa?
protein and vitamin B6 ingestion
Side effects of Levodopa?
dyskinesia and wears off over the years
Why is carbidopa added to levodopa?
inhibits enzyme that breaks down the levodopa, but still looses effectiveness over time
Steps of Deep Brain Stimulation (DBS)?
1) surveying
2) placement of permanent electrodes into the basal ganglia.
Main target areas of the brain DBS?
globus pallidus internal & subthalamic nucleus
Parkinsons’ Nursing Management and Implementation - diet?
- Promote balanced diet, exercise, sleep
- Need food that
- is easily chewed and swallowed
- cut into bite-sized pieces
- Several small meals to prevent fatigue
- Give ample time to avoid frustration
Parkinsons’ Nursing Management and Implementation - exercise & movement?
- Finger exercises (typing), ROM
- Bradykinesia - problems can be alleviated by
- Consciously thinking about stepping over a line on the floor
- Lifting toes when stepping
- Chair - use arms and place the back legs of chair on small blocks to assist in rising
- Remove rugs and excess furniture
- Simplify clothing from buttons and hooks
- Use elevated toilet seats
Meds for Myasthenia Gravis?
Pyridostigmine (Mestinon) - an Anticholinesterase or cholinesterase inhibitor
Nursing implementationfor Myasthenia Gravis?
- Maintain adequate ventilation-monitor respiratory status
- Supportive care:
- extreme weakness with repeated movement – improves with rest
- monitor for choking/aspiration of food
Drug therapy for Amyotrophic Lateral Sclerosis?
Rilutek (slows progression of disease)
Nursing care for Amyotropic Lateral Sclerosis?
- Supportive/symptomatic
- Nutrition
- Physical therapy; adaptive equipment
- Recognize as progressive, terminal disease
Non-drug management of Restless Legs Syndrome?
- Regular sleep and exercise
- Eliminate aggravators - caffeine, alcohol
Medications for Restless Legs Syndrome?
- Dopamine receptor agonists (requip, mirapex)
- Dopamine precursors (carbidopa/levodopa)
- Anti-seizure (neurontin)
