Chronic Neurological Problems Flashcards
Tension-Type Headache
Bilateral, pressing/tightening
mild to moderate no prodrome (aura)
may have photophobia
Migraine headache
unilateral or bilateral throbbing pain
May have prodrome
Females more likely to have
peak incidence between 20-30y.o
“Hibernate”
Migraine triggers
foods, stress, hormone, meds,fatigue
Migraine s/s
irritable, generalized edema, pallor, N/C, photophobia
Cluster Headaches
Rare
Sharp, stabbing pain, usually around the eyes radiating to forehead, temple, cheeks, nose, gums
Agitated/restless
May last 4-8wks = get them and then they go away for a period before coming back
Prodrome
“Aura” - sensory input
Smell, taste, vision that happens before a headache
Headache Dx
Dx by exception - r/o other causes (brain tumor, injury)
HPI, headache hx
EMG (Tension-Type)
CT/MRI if headache is abnormal
Headache Tx
NSAIDS/Acetaminophen – NO OPIOIDS
Muscle relaxants = Tension Type
Serotonin receptor agonist = migraines
100% O2 = acute clusters
Overall goals for headaches
reduced or no pain
increased comfort/decrease anxiety
demonstrate an understanding of triggering events and tx strategies
positive coping strategies to deal with chronic pain
increased quality of life and decreased disability
Nursing Management/Teaching for Headaches
headache diary
quiet, dim environment
moist head and massage to the neck
Seizure
Paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function
abnormal firing of brain; location determines presentation (not every seizure is the same)
May be idiopathic
Most stop on their own
Idiopathic
symptoms of another disease/disorder/ or without apparent cause
Epilepsy
spontaneous recurring seizures from a chronic cause
75% are idiopathic – don’t know the etiology
Non-neurological reasons for seizures
alcohol withdrawal, extreme temp. changes, brain tumors, hypo/hypernatremia, hypoglycemia, excessive amounts of toxins in the body (ecstasy)
Seizure Disorder/Epilepsy Clinical manifestations
Prodromal phase
Aural phase
Ictal phase
Postictal phase
Prodromal phase
sensation of a seizure coming
Aural phase
sensory input
Ictal phase
during seizure
Postictal phase
immediately after seizure
confused, can be combative
Generalized Seizures
loss of consciousness
Tonic clonic, atypical and typical absence (in children)
Tonic Clonic (grand mal)
loss of consciousness and falling to the ground
Stiffness of the body (tonic) - cannot breathe, excessive salivation, tongue or cheek biting, incontinence
jerking of the extremities when the brain relaxes (clonic)
Partial aka Focal Seizures
one areas of the brain is affected
Simple or Complex partial
Status Epilepticus
continuous tonic clonic seizures
at risk for brain damage, hyperthermia, muscle breakdown, death if left untreated
Seizure disorders/Epilepsy complications
Status epilepticus
Physical injury
psychosocial
Seizure disorders/Epilepsy Dx
CBC/Chemistries/LFT/UA to r/o metabolic disease
CT or MRI
EEG - electrical activity in the brain
Seizure Disorder/Epilepsy Tx
treat underlying disease if possible
Client Safety
Ativan - tops active seizures
surgical therapy
O2 in the room, Padded bedside rails, suction kit, nasal cannula
seizure disorder/epilepsy teaching
monitor serum levels
med teaching: side effects, don’t stop taking them
adequate rest, proper diet, exercise
avoid excessive alcohol intake
Medical alert bracelet
Driving considerations
Multiple Sclerosis
chronic, progressive, degenerative d/o of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord
slow onset; chronic w/ periods of remission and exacerbations
onset between 20-50y.o
mostly in females
cause unknown: viral, immunologic,genetic
Multiple Sclerosis clinical manifestations
weakness, paralysis of limbs, trunk, head diplopis scanning speech pasasthesia scotomas (patchy blindness) decreased hearing fatigue spasticity constipation urinary urgency/freqeuncy/ dribbling/ incontinence decreased libido erectile dysfunction remission or improvement with pregnancy but high risk of exacerbation during postpartum emotional lability intellectual functioning unaffected
multiple sclerosis dx
MRI
LP for analysis of CSF
multiple sclerosis tx
no cure corticosteroids immunomodulator - interferons immunosuppressants anticholinergics - bladder symptoms muscle relaxations - for spasticity CNS stimulants - for fatigue PT, OT, speech therapy
Nutrition: Vit. B12, C, low fat, gluten free; high roughage
Be aware for triggers
Life expectance >25 yrs after onset
Death usually from infection r/t immobility or unrelated disease
Myasthenia Gravis
autoimmune disease
Antibodies attack acetylcholine receptors
exacerbations: stress, secondary illness, menses, pregnancy, trauma, temp. extremes, hypokalemia, certain meds
Myasthenia Gravis clinical manifestations
fluctuating weakness of skeletal muscle
strength restored with rest
muscles used for movement of eyes, eyelids, chewing, swallowing, speaking, and breathing most commonly involved
muscles are strongest in the morning with weakness most prominent at night
no sensory loss, reflexes are normal
muscle atrophy is rare
Myasthenia Crisis
acute exacerbations of weakness
affects swallowing and breathing
Myasthenia Gravis Dx
Hx and PE
EMG
Anti-achr antibodies
anticholinesterase agent (Tensilon Test) - dx and therapeutic –> ATROPINE at bedside!!!
Myasthenia Gravis tx
anti cholinesterase drugs alternate day corticosteroids immunosuppressants Thymectomy (if thymoma present) Plasmapheresis - short term for crisis Immunoglobulin G - second line tx
Amyotrophic Lateral Sclerosis
rare - degeneration of motor neurons in the brainstem and spinal cord
mostly in med usually 40-70y.o
dx w/ HPI no specific tests
Amyotrophic Lateral Sclerosis manifestations
weakness in upper extremities dysarthria dysphagia muscle wasting no cognitive impairments death usually occurs from respiratory infection or compromised respiratory function
ALS collaborative Care
no cure
Riluozle - delays need for tach and death
moderate exercise supportive cognitive and emotional functioning reduce risk of aspiration treat pain reduce risk of injury diversional activities support family/friends
Huntington’s Disease
genetically transmitted autosomal dominant disorder in men and women
offspring client have 50% chance of getting disease
onset between 30-50 y.o
Deficiency of Ach and GABA, excess Dopamine
Huntington’s Disease minifestations
abnormal and excessive involuntary movements (chorea) twisting movement of face, limbs, body speech impairment loss of cognitive ability emotional lability psychotic behavior difficulty swallowing, chewing
Huntington’s Disease Dx
HPI, presence of gene
No cure
death usually 10-20ys after onset due to infection, choking, pneumonia
palliative care: antipsychotic meds, maintain safety, reduce risk of aspiration, high calorie diet due to chorea (4-5000 calories), provide family support
