Exam 2: Chronic Neurological Problems Flashcards
What are the 3 types of headaches ?
- Tension
- Migraine
- Cluster
Specify the location of each type of headache (bilateral or unilateral)
- Tension: ?
- Migraine: ?
- Cluster: ?
- Tension: Bilateral
- Migraine: Unilateral
- Cluster: Unilateral
What type of headache presents as…
- band-like
- constant
- squeezing
- Neck/shoulder tension
Tension headache
What type of headache presents as…
- throbbing
- Premonitory symptoms of aura
- improves with sleep
Migraine headache
What type of headache presents as…
- severe
- nocturnal - awakes from sleep
- have multiple a day
Cluster headaches
What is the Tx for tension headaches ?
- NSAID/analgesic combinations
What is the Tx for Migraines ?
- NSAIDS
- Maxalt
- Imitrex
- Analgesics
What is the Tx for Cluster headaches ?
- A (Alpha) Adrenergic blockers (Ex: Ergotamine)
- Maxalt
- Imitrex
What is the prevention for Migraines ?
Avoid triggers !
- Food
- ETOH
What is the prevention for Tension Headaches ?
Relaxation
What is the prevention for Cluster headaches ?
Biofeedback
What is Epilepsy defined as ?
A predisposition to seizures
Seizures can be caused by what types of things ?
- Electrolyte imbalances
- Hypoglycemia
- ETOH withdrawl
- Withdrawl from benzodiazepines
(ex: Ativan, valum)
What are seizures defined as ?
Transient, uncontrolled electrical discharge of neurons in the brain, interrupting normal function
Seizures can be what ?
- Spontaneous (idiopathic)
- Systemic or metabolic
Systemic or metabolic seizures are not considered to be what ?
Epilepsy
if they end when the condition is corrected
(ex: febrile seizure)
Focal seizures happen where ?
in 1 hemisphere of the brain
Generalized seizures happen where ?
Involve both hemispheres of the brain
Clinical manifestations of seizures depend on what ?
The type & location of the seizure
What are the 4 phases of a seizure ?
- Promodal phase
- Aural phase
- Ictal phase
- Postictal phase
what is the Promodal phase of a seizure ?
Sensations that precede the seizure
- can be hrs or days before the presence of the seizure
The Aural phase of a seizure happenes when ?
Right before the seizure
What is the Aural phase of a seizure present as ?
A sensory warning
(ex: a feeling of warmth, visual changes, etc)
- its similar each time
- Happen before a tonic clonic seizure
What is the Ictal phase of a seizure defined as ?
From the 1st symptom (ex: twitching in face) of the seizure to the end of the seizure activity
What is the postictal phase of a seizure defined as ?
The recovery phase after the seizure
What diagnostics are used for Seizures ?
- Good H&P
- Detailed seizure description
- EEG, LP, CBC, UA, Electrolytes, BS
- CT, MRI, PET
(generally used to rule out any anomalies (tumors, lesions) in the brain which could be causing seizures)
What type of therapies are used seizures ?
- Ant-seizure medications
- Surgery
(if an area of the brain can be identified as the source of the seizure activity) - Vagal nerve stimulation
What is the Nursing Management GOAL with seizures ?
- keep pt’s Free Of Injury !
- Maintain airway !
What are nursing interventions used during seizures ?
- Protect from injury
- Note time, duration, and characteristics of seizure
- Assess behavior at onset
- Administer meds to stop onset
- Document seizure
- Allow to rest after seizure
What is vagal nerve stimulation ?
An electrode is implanted into the neck that can be programed to provide electrical impulses to the vagus nerve.
- hyper stimulating the vagus nerve can reduce seizure activity
In the hospital setting when someone is under seizure precautions, what is always kept at the bed side ?
Suction ! always set up
What is the medication (category) of choice to stop a seizure ?
A Benzodiazipine
example:
- lorazepam
- ativan
What is the Goal of drug therapy with seizures ?
Maximal control with minimal toxic side effects !
What should you do when initiating drug therapy for a seizure ?
Start with a single drug
- Increase until the seizure is controlled OR toxic s/e occur
If seizure control Is not achieved with a single drug, what should you do ?
Add a second drug
When controlling seizures with drug therapy, what should you do ?
- Monitor serum drug levels
- Do not stop the drug abruptly
During acute seizures what type of drug therapy is usually used to stop seizures ?
Benzodiazepines
- valium
- Ativan
What are side effects of Anti-seizure drugs, that occur outside of the CNS ?
- Rashes
- Hyperplasia of gingiva (overgrowth of the gums)
- Blood dycrasias (change in the WBC count)
- Toxicity on Liver & kidneys
What are patient teaching points for Seizures ?
- Take all medications as prescribed
- If miss a dose - CHECK W/ THE DR.
- DO NOT stop meds without MD authorization
- Wear medic alert tag
- Avoid excessive ETOH, fatigue, & loss of sleep
- Regular meals & snacks if feeling shaky, faint, or hungry
- Family teaching- what to do if a seizure occurs
What disease is defined as a “Chronic, progressive, degenerative disorder of the CNS, characterized by disseminated demyelination of nerve fibers of the brain and spinal cord” ?
Multiple Sclerosis
What type of chronic Neurological problem is Insidious & gradual and varies with individuals and the type ?
(The above, makes this problem difficult to diagnose)
Multiple Sclerosis
What chronic neurological problem includes Manifestations such as ?
- Blurred or double vision
- Muscle weakness
- Paresthesia, numbness, tingling, or pins & needles
- fatigue (80% of people - *common problem)
- Bowel and bladder problems (constipation, incontinence)
- Impairment of ADLs
- Cognitive problems
- Pain
- Decreased sexual response in women
- Erectile dysfunction
- Depression
- Anger
Multiple sclerosis
What kind of disease is MS ?
Autoimmune
What disease is….
- An autoimmune disease
- T cell mediated
- T cells cross the BBB causing an autobody antigen reaction
- Inflammatory response occurs
- And destruction of myelin results
Multiple sclerosis
True or False: There is no cure for MS, but there are lots of treatments to lengthen remissions and to reduce the severity of exacerbations, decrease the symptoms, and optimize the patients function ?
True
True or False: There is no definitive test for MS. However, when attempting to diagnose MS, we are generally looking for evidence of at least two (of the three) different areas of damage in the CNS ?
Three areas = Brain, Spinal, Cord, & Optic Nerve
True
When trying to diagnose MS, and MRI of the brain & Spinal cord is done, looking for what types of things ?
Plaques
Inflammation
Atrophy
Breakdown
If CSF is collected for analysis for diagnosing MS, may we see ?
Increased IGG
Gives us an indication of an Autoimmune response that is happening in the body, which would point towards MS
What does therapy include for MS ?
- Medications
- Surgery - Thalamotomy
(Surgeries = NOT curative, but can provide symptom relief, etc. - PT & OT
What is a Thalamotomy?
Opening made in the thalamus
What types of drug therapy is used for MS ?
- Disease modifying drugs (Beta-interferon)
- Monoclonal Antibody
- Corticosteroids for exacerbations
- Drugs for symptoms management
- Cholinergics
- Anticholenergiccs
- Muscle relaxants
- Nerve conduction enhancers
-
What an example of a Cholinergic medication ?
Bethanecol
What drug therapy for MS, targets lymphocytes that are moving across the BBB ?
Monoclonal Antibody
What drug therapy for MS reduces the body immune function ?
Disease Modifying drugs
What drug category for MS reduces the immune response ?
Corticosteroids
What is an example of a muscle relaxant (MS) ?
Baclofen
Anti-spasmodic
True or False: Very often individuals diagnosed with MS are young ?
Ture
What are triggers that can cause an exacerbation in MS, and thus should be avoided ?
- Infection
- Trauma
- stress
- etc,.
True or False: Many MS patients are at risk for falls ?
True
True or False: In pt’s with MS its very important to keep them moving ?
Exercise, exercise exercise :)
True !
Want to maintain strength and functioning
True or False: With MS, mood swings and emotional alterations are apart of the disease
True
What disease is a progressive neurological disorder due to degeneration of dopamine-producing neurons in the substantia nigra of the midbrain ?
Parkinson’s Disease
___________ is responsible for smooth and purposeful movements ?
Dopamine
What disease do these clinical manifestations match with ?
- Motor dysfunction
- Postural and gait disturbances
- Decreased eye movement
- Dysphagia
- Speech problems
- Autonomic dysfunction
- Cognitive and psychosocial dysfunction
Parkinsons disease
What is the acronym used for Motor manifestations of Parkinson’s disease ?
Tremor (non intentional at rest, but not sleep)
Rigidity
Akinesia/Bradykinesia (freezing/slow)
Postural instability
What are Postural/Gait manifestations associated with Parkinson’s disease ?
- Shuffled gait
- Festination (propulsion, retropulsion)
- Lack of arm swing
- Difficulty maintaining balance & sitting erect
- Cant catch self when balance lost
What are speech manifestations that are seen in Parkinson’s disease ?
- Monotone
- Low tone (quiet)
- Slurred
- Difficulty starting words
Autonmonic dysfunction Manifestations listed below are seen with which Chronic Neurological problem ?
- Skin: oily, excessive persperation
- Heat intolerance
- Postural hypotension (d/t disease & meds)
- Constipation (d/t hypo motility)
- Urinary frequency, hesitance, incontinence
Parkinsons Disease
What are Cognitive & Psychosocial Manifestations of Parkinson’s disease. ?
- Dementia
- Lack of insight
- Memory loss
- Decreased intellectual abilities
- Impulsiveness
- Anxiety
- Depression
What are complications of Parkinson’s disease ?
- Falls
- Fractures
- Impaired communication
- Social isolation
- Risk for aspiration
- Malnutrition
- Skin breakdown
- Dizziness
- Constipation
- Loss of ability to function
What Diagnostics are used to detect Parkinson’s ?
- H & P
- Positive response to Anti-parkinson medication
- Rule out side effects of other drugs such as Benzodiazepines and haloperidol
- Scans/MRIs
What are treatment options for Parkinson’s disease ?
- Symptom relief*
- Anti-parkinson medication
- Deep brain stimulation
What is the Drug of choice for Parkinson’s disease ?
Levodopa/carbidopa
With Parkinson’s, what is drug therapy aimed at ?
Aimed at correcting imbalance of neurotransmitters within the CNS
True or False: Over time the response to the drug Sinemet (Levodopa/Carbidopa) is less effective ?
True
Will add another drug when this happens
What is the precursor of Dopamine ?
Levodopa
Idealy how many drugs are used the Tx of Parkinson’s ?
1 - Monotherapy
True or False: Carbidopa allows levodopa to remain functional and active in the blood stream ?
True
When talking about drug therapy for Parkinson’s disease what do we know about the medication administration ?
Timing of medication administration crucial for symptoms management !!
What is Levodopa/Carbidopa used for ?
&
what is another name for it ?
- Parkinsons disease
- Sinemet
What drug is used in the early stages of Parkinson’s disease to slow the progression ?
Selegeline (elderly)
What is another drug that is used to treat how ?
Mirapex
Side Effects of Drug therapy for those with Parkinson’s ?
- Hypotension (orthostatic)
- Dyskinesia
- Confusion
- Hallucinations
- Dry mouth
- Chorea (quick movements of the hands and legs)
What Chronic Neurological Problem is an Autoimmune disorder in which antibodies attack acetylcholine, resulting in decreased number of Ach receptor sites at the neuromuscular transmission ?
Myasthenia Gravis
What is Myasthenia Gravis due to ?
- Insuffiecient secretion of acetylcholine
- Excessive secretion of cholinest
- Unresponsiveness of the muscle fibers to acetylcholine
What is Myasthenia Gravis characterized by ?
Fluctuating muscle weakness of certain muscle goups
What two things should we think of when thinking about Myasthenia Gravis and what it is ?
- Autoimmune disease
- Insufficient circulating acetylcholine
Is Myasthenia Gravis accompanied by weakness, that gets better with rest ?
Yes !
Manifestations such as those listed below are due to what ?
- Weakness & fatigue
- Extreme muscle weakness, which become progressively worse with use & disappears with rest
- Difficulty chewing
- Dysphagia
- Ptosis (drooping eyelid)
- Diplopia (double vision)
- Weak, hoarse voice
- Difficulty breathing & diminished breath sounds (causing Hypoventilation)
- Respiratory paralysis & failure (can deteriorate to this)
Myasthenia Gravis
What diagnostics are used to help diagnose Myasthenia Gravis ?
- H&P
- Fatigability with prolonged upward gaze (2-3min)
(pt’s will have a hard time with this) - EMG (looks @ muscle response when nerves are stimulated)
- Tensilon test
- Acetylcholine antibodies
What is a classic test for diagnosing Myasthenia Gravis ?
Tensilon test
What does the medication Tensilon do ?
Blocks acetylcholinesterase, so that there is more circulating acetylcholine, which is what we want
What is the Tensilon test ?
Brief improvement of symptoms (upward gaze) after IV injection of Tensilon
What does the drug therapy for the Tx of Myasthenia Gravis include ?
- Acetylcholinesterase agents (we want to maintain acetylcholine)
- Corticosteroids (will block the autoimmune/inflammatroy response)
- Immunosuppressive agents**
- Azathioprine**
- Imuran - Plasmapheresis
(can remove the antibodies that are the problem, so that we can see more circulating Acetylcholine)
What are 2 Immunosuppressive agents that are used To treat Myasthenia Graves ?
- Azathioprine
- Imuran
What is the Nursing Management Goal with Myasthenia Gravis ? (2)
- Return of normal muscle endurance
- Minimize complications
True or False: When talking about administering meds for Myasthenia Graves, there is a strict time schedule to prevent symptoms ?
True !
What should be kept at the bed side in pt’s with Myasthenia Gravis & why ?
- Emergency tract set
- Why: incase the muscles for breathing become too weak to support respirations
What things should pt’s with Myasthenia Gravis avoid (3) ?
- Stress
- Infection
- OC meds (oral contraceptives)
True or false: You should plan activities in pt’s with Myasthenia Gravis to avoid fatigue ?
True!
How should we encourage pt’s with Myasthenia Graves to eat ? and why ?
- Encourage pt to sit up and eat
- Why: To avoid aspiration
What are other Nursing Interventions for pt’s with Myasthenia Gravis ?
- Monitor ability to breath
- Medic alert bracelet
- B/c patient may go into respiratory failure
- Differentiate between myasthenia crisis vs. overdose of anticholinergic drugs (cholinergic crisis)
