Exam 3 Neuro: Problems of the Central Nervous System: The Brain (12 questions) Flashcards
Risk factors for migraines and clusters
- Alcohol
- Environmental allergies
- Medication
- Intense odors, bright lights
- Fatigue, sleep deprivation
- Depression
- Emotional/physical stress, anxiety
- Menstrual cycle, oral contraceptive use
- Foods (Tyramine, caffeine, MSG, nitrites, milk products)
Migraine symptoms
- Intense pain, unilateral
- Throbbing
- Worsens with movement,
- Photophobia or phonophobia
Migraine categories
- Aura (classic migraine)
- No aura (common migraine)
- Atypical
Aura migraine phases
- Prodrome phase
- Aura phase (Second Phase)
- Termination phase (Third phase)
No aura migraine duration
4 to 72 hours
Atypical migraines
- Status (longer than 72 hours)
- Migrainous infarction
- Unclassified
3 Steps to managing a migraine
- Recognize migraine symptoms
- Respond and health care provider
- Relieve pain and associated symptoms
Abortive migraine therapy: mild
- Acetaminophen
- NSAIDS
Ibuprofen, naproxen - Migraine specific OTC formulations
- Antiemetics
-Stops migraines
Abortive migraine therapy: Severe
- Triptan preparations
- Ergotamine preparations
- Isometheptine combination
- Stops migraine
Preventative migraine therapy
- NSAID
- Beta blocker
Propranolol, timolol, - Calcium channel blocker
verapamil - Antiepileptic drugs
Topiramate - Avoid triggers (risk factors)
-prevents migraines
Complementary & Alternative therapy for migraines
- Yoga
- Meditation therapy
- Massage
- Exercise
- Biofeedback
- Acupuncture
- Herbal remedies
Observation and documentations during seizures
- TIme
- Description (Tonic, clonic, absent)
- Whether more than one type of seizure occurs
- Sequence of seizure progression (Where it began)
- Changes in pupil size and eye deviation
- LOC
- Whether the seizures are preceded by an aura (dizziness)
- What patient does after seizure
- How long it takes for patient to return to pre-seizure status
Acute Seizure Management
- Lorazepam (Ativan)
- Diazepam (Valium)
- Diastat
- IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Status Epilepticus
Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency!
Status Epilepticus treatment
- Establish airway
- ABGs
- IV push lorazepam, diazepam
- Rectal diazepam
- Loading dose IV phenytoin
Viral meningitis risk factors
Viral illnesses: mumps, measles, herpes, West Nile
Fungal meningitis risk factors
AIDS
Bacterial meningitis risk factors
- Otitis media, pneumonia, sinusitis
- Immunosuppression
- Invasive procedures
- Overcrowded living conditions
- Streptococcus pneumoniae & Neisseria meningitidis
- Haemophilus influenzae
Viral meningitis unique characteristic
- There is no vaccine against it
Meningitis symptoms
- Fever
- Headache
- Photophobia
- Indications of increased ICP
- Nuchal rigidity
- Positive Kernig’s, Brudzinski’s signs
- Decreased mental status
- Focal neurological deficits
- Nausea and vomiting
Meningitis Nursing care
- Bacterial
Isolation: droplet precautions - Fever reduction
- Dark, quiet environment
- Bedrest, HOB elevated
- Seizure precautions
- Neuro checks q 2-4 hours
Cranial nerves III, IV, VI, VII, VIII
Meningitis Drug therapy
- Broad-spectrum antibiotic
- Fever-reducing agents
- Acetaminophen, ibuprofen
- Hyperosmolar agents
- Anticonvulsants
- Phenytoin
- Steroids (controversial)
Meningitis prevention
Prophylaxis treatment for those in close contact with meningitis-infected patient
Parkinson’s Disease Pathophysiology
- Degeneration of the substantia nigra results on decreased production of dopamine
- Overstimulation of the basal ganglia by acetylcholine
Parkinson’s Disease Symptoms
- Tremor
- Muscle rigidity
- Bradykinesia
- Postural instability
Parkinson’s Disease Medications/medication therapy
- Dopamine agonists
- Anticholinergics
- Catechol O-methyltransferase inhibitors
- Most effective in the first 3 to 5 years of use
- Monitor levels
- Drug holiday
Parkinson’s Disease Nursing care
Collaborative
- Mobility
- Nutrition
- Psychological
- Speech therapy
Huntington’s Disease pathophysiology
- Hereditary disorder
- Autosomal dominant
- Decrease in the GABA (inhibitory transmitter in the basal ganglia
- Increase in glutamate
Huntington’s Disease Patient Teaching
Health teaching – include psychosocial support resources
Huntington’s Disease medications
tetrabenazine
Alzheimer’s Pathophysiology
- Chronic progressive
- Structural changes in brain
Neuritic plaques, granulovascular degeneration,
Neurofibrillary tangles
Alzheimer’s Symptoms
- Gradual memory loss, short term first
- Changes in behavior & personality
- Eventual language, motor skills lost
Alzheimer’s medication
- Cholinesterase inhibitors
donepezil (Aricept)
galantamine (Reminyl)
rivastigmine (Exelon) - N-methyl-D-aspartate receptor antagonist (NMDA)
memantine (Namenda) - Antidepressants
SSRIs
Avoid tricyclic antidepressants
Alzheimer’s nursing care/safety measures
- Interventions and support (patient and caregiver)
- Cognitive stimulation and memory training
- Structuring the environment
- Orientation and validation therapy
- Promoting self-management
- Promoting bowel and bladder continence
- Promoting communication
