ICP, HA, Seizures, Myanstasia Gravis, Multiple Sclerosis, Parkinson's, ALS, Huntinington's Flashcards
What are the signs and symptoms of a concussion?
- brief disruption in LOC
- amnesia
- HA
- Dizziness
- N/V
What are the signs and symptoms of post-concussion syndrome?
- persistent HA
- lethargy
- personality and behavior changes
- shortened attention span
- dec short-term memory
- changes in intellectual ability
When is it considered post-concussion syndrome?
if the symptoms of concussion persist for 2weeks- 2 months
contusion
bruising of brain tissue w/n a focal area
What do you do when someone has a cerebral laceration?
give prophylactic antibiotics until you can rule out meningitis
contusion
bruising of brain tissue w/n a focal area
contusion can elicit seizures
What do you do when someone has a cerebral laceration?
give prophylactic antibiotics until you can rule out meningitis
What is it important to assess when someone presents with a contusion/ cerebral laceration?
if they are on anticoagulants
What are the 3 different types of hematoma?
- epidural
- subdural
- intracerebral
epidural hematoma
- blood btw the skull and dura mater
- pt has brief unconsciousness — then awake and lucid — then has decreased LOC
- most serious type of hematoma => coma
- surgical emergency
tx for epidural hematoma
craniotomy -rapidly evacuate the tumor
If there is an inc in ICP… administer high doses of lasix
subdural hematoma
- blood btw dura matter and arachnoid layer
- SLOW growing hematoma
- d/t arterial hemorrhage we will see symptoms on day 2 and symptoms may last up to 14 days
- often misinterpreted as a stroke or demential in older adults
- chronic alcoholics are at risk d/t lack of nourishment and freq falls
intracerebral hematoma
- blood deep in the brain tissue d/t injury form the frontal and temporal lobes
- occurs when a blood vessel w/n the brain ruptures allowing blood to leak inside the brain
- bone might become depressed and if there is an indentation we might need to do a craniotomy to get it back into shape
- or craniotomy and then a cranioplasty to cover the area
What are issues that the older pt faces when they have major head trauma?
- less able to tolerate respiratory problems
- atypical presentation
- poor stamina may impede participation in rehabilitation
- pre-existing cognitive problems impact recovery
What are the nursing interventions for someone with a hematoma?
- Airway, Breathing, Circulation
- keep free from pain, discomfort, and infection
- monitor for CSF leakage and increased ICP
When is bacterial meningitis prevalent?
- fall, winter, and early spring because everyone is inside in close confinement with others
What does bacterial meningitis lead to?
- increase in CSF
- increase in ICP
What are the s/s of bacterial meningitis?
- photophobia
- nuchal rigidity (neck stiffness)
- fever
- severe HA
- N/V
- positive kerning’s sign
- positive brudzinski’s sign
- inc ICP
- seizure
What s/s of bacterial meningitis are specific to street-meningococcus organism?
- petechiae
- skin rash
what is positive kerning’s sign?
pt lays flat on back, flex the hip and knee and try to extend the leg at the knee joint
( if there is pain (i.e severe HA) or spasm in the hamstring then it is positive)
What is positive brudzinski’s sign?
when you put the neck to the chest and the legs come up with them?
What are the s/s of inc ICP?
- vision changes, changes in ocular movements
- loss of corneal reflex
- seonsory loss
- facial paresis
- tinnitus
- vertigo
- hemiparesis
- dysphagia
- hemianopia
- hydrocephalus if CSF is obstructed
How do you diagnose bacterial meningititis?
- lumbar puncture and analysis of CSF
- ## x-rays, CT scan, MRI
What are the s/s of inc ICP?
- vision changes, changes in ocular movements
- loss of corneal reflex
- sensory loss
- facial paresis
- tinnitus
- vertigo
- hemiparesis
- dysphagia
- hemianopia
- hydrocephalus if CSF is obstructed
How do you diagnose bacterial meningititis?
- lumbar puncture and analysis of CSF
- x-rays, CT scan, MRI
What must be done prior to a lumbar puncture to r/o bacterial meningitis?
CT scan to r/o obstruction of the foramen magnum
What are nursing interventions for bacterial meningitis?
- quiet, dark environment
- elevate HOB 20-30 degrees (no more than 30)
- provide with small freq meals because they will lose their appetite
- possibly administer antienemics with small sips of water for nausea
- initiate seizure precautions
- put pt on respiratory (droplet and contact) isolation
- normothermal environment
what is the tx for bacterial meningitis?
antibiotics: rocephin or vancomycin
What is the most important pt teaching to prevent bacterial meningitis?
- vaccines
What causes viral meningitis?
- enterovirus
- arbovirus
- HIV
- HSV
What are the s/s of viral meningitis?
- HA
- Fever
- Photophobia
- Stiff Neck
- ***NO INC IN ICP
How do you diagnose/differentiate viral meningitis?
- lumbar puncture and get the CSF via Xpert EV test
What are the primary types of HA (from least severe - most severe)?
- tension
- migrane
- cluster
What are the s/s of a tension HA?
- mild or moderate and can last minute or days
- aka stress headache
- bilateral, band-like feeling of pressure around the head
- neck tenderness
- possible sensitivity to light and sound
How do you diagnose someone as having a tension HA?
- assess if there is resistance to move head and neck
- EMG might reveal sustainedd contraction of the neck, scalp, or facial muscles
Tx for Tension HA
- aspirin or tylenol
- sedative/ muscle relaxant or codeine or butalbital-aspirin (florinal)
What are the s/s of a migraine HA?
- mod to severe
- more common in females 20-30
- each episode with last 4-72 hours
- unilateral or bilateral throbbing or pounding pain that usually involves one temple
- may be preceded by an aura
- sensory dysfunction
- motor dysfunction
- n/v
- sweating
- palor
- irritability
How do you diagnose someone as having a tension HA?
- assess if there is resistance to move head and neck
- EMG might reveal sustained contraction of the neck, scalp, or facial muscles
What are the s/s of a migraine HA?
- mod to severe
- more common in females 20-30
- each episode with last 4-72 hours
- unilateral or bilateral throbbing or pounding pain that usually involves one temple
- may be preceded by an aura
- sensory dysfunction
- motor dysfunction
- n/v
- sweating
- palor
- irritability
Tx for migrane HA
- aspirin or tylenol
- triptans (imitrex or treimet)
Preventative drug therapy for for migrant HA
- topamax
- depakote
- botox
- clonidine
- *takes 2-3 months to start working
What are the contraindications for the triptans?
must avoid in pots with CAD or a history of MI because it causes unilateral artery vasoconstriction
What are the s/s of a cluster HA?
- sharp, stabbing pain that lasts from minutes to hours
- pain can occur every other day or as often as 8 times a day
- pain located around the eye, radiating to the temple, forehead, cheek, nose or gums
- eye edema, lacrimation, facial flushing, and rhinitis
- obstruction of the pupil
- agitation and restlessness
How do you diagnose cluster HA?
- pt hx and r/o other disease processes via CT, MRI, lumbar puncture
What are the cardinal signs of a cluster HA
- eye edema, tearing, and ptosis
What is the treatment for cluster HAs?
- 100% O2 delivered at a rate of 6-8 L/min over 10-20 mins
What medication can be used to prevent cluster HAs?
- verpamil
- lithium
- imitrex
- ergotamine
- depakote
Do you give oral narcotics for cluster HAs?
NO
Do you give oral narcotics for cluster HAs?
NO
What can lead to seizure?
- low BG
- high fever
- drug or alcohol withdrawal
- infections
- brain trauma
- brain tumors
- 75% are idiopathic
What are side effects of anti-epileptic meds?
- diplopia
- drowsiness
- ataxia
- mental slowing
- rash
- hyperplasia of gingiva
- blood dyscrasia
- dec WBC
- effects liver and kidney
Gerotologic considerations for anti-epileptic meds?
NO PHENYTONIN- it may be problematic for older patients with diminished liver function
What things do we need to assess during a seizure?
- sequence
- length
- direction of eye or head deviation
- respirations (labored or frothy)
- incontinence
- loss of consciousness
- types and parts of body movement
What are nursing interventions for seizure patients
- seizure precautions
- suction equipment at bedside
- lay pt on side
- ensure safe, clear area
- IV access
- no oral temps
How do we give anti seizure meds when a pt is on tube feedings?
- turn off feeding tube for 2 hours before and 2 hours after
What are types of generalized seizures?
- tonic-clonic
- absence
- myoclonic
- tonic
- clonic
- atonic
What are types of partial seizures?
- simple
- complex
How do you differentiate btw simple and complex partial seizures?
simple partial seizures have motor (jacksonian marching, involuntary arm movements), somatosensory (numbness, tingling, changes in speech, extreme emotional changes), autonomic manifestations (tachycardia, tachypnea, pallor), or psychic manifestations (strange smells, noise, taste)
tonic- clonic
body stiffens (tonic) with subsequent jerking of extremities (clonic - Loss of consciousness and falling
tx for tonic-clonic seizures
- phenytoin (dilantin), carbamazepine (tegratol), phobarbital, divalproex (depakokte)
- gabapentin (neurontin), lamotrigine (lamictal), topiramate (topamax), levetiracetam (keppra), pregabalin (lyrica), felbamate (felbatol)
absence seizures
- typically occur in children
- brief loss of consciousness
tx for absence seizures
clonazepam (klonopin)
ethosximide (zarontin)
divalproex (depakote)
myoclonic seizures
- sudden, excessive jerking of body and extremities
- can cause a fall
treatment for myoclonic
clonazepam (klonopin)
ethosuximide (zarontin)
- divalproex (depakote)
tonic seizures
- sudden stiffening of muscles
- pts fall
clonic seizures
- begins with loss of consciousness and then sudden loss of muscle tone, and then limb jerking
atonic seizures
“drop attacks”
- paroxysmal loss of muscle tone => falls
- big risk of head injury
tx for atonic seizures
clonazepam (klonopin)
ethosximide (zarontin)
divalproex (depakote)
tx for atonic seizures
clonazepam (klonopin)
ethosximide (zarontin)
divalproex (depakote)
tx for atonic seizures
clonazepam (klonopin)
ethosximide (zarontin)
divalproex (depakote)
lyrica
- new anti-epileptic med
- it is an adjunct med for those who aren’t successful with one medication
febatol
- new anti-epileptic med
- causes liver damage and aplastic anemia
status epilepticus
continuous seizig without return to consciousness btw seizures
treatment for status epilepticus
IV lorazepam (ativan)
IV diazepam
IV phenytoin
IV pentobarbital or propofol (as a last resort)
treatment options for seizures if drugs are inadequate
- vagal nerve stimulation
- biofeedback
- surgury (hemispherectomy, corpus callostomy
what are lifestyle precautions and self care activities to teach the pt?
- importance of adherence to meds
- no driving for 6-12 months follwing a seizure
- identify triggers
- water and fire precautions
- med alert bracelets
- avoid heights and power tools
- encourage regular pattern of diet, sleep, rec, and exercise
- support groups
- teach family what to do during a seizure
What are the 4 phases of seizures?
- prodromal
- aural
- ictal
- postictal
MS
plaque causes inflammation and starring in the CNS. IT causes damage to the myelin sheath and then eventually the nerve fiber.
- autoimmune, possibly d/t epstein barr virus
What are the 3 mpathological processes that characterize MS?
chronic inflammation
demyelination
gliosis (scarring in the CNS)
What are the clinical manifestations of MS?
- severe fatigue
- weakness or tingling
- vision loss or diplopia
- incoordination or balance issues
- bowel and bladder dysfunction
- short term memory loss
- depression
- vertigo, tinnitus
- dec in hearing
- sexual dysfunction and dec libido
- pain with intercourse
- during preg they feel better and then after they are worse
