MS III Final Flashcards
Ischemic Stroke
Appear without warning
Cause: Embolus
S/S: one-sided weakness, numbness, visual problems, confusion and memory lapses, headache, dysphagia, and language problems
Tx: Tissue plasminogen activator (rt-PA, alteplase, activase) given to dissolve clots in acute ischemic strokes; Mannitol, Nimodipine, Phenytoin (Dilantin) and phenobarbital; Aspirin, Ticlid, Aggrenox, and clopidogrel (Plavix); Surgery for some hemorrhagic strokes (based on Age/ICP/Location of hem); IV fluids; Diet based on ability to eat
Hemorrhagic Stroke
Occurs suddenly
Cause: Aneurysm
S/S: severe HA, stiff neck, LOC, vomiting, and seizures
Tx: Surgery
Aphasia
A defect in the use of language; speech, reading, writing, or word comprehension
Dysarthria
The inability to speak clearly
Dysphagia
Swallowing difficulty
Dyspraxia
The partial inability to initiate coordinated voluntary motor acts
Hemiplegia
Paralysis of one side of the body
TIA
Temporary Neurologic deficit caused by impairment of cerebral blood flow
Blood vessels occluded by spasms, fragments of plaque, or blood clots
Important warning signs for the individual experiencing a full stroke
S/S: dizziness, momentary confusion, loss of speech, loss of balance, tinnitus, visual disturbances, ptosis, dysarthria, dysphagia, drooping mouth, weakness, and tingling/numbness on one side of the body
Tx: Aspirin, Ticlopidine hydrochloride (Ticlid), ER dipridamole (Aggrenox), or Clopidogrel bisulfate (Plavix), Warfarin and Heparin, Carotid endarterectomy and transluminal angioplasty
CVA
An abrupt impairment of brain function resulting in a set of neurologic S/S that are caused by impaired blood flow to the brain and lasts more than 24 hrs
Can be ischemic or hemorrhagic
Acute phase: onset of S/S until VS (esp BP and neurologic condition) stabilize (usually 24-48 hrs)
Major focus areas:
- HTN
- Oxygenation
- Hyperthermia
- Hyperglycemia
Tx: Tissue plasminogen activator (rt-PA, alteplase, activase) given to dissolve clots in acute ischemic strokes; Mannitol, Nimodipine, Phenytoin (Dilantin) and phenobarbital; Aspirin, Ticlid, Aggrenox, and clopidogrel (Plavix); Surgery for some hemorrhagic strokes (based on Age/ICP/Location of hem); IV fluids; Diet based on ability to eat
How do you care for a person during and after a seizure?
Keep a person safe during a seizure (priority); Post seizure: largest need is sleep/rest; give Lorazepam or Ativan post seizure
Dilantin (Phenytoin)
- Antiepileptic: Works by slowing down impulses in the brain that cause seizures.
- if Hx of seizure: decrease slowly
- Treats antiarrhythmias caused by digoxin
- Gingival swelling
- Anemia by messing with folic acid absorption
- Side Effects: Decreased coordination, mental confusion, nervousness, slurred speech, trouble with breathing, speaking, or swallowing, unsteadiness, trembling, or other problems with muscle control or coordination
- An overdose of phenytoin can be fatal. Overdose symptoms may include twitching eye movements, slurred speech, loss of balance, tremor, muscle stiffness or weakness, nausea, vomiting, feeling light-headed, fainting, and slow or shallow breathing.
- Anticonvulsant: PO daily in 2-3 doses
- Status Epilepticus: IV
- Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression
- Monitor CBC, serum calcium, albumin, and hepatic function tests
Aura
-Sensation, either of weakness, numbness, or a hallucinatory odor or sound, that occurs immediately before a generalized tonic-clonic seizure
Postictal Phase
Time after a tonic-clonic seizure during which some or all of the following may occur: headache, fatigue, deep sleep, confusion, nausea, and muscle soreness.
Preictal Phase
Time immediately before a tonic-clonic seizure consisting of vague emotional changes, such as depression, anxiety, and nervousness
Status Epilepticus
Condition marked by a series of tonic-clonic seizures in which the client does not regain consciousness between seizures
Absence Seizure
- Formerly Petit Mal Seizures
- More common in children
- Breif loss of consciousness of cognition during which physical activity ceases. The person stares blankly; eyelids flutter; lips move; slight movement of the head, arms, and legs
- Typically last for a few seconds; Person seldom falls on the ground
- Often unnoticed due to brief duration and relative lack of prominent movements
- Multiple may occur per day
- Before Dx: children often thought to have a learning disability
Know the basics of Guillain Barre. How it comes and how it goes. Care will be the same for almost any neuro disease.
Acute inflammatory demyelinating polyneuropathy that affects the peripheral nervous system
Thought to be an autoimmune disease
Causes motor weakness and sensory abnormalities
5 Types
3 Phases
Acute: begins with the onset of the first symptoms and continues through the disease’s rapid progression until no further symptoms or deterioration occurs; usually lasts up to 4 weeks
Plateau: Symptoms remain but don’t worsen; usually lasts from a few days to a few weeks
Recovery: the patient’s condition begins to improve, often to a full recovery; usually lasts from a few weeks up to 2 years.
Risk: ages [15,35] and [50,75]
Safety is a priority
S/S: mild to severe pain (usually worse at night and in lower large muscle groups); muscle weakness (starts distally); autonomic dysfunction; paresthesia (numbness/prickly/tingling/burning in hands and feet); Muscle aches and cramps; hyperesthesia (painful oversensitivity to touch); diminished ability to sense joint position, vibration, and temp sensation;
Dx: made by exclusion; nerve conduction velocity test may show demyelination; lumbar puncture
Tx: plasmapheresis
Know the basics of ALS. How it comes and how people lose the ability to care for themselves.
Progressive neuromuscular disorder that involves the degeneration of both the upper and lower motor neurons, leading to eventual wasting and atrophy of all voluntary muscles, including resp muscles;
S/S: Slow, chronic progression of symptoms; 1st symptom is usually unexplained weakness in a limb; Upper Neuron: spasticity and hyperactive tendon reflexes, and Positive Babinski Reflex (plantar surface of foot stroked => toes fan out and draw back instead of contract and draw together); Lower Neuron: Atrophy, weakness, depressed reflexes, and fasciculation
How will this person feel? Provide accurate info; Involve family in decision-making; encourage communication
Basics for MS. How it comes and what can be done for it?
Immune-mediated progressive neurodegenerative disease of the CNS that typically manifests itself with periods of disease activity followed by intervals of remission.
Immune cells cross the blood brain barrier,triggering inflammation and scarring of myelin. Demyelination of the nerves in the brain and spinal cord interrupt the conduction of nerve impulses; Cause: Genetic predisposition plus environment
S/S: paresthesia; ataxia; bertigo; weakness and fatigue; spasticity; loss of vision or double vision
Can we do anything for MS? Not really treatable; is not reversible; provide support
Who gets meningitis and what are the signs and symptoms?
Inflammation of the membranes that surround the brain
Most likely to get meningitis: people living in close groups (ie College students, military personnel)
S/S: Fever; neck stiffness (nuchal rigidity); changes in LOC; HA; nausea; vomiting; chills; malaise; back, abdominal, and extremity pain; irritability from increasing ICP; seizures; photophobia;
Dx: lumbar puncture
What causes Autonomic Dysreflexia?
Syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above)
Acute Emergency
S/S: Severe HTN; slow heart rate; pounding HA; nausea; blurred vision; flushed skin; sweating; goosebumps; nasal stuffiness; anxiety
Uncontrolled can lead to seizures, stroke, and death; Prevention is the best Tx
Early signs of ICP
Dec LOC until the patient becomes comatose
Changes in mental status (ie disorientation, restlessness, mental confusion); purposeless movements; inc resp effort; pupillary changes; weakness in one extremity or on one side of the body; constant HA that inc in intensity and is aggravated by movement or straining; N/V; seizures; dec RR and PR; inc BP and temp; projectile vomiting; hemiplegia; loss of brain stem reflexes (pupillary, corneal, gag, swallowing)
Timolol, why is it used? Are there any contraindications?
Med for glaucoma; eye drop; (B1 and B2) beta blocker; watch for systemic effects with some patients (watch for heart or resp issues)
Post op cataract surgery. What does the patient need to know.
May have a guard on their eye to go home. Also, wear it at night
Care for the person with a detached retina
Keep the patient calm/quiet; darken the room
Care of a person after regaining consciousness.
Reorient them upon waking
Meniere’s Disease, review how to avoid the signs and symptoms.
Low sodium diet
Otitis media or any infection, why is there a need for a follow up?
To make sure the infection has resolved or for any damage
Eye injury on the job especially if there is a foreign object in one eye.
Stabilize and cover injured eye and patch the other
Care for a patient with Parkinson’s
Dopamine cells in the Substantia nigra are lost so no dopamine gets carried to corpus striatum => depletion of dopamine stores => imbalance of acetylcholine (excitatory) and dopamine (inhibitory) neurotransmitters in the corpus striatum => impairment of extrapyramidal tracts controlling complex body movements
Progressive
S/S: Tremor at rest; bradykinesia; muscle rigidity
Tx: Levodopa/Carbidopa; watch for: postural hypoTN, dysphagia, and urinary dysfunction
Baclofen
- Muscle relaxant; Respiratory Depressant; can not stop suddenly (could cause hallucinations or muscle spasms if stopped);
- PO: Treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions.
- IT: Treatment of severe spasticity of cerebral or spinal origin (should be reserved for patients who do not respond or are intolerant to oral baclofen) (should wait at least one year in patients with traumatic brain injury before considering therapy).
- Unlabeled Use:Management of pain in trigeminal neuralgia.
- Action: Inhibits reflexes at the spinal level.
- Therapeutic Effects: Decreased muscle spasticity; bowel and bladder function may also be improved.
Subdural Hematoma
- Results from venous bleeding, with blood gradually accumulating in the space below the dura
- Classified as acute, subacute, and chronic
- Acute: symptoms worsen in first 24 hours
- Subacute and Chronic: become symptomatic after 24 hours to 1 week
Epidural Hematoma
Stems from arterial bleeding, usually from the middle meningeal artery, and blood accumulation above the dura; characterized by rapidly progressive neurologic deterioration.
Intracranial Hematoma
Bleeding within the brain that results from an open or closed head injury or from a cerebrovascular condition such as a ruptured cerebral aneurysm
Concussion
- Results from a blow to the head that jars the brain
- Usually a consequence of falling, striking the head against a hard surface such as a windshield, colliding with another person, being the victim of violence
- Causes diffuse and microscopic injury to the brain.
- Causes temporary neurologic impairment but no immediate evidence of serious damage to cerebral tissue
Contusion
- More serious than a concussion and leads to gross structural injury to the brain
- Results in bruising and sometimes hemorrhage of superficial cerebral tissue
Contrecoup
Dual bruising to the brain during a contusion. Force is strong enough to send the brain ricocheting to the opposite side of the skull
Coup Injury
Injury to the brain when the head is struck directly
CTE (Chronic Traumatic Encephalopathy)
- a form of neurodegeneration
- Cumulative and sustained concussions can result in long-term effects such as dementia, depression, Parkinson’s disease, and early-onset Alsheimer’s
