Nervous System Disorders Flashcards
Inhibit neural pathways. Local anesthetic capable of inhibiting impulse pathways.
Therapeutic nerve blocks
Instituted for those who suffer from chronic headaches. Acquired skill to control bodily functions: HR, BP. Teaching sessions are needed.
Biofeedback
What neuron recovers first?
Motor recovers sooner than sensation
This block is considered a regional anesthesia because the nerve block occurs distal to where the med is administered.
Nerve block
What medication is used for a nerve block?
Lidocaine benzopine
What contains side effects of dysrythmias, tachycardia, confusion, tinnitus, blurred vision, N/V, or metallic taste.
Nerve block
A permanent change or destruction of nerve fibers.
Neuroablation
Permanent destruction from administration of a chemical agent
Chemical ablation
Radio frequency (heat) to nerve to cause destruction
Thermal ablation
Surgical ablation of a nerve route
Rhizotomies
Extreme cold to nerves to cause destruction
Cryoablation
Severing of the spinothalamic tract
Cordotomies
Severing at the level of the brain stem
Tractotomies
Severing of only sensory fibers. Motor should still be intact.
Dorsal route
Produced by a better powered implant when it sends electrical impulses it blocks nerve pathways
Electrical stimulation
Implant into the chest wall for the spinal cord and vagal nerve (rarely used for pain, but used for Parkinson’s)
Deep brain stimulation
Standard with chronic low back pain
Spinal cord stimulation
Electrodes are wrapped around the vagal nerve used for treating seizures with varying frequencies and strengths to the vagus nerve
Vagal nerve stimulation
Where do most inflammatory conditions of the nervous system begin?
In the bloodstream
Acute inflammation of the meninges and infection of CSF and arachnoid Mater
Meningitis
Meningitis is usually associated with what disease?
Upper respiratory infection
What are the causes of meningitis?
Viral, bacterial, fungal, and Protozoa
What causes a thickened viscosity of the CSF fluid?
When proteins spills because the blood brain barrier is no longer intact
Why does less glucose pass?
When the blood brain barrier is damaged glucose levels decrease
This type of meningitis caused purulent secretions
Bacterial
What pathogen cause streptococcal meningitis?
Hemophilius influenza
What is the percentage of cases of streptococcal pneumonia/neisseria menigitides
80%
The mortality rate is
25% treated and 100% untreated
What is the first sign of bacteria meningitis?
Severe HA
What are the signs and symptoms of bacteria meningitis?
HA N/V Fever Stiff neck Skin rash/petechiae
What is nuchal rigidity?
Stiff neck
Flexion of the neck; knees automatically flex
Positive brudzinskis sign
Lying down and hips flexed and cannot extend the knee
Positive kernig
What is a common complication of bacterial meningitis?
IICP
What cranial nerves are involved with IICP?
2,3,4,6,8
1/3 of the patients with bacterial meningitis will have?
Seizures
What is a common cranial nerve issue with bacterial meningitis?
Photophobia
What Could be a permanent complication of bacterial meningitis?
Deafness
A pathological process caused by numerous small clots (countless amounts)
DIC- disseminated intravascular coagulation
How is bacterial meningitis diagnosed?
C&S (blood, sputum, nasal)
Imaging (X-ray, CT, or MRI)
Lumbar Puncture (DEFINITIVE TOOL)
How is bacterial meningitis treated?
Broad spectrum antibiotics until the pathogen is identified. Given in large, rapid doses of IV and PO.
What is Waterhouse-Friderichsen syndrome?
Severe vascular dysfunction
Why is decadron used?
It decreases cerebral edema. It also reduces mortality rate and hearing loss.
What precautions will a bacterial meningitis patient be on?
Droplet precautions
Meningococcal meningitis is
HIGHLY CONTAGIOUS
What is key in bacterial meningitis?
Prevention
What is critical to manage with a patient positive for bacterial meningitis due to increased risk of seizures?
Fever
What is viral meningitis usually caused by?
Measles, mumps, herpes, HIV
This disease is not as severe as bacterial meningitis and usually resolves within
2 weeks
What is different about viral and bacterial meningitis?
Viral doesn’t have purulent secretions and may have a normal or low glucose level.
How is viral meningitis diagnosed?
CSF sample (clear or cloudy)
PCR (blood test)
Stains and grams (negative for organisms)
What is the treatment for viral meningitis?
Treat symptoms only
Acute inflammation of the brain usually caused by a virus
Encephalitis
Mosquitoes and ticks can transmit the virus to a human via an insect bite
Encephalitis
The onset of encephalitis is
2-3 days
Encephalitis is a mild to severe manifestation that has what type of symptoms?
Flu-like symptoms
Encephalitis needs to be diagnosed when to have a favorable outcome?
Early
How is encephalitis treated?
Acyclovir (antivirals) and decadron
What else is treated with encephalitis?
Symptoms
Localized collections of pus within the brain tissue
Brain abscess
The infection is usually by a direct extension by
The ear, mastoid, tooth, and sinuses
Trauma or neurosurgery including tongue piercing and chipped teeth can cause
Brain abscess
Brain abscesses can be because of the bloodstream and septic emboli because it
Travels to the CNS from somewhere else
What organisms are usually associated with brain abscesses?
Streptococci
Staph aureus
What side of the brain does the abscess occur on?
The same side as the primary infection
Liquid necrotic tissue is encapsulated in a thick fibrous wall within
2 weeks
What are the systemic signs and symptoms of brain abscess
HA Fever Chills N/V Malaise
How does the brain abscess affect the temporal lobe?
Visual changes and receptive aphasia
How does the brain abscess affect the occipital lobe?
Visual impairment
How does the brain abscess affect the frontal lobe?
Expressive aphasia and motor weakness
How does the brain abscess affect the cerebellar region?
Ataxia
How do we diagnose brain abscesses?
WBC and ESR (to determine infection)
Cultures (ear,nose, and throat)
Imaging (to actually see the abscess)
How do we treat the brain abscess?
IV antibiotics administered in large doses to cross the blood brain barrier
What surgery is performed to remove and drain the abscess?
Craniotomy
Infection of ANY part of the nervous system
Neurosyphilis
Tertiary syphilis “treponema pallidum” can invade the CNS in a few months of original infection and can lay dormant for
10 years
Neurosyphilis is not contagious but can be fatal and Neuro deficits are
Permanent
Neurosyphilis is diagnosed by
RPR (rapid plasma regain)
A specific syphilis test
Signs and symptoms of Neurosyphilis are
Progressive ataxia Lightening pain (shooting) Slapping gait (toes slap the ground) Loss of DTR and proprioception (deep tendon reflexes) (walking into the table) Charcots joints (enlarged with instability and loss of sensation)
Treatment for Neurosyphilis
PCN
Most common type of pain
Headache
Primary or functional problem of a headache is
The actual headache
The secondary or organic problem of a headache is
The headache is a result of another medical condition
What are the three types of headaches
Tension
Migraine
Cluster
This headache is mainly caused by stress
Tension Headache
This is the most common type of headache
Tension headache
Tension headaches occur
Intermittently (weeks to years)
The duration of a tension headache is
Minutes to days
Migraines are more prevalent in
Women
The onset of migraines usually occur at what age?
20-30 years old
The cause of migraines is
Unknown
What are the triggers of a migraine?
Food, medications, hormones
What kind of foods contain tyramine?
Chocolate, smoked fish, aged cheese, hot dogs, pickles, yeast, coffee, and wine.
How long does a migraine typically last?
4-72 hours
What are the symptoms of a migraine
Unilateral pain Throbbing Photophobia Phonophobia N/V
What are some factors that contribute to migraines?
Stress Menses Sleep problems Bright lights Missed meals Smells
What is the most common type of migraine?
Migraine without an Aura
What is an aura?
Sensation that immediately perceives a HA, paralysis of limbs, abnormal feeling, blurred vision, spots in the eyes.
Hours to days prior to preceding migraine including mood and food craving
Prodromal period
When the HA begins and intensifies over hours with a tendency to hibernate
Second phase or headache phase
Pain is improving with residual effects of scalp tenderness and neck tenderness
Third phase and gradual subsiding
What is the first line of defense for migraines and is highly effective?
Triptans
What is the anti-inflammatory to take with Triptans?
Treximet
Affects serotonin receptors to inhibit neurogenic inflammation and cause cranial vasoconstriction
Triptans
What are side effects of Triptans
Flush
Tingling
Hot sensation
Who is contraindicated to take Triptans?
Someone with vascular conditions, HTN, and CVD
Tripten vs. Ergotamine
Can’t be taken together because it causes too much constriction
This type of medication is used to treat migraines. It causes constriction by affecting vascular smooth muscle.
Ergotamine
What are 4 treatments that are used prophylactically for migraines?
Antihypertensives
Anticonvulsants
Antidepressants
Botox
With topamax it is recommended to increase fluids. Why?
It increases the risk of kidney stones
When taking anticonvulsants what is important about treatment?
Do not abruptly discontinue treatment. Can trigger rebound seizure activity.
A rare form of headache that occurs usually in males age 20-40 years old and tends to precede over the eye.
Cluster headaches
What is the thought cause of cluster headaches?
Hypothalamic dysfunction
What are the signs and symptoms of a cluster migraine?
Extremely severe
Unilateral burning or stabbing pain
Lasts 45 minutes
1-8 times a day
What is unique about cluster headaches?
They come back at the same time of year and season
What symptoms are present on the affected side of the cluster headache?
Ipsilateral tearing Rhinorrhea (nasal congestion) Facial flushing/pallor Miosis (constricted pupil-one sided) Periorbital edema
What are some triggers of cluster headaches?
ETOH Smoke Strong odors Vasodilators Napping
What treatment is used prophylactically for cluster headaches?
Migraine medications
What is abortive treatment for cluster headaches?
Oxygen 100% by face mask
6-8L for 10 minutes AND
Triptans
Two different types of surgery that can be performed for cluster headaches?
Ablation with percutaneous radio frequency
Deep brain stimulation to the hypothalamus
Paroxysmal uncontrolled electrical discharge of neurons; interrupts normal function caused by abnormal motor and sensory autonomic activity.
Seizures
Tumors may be a symptom of a disease. What is the primary reason for seizures.
Tumor
Seizures may also spontaneously. What is the percentage of cases not related to a source?
75%
A chronic condition of abnormal spontaneous depolarization or uncontrolled electrical discharge affecting 3 million people.
Epilepsy
Is believed to start at the foci and is thought to be involved with gliosis or Astrocyte involvement.
Epilepsy
Males, Alzheimer’s/stroke, AA, family history and socially disadvantaged are all what?
Risk factors
20-30 years of age diagnosed with a seizure is usually related to
Tumor or trauma
A diagnosis of seizure often due to a noxic event or inadequate oxygen is found in who?
Infants
Seizures diagnosed in patients over the age of 50 are usually caused by
Stroke or tumor
EEG is
Not a definitive test for seizures
How is a seizure diagnosed?
CT scan
MRI
Cerebral angiography
MRA
What test can look for seizures but only indicates abnormalities predisposing of seizures?
Serum labs
Behavioral changes that precede the seizure
1st phase: Prodromal phase
Sensory warning (smell, sound, heard)
2nd phase: aural phase
During the seizure
3rd phase - ictal phase
After the seizure
4th phase - post ictal phase
Tingling or cheek biting, incontinence, excessive salivation and cyanosis are symptoms of what seizure?
Grand mal
During what phase will a patient sleep for hours with no memory and soreness?
Post ictal
In general seizures what part of the brain is involved?
Entire brain
What is the most common type of seizure and results in loss of consciousness?
Tonic-clonic
Medical term for stiffness during a seizure
Tonic
Medical term for jerking during a seizure
Clonic
How long does jerking last?
2-5 minutes
Medical management is based on stabilizing the nerve cell membrane by what?
Administering anti-seizure medications
What medication still needs to be monitored by blood serum labs?
Dilantin
What is important about anti-seizure meds?
Start with a low dose and if inadequate add more. Give minimal dose necessary.
What meds have numerous side effects?
Anti-epileptic drugs
What patient teaching is pertinent to the medication regime?
Take med at the same time everyday and do not abruptly discontinue.
Removing the epileptic focus to prevent the spread of abnormal firing. Must meet 3 criteria points:
Confirm diagnosis
Failed drug trial
Identify type of seizure
Surgical intervention
A device that can be used to stop abnormal firing and is attached around the nerve with a battery and the electrode has varied strength and frequencies.
Vagal nerve stimulation
A specific diet that has extremely low carbs and alters brain metabolism and prevent seizures is called
Ketogenic diet
The state of continuous seizures and is 2x more of risk for death
Status epilepticus
Status epilepticus is considered
A medical emergency and can cause brain damage
What is the two priority treatments for emergency complications of seizures?
IV access
Airway
When a patient is at risk for aspiration what does the nursing care include during a seizure?
Turn the head to the side to prevent swallowing the tongue and aspirating saliva contents.
This type of seizure is unilateral due to local focal abnormality
Partial seizure
This type of seizure is bilateral
Generalized seizure
A partial seizure does NOT precede a loss of
Consciousness
A generalized seizure DOES precede
Complete loss or alteration of consciousness
This type of seizure manifests as intact consciousness, they tend to last less than a minute, will be one sided, and el have motor, sensory, and autonomic manifestations.
Simple partial seizure
This seizure will manifest as altered consciousness with confusion or clouding, last longer than a minute, behavior changes, emotional changes, altered memory, and repetitive movement.
Complex partial seizures
The medical term for repetitive movement
Automateisms
What seizure usually involves the temporal lobe
Complex partial seizures
The confused state is called
Post ictal
Atypical absence associated with staring spells and peculiar behavior and post ictal confusion
Absence seizures
What is the worst seizure?
Tonic-Clonic seizure
This type of seizure can last seconds an is associated with forceful jerking and tends to occur in clusters
Myoclonic seizures
This type of seizure is associated with stiffness abruptly with possible loss of consciousness
Tonic seizure
This seizure is classified as abrupt jerking occurs with muscle flaccidity; seen on childhood and usually resolves or progresses to another type of seizure
Clonic seizure
A seizure classified as a “drop attack” with sudden flaccidity and regains consciousness by the time they hit the floor. High risk for injury.
Atonic seizures
Partial seizures usually progress to
Generalized seizures