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AH1 - Exam II > Neuro > Flashcards

Neuro Flashcards

1
Q

What are seizures?

A

Paroxysmal, uncontrolled, excessive firing of hyperexcitable neurons in the brain.
Nerve cells continue to fire despite a determined “task” is completed… this continued firing cause parts of the body controlled by that nerve to move erratically
Normally neurons in the brain communicate with each other by rapid firing electrochemical signals
In a seizure, groups of neurons fire at the same time in one sudden burst

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2
Q

Define epilepsy.

A

Epilepsy is defined by 2 or more seizures experienced by a person
GABA or neurotransmitter imbalance or both

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3
Q

What are the causes or risk factors of seizures?

A

50% of seizure cases have no known cause—primary or idiopathic
Stroke
Hypoxemia of any cause, including vascular insufficiency (heart disease)
High Fever
Head injury
CNS infections
Metabolic and toxic conditions (e.g., kidney injury, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure)
Brain tumor
Drug and alcohol withdrawal

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4
Q

What are the pre and post phases of seizures?

A

Preictal- what occurred immediately before the seizure activity began?
Postictal- can lasts minutes to hours depending on type and severity of the seizure activity

Patient may be confused, lethargic, in pain, show debilities that will likely resolve once body recovers

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5
Q

What are partial seizures?

A
  • No loss of consciousness
  • Hand may shake or other single part of the body
  • Mouth may twitch
  • Lasts up to 90 seconds
  • Usually has an aura before the seizure
    Dizzy, smell, sound, vision, “unusual feeling”
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6
Q

What are Tonic-clonic (grand mal) seizures?

A

Entire cerebral cortex is involved
Aura present
- Irritability and tension may precede, most begin without warning
Tonic phase and clonic phase
- Generalized tonic extension of extremities lasting a few seconds
- Followed by clonic rhythmic movements and prolonged postictal confusion
Doesn’t feel, see, or remember anything during the seizure
Lasts 2-5 minutes

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7
Q

How do seizures differ in older adults?

A

Complex partial is most common type

Symptoms may appear similar to dementia or psychosis

New onset is typically associated with hypertension, diabetes, dementia, stroke, and recent brain injury

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8
Q

What is status epilepticus?

A

-Prolonged or frequent seizures
Most often a results of abrupt stop in AED medication
May also be caused by untreated or inadequately treated conditions
-A single seizure lasting more than 5 minutes
-Intermittent seizure activity lasting 30 minutes or more
Recovery between seizures is incomplete
Medical Emergency
10% mortality rate
Typically any seizure lasting longer than 5 minutes will NOT stop spontaneously
Intervene immediately with IV Lorazepam/Diazepam, then IV AED

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9
Q

What are seizure precautions?

A 
Oxygen
Suction equipment
Airway
Iv access
Side rails up and padded
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10
Q

What is seizure “first aid”?

A
  1. Time the seizure
  2. Speak calmly
  3. Don’t grab or hold
  4. Explain to others
  5. Block hazards
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11
Q

What should you do while the seizure is occurring?

A

Protect patient from injury

  • Move furniture
  • Place something under head if not in bed
  • Turn patient on side in case of foaming in mouth or vomiting
  • Do not restrain patient

Maintain airway

  • Use oral suction as needed
  • NEVER force anything into the patient’s mouth

Observe!

  • Length
  • Body parts involved
  • Incontinence
  • Any sounds patient may make

After seizure is over

  • vital signs
  • neuro checks
  • allow for rest
  • keep in side lying position
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12
Q

What is the medication management for seizures?

A 
Diazepam or Lorazepam
Diastat
Phenytoin
Fosphenytoin
Valproate
Carbamazepine
Lamotrigine
Levetiracetam
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13
Q

What considerations for discharge for a pt with seizures/epilepsy?

A 
Continuing medications
Avoid alcohol and excessive fatigue
Follow up appointments
Family member is aware of interventions if a seizure occurs
Medical bracelet
NO DRIVING
Social implications
Can the patient still work?
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14
Q

How is epilepsy diagnosed?

A
  • Epilepsy is diagnosed by taking a careful history and ruling out secondary causes first
  • MRI is essential to helping detect causes
  • Complete cessation of seizures using a single AED without side effects is the goal of therapy
  • Failure of 2 AEDs suggests that the diagnosis may be incorrect or that the patient has intractable epilepsy requiring a referral to a neurologist and/or neurosurgeon
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15
Q

What is Guillain-Barre?

A

Demyelination of peripheral nerves
Commonly results from immune response following febrile illness or vaccine (flu)
There are some reports of this response following the covid vaccine
Symptoms
-Initial muscle weakness and pain
- Ascending paralysis
- Autonomic dysfunction

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16
Q

What is the plan of care for Guillain-Barre?

A 
Priorities
-Respiratory care
-Pain management and paresthesias
-Skin and mobility
-Nutritional needs
Involvement of family
Education
-Medical treatments
-Plasmapheresis
-IVIG - Intravenous Immunoglobulin
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17
Q

What is a stroke?

A
  • A sudden loss of brain function resulting from disruption of the blood supply to a part of the brain and depriving oxygen delivery
  • This is the 3rd leading cause of death and disability in the United States
  • Ischemic vs hemorrhagic
  • –> MCA is most common location
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18
Q

What are the different types of strokes?

A
  1. Hemorrhagic – the brain bleeds due to a rupture in the blood vessel
    - This can be traumatic or spontaneous
    - SAH vs ICH
    - Can be from ruptured aneurysm
    - Uncontrolled blood pressure
    - “Worst headache of their life”
    – Embolic vs Thrombotic
    (I) Embolic – a clot has blocked the flow of blood through the vessels in the brain
    (II) Thrombotic – an occluded/narrowed vessel, usually due to plaque build up – the blood cannot travel through to reach all areas of the brain
    (III) TIA - mini stroke (transient ischemic attack)
    Used as a warning that a major stroke is coming if not properly treated
    Always ischemic
    Symptoms usually resolve within a short amount of time.
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19
Q

What are the risk factors for stroke?

A 
Hypertension – may be med induced
Heart disease – Afib and mitral valve
Diabetes 
Sleep apnea
Cholesterol
Sedentary lifestyle
smoking
Substance abuse
Hormone replacement and birth control
Obesity
ethnicity
Trauma/falls
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20
Q

What are the symptoms of left-sided stroke?

A 
Aphasia and Agraphia
Memory deficit
Inability to recognize words or letters
Anxiety
Quick to anger
Slow to respond
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21
Q

What are the symptoms of right-sided stroke?

A 
Personality changes
Disorientation or inability to recognize faces
Loss of depth perception
Impulsive, unaware of deficits
Poor judgment
Loss of hearing and tone variations
22
Q

What are the general symptoms of stroke?

A

Frontal lobe effects emotional and personality changes
Broca’s area = expressive aphasia
Wernicke’s area = receptive aphasia
Long term may develop vascular dementia, especially when more than one stroke occurs

23
Q

What does the acronym “FAST” stand for?

A

Time is brain so act fast

Face - has their face changed?
Arms - can they lift both arms?
Speech - slurred? Can they understand you?
Time. is critical

  • Last known “well” time
  • Time to call 911
24
Q

What are the stroke levels?

A 
Level 1
- 0-3.5 hours
Level 2
- 3.5-6 hours
Level 3
- Anyone greater than 6 hours
25
Q

what is the NIH scale?

A

Universal assessment of the severity of deficits
Used to test mobility, strength, vision, and cognitive ability
“FLEAS GIVE ME A STROKE”
Face, Loc, eyes, arms/legs, speech

26
Q

Describe the flow of care for stroke.

A
27
Q

What tests/labs will be done for stroke patients?

A 
CT – rule out bleed
MRI – confirm CVA and location
Carotid US to look for blockages
--> endocardectomy
Echo – looking for heart damage
--> Ejection fraction
Lipid panel and Hgb A1C
Will be discharged on Aspirin or Clopidogrel and Cholesterol medication based on labs and initial cause
Screen for other comorbidities
28
Q

What are the treatment option for stroke?

A

TPA – time sensitive
Embolectomy
Place on telemetry
Strictly monitor ICP and BP
Treat the cause – angioplasty, carotid endoarterectomy, medication management of DM, Cholesterol, HTN
PT/OT/ST
- Swallow study
- Nutritional support if difficulty swallowing
Surgery if it is hemorrhagic to evacuate blood and discontinue all blood thinners
- Monitor for vasospasm - - tx with Nimodipine (Nimotop)

29
Q

What is TPA?

A

TPA- 
tissue plasminogen activator

Only used on Level 1
Requires informed consent
Weight based dosing
Strict monitoring for 24-48 hours after given
Restricted for 
- Older than 80
- On anticoagulant
- NIH score greater than 22
- History of both stroke and diabetes
30
Q

How can clots be prevented?

A

SCD machine
Aspirin
Warfarin
Heparin/Enoxeparin
Clopidogrel (Plavix)
Dipyridamole (Aggrenox) - IR asa and er dipyridamole
Apixaban (Eliquis) - no lab monitoring and does have some restrictions with Afib types

31
Q

What does rehabilitation look like for stroke patients?

A

Increase mobility and strength
Learn alternate ways to complete ADLs
Alternative communication and eating needs
Determine how much assistance patient will need at discharge

32
Q

What education is important for stroke patients?x`

A 
Risk factors
Life style changes
S/S to look for – FAST
Include family in education
Available support groups – AHA and stroke folks
33
Q

What is dementia?

A

Must have at least 2 of the following impairments to receive diagnosis of dementia

  1. Memory
  2. Communication and language
  3. Attention span or ability to focus
  4. Reasoning and judgment
  5. Visual perception
34
Q

What are the types of dementia?

A
  1. Vascular dementia - Vascular dementia for patients with any chronic disease process cause vascular changes in the brain
    Stroke
    DM
    Heart disease
  2. Drug-induced dementia
    Long term drug use or overdose
    Exposure to environmental toxins such as lead
35
Q

What is Alzheimer’s Disease?

A

A form of dementia - Accounts for 50% of dementia cases
Effects women more than men
Decreases ability to learn new information
Impairs memory
Decreased language and communication
Decreased attention span
Begin to forget how to perform basic ADLs safely and effectively

36
Q

How is Alzheimer’s diagnosed?

A

Typically a rule out diagnosis… we have ruled out all other possibilities
Autopsy is only definitive way to diagnose
- Neurofibrillary tangles and neuritic plaques
Genetic tests - APOE4
Amyloid beta protein precursor (BPPs)
Obtain patient and family history
- Risk factors include age, gender, and family history
- TBI or repeated Head trauma, herpes virus exposure, down syndrome, and high level exposures to zinc and copper?
- African American and hispanic populations
Mini Mental State Exam - score of 5 or lower

37
Q

What would you find on assessment with Alzheimer’s?

A 
Speed of information processing
Difficulty following directions
Decreased attention and concentration
Forgets daily activities
Short term memory loss
Communication – apraxia, aphasia, anomia, and agnosia
- May not be able to tell you when something is wrong but will have a behavioral change
Lost easily
Functional decline
Tactile changes
Wandering
Poor judgment
38
Q

What is the treatment for Alzheimer’s?

A

NO CURE
Death is usually associated with complications of immobility
Symptom management
Medication options:

Donepezil (Aricept)
Rivastigmine (Exelon)
Memantine (Namenda)
Antidepressants
- Avoid amitriptyline (Elavil)
- Paroxetine and sertraline
Antipsychotics should be avoided
39
Q

Describe the nursing management for Alzheimer’s.

A 
Safety/Airway
Don't try to orient (late stage)
short directions
routines
familiar objects
Meds (BEERS list)
Delirium - assess/high risk
mobility/ADLs 
Sundowning - 
end of life planning
realistic expectations
Safe to go home?
redirection/distraction
community resources
safe return/gps 
MPOA
nutrition
Maintain safety and airway
Attempting to orient patient is not main goal
give 1 short direction at a time and time to respond
Keep consistent routines
Provide familiar objects
Avoid overmedicating and BEERS list
Delirium assessment, high risk patients
Assist with mobility/ADL management
Sundowning – bed alarms, sitters, etc
Redirection and distraction activities
Breaks between activities
Optimize nutritional intake
Family/Caregiver support
Written reminders
Medication box
End of life planning
Living will, MPOA
Set goals for daily life and realistic expectations
Is the patient safe to go home (table 42-2)
Community resources
Safe Return Program and/or GPS
40
Q

What is Parkinson’s Disease?

A

Movement disorder

  • A progressive neurologic disorder resulting from degeneration of basal ganglia in the cerebellum
  • 2nd most common neurologic disease in elderly
  • Most commonly develops after age 50
41
Q

Describe the patho behind Parkinson’s Disease.

A

Dopamine is an essential part of neuromuscular function and is excreted by the basal ganglia
Decreases in dopamine diminishes normal neuromuscular function and control
- Most persons will lose 50% of their dopamine before noticing the symptoms
Primary cause may be hereditary or have no known cause
Secondary may be related to other neurological disorders, drugs, and toxins
Progressively worsens over many years until death… death often due to pneumonia or other infection r/t immobility

42
Q

What would you find on assessment for Parkinson’s?

A 
4 Cardinal signs
1. Tremor… this is an early sign
2. Bradykinesia or akinesia
3. Decreased muscle tone and rigidity (cogwheel rigidity)
4. Postural instability (later sign)
Additionally
- Micrographia
- Hypophonic dysarthria
- Shuffling steps
- Infrequent eye blinking
- Diminished facial expression
43
Q

what additional symptoms develop throughout the disease process of Parkinson’s?

A 
Fatigue
Stooped posture
Mask like face and muffled voice
Dysphagia
Constipation
Othostatic hypotension– due to reduction in sympathetic nervous system
Drooling and nocturia
Depression and/or withdrawal
RLS
RBD
44
Q

How is Parkinson’s diagnosed?

A 
Clinical symptoms
r/o alternatives
Family history
Age of symptom onset
Evaluation of non-motor symptoms that are occurring too
DaTscan
45
Q

What medications can be used for Parkinson’s?

A 
Motor symptoms
- Levodopa/Carbidopa--Duopa
Dopamine Agonists
- Ropinirole
- Pramipexole
Benztropine(Cogentin)s
Selegiline

Non-Motor symptoms

  • Antidepressants-Escitalopram
  • Antianxiety-Buspirone
  • Scopolamine/botox
  • Donepezil/Memantine
  • Domperidone
46
Q

What are the treatment options for Parkinson’s?

A

NO CURE!!!!
Symptom management and provide support
Medications
Duopa - pump provides up to 16 hours of continuous carbidopa/levodopa infusion, gel direct to intestines

DBS - deep brain stimulation, device implanted in chest to deliver electrical stimulation in areas of brain that control movement

Pallidotomy - surgical procedure which involves destroying a tiny area in a part of the brain called the Globus Pallidus interna (GPi or pallidum). (Bc it is overactive and this can help with rigidity and tremors

Drug holidays

47
Q

Describe the nursing management of Parkinson’s.

A

Goal is to preserve mobility, cognition, and quality of life
SAFETY
Exercise
Maintain airway
Manage diet to appropriate consistency and assist with feedings
- High protein and high calorie foods and use of supplements
Allow extra time for patient to respond
Provide alternative communication methods
ADL function
Monitor for cognitive changes
Avoid naps and caffeine
Patient and family education
Home management and safety
Support for coping
Long term planning

48
Q

What are the most important things to remember about Parkinson’s?

A

Parkinson disease has 4 major signs: resting tremor, cogwheel rigidity, bradykinesia, and postural instability
Levodopa is most effective medication for treatment of symptoms
There are motor, cognitive, and emotional/behavioral consequences to this disease
A careful history should always be taken to determine primary or secondary diagnosis
Avoid use of typical antipsychotics and reglan/metoclopramide

49
Q

What is the As of left-sided stroke (mnemonic)?

A 
aphasia
agraphia
ABCDs (can't recognized words/letters)
anger
anxiety
amnesia (memory deficits)
awkward pauses (slowed responses)
50
Q

What are the Ds of right-sided stroke (mnemonic)?

A 
Dick (personality changes)
disorientation (incl recognizing faces)
depth perception
decisions
daredevils (poor judgment/impulsivity)
deaf (loss of hearing and tone variations)

AH1 - Exam II (7 decks)

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