Neuro Flashcards
Headache
Priority is to determine underlying cause of headache prior to treatment
Thorough history and physical
*Distinguish what causes it; is there an aura?
Headache: Nursing Assessment
Health History
Seizures, cancer, stroke, trauma, asthma or allergies, mental illness, stress, menstruation (where are they in their menstruation/pregnancy?), exercise, food (nuts, chocolates, wines, MSG), bright lights (low light: not enough lighting; eyes could be straining), noxious stimuli
Medications (What are they using?)
Surgery and other treatments (cranial/facial could be manifestation)
Headache: Nursing Assessment
Objective Data
Anxiety or apprehension
Diaphoresis, pallor, unilateral flushing with cheek edema, conjunctivitis
*Migraines can often mean something more severe
Migraine Headache
Recurring
Characterized by unilateral or bilateral throbbing pain
Triggering event or factor
Family history
Migraine Headache: Drug Therapy
Goal is to terminate or decrease symptoms
Mild to moderate headache can obtain relief with aspirin or acetaminophen
One in progress may need narcotics (narcotics can cause onset; stopping treatment can result in withdrawal)
Antiemetics
Migraine Headache: Drug THerapy
Serotonin receptor agonists Alpha- and beta-adrenergic blockers Tricyclic antidepressants Calcium channel blockers (common) Antiseizure drugs
Migraine Headache: Drug Therapy
Propanolol (prevents dilation of cerebral blood vessels)
Verapamil (controls cerebral vasospams)
Amitriptyline (blocks uptake of serotonin and catecholamines)
Methysergide maleate (dec. serotonin action)
Ergomar or Cafergot (helps to dec. severity; Can be given by supp.)
Imitrex and Zomig (act rapidly to stop migraine; Self-injection)
Tension-Type Headache: Drug Therapy
Non-narcotic analgesic used alone or in combination with a sedative, muscle relaxant, tranquilizer, or codeine
*Tylenol, Ibuprofen. Combine with muscle relaxant. Heat and cold therapy may help
Cluster Headache: Treatment
Similar meds as migraines may control these
Oxygen (10-20 min. continuous flow)
Ergotamine tartrate give HS rectally)
*Look at changing the triggers - Fall (season) and alcohol intake
Tension-Type Headache: Diagnostic Studies
Careful history taking
Electromyography may be performed (may reveal sustained contraction of neck, scalp, or facial muscles)
Tension Headache: Drug Therapy
Nonnarcotic analgesics (Aspirin/ Tylenol) Elavil may be given at bedtime
Cluster Headavhe: Diagnostic Studies
Primarily history
CT, MRI, or MRA may be performed to rule out aneurysm, tumor, or infection
Cluster Headache: Drug Therapy
Alpha-adrenergic blockers
Vasoconstrictors
Acute treatment is inhalation of 100% oxygen delivered at a rate of 7-9L/min for 15-20 minutes
Headache
Can be first symptom of a more serious illness
Can accompany subarachnoid hemorrhage; brain tumours; other intracranial masses; arteritis; vascular abnormalities; trigeminal neuralgia; diseases of the eyes, nose, and teeth; and systemic illness
Headache: Collaborative Care
If no systemic underlying disease is found, therapy is directed toward functional type of headache
Includes drugs, medication, yoga, biofeedback, cognitive-behavioural therapy, and relaxation training
Headache: Nursing Diagnoses
Acute pain
Anxiety
Hoplessness
Headache: Planning
Have reduced or no pain
Experience increased comfort and decreased anxiety
Demonstrate understanding of triggering events and treatment strategies
Use positive coping strategies to deal with chronic pain
Experience increased quality of life
Headache: Nursing Implementation
Daily exercise, relaxation periods, and socializing help decrease recurrence and should be encouraged
Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis
Help client examine lifestyle, recognize stressful situations, and learn to cope with them more appropriately
Headache: Nursing Iplementation
Massage and heat packs can help with tension-type
Client should make a written note to prevent accidental overdose
Teach client about prophylactic treatment
Dietary counselling for food triggers
Avoid smoking and smoke exposure and other environmental triggers
Meningitis
Inflammation of the meninges: brain and spinal cord
Bacterial: 100 cases a year in Canada - 21% due to pneumococcal
Viral: Less severe, shorter course
Meningitis: Clinical Manifestations (Assessment)
Nuchal rigidity Positive Kernig's sign Positive Brudzinski's sign Photophobia Seizures & Increased ICP Rash
Meningitis: Management
Diagnosis: Lumbar puncture culture CSF & blood
Pharmacological Treatment: Antibiotics that cross blood brain barrier (BBB); Dexamethasone (corticosteroid)
Meningococcemia
Spread airborne droplets
Highly contagious
Death can occur 10-12 hours after fever and petechial rash
Due to overwhelming septicaemia, vascular collapse and adrenal hemorrhage
Public Health Issues
Since highly contagious individuals exposed are placed on prophylactic antibiotics
Rifampin and ciprofloxacin
Must be reported to health dept.
Preventative vaccination program
Meningitis: Treatment
Viral: Focuses on relieving symptoms. Antipyretics and analgesics. No need for isolation
Bacterial: Rapid diagnosis. Antibiotic therapy immediately; IV penicillin, cephalosporins, more specific with C&S- high doses to cross BBB. Airborne isolation precautions
Encephalitis: Treatment
Antiviral medications (Vudarabine and acyclovir) No need for isolation as not transmitted from person to person
Brain Abscess
Treatment focuses on prompt antibiotic therapy
Treatment of symptoms
Surgical interventions (when antibiotics not effective): Drainage of abscess, craniotomy to remove encapsulated abscess
Brain Infections: Nursing Care
Assessment: VS/LOC Changes in vision/hearing Brudzinski's and Kernig's signs Seizures/restlessness or agitation Petechial rash Exposure to mosquitoes or ticks Hx of head injury, brain surgery, otitis media or bacterial endocarditis
Brain Infections: Nursing Care
Diagnoses: Risk for Ineffective Tissue Persion: Cerebral; Hyperthermia; Acute pain
Evaluation: Afebrile; Absence of headache/ signs of IICP; Knowledge of anti-infective therapy
Relief of other symptoms
Anticonvulsants Antipyretics Analgesics Osmotic diuretics Corticosteroids Antiemetics IV fluids
Brain Infections: Nursing Care
VS & clinical status
Monitor I&O: Hydration vs overload
Precautions: Infection control measure
Fever management
MS: Nursing Assessment
Health Hx: Viral infections or vaccnations Residence in cold or temperate climates Physical and emotional stress Medications Elimination problems Weight loss, dysphagia
MS: Nursing Assessment
Muscle weakness or fatigue, tingling or numbness, muscle spasms
Blurred or lost vision, diplopia, vertigo, tinnitus
Decreased libido, impotence
Anger, depression, euphoria, isolation
MS: Nursing Assessment (Objective Data)
Aptahy, inattentiveness
Pressure Ulcers
Scanning speech, tremor, nystagmus, ataxia, spasticity, hyperreflexia, decreased hearing
Muscular weakness, paresis, paralysis, foot dragging, dysarthria
MS: Drug Therapy
Corticosteroids
Treat acute exacerbations by reducing edema and inflammation at the site of demyelination
Do not affect the ultimate outcome or degree of residual neurological impairment from exacerbation
MS: Immunosuppressive Therapy
Beneficial effects in clients with progressive-relapsing, secondary-progressive, and primary-progressive MS
Potential benefits counterbalanced against potentially serious side effects
MS: Immunomodulators
Interferon ß-1b (Betaseron) Interferon ß-1a (Avonex, Rebif) Glatiramer (Copaxone) Natalizumab (Antegren) Mitoxaantrone (Novantrone)
MS: Collaborative Care
Antispasmotics
CNS stimulants
Anticholinergics
Tricyclic antidepressants and anti seizure drugs
Urinary retention treated with cholinergics such as bethanechol (Urecholine) or neostigmine (Prostigmine)
MS: Collaborative Care
Surgery
Dorsal-column electrical stimulation
Intrathecal baclofen pump
Physical therapy helps: Relieve spasticity; Increase coordination; Train the client to substitute unaffected muscles for impaired ones
Nutritional therapy includes megavitamins and diets consisting of low-fat, gluten-free food, and raw vegetables
High-protein diet with supplementary vitamins is often prescribed
MS: Nursing Diagnoses
Impaired physical mobility Dressing/grooming self-care deficit Risk for impaired skin integrity Impaired urinary elimination pattern Sexual dysfunction Interrupted family processes
MS: Nursing Planning
Maximize neuromuscular function
Maintain independence in activities of daily living for as long as possible
Optimize psychosocial well-being
Adjust to the illness
Reduce factors that precipitate exacerbations
MS: Nursing Implementation
Help client identify triggers and develop ways to avoid them or minimize their effects
Reassure client during diagnostic phase
Assist client in dealing with anxiety caused by diagnosis
Prevent major complications of immobility
MS: Nursing Implementation
Focus teaching on building general resistance to illness (Avoiding fatigue, extremes of hot and cold, exposure to infection)
Teach good balance of exercise and rest, nutrition, avoidance of hazards of immobility)
Teach self-catheterization if necessary
Teach adequate intake of fibre to promote regular bowel habits
Increased Intracranial Pressure (IICP): Complications
Inadequate cerebral perfusion
Cerebral herniation
IICP: Diagnostic Studies
MRI CT Cerebral angiography Transcranial Doppler studies Near-infrared spectroscopy PET and SPECT
IICP: Collaborative Care
Normothermia Adequate oxygenation PaO2 maintenance at 100 mm Hg or greater ABG analysis guides the oxygen therapy May require mechanical ventilator
IICP: Drug therapy
Mannitol Loop Diuretics Corticostroids Barbiturates Antiseizure drugs Antipyretics
IICP: Nutrtional Therapy
Client is in hyper metabolic and hyper catabolic state
^ need for glucose
Keep client normovolemic (IV 0.45% or 0.9% NaCl)
IICP: Nursing Assessment
Subjective data from client or family members
Glasgow Coma Scale (GCS)
Neurological assessment
IICP: Nursign Diagnoses
Ineffective airway clearance
ineffective tissue perfusion
Impaired skin integrity
Self-care deficit
IICP: Planning
Overall goals: ICP normalized Maintain patent airway Normal fluid and electrolyte balance No complications secondary to immobility
IICP: Nursing Implementation
Respiratory function Fluid and electrolyte balance Monitoring of intracranial pressure Body position maintained in head-up position Protection from injury Psychological considerations Family support
Seizures: Nursing Assessment
Birth defects or injuries, anoxic episodes, CNS trauma, tumors, metabolic disorders, alcoholism, exposure to renal failure
Compliance with anti seizure medications, barbiturate or alcohol withdrawal, cocaine/amphetamines
Seizures: Nursing Assessment
Family Hx
Headaches, aura, mood or behavioural changes before seizure
Anxiety, depression, loss of self-esteem, social isolation
Decreased sexual drive, ED
Seizures: Nursing Assessment
Metabolic acidosis or alkalosis, hyperkalemia, hypoglycemia, dehydration, water intoxication
Bitten tongue, soft tissue damage, cyanosis
Abnormal respiratory rate, apnea (ictal), absent or abnormal breath sounds, airway occlusion
Seizures: Nursing Assessment
Hypertension, tachy/bradycardia
Bowel/urinary incontinence, excessive salivation
Weakness, paralysis, ataxia (postical)
Abnormal CT, MRI, EEG
Seizures: Nursing Assessment
Tonic-clonic: loss of consciousness, muscle tightening then jerking, dilated pupils, hyperventilation then apnea, post-octal somnolence
Absence: altered consciousness, minor facial motor activity
Seizures: Nursing Assessment
Simple: aura; focal sensory, motor, cognitive or emotional phenomena; unilateral “marching”; motor seizure
Complex: altered consciousness with inappropriate behaviours, amnesia of event
Seizures: Complications
Status epilepticus is a state of constant seizure or a condition in which seizures recur in rapid succession without return to consciousness between seizures
Neurological emergency
Can involve any type of seizure
Seizure: Complications
Tonic-clonic status epilepticus is most dangerous because it can cause ventilatory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, and systemic acidosis
Trauma during seizures can cause severe injury and death
Seizures: Complications
Social stigma: Interferes with values of self-control, conformity, and independence
Discrimination in employment and education
Driving sanctions
Seizures: Collaborative Care
Drug therapy aimed at prevention:
Stabilize nerve cell membranes and prevent spread of epileptic discharge
70% of clients controlled with medication
Monitor drug serum levels
