Neuro Flashcards
most common pain experienced
headache
what types of headaches are there
tension, migraine, cluster
describe a tension headache
typical headache
base of skull, forehead, neck/shoulder
tension headache relieved with what
rest, NSAIDS, OC meds
determine cause to alleviate
what are the precipitating factors of tension headaches
stress, hunger, lack of sleep, withdrawal from coffee, eye strain
what is the patho of migraines
“pathological cause”
- vascular, genetic, chemical, trigemal vascular system (spasms, decreased blood flow), hypoxia, artery dilation (prostaglandin trigger)
- these cause increase in swelling and sensitivity to pain
s/s of migraine
throbbing pain, worse behind one eye/ear, photophobia, anorexia, nausea, sensitive scalp, sound
three types of migraines
with aura, without aura, atypical
describe migraine with aura
- sensation that indicates onset of migraine or seizure
- develops over several minutes and lasts for less 1 hr
- subjective feeling of doom
- may consist of flashing lights, noises, distorted vision
describe migraines without aura and atypical
without aura: most migraines without aura
atypical: menstrual and cluster
stages of migraines
1) prodrome: specific s/s and mood change
2) aura: visual change, diplopia, flashing light
3) headache: lasts hrs-days
4) termination: intensity decreases
5) postprodrome: fatigue, irritability
what can be triggers of migraines
fatigue, anger, stress, hunger, irritability, chocolate, caffeine, alcohol, insomnia, hormones, meds, artificial sweeteners
what are the typical drugs for migraines
NSAIDS, beta blockers, calcium channel blockers,
antidepressants, opioids, Triptan preparatons serotonin (Imitrex*, Zomig, Relpax)
what abortive drugs are used for migraines
ASA and tylenol
taken during aura to prevent migraine from occurring
what is meningitis
- inflammation of protective membrane covering the brain and spinal cord (meninges)
- bacterial(most dangerous) and viral
- medical emergency, high mortality
what do we vaccine against
meningococcal
s/s of meningitis
*nuchal rigidity, headache, fever, chills, photophobia, N/V, altered level of consciousness, tachycardia, seizures, red macular rash, Kernig’s sign, Brudzinski’s sign
what is a positive Kernig and Brudzinski
Kernig: resistance to extension of pt leg from flexed position
Brudzinski: flexion of extremities with deliberate flexion of pt neck
1 indicator of meningitis
have pt put chin to neck
positive for meningitis will NOT be able to do it, too painful
describe viral meningitis
occurs most often and resolves without treatment
describe bacterial meningitis
organisms enter CNS through BBB
results in inflammatory response
what are the risk factors of bacterial meningitis
bacterial infection (ie/ resp infection), immunosuppression, invasive procedure, head injury, overcrowded living conditions (college dorms)
how is bacterial meningitis diagnosed
cerebrospinal fluid analysis: obtained via lumbar puncture
*broad spectrum antibiotic given BEFORE puncture
nursing care of meningitis
- monitor ABC
- neuro and VS check every 2-4 hrs
- motor changes and I & Os
- antibiotics (Rocephin and antiepileptics)
- decreased environmental stimuli
- isolation precautions (standard unless airborne bacteria identified)
what complications of meningitis do you want to prevent
- increased ICP (brain swelling would cause pupil changes)
- vascular dysfunction
- seizures, shock
- fluid and electrolyte imbalance
difference between Ach and dopamine
Ach: excitatory neurotransmitter
dopamine: inhibitory neurotransmitter
what are the four signs of Parkinson’s
1) rigidity
2) slow movement (akinesia)
3) tremor at rest
4) impaired postural reflexes, fall forward
what is akinesia
slow movement
patho of Parkinson’s
- neurotransmitter disease
- balance of dopamine and Ach is disrupted
- degeneration of dopamine(decreased) producing neuron
- decreased norepinephrine also causes orthostatic changes
when do symptoms appear in Parkinson’s
when 80% of basal ganglia are gone
what are the risk factors of parkinson’s
increased with age
more common in men
genetics or brain injury may cause this
what are the stages of Parkinson’s
1) symptoms on one side of body, tremors
2) bilateral limb movement, slow gait
3) shuffling, propulsive gait with flexed arms
4) akinesia, rigidity
5) complete dependence (may never reach this stage)
Cogwheel
rhythmic movement
dysarthia
slurred speech
features of Parkinson’s
- stooped posture
- shuffling, propulsive gait
- bradykinesia and cogwheel
- dysarthia, echolalia, hypophobia
- liable, mood swings
what are the signs of Parkinson’s
- cannot relax arms or face (masklike)
- orthostatic hypotension (fall risk)
- tremors at rest, lack inhibitory neurotransmitter (dopamine)
diagnostic test of Parkinson’s
no specific test
diagnosis when 2 or 3 characteristics are present
triad (tremor, rigidity, bradykinesia)
when is Parkinson’s confirmed
positive response to antiparkinonian drugs
what is drug therapy for Parkinson’s
- correct imbalance of neurotransmitters
- enhance or release supply of dopamine
- goal is to decrease symptoms
drug that is a precursor to dopamine
given for Parkinson’s
Levodopa
cross BBB and turns into dopamine in basal ganglia
cannot give straight dopamine because it will NOT cross BBB
what is given with Levodopa for Parkinson’s
Carbidopa
inhibits enzyme that breaks down levodopa before it reaches the brain
why is Requip given to Parkinson’s pt
dopamine agonist
stimulates production of dopamine
BUT can cause hypotension and hallucinations
why is Cogentin give to Parkinson’s pt
anticholinergic
decreases Ach, controls tremors, rigidity and sweating
what do anticholinergics do (broadly)
dry the pt out
other therapies for Parkinson’s
exercise and ambulation
injury prevention, counseling
OT and ADL and ST therapy
nutrition, soft food, thicken foods
inability to use words or objects correctly
apraxia
inability to find words
anomia
inability to speak or understand
aphasia
loss of sensory comprehension
agnosia
agnosia, aphasia, anomia, and apraxia are found in what disease
Alzheimer’s
