NEURO DISORDERS Flashcards
1
Q
Viral meningitis
A
- most common meningitis..usually no lasting effect
- s/s: CSF–clear, pressure <259, lymphocytes elevated
- protein WNL, glucose WNL
- viral less dangerous because there’s no risk of death
2
Q
Bacterial meningitis
A
- nesseira, strep, HIB are causes
- CSF is cloudy due to WBC elevated , pressure elevated, neutrophils, protein elevated, glucose decreased due to bacteria eating it , can be fatal, seizures can occur, PT in ICU
3
Q
Meningitis treatment
A
- antibiotics (vancomycin) for bacterial
- analgesics (Tylenol)
- antipyretics
- steroids (treats inflammation)
- dark room
- symptom mgmt
- anti viral (acyclovir) for viral
4
Q
Meningitis s/s
A
- nuchal rigidity… treat with analgesic
- severe headache
- Kernigs (knee flexed = neck hurts) and brudzinskis (neck flexed =knee flexes)signs
- opisthotonus —body arched up
- carnival neves III IV VI VII VIII affected
- cold hands/feet
- photophobia
- possible sore throat m
5
Q
Encephalitis
A
- caused by West Nile virus, mononucleosis, mumps, herpes simplex, parasites, toxins, bacteria, vaccines
- s/s: headache, nuchal rigidity, <LOC, ataxia (no coordination), hemiparesis, sleep disturbances
- herpes encephalitis : nuchal rigidity, edema/necrosis, leads to IICP or brain herniation, c/o seizures, personality changes, possible blindness r/t hemorrhage
6
Q
Meningitis DX
A
- CT without dye because we don’t know anything yet
- lumbar puncture ( L4)
- MRI
7
Q
Encephalitis Dx & Tx
A
- CT scan, MRI, Lumbar puncture , EEG
- treatment : neuro assessments, anticonvulsants (phenytoin), antipyretics, analgesics (Tylenol), antivirals (acyclovir)
8
Q
IICP
A
- normal pressure 0-15 mmHg
- caused by any brain insult ie brain tumors, intracranial hemorrhage, brain trauma
- can be increased by hypoxemia/hypercapnia, suctioning, valsalva maneuver (bearing down for BM= syncope), coughing/sneezing, positioning, external stimulation (noise), straining
- PT may be on stool softeners or cough medicine to recuse these factors
9
Q
IICP S/s
A
- altered LOC, irritability & restlessness, vomiting, headache, cushings (increased sys, decreased HR, irregular respirations), papilledema, altered temp/respirations/pulse,
- monitor changes, PT may be in ICU for bolt in cerebral parenchyma
10
Q
IICP Tx
A
- maintain sys >90 for organs perfusion
- avoid hypotonic solutions, hyperventilate PRN
- CNS depressants like benzodiazepines to suppress seizures
- steroids like dexamethasone
- osmotic diuretics ie mannitol
- anticonvulsants (phenytoin) range is 10-20 mcg
- antiemetic (zofran) for N/V
- antipyretic for fever
- anti-HTN for BP
- analgesic for pain
11
Q
Migraine headaches
A
- possibly from vasoconstriction , vasodilation
- hormonal (menstrual)
- overactive immune
- with or without aura
- 4 phases: prodromal (you have it), aura (it’s coming, can look like stroke), headache (actual migraine occurring ), resolution (migraine gone)
- treat with analgesics
12
Q
Tension Headache & Tx
A
- PMS, persistent scalp/facial muscle contraction, anxiety, emotional distress
- tx: analgesics, relaxation, massage muscles, no stimuli, localized heat
13
Q
Cluster Headaches
A
- occur in clusters during specific time span
- caused by stress, anxiety, emotional distress, ETOH may worsen episodes
- tx: quiet dark environment, NSAIDS, tricyclic antidepressants (Elavil) aka protriptyline, (Vivactil) aka nortriptyline
14
Q
Headache Triggers and Diagnostics
A
- wine, excessive caffeine, nuts, chocolate, hormones, smoking, lack of sleep, bright lights, loud noise, strong odors
- MRI, CT, EEG, cranial nerve testing, spinal tap, cranial X-rays
15
Q
Headache Tx
A
- control triggers, NSAIDs, ca channel blockers (nifedipine), ergots (cafergot..caffeine helps headaches), serotonin agonist (Zomig, Imitrex)
- Narcs..but they dont necessarily helps with headache cessation, acupuncture, biofeedback, relaxation techniques, stress reduction exercises
16
Q
Seizure Classes
A
- seizing is an abnormal discharge within brain’s neural structure
- partial: begins on 1 side of cerebral cortex (L/R Hemispheres)
- simple partial: still conscious
- complex partial: loss of consciousness
- generalized: affect the entire brain..both cerebral hemispheres
- absence: blank staring, usually kids
- tonic/clonic: aka grand mal…
17
Q
Seizure Causes and S/S
A
- can be idiopathic, or acquired–cerebral lesion, biochemical disorder, post-trauma seizure, postictal period
- Patrial S/S: automatism (inappropriate social behaviors), Loss of conscious (complex), lasts 2-15 minutes, paraesthesia from parietal, visual disturbance, beings in arm/hand, spreads to face/legs ..L OR R
- generalized S/S: absence (petit mal), staring blankly, tonic-clonic (flailing extremities, conscious loss, incontinence, frothing, vomiting, postictal–disorientation/aggression/sleep).. L AND R
18
Q
Seizure Tx
A
- tegretol or carbatol ..1st choice for partial/general tonic clonic/mixed siezures, decreases synaptic transmissions..adverses are fatigue, vision changes, nausea, dizziness, rash, leukopenia
- keppra (levetiraceTAM): epilepsy drug…s/e tiredness, weakness
- lyrica (pregabalin) for partial seizure …s/e dizzy, sleepiness, wt gain, can’t concentrate
- neurotonin (gabapentin) -treats partial and some generalized seizures, can also treat neuropathy
- depakote: limits seizures, s/e n/v
- phenobabrital–raises seizure threshold, s/e drowsiness
-TAM meds are usually anticonvulants that may cause behavioral changes
19
Q
Seizure Therapeutic Tx
A
- seizure precautions
- rail pads on bed, bath blankets folded over/pinned in place
- assist with ambulation
- keep suction/oral airway at beside
- loosen tight clothing
- turn to side when able to prevent aspiration
- monital vitals
- do NOT restrain
20
Q
Status Epilepticus
A
- series of seizures usually lasting 30 minutes without regaining conciousness
- irreversible nuero damage can occur if O2 depelted..if O2 needed, supply O2, then venti mask, then non rebreather, then intubate
- these seizures ten to use alot of O2/glucose..supple dextrose 5% to replenish sugar
- administer IV diazepam (valium), follow with dilantin
- know PTs baseline seizure
- tx with anticonvulsants: lorazepam, diazepam, phenytoin, valproic acid, lamotrigine
21
Q
T.B.I.s
A
- concussion– temporary alteration in neuro function
- cerebral contusion: brusied brain tissue, possible hemorrhage
- cerebal hematoma/bleed: subd. hematoma, epi. hematoma, subarachnoid, intracerebral
- quiet environment, noise can trigger seizures/I.I.C.P.
most head inuries are caused by accidents
22
Q
T.B.I. S/S
A
- Concussion: headache, vertigo, irritability, confusion, unsteady gait, altered LOC, early ambulation
- contusion: symptomology the same as concussioln… s/s of ICP, s/s depends on brain area affected, bedrest
23
Q
Subdural hematoma
A
- acute s/s within 48 hrs, subacute s/s within 2 days-2 wks, chronic s/s occur after 2 wks
- veinous in nature, blood pools between dura & arachnoid membranes..headache may occur
- may ocause altered LOC, PT may experience one-sided paralysis/extraoccular movement as hematoma sz increases
- extremity weakness, pupil dilation, alcoholics & elderly more prone to chronic subdural r/t brain atrophy (nontrauma SDH causing broken vessels)
24
Q
Epidural Hematoma
A
- lose conciousness ASAP post-injury
- concious again and coherent for a brief time
- develops dilated pupils/paralyzed extraocular muscle on side of hematoma, becomes less responsive
- once PT has s/s, deterioration is rapid, fatal risk once I.I.C.P. is uncontrollable
25
Q
Basilar Skull Fracture
A
- battles sign (ecchymosis by mastoid), raccoon sign (periobrital ecchymosis w/ edema)
- no NG tube/nohing in nose, will enter skull from posterior
- rhinorrhea–nose drainage, otorrhea– ear drainage, halo sign CSF, AVOID NASAL SUCTION
26
Q
T.B.I. Care and Complications
A
- assess LOC, maintain airway, maybe ventialted, montor I.I.C.P…vitals may be labile/chaotic, Wound care, avoid sedation
- meds: Mannitol, decadron (steroid), dilantin, barbs decreases brain metabolic needs, vasopressor (increase BP)
- complications: brain hernia from uncontrollable IICP, brain tissue edema=dsiplaced tissue to brainstem..organ donor, diabetes insipidus: polyuria, polydipsia from low ADH, clear urine from fast filteration, BP drops below 90
complications also include PTSD, hydrocephalus, personality changes, may need rehab
27
Q
Brain Tumors
A
- growth in brain or meninges; pituitary gland involved as hormone secretions change
- s/s are vague, related to brain area and growth rate: seziures, motor/sensory deficits, headahces, n/v, speech/visual issues..s/s caused by compressed or infiltrated brain tissue
- secondary tumors spread arterially
- supra–adults, infra–kids,
- risk factors: >45 y.o. white men/PTs exposed to chemicals. family history
- glial blastomas: slow yet lethal tumor; where primary tumors arise in CNS
28
Q
Malignant and Benign
A
- malignant: usually indicates poor outcome
- benign: usually considered curable
29
Q
Intracranial vs Extra cranial Brain Tumors
A
- extra: meningioma—slow growing, great prognosis with total removal
- intra: astrocytoma—frontal/temporal/parietal, 6-7 of life ..complete removal rare, glioblastoma—highly malignant & fast growing, 12-18 mos of life, astrocytoma—in cerebellum (child), prognosis excellent, medulloblastoma—in medulla (child), 5 yr prognosis
30
Q
Symptom Location
A
- frontal: personality changes, headache, aphasia, motor impairment
- parietal: sensory deficits, agnostics, decreased sensation
- temporal: silence, auditory hallucination, receptive aphasia
- occiput: infrequently seen, visual disturbance
- brain stem: breathing, cardiac issue, swallow/gag issue
- cerebellum: clumsy, fall, unsteady gait, vertigo
31
Q
Brain Tumor Therapy
A
- medical/surgical: control symptoms, radiation Tx (brachytherapy), chemotherapy(blood brain barrier=larger dose required), complementary therapy, surgical removal
- complications: difficult to differentiate between the symptoms of brain tumor and treatment
- dx: MRI, CT scan, angiogram, bx
32
Q
Intracranial surgery
A
- removes tumor, depresses skull, remove lesion (hematoma)
- craniotomy: surgical opening of the skull
- craniectomy: removal of part of the cranial bone
- cranioplasty: repair of bone or prosthesis to replace bone
- done with canady vieira hybrid plasma scalpel
- post op: teaching, baseline assessment, easing Pt’s anxiety
33
Q
Spinal Disorders
A
- Herniated Disk – disk moves from anatomical position, Annulus fibrosus tears, Correlated with heavy lifting or accident
- cervical herniated disc–neck pain, muscle spasms, decreased ROM, hand/arm pain, numbness and tingling, arm weakness
- lumbar herniated disc–back pain, pain radiates to one leg, numbess/tingling, leg weakness, L5-S1 may affect bowels/bladder, Hand & arm pain is unilateral
34
Q
Spinal Disorder Dx and Tx
A
- dx: MRI, myelogram
- tx: bedrest, physical therapy, traction, TENS unit, NASIDs, steroids, epidural inj, surgery, Other treatment– root rhizotomy last resort- sever sensory nerve root d/c pain & provide symptomatic relief
- Chemonucleolysis— inject enzyme into the disk to dissolve bulging portion (relief not immediate).. if not effective procedure cant be repeated due to build up of antibiodies to the enzyme Obvious adv. Shorter hospital stay Less invasive lower cost (success rate 70%)
35
Q
Log rolling
A
- for PTs with spinal issues or post-op for spine …safer, less painful, for limited mobility
- requires multiple staff… MUST KEEP SPINAL COLUMN ALIGNED
36
Q
Laminectomy care and teaching
A
- laminectomy: laminae (flat bone piece on vertebrae) removal for pressure relief/removal of herniated disk
- post-op: spinal assessment, no lifting with arms (cervical), no leg pushing (lumbar), log roll for r/p, dressings should have sm. Amt. of drainage 24-48 hrs post op, watch for CSF leak, monitor urine retention r/t anesthesia , observe incision for infection/edema
- paralytic ileus- from nerve damage, edema, anesthesia (check for hard abd., bowel distensión, n/v)
- teach PT good body mechanics, no sitting for long periods, firm mattress @ home, may use TENS post op, no lifting +10lbs, intermittent catheter PRN
37
Q
Parkinson’s Causes & S/S
A
- chronic degenerative disorder of basal ganglia, usually affects people 60+, occurs deep in brain above stem, caused by destroyed substantia nigra cells which decreases dopamine production
- s/s: tremors at rest, rigidity, bradykinesia, leaned forward posture makes them risk r/t falls, festination (shuffles), akinesia, akathisia (restless), drooling, incontinence due to slow movement to BR
38
Q
Parkinson/LBD meds & Tx
A
- promote independence as long as possible, tx should relieve symptoms by providing dopamine to ganglia, pallidotomy
- meds: MAOIs (Azilect for increases CNS dopamine), COMTs (Comtan for levodopa prolonging action), dopamine agonist (Levodopa is made into dopamine in brain) (Symmetrel for dopamine secretion/production),…surgery
39
Q
Levodopa
A
- or carbidopa, brand name Sinemet…Parkinson med (dopamine agonist) that converts into dopamine for the basal ganglia
- s/e: n/v, take 15 before meals, decrease protein
40
Q
Huntington Disease
A
- progressive, hereditary, incurable neuro disorder
- child has 50% of having this parent has it
- s/s: middle age, slow onset, personality/behavior changes (inappropriate), paranoia, jerky movement, violent sometimes…Huntington PTs tend to commit suicide at high rate
- dx: family hx, MRI/CT, gene testing
- tx: minimize s/s, antipsychotics, antidepressants, anti-choreic meds, outpatient basis initally, calm environment
- pt may develop dysphagia
41
Q
Glascow Coma Scale
A
- used for neuro assessments
- 7-15…15 means fully AAO
42
Q
Aphasia
A
- usually issue arising from frontal
- wernickes (expressive)& brocas (receptive)
- temporal: receptive aphasia
- keep beside suction for dysphagia
43
Q
Cervical spinal injury may cause ____
A
issues with respiratory/respirations
44
Q
Autonomic Dysreflexia
A
- when CNS & PNS are impaired, occurs in PTs with spinal damage above T6, Parasympathetic response cannot descend below the site of injury
- caused by wrinkled sheet, urine retention, fecal impaction, pregnancy
- main s/s: stuffy nose, headache, pale skin, bradycardia
- assess PT urination, monitor V.S., high fowler’s, catheter patency, rectal exam
- NANDAs: risk of A.D. r/t stimuli below injury lvl, reflex urinary incontinence r/t spinal cord damage
45
Q
HALO traction
A
- used for PTs with cervical spine injury
- attaches to skull via 4 pins…infection risk, apply bacterial ointment to pins per Dr order, Pt should NOT MOVE/ROTATE/FLEX NECK
- Observe respiratory status (PT wears vest), small frequent meals, indepence for mobility possible with HALO, impaired mobility/senses, skin integrity check
46
Q
Dilantin
A
- aka phenytoin, anticonvulsant, used for seizures, ICP, meningitis, etc
- contraindicated with birth control
- toxicity s/s includes hyperplasia of gums, nystagmus
- therapeutic range: 10-20 mcg
47
Q
An injury of the C4 and above can cause:
A
Respiratory dysfunction, quadriplegia
48
Q
Hemiplegia can be caused by:
A
Concussion from TBI
49
Q
A thoracic (T1-T5) injury can result in
A
Paraplegias
