Neuro - Exam 4 Flashcards
cerebral angiography
- to visualize blood flow in brain, ID aneurysms, vascularity of tumors, inject medications to treat blood cloths & chemotherapy
Nursing care:
- to prevent aspiration –> NPO 4-6 hours before, medicate for nausea
- check dressing for bleeding and swelling
- apply ice pack
- keep extremity straight (catheter placed in groin to inject dye)
Risks: allergic rxn to dye
- thrombosis
- bleeding from entry site
Cerebral Computed Tomography (CT) Scan
Noninvasive way to diagnose neurologic problems
- May or may not use contrast dye
- ID tumors, infarctions, abnormalities, monitor response to treatment, and guide biopsy needles
Nursing care:
- monitor patient for delayed allergic rxn if contrast dye was used
Electroencephalography (EEG)
- ID and determine seizure activity
- detect sleep disorders and behavioral changes
Nursing care:
- instruct patient not to fast (hypoglycemia alters readings)
- avoid use of sedatives or stimulants 12-24 prior
Magnetic Resonance Imaging (MRI) scan
- Discriminates soft tissue from tumor or bone
- monitor response to treatment
- guide biopsy needles
Nursing Care:
- no metal on patient
- no special follow up
- avoid gadolinium contrast in pts w/low renal function
Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) scans
Produce 3-D images of head to assess tumor activity
- response to treatment
- presence of dementia
- pt is injected w/deoxyglucose (which is attached to an isotope)
Nursing care:
- instruct pt to w/hold caffeine, alcohol, tobacco for 24 hour prior
- NPO for 4-12 hours prior
- radioisotope is eliminated in urine - no special precautions req’d –> increase fluid intake
lumbar puncture
- insert needle between 3-4 or 4-5 lumbar vertebrae
- do not do on pt w/ICP
- pt in fetal position
- instruct not to move
- let HCP know if feel shooting pain or tingling sensation
Classic migraine - prodromal phase (first)
- aura develops over a period of a few min & lasts no longer than 1 hour
- food cravings or mood changes
Classic migraine - aura phase
- pain may be preceded by: visual disturbances (flashing lights) or
- variety of neurologic changes: numbness, tingling of lips or tongue, acute confusion, vertigo
Classic migraine - headache phase
may last a few hours or a few days
Classic migraine - termination phase
intensity of headache decreases
Cluster headache
brief (30 min - 2 hour) - lasts less than 4 hours
- intense, unilateral pain
- occur in spring & fall w/o warning
- mainly men between 20-50 yrs old
- occur at same time of day for 4-12 weeks
- remission for 9 mos to year
- may pace, walk, or sit & rock
NI
- emphasize consistent sleep-wake cycle
- teach about drug options
- high flow O2 may help
- teach pt to wear sunglasses, sit facing away from window to reduce glare
lithium - therapeutic and toxic levels
therapeutic - 0.6 - 1.2
toxic - > 2.0
watch Na+ levels
digoxin - therapeutic and toxic levels
therapeutic - 0.5 - 2.0
toxic - > 2.0
watch K+ levels
dilantin - therapeutic and toxic levels
therapeutic - 10 - 20
toxic - > 30
Care of patient w/meningitis
- prioritize A, B, C’s
- take vitals and perform neurologic checks every 2-4 hours
- check Cranial Nerves
- manage pain
- perform vascular assessment and monitor for changes
- HANDWASHING!
Drug treatment for Parkinson’s
- dopamine agonists - most effective 1st 3-5 years
- apomorphine (Apokyn)
- pramipexole (Mirapex)
- ropinirole (Requip) - Cathechol O-methyltranferases (COMTs) inhibitors - block the enzyme that inactivates dopamine (prolonging the action of levodopa)
- entacapone (Comtan) - often used in combo w/levodopa
- levodopa+carbidopa+entacapone (Stalevo) - MAO-B - used in pts w/early or mild symptoms
- selegiine (Deprenyl)
- rasagiline mesylate (Azilect)
[pts need to avoid food w/tyramine - cheese, aged, smoked or cured foods and sausage] - Antiviral
- amantadine (Symmetrel0 - Cholinesterase inhibitor -
rivastigmine (Exelon)
Pts need to take drug holidays - up to 10 days to reduce drug tolerance
prosopagnosia
- inability to recognize oneself and other familiar faces
- encourage family to provide picture of family members and close friends
- use reminiscence therapy while assisting pt w/ADLs
MS drug - natalizumab (Tysabri)
- IV infusion
- monitor for anaphylactic shock/allergy
- high risk for progressive multifocal leukoencephalopathy (PML) - opportunistic viral infection that leads to death or severe disability
- damages hepatic cells
NI - monitor liver enzymes
- teach pts to have frequent lab tests to assess for changes
MS drug - fingolimod (Gilenya)
- oral immunomodulator - inhibits immune cells
- drug can cause bradycardia (pt must monitor pulse)
- can cause facial flushing
- GI disturbances
care for craniotomy patient - supratentorial surgery
- elevate HOB 30 degrees (or as tolerated) to help promote venous drainage from hear
- avoid extreme hip or neck flexion
- maintain head in midline/neutral position to prevent increased ICP
- turn to prevent pressure ulcers and pneumonia
care for craniotomy patient - infratentorial surgery
- keep flat and side-lying position (prevents pressure on neck-area incision site)
- alternate sides Q2H for 24-48 hours
- NPO for 24 hours to reduce edema around medulla and lower cranial nerves = vomiting and aspiration
how much drainage OK for craniotomy patient?
30-50 ml Q8H
- more than that, report immediately
