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Neurologic Disorders Flashcards

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1
Q

Seizures

A

abnormal discharges in the brain for a single event of which results in an abrupt and temporary altered cerebral function state

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2
Q

Epilepsy

A

a disease of the brain that involves unpredictable and unprovoked seizures

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3
Q

What conditions must a person meet to be considered Epileptic?

A
  • at least two unprovoked seizures occurring more than 24 hours apart
  • 1 unprovoked seizure and the probability of more
  • diagnosis of epilepsy syndrome
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4
Q

Status Epilepticus

A

Continuous seizure activity for more than 5 minutes or two or more sequential seizures without full recovery of consciousness b/t seizures

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5
Q

What seizures are less likely to stop without intervention?

A

seizures lasting longer than 5-10 minutes

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6
Q

What type of emergency is Status Epilepticus?

A

a neurological emergency and can be life threatening

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7
Q

What can cause a seizure?

A
  • Fever
  • Cerebrovascular disease/Hypoxia
  • Hypertension
  • Head Injury
  • Brain tumor
  • Drug/alcohol withdrawal
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8
Q

Pathophysiology of Seizures

A

Brain cells continue firing electrical signals even after completing their task which equals seizure activity

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9
Q

S/S of FOCAL Seizures

A
  • may or may not retain awareness
  • May talk unintelligibly/may be dizzy
  • May remain motionless or move inappropriately
  • Experience excessive emotions of fear, elation, or irritability
  • Will not remember the episode when its over
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10
Q

What are focal seizures?

A

Start in ONE area of the brain

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11
Q

S/S of Generalized Seizures

A
  • tonic-clonic contraction
  • may bite tongue or inner cheek
  • may be incontinent
  • After 1-2 minutes convulsive movements subside and patient relaxes into deep coma
  • May be confused after and sleep for hours
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12
Q

Tonic-Clonic Contractions

A

intense rigidity of the entire body followed by alternating muscle relaxation and contraction

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13
Q

What may a patient report after waking up from a seizure?

A
  • headache
  • sore muscles
  • weakness
  • noisy breathing
  • depression
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14
Q

How is a medical diagnosis of seizures made?

A

The patient is asked about common triggers associated with seizures which may be: odors, visuals, auditory, lack of sleep, hypoglycemia, stress, illness, alcohol/drug use, etc..

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15
Q

What tests are used to diagnose seizure activity?

A
  • MRI/CT
  • PET
  • SPECT
  • EEG
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16
Q

Which tests are used to detect lesions, focal abnormalities, cerebrovascular abnormalities, and cerebral degenerative changes?

A

MRI/CT, PET, SPECT

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17
Q

Which test is used for diagnostic evidence for a substantial portion of patients with epilepsy and assists in classifying the type of seizures?

A

EEG

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18
Q

What are the goals of treatment for seizures?

A
  • stop the seizure as quickly as possible
  • ensure adequate cerebral oxygenation
  • maintain seizure free state
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19
Q

What does the nurse do during an active seizure?

A
  • Administer oxygen via N/C
  • Monitor pulse oximetry
  • May suction the airway
  • Ensure patent IV line
  • VS taken q 1-2 hours
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20
Q

What medications may be administered during an ACTIVE seizure?

A
  • *Administered IV
  • Ativan (Lorazepam)
  • Valium (Diazepam)
  • Versed (Midazolam)
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21
Q

Antiepileptic Drugs (AEDs)

A

**Administered IV, Reserved for the ER
-Used to maintain a seizure free state
Dilantin (Phenytoin) and Phenobarbital

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22
Q

Why is Dilantin administered slowly through IV?

A

Because of the effect it has on the myocardium

  • potential for arrhythmias
  • will precipitate in D5W
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23
Q

What should the nurse do if a therapeutic range can NOT be maintained?

A

Call the doctor

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24
Q

What are the therapeutic levels for Dilantin and Phenobarbital?

A

D: 10-20 mg/mL
P: 10-25 mg/mL

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25
Q

What should the nurse document during a seizure?

A
  • circumstances before seizure
  • occurrence of an aura
  • the first thing a patient exhibits in the seizure, conjugate gaze position, and the position of the head at the beginning
  • types of movement
  • duration of seizure
  • incontinence
  • unconsciousness
  • paralysis or weakness
  • inability to speak
  • does the patient sleep after
  • cognitive status after
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26
Q

What should the nurse do if the patient is beginning to have a seizure?

A
  • provide privacy
  • ease the patient to the floor if not in bed
  • protect the head
  • remove eye glasses and loose clothing
  • raise side rails and place on side in bed
  • have suction available
  • DO NOT attempt to open the patients mouth
  • DO NOT attempt to restrain the patient
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27
Q

Nursing Care AFTER the seizure

A
  • keep patient on side to avoid aspiration
  • reorient patient to environment
  • use calm persuasion if agitated
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28
Q

Multiple Sclerosis

A

“disruption of flow b/t the brain and the body”

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29
Q

What is the leading cause of nontraumatic disability in young adults?

A

Multiple Sclerosis

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30
Q

Characteristics of Multiple Sclerosis

A
  • Progressive demyelinating disease of the CNS
  • Typically occurs b/t ages 20-40
  • Women
  • No known cause
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31
Q

Multiple Sclerosis Patho

A

T cells should cross the BBB and LEAVE, but

  • Sensitized T cells REMAIN in the CNS and promote the infiltration of other agents that damage the immune system
  • Demyelinated axons are scattered throughout the CNS and begin to degenerate resulting in permanent and irreversible damage
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32
Q

How does Multiple Sclerosis manifest?

A
  • 85-90% have relapsing-remitting course (RR)
  • 40% w/ RR course progress to the secondary progressive course
  • 10-15% have a primary progressive course
33
Q

Relapsing-Remitting Course of Multiple Sclerosis

A

W/ each relapse , recovery is usually complete; however, residual deficits may occur and accumulate over time contributing to functional decline

34
Q

Secondary Progressive Course for Multiple Sclerosis

A

Disease progression occurs with or without relapse

35
Q

Primary Progression Course for Multiple Sclerosis

A

Disabling symptoms steadily increase

36
Q

Most common S/S for Multiple Sclerosis

A
  • Unilateral vision loss w/ orbital pain
  • Fatigue
  • Weakness
  • Difficulty w/ coordination, loss of balance (Ataxia)
  • Limb numbness
  • Pain
37
Q

What are the goals for treating Multiple Sclerosis?

A
  • Treat acute exacerbations
  • Delay the progression
  • Manage chronic symptoms
38
Q

What are some symptoms of MS that require intervention?

A
  • Spasticity
  • Fatigue
  • Bladder dysfunction
  • Ataxia
39
Q

What are the Disease Modifying Therapies used for MS?

A
  • Interferon beta-1a (rebif) and interferon beta-1b (Betaseron) w/ interferon beta 1a (Avonex)
  • Glatiramer acetate (Copaxone)
  • IV Methylprednisolone
40
Q

Rebif, Betaseron, and Avonex

A

Rebif (interferon beta 1a) and Betaseron (interferon beta 1b) are administered subcutaneously w/ another preparation of Avonex (interferon beta 1a) IM once a week

41
Q

Copaxone

A

reduces the rate of relapse in the RR course of MS

42
Q

IV Methylprednisolone

A

treats the acute relapse in the RR course and shortens the duration of the relapse

43
Q

How to support physical mobility for MS?

A
  • use assistive devices prn
  • daily exercise + stretching
  • Encourage to work/exercise to a point just short of fatigue
  • Frequent short rests
  • minimize periods of immobility
44
Q

Enhancing Bowel and Bladder Control for MS

A
  • Set up voiding schedule (q 2 hours then increase)
  • Drink fluids q2hrs and attempt to void 30 mins after
  • Meds for bladder spasticity
  • Intermittent self catheterization
  • Urinary Diversion
45
Q

Myasthenia Gravis

A

autoimmune disorder affecting the neuromuscular junction characterized by fatigability and degree of muscle weakness of the voluntary muscles

46
Q

What is the average onset of Myasthenia Gravis for men and women?

A

Men- age 42

Women- age 28

47
Q

MG Patho

A

there is a reduction in the number of acetylcholine receptor sites b/c antibodies impair transmission of impulses across the neuromuscular junction. Fewer receptors are available for stimulation resulting in voluntary muscle weakness

48
Q

Initial S/S of MG

A
  • Diplopia (double vision)

- ptosis (drooping eyelids)

49
Q

Hallmark S/S of MG

A
  • Fluctuating muscle weakness- intensifies w/ activity and improves w/ rest
  • Weakness of the muscles of the face and throat (dysphonia)
  • Generalized weakness of all extremities and intercostal muscles
50
Q

What is the diagnostic test of choice for MG?

A

Acetylcholinesterase test is used to diagnose MG. The drug Tensilon is used b/c it has a rapid onset of 30 seconds and short duration of 5 mins. Immediate improvement in muscle strength after administration represents a positive test and usually confirms diagnosis

51
Q

What other two test may be used to diagnose MG?

A

CT scan and MRIs

52
Q

What is the progression of drugs for MG?

A
  • Mestinon (Pyridostigmine Bromide)
  • Prednisone (Corticosteroid)
  • Imuran (Azathioprine)
53
Q

Mestinon

A
  • an anticholinesterase medication, is 1st line of therapy

- dosage may gradually increase and administered 4 times a day

54
Q

Prednisone

A
  • started of Mestinon loses its effectiveness

- given daily until symptoms improve and then the drug is tapered

55
Q

Imuran

A
  • started if the corticosteroid does not work
  • therapeutic effects may not be seen for 3-12 months
  • tough on the liver
56
Q

Myasthenic Crisis

A
  • sudden, temporary exacerbation of symptoms of MG
  • can cause respiratory distress, dysphagia and muscle weakness
  • may be caused by infection
57
Q

Cholinergic Crisis

A
  • a problem of overmedication
  • Results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretions which may result in respiratory failure
58
Q

Guillian-Barre Syndrome (GBS)

A
  • Autoimmune attack on the peripheral nerve myelin
  • Results in demyelination of peripheral and cranial nerves
  • Ascending weakness w/ dyskinesia and paresthesia
59
Q

Why is GBS considered a medical emergency?

A

Because of the possibility of rapid progression in neuromuscular respiratory failure

  • Requires management in ICU
  • Respiratory therapy/mechanical ventilation may be necessary
60
Q

What is the Nursing Care for GBS?

A
  • physical therapy
  • monitor for DVT
  • provide adequate nutrition
  • communicate w/ pictures or blinking
  • emotional support
61
Q

Parkinson’s Disease (PD)

A

slowly progressing neurological movement disorder that eventually leads to disability

62
Q

What is the cause of PD?

A

**NO known cause
-but causative factors:
genetics
atherosclerosis
viral infections
head trauma

63
Q

What the cardinal signs of PD?

A 
"TRAP"
T-tremors
R-rigidity 
A-akinesia
P-postural disturbances
64
Q

What is the most common reason people seek medical attention for PD?

A

Tremors

  • evident when extremities are motionless and may be rhythmic
  • increase w/ walking and anxiety
65
Q

Cogwheel Rigidity

A

characterized by jerky rhythmic tone on passive muscle stretching

66
Q

Postural Reflexes

A

a loss of postural reflexes occurs and the patient stands with the head bent forward and walks with a propulsive gait

67
Q

Antiparkinsons Medication

A

-Levodopa (Larodopa)

68
Q

Levodopa for PD

A
  • the most effective treatment agent
  • converted to dopamine producing symptom relief
  • weakens over time
  • combined w/ Sinemet (carbidopa) which maximizes effect
69
Q

Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease)

A

Degenerative Disease characterized by the loss of both upper and lower motor neurons

  • 90% of cases occur sporadically
  • 5-10% is familial
70
Q

What is the prognosis for ALS based on?

A

Based on the area of the CNS involved and the speed at which the disease progresses

71
Q

Why does death typically occur with ALS?

A

infection, respiratory failure, aspiration

72
Q

Who is more likely to develop ALS?

A
  • Men
  • Veterans
  • Ages 65-75
73
Q

S/S of ALS

A
  • Fatigue
  • Limb weakness
  • Upper extremity onset causes reduced dexterity
  • Lower extremity onset may result in tripping, falling, changes in gait
  • Difficulty swallowing
  • Impaired speaking
74
Q

How is ALS diagnosed?

A
  • Based on S/S b/c there are no clinical or laboratory tests specific to the disease
  • EMG will demonstrate fibrillations
75
Q

What is the main focus for a patient with ALS?

A

NO CURE

-maintain or improve function, well being, and quality of life

76
Q

Symptomatic Treatment for ALS

A
  • Most can manage at home
  • Rilutek
  • Lioreseal or Valium
77
Q

Rilutek (Riluzole)

A
  • a glutamate antagonist
  • only drug approved by the FDA for ALS
  • MAY have a neuroprotective effect in the early stages of ALS
78
Q

Lioreseal (Baclofen) or Valium (Diazepam)

A

-may be useful for spasticity which causes pain and interferes with ADL’s for ALS patients

79
Q

Non medical treatment for ALS

A
  • Enteral feeding (PEG)
  • Respiratory support- tracheostomy, invasive ventilation
  • Discuss w/ patient/family living wills and end of life decisions

Nursing (21 decks)

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