Neurologic Disorders Flashcards
Seizures
abnormal discharges in the brain for a single event of which results in an abrupt and temporary altered cerebral function state
Epilepsy
a disease of the brain that involves unpredictable and unprovoked seizures
What conditions must a person meet to be considered Epileptic?
- at least two unprovoked seizures occurring more than 24 hours apart
- 1 unprovoked seizure and the probability of more
- diagnosis of epilepsy syndrome
Status Epilepticus
Continuous seizure activity for more than 5 minutes or two or more sequential seizures without full recovery of consciousness b/t seizures
What seizures are less likely to stop without intervention?
seizures lasting longer than 5-10 minutes
What type of emergency is Status Epilepticus?
a neurological emergency and can be life threatening
What can cause a seizure?
- Fever
- Cerebrovascular disease/Hypoxia
- Hypertension
- Head Injury
- Brain tumor
- Drug/alcohol withdrawal
Pathophysiology of Seizures
Brain cells continue firing electrical signals even after completing their task which equals seizure activity
S/S of FOCAL Seizures
- 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
What are focal seizures?
Start in ONE area of the brain
S/S of Generalized Seizures
- 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
Tonic-Clonic Contractions
intense rigidity of the entire body followed by alternating muscle relaxation and contraction
What may a patient report after waking up from a seizure?
- headache
- sore muscles
- weakness
- noisy breathing
- depression
How is a medical diagnosis of seizures made?
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..
What tests are used to diagnose seizure activity?
- MRI/CT
- PET
- SPECT
- EEG
Which tests are used to detect lesions, focal abnormalities, cerebrovascular abnormalities, and cerebral degenerative changes?
MRI/CT, PET, SPECT
Which test is used for diagnostic evidence for a substantial portion of patients with epilepsy and assists in classifying the type of seizures?
EEG
What are the goals of treatment for seizures?
- stop the seizure as quickly as possible
- ensure adequate cerebral oxygenation
- maintain seizure free state
What does the nurse do during an active seizure?
- Administer oxygen via N/C
- Monitor pulse oximetry
- May suction the airway
- Ensure patent IV line
- VS taken q 1-2 hours
What medications may be administered during an ACTIVE seizure?
- *Administered IV
- Ativan (Lorazepam)
- Valium (Diazepam)
- Versed (Midazolam)
Antiepileptic Drugs (AEDs)
**Administered IV, Reserved for the ER
-Used to maintain a seizure free state
Dilantin (Phenytoin) and Phenobarbital
Why is Dilantin administered slowly through IV?
Because of the effect it has on the myocardium
- potential for arrhythmias
- will precipitate in D5W
What should the nurse do if a therapeutic range can NOT be maintained?
Call the doctor
What are the therapeutic levels for Dilantin and Phenobarbital?
D: 10-20 mg/mL
P: 10-25 mg/mL
What should the nurse document during a seizure?
- 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
What should the nurse do if the patient is beginning to have a seizure?
- 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
Nursing Care AFTER the seizure
- keep patient on side to avoid aspiration
- reorient patient to environment
- use calm persuasion if agitated
Multiple Sclerosis
“disruption of flow b/t the brain and the body”
What is the leading cause of nontraumatic disability in young adults?
Multiple Sclerosis
Characteristics of Multiple Sclerosis
- Progressive demyelinating disease of the CNS
- Typically occurs b/t ages 20-40
- Women
- No known cause
Multiple Sclerosis Patho
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
How does Multiple Sclerosis manifest?
- 85-90% have relapsing-remitting course (RR)
- 40% w/ RR course progress to the secondary progressive course
- 10-15% have a primary progressive course
Relapsing-Remitting Course of Multiple Sclerosis
W/ each relapse , recovery is usually complete; however, residual deficits may occur and accumulate over time contributing to functional decline
Secondary Progressive Course for Multiple Sclerosis
Disease progression occurs with or without relapse
Primary Progression Course for Multiple Sclerosis
Disabling symptoms steadily increase
Most common S/S for Multiple Sclerosis
- Unilateral vision loss w/ orbital pain
- Fatigue
- Weakness
- Difficulty w/ coordination, loss of balance (Ataxia)
- Limb numbness
- Pain
What are the goals for treating Multiple Sclerosis?
- Treat acute exacerbations
- Delay the progression
- Manage chronic symptoms
What are some symptoms of MS that require intervention?
- Spasticity
- Fatigue
- Bladder dysfunction
- Ataxia
What are the Disease Modifying Therapies used for MS?
- Interferon beta-1a (rebif) and interferon beta-1b (Betaseron) w/ interferon beta 1a (Avonex)
- Glatiramer acetate (Copaxone)
- IV Methylprednisolone
Rebif, Betaseron, and Avonex
Rebif (interferon beta 1a) and Betaseron (interferon beta 1b) are administered subcutaneously w/ another preparation of Avonex (interferon beta 1a) IM once a week
Copaxone
reduces the rate of relapse in the RR course of MS
IV Methylprednisolone
treats the acute relapse in the RR course and shortens the duration of the relapse
How to support physical mobility for MS?
- 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
Enhancing Bowel and Bladder Control for MS
- 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
Myasthenia Gravis
autoimmune disorder affecting the neuromuscular junction characterized by fatigability and degree of muscle weakness of the voluntary muscles
What is the average onset of Myasthenia Gravis for men and women?
Men- age 42
Women- age 28
MG Patho
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
Initial S/S of MG
- Diplopia (double vision)
- ptosis (drooping eyelids)
Hallmark S/S of MG
- 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
What is the diagnostic test of choice for MG?
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
What other two test may be used to diagnose MG?
CT scan and MRIs
What is the progression of drugs for MG?
- Mestinon (Pyridostigmine Bromide)
- Prednisone (Corticosteroid)
- Imuran (Azathioprine)
Mestinon
- an anticholinesterase medication, is 1st line of therapy
- dosage may gradually increase and administered 4 times a day
Prednisone
- started of Mestinon loses its effectiveness
- given daily until symptoms improve and then the drug is tapered
Imuran
- started if the corticosteroid does not work
- therapeutic effects may not be seen for 3-12 months
- tough on the liver
Myasthenic Crisis
- sudden, temporary exacerbation of symptoms of MG
- can cause respiratory distress, dysphagia and muscle weakness
- may be caused by infection
Cholinergic Crisis
- a problem of overmedication
- Results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretions which may result in respiratory failure
Guillian-Barre Syndrome (GBS)
- Autoimmune attack on the peripheral nerve myelin
- Results in demyelination of peripheral and cranial nerves
- Ascending weakness w/ dyskinesia and paresthesia
Why is GBS considered a medical emergency?
Because of the possibility of rapid progression in neuromuscular respiratory failure
- Requires management in ICU
- Respiratory therapy/mechanical ventilation may be necessary
What is the Nursing Care for GBS?
- physical therapy
- monitor for DVT
- provide adequate nutrition
- communicate w/ pictures or blinking
- emotional support
Parkinson’s Disease (PD)
slowly progressing neurological movement disorder that eventually leads to disability
What is the cause of PD?
**NO known cause
-but causative factors:
genetics
atherosclerosis
viral infections
head trauma
What the cardinal signs of PD?
"TRAP" T-tremors R-rigidity A-akinesia P-postural disturbances
What is the most common reason people seek medical attention for PD?
Tremors
- evident when extremities are motionless and may be rhythmic
- increase w/ walking and anxiety
Cogwheel Rigidity
characterized by jerky rhythmic tone on passive muscle stretching
Postural Reflexes
a loss of postural reflexes occurs and the patient stands with the head bent forward and walks with a propulsive gait
Antiparkinsons Medication
-Levodopa (Larodopa)
Levodopa for PD
- the most effective treatment agent
- converted to dopamine producing symptom relief
- weakens over time
- combined w/ Sinemet (carbidopa) which maximizes effect
Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease)
Degenerative Disease characterized by the loss of both upper and lower motor neurons
- 90% of cases occur sporadically
- 5-10% is familial
What is the prognosis for ALS based on?
Based on the area of the CNS involved and the speed at which the disease progresses
Why does death typically occur with ALS?
infection, respiratory failure, aspiration
Who is more likely to develop ALS?
- Men
- Veterans
- Ages 65-75
S/S of ALS
- Fatigue
- Limb weakness
- Upper extremity onset causes reduced dexterity
- Lower extremity onset may result in tripping, falling, changes in gait
- Difficulty swallowing
- Impaired speaking
How is ALS diagnosed?
- Based on S/S b/c there are no clinical or laboratory tests specific to the disease
- EMG will demonstrate fibrillations
What is the main focus for a patient with ALS?
NO CURE
-maintain or improve function, well being, and quality of life
Symptomatic Treatment for ALS
- Most can manage at home
- Rilutek
- Lioreseal or Valium
Rilutek (Riluzole)
- a glutamate antagonist
- only drug approved by the FDA for ALS
- MAY have a neuroprotective effect in the early stages of ALS
Lioreseal (Baclofen) or Valium (Diazepam)
-may be useful for spasticity which causes pain and interferes with ADL’s for ALS patients
Non medical treatment for ALS
- Enteral feeding (PEG)
- Respiratory support- tracheostomy, invasive ventilation
- Discuss w/ patient/family living wills and end of life decisions
