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