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Critical Care Nursing > Neurologic Disorders > Flashcards

Neurologic Disorders Flashcards

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1
Q

What are 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

What are the 3 conditions a patient must meet to be diagnosed w/ Epilepsy?

A
  • at least 2 unprovoked seizures occurring more than 24 hours apart
  • 1 unprovoked seizure and probability if more
  • diagnosis of epilepsy syndrome
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3
Q

Epilepsy Syndromes are classified by what?

A

Specific patterns of clinical features including age at onset, family history, and seizure type

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4
Q

Status Epilepticus

A

continuous seizure activity for more than 5 minutes or two or more sequential seizures w/o full recovery of consciousness b/t seizures

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5
Q

Seizures can also occur as a result of what besides epilepsy?

A
  • hyponatremia

- high fever

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6
Q

Epilepsy is a disease that refers to what?

A

Recurrent, unpredictable, and unprovoked seizures

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7
Q

Seizures require what 3 conditions?

A
  • excitable neurons
  • increase in excitatory glutaminergic activity
  • reduction in activity of normal inhibitory GABA projection
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8
Q

When do seizures occur?

A

When there is an imbalance b/t inhibition and excitation w/in the CNS

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9
Q

Causes of Acquired Seizures

A
  • cerebrovascular disease
  • hypoxemia
  • fever
  • head injury
  • HTN
  • CNS infection
  • metabolic/toxic conditions-hyperkalemia,hyponatremia, hypoglycemia
  • brain tumor
  • drugs/alcohol
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10
Q

What are the goals of treatment for seizures?

A
  • Stop the seizure as quickly as possible
  • ensure adequate cerebral oxygenation
  • maintain patient in seizure free state
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11
Q

What medications may be administered to halt seizures?

A
  • lorazepam (Ativan)
  • diazepam (Valium)
  • midazolam (Versed)
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12
Q

What drugs may be administered later to maintain a seizure free state?

A

Antiepileptic drugs

  • levetiracetam
  • phenytoin
  • phenobarbitol
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13
Q

Why must Phenytoin (Dilantin) IV be administered slowly?

A
  • B/c of its effect on the myocardium and potential for arrhythmia development
  • irritating to veins so must be monitored for phlebitis
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14
Q

Focal Seizures w/ Retained Awareness S/S

A
  • finger/hand shake
  • mouth may jerk uncontrollably
  • unintelligible speech
  • dizziness
  • unusual/unpleasant sights, sounds, odors, or taste
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15
Q

Focal Seizures w/ Altered Awareness S/S

A
  • remains motionless or moves automatically but inappropriately
  • excessive emotions of fear, anger, elation, irritability
  • person won’t remember what happens
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16
Q

Generalized Seizures S/S

A
  • intense rigidity
  • alternating muscle relaxation and contraction
  • epileptic cry
  • incontinent of urine or feces
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17
Q

After the Generalized Seizure is over patients usually appear?

A
  • confused
  • hard to arouse
  • headache
  • sore muscles
  • extremity weakness
  • fatigue
  • depression
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18
Q

What is the SPECT useful for?

A

identifying the epileptogenic zone so that the area in the brain giving rise to seizures can be removed surgically

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19
Q

What is an EEG useful for w/ seizures?

A

Assists in classifying the type of seizure

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20
Q

A patient who has received long term antiepileptic therapy is at increased risk for what?

A

Fractures resulting from bone disease

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21
Q

Bacterial meningitis is commonly caused by what bacteria?

A

streptococcus pneumonia

neisseria meningitidis

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22
Q

What increases a persons risk for developing bacterial meningitis?

A
  • tobacco use
  • otitis media
  • mastoiditis
  • pneumonia
  • immunosupressed
  • chronic steroid therapy
  • HIV
  • traumatic injury
  • surgery
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23
Q

Meningeal Infections generally originate in what two ways?

A
  • direct contact

- through blood stream from other infection

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24
Q

Prophylactic agents are given to what type of traumatic injury patients to prevent bacterial meningitis?

A

Traumatic injury where CSF is escaping through ears or nose

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25
Q

What are some complications of bacterial meningitis?

A
  • visual impairment
  • deafness
  • seizures
  • paralysis
  • hydrocephalus
  • septic shock
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26
Q

What are frequently the initial symptoms of Bacterial meningitis?

A

headache and fever

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27
Q

S/S of Meningitis

A
  • nuchal rigidity
  • positive kernig sign
  • positive brudinski sign
  • photophobia
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28
Q

What is Nuchal Rigidity?

A

stiff neck

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29
Q

Positive Kernig Sign

A

patient is lying supine w/ the hip flexed 90 degrees, resistance/pain to passive extension of the knee is positive sign

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30
Q

Positive Brudzinski Sign

A

when the patient’s neck is flexed, flexion of the knees and hips is produced

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31
Q

What is included in the classic triad of bacterial meningitis?

A
  • stiff neck
  • altered LOC
  • fever
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32
Q

If bradycardia and decreased respirations are seen w/ bacterial meningitis the nurse should suspect what?

A

ICP

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33
Q

What is the gold standard for diagnosis of bacterial meningitis?

A

Bacterial culture and gram staining of CSF and blood

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34
Q

What medications may be used to treat bacterial meningitis?

A
  • penicillins
  • cephalosporins
  • vancomycin w/ or w/o rifampin
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35
Q

What signs are first present w/ viral meningitis?

A
  • headache
  • low grade fever
  • stiff neck
  • photophobia
  • malaise
  • flu like symptoms
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36
Q

What type of disease is Multiple sclerosis?

A

immune-mediated progressive demyelinating disease of the CNS

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37
Q

Multiple Sclerosis typically affects who?

A

Adults ages 20-40

women more than men

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38
Q

What is the Secondary Progressive course of Multiple Sclerosis?

A

Disease progression occurs w/ or w/o relapse

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39
Q

Primary Progressive course of Multiple Sclerosis

A

disabling symptoms steadily increase w/ rare plateaus and temporary improvement

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40
Q

Primary Progressive MS may result in what?

A
  • quadriparesis
  • cognitive dysfunction
  • visual loss
  • brain stem syndromes
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41
Q

Progressive Relapsing form of MS

A

characterized by relapses w/ continuous disabling progression b/t exacerbations

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42
Q

What are the symptoms most commonly reported w/ MS?

A
  • unilateral vision loss
  • orbital pain w/ eye movement
  • fatigue
  • depression
  • weakness
  • limb numbness
  • poor coordination/balance
  • pain
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43
Q

Visual disturbances w/ MS may also include what?

A
  • blurred vision
  • diplopia
  • nystagmus
  • patchy/total blindness
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44
Q

What happens during exacerbations of MS?

A

New symptoms appear and existing ones worsen

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45
Q

What happens during remission of MS?

A

symptoms decrease or disappear

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46
Q

What are some secondary complications of MS?

A
  • UTI
  • constipation
  • pressure ulcers
  • contracture deformities
  • pedal edema
  • pneumonia
  • depression
  • decreased bone density
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47
Q

How is MS diagnosed?

A
  • clinical exams
  • MRI
  • EPS
  • examination of CSF
48
Q

What will be seen on an MRI of a patient w/ MS?

A

Bright spots of demyelinated lesions/plaques

49
Q

What is the goal of treatment for MS?

A

Treat acute exacerbations, delay progression of disease, and manage chronic symptoms

50
Q

What medications may be used with MS to reduce the frequency and duration of relapse and the number and size of plaques?

A
  • interferon beta
  • glatiramer acetate (Copaxone)
  • IV methylprednisone
51
Q

What is the medication of choice for treating Spasticity in MS?

A

Baclofen

52
Q

What does walking/exercising help w/ in MS?

A

improve gait and help w/ the problem of loss of sense of position of legs and feet

53
Q

The patient w/ MS is encourages to exercise until when?

A

the point just short of fatigue

54
Q

Myasthenia Gravis is characterized by what?

A

Fatigability and degrees of muscle weakness of the voluntary muscles

55
Q

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

A

Women 28 years

Men 42 years

56
Q

With MG there is a reduction in the number of what receptor sites?

A

Acetylcholine

57
Q

With fewer Acetylcholine receptors available for stimulation w/ MG this results in what?

A

voluntary muscle weakness that escalates w/ continued activity

58
Q

The initial S/S of MG usually involves what?

A

Ocular Muscles

59
Q

S/S of Myasthenia Gravis

A
  • diplopia
  • ptosis
  • weak facial and throat muscles
  • generalized weakness
  • dysphonia
60
Q

MG is purely a what type of disorder?

A

Motor disorder and doesn’t effect sensation or coordination

61
Q

What is used to diagnose MG?

A

Acetylcholinesterase test

62
Q

Acetylcholinesterase Test for MG

A

The drug Tensilon is administered b/c it has a rapid onset of 30 seconds and short duration of 5 minutes
-immediate improvement in muscle strength after administration is positive

63
Q

What types of medications may be administered for MG?

A
  • anticholinesterase meds
  • immunosupressive therapy
  • plasmapheresis
  • intravenous immunoglobulin
  • thymectomy
64
Q

What gland may be enlarged w/ MG?

A

Thymus gland

65
Q

What is the first line of therapy for MG?

A

Pyridostigmine bromide (Mestinon) an anticholinesterase med

66
Q

What immunosuppressive drugs are used if Mestinon is not effective for MG?

A
  • corticosteroid Prednisone

- cytotoxic med Imuran

67
Q

What is mandatory of all patients w/ long term Prednisone usage?

A

Prophylactic treatment for Osteoporosis and careful follow ups

68
Q

What surgery can be done to improve MG?

A

Thymectomy

69
Q

Any delay in medications for MG may result in what?

A

Exacerbate muscle weakness and make it impossible for patient to take oral meds

70
Q

What is a Cholinergic Crisis w/ MG?

A

problem of over medication that results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretions

71
Q

What medication may be given during an Cholinergic Crisis?

A

Atropine

72
Q

Treatment for Cholinergic Crisis

A
  • Endotracheal intubation/mechanical ventilation

- Stop medication until improvement is seen

73
Q

What is a Myasthenic Crisis for MG?

A

a sudden, temporary exacerbation of symptoms of MG

74
Q

What is a common precipitating event for Myasthenic Crisis?

A

infection

75
Q

S/S of Myasthenic Crisis

A
  • respiratory distress
  • dysphagia
  • dysarthria
  • eyelid ptosis
  • diplopia
  • prominent muscle weakness
76
Q

Nursing Interventions for Myasthenic Crisis

A
  • Chest physiotherapy
  • I/O’s
  • daily weights
  • pulmonary assessments
  • NG tube feedings if needed
77
Q

Guillain-Barre Syndrome

A

an automimmune attack on the peripheral nerve myelin

78
Q

GBS results in what?

A

acute, rapid demyelinization of peripheral/cranial nerves producing ascending weakness w/ dyskinesia, hyporeflexia, and paresthesias

79
Q

What are the beginning signs of GBS?

A

muscle weakness and diminished reflexes of the lower extremities

80
Q

Hyporeflexia and weakness w/ GBS may progress to what?

A

tetraplegia

81
Q

Weakness usually begins where in GBS?

A

in the legs and progresses upwards

82
Q 
How long may it take a person to regain complete
 function with GBS?
A

2 years

83
Q

Cranial Nerve demyelination w/ GBS can result in what?

A
  • optic nerve demyelination-blindness
  • inability to swallow or clear secretions
  • instability of the cardiovascular system-tachycardia, bradycardia, HTN, or orhtostatic hypotension
84
Q

GBS will not affect what?

A

Cognitive function or LOC

85
Q

Nursing Management of GBS

A
  • identify baseline values
  • respiratory therapy or mechanical ventilation may be necessary
  • anticoagulant agents
  • thigh high stockings or SCD’s
86
Q

What medications are given to help w/ GBS?

A

Plasmapheresis and IVIG

87
Q

How often should passive ROM exercises be performed with GBS patients?

A

Twice daily

88
Q

Parkinson Disease

A

slowly progressing neurologic movement disorder that eventually leads to disability

89
Q

Risk Factors for Parkinson

A
  • genetics
  • atherosclerosis
  • viral infections
  • head trauma
  • chronic use of anti-psychotic meds
  • environmental exposures
90
Q

Parkinson is associated with a decreased level of what?

A

dopamine

91
Q

The loss of dopamine in Parkinson Disease causes what?

A

More excitatory neurotransmitters than inhibitory leading to an imbalance that affects voluntary movement

92
Q

What are the cardinal signs of Parkinson Disease? (TRAP)

A

T-tremor
R-rigidity of muscles
A-akinesia/bradykinesia
P-postural disturbances

93
Q

What type of tremor is present w/ Parkinson?

A

Resting tremor

94
Q

Resting Tremor

A

disappears w/ purposeful movement but its evident when extremities are motionless
-present while at rest and increases w/ walking or anxiety/stress

95
Q

Cogwheel Rigidity w/ Parkinson

A

characterized by jerky rhythmic tone on passive muscle stretching

96
Q

When does involuntary stiffness increase w/ Parkinson?

A

when another extremity increases when another extremity is engaged in voluntary activity

97
Q

What type of Posture would you see with Parkinson?

A

Stands w/ head bent forward and walks w/ a propulsive gait

shuffling gait

98
Q

Other S/S of Parkinson

A
  • excessive/uncontrolled sweating
  • paroxysmal flushing
  • orthostatic hypotension
  • gastric/urinary retention
  • constipation
  • sexual dysfunction
  • depression
  • sleep probs
99
Q

Anti-Parkinson Medications

A
  • Levadopa
  • Carbidopa (Sinemet)
  • Artane
  • Cogentin
  • Symmetrel
  • Parlodel
  • Permax
100
Q

How does Levadopa work for Parkinson?

A

It is converted to dopamine

101
Q

W/in 5-10 years patients taking Levidopa and Sinemet develop a response to meds characterized by what?

A

Dyskinesia including

  • facial grimacing
  • jerking movements of hands
  • head bobbing
  • chewing/smacking movements
  • involuntary movement of trunk and extremities
102
Q

What type of stimulation is used to treat Parkinson?

A

Deep brain stimulation

103
Q

What type of disease is Alzheimer’s?

A

a progressive, irreversible, degenerative neurologic disease that begins insidiously

104
Q

Alzheimer’s is characterized by what?

A

gradual loss of cognitive function and disturbances in behavior and affect

105
Q

Early Stage Alzheimer S/S

A

Forgetfulness and subtle memory loss

Depression

106
Q

Personality changes in patient w/ Alzheimer

A
  • depression
  • suspicion
  • paranoid
  • hostile
  • combative
107
Q

How is a definitive diagnosis of Alzheimer made?

A

Based on meeting the criteria and histologic evidence based on examination of brain tissue obtained by biopsy

108
Q

What medication may be given to help maintain memory skills longer w/ Alzheimer?

A

Cholesterase inhibitors

  • Aricept
  • Exelon
  • Reminyl
109
Q

What is ALS?

A

degenerative disease characterized by the loss of both upper and lower motor neurons

110
Q

What are the chief symptoms of ALS?

A

Fatigue and limb weakness

111
Q

S/S of ALS

A
  • tripping/falling
  • changes in gait
  • spasticity
  • deep tendon reflexes are brisk/over reactive
112
Q

Weakness typically starts where with ALS?

A

Muscles supplied by the cranial nerves and difficulty in talking, swallowing, and breathing occur

113
Q

How is ALS diagnosed?

A

On the basis of signs and symptoms

114
Q

What are the most common reasons for hospitalization for a patient w/ ALS?

A

dehydration
malnutrition
pneumonia
respiratory failure

115
Q

What is the only drug approved by the FDA to treat ALS?

A

Riluzole (Rilutek)

116
Q

S/S of Diaphragmatic weakness in patients w/ ALS

A
  • paradoxical movement of abdominal wall during inspiration
  • SOB
  • orthopnea
117
Q

S/S of Nocturnal Retention of Carbon Dioxide w/ ALS

A
  • interrupted sleep
  • morning headaches
  • anorexia
  • daytime somnolence

Critical Care Nursing (14 decks)

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