Neurologic Disorders Flashcards
(117 cards)
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
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
3
Q
Epilepsy Syndromes are classified by what?
A
Specific patterns of clinical features including age at onset, family history, and seizure type
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
5
Q
Seizures can also occur as a result of what besides epilepsy?
A
- hyponatremia
- high fever
6
Q
Epilepsy is a disease that refers to what?
A
Recurrent, unpredictable, and unprovoked seizures
7
Q
Seizures require what 3 conditions?
A
- excitable neurons
- increase in excitatory glutaminergic activity
- reduction in activity of normal inhibitory GABA projection
8
Q
When do seizures occur?
A
When there is an imbalance b/t inhibition and excitation w/in the CNS
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
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
11
Q
What medications may be administered to halt seizures?
A
- lorazepam (Ativan)
- diazepam (Valium)
- midazolam (Versed)
12
Q
What drugs may be administered later to maintain a seizure free state?
A
Antiepileptic drugs
- levetiracetam
- phenytoin
- phenobarbitol
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
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
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
16
Q
Generalized Seizures S/S
A
- intense rigidity
- alternating muscle relaxation and contraction
- epileptic cry
- incontinent of urine or feces
17
Q
After the Generalized Seizure is over patients usually appear?
A
- confused
- hard to arouse
- headache
- sore muscles
- extremity weakness
- fatigue
- depression
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
19
Q
What is an EEG useful for w/ seizures?
A
Assists in classifying the type of seizure
20
Q
A patient who has received long term antiepileptic therapy is at increased risk for what?
A
Fractures resulting from bone disease
21
Q
Bacterial meningitis is commonly caused by what bacteria?
A
streptococcus pneumonia
neisseria meningitidis
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
23
Q
Meningeal Infections generally originate in what two ways?
A
- direct contact
- through blood stream from other infection
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
25
What are some complications of bacterial meningitis?
- visual impairment
- deafness
- seizures
- paralysis
- hydrocephalus
- septic shock
26
What are frequently the initial symptoms of Bacterial meningitis?
headache and fever
27
S/S of Meningitis
- nuchal rigidity
- positive kernig sign
- positive brudinski sign
- photophobia
28
What is Nuchal Rigidity?
stiff neck
29
Positive Kernig Sign
patient is lying supine w/ the hip flexed 90 degrees, resistance/pain to passive extension of the knee is positive sign
30
Positive Brudzinski Sign
when the patient's neck is flexed, flexion of the knees and hips is produced
31
What is included in the classic triad of bacterial meningitis?
- stiff neck
- altered LOC
- fever
32
If bradycardia and decreased respirations are seen w/ bacterial meningitis the nurse should suspect what?
ICP
33
What is the gold standard for diagnosis of bacterial meningitis?
Bacterial culture and gram staining of CSF and blood
34
What medications may be used to treat bacterial meningitis?
- penicillins
- cephalosporins
- vancomycin w/ or w/o rifampin
35
What signs are first present w/ viral meningitis?
- headache
- low grade fever
- stiff neck
- photophobia
- malaise
- flu like symptoms
36
What type of disease is Multiple sclerosis?
immune-mediated progressive demyelinating disease of the CNS
37
Multiple Sclerosis typically affects who?
Adults ages 20-40
| women more than men
38
What is the Secondary Progressive course of Multiple Sclerosis?
Disease progression occurs w/ or w/o relapse
39
Primary Progressive course of Multiple Sclerosis
disabling symptoms steadily increase w/ rare plateaus and temporary improvement
40
Primary Progressive MS may result in what?
- quadriparesis
- cognitive dysfunction
- visual loss
- brain stem syndromes
41
Progressive Relapsing form of MS
characterized by relapses w/ continuous disabling progression b/t exacerbations
42
What are the symptoms most commonly reported w/ MS?
- unilateral vision loss
- orbital pain w/ eye movement
- fatigue
- depression
- weakness
- limb numbness
- poor coordination/balance
- pain
43
Visual disturbances w/ MS may also include what?
- blurred vision
- diplopia
- nystagmus
- patchy/total blindness
44
What happens during exacerbations of MS?
New symptoms appear and existing ones worsen
45
What happens during remission of MS?
symptoms decrease or disappear
46
What are some secondary complications of MS?
- UTI
- constipation
- pressure ulcers
- contracture deformities
- pedal edema
- pneumonia
- depression
- decreased bone density
47
How is MS diagnosed?
- clinical exams
- MRI
- EPS
- examination of CSF
48
What will be seen on an MRI of a patient w/ MS?
Bright spots of demyelinated lesions/plaques
49
What is the goal of treatment for MS?
Treat acute exacerbations, delay progression of disease, and manage chronic symptoms
50
What medications may be used with MS to reduce the frequency and duration of relapse and the number and size of plaques?
- interferon beta
- glatiramer acetate (Copaxone)
- IV methylprednisone
51
What is the medication of choice for treating Spasticity in MS?
Baclofen
52
What does walking/exercising help w/ in MS?
improve gait and help w/ the problem of loss of sense of position of legs and feet
53
The patient w/ MS is encourages to exercise until when?
the point just short of fatigue
54
Myasthenia Gravis is characterized by what?
Fatigability and degrees of muscle weakness of the voluntary muscles
55
What is the average age of onset for men and women w/ Myasthenia Gravis?
Women 28 years
| Men 42 years
56
With MG there is a reduction in the number of what receptor sites?
Acetylcholine
57
With fewer Acetylcholine receptors available for stimulation w/ MG this results in what?
voluntary muscle weakness that escalates w/ continued activity
58
The initial S/S of MG usually involves what?
Ocular Muscles
59
S/S of Myasthenia Gravis
- diplopia
- ptosis
- weak facial and throat muscles
- generalized weakness
- dysphonia
60
MG is purely a what type of disorder?
Motor disorder and doesn't effect sensation or coordination
61
What is used to diagnose MG?
Acetylcholinesterase test
62
Acetylcholinesterase Test for MG
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
What types of medications may be administered for MG?
- anticholinesterase meds
- immunosupressive therapy
- plasmapheresis
- intravenous immunoglobulin
- thymectomy
64
What gland may be enlarged w/ MG?
Thymus gland
65
What is the first line of therapy for MG?
Pyridostigmine bromide (Mestinon) an anticholinesterase med
66
What immunosuppressive drugs are used if Mestinon is not effective for MG?
- corticosteroid Prednisone
| - cytotoxic med Imuran
67
What is mandatory of all patients w/ long term Prednisone usage?
Prophylactic treatment for Osteoporosis and careful follow ups
68
What surgery can be done to improve MG?
Thymectomy
69
Any delay in medications for MG may result in what?
Exacerbate muscle weakness and make it impossible for patient to take oral meds
70
What is a Cholinergic Crisis w/ MG?
problem of over medication that results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretions
71
What medication may be given during an Cholinergic Crisis?
Atropine
72
Treatment for Cholinergic Crisis
- Endotracheal intubation/mechanical ventilation
| - Stop medication until improvement is seen
73
What is a Myasthenic Crisis for MG?
a sudden, temporary exacerbation of symptoms of MG
74
What is a common precipitating event for Myasthenic Crisis?
infection
75
S/S of Myasthenic Crisis
- respiratory distress
- dysphagia
- dysarthria
- eyelid ptosis
- diplopia
- prominent muscle weakness
76
Nursing Interventions for Myasthenic Crisis
- Chest physiotherapy
- I/O's
- daily weights
- pulmonary assessments
- NG tube feedings if needed
77
Guillain-Barre Syndrome
an automimmune attack on the peripheral nerve myelin
78
GBS results in what?
acute, rapid demyelinization of peripheral/cranial nerves producing ascending weakness w/ dyskinesia, hyporeflexia, and paresthesias
79
What are the beginning signs of GBS?
muscle weakness and diminished reflexes of the lower extremities
80
Hyporeflexia and weakness w/ GBS may progress to what?
tetraplegia
81
Weakness usually begins where in GBS?
in the legs and progresses upwards
82
```
How long may it take a person to regain complete
function with GBS?
```
2 years
83
Cranial Nerve demyelination w/ GBS can result in what?
- optic nerve demyelination-blindness
- inability to swallow or clear secretions
- instability of the cardiovascular system-tachycardia, bradycardia, HTN, or orhtostatic hypotension
84
GBS will not affect what?
Cognitive function or LOC
85
Nursing Management of GBS
- identify baseline values
- respiratory therapy or mechanical ventilation may be necessary
- anticoagulant agents
- thigh high stockings or SCD's
86
What medications are given to help w/ GBS?
Plasmapheresis and IVIG
87
How often should passive ROM exercises be performed with GBS patients?
Twice daily
88
Parkinson Disease
slowly progressing neurologic movement disorder that eventually leads to disability
89
Risk Factors for Parkinson
- genetics
- atherosclerosis
- viral infections
- head trauma
- chronic use of anti-psychotic meds
- environmental exposures
90
Parkinson is associated with a decreased level of what?
dopamine
91
The loss of dopamine in Parkinson Disease causes what?
More excitatory neurotransmitters than inhibitory leading to an imbalance that affects voluntary movement
92
What are the cardinal signs of Parkinson Disease? (TRAP)
T-tremor
R-rigidity of muscles
A-akinesia/bradykinesia
P-postural disturbances
93
What type of tremor is present w/ Parkinson?
Resting tremor
94
Resting Tremor
disappears w/ purposeful movement but its evident when extremities are motionless
-present while at rest and increases w/ walking or anxiety/stress
95
Cogwheel Rigidity w/ Parkinson
characterized by jerky rhythmic tone on passive muscle stretching
96
When does involuntary stiffness increase w/ Parkinson?
when another extremity increases when another extremity is engaged in voluntary activity
97
What type of Posture would you see with Parkinson?
Stands w/ head bent forward and walks w/ a propulsive gait
| shuffling gait
98
Other S/S of Parkinson
- excessive/uncontrolled sweating
- paroxysmal flushing
- orthostatic hypotension
- gastric/urinary retention
- constipation
- sexual dysfunction
- depression
- sleep probs
99
Anti-Parkinson Medications
- Levadopa
- Carbidopa (Sinemet)
- Artane
- Cogentin
- Symmetrel
- Parlodel
- Permax
100
How does Levadopa work for Parkinson?
It is converted to dopamine
101
W/in 5-10 years patients taking Levidopa and Sinemet develop a response to meds characterized by what?
Dyskinesia including
- facial grimacing
- jerking movements of hands
- head bobbing
- chewing/smacking movements
- involuntary movement of trunk and extremities
102
What type of stimulation is used to treat Parkinson?
Deep brain stimulation
103
What type of disease is Alzheimer's?
a progressive, irreversible, degenerative neurologic disease that begins insidiously
104
Alzheimer's is characterized by what?
gradual loss of cognitive function and disturbances in behavior and affect
105
Early Stage Alzheimer S/S
Forgetfulness and subtle memory loss
| Depression
106
Personality changes in patient w/ Alzheimer
- depression
- suspicion
- paranoid
- hostile
- combative
107
How is a definitive diagnosis of Alzheimer made?
Based on meeting the criteria and histologic evidence based on examination of brain tissue obtained by biopsy
108
What medication may be given to help maintain memory skills longer w/ Alzheimer?
Cholesterase inhibitors
- Aricept
- Exelon
- Reminyl
109
What is ALS?
degenerative disease characterized by the loss of both upper and lower motor neurons
110
What are the chief symptoms of ALS?
Fatigue and limb weakness
111
S/S of ALS
- tripping/falling
- changes in gait
- spasticity
- deep tendon reflexes are brisk/over reactive
112
Weakness typically starts where with ALS?
Muscles supplied by the cranial nerves and difficulty in talking, swallowing, and breathing occur
113
How is ALS diagnosed?
On the basis of signs and symptoms
114
What are the most common reasons for hospitalization for a patient w/ ALS?
dehydration
malnutrition
pneumonia
respiratory failure
115
What is the only drug approved by the FDA to treat ALS?
Riluzole (Rilutek)
116
S/S of Diaphragmatic weakness in patients w/ ALS
- paradoxical movement of abdominal wall during inspiration
- SOB
- orthopnea
117
S/S of Nocturnal Retention of Carbon Dioxide w/ ALS
- interrupted sleep
- morning headaches
- anorexia
- daytime somnolence
