Neurologic Disorders Flashcards
What are seizures?
Abnormal discharges in the brain for a single event of which results in an abrupt and temporary altered cerebral function state
What are the 3 conditions a patient must meet to be diagnosed w/ Epilepsy?
- at least 2 unprovoked seizures occurring more than 24 hours apart
- 1 unprovoked seizure and probability if more
- diagnosis of epilepsy syndrome
Epilepsy Syndromes are classified by what?
Specific patterns of clinical features including age at onset, family history, and seizure type
Status Epilepticus
continuous seizure activity for more than 5 minutes or two or more sequential seizures w/o full recovery of consciousness b/t seizures
Seizures can also occur as a result of what besides epilepsy?
- hyponatremia
- high fever
Epilepsy is a disease that refers to what?
Recurrent, unpredictable, and unprovoked seizures
Seizures require what 3 conditions?
- excitable neurons
- increase in excitatory glutaminergic activity
- reduction in activity of normal inhibitory GABA projection
When do seizures occur?
When there is an imbalance b/t inhibition and excitation w/in the CNS
Causes of Acquired Seizures
- cerebrovascular disease
- hypoxemia
- fever
- head injury
- HTN
- CNS infection
- metabolic/toxic conditions-hyperkalemia,hyponatremia, hypoglycemia
- brain tumor
- drugs/alcohol
What are the goals of treatment for seizures?
- Stop the seizure as quickly as possible
- ensure adequate cerebral oxygenation
- maintain patient in seizure free state
What medications may be administered to halt seizures?
- lorazepam (Ativan)
- diazepam (Valium)
- midazolam (Versed)
What drugs may be administered later to maintain a seizure free state?
Antiepileptic drugs
- levetiracetam
- phenytoin
- phenobarbitol
Why must Phenytoin (Dilantin) IV be administered slowly?
- B/c of its effect on the myocardium and potential for arrhythmia development
- irritating to veins so must be monitored for phlebitis
Focal Seizures w/ Retained Awareness S/S
- finger/hand shake
- mouth may jerk uncontrollably
- unintelligible speech
- dizziness
- unusual/unpleasant sights, sounds, odors, or taste
Focal Seizures w/ Altered Awareness S/S
- remains motionless or moves automatically but inappropriately
- excessive emotions of fear, anger, elation, irritability
- person won’t remember what happens
Generalized Seizures S/S
- intense rigidity
- alternating muscle relaxation and contraction
- epileptic cry
- incontinent of urine or feces
After the Generalized Seizure is over patients usually appear?
- confused
- hard to arouse
- headache
- sore muscles
- extremity weakness
- fatigue
- depression
What is the SPECT useful for?
identifying the epileptogenic zone so that the area in the brain giving rise to seizures can be removed surgically
What is an EEG useful for w/ seizures?
Assists in classifying the type of seizure
A patient who has received long term antiepileptic therapy is at increased risk for what?
Fractures resulting from bone disease
Bacterial meningitis is commonly caused by what bacteria?
streptococcus pneumonia
neisseria meningitidis
What increases a persons risk for developing bacterial meningitis?
- tobacco use
- otitis media
- mastoiditis
- pneumonia
- immunosupressed
- chronic steroid therapy
- HIV
- traumatic injury
- surgery
Meningeal Infections generally originate in what two ways?
- direct contact
- through blood stream from other infection
Prophylactic agents are given to what type of traumatic injury patients to prevent bacterial meningitis?
Traumatic injury where CSF is escaping through ears or nose
What are some complications of bacterial meningitis?
- visual impairment
- deafness
- seizures
- paralysis
- hydrocephalus
- septic shock
What are frequently the initial symptoms of Bacterial meningitis?
headache and fever
S/S of Meningitis
- nuchal rigidity
- positive kernig sign
- positive brudinski sign
- photophobia
What is Nuchal Rigidity?
stiff neck
Positive Kernig Sign
patient is lying supine w/ the hip flexed 90 degrees, resistance/pain to passive extension of the knee is positive sign
Positive Brudzinski Sign
when the patient’s neck is flexed, flexion of the knees and hips is produced
What is included in the classic triad of bacterial meningitis?
- stiff neck
- altered LOC
- fever
If bradycardia and decreased respirations are seen w/ bacterial meningitis the nurse should suspect what?
ICP
What is the gold standard for diagnosis of bacterial meningitis?
Bacterial culture and gram staining of CSF and blood
What medications may be used to treat bacterial meningitis?
- penicillins
- cephalosporins
- vancomycin w/ or w/o rifampin
What signs are first present w/ viral meningitis?
- headache
- low grade fever
- stiff neck
- photophobia
- malaise
- flu like symptoms
What type of disease is Multiple sclerosis?
immune-mediated progressive demyelinating disease of the CNS
Multiple Sclerosis typically affects who?
Adults ages 20-40
women more than men
What is the Secondary Progressive course of Multiple Sclerosis?
Disease progression occurs w/ or w/o relapse
Primary Progressive course of Multiple Sclerosis
disabling symptoms steadily increase w/ rare plateaus and temporary improvement
Primary Progressive MS may result in what?
- quadriparesis
- cognitive dysfunction
- visual loss
- brain stem syndromes
Progressive Relapsing form of MS
characterized by relapses w/ continuous disabling progression b/t exacerbations
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
Visual disturbances w/ MS may also include what?
- blurred vision
- diplopia
- nystagmus
- patchy/total blindness
What happens during exacerbations of MS?
New symptoms appear and existing ones worsen
What happens during remission of MS?
symptoms decrease or disappear
What are some secondary complications of MS?
- UTI
- constipation
- pressure ulcers
- contracture deformities
- pedal edema
- pneumonia
- depression
- decreased bone density
How is MS diagnosed?
- clinical exams
- MRI
- EPS
- examination of CSF
What will be seen on an MRI of a patient w/ MS?
Bright spots of demyelinated lesions/plaques
What is the goal of treatment for MS?
Treat acute exacerbations, delay progression of disease, and manage chronic symptoms
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
What is the medication of choice for treating Spasticity in MS?
Baclofen
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
The patient w/ MS is encourages to exercise until when?
the point just short of fatigue
Myasthenia Gravis is characterized by what?
Fatigability and degrees of muscle weakness of the voluntary muscles
What is the average age of onset for men and women w/ Myasthenia Gravis?
Women 28 years
Men 42 years
With MG there is a reduction in the number of what receptor sites?
Acetylcholine
With fewer Acetylcholine receptors available for stimulation w/ MG this results in what?
voluntary muscle weakness that escalates w/ continued activity
The initial S/S of MG usually involves what?
Ocular Muscles
S/S of Myasthenia Gravis
- diplopia
- ptosis
- weak facial and throat muscles
- generalized weakness
- dysphonia
MG is purely a what type of disorder?
Motor disorder and doesn’t effect sensation or coordination
What is used to diagnose MG?
Acetylcholinesterase test
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
What types of medications may be administered for MG?
- anticholinesterase meds
- immunosupressive therapy
- plasmapheresis
- intravenous immunoglobulin
- thymectomy
What gland may be enlarged w/ MG?
Thymus gland
What is the first line of therapy for MG?
Pyridostigmine bromide (Mestinon) an anticholinesterase med
What immunosuppressive drugs are used if Mestinon is not effective for MG?
- corticosteroid Prednisone
- cytotoxic med Imuran
What is mandatory of all patients w/ long term Prednisone usage?
Prophylactic treatment for Osteoporosis and careful follow ups
What surgery can be done to improve MG?
Thymectomy
Any delay in medications for MG may result in what?
Exacerbate muscle weakness and make it impossible for patient to take oral meds
What is a Cholinergic Crisis w/ MG?
problem of over medication that results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretions
What medication may be given during an Cholinergic Crisis?
Atropine
Treatment for Cholinergic Crisis
- Endotracheal intubation/mechanical ventilation
- Stop medication until improvement is seen
What is a Myasthenic Crisis for MG?
a sudden, temporary exacerbation of symptoms of MG
What is a common precipitating event for Myasthenic Crisis?
infection
S/S of Myasthenic Crisis
- respiratory distress
- dysphagia
- dysarthria
- eyelid ptosis
- diplopia
- prominent muscle weakness
Nursing Interventions for Myasthenic Crisis
- Chest physiotherapy
- I/O’s
- daily weights
- pulmonary assessments
- NG tube feedings if needed
Guillain-Barre Syndrome
an automimmune attack on the peripheral nerve myelin
GBS results in what?
acute, rapid demyelinization of peripheral/cranial nerves producing ascending weakness w/ dyskinesia, hyporeflexia, and paresthesias
What are the beginning signs of GBS?
muscle weakness and diminished reflexes of the lower extremities
Hyporeflexia and weakness w/ GBS may progress to what?
tetraplegia
Weakness usually begins where in GBS?
in the legs and progresses upwards
How long may it take a person to regain complete function with GBS?
2 years
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
GBS will not affect what?
Cognitive function or LOC
Nursing Management of GBS
- identify baseline values
- respiratory therapy or mechanical ventilation may be necessary
- anticoagulant agents
- thigh high stockings or SCD’s
What medications are given to help w/ GBS?
Plasmapheresis and IVIG
How often should passive ROM exercises be performed with GBS patients?
Twice daily
Parkinson Disease
slowly progressing neurologic movement disorder that eventually leads to disability
Risk Factors for Parkinson
- genetics
- atherosclerosis
- viral infections
- head trauma
- chronic use of anti-psychotic meds
- environmental exposures
Parkinson is associated with a decreased level of what?
dopamine
The loss of dopamine in Parkinson Disease causes what?
More excitatory neurotransmitters than inhibitory leading to an imbalance that affects voluntary movement
What are the cardinal signs of Parkinson Disease? (TRAP)
T-tremor
R-rigidity of muscles
A-akinesia/bradykinesia
P-postural disturbances
What type of tremor is present w/ Parkinson?
Resting tremor
Resting Tremor
disappears w/ purposeful movement but its evident when extremities are motionless
-present while at rest and increases w/ walking or anxiety/stress
Cogwheel Rigidity w/ Parkinson
characterized by jerky rhythmic tone on passive muscle stretching
When does involuntary stiffness increase w/ Parkinson?
when another extremity increases when another extremity is engaged in voluntary activity
What type of Posture would you see with Parkinson?
Stands w/ head bent forward and walks w/ a propulsive gait
shuffling gait
Other S/S of Parkinson
- excessive/uncontrolled sweating
- paroxysmal flushing
- orthostatic hypotension
- gastric/urinary retention
- constipation
- sexual dysfunction
- depression
- sleep probs
Anti-Parkinson Medications
- Levadopa
- Carbidopa (Sinemet)
- Artane
- Cogentin
- Symmetrel
- Parlodel
- Permax
How does Levadopa work for Parkinson?
It is converted to dopamine
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
What type of stimulation is used to treat Parkinson?
Deep brain stimulation
What type of disease is Alzheimer’s?
a progressive, irreversible, degenerative neurologic disease that begins insidiously
Alzheimer’s is characterized by what?
gradual loss of cognitive function and disturbances in behavior and affect
Early Stage Alzheimer S/S
Forgetfulness and subtle memory loss
Depression
Personality changes in patient w/ Alzheimer
- depression
- suspicion
- paranoid
- hostile
- combative
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
What medication may be given to help maintain memory skills longer w/ Alzheimer?
Cholesterase inhibitors
- Aricept
- Exelon
- Reminyl
What is ALS?
degenerative disease characterized by the loss of both upper and lower motor neurons
What are the chief symptoms of ALS?
Fatigue and limb weakness
S/S of ALS
- tripping/falling
- changes in gait
- spasticity
- deep tendon reflexes are brisk/over reactive
Weakness typically starts where with ALS?
Muscles supplied by the cranial nerves and difficulty in talking, swallowing, and breathing occur
How is ALS diagnosed?
On the basis of signs and symptoms
What are the most common reasons for hospitalization for a patient w/ ALS?
dehydration
malnutrition
pneumonia
respiratory failure
What is the only drug approved by the FDA to treat ALS?
Riluzole (Rilutek)
S/S of Diaphragmatic weakness in patients w/ ALS
- paradoxical movement of abdominal wall during inspiration
- SOB
- orthopnea
S/S of Nocturnal Retention of Carbon Dioxide w/ ALS
- interrupted sleep
- morning headaches
- anorexia
- daytime somnolence
