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Nurb test 3: chronic neuro Flashcards

0
Q

cause is not from an illness or another condition Ex: cluster, tension, migraine

A

primary headache

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1
Q
  • most common type of pain experienced
  • can have more than one type
  • history will help a lot in determining which or what kind they are experiencing
A

Headaches

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2
Q

caused by another illness or infection Ex: sinus infection, neck injury, or a stroke

A

secondary headache

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3
Q

-four most common types of headache

A

tension, cluster, sinus, and migraine

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4
Q

lateral location, tightening or pressing quality, mild or moderate, not worsened with physical activity

A

Tension HA

1a. Characterized by:

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5
Q

episodic or chronic, come and go or be there a long time, can last 30 min up to 7 days, can occur intermittently for weeks months or even a year
-caused by neurovascular factors very similar to migraines

A

1b. Duration:

tension ha

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6
Q

sensitivity to light or sound, stiff neck

A

1c. Clinical Manifestations:

tension ha

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7
Q

(emg) electromyography= shows the contraction of neck, scalp, and facial muscles

A

1d. Diagnostic Testing:

tension ha

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8
Q

reoccurring, unilateral, can be bilateral sometimes, described as a throbbing pain
- Usually caused by a triggering event Ex: certain type of food or hormone levels
Age for onset-years old ___

A

Migraine HA
2a. Defined by:
20-30

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9
Q

very strong family history, low socioeconomic status, and increase workload

A

risk factors

migraine ha

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10
Q

(early signs and symptoms before the headache) = sensitivity to light, irritability, possibly food cravings,

A

Clinical Manifestations:
A. protodon
migraine ha

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11
Q

= immediate precedes headache= patchy blindness, hearing sounds

A

sx
ora
migraine ha

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12
Q

generalized edema, become very pallor, n/v = common

A

sx C. With headache:

migraine ha

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13
Q
  • 70% have a first degree relative that has as well
  • can be associated with seizures, asthma, turrets, and anxiety
    2c. Duration: hours , improvement with sleep
A

migraine ha

4-72

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14
Q
  • Really rare less than .1 percent of pop
  • Repeated headache that can last weeks to months that is followed by periods of remission
  • Attacks occur in clusters can last 2-3 weeks
  • Happens typically same time of day or same time (season) of year
  • Cause is unknown
A

Cluster HA

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15
Q

sharp stabbing pain, usually around the eye, can radiate to temple forehead, cheeks, nose, and gums
-can even have swelling around your eyes
During an attack you get restless and agitated

A

3a. Characterized by:

cluster ha

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16
Q

3c. Triggers: alcohol, strong odors, napping

A

cluster ha

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17
Q

–sudden and happen at night, not a lot of drug therapy useful

A

Collaborative Care Cluster

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18
Q

vasoconstrictor, 100 percent at 6-8 liters for 10 minutes also increases serotonin synthesis

A

Oxygen-

symptomatic tx cluster a

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19
Q

chronic progressive degenerative disorder of the central nervous system
- demyelination of the nerve fibers of brain and spinal cord, messes up flow of information between the brain and the body
Autoimmune disease

A

Multiple Sclerosis-

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20
Q

Characterized by: Chronic inflammation, Demyelination, Gliosis (scarring)

A

multiple sclerosis

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21
Q

Onset: __year olds
Risk factors: women, climate between 45-65 degrees= us, Canada, and Europe
Cause is unknown

A

multiple sclerosis

20-50

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22
Q

Susceptibility is inherited
Precipitating Factors: controversial may not be a cause and effect relationship
- possible precipitating factors= physical injury, stress, infection, fatigue, pregnancy, and poor state of health

A

multiple sclerosis

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23
Q

Trigger (virus) then Lymphocytes (T cells) to central nervous system, inflammation starts, then Demyelination, n then Plaque formation.
Then Glial scar tissue, Destruction of nerve axons, Impulses blocked, Permanent loss of function

A

MS Pathophysiology

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24
Q
  • gradual onset with vague symptoms
    -occurs intermittently over months to years
  • progressive deterioration in neurological function from demyelination
    signs and sx different form person to person, makes it even more difficult Ex: some could have severe at first and others could be mild for years
A

Clinical Manifestations: Multiple Sclerosis

25
Q
  • motor: weakness and paralysis
  • sensory: numbness, blurred vision,
  • cerebral: dysphasia, ataxia
  • fatigue
  • depression
  • bowl and bladder function
A

sx multiple sclerosis

26
Q

no definitive test, based on pt history*, as well as Sx and signs, presence of multiple lesions or plaques in brain
-csf= shows increase immunoglobulin g and increase in lymphocytes = rushing to help

A

Dx MS:

27
Q

A. Educate on triggers or causes that worsen the disease
B. Prevent complications from immobility even bed rest
C. Resistance building- avoid fatigue, extreme hot cold
D. Bladder/bowel function- self cath maybe, bowl constipation to increase fiber

A

Nursing Implementation: MS

28
Q

chronic progressive neurodegenerative disorder
char by: slowness of movement, rigidity, trimmers at rest, gate disturbance
- dev gradually
-dx increases with age, strong familial link

A

Parkinson’s Disease-

29
Q

-Degeneration of neurons that produce dopamine in the mid brain, bc neurons are dying the affects dopamine needed for function of extrapyramidal motor system=which control your movements

A

Pathophysiology PD

30
Q
  • don’t start till 80 percent of neurons are gone, by time your are having symptom it progressed
  • Gradual onset and prolonged course
  • can start with one side of the body classic signs is the triad
A

Sx PD

31
Q
  • first sign, more promoinate at rest, aggravated by stress
  • second sign, jerky quality to movements
  • slowness in movement: stoop posture, drooling, shuffling
A

Parkinson’s Disease: Clinical Manifestations of Triad of symptoms
tremor
rigidity
bradykinesia

32
Q

Triad: trimmer, rigidity, and bradykinesia

A

Classic Signs: parkinson

33
Q

shuffle, posture issues=stoop over

-Pulpsaive gate- stooped, head is pointed down and out, very stiff

A

Later Stages:

parkinsons

34
Q

little or no facial expression, arm may not swing with walk

A

Beginning Stages:

Parkinson

35
Q

first used, monitor for signs of dyskinesia/ very common drug used

  • : med brain converts to dopamine
  • : what makes sure dopamine reaches brain before broke down
A

Levodopa+carbidopa = (Sinemet)=

  • Levodopa
  • carbidopa

Antiparkinsonian/Dopaminergics

36
Q

Promote physical exercise- help body to prevent muscle atrophy
Well balanced diet- prevent malnutrition and constipation
Dysphasia and Bradykinesa- soft food easy to chew
Encourage independence- as much as possible, alter enviro to needs Ex: shoes that slip on, velcro, no buttons hard for them, elevated toilet seat
- anything that makes life easier to do on own
Medication regimen
-Assess for improvement or lack of
-Levadopa assess for freezing= overdose

A

Parkinson’s Disease: Nursing Mgt

37
Q

autoimmune disease of the neuromuscular junction

  • char by weakness of certain musculoskeletal groups
  • commonly occurs between ages __years old
  • women peak age is child bearing years
A

Myasthenia Gravis-

10-75

38
Q
  • Antibodies attack acetylcholine receptors which decrease the receptor sites and prevents muscle from contracting which can lead to muscle weakness
A

Patho MG

39
Q

primary = fluctuating weakness in skeletal muscles (strength can come back after period of rest and gone again, comes and goes)

  • muscles involved those that make moving your eyes possible, eye lids, chewing, swallowing, speaking, and breathing
  • Muscles strongest in morning progressively weaker throughout the day
  • Exacerbations can be caused by stress, pregnancy, temperature extremes, trauma, other illnesses
  • Exacerbation can lead to a myasthenic crisis: acute exacerbation
A

Clinical Manifestations MG

40
Q
  • hx of patient
    1. EMG- shows decreased response to stimulation=muscle fatigue
    2. - improvement in contractility after injection of stuff= anticholinesterase
  • useful to dx cholinergic crisis= overdose of anticholinesterase drugs
A

Myasthenia Gravis Diagnostic Studies

  1. emg
  2. tensilon test
41
Q
  • rare progressive neurologic disorder char by loss of motor neurons
  • death 2-6 years after diagnosed, some can live 10 years
  • more common in men
    onset 40-70 years old
    unknown why brainstem and spinal cord generate, dead motor neurons can’t transmit to muscle you then have wasted muscle
    AKA: Lou Gehrig’s Disease
A

Amyotrophic Lateral Sclerosis (ALS)

42
Q

Muscle wasting, Drooling, Depression, Foot drop, Weakness in legs, Hand weakness, Slurring speech, Difficulty swallowing, Fatigue

  • Death usually is a result of resp infection
  • Important to know cognitive function is perfectly fine, but body is just wasting away
A

ALS: Clinical Manifestations

43
Q

Facilitate communication-computer assisted communication device, hard to talk when whole body won’t do anything
Reduce risk of aspiration- difficulty swallowing
Comfort- treat pain
Safety-assess risk for fall, do some altered enviro
Support- bc they can still function cognitively, try to find ways to help them communicate= can be frustrating
-emotionally
Exercises important to prevent spasticity
Pay attention to resp issues identify asap

A

Nursing Mgt ALS

44
Q

cranial nerve disorder

  • very sudden
  • typically unilateral
  • severe stabbing recurrent pain
  • most commonly dx neuralgic condition
  • more common in women
  • 5th cranial nerve, three branches does motor and sensory,only focus on sensory
  • affects mandibular and axillary not ophthalmic
A

Trigeminal Neuralgia-

45
Q

not fully understood, studies : blood vessels become compressed and leads to irrigating the nerve, keeps firing off sensory fibers
Risk factors- multiple sclerosis, hypertension

A

Patho TN :

46
Q

feature is abrupt onset of pain in lips, gum, forehead, side of nose, cheek
Reoccurrences are very unpredictable
-can last seconds to a few minutes
Sx: Pain, Twitching, Decreased facial sensation, Grimacing, frequent blinking or tearing with attacks

A

Clinical Manifestations TN

Classic:

47
Q

stimulation at trigger site

Chewing, Tooth brushing, Hot/cold, Yawning, Talking

A

Triggers TN

48
Q

Outpatient, assess for triggers, Comfort, response to drug therapy
Education: nutrition, oral hygiene
-Environmental management, Decrease stimuli, prevent acute attacks
Oral hygiene- decreased stimulation= soft tooth brush, chew soft food
Nutrient: luke warm foods, not hot or cold extreme food
Communication

A

Trigeminal Neuralgia: Nursing Mgt

49
Q
  • acute peripheral facial paralysis
  • inflammation of cranial nerve 7 on one side of the face
  • affects ___ year olds
  • Disruption of CN VII on one side of face
  • Unknown cause, herpes simplex virus may be related because it cause inflammation, demyelination,
  • Can recover fully in 6 months
A

. Bell’s Palsy
20-60

50
Q
  • Onset comes with an outbreak of herpes in and around the ear
  • often have Fever
  • Tinitis
  • drooping mouth on one side
A

Bell’s Palsy: Clinical Manifestations

51
Q

relief of sx and prevent complication

- protect eye on the affected side

A

Collaborative Care BP-

52
Q

Moist heat, Gentle massage, Prescribed exercises, Electrical stimulation, Protective measures

A

Conservative Therapy BP

53
Q

Early recognition is key*, outpatient
Comfort- mild analgesic for pain
Protect from drafts- don’t want cold air hot wet packs for lesions helps promote circulation and decrease pain
Promote adequate nutrition- chew on unaffected side
Eye protection- artificial tears, wear dark sunglasses
Support- reassure it won’t last, will make a full recovery

A

Bell’s Palsy: Nursing Mgt

54
Q
  • acute rapidly progressing and potentially fatal form of polyneuritis
    char= by ascending symmetric paralysis
  • affecting cranial nerves and peripheral nervous system
  • complete recovery 85-95%
    cause- unknown
A

Guillain-Barre Syndrome

55
Q

Loss of myelin causing loss of nerve transmission

A

patho guillain- barre syndrome

56
Q

Preceded by: Viral infection, Viral immunizations, Trauma, Surgery, HIV

A

guillain-barre syndrome

57
Q

1-3 weeks after an upper respiratory or Gi infections
Weakness of lower extremities peaks about day 14
distal muscles have numbness and tingling followed by paralysis
*Most dangerous autonomic nervous system dysfunction= Orthostatic Hypotension
Pain- most worse at night
*Most serious complication difficult breathing which could lead to respiratory failure

A

Guillain-Barre Syndrome: Clinical Manifestations

58
Q
  • based on history and sx
    1. and 2. -show abnormal
    3. - show increase in protein but not till after 7-10 days
A

Guillain-Barre Syndrome Diagnostics

  1. emg
  2. nerve conduction
  3. csf
59
Q
  • supportive care
  • IV, can be just as effective as plasma exchange, immediately available, increases safety , better option, *but pt has to be hydrated and have to have good renal function
A

Guillain-Barre Syndrome Collaborative Care
1. Immunoglobulin
(Sandoglobulin)

60
Q
  • 1st two weeks, decrease hospital stay, decrease time on vent, and decrease recovery time
A

Guillain-Barre Syndrome Collaborative Care

2. Plasmapheresis

61
Q

Respiratory support
Encourage nutrition- may have difficulty swallowing= upright position* don’t want to aspiration
Communication- dwindles as syndrome progresses, think of other ways
Urinary retention -very common for a few days, I and O cath preferred to decrease chances of uti
Goal= full recovery
Support and encouragement for the pt and the family

A

Guillain-Barre Syndrome: Nursing Mgt

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