Nurb test 3: chronic neuro Flashcards
cause is not from an illness or another condition Ex: cluster, tension, migraine
primary headache
- 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
Headaches
caused by another illness or infection Ex: sinus infection, neck injury, or a stroke
secondary headache
-four most common types of headache
tension, cluster, sinus, and migraine
lateral location, tightening or pressing quality, mild or moderate, not worsened with physical activity
Tension HA
1a. Characterized by:
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
1b. Duration:
tension ha
sensitivity to light or sound, stiff neck
1c. Clinical Manifestations:
tension ha
(emg) electromyography= shows the contraction of neck, scalp, and facial muscles
1d. Diagnostic Testing:
tension ha
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 ___
Migraine HA
2a. Defined by:
20-30
very strong family history, low socioeconomic status, and increase workload
risk factors
migraine ha
(early signs and symptoms before the headache) = sensitivity to light, irritability, possibly food cravings,
Clinical Manifestations:
A. protodon
migraine ha
= immediate precedes headache= patchy blindness, hearing sounds
sx
ora
migraine ha
generalized edema, become very pallor, n/v = common
sx C. With headache:
migraine ha
- 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
migraine ha
4-72
- 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
Cluster HA
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
3a. Characterized by:
cluster ha
3c. Triggers: alcohol, strong odors, napping
cluster ha
–sudden and happen at night, not a lot of drug therapy useful
Collaborative Care Cluster
vasoconstrictor, 100 percent at 6-8 liters for 10 minutes also increases serotonin synthesis
Oxygen-
symptomatic tx cluster a
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
Multiple Sclerosis-
Characterized by: Chronic inflammation, Demyelination, Gliosis (scarring)
multiple sclerosis
Onset: __year olds
Risk factors: women, climate between 45-65 degrees= us, Canada, and Europe
Cause is unknown
multiple sclerosis
20-50
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
multiple sclerosis
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
MS Pathophysiology
- 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
Clinical Manifestations: Multiple Sclerosis
- motor: weakness and paralysis
- sensory: numbness, blurred vision,
- cerebral: dysphasia, ataxia
- fatigue
- depression
- bowl and bladder function
sx multiple sclerosis
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
Dx MS:
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
Nursing Implementation: MS
chronic progressive neurodegenerative disorder
char by: slowness of movement, rigidity, trimmers at rest, gate disturbance
- dev gradually
-dx increases with age, strong familial link
Parkinson’s Disease-
-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
Pathophysiology PD
- 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
Sx PD
- first sign, more promoinate at rest, aggravated by stress
- second sign, jerky quality to movements
- slowness in movement: stoop posture, drooling, shuffling
Parkinson’s Disease: Clinical Manifestations of Triad of symptoms
tremor
rigidity
bradykinesia
Triad: trimmer, rigidity, and bradykinesia
Classic Signs: parkinson
shuffle, posture issues=stoop over
-Pulpsaive gate- stooped, head is pointed down and out, very stiff
Later Stages:
parkinsons
little or no facial expression, arm may not swing with walk
Beginning Stages:
Parkinson
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
Levodopa+carbidopa = (Sinemet)=
- Levodopa
- carbidopa
Antiparkinsonian/Dopaminergics
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
Parkinson’s Disease: Nursing Mgt
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
Myasthenia Gravis-
10-75
- Antibodies attack acetylcholine receptors which decrease the receptor sites and prevents muscle from contracting which can lead to muscle weakness
Patho MG
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
Clinical Manifestations MG
- 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
Myasthenia Gravis Diagnostic Studies
- emg
- tensilon test
- 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
Amyotrophic Lateral Sclerosis (ALS)
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
ALS: Clinical Manifestations
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
Nursing Mgt ALS
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
Trigeminal Neuralgia-
not fully understood, studies : blood vessels become compressed and leads to irrigating the nerve, keeps firing off sensory fibers
Risk factors- multiple sclerosis, hypertension
Patho TN :
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
Clinical Manifestations TN
Classic:
stimulation at trigger site
Chewing, Tooth brushing, Hot/cold, Yawning, Talking
Triggers TN
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
Trigeminal Neuralgia: Nursing Mgt
- 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
. Bell’s Palsy
20-60
- Onset comes with an outbreak of herpes in and around the ear
- often have Fever
- Tinitis
- drooping mouth on one side
Bell’s Palsy: Clinical Manifestations
relief of sx and prevent complication
- protect eye on the affected side
Collaborative Care BP-
Moist heat, Gentle massage, Prescribed exercises, Electrical stimulation, Protective measures
Conservative Therapy BP
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
Bell’s Palsy: Nursing Mgt
- 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
Guillain-Barre Syndrome
Loss of myelin causing loss of nerve transmission
patho guillain- barre syndrome
Preceded by: Viral infection, Viral immunizations, Trauma, Surgery, HIV
guillain-barre syndrome
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
Guillain-Barre Syndrome: Clinical Manifestations
- based on history and sx
1. and 2. -show abnormal
3. - show increase in protein but not till after 7-10 days
Guillain-Barre Syndrome Diagnostics
- emg
- nerve conduction
- csf
- 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
Guillain-Barre Syndrome Collaborative Care
1. Immunoglobulin
(Sandoglobulin)
- 1st two weeks, decrease hospital stay, decrease time on vent, and decrease recovery time
Guillain-Barre Syndrome Collaborative Care
2. Plasmapheresis
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
Guillain-Barre Syndrome: Nursing Mgt
