Problems of the CNS: The Brain Flashcards
Risk factors for headaches
Alcohol Environmental allergies Medication Intense odors, bright lights Fatigue, sleep deprivation Depression Emotional/physical stress, anxiety Menstrual cycle, oral contraceptive use Foods (Tyramine, caffeine, MSG, nitrites, milk products)
Multifaceted (vascular,genetic,neurologic, hormonal,environmental) headaches
migraines
Symptoms of migraines
Intense pain, unilateral
Throbbing
Worsens with movement,
Photophobia or phonophobia
Types of migraine headaches
aura, no aura, atypical
Classic migraine
aura
4-72 hours duration (common)
no aura
Longer than 72 hours, unclassified
atypical
3 R’s
Recognize migraine symptoms
Respond and health care provider
Relieve pain and associated symptoms
Mild abortive therapy
Acetaminophen
NSAIDS (Ibuprofen, naproxen)
Migraine specific OTC formulations
Antiemetics
Severe abortive therapy
Triptan preparations
Ergotamine preparations
Isometheptine combination
Preventative therapy
NSAID Beta blocker (Propranolol, timolol) Calcium channel blocker (verapamil) Antiepileptic drugs (Topiramate) Avoid triggers
Migraine trigger foods
chocolate, alcoholic beverages, aged cheese, caffeine, caffeine withdrawals, foods with yeast (bread/pastry), MSG, nitrates (meats), nuts, artificial sweeteners, smoked fish
Migraine trigger drugs
cimetidine, estrogens, nitroglycerin, nifedipine
Migraine trigger (other)
anger, fatigue, hormonal, light glare, missed meals, hypoglycemia, psychological stress, sleep problems, smells (tobacco), traveling at different altitudes
Complementary & Alternative therapy
Yoga Meditation therapy Massage Exercise Biofeedback Accupuncture Herbal remedies (always review with provider first)
Trigeminal autonomic cephalgia Brief, intense, unilateral pain Described as non-throbbing or “boring” 30 min to 2 hours Occurring daily for 4 to 12 weeks No warning
cluster headache
Vasoreactivity & neurogenic inflammation
cluster headache
Symptoms of cluster headaches
Tearing of eye with nasal congestion Facial sweating Drooping eyelid (ptosis) and eyelid edema Miosis Facial pallor Nausea & vomiting Pacing, walking, and rocking activities
Treatment of cluster headaches
Triptans, ergotamine, anti epileptics, CCB, lithium, corticosteroids, melatonin, glucosamine
Oxygen therapy (100% for short period during HA, then d/c)
Consistent sleep-wake cycle
Review triggers such as bursts of anger, excessive physical activity
Deep brain stimulation or surgery as last resort
Types of seizures
generalized, partial, unclassified, secondary
Types of epilepsy
primary or idiopathic
Generalized seizures
tonic-clonic, tonic, clonic, absence, myoclonic, atonic
Both cerebral hemispheres 2 -5 minutes Loss of consciousness Incontinent Biting of tongue Post-ictal period with fatigue, lethargy, confusion
tonic-clonic
Abrupt increase in muscle tone
LOC
tonic
Muscle contraction and relaxation
clonic
Brief jerking or stiffening of extremities
myoclonic
Sudden loss of muscle tone
atonic
Parietal seizures
local or focal
LOC 1-3 minutes
Automatisms (an action performed unconsciously or involuntarily) can occur
Amnesia post seizure
Also called psychomotor or temporal lobe seizures
More common in older adults
complex partial
Remains conscious Aura may occur One sided movement Unusual sensations Can have autonomic symptoms
simple partial
Seizure risks
Metabolic disorders Acute alcohol withdrawal Electrolyte disturbances Heart disease High fever Stroke Substance abuse
Seizure precautions
Oxygen Suction equipment Airway IV access Siderails up No tongue blades
Seizure management
Depends on type of seizure Patient safety Observation and documentation Side-lying position (recovery position) No restraints
Acute seizure management
Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency
status epilepticus
Status Epilepticus management
Establish airway ABGs IV push lorazepam, diazepam Rectal diazepam Loading dose IV phenytoin
Drug therapy of status epileptics
Evaluate most current blood level of medication, if appropriate
Be aware of drug-drug/drug-food interactions
Maintain therapeutic blood levels for maximal effectiveness
Do not administer warfarin with phenytoin (therapeutic level 10-20)
Document and report side/adverse effects
Education of status epileptics
Compliance with AEDs
Social service resources to assist with medication costs
Discrimination prohibited
Alternative employment may be needed
Vocational rehabilitation may be subsidized
Surgical management of status epileptics
Vagal nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Partial corpus callosotomy
inflammation of meninges
meningitis
Risk factors of meningitis
Viral (mumps, measles, herpes, West Nile)
Fungal (AIDS)
Bacterial (Otitis media, pneumonia, sinusitis, immunosuppression, invasive procedures,overcrowded living conditions, Streptococcus pneumoniae & Neisseria meningitidis, Haemophilus influenzae)
General symptoms of meningitis
fever
Neurological symptoms of meningitis
Headache Photophobia Indications of increased ICP Nuchal rigidity Positive Kernig’s, Brudzinski’s signs Decreased mental status Focal neurological deficits
GI symptoms of meningitis
Nausea and vomiting
Reflex contraction & pain in hamstring when extend leg after flexion at hip.
Kernig’s sign
Involuntary flexion of knee when neck flexed
Brudzinski’s sign
Laboratory Assessment of Meningitis
CSF analysis (elevated protein >25, WBC, CSF pressure >200 or >15, decreased glucose
Nursing care of meningitis
Bacterial (isolation: droplet precautions) Fever reduction Dark, quiet environment Bedrest, HOB elevated Seizure precautions Neuro checks q 2-4 hours Cranial nerves III, IV, VI, VII, VIII
Drug therapy of meningitis
Broad-spectrum antibiotic
Fever-reducing agents (acetaminophen, ibuprofen)
Hyperosmolar agents
Anticonvulsants
Phenytoin
Steroids (controversial)
Prophylaxis treatment for those in close contact with meningitis-infected patient
Inflammation of brain tissue
Cerebrum, brain stem, cerebellum
No exudate formation
Degeneration of neurons, demyelination of axons
Encephalitis
Causes of encephalitis
Arboviruses spread by infected mosquitoes or ticks
Enteroviruses such as herpes zoster
Amebic meningoencephalitis
Symptoms of encephalitis
High fever Changes in mental status Motor dysfunction Focal neuro deficits Photophobia Fatigue Joint pain Headache Signs of increased ICP
How to diagnose encephalitis
Lumbar puncture (PCR)
EEG
CT scan
Preventative measures for encephalitis
protection from mosquitoes
Nursing care of encephalitis
similar to meningitis
Treatment of encephalitis
supportive and acyclovir if it is herpes
What can result from herpes simplex encephalitis
hemorrhagic necrosis
Degeneration of the substantia nigra results on decreased production of dopamine
Overstimulation of the basal ganglia by acetylcholine
Parkinson disease
Risk factor of Parkinson disease
Age 40 to 70 Gender: men Genetic predisposition Exposure to environmental toxins Chronic use of antipsychotic medication
Symptoms of Parkinson disease
Tremor Muscle rigidity Bradykinesia Postural instability Mask like facial expression Shuffling gait Reduced arm swinging
Physical assessment of Parkinson disease
Autonomic dysfunction (orthostatic hypotension, Flushing)
Emotionally labile
Depressed, paranoid
Drug therapy of Parkinson disease
Dopamine agonists (levodopa) Anticholinergics Catechol O-methyltransferase inhibitors Most effective in the first 3 to 5 years of use Therapeutic levels Drug toxicity interventions Drug holiday
Nursing care of Parkinson disease
Mobility
Nutrition
Psychological
Speech therapy
Chronic progressive
Structural changes in brain
(Neuritic plaques, granulovascular degeneration,
Neurofibrillary tangles)
Alzheimer’s Disease
Stages of Alzheimer’s disease
Early or Mild
Middle or Moderate
Late or Severe
Risk factors of Alzheimer’s disease
Gender Family history African Americans more than Euro-Americans Environmental agents (Viruses, Toxic metals) Head trauma Age
Health promotion of Alzheimer’s disease
Walking, swimming, exercise
Balanced diet (Dark colored fruits & vegetables
Folate, vitamins B12, C and E)
Symptoms of Alzheimer’s disease
Gradual memory loss, short term first
Changes in behavior & personality
Eventual language, motor skills lost
Diagnostic testing of Alzheimer’s disease
MMSE (Orientation, registration, attention & calculation, recall, speech-language)
CT scan, Lab studies, EEG
Priority care of Alzheimer’s disease
Interventions and support (patient and caregiver) Cognitive stimulation and memory training Structuring the environment Orientation and validation therapy Promoting self-management Promoting bowel and bladder continence Promoting communication Traumatic relocation syndrome
Medication therapy of Alzheimer’s disease
Cholinesterase inhibitors (Donepezil (Aricept); galantamine (Reminyl) N-methyl-D-aspartate receptor antagonist (Memantine (Namenda) Antidepressants (SSRIs)
Hereditary disorder
Autosomal dominant
Decrease in the GABA (inhibitory transmitter in the basal ganglia
Increase in glutamate
Huntington Disease
When does Huntington disease begins
30 to 50 years
Stages of Huntington disease
Stage 1: onset
Stage 2: increasing dependence on others
Stage 3: loss of independent function
Physical assessment of Huntington disease
Progressive mental status changes Choreiform movements (brisk, jerky, purposeless movements)
Drug therapy for Huntington disease
tetrabenazine
Teaching for Huntington disease
include psychosocial support resources
