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Adult Health l > Problems of the CNS: The Brain > Flashcards

Problems of the CNS: The Brain Flashcards

1
Q

Risk factors for headaches

A 
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)
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2
Q

Multifaceted (vascular,genetic,neurologic, hormonal,environmental) headaches

A

migraines

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3
Q

Symptoms of migraines

A

Intense pain, unilateral
Throbbing
Worsens with movement,
Photophobia or phonophobia

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4
Q

Types of migraine headaches

A

aura, no aura, atypical

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5
Q

Classic migraine

A

aura

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6
Q

4-72 hours duration (common)

A

no aura

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7
Q

Longer than 72 hours, unclassified

A

atypical

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8
Q

3 R’s

A

Recognize migraine symptoms
Respond and health care provider
Relieve pain and associated symptoms

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9
Q

Mild abortive therapy

A

Acetaminophen
NSAIDS (Ibuprofen, naproxen)
Migraine specific OTC formulations
Antiemetics

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10
Q

Severe abortive therapy

A

Triptan preparations
Ergotamine preparations
Isometheptine combination

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11
Q

Preventative therapy

A 
NSAID
Beta blocker (Propranolol, timolol)
Calcium channel blocker
(verapamil)
Antiepileptic drugs
(Topiramate)
Avoid triggers
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12
Q

Migraine trigger foods

A

chocolate, alcoholic beverages, aged cheese, caffeine, caffeine withdrawals, foods with yeast (bread/pastry), MSG, nitrates (meats), nuts, artificial sweeteners, smoked fish

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13
Q

Migraine trigger drugs

A

cimetidine, estrogens, nitroglycerin, nifedipine

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14
Q

Migraine trigger (other)

A

anger, fatigue, hormonal, light glare, missed meals, hypoglycemia, psychological stress, sleep problems, smells (tobacco), traveling at different altitudes

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15
Q

Complementary & Alternative therapy

A 
Yoga
Meditation therapy
Massage
Exercise
Biofeedback
Accupuncture
Herbal remedies (always review with provider first)
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16
Q 
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
A

cluster headache

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17
Q

Vasoreactivity & neurogenic inflammation

A

cluster headache

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18
Q

Symptoms of cluster headaches

A 
Tearing of eye with nasal congestion
Facial sweating
Drooping eyelid (ptosis) and eyelid edema
Miosis
Facial pallor
Nausea & vomiting
Pacing, walking, and rocking activities
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19
Q

Treatment of cluster headaches

A

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

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20
Q

Types of seizures

A

generalized, partial, unclassified, secondary

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21
Q

Types of epilepsy

A

primary or idiopathic

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22
Q

Generalized seizures

A

tonic-clonic, tonic, clonic, absence, myoclonic, atonic

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23
Q 
Both cerebral hemispheres 
2 -5 minutes
Loss of consciousness
Incontinent
Biting of tongue
Post-ictal period with fatigue, lethargy, confusion
A

tonic-clonic

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24
Q

Abrupt increase in muscle tone

LOC

A

tonic

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25
Q

Muscle contraction and relaxation

A

clonic

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26
Q

Brief jerking or stiffening of extremities

A

myoclonic

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27
Q

Sudden loss of muscle tone

A

atonic

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28
Q

Parietal seizures

A

local or focal

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29
Q

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

A

complex partial

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30
Q 
Remains conscious
Aura may occur
One sided movement
Unusual sensations
Can have autonomic symptoms
A

simple partial

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31
Q

Seizure risks

A 
Metabolic disorders
Acute alcohol withdrawal
Electrolyte disturbances
Heart disease
High fever
Stroke
Substance abuse
32
Q

Seizure precautions

A 
Oxygen 
Suction equipment
Airway
IV access
Siderails up
No tongue blades
33
Q

Seizure management

A 
Depends on type of seizure
Patient safety
Observation and documentation
Side-lying position (recovery position)
No restraints
34
Q

Acute seizure management

A

Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

35
Q

Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency

A

status epilepticus

36
Q

Status Epilepticus management

A 
Establish airway
ABGs
IV push lorazepam, diazepam
Rectal diazepam
Loading dose IV phenytoin
37
Q

Drug therapy of status epileptics

A

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

38
Q

Education of status epileptics

A

Compliance with AEDs
Social service resources to assist with medication costs
Discrimination prohibited
Alternative employment may be needed
Vocational rehabilitation may be subsidized

39
Q

Surgical management of status epileptics

A

Vagal nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Partial corpus callosotomy

40
Q

inflammation of meninges

A

meningitis

41
Q

Risk factors of meningitis

A

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)

42
Q

General symptoms of meningitis

A

fever

43
Q

Neurological symptoms of meningitis

A 
Headache
Photophobia
Indications of increased ICP
Nuchal rigidity
Positive Kernig’s, Brudzinski’s signs
Decreased mental status
Focal neurological deficits
44
Q

GI symptoms of meningitis

A

Nausea and vomiting

45
Q

Reflex contraction & pain in hamstring when extend leg after flexion at hip.

A

Kernig’s sign

46
Q

Involuntary flexion of knee when neck flexed

A

Brudzinski’s sign

47
Q

Laboratory Assessment of Meningitis

A

CSF analysis (elevated protein >25, WBC, CSF pressure >200 or >15, decreased glucose

48
Q

Nursing care of meningitis

A 
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
49
Q

Drug therapy of meningitis

A

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

50
Q

Inflammation of brain tissue
Cerebrum, brain stem, cerebellum
No exudate formation
Degeneration of neurons, demyelination of axons

A

Encephalitis

51
Q

Causes of encephalitis

A

Arboviruses spread by infected mosquitoes or ticks
Enteroviruses such as herpes zoster
Amebic meningoencephalitis

52
Q

Symptoms of encephalitis

A 
High fever
Changes in mental status
Motor dysfunction
Focal neuro deficits
Photophobia
Fatigue
Joint pain
Headache
Signs of increased ICP
53
Q

How to diagnose encephalitis

A

Lumbar puncture (PCR)
EEG
CT scan

54
Q

Preventative measures for encephalitis

A

protection from mosquitoes

55
Q

Nursing care of encephalitis

A

similar to meningitis

56
Q

Treatment of encephalitis

A

supportive and acyclovir if it is herpes

57
Q

What can result from herpes simplex encephalitis

A

hemorrhagic necrosis

58
Q

Degeneration of the substantia nigra results on decreased production of dopamine
Overstimulation of the basal ganglia by acetylcholine

A

Parkinson disease

59
Q

Risk factor of Parkinson disease

A 
Age 40 to 70
Gender: men
Genetic predisposition
Exposure to environmental toxins
Chronic use of antipsychotic medication
60
Q

Symptoms of Parkinson disease

A 
Tremor
Muscle rigidity
Bradykinesia
Postural instability
Mask like facial expression
Shuffling gait
Reduced arm swinging
61
Q

Physical assessment of Parkinson disease

A

Autonomic dysfunction (orthostatic hypotension, Flushing)
Emotionally labile
Depressed, paranoid

62
Q

Drug therapy of Parkinson disease

A 
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
63
Q

Nursing care of Parkinson disease

A

Mobility
Nutrition
Psychological
Speech therapy

64
Q

Chronic progressive
Structural changes in brain
(Neuritic plaques, granulovascular degeneration,
Neurofibrillary tangles)

A

Alzheimer’s Disease

65
Q

Stages of Alzheimer’s disease

A

Early or Mild
Middle or Moderate
Late or Severe

66
Q

Risk factors of Alzheimer’s disease

A 
Gender
Family history
African Americans more than Euro-Americans
Environmental agents 
(Viruses, Toxic metals)
Head trauma
Age
67
Q

Health promotion of Alzheimer’s disease

A

Walking, swimming, exercise
Balanced diet (Dark colored fruits & vegetables
Folate, vitamins B12, C and E)

68
Q

Symptoms of Alzheimer’s disease

A

Gradual memory loss, short term first
Changes in behavior & personality
Eventual language, motor skills lost

69
Q

Diagnostic testing of Alzheimer’s disease

A

MMSE (Orientation, registration, attention & calculation, recall, speech-language)
CT scan, Lab studies, EEG

70
Q

Priority care of Alzheimer’s disease

A 
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
71
Q

Medication therapy of Alzheimer’s disease

A 
Cholinesterase inhibitors
(Donepezil (Aricept); galantamine (Reminyl)
N-methyl-D-aspartate receptor antagonist
(Memantine (Namenda)
Antidepressants
(SSRIs)
72
Q

Hereditary disorder
Autosomal dominant
Decrease in the GABA (inhibitory transmitter in the basal ganglia
Increase in glutamate

A

Huntington Disease

73
Q

When does Huntington disease begins

A

30 to 50 years

74
Q

Stages of Huntington disease

A

Stage 1: onset
Stage 2: increasing dependence on others
Stage 3: loss of independent function

75
Q

Physical assessment of Huntington disease

A 
Progressive mental status changes
Choreiform movements (brisk, jerky, purposeless movements)
76
Q

Drug therapy for Huntington disease

A

tetrabenazine

77
Q

Teaching for Huntington disease

A

include psychosocial support resources

Adult Health l (9 decks)

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