T3 - Probs of CNS (Brain) (Josh) Flashcards
Risk factors for Headaches
ETOH
Environmental allergies
Meds
Intense odors / bright lights
Fatigue / Sleep Depr.
Depression
Emotional/Physical Stress; Anxiety
Menstrual Cycle; Oral Contraceptive use
Foods
Which foods increase risk for headaches?
Tyramine
- aged cheese, meats, etc
Caffiene
MSG
Nitrites
Milk products
Describe the characteristics of a Migraine Headache.
Intense, UNILATERAL pain
Worsens w/ mvmt
Photophobia or Phonophobia
What are the categories of a Migraine?
Aura (classic migraine)
No Aura (most common)
Atypical
What are the Phases of an Aura Migraine?
Prodrome
Aura
Termination
How long does a No Aura Migraine last?
How long does an Atypical Migraine last?
4-72 hrs
longer than 72 hrs
What are characteristics of a Cluster Headache?
Trigeminal Autonomic Cephalalgia
Brief, Intense, UNILATERAL pain
Non-throbbing or BORING pain
30 mins to 2 hrs in length
Occurs daily for 4-12 wks
No warning
What is the patho of a Cluster Headache?
vasoreactivity and neruogenic inflammation
Which headache?
- Tearing of eye w/ nasal congestion
- Facial sweating
Drooping eyelid (ptosis) and eyelid edema
- Miosis
- Facial pallor
- N/V
- Pacing, walking, and rocking activities
Cluster Headache
What meds for Abortive treatment for Migraine?
Mild
- Acetaminophen
- NSAIDs (ibuprofen; naproxen)
- Migraine specific OTC formulations
- Antiemetics
Severe
- Triptans
- Ergotamines
- Isometheptenes
Which meds for Preventive treatment for Migraine?
NSAIDs
Beta Blockers (propanolol; timolol)
CCBs (verapamil)
Antiepileptics (topiramate
Avoiding triggers
What non-pharmacological treatments for Migraines?
O2 Therapy (100% for short time)
Complimentary and Alternative Therapy (yoga, etc)
Consistent sleep/wake cycle
Review triggers such as bursts of anger or excessive physical activity
Deep brain stimulation or surgery as last resort
Triggers for Migraines.
Tyramine foods (pickles, caffeine, ETOH, aged cheese, artificial sweeteners, NUTS)
MSGs
Meds
- Ranitidine
- Estrogen
- Nitro
- Nifedipine
Anger
Lack of sleep/rest
Triggers for Cluster Headaches.
Anger outburst
Anxiety w/ prolonged anticipation
Excessive physical activity; fatigue
Altered sleep-wake cycles
What are the different types of Generalized Seizures?
Tonic-Clonic
Tonic
Clonic
Absence
Myoclonic
Atonic
Characteristics of a Tonic-Clonic Seizure.
Both cerebral hemispheres
2-5 mins
Loss of consciousness
Incontinent
Biting of Tongue
Post-ictal period with fatigue, lethargy, and confusion
What is the Tonic stage and what is the Clonic stage?
Tonic = abrupt increase in muscle tone with loss of consciousness
Clonic = muscle contraction and relaxation
Which seizure involves staring off in space (looks like day-dreaming) and happens in kids?
Absence
Which seizure involves brief jerking or stiffening of extremities?
Myoclonic
Which seizure involves a sudden loss of muscle tone?
Atonic
What are the two classifications of Partial Seizures?
Complex Partial
Simple Partial
Characteristics of a Complex Partial Seizure?
Loss of consciousness for 1-3 mins
Automatisms can occur
Amnesia post seizure
AKA: Psychomotor or Temporal Lobe Seizures
***more common in older adults
Characteristics of Simple Partial Seizure?
Remains CONSCIOUS throughout
Aura may occur
One sided mvmt in extremities
Unusual sensations (DEJA VU)
Can have autonomic symptoms
Pain or offensive smell
Risk factors for Seizures
Metabolic Disorders
Acute ETOH withdrawal
Electrolyte disturbances
Heart Disease
High Fever
Stroke
Substance Abuse
What are some meds we can give for an Acute Seizure?
Lorazepam (ativan)
Diazepam (valium)
Diastat
IV Phenytoin or Fophenytoin
Which med is the DOC for acute Seizure treatment?
Lorazepam (Ativan)
- **can be given IV
- **few s/e than Diazepam
What do we need to remember about Phenytoin?
don’t administer w/ Warfarin
What is Status Epilepticus?
prolonged seizure (5-30 mins) or repeated seizures over course of 30 mins
What is emergency treatment for Status Epilepticus?
Establish Airway
ABGs
IV push of lorazepam (or diazepam)
Rectal diazepam
Loading dose of IV Phenytoin
Which type of Meningitis is most common?
Bacterial (due to overcrowded living conditions)
What are some risk factors for Viral Meningitis?
Mumps
Measles
Herpes
West Nile
What are some risk factors for Bacterial Meningitis?
Otitis Media; Pneumonia; Sinusitis
Immunosuppression
Invasive Procedures
Overcrowded living conditions
Step. pneumoniae; Neisseria meningitidis
Haemophilus influenzae
Fungal Meningitis is the least common type. Who is most at risk?
AIDS patient
S/S of Meningitis
Fever
Headache
Photophobia
Increased ICP
Nuchal ridigity
Positive Kernigs and Brudzinskis
Decreased Mental Status
Focal Neuro Deficits
N/V
What is Kernig’s Sign?
Brudzinskis?
Kernigs = pain when leg extended and flexed at hip
Brudzinskis = involuntary flexion of knee when neck is flexed
Nursing Care for Meningitis
Isolation and Droplet precautions (w/ bacterial)
Fever reduction
Dark, quiet environment
Bedrest; HOB elevated
Seizure precautions
Neuro Checks q 2-4 hrs
When doing neuro checks for Meningitis, which Cranial Nerves are we focusing on?
III: Oculomotor
IV: Trochlear
VI: Abducens
VII: Facial
VIII: Vesibulocochlear
Medications for Meningitis
Broad spectrum antibiotic (bacterial)
Fever reducing agents (Acetaminophen; Ibuprofen)
Hyperosmolar Agents
Anticonvulsants (Phenytoin)
Steroids (CONTROVERSIAL)
Prophylaxis treatment for those in close contact w/ meningitis infected client
S/S of Encephalitis
High Fever
Changes in Mental Status
Motor Dysfunction
Focal neuro deficits
Photophobia
Fatigue
Joint Pain
Headache
Increased ICP
Encephalitis can be caused by —
mosquitoes and ticks
***Caused by arbovirus spread by mosquitoes and ticks
If Encephalitis is caused by Herpes, what do you treat it with?
Acyclovir
Parkinson’s is a degeneration in which area of the brain?
What does it result in?
substantia nigra
results in decreased production of DA
In Parkinson’s, there is a decrease in — and an increase in —
DA
ACh
What are risk factors for Parkinson’s Disease?
Age 40-70
Men
Genetic predisposition
Exposure to environmental toxins
Chronic use of antipsychotic meds
S/S of Parkinson’s Disease
Tremor
Muscle Rigidity
Postural Instability
What will posture of Parkinson’s patient look like?
Fwd tilt of trunk
Rigidity and trembling of head
Reduced arm swinging
Shuffling gait w/ short steps
What will the face of a Parkinson’s client look like?
mask-like facial expression
Medications used to treat Parkinson’s
DA agonists
Anticholinergics
Catechol O-methyltransferase Inhibitors
What should we remmber about Parkinson’s Meds?
most effective first 3-5 years
Need drug holidays
What are the structural changes in brain associated with Alzheimers?
Neuritic Plaques
Granulovascular Degenerations
Neurofibrillary Tangles
Symptoms of Alzheimers
Gradual memory loss (short term first)
Behavior/Personality changes
Eventually lose language and motor skills
Medication classes for Alzheimers
Cholinisterase Inhibitors
NMDA Receptor Antagonists
SSRIs
What are the Cholinisterase Inhibitors used for Alzheimers?
Donepezil
Galatamine
What are the NMDA Receptor Antagonists used for Alzheimer’s?
Memantine
- **usually for late stages
- **can be taken w/ one of the other classifications
Why do we take Cholinisterase Inhibitors with Alzheimer’s?
prevent the breakdown of ACh, which increases the amount available for nerve impulses
Alzheimers:
Nursing Considerations for Donepezil (Cholinisterase Inhibitor)
Observe for frequent stools or upset stomach
Monitor for dizziness or headache
Use caution if they have COPD or Asthma
When does Huntington’s Disease usually begin?
30-50 years old
What is the patho behind Huntington’s?
decrease in GABA and increase in Glutamate
S/S of Huntington’s
Progressive mental status change
Choreiform movements
***Brisk, jerky, purposeless mvmts
What medication for Huntington’s
tetrabenazine
Which type of headache is familial?
Which type of headache can occur at same time every day?
Migraine
Cluster
Which medications can trigger migraines?
Ranitidine
Estrogen
Nitro
Nifedipine
What are the Autonomic Symptoms of Simple Partial Seizures?
Changes in HR and abnormal flushing
Meningitis:
Which type has CLEAR CSF and which type has CLOUDY CSF?
Clear = Viral
Cloudy = Bacterial
