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Acute Care 3 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

What are seizures?

A

abnormal episodes of motor, sensory, autonomic , or psychic activity resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons.

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2
Q

What are seizures classified based on?

A

-type of seizure at onset
-awareness during the seizure
-motor or other symptoms present
each seizure lasts a few seconds or few minutes

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3
Q

what are the classifications of seizures?

A

-Focal: originates in one hemisphere
-Generalized: occur and engage bilaterally
-Unknown: epilepsy spasms
“provoked” related to acute, reversible condition

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4
Q

Epilepsy etiology and pathophysiology

A

A chronic disturbance of the nervous system characterized by various types of persistent seizures that are the result pf abnormal electrical activity of the brain.

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5
Q

Epilepsy etiology and pathophysiology cont….

A

Epilepsy is defined as at least 2 unprovoked seizures occurring more than 24 hours apart.

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6
Q

Causes of seizures…

A
  1. Cerebrovascular disease
  2. Hypoxemia
  3. Fever (childhood)
  4. Head injury
  5. Hypertension
  6. Central nervous system infections
  7. Metabolic and toxic conditions
  8. Brain tumor
  9. Drug and alcohol withdrawal
  10. Allergies
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7
Q

Partial of focal seizures

A

involves only 1 hemisphere

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8
Q

what are the two types of partial/focal seizure?

A

Complex:
automatisms (behaviors, pt is unaware of such as lip smacking) can cause loss of consciousness, amnesia can occur prior to and after seizure

Simple:
consciousness is maintained
unusual sensations, sense of deja vu, changes in HR, abnormal flushing, unilateral abnormal extremity movement, pain, or offensive smell

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9
Q

Generalized Seizure

A

involves both hemisphere (the whole brain)
there is no warning or aura (feeling)
the patient usually quickly loses consciousness and is unconscious for a few seconds up to several minutes.
manifestations depend on the area of the brain where the abnormal firing occurs

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10
Q

Generalized seizures cont….

A

Divided into motor and nonmotor (absence) seizure

Absence seizures may last only a few seconds

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11
Q

Generalized seizure cont…

A

Absence seizures may last only few seconds

  • Sudden onset, with no aura or warning and no postictal symptoms.
  • Tend to to affect children between 5 and 12 years age disappear puberty
  • twitching around eyes and mouth
  • remains standing or sitting and appears to have had no more than a lapse of attention or a moment of absentmindedness
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12
Q

Motor seizures

A

Tonic-Clonic:
Begins with stiffening of muscles (tonic) and loss of consciousness.
1-2 min episode of rhythmic jerking (clonic) follows
Cyanosis, bitting of cheek or tongue, and incontience may occur.
Postictal phase (period of confusion and sleepiness after seizure
only last <30 secs (only tonic)
clonic phase lasts several mins

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13
Q

Myoclonic

A

brief jerking or stiffening of extremities

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14
Q

Atonic

A

loss of muscle tone loss, may result in fall

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15
Q

What is status epilepticus?

A

prolonged partial or generalized seizure of 5 mins without recovery between attacks. Medical emergency

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16
Q

Treatment of status epilepticus?

A

rapid assessment and treatment are needed
IV lorazepam, IM midazolam, or rectal diazepam
Iv meds are preferred, but other routes can be used when IV access is not available.
intubation and respiratory support may be required

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17
Q

Epilepsy Diagnosis

A

2 unprovoked seizures occur more than 24 hours apart
Physical exam
EEG, MRI
Electrolytes imbalances, infection, or other reversible causes are ruled out

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18
Q

Epilepsy Treatment

A 
Control or eliminate cause 
Antiepileptic drugs and patient teaching 
Keto diet 
Biofeedback 
Surgery
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19
Q

Medications for seizure control

A 
Carbamazepine 
Diazepam
Felbamate 
Fosphenytoin
Gabapentin 
Lacosamide 
Lamotrigine 
Levetriracetam
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20
Q

Antiepioleptic Drugs (AEDs)

A

also known as anticonvulsants
to control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug induced toxicity
LIFELONG

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21
Q

Mechanism of Action and Drug effect for AEDs

A 
not known (mechanism) 
effects: reduced nerve ability
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22
Q

Phenytoin (Dilantin)

A

first line drug, prototypical drug

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23
Q

adverse effects for Phenytoin?

A 
gingival hyperplasia 
acne
hirsutism 
dilantin faces (short nose, flat nose, large head and osteoporosis 
Therapeutic drug levels are 10-20 mcg/mL
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24
Q

Carbamazepine (Tegretol)

A

Second most prescribed antispileptic drug
Autoinduction of hepatic enzymes
stops seizure before it starts

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25
Q

Adverse Effect for Carbamazepine (Tegretol)

A 
Headache 
Dizziness 
Unusual eye movements
Visual Changes
Behavioral changes 
Rash 
Abdominal pain
Gi upset
Nausea 
abnormal gait
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26
Q

Drug interactions for Carbamazepine

A 
Azoles 
diltiazem 
macrolides
SSRIs
acetaminophen 
antidepressants 
MAOIs
antidepressants
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27
Q

(Keppra) Levetiracetam

A

Adjunct therapy for partial seizure with and without secondary generalization
contraindication: known drug allergy
well tolerated

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28
Q

Antiseizure medication patient education

A

take as prescribed
causes some degree of sedation, drowsiness and lethargy
should not sop taking abruptly
check interactions

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29
Q

Observations to make during a seizure?

A

Time the seizure began and the time it ended
what patient was doing before seizure
where in the body seizure began, what body part is involved?
which way eyes are moving?

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30
Q

Observations cont…

A

what side head turns toward
whether patient cries out or screams as the seizure begins
lip smacking, chewing, grimacing, tapping or pill rolling

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31
Q

observations cont…

A

whether movement is bilateral and symmetrical
incontinence of urine or stool
changes in skin color or profuse perspiration

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32
Q

Care for a patient experiencing a seizure

A

place patient on side lying, maintain airway
place bed in low position with side rails up and padded
NEVER try to pry open mouth or insert something
protect head if on hard surface
Do not try to restrain
Loosen clothes
supplemental oxygen is near, should be administrated, if possible

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33
Q

Care for a patient experiencing seizure

A

suction if needed
check oxygen saturation with pulse ox
check glucose lelvel
stay with patient until they are completely conscious.
reassure them once fully conscious
should be allowed to rest
thoroughly document the event in medical record

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34
Q

Postictal Assessment

A

after patent airway is ensured

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35
Q

Transient Ischemic Attack

A

TIA brief interruption in blood flow

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36
Q

Seizures may occur anytime in the what? and deprived of what?

A

Brain and oxygen

37
Q

seizures can be caused by what?

A 
Brain injury 
brain tumor
fever
uremia
drug toxicity
38
Q

Generalized seizures are characterized by what?

A

Bilateral Synchronous electrical discharges in the brain

39
Q

Automatisms

A

Behaviors patients are unaware of such as lip smacking

40
Q

Manifestations of epilepsy depend on what?

A

the area of the brain affected

41
Q

Status epilepticus is dangerous because what?

A

irreversible brain damage

could lead to death

42
Q

Focal Seizures affect what?

A

one hemisphere of the brain, leading to localized symptoms on that part of the brain affected

43
Q

Seizures are classified based on what?

A

where it came from in the brain?

44
Q

During tonic clonic seizure what happens?

A

lose consciousness and may have incontinence

45
Q

What is the goal of anticonvulsant therapy?

A

to control the seizures by using the least amount of the drug with the fewest side effects

46
Q

When a seizure occurs, what should you as the nurse note (observations)

A 
Time
what they were doing prior
where in body it begins 
which way eye moves
which way head moves 
if they cry out or scream 
incontinence (bowel or urinary)
47
Q

TIA (Transient ischemic attacks) are warnings that

A

a stroke may occur and patient should be evaluated by medical personnnel

48
Q

Who are most at risk for a stroke?

A

individuals who have hypertension ,a.fib, and diabetes

49
Q

when you suspect a stroke, you tell patient to do what?

A

smile, hold arms straight up, repeat what you say, and answer a simple question

50
Q

Thrombosis occur

A

slowly ( inside brain) build up overtime

51
Q

embolus occur

A

quickly (came from somewhere else)

52
Q

subarachnoid hemorrhage is a risk for developing what?

A

Hydrocephalus

53
Q

patient with leaking cerebral aneurysm often presents with?

A

severe headache

54
Q

embolus causing stoke often arises from the what?

A

heart in patients who has a.fib

55
Q

structures that can cause intercerebral hemorrhage are what?

A

aneurysm and arteriovenous malformation (AV malformation) (congenital)

56
Q

Subarachnoid hemorrhage often causes what?

A

Rapid onset of neurologic signs and loss of consciousness

57
Q

Meningitis is what?

A

inflammation of the membranes covering the brain and spinal cord

58
Q

Bacterial Meningitis frequently follows?

A

upper respiratory infection

59
Q

Classic signs of meningitis?

A

nuchal rigidity, persistent headache, and fever (all sudden)

60
Q

Petechial rash on the chest and extremities accompanies whT?

A

meningococcal meningitis

61
Q

Meningitis is confirmed by what?

A

lumbar puncture

62
Q

Viral meningitis signs and symptoms?

A

fever, headache, photophobia and nuchal rigidity (stiff neck)

63
Q

Nonvector transmitted form of encephalitis is what?

A

herpes simplex virus type 1

64
Q

Encephalitis is spread by vectors such as?

A

mosquitos, and ticks

65
Q

what are vectors?

A

living agent that carries and transmit an infectious pathogen to another living organism

66
Q

Environmental toxicins

A

substances that seem to play a role in the occurrence of parkinson disease

67
Q

Primidone is metabolized in what?

A

the liver to phenobrbital

68
Q

Primidone most common adverse effect

A

sedation

69
Q

adverse effect of primidone?

A

cardiovascular, CNS, GI and dermatologic reactions

70
Q

Barbiturates

A

first introduced in 1903, were the standard drugs for insomnia and sedation

71
Q

Barbiturates mechanism of action

A

Site of action: brainstem

By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited

72
Q

Benzodiazepines: Sedative-Hypnotic types

A

Long acting: Clonazepam, diazepam, flurazepam
Intermediate acting: Alprazolam, Lorazepam, Temazepam
Short acting: Midazolam, triazolam,

73
Q

Benzodiazepines Mechanism of action

A

Depress CNS activity by affecting hypothalamic, thalamic, and limbic systems of the brain
exact mechanism is uncertain

74
Q

Benozdiapines Receptors

A

Gamma-aminobutyric acid (GABA)- primary inhibitory neurotransmitter in the brain, acts to inhibit overstimulation

75
Q

Transient Ischemic Attack

A

neurologic dysfunction cause by focal brain, spinal cord or retinal ischemia, without acute infarction
Symptoms are like those of a stroke

76
Q

10% to 15% patients who have a TIA what in 90 days?

A

a stroke

77
Q

how long do symptoms last for a TIA?

A

last more than 1 hour and completely resolves within 24 hours without residual deficits

78
Q

during a tia what might the patient feel?

A

a sudden weakness or numbness on one side of the body, slurring of speech or inability to talk,

79
Q

Treatment for TIA and diagnosis

A 
(Diagnosis)
physical assessment 
NIH scale within 10 minutes of arrival 
carotid duplex ultrasound 
blood tests
MRI
EEG
(Treatment) 
angioplasty procedure with stent implantation or a carotid endarterectomy 
diet, lifestyle modification 
aspirin (platelet aggregation)
80
Q

what substance play a role in the occurrence of parkinson disease?

A

environmental toxins

81
Q

what type of deficiency does parkinson disease have?

A

dopamine causing balance and coordination problems

82
Q

multiple sclerosis is a disease of the central nervous system and its symptoms are caused by what?

A

demyelination of the nerve fibers

83
Q

what are the four types of clinical progression of MS?

A

relapsing remitting (most common)
primary progressive
secondary progressive
relapsing progressive

84
Q

amyotrophic lateral sclerosis is?

A

progressive neuromuscular disease characterized of the gray matter

85
Q

Guillan Barre syndrome usually follows what?

A

viral infection, but can occur after flu vaccine

86
Q

pathologic changes that occur with gullain barre?

A

demyelination, nerve root compression, edema

87
Q

when the lower brainstem becomes involved in GBS, what is affected?

A

cranial nerves

88
Q

GBS is characterized by the appearance of what?

A

ascending paralysis

Acute Care 3 (4 decks)

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