Test #4 Neuro Flashcards
What is a seizure?
A seizure is a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function.
What is Epilepsy?
Epilepsy is a condition in which a person has spontaneous reoccurring seizures caused by a chronic underlying condition.
What are the 4 stages of a seizure?
1) the prodromal phase (signs or activity that precedes the seizure), 2) the aural stage (with sensory warning), 3) the ictal stage (with the full seizure), 4) the post-ictal stage (recovery period after the seizure)
What is a “tonic-clonic” seizure?
A tonic clonic seizure is characterized by loss of consciousness and falling to the ground (if upright), followed by stiffening of the body (tonic phase) for 10 to 20 seconds and subsequent jerking of the extremities (clonic phase) for another 30-40 seconds.
What is an “absence seizure”?
A brief period of staring that lasts only a few seconds and frequently goes unnoticed.
What is an “atypical absence seizure”?
An atypical absence seizure is a brief staring spell but with brief warnings, peculiar behavior during the seizure or confusion after the seizure.
What would EEG show in the case of an absence seizure?
A 3-Hz (cycle per second) spike and wave pattern that is unique to this type of seizure.
What would EEG show in the case of an atypical absence seizure?
Usually greater or less than 3-Hz
What is a “myoclonic seizure”?
A sudden, forceful jerk of the body or extremities (possibly forceful enough to hurl the person to the ground)
What is an “atonic seizure”?
An atonic seizure is a sudden loss of muscle tone and begins suddenly with the person falling to the ground. *Note: people with this type of seizure are at a great risk of head injury and often have to wear protective helmets.
What is a “tonic” seizure?
A tonic seizure is characterized by a sudden increase in the muscle tone of the extensor muscles. (these patients often fall)
What is a “simple partial seizure”?
Simple partial seizures have elementary symptoms, do not involve loss of consciousness and rarely last longer than 1 minute.
What is a “complex partial seizure”?
Complex partial seizures usually originate from the temporal lobe (sometimes referred to as “temporal lobe seizures”), last longer than 1 minute and are frequently followed by a post-ictal state.
What distinguishes simple partial seizures from complex partial seizures?
Complex usually involve an alteration in consciousness
What is “temporal lobe absence”?
It is a confused state without any motor or sensory components; it may be the sole manifestation of a complex partial seizure
What is the most common partial seizure?
The most common partial seizure involves lip smacking and automatism (inappropriate repetitive movements). These are often called “psychomotor seizures”.
What is a “psychogenic seizure”?
Also called pseudo-seizures, they resemble epileptic seizures but are psychiatric in orgin
What is “status epilepticus”?
Is is back-to-back seizures without a return to consciousness between seizures.
What are “subclinical seizures”?
They are a form of status epilepticus but in a sedated patients and generally do not have the clinical signs due to the sedation
In the event of an acute seizure, what medications would the nurse anticipate using to control the seizures?
Phenobarbital, Dilantin, or benzodiazapines
What education should the nurse provide a patient starting Tegretol (carbamazepine) therapy?
- do not take with grapefruit juice
- report any visual abnormalities
- do not stop the medication abruptly (it may cause seizures)
What criteria should a patient meet before being weaned from antiseizure drugs?
The patient must be seizure-free for a prolonged period of time (2-5 years) and have a normal neurologic exam
What drug may be given to patients who seizures do not respond to other medications?
Felbamate
What are notable side effects of Felbamate?
Aplastic anemia and liver toxicity
A patient on drug therapy for seizures misses a dose. What should they do?
If the omission is realized within 24 hours, the dose should be made up
A home health nurse is caring for a patient who seizes. Should the nurse call 911?
It isn’t necessary to call an ambulance or send a patient to the hospital after just 1 seizure unless the seizure is prolonged, another seizure immediately follows or injury occurred.
What is MS?
Multiple Sclerosis is a chronic, progressive disease characterized by widespread demyelination of nerve fibers.
What is the “patchy blindness” that some patients with MS experience called?
Scotomas
What is “Lhermitte’s sign”?
A transient sensory symptom described as an electrical shock radiating down the spine or into the limbs on flexion of the neck
What drugs are used to treat acute exacerbation of MS?
Adrenocorticotropic hormone, methylprednisolone, and prednisone
What MS drug has a lifetime limit due to cardiac toxicity?
mitoxantrone (Novantrone)
What are the key signs and symptoms of Amyotrophic Lateral Sclerosis (Lou Gherig’s Disease)?
> Weakness of the upper extremities
Dysphagia (trouble swallowing)
Dysarthria (trouble speaking)
For patients with ALS, death usually results from what complication?
Respiratory infection due to compromised respiratory function
What drug is used to treat ALS?
riluzole (Rilutek); it slows the progression of the disease by decreasing the amount of glutamate in the brain.
ALS usually leads to death in what time period?
2-6 years
What should a patient taking corticosteroids for MS be taught?
- restrict salt intake
- do not abruptly stop therapy
- know drug interactions
What bowel problem is common in MS patients?
Constipation
What should an MS patient on beta-interferon be taught?
- rotate injection sites with each dose
- report side effects
- wear sun screen and protective clothing when exposed to the sun
What psych complication should the nurse assess an MS patient treated with beta-interferon for?
Depression and suicidal ideation
What are the three types of beta-interferon given to treat MS?
- B-1b (Betaseron) which is given subQ every-other-day. - B-1a (Avonex) which is given IM
- B-1a (Rebif) which is given subQ 3x weekly.
A patient whose seizure disorder is refractory to other drugs may be treated with what?
Felbatol (felbamate)
What are notable side effects of Felbatol?
Aplastic anemia and liver toxicity.
What is Dilantin not the optimal drug for treating seizures in the elderly?
Dilantin is metabolized by the liver; the liver has a decreased ability to metabolize drugs due to age related changes.
What medication is frequently used as an “add-on” for seizure disorders that are not responding to a single mode of treatment?
Lyrica (pregabalin)
Stimulation of what nerve (via implantable device) is used as adjunct therapy to medication when surgery is not indicated? (for treatment of MS)
Vagus
What kind of diet reduces the number of seizures for children?
A ketogenic diet
In MS, what does a spastic bladder indicate?
A spinal lesion above the second sacral nerve
In MS, a flaccid bladder indicates what?
A lesion in the reflex arc controlling bladder function.
CSF analysis, for an MS patient, would show what?
Increased immunoglobulin G, as well as a high number of lymphocytes and monocytes
For MS patients, what drug is used when the response to other drugs is inadequate?
Monthly IV natalizumab (Tysabri)
What are notable side effects of Tysabri?
It increases the risk of progressive multifocal leukoencephalopathy–a potentially fatal viral infection of the brain.
What drug is given to MS patients to help increase walking speed?
dalfampridine (Ampyra)
How does Ampyra work?
It is a selective potassium channel blocker that improves nerve conduction in damaged nerve segments.
Who is Ampyra contraindicated for?
Ampyra is contraindicated for patients with a history of seizure disorders or moderate-to-severe kidney disease.
What are the 3 ways that anticonvulsant drugs work?
- By suppressing sodium influx
- By suppressing calcium influx
- By increasing the action of GABA, which inhibits neurotransmitter activity throughout the brain
Why should phenytion (Dilantin) not be used during pregnancy?
Because it can have a teratogenic effect on the baby
What type of seizures is Dilantin not effective against?
Petite mal (or abscence) seizures
A patient with seizure disorder is prescribed Tegretol. What should the nurse instruct the patient NOT to take the medication with?
Grapefruit juice
A woman of childbearing age prescribed Dilantin should be warned of what?
That Dilantin may reduce the effectiveness of oral birth control pills
What is the “therapeutic level” of Dilantin–needed to be effective?
10-20
How is the dosage of anticonvulsants varied based on liver metabolism?
Dosages will be decreased in newborns, people with liver disease and the elderly–because the decrease in metabolism means more available drug for therapeutic effects
What is the “toxic level” for Dilantin?
30-50
What is the distinctive side effect of Dilantin?
Gingival hyperplasia (gum enlargement)
Folic acid, calcium, and antacids have what effect on Dilantin?
They reduce its effectiveness
What should a diabetic patient be warned of before starting Dilantin?
It may cause hyperglycemia
What must be ruled out prior to taking Depakote?
Pregnacy
What labs should be monitored (in addition to Dilantin levels) in the patient taking Dilantin?
CBC–for early detection of blood disorders
What is the “drug of choice” for treating status epilepticus?
Valium
If absence seizures do not respond to valproic acid or Zarontin, what med would be given?
Klonopin
A client with Parkinsons is taking Cogetin (benzotropine). The nurse knows that what is a side effect of Cogentin?
Urinary retention
What is the therapeutic level of Tegretol?
4-12
At what level does Tegretol become toxic?
Mild toxicity can begin at 10; critical levels are 30-40
The patient with MS should be warned that beta-interferon frequently causes what?
Flu-like symptoms
What is the typical clinical presentation of ALS?
Weakness of the muscles of the legs that progresses to weakness in the upper extremities, dysarthria (difficulty in speech), and dysphagia (difficulty swallowing) are all classic symptoms of ALS.
A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. What should the nurse immediately assess the patient for?
Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech.
What is a side effect of carbidopa/levodopa (Sinemet)?
Dyskinesia (uncontrolled/involuntary movements)
What is the most important assessment of a patient with Masthenia Gravis?
Respiratory Effort
What side effect are children with spina bifida at risk for developing?
Latex allergy
What is the first test performed to screen for spinda bifida?
alpha-fetoprotein levels tested at 16-18 weeks gestation
How should Phenytoin be administered?
Intravenously through a large-bore IV, PICC line or Central line. At a rate less than 50 mg/min,
What is a notable side effect of the Parkinson’s drug Parlodel?
Hypotension
What would the nurse include in patient teaching for a patient with Myasthenia Gravis asking how they “will be able to get everything done”?
Instruct them to perform physically demanding tasks in the morning (when the muscles are strongest)
What is the theraputic range of Phenobarbital?
20-40
What drug class treats petit mal (or absence) seizures?
Succinimides
What is the Succinimide drug of choice?
Zarontin
When performing a physical assessment of a patient with myasthenia gravis, what are the manifestations that the nurse is likely to find?
Impaired facial mobility, Difficulty in swallowing food and Voice fading after a long conversation
What class of drugs would be given to a patient with MS to treat bladder symptoms?
Anticholinergics
How is the immunomodulating drug, Copaxone, given?
(It is for MS) It is given subQ every day
If a patient overdosed on levodopa, what would the nurse notice?
“Freezing”, dyskinetia–usually athetosis (slow writhing, continuous involuntary movement of the neck)
Why should a patient with Parkinson’s probably not eat a high-protein diet?
Because protein interferes with the primary drug used to treat parkinson’s (Sinemet)
What common drug can contribute to Restless Leg Syndrome?
Benadyrl
When performing a physical assessment on a patient with amyotrophic lateral sclerosis, which manifestations is the nurse likely to find?
Limb weakness, Difficulty articulating words and
Difficulty swallowing
When establishing a diagnosis of multiple sclerosis (MS), what diagnostic studies should the nurse teach the patient about?
Computed tomography (CT) scan, Evoked response testing and Cerebrospinal fluid analysis
What is the primary drug used in the treatment of Myasthenia Gravis?
Mestinon
What is the primary drug used in the treatment of Amyotrophic Lateral Sclerosis?
Rilutek
What is the primary drug used in the treatment of Huntington’s Disease?
Xenazine
