TOPIC 11 - neuro part 2 Flashcards
types of headaches
primary
tension
migraine
cluster
secondary
primary vs secondary headaches
primary are not caused by disease or another medical condition (ex: tension, migraine, cluster)
secondary are caused by another condition or disorder (ex: sinus infection, neck injury, brain tumor)
pain location of tension headaches
Tension headache is often described as a feeling of a weight in or on the head and/or a band squeezing the head.
pain location of migraine headaches
Migraine headache is described as an intense, throbbing or pounding pain that involves one temple. The pain usually is unilateral (on one side of the head), although it can be bilateral.
pain location of cluster headaches
Cluster headache pain is focused in and around one eye and is often described as sharp, penetrating, or burning.
tension headaches
most common
bilateral location : pressing/tightening quality
mild or moderate
episodic or chronic
bilateral frontal-occipital : contant, dull, bandlike
NO warning symptoms, NO nausea or vomiting, NO trouble with physical activity
SENSITIVITY to light or sound
migraine headaches
unilateral throbbing pain, premonitory symptoms or triggers, onset between 20-30, affects more females than males, state of neuronal hyper-excitability in occipital cortex of the cerebral cortex, may or may not have known precipitating factors
what medical issues are migraine headaches associated with
seizure disorders, ischemic stroke, asthma, depression, anxiety, myocardial infarction, Raynaud’s syndrome, and irritable bowel syndrome.
precipitating factors for migraine headaches
include foods, menstruation, head trauma, physical exertion, fatigue, stress, missed meals, weather, and drugs. Food triggers include chocolate, cheese, oranges, tomatoes, onions, monosodium glutamate, aspartame, and alcohol (particularly red wine).
risk factors for migraine headaches
Family history
Low level of education
Low socioeconomic status
High workload
Frequent tension-type headaches
clinical manifestations of migraine headaches
neurologic, psychologic, or other premonitory manifestations
aura
steady, throbbing
synchronous with pulse
may last 4-72 hrs
vary in severity
cluster headaches
generally occur at same time of day or night
onset between 20-45
men more affected
what is the most common type of headache
tension
what is the most severe primary headache
cluster
triggers for cluster headaches
alcohol
strong odor
weather changes
what part of the brain is affected in cluster headaches
ophthalmic branch of trigeminal nerve
hypothalmus
irregularities with melatonin and cortisol
manifestations of cluster headaches
Sharp, stabbing, intense pain lasts minutes to 3 hours
May occur every other day and as often as 8x/day
Can occur in cycles with remission periods in between
Pain is generally located around the eye, radiating to the temple, forehead, cheek, nose, or gums
Swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and miosis (constriction of the pupil).
often agitated and restless, unable to sit still or relax
aura similar to migraine may occur in 14% of patients up to 60 minutes before an attack.
Cluster headaches can occur every other day and as often as eight times a day.
Because cluster periods often occur seasonally, headaches may be mistaken for symptoms of allergies.
health history for assessment of headaches
Seizures, cancer, stroke, trauma, asthma or allergies, mental illness, stress, menstruation, exercise, food, bright lights, noxious stimuli
Medications
Surgery and other treatments
objective data for assessment of headaches
Anxiety or apprehension
Diaphoresis, pallor, unilateral flushing with cheek edema, conjunctivitis
details about the headache in assessment
Location, Type of pain
Onset, Frequency, Duration, time of day
Relation to outside events
if no systemic underlying disease is the cause of the headache, what guides therapy
the type of headaches
types of therapies: Drugs, medications, yoga, biofeedback, cognitive-behavioral therapy, and relaxation training
symptomatic drug therapy for tension headaches
Mild-moderate headache treated with aspirin, acetaminophen, or an NSAID alone or in combination with a sedative, muscle relaxant, or tranquilizer
preventative drug therapy for tension headaches
Tricyclic antidepressants
Antiseizure medications
preventative drug therapy for migraine headaches
Antiseizure drugs - GABA, topiramate
Botox
SSRIs
symptomatic drug therapy for migraine headachces
Mild to moderate headache can obtain relief with NSAID, aspirin, or caffeine-containing combination analgesics
skin patch for migraine headaches
zecuity
first line therapy for moderate to severe headaches
triptans
- vasoconstrict : caution to pt with heart disease or stroke
preventative drug therapy for cluster headaches
High-dose verapamil
Varied other options : lithium, ergotamine, antiseizure drugs (e.g., topiramate), and melatonin.
Invasive nerve blocks, deep brain stimulation, and ablative neurosurgical procedures have been used for refractory cluster headaches
symptomatic drug therapy for cluster headaches
triptans (dont give to pt with vascular risk factors)
100% oxygen at 6-8 L/min for 10 min non rebreather (repeat after 5 min rest)
headache nursing implementation
Teach patient about preventive treatment
Dietary counseling for food triggers
Avoid smoking and other environmental triggers
An inability to cope with daily stresses can cause headaches
Daily exercise, relaxation periods, and socializing help reduce recurrence and should be encouraged
Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis
Encourage a quiet, dim environment
Massage and heat packs can help with tension-type
Patient should make a written note of medications to prevent accidental overdose
headache provoking foods
chocolate, cheese, oranges, tomatoes, onions, monosodium glutamate, aspartame, alcohol, excessive caffeine, fermented or marinated foods
what med is prescribed to be taken before planes take off to decrease likelihood of attacks that occur at high altitudes
ergotamine
dementia causes dysfunction of loss of :
Memory
Orientation
Attention
Language
Judgment
Reasoning
Behavior or personality
what factors does dementia interrupt
Work
Social responsibilities
Family responsibilities
Ability to perform ADLs
what are the most common causes of dementia
neurodegenerative conditions (alzheimers)
vascular conditions
vascular dementia results from what
ischemic or hemorrhagic brain lesions caused by cardiovascular disease
mixed dementia
2 or more types of dementia at the same time
usually alzheimers with vascular dementia
lewy bodies dementia
neurodegenerative dementia
presence of lewy bodies in brainstem and cortex (intraneural cytoplasmic inclusions)
includes features of parkinsons
normal pressure hydrocephalus
uncommon
caused by obstruction of CSF flow : meningitis, encephalitis, head injury (manifestations = dementia, urinary incontinence, difficulty walking)
treatable if diagnosed early
what ethnicity is alzhemiers most common in
african americans and hispanics
lower socioeconomic status / poor access to healthcare
alzheimers disease
chronic, progressive, neurodegenerative brain disease
cannot be prevented, cured, or slowed
patho of alzheimers
Abnormal amounts of β-amyloid are cleaved from the amyloid precursor protein (APP) and released into the circulation. The β-amyloid fragments come together in clumps to form plaques that attach to the neuron. Microglia react to the plaque, and an inflammatory response results.
early warning signs of alzheimers
Memory loss that affects job skills
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or ↓ judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
Changes in personality
Loss of initiative
diagnostics of alzheimers
patient evaluation :
Complete health history
Physical examination
Neurologic assessment
Mental status assessment
labs
imaging : CT, MRI, PET
examples of neuropsychologic testing for alzheimers
Mini-Cog
Mini-Mental State Examination (MMSE)
– Used to determine a baseline from which to evaluate change over time
mini mental state vs mini cog
mini cog : draw a clock
MMSE : oriented to time, registration, naming, reading
confusion assessment method
BEST PRACTICE FOR ASSESSING CONFUSION IN OLDER ADULTS
Assess onset, attention level, type of thinking, LOC, disorientation, memory impairment, perceptual disturbance, psychomotor agitation, psychomotor retardation, and the sleep-wake cyle
subjective and objective data for alzheimers assessment
subjective =
Past health history
Medications
Health perception–health management
Nutritional-metabolic
Elimination (incontinence)
Activity-exercise
Sleep–rest pattern
Cognitive-perceptual
objective =
Disheveled appearance
Neurologic
Early, middle, late changes
gradual vs abrupt onset of dementia
gradual and progressive = neurologic degeneration
abrupt = vascular dementia
what can you do to treat and prevent vascular dementia
treat risk factors :
Hypertension, diabetes, smoking, hypercholesterolemia, cardiac dysrhythmias
care for alzheimers
NO CURE
care is aimed at :
Delaying onset of symptoms
Controlling undesirable behavioral manifestations
Providing support for family caregiver
drug therapy for alzheimers
memantine - protects nerve cells against excess amounts of glutamate
SSRI’s
antidepressants - trazodone may help with problems with sleep
antipsychotic drugs - managing behavioral problems
health promotion for alzheimers
Avoid harmful substances
Challenge your mind
Exercise regularly
Stay socially active
Avoid trauma to the brain
Take care of mental health
Treat diabetes
Take care of your heart
Get enough sleep
Get the right fuel
patient responses to alzheimers diagnosis
Depression
Denial
Anxiety and fear
Withdrawal
Feelings of loss
when there is an inability to communicate symptoms who is in charge of communicating for the pt
caregiver or health care professionals
behavioral problems with AD
Repetitiveness
Delusions
Hallucinations
Agitation
Aggression
Altered sleep patterns
Wandering
Hoarding
Resisting care
interventions of behavioral problems
assess physical status before environment
remove stimulus
reassure about safety
rely on mood and behavior rather than verbal communication
nursing strategies for behavioral problems
redirection
distraction
reassurance
sundowning
Specific type of agitation
Patient becomes more confused and agitated in late afternoon or evening
May be due to disruption of circadian rhythms
nursing interventions for sundowning
Create a quiet, calm environment
Maximize exposure to daylight
Evaluate medications
Limit naps and caffeine
Consult health care provider on drug therapy
safety risks with alzheimers
Injury from falls
Ingesting dangerous substances
Wandering
Injury to others and self with sharps
Burns
Inability to respond to crisis
manifestations of infection
change in behavior, fever, cough (pneumonia), pain, urination (bladder problems)
caregiver support
Work with the caregiver to assess stressors and to identify coping strategies to reduce the burden of caregiving.
Determining what the caregiver views as most disruptive or distressful can help to establish priorities for care.
expected outcomes for alzheimers disease
Functions at highest level of cognitive ability
Experiences no injury
Remains in restricted area during ambulation and activity
Performs basic personal care activities of daily living including
delirium
state of temporary but acute mental confusion
often preventable or reversible
can be life threatening
contributing factors to delirium
Impairment of cerebral oxidative metabolism
Cholinergic deficiency
Excess release of dopamine
Change in serotonin
Stress, surgery, sleep deprivation
COGNITIVE
Dementia
Cognitive impairment
Depression
History of delirium
ENVIRONMENT
Admission to ICU
Use of physical restraints
Pain (especially untreated)
Emotional stress
Prolonged sleep deprivation
FUNCTION
Functional dependence
Immobility
History of falls
SENSORY
Sensory deprivation
Sensory overload
Visual or hearing impairment
DELIRIUM MNEUMONIC CAUSES
Dementia, dehydration
Electrolyte imbalances, emotional stress
Lung, liver, heart, kidney, brain
Infection, ICU
Rx Drugs
Injury, immobility
Untreated pain, unfamiliar environment
Metabolic disorders
when does delirium develop
over 2-3 day period
can develop within hours
early manifestations of delirium
Inability to concentrate
Disorganized thinking
Irritability
Insomnia
Loss of appetite
Restlessness
Confusion
later manifestations of delirium
Agitation
Misperception
Misinterpretation
Hallucinations
how long do delirium symptoms last
1-7 days
can be years
can never recover
distinctions of delirium rather than dementia
Sudden cognitive impairment
Disorientation
Clouded sensorium
diagnostic studies for delirium
Medical history
Psychologic history
Physical examination
Careful attention to medications
Cognitive measures
Confusion Assessment Method (CAM)
lab tests to look at for delirium
Serum electrolytes
Blood urea nitrogen level
Creatinine level
Complete blood count (CBC)
Drug and alcohol levels
Electrocardiogram (ECG)
Urinalysis
Liver and thyroid function tests
Oxygen saturation level
Lumbar puncture
role as nurse for delirium
Prevention
Early recognition
Treatment
Focus on eliminating precipitating factors
Protect patient from harm
Encourage family members to stay at bedside
If delirium is secondary to infection, antibiotic therapy is started
Reorientation and behavioral interventions
Create a calm and safe environment
Provide reassurance
Pay attention to environmental stimuli
Other risks for people with delirium
Immobility
Skin breakdwon
Drug therapy for delirium
reserved for those with severe agitation
puts patients more at risk for falls and injury
Dexmedetomidine (Precedex) for sedation
Neuroleptics
Haloperidol (Haldol)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Short acting benzos
