UNIT 3 Chapter 39 NEURO: Concepts of Care for Migraine, Headaches, and Epilepsy, Parkinson's Disease

Question 1

What is Parkinsons’s Disease and what are the Cardinal Signs?

Answer 1

Parkinson disease (PD) , also referred to as Parkinson’s disease and paralysis agitans, is a progressive neurodegenerative disease that is one of the most common neurologic disorders of older adults. It is a debilitating disease affecting mobility and is

characterized by four cardinal symptoms: tremor, muscle rigidity, bradykinesia or akinesia (slow movement/no movement), and postural instability.

Usually asymmetric tremors in upper extremities which spread to other
parts of body
* Restless during sleep / can cause insomnia
* Decreasing sense of smell

Question 2

What is the Pathophysiology of Parkinson’s Disease?

A. low or depleted levels of dopamine in the body
B. myelin sheath is destroyed
C. Intraoccular pressure is increased
D. A sudden increase of dopamine in the body

Answer 2

A. low or depleted levels of dopamine in the body

In PD, widespread degeneration of the substantia nigra leads to a decrease in the amount of dopamine in the brain. When dopamine levels are decreased to 70% to 80% of usual levels, a person becomes symptomatic and loses the ability to refine voluntary movement

Chronic, terminal disease caused by degeneration of substantia nigra cells in the basal ganglia of the brain causing decreased dopamine, which normally functions to promote voluntary muscle and sympathetic nervous system control

Question 3

What safety measure is critical for an older adult patient with Parkinson’s Disease?

A. Fluid overload
B. Risk for falls
C. impaired nutrition
D. Fluid deficit

Answer 3

B. Risk for falls

CARE OF PD PATIENT

• Place the patient on Fall Precautions according to agency protocol.

Question 4

Is cardiac output in a patient with Parkinson’s decreased or increased?
A. Decreased
B. Increased

Answer 4

A. Decreased

PD interferes with movement as a result of dopamine loss in the brain, but it also reduces the sympathetic nervous system influence on the heart, blood vessels, and other areas of the body. This loss results in the orthostatic hypotension, drooling, nocturia (voiding at night), and other autonomic symptoms frequently seen in the patient with PD.

Question 5

Which of the following is a risk factor in Parkinson’s Disease?

A. A family member with a history of Parkinson’s Disease
B. being a woman
C. children
D. a teenager with a knee injury

Answer 5

A. A family member with a history of Parkinson’s Disease

NONMODIFIABLE
Familial link
* Over 40, especially over 60
* Affects men more than women

MODIFIABLE
Well water
* Low Estrogen
* Industrial and Chemical metals
* Exposure to pesticides and
herbicides

Question 6

OTHER SIGNS AND SYMPTOMS OF PARKINSON’S DISEASE. NAME 5

Answer 6

PILL ROLLING: CLENCHED FIST WITH THUMB MOVING AROUND
* REDUCTION IN DEXTERITY
* MASKED FACIES: DECREASED FACIAL EXPRESSIONS
* SLEEP DISTURBANCES
* AUTONOMIC DYSFUNCTION: CONSTIPATION, SWEATING, SEXUAL
DYSFUNCTION
* BRADYPHRENIA: REDUCTION OF COGNITION – CAN’T THINK QUICKLY OR
CLEARLY
* DEMENTIA: ADVANCED PARKINSON’S
* NIGHTTIME DROOLING

Question 7

Is aspiration a health risk for patient with Parkinson’s Disease?

A. No
B. Yes

Answer 7

B. Yes

Question 8

Does Parkinson’s affect a patient’s self esteem?

Answer 8

Recognize that Parkinson disease can affect the patient’s self-esteem. Focus on the patient’s strengths.

Question 9

Diagnostics or labs for PD

Answer 9

A lumbar puncture to analyze the CSF aids in determining
dopamine levels. Diagnostic tests such as an MRI, Single-photon
emission computed tomography (SPECT), or Positron emission
tomography (PET) mat aid in ruling out other causes for the
clinical manifestations

Question 10

CARE FOR THE PD PATIENT

Answer 10

• Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board or handheld mobile device. Refer to the speech-language pathologist.
• Monitor the patient’s ability to eat and swallow. Monitor actual food and fluid intake.
• Collaborate with the registered dietitian nutritionist to provide high- protein, high-calorie foods or supplements to maintain weight.
• Recognize that Parkinson disease can affect the patient’s self-esteem. Focus on the patient’s strengths.
• Assess for depression, anxiety, and impaired cognition
• Assess for insomnia or sleeplessness.

Question 11

NURSING CARE/ INTERVENTIONS FOR PD

Answer 11

MULTIDISCIPLINARY APPROACH (SLT( speech-language pathologist.)
, PT, OT, NEUROLOGY, DIETICIAN)
* FALL PRECAUTIONS!!
* ASPIRATION PRECAUTIONS: ASPIRATION PNEUMONIA IS A MAJOR CAUSE OF DEATH IN PARKINSON’S
* MEDICATIONS ON TIME, EVERY TIME
* CONTINUAL NUTRITIONAL ASSESSMENT
* HIGH-CALORIE/HIGH-PROTEIN/HIGH-FIBER MEAL
* SMALL, FREQUENT MEALS
* I&0
* SCREEN FOR DEPRESSION/PSYCHOSIS
* CONSTIPATION

Question 12

What are some drugs or drug classes that are used for a patient with Parkinson’s Disease?

Answer 12

Levodopa/carbidopa
Anti-cholinergic- Benztropine, trihexyphenidyl HCl, and procyclidine
Anti-virals- Amantadine
Dopamine Agonist- Bromocriptine, pramipexol, and ropinirole. Another drug in this class, rotigotine,

Question 13

What is the use of the anti-cholinergic Benztropine In a patient with Parkinson’s Disease?

Answer 13

For severe motor symptoms such as tremors and rigidity,

Question 14

What is the use of the anti-viral Amantadine In a patient with Parkinson’s Disease?

Answer 14

It may be given early in disease to reduce symptoms. It is also prescribed with levodopa-carbidopa preparations to reduce dyskinesias

Question 15

What is the use of the Dopamine Agonist Bromocriptine In a patient with Parkinson’s Disease?

Answer 15

may be prescribed to promote the release of dopamine. It may be used alone or in combination with carbidopa/levodopa. Some providers may prescribe bromocriptine early in the course of treatment. It is especially useful in the patient who has experienced side effects such as dyskinesias or orthostatic hypotension while receiving levodopa or a combination drug.

SYNTHETIC DOPAMINE AGONIST - ACTS(MIMIC) LIKE DOPAMINE IN THE BRAIN BUT DOES NOT CONVERT TO DOPAMINE

Question 16

What is the use of the Levodopa/ Carbidopa In a patient with Parkinson’s Disease?

Answer 16

Almost all patients are on levodopa or a combination levodopa-carbidopa drug at some point in their disease. It may be the initial drug of choice if the patient’s presenting symptoms are severe or interfere with daily life.

Most effective drug therapy for Parkinson’s Disease, which is converted into dopamine in the brain.

Question 17

Is there a cure for Parkinson’s?

Answer 17

No, there is symptom management treatment to help the patient manage and slow down the progression the diseases

Question 18

Adverse effects of Dopamine Agonist?

Answer 18

Dopamine agonists are associated with adverse effects, such as orthostatic (postural) hypotension, hallucinations, sleepiness, and drowsiness, and can be mistaken for signs and symptoms of PD.

Question 19

Can Medical Marijuana a treatment to treat symptoms of PD?

A. Yes
B. No

Answer 19

A. Yes

Medical marijuana. Medical marijuana, also called cannabis, has been legalized in Canada and most states in the United States. Although there is inadequate evidence that medical marijuana is effective in managing symptoms associated with PD, many patients report its ability to help relieve tremors, dyskinesias, pain, insomnia, and depression (Maxwell & Farmer, 2018). Large studies are needed to provide strong evidence that marijuana is an appropriate drug to prescribe to patients with PD.

Question 20

What are other Nursing Interventions and Interdisciplinary Care for a pt who has Parkinson’s Disease?

Answer 20

-Early in the disease process, collaborate with physical and occupational therapists to plan and implement a program to keep the patient flexible, prevent falling, and retain mobility by incorporating active and passive range-of-motion (ROM) exercises, muscle stretching, and out-of-bed activity.

-Remind the patient to avoid concentrating on his or her feet when walking to prevent falls.

-If the patient is hospitalized for any reason, be sure that he or she is placed on Fall Precautions according to agency policy.

• The occupational therapist (OT) evaluates the patient for the need for adaptive devices (e.g., special utensils for eating).

-Collaborate with the registered dietitian nutritionist, if needed, to evaluate the patient’s food intake and ability to eat. The patient’s intake of nutrients is evaluated, especially in the patient who has difficulty swallowing or is susceptible to injury from falling.

• If the patient has trouble swallowing, collaborate with the speech-language pathologist (SLP) for an extensive swallowing evaluation. Based on these findings and the patient interview, an individualized nutritional plan is developed. Usually a soft diet and thick, cold fluids, such as milk shakes, are tolerated more easily.

-Small, frequent meals or a commercial powder, such as Thick-It, added to liquids may assist the patient who has difficulty swallowing. Elevate the patient’s head to allow easier swallowing and prevent aspiration.

-Collaborate with the SLP if the patient has speech difficulties. Together with the interprofessional health care team, patient, and family, develop a communication plan. The SLP teaches exercises to strengthen muscles used for breathing, speech, and swallowing.

-Remind pt to speak slowly and clearly

• Remind the patient to organize his or her thoughts before speaking and use facial expression and gestures, if possible, to assist with communication. In addition, he or she should exaggerate words to increase the listener’s ability to understand.

Question 21

Is Parkinson’s Disease related to this quote

” A freezing gait and postural instability”

A. Yes
B. No

Answer 21

A. Yes

A freezing gait and postural instability are major problems for patients with PD.

Question 22

What is Migraine Headache?

Answer 22

A migraine headache is a common clinical syndrome characterized by recurrent episodic a ttacks of head pain that serve no protective purpose.

Migraine headache pain is usually described as throbbing and unilateral. Migraines are often accompanied by associated symptoms such as nausea or sensitivity to light, sound, or head movement and can last 4 to 72 hours.

They tend to be familial, and women are affected more commonly than men. Women diagnosed with migraines are more likely to have major depressive disorder.

Migraine sufferers are also at risk for stroke and epilepsy (McCance et al., 2019).

Question 23

What are the 3 types of Migraine Headaches?

Answer 23

Migraines fall into three categories: migraines with aura, migraines without aura, and atypical migraines.

MIGRAINES WITH AURA

MIGRAINES W/O AURA

ATYPICAL MIGRAINES

Question 24

Which of the following statements are true?

A. “Aura related to migraines occur after the stimuli of the migraine headache”.
B. “ Most headaches occur without auras”.
C. Migraines headaches are caused by dark room and no noise”.
D. Nursing interventions for migraine headaches would include loud music and bright lights

Answer 24

B. “ Most headaches occur without auras”.

. Most headaches are migraines without aura.

Question 25

What is an Aura related to migraine headaches?

Answer 25

An aura is a sensation (e.g., visual changes) that signals the onset of a migraine headache or seizure. In a migraine, the aura occurs immediately before the migraine episode.

Question 26

What are the Modifiable Changes that can decrease Migraine Headaches.

Answer 26

Individualized triggers such as photophobia and phonophobia
* Stress
* Smells
* Food

Question 27

Are people with Migraine Headaches more susceptible to stroke and seizures?

A. No
B. Yes

Answer 27

B. Yes

Migraine sufferers are also at risk for stroke and epilepsy

Question 28

What is great non pharmacological intervention for a patient who is currently suffering from a Migraine Headache?

Answer 28

• Quiet room
  -Dark Room
  -low stimulation

Question 29

Is there clear Pathophysiology or cause of Migraine Headaches?

A. Yes
B. No

Answer 29

B. No

The cause of migraine headaches is not clear but includes a combination of neuronal hyperexcitability and vascular, genetic, hormonal, and environmental factors.

Question 30

Migraines without Aura

Answer 30

Migraine Without Aura (Common Migraine)
* Migraine beginning without an aura before the onset of the headache
* Pain aggravated by performing routine physical activities
* Pain that is unilateral and pulsating
* One of these symptoms is present:
* Nausea and/or vomiting
* Photophobia (light sensitivity)
* Phonophobia (sound sensitivity)
* Headache lasting 4 to 72 hours
* Migraine often occurring in the early morning, during periods of
stress, or in those with premenstrual tension or fluid retention

Question 31

Atypical Migraines

Answer 31

Atypical Migraine
* Status migrainosus:
* Headache lasting longer than 72 hours
* Migrainous infarction:
* Neurologic symptoms not completely reversible within 7 days * Ischemic infarct noted on neuroimaging
* Unclassified:
* Headache not fulfilling all of the criteria to be classified a migraine

Question 32

Migraines with Aura

Answer 32

• Aura that develops over a period of several minutes and lasts no longer than 1 hour
• Well-defined transient focal neurologic dysfunction * Pain may be preceded by:
• Visual disturbances
• Flashing lights
• Lines or spots
• Shimmering or zigzag lights
• A variety of neurologic changes, including:
• Numbness, tingling of the lips or tongue * Acute confusional state
• Aphasia
• Vertigo
• Unilateral weakness * Drowsiness

Question 33

What is the primary nursing intervention for a patient suffering from migraines?

Answer 33

The priority for care of the patient having migraines is pain management

This outcome may be achieved by abortive and preventive therapy

Question 34

What is Abortive Therapy in treating migraines

Answer 34

Abortive Therapy
Abortive therapy is aimed at alleviating pain during the aura phase (if present) or soon after the headache has started

TREATING OR TRYING TO DIMINISH THE MIGRAINE BEFORE IT COMES IN FULL EFFECT

Question 35

Should a patient take triptan (MIGRAINE DRUGS) as soon as the symptoms of a headache appear?

A. No
B. Yes

Answer 35

B. Yes

Teach patients taking triptan drugs to take them as soon as migraine symptoms develop. Instruct patients to report angina (chest pain) or chest discomfort to their primary health care providers immediately to prevent cardiac damage from myocardial ischemia

Question 36

What drugs would be used to treat mild migraines? SELECT ALL THAT APPLY

A. Morphine
B. Sumatripton
C. Acetominophen
D. Naloxone
E. Ibuprofen
F. Naprosyn

Answer 36

C. Acetominophen
F. Naprosyn
E. Ibuprofen

Mild migraines may be relieved by acetaminophen (APAP). NSAIDs such as ibuprofen and naproxen may also be prescribed.

Question 37

What foods may be a trigger for a patient that suffers from Migraines? SELECT ALL THAT APPLY

A. Sugar
B. Beer
C. Smoked sausage
D. Pickles
E. Caffeine
F. Wine

Answer 37

B, C, D, E, F

In addition to drug therapy, trigger avoidance and management are important interventions for preventing migraine episodes. For example, some patients find that avoiding tyramine-containing products, such as pickled products, aged cheeses, smoked sausages, and beer; caffeine; wine; preservatives; and artificial sweeteners reduces their headaches.

Question 38

What drugs would you use to treat Abortive Severe Migraines?

Answer 38

sumatriptan, eletriptan, naratriptan, and almotriptan.

Ditans, such as the recently approved lasmiditan, are a newer group of abortive drugs that block only one specific serotonin receptor without constricting blood vessels. Therefore this class of drugs tends to be safer and work more effectively than triptans.

For more severe migraines, drugs such as triptans, ditans, ergotamine derivatives, and isometheptene combinations are often needed. A potential side effect of these drugs is rebound headache, also known as medication overuse headache, in which another headache occurs after the drug relieves the initial migraine.

Question 39

Would you use Sumatriptan for a patient with migraines with a medical history of hypertension?

A. Yes
B. No

Answer 39

B. No

Therefore most triptans are contraindicated in patients with actual or suspected ischemic heart disease, cerebrovascular ischemia, hypertension, and peripheral vascular disease and in those with Prinzmetal angina because of the potential for coronary vasospasm.

Question 40

What is Preventative Therapy in Migraines

Answer 40

Prevention drugs and other strategies are used when a migraine occurs more than twice per week, interferes with ADLs, or is not relieved with acute treatment.

MAINTENANCE DRUG TO PREVENT FROM GETTING A MIGRAINE

Question 41

What are the drugs that are used In Preventative Therapy in Migraines?

Answer 41

Topiramate is one of the most common antiepileptic drugs (AEDs) used for migraines, but it should be used in low doses of 25 to 100 mg daily.

Nortriptyline is a tricyclic antidepressant that is often effective as a drug to prevent or reduce migraine episodes.

Propranolol and timolol are common beta blockers approved for migraine prevention.

Question 42

What is a Seizure/ Epilepsy?

Answer 42

A seizure is an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness (LOC), motor or sensory ability, and/or behavior.

Epilepsy is defined by the National Institute of Neurological Disorders and Stroke as a chronic disorder in which repeated unprovoked seizure activity occurs. It may be caused by an abnormality in electrical neuronal activity; an imbalance of neurotransmi ers, especially gamma aminobutyric acid (GABA); or a combination of both

Question 43

What is priority nursing intervention for a patient experiencing a seizure.

Answer 43

• Protect the patient from injury.
• Do not force anything into the patient’s mouth.
• Turn the patient to the side to prevent aspiration and keep the airway clear.
• Remove any objects that might injure the patient.
• Suction oral secretions if possible without force.
• Loosen any restrictive clothing the patient is wearing.
• Do not restrain or try to stop the patient’s movement; guide movements if necessary.
• Record the time the seizure began and ended.
• At the completion of the seizure:
• Take the patient’s vital signs.
• Perform neurologic checks.
• Keep the patient on his or her side. * Allow the patient to rest.
• Document the seizure:
• How often the seizures occur: date, time, and duration of the seizure
• Whether more than one type of seizure occurs
• Observations during the seizure:
• Changes in pupil size and any eye deviation * Level of consciousness
• Presence of apnea, cyanosis, and salivation
• Incontinence of bowel or bladder during the seizure
• Eye flu ering or blinking
• Movement and progression of motor activity
• Lip smacking or other automatism
• Tongue or lip biting
• How long the seizure lasts
• When the last seizure took place
• Whether the seizure was preceded by an aura
• What the patient does after the seizure
• How long it takes for the patient to return to pre-seizure status

Question 44

What is Status Epilepticus?

Answer 44

Status epilepticus is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a potential complication of all types of seizures. Seizures lasting longer than 10 minutes can cause death! Common causes of status epilepticus include:
* Sudden withdrawal from antiepileptic drugs * Infection
* Acute alcohol or drug withdrawal
* Head trauma
* Cerebral edema
* Metabolic disturbances

Question 45

How do you treat Status Epilepticus? What drug class is used to STOP OR BREAK the action of Status Epilepticus.

Answer 45

WITH THE LAMS AND PAMS TO STOP STATUS EPILEPTICUS (BENZODIAZEPINES)

BENZOS BREAK THE SZ!!

The drugs of choice for treating status epilepticus are IV-push lorazepam or diazepam. Diazepam rectal gel may be used instead. Lorazepam is usually given as 4 mg over a 2-minute period. This procedure may be repeated, if necessary until a total of 8 mg is reached.

Question 46

What is the drug of choice to prevent the return of Status Epilepticus

Answer 46

To prevent additional tonic-clonic seizures or cardiac arrest, a loading dose of IV phenytoin is given and oral doses are administered as a follow- up after the emergency is resolved.

Question 47

What is the priority nursing action when a pt is currently going through Status Epilepticus?

Answer 47

Convulsive status epilepticus must be treated promptly and aggressively! Establish an airway and notify the primary health care provider or Rapid Response Team immediately if this problem occurs! Establishing an airway is the priority for this patient’s care.

Question 48

PATIENT EDUCATION/ TEACHING FOR SEIZURES

Answer 48

• Know drug therapy information:
• Name, dosage, time of administration
• Actions to take if side effects occur
• Importance of taking drug as prescribed and not missing a dose * What to do if a dose is missed or cannot be taken
• Understand importance of having blood drawn for therapeutic or toxic levels as requested by the primary health care provider.
• Do not take any drug, including over-the-counter drugs, without asking your primary health care provider.
• Wear a medical alert bracelet or necklace or carry an identification card indicating epilepsy.
• Follow up with your neurologist or other primary health care provider as directed.
• Be sure that a family member or significant other knows how to help you in the event of a seizure and knows when your primary health care provider or emergency medical services should be called.
• Investigate and follow state laws concerning driving and operating machinery.
• Avoid alcohol and excessive fatigue.

Question 49

Acute Seizure Management

Answer 49

OBSERVATION & DOCUMENTATION
* RECORD TIME IT BEGAN & ENDED
* TYPES OF MOVEMENTS
* ONGOING SZ OBSERVATIONS
* POST-ICTAL ASSESSMENT-OFTEN INVOLVES REORIENTATION
* PT SAFETY
* IF STANDING/SITTING, PLACE THE PT ON THE FLOOR
* CONTINUAL ASSESSMENT OF ABC’S

Question 50

Priority nursing intervention for a patient undergoing a seizure

Answer 50

PT SAFTEY IS THE PRIORITY

• PT SAFETY
• IF STANDING/SITTING, PLACE THE PT ON THE FLOOR
• CONTINUAL ASSESSMENT OF ABC’S
  *SIDE-LYING POSITION
• SUCTION SECRETIONS
• NO RESTRAINTS
• LOOSEN RESTRICTIVE CLOTHING
• NEVER FORCE ANYTHING INTO THE PT’S MOUTH
• NO TONGUE BLADE! EVER!
• DO NOT ATTEMPT TO STOP MOVEMENTS!

Question 51

What type of seizure is this?

PROLONGED SZ THAT LAST >5MIN OR
REPEATED SZ OVER A COURSE OF 30MIN-
MEDICAL EMERGENCY

Answer 51

Status epilepticus is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes.

TREATMENT

ESTABLISH AIRWAY
* ABG’S
* IV PUSH LORAZEPAM, DIAZEPAM
* LOADING DOSE IV PHENYTOIN

Question 52

The male client is sitting in the chair and
his entire body is rigid with his arms and
legs contracting and relaxing. The client is
not aware of what is going on and is making guttural sounds. Which action should the nurse implement first?
1. Push aside any furniture.
2. Place the client on his side.
3. Assess the client’s vital signs.
4. Ease the client to the floor.

Answer 52

4. Ease the client to the floor.

The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities.