Unit 5 -Neuro Flashcards
seizure
Brief abnormal nurst of electrical activity in the brain that alters one or more of the following:
movement, sensation, behaviour, awareness
what causes someone be diagnosed with a seizure disorder
2 or more seizures 24 hours apart. Or if they have one that puts them at high risk
Pre ictal phase of a seizure
Warning signs before a seizure occurs.
Ora: Sensory, motor, emotional symptoms
Ictal phase
seizure activity seconds to minutes, abnormal activity
Post ictal phase
recovery, confusion, fatigue, mins to hours
age related seizure causes
Children: Birth trauma, infection, febrile, congenital abnormalities
Middle years: Trauma, inf, alcohol, drugs
Elderly: CVA and metastatic brain tumour
seizure causes
brain tumour, trauma, vascular disease, borth hypoxia
Possible seizure triggers
specific time of day or night, sleep deprivation, fever or other illness, alcohol, stress, hormonal/metabolic, specific foods, meds taking/not taking, accident/injury, senses (light, smell), hypoglycemia, dehydration, over exertion
seizure lab work
decreased NA and Cam Hypoglycemia, kidney function,
Partial seizure
electrical disturbance limited to 1 area of the brain.
Simple: awareness, consciousness, and memory perserved less then 1 minute.
Complex: altered consiousness for more then 1 minute. Post-ictal. Often involve lip smoking and repetitive movement.
Generalized seizure
Electrical disturbance affects the entire brain.
Tonic: Decreased LOC, tonic stiffening, clonic jerking, entire body stiffens as the mucles contract. Absence: rarely beyond adolescence.
tonic phase presentation adn duration
LOC. May cry out. Fall down. Entire body stiffens as the muscle contract. cyanosis.
10-20 sec
Clonic phase presentation and duration
Jerking of extremities, cyanosis, excessice salivation, tongue/cheek biting, incontinance
Post seizure presentation
groggy, muscle soreness, no recall of event, tired, sleepy, can be aggressive. varies in how long it lasts,
How to protect your patient from injury during seizure
if they are upright ease to floor, portect head with padding, push aside any furnature that is in the way.
Raise side rails, bed at lowest position, DO NOT open jaws that are clenched and insert anything in, restain the pateint in any way
Seizures mimic
migraine, syncope, stroke, non epipetic spell, movement disorder, night terrors, panic attacks
seizure precautions
working O2, suction, oral airway HOB, IV access, rectal temp, bed in lowest position, padded rails, brain on, patient on side, privacy
Observe and record what during seizure
time, what they are doing, aura, triggering events, seizure progression and symmetry, eyes
Post ictal nursing management
ensure patent airway, check for injury especally tongue and oral cavity, suction PRN, IV access, NPO, remove loosen tight clothing, document, offer emotional support
Epilepsy
2 or more unprovoked seizures seperated by atleast 24 hours, recurring seizure. Only 1% of people will suffer from epilesy
when is a seizure an emergency
longer then 5 mins, 2nd without regaining consciousness, repeated seizure over a 30 minute perios
AED
Anti epileptic drug, effective in 70% of patients, take as perscribed, do not suddently stop,
Nursing managment for epilepsy
Health promotion, ensure treatment, assess progress, involve the family, have a predetermined plan for seizure
Nursing priorites for epilepsy
ABC
-prevent or control seizure, protect pateint from injury, maintain airway or resp function, promote positive self esteem, provide info about disease prognosis
How long should someone be seizure free until driving
3-12 months
water safety for seizures
take shwers not baths, shower chair or sit in the bottom of an unfilled tip. swimming safety
OPA
used for airway through the mouth. Measure jawline angle across, invert, insert, noninvasive. For people with no gauge reflex.
NPA
Used for intact gag , though nose, better tolerated.
MS
Chronic, progressive, degenerative autoimmune disorder of the CNS characterized by disseminated demyelination of nerve fibres of the brain, spinal cord, optic nerve
Immunologic causes of MS
MS Causes damage to the protective fatty coating that surrounds nerve cells, causing signals from the cells to slow down or stop all together
Environemental causes of MS
People exposed to more vit D help prevent MS
MS women to men
3:1 women to men
When do people develop symptoms
15-50
Neuro effect of MS
difficulty speaking, involuntary eye movement, tremors, double vision, weakness, decreased bowel and bladder function, blurred vision
patho of MS
autoimmune disorder, brain and spinal cord lined by myelin sheath. Body perceives its own myeline as an intruder adn attacks it. Causes inflammation, degeneration and scarring of the myelin, electrical impulses impaired
Types of MS
Benign: minimal disability between attacks 10-20%
Relapsing-remitting: Attacks may leave permanent deficits followed by periods of remission 75%
Primary progressive: steady increase in disability. Older age of onset and no relapse. 10-20%
Secondary progressive. Initail RRMS that begins to decline wihout perios of remission
Chronic preogressive stead decline since disease onset
favorable prognosis
women, under 40, low relapse yearly, long interval between attacks, young age of onset, low disability at 2-5 yeats from disease onset, later cerebral involvment
Unfavorable prognosis
Male, over 40, high rate of relapse, short interval between attacks, symptoms from efferent (motor tract), Older age at onset, earlier cerebellar involvement
Clinical manifestation for MS
Involuntary eye movement, vision loss, abnormal eye alignment, double vision, muscular atrophy, spasm, lack of muscle coordination, heightened pain, reduced sense of touch, constant tingling and burning, fatigue, cognitive impairment, depression, unstable mood, hearing loss, stuttering, diffculty swallowing, incontinance, diarreah.
steps to diagnose MS
History, clinical manifestation, MRI, (this is the gold standard) Presence of multiple lesions over time, Spinal can also be done.
How MS progresses
1.0: No disability, minimal signs of ms
3.0: Moderate disability in one system, or mild disability in up to 4 systems. No impairment of walking
5.0: Disability severe ebough to impair full daily activities able to walk without aid for 200 m
6.0: Requires a walk aid, cane, or crutch to walk 100 m
7.5: Unable to take more then a few steps. Restricted to wheelcahri usage.
9.0: Confined to bed. Can still communicate and eat.
10: DEATH
Frontal lobe symptoms of MS
Speech, mood, though, planning, language
Occiptal lobe symtpoms of MS
Vision
Symptoms of MS in temporal lobe
Memory and emotion
Symptoms of MS in Brain Stem
Breathing, regulating heart rate, seeing and hearing, sweating, BP, Digestion, Temp regulation
Symptoms of MS in Cerebellum
Coordination and body movement, regu;ates balance and equilibrium
Goals of MS treatment
- Stop acute relapse by steroid use
- DMT (Disease modifying therapies) Disease progression
- Symptoms management
-maintain immune system. find therapies that supress the immune system enought to decrease immune attack.
Can you cure MS
No, only treat symptoms
Nursing management in MS
Maximise neuromuscular function, maintain indépendance for as long as possible, manage associated symptoms
Assessment for MS
Symptoms, Trigger (Infection), trauma, immunization, post partum, stress, change in climate
Drug therapy for MS
Corticosteriods, immunosupressice drugs, immunomodular drugs
Nutrition for MS
Well balanced, high protein (helps with tissue repair), Extra Vit C to keep urine acidity, Hifh roughage,
Physical therepies for MS
prevent contractures, water exercise, stretching, balance, assistive device
Patho of parkinsons disease
- progressice neurodengerative disorder
- progressive destruction of dopaminergic nerurons in the basal ganglia and substantial nigra
- Results in domapine deficency and degeneration of muscular function affectign movement, mood, cognition, swallowing, and communication.
Bradykinesia
slow movement and speed (common in parkinsons)
Dyskinesia
Irradic involuntary movement,
Non modifiable and modifiable risk factors for Parkinson’s
Non-modifiable:
age, mal, fam hx
Modifiable:
exposure to toxins, head trauma
Assessment of TRAP for parkinsons
T: Tremor (pill rolling hand movement, often asymmetric, inhitibited during sleep) Progressive
R: Rigidty (jerky, facial, can’t swallow)
A: Akinesia/Bradykinesia (Slow/absent movement)
P: Postural instability (Unable to stand, hold posture)
Symptoms of parkinsons to assess/monitor
-Aspiration risk
-Motor exam
-Psychosocail
-HEENT
-Nutrition
-ABDO (constapation and incontinance)
-Derm
-Neuro exam (LOC, language, cranial change)
-Coordination
-sensory
-gait/posture assessment
Drug therapy for parkinsons
Dopaminergic (enahance the release or supply of dopamine to decrease tremors, rigidity, bradykinesia) Levodopa with cardipo are common
Anticholergic (Antagonize or block the effect of acetylcholine) and decrease tremors (cogentin is common)
Antihistamins (bendryl) Can manage tremors
MOA inhibitor (selegilene) used to slow down the breaksown of dopamine thereby increase teh doapmine levels
Investiagtions that must be done before diagnosis of parkinsons
Blood work (rule out any other reason they may be experiencing tremor/other symptoms) Radiology/imaging looking for lesions, Psych (depression is high in these pateints(
How long do parkinson medication usually work
for around 4-6 years and then they wear off
Surgical therapies for parkinsons
Deep brain stimulation (surgical implanted medical device that delivers electrical stimulation to the brain)
Transplantation fetal neural tissue stem cells transplanted
Nurse teaching for parkinsons
med: adherance, side effects
Nutrition: position when eating, smaller more frequent, soft foods or thickened fluids, supplimenets
Fall risk
Psychosocial
Indications for hosptialization for parkinsons
Neuropsychiatric disturbances, delerium, frequent falls, failure to cope at home
Complications with parkinsons
psychiatric: depression, hallucinations, psychosis
Cognitive: dementia
Autonomic dysfunction: hypotension, urinary urgency, constapation
Sleep disturbances: REM behaviour disorder, insomnia
Posture instability: balance and fall risk
Med related: dyskinesia
