WEEK 4 (Neuro part 1) Flashcards
Alternations in Neurological System (headaches/migraines, seizures, strokes)
1
Q
types of headaches
A
primary: tension, cluster, migraines
secondary: has an underlying cause
2
Q
what the cause of primary headaches
A
not identifiable cause
3
Q
etiology of tension headaches
A
stress
posture
depression
4
Q
etiology of cluster headaches
A
stress, allergens, environment, medications (nitroglycerin), tobacco, alcohol
5
Q
etiology of migraines
A
genetic
trauma
environment
food/additives
6
Q
migraine tiggers
A
Head trauma
Caffeine
Foods containing nitrates or tyramine
Artificial sweeteners
Hormonal changes
Bright lights
Strong odors
Changes in weather
Stress
Skipping meals
7
Q
etiology of secondary headaches
A
dependent on the underlying process that precipitates the headache
there are causes and risk factors
8
Q
Causes and Risk Factors of Secondary Headaches
A
Carbon monoxide poisoning
Cerebrovascular accident
Intracranial hemorrhage
Hypertension emergencies
Meningitis
Encephalitis
Acute angle-closure glaucoma
9
Q
plan of care for secondary headaches
A
the causes of these headaches can vary greatly; therefore, the treatment plan must focus on treating the underlying cause.
10
Q
Comorbidities of Headaches
A
Cardiovascular and cerebrovascular events-increased risk
Diabetes mellitus
Obesity
Hypothyroidism
Endometriosis
Epilepsy
Depressive disorders
Bipolar disorder
Anxiety disorders
Post-traumatic stress disorder
11
Q
clinical presentation of TTH (tension-type headache)
A
mild to mod pain in both sides of their head
“dull” or “band-like” pressure
12
Q
how long do tension-type headaches usually last
A
30 mins to 7 days
13
Q
clinical presentation of cluster headaches
A
severe pain on one side of head, usually behind the eye
lacrimation, eyelid swelling, dropping of eye
14
Q
adjectives for cluster headaches
A
excruciating and nonfluctuating
15
Q
how long do cluster headaches last?
A
15 mins to several hours, and can occur multiple times a day
16
Q
lacrimation
A
Secretion of tears.
cluster headaches
17
Q
four stages of migraine headaches
A
prodromal
aura
headache
postdromal
18
Q
Manifestations of the prodromal phase may include the following (migraines)
A
Sensitivity of light, sound, and odor
Fatigue
Uncontrolled yawning
Food cravings
Excessive thirst
Mood swings
Constipation or diarrhea
19
Q
how long does prodromal phase of a migraine last?
A
hours to days prior to the actual headache
20
Q
all manifestations of aura are what?
A
reversible
21
Q
manifestations of aura (migraine) include
A
stage before having a migraine
Visual, sensory, or motor disturbances
Tunnel vision or complete blindness
Visual field loss
Heaviness in limbs
Speech and language disturbances
Scintillating scotoma (a spot of flickering light near the center of the visual field)
Tingling sensations in face and limbs
22
Q
how long does aura last
A
60 minutes
23
Q
what is the headache phase usually described as
A
throbbing and unilateral intense pain
24
Q
how long does a migraine headache usually last (3rd phase)
A
few hours to one or more days
25
status migraininosus
migraine lasting longer than 72 hours and doesn't respond to any usual treatment
26
manifestations of headache (migraine) phase
Nausea/vomiting
Photophobia (sensitivity to light)
Phonophobia (sensitivity to sound)
Rhinorrhea (runny nose)
Lachrymation (eye tearing)
Loss of appetite
Fatigue
27
postdromal phase is also called what
migraine hangover
28
how long does the postdromal phase last (migraine)
one to two days following the migraine
29
manifestations of postdromal phase for migraine
Pain with movement in the same location of migraine
Exhaustion
Dizziness
Difficulty concentrating
Euphoric feeling (great happiness or excitement)
30
Which of the following manifestations may a client experience during the prodromal phase of migraine?
a
Uncontrolled yawning
b
Visual disturbances
c
Throbbing headache
d
Photophobia
A
31
A nurse is teaching a client who has a history of chronic headaches. Which of the following information should the nurse provide?
Learn to identify headache triggers
32
treatment of an acute headache
analgesics, triptans, IV fluids, or parenteral steroids. Provide the client with a dark, quiet room to rest in or a cold pack to the eyes or neck.
33
treatment of chronic headaches
education
identifying triggers
abortive medications
lifestyle changes
34
medication to know for headaches/migraines?
sumatriptan
35
sumatriptan brand name
Imitrex
36
what is class of sumatriptan
serotonin agonist
37
indication of sumatriptan
migraines and cluster headaches
38
patho of sumatriptan
vasoconstricts the brain vessels
39
contraindications for sumatriptan
coronary artery disease and uncontrolled hypertension
40
key point for sumatriptan?
screen for history of uncontrolled HTN and REPORT it!
41
An ATI question focusing on education for the patient (for sumatriptan)
teach the patient to report angina (coronary vasospasms)
42
ergotamine (indication)
treatment of migraines
43
patho of ergotamine
vasoconstriction of brain vessels
44
what is a priority for ergotamine?
pale extremeties (priority: pale)
due to vasocontriction, blood flood can be decreaed to the extremities
45
ATI question of ergotamine
teach: take ONSET of headache
because it is an abortive med for migraines, and you need to educate to take those whenever you FIRST show symptoms of that migraine
46
why do seizures occur?
abnormal and unregulated electrical impulses in the brain’s gray matter which interrupts the normal function of the brain
47
what determines how intense or widespread a seizure is
the number of neurons affected
48
define epilepsy
A chronic condition that consists of recurrent seizures.
49
three types of seizures
generalized
focal (partial)
unknown
50
what does generalized seizures mean
involves BOTH cerebral hemispheres
51
what does partial (focal) seizures mean
begin in part of ONE hemisphere
52
types of generalized seizures
tonic-clonic
myclonic
atonic
absence
53
types of partial (focal) seizures
complex
simple
54
causes of seizures (memory aid)
Causes are anything that causes brain swelling or hypoxia. It can include infections, trauma, brain tumors, increased intracranial pressure, fever in children especially infants, and withdrawal from drugs and alcohol.
55
seizure triggers
increased physical activity
excessive stress
hyperventilation
overwhelming fatigue
acute alcohol ingestion
excessive caffine intake
exposure to flashing lights
substance use
56
define tonic-clonic seizures
generalized type
phases of tonic (Tense) and clonic (Contractions, jerking)
Loss of consciousness
57
define myoclonic seizures
generalized
sudden, breif, shock contractions of a muscle or muscle groups
LOC?
58
define atonic
generalized
abrupt loss of muscle tone
LOC?
59
define absence seizure
generalized
loss of consciousness
staring off into space
60
define complex seizures
focal (partial)
impaired consciousness ranging from confusion to syncope or unresponsive
61
define simple seizures
partial (focal)
no loss of consciousness, may experience twitching, sensory changes, or autonomic symptoms
62
seizure risk factors
Genetic predisposition
Acute febrile state
Head trauma
Cerebral edema
Abrupt cessation of antiepileptic meds
Infection (meningitis)
Metabolic disorder
Exposure to toxins
Stroke
Heart disease
Brain tumor
Hypoxia
Acute substance withdrawal
Fluid & electrolyte imbalances
63
stages of seizures
prodromal
early ictal/aura
ictal
postdromal
64
prodromal (seizures)
warning signs before a seizure leading up to aura phase
65
aura phase (seizures)
visual, auditory clue that happens prior to a major seizure
66
ictal phase
= seizure phase
THINK ignition phase, the period of the active seizure
67
postictal phase
hangover phase after the stage - think POST-ignition phase
confused, disoriented, major headache, and typically feels tired or sleepy
68
manifestations of prodromal stage for seizures
anxiety
confusion
mood changes
difficulty sleeping
headaches
69
how long with a prodromal phase for seizures usually occur
hours to days before the seizure occurs
70
manifestations of the early ictal (aura) phase for seizures
first sign of seizure activity (first clue!)
strange tastes
strange smells
strange feelings like Deja vu, excitement
71
ictal stage of seizure
when you see the seizure
so either the genralized like tonic-clonic, atonic, etc
or focal like complex, simple
72
status epilepticus
medical emergency!!!
seizure longer than 5 mins or 2 or more in 30 mins
73
post ictal stage of seizures
after the seizure ends
lasts 5-30 mins
recovery phase
74
signs and symptoms used the post ictal seizure phase
confusion, fatigue, headache, alterations in mental status, weakness, nausea, or anxiety
75
When assessing a client having a seizure, certain cues may indicate that there is an immediate concern. These cues include an
alteration in the client’s ABCs or a seizure lasting five minutes or longer. If this concern is not addressed immediately, the client is at risk for potentially severe complications
76
what NOT to do during a seizure
do NOT restrain
do NOT open jaw
do NOT put anything in mouth
do NOT use padded tongue blades
77
what TO do during a seizure
protect:
airway
from injury
suction secretions
decrease risk of aspiration (lay on side)
keep yourself safe
loose clothing for patient
DOCUMENT
78
what are the 3 big things with seizure documentation
oneset time
duration (how long)
findings (like any injuries, any events, etc)
79
what are some preventative actions for seizures
admin anticonvulsants and avoid seizure triggers
80
what to take note of with seizure anticonvulsants
avoid alcohol
don't discontinue abruptly
carry medical identification
81
5 S's with seizures (tiggers)
stress
sleep deprivation (fatigue)
strobe lights
stimulations (caffine, alcohol)
sugar and sodium LOW
82
what is #1 thing to consider with seizures
AIRWAY
turn on side
prepare for suctioning
never go in mouth and never restrain or "hold down arms"
83
meds that can help with seizures (like acutely, in the moment)
Lorazepam (Ativan)
Diazepam (Valium)
rectal or IV
84
what are two meds to know for this exam about seizures?
Phenytoin
Carbamazepine
85
what meds to avoid taking while on phenytoin?
oral contraceptives and warfarin
86
memory aid: tonic
TENSE and TIGHT
87
memory aid: clonic
Convulsions, Contraction, Clicking (jerking)
88
memory aid: tonic-clonic
TIGHT and Convulsions
89
memory aid: absence
"spaced out" or daydreaming
90
memory aid: complex seizure
lip smacking
biting
picking
91
main difference between focal simple and focal complex
simple NO loss of consciousness
complex there IS a loss of consciousness
92
what would the phase be if a client has a headache and confusion post a 20-min long seizure?
postictal (postdromal) phase
93
what is priority patient in patients with seizures?
someone in the aura phase
94
define a transient ischemic attack (TIA)
short episode of symptoms resembling a stroke
can be a warning sign for a stroke!
95
pathophysiology of a TIA
blood flow to the brain is temporarily obstructed and only causes a temporary blockage with no lasting effects. Symptoms of a TIA are similar to that of a stroke but resolve within 24 hours.
96
when will a TIA resolve
within 24 hours
97
what is a TIA also caused or known as
a "mini-stroke"
98
memory aid of a TIA (T. I. A.)
Transient: short time frame
Ischemic: low oxygen
Attack: happens suddenly (TIAs come and go often)
99
what is a TIA considered to be?
a warning sign for a stroke
100
define a cerebrovascular accidents (CVA)
aka strokes
disruption of cerebral blood flow secondary to ischemia, hemorrhage, brain attack, or embolism
101
types of strokes
ischemic
hemorrhagic
102
what are ischemic strokes seperated into
thrombotic or embolic
103
ischemic strokes
Lack of oxygen in an area of the brain from a clot forming in the block vessels
Clot blocks the normal blood flow of the vessels in the neck or brain
thrombotic or embolic
104
hemorrhagic stroke
Bleeding in the brain or spaces surrounding the brain
105
what does a hemorrhagic stroke come secondary to?
a ruptured artery or aneurysm
106
ischemic strokes: thrombotic strokes
occur secondary to?
causes what?
evolution of these strokes?
occur secondary to the development of a blood clot in a cerebral artery that
gradually shuts off the artery and causes ischemia distal to the occlusion.
These evolve over a period of several hours to day
107
ischemia definition
an inadequate blood supply to an organ or part of the body
108
ischemic strokes: embolic strokes
caused by what?
causes what?
are caused by an embolus (clot) traveling from another part of the body to a cerebral artery.
Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a loss of consciousness to instantly occur.
109
what are diseases that can increase your risk of having a CVA?
hypertension
DM
smoking
110
Strokes: Health Promotion & Disease Prevention
Hypertension control
Diabetes mellitus control
Tobacco cessation
Maintaining healthy weight
Regular exercise
111
what is the classic symptom of a stroke?
a headache
client will say "this is the worst headache of my life"
112
what BP can indicate an ischemic stroke
greater than 180/110
113
major risk factor for a TIA
hypertension
114
other main risk factors for a TIA
cardiovascular disease
DM
low physical activity
hyperlipidemia
smoking
obesity
excessive alcohol intake
low socioeconomic status
family history
115
A client who has had a TIA has increased risk for
another TIA or a stroke
116
ABCD2 Score
for TIAs (study this)
117
clinical presentation of a TIA
SUDDEN ONSET
FAST
facial drooping
arm weakness
speech disturbance (slurring of speech)
time to call 911
ataxia, higher BP, unilateral weakness
118
what to test for when a patient is having a TIA/stroke?
glucose!!!
hypoglycemia can mimic a stroke or TIA
119
The primary goal of treatment of a TIA is
to prevent stroke or another TIA
120
what is the main difference between a TIA and a stroke?
Unlike a stroke, a TIA resolves completely and does not cause residual neurological manifestations
A TIA may last for only a few minutes or up to 24 hr and needs to be taken as a major warning sign to seek medical attention immediately.
121
what artery is associated with a TIA/stroke usually?
the carotid artery
122
a patient presents with slurred speech and left sided facial drooping. what does the nurse do FIRST?
conduct a fast assessment
the patient is presenting with the F and S
123
which main artery supplies blood to the brain
the carotid artery
124
Most strokes are ischemic strokes, which occur when
embolisms or plaques block arteries that supply the brain with blood
125
Because motor and sensory neurons cross to the other side of the spinal cord as they exit the medulla oblongata,
the effects of a right hemisphere stroke are evident on the left side of the body and the effects of a left hemisphere stroke are evident on the right side of the body
126
so right sided stroke...
manifestations of the left side
127
so left sided stroke...
manifestations of the right side
128
most common risk factor for stroke
HTN
129
common deficits of a right sided stroke
left hemiparesis and hemisensory loss
right visual field loss (hemianopsia)
aphasia
130
common deficits of a left sided stroke
right hemiparesis and hemisensory loss
left visual field loss (hemiparesis)
131
is hyperlipidemia low or high HDL
low
HDL is good cholesterol and LDL is bad, so hyperlipidemia would be TOO much of the BAD stuff and too LOW of the good stuff, leading to a CVA/TIA
132
define hemianopsia
loss of vision in half of the visual field
133
define ataxia
Poor muscle control that causes clumsy movements
134
define dysarthria
difficulty speaking (aka difficulty ARTiculating)
135
define hemiparesis
paralyzed on side of the body
136
manifestations of a stroke
Hemiparesis
Unilateral sensory deficits
Facial drooping
Aphasia or dysarthria
Changes in or loss of vision
Ataxia
137
manifestations more common with hemorrhagic strokes
Headache
Nausea and vomiting
Seizures
138
BEFAST with strokes!!
apply when you first notice these, as every minute counts to help save brain cells
Balance (sudden loss of Balance)
Eyes (sudden loss of vision in one which is hemianopia or both eyes)
Facial drooping (unilateral) or uneven smile
Speech (slurred speech, trouble speaking or dysarthria)
Time is critical! so call 911 immediately
139
3 steps to stroke recognition
ask the person to smile
ask them to say a complete sent
ask them to raise both of their hands up
140
steps to take if you have a patient with a stroke
1. note the time of onset
2. take a glucose
3. prep for CT
141
what is the goal of a CT for stroke?
door-to-CT in 25 mins
NEVER delay a CT!
142
TIA/Stroke: Changes in LOC may indicate
increased intracranial pressure
143
what to monitor for a TIA/stroke
vitals every 1-2 hours
provide oxygen
monitor cardiac rhythm
monitor LOC
monitor BS
institute seizure precautions
144
when to do seizure precautions?
really for any neuro patient, as they have a risk for a seizure
145
treatment for ischemic stroke
Tissue Plasminogen Activator (TPA)
146
TPA: when to give and door to need time
give within 3.5-4 hours of onset
door to need time is usually 60 mins
147
treatment of hemorrhagic stroke
hypertensive meds
surgery
148
what meds to study for this exam
TPA, TnK
149
Maria has been diagnosed with a hemorrhagic stroke. Which of the following medications should be stopped immediately?
Aspirin!!!
it is an anticoagulant and a hemorrhagic stroke is a brain bleed!!
150
Maria’s blood pressure upon arrival was 195/112. Which of the following describes how high blood pressure increases the risk of stroke?
It can cause the arteries to rupture and cut off oxygen supply.
