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110 Cards in this Set

  • Front
  • Back

most common type of pain

headache

headache classified as what two categories

primary or secondary

primary cause of headaches and examples

cause is not a disease or medical condition


ie tension, migraine, cluster

secondary headaches

headaches caused by conditions such as sinus infection, neck injury or stroke

Prodrome

Early s/s of impending disease, may last for severeal hours or days

what are two types of prodrome and examples

neurogenic ie photophobia


psychologic ie hyperactivity, irritability

aura

immediately precedes the headache and may last for 10-30 minutes

What are symptoms of an aura

bright lights, scotomas (patchy blindness), visual distortions such as zigzag lines, sensory-hearing voices or sounds that don't exsist, strange smells, motor-weakness, parallysis, feeling that limbs are moving

Most common type of headache

tension

what headaches are more common in women

tension, and migraine

site and quality of tension headache

bilateral bandlike pressure "band squeezing the head", constant squeezing tightness

Duration of tension

30 mins to 7 days

Do tension headaches have aura or prodrome?

No prodrome


May have aura such as photophobia or phonophobia. may reveal palpable neck and shoulder muscles, stiff neck

Dx studies of tension headache

electromyography (emg)

drug therapy for tension headaches

NSAIDs with or without sedatives, muscle relaxer, tranquilizer.

If taking aspirin what is the increased risk of

upper gi bleed

what can happen with chrnoic and large doses of tylenol

kidney damage and liver damage

age of onset of migraines

20-30 y/o

quality and site of migraines

usually unilateral. may switch sides. commonly anterior.


usually throbbing, synchronous w/ pulse

duration of migraines

4-72 hours

is migraine with or without aura more common

without

triggering events of migraine

food, hormonal fluctations, and stress. onset on awakening common

are there prodrome and auras in migraines?

Yes they may be preceded.

What are some symptoms associated with migraine?

N/V, irritability, sweating, "hibernate"-seek shelter from noise, light, odors, people, and problems.

Dx studies for migraine

no specific test for migraines. if atypical r/t secondary may do a mri/ct

moderate complaints med for migraines

ASA, NSAIDs, caffeine containing combo.

severe complaints med for migraines

Triptans-Sumatriptan (Imitrex)

When should sumatriptan not be given?

When a pt has hx of ischemic cardiac, cerebrovascular, or pheriphereal vascular, untrolled htn

additional meds that may be prescribed for migraines

Topamax (antiseziure drug)


BB, CCB, Botox, antidepressants (Elavil)

How long can it take for tx to work for migraines

2-3 weeks

What to keep in mind when teaching a patient who is taking Topamax?

Do not d/c abruptly-can cause seizures

What is something that a patient with any headache should do for tx of headaches and planning?

Keep diary of headaches

Cluster headaches site and quality

Unilateral, radiating up or down from one eye, severe bone-crushing

Who is cluster headaches more common is, how common are they?

Men, rare

What might preciptate an attack of cluster headache?

High altitudes with low o2

Duration of cluster headaches

few minutes to 3 hours

Time of onset of cluster headaches

nocturnal, common on awakening. suddenly.

triggers of cluster headaches

alcohol, strong odors, napping.

Associated symptoms of cluster headaches

facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis. sharp, stabbing head pain. pupil constriction

what nerve is in cluster headaches that cause the most pain

trigeminal nerve (CN 5)

What dx studies may done for cluster headache?

Hx, diary, CT/MRI to rule out aneurysm, tumor, infection

Tx for cluster headaches.

Sudden onset make medication not as useful. acute tx is inhalation of 100% oxygen therapy x 10 minutes and can be repeated after a 5 minute rest. triptans are also effective. intranasal lidocaine is useful. prophylactic drugs-verapamil, lithium.

Most effective strategy in helping pts with headaches

examine lifestyle, recognize stressful situations, and learn to cope with them more appropriately.


daily exercise, relaxation periods.

Non drug therapy for tension headache

massage and moist hot packs to neck and head

Non drug therapy for migraine headache

quiet, dim light, enviornment

Avoid _________ and using ____________ may decrease headaches

smoking, perfumes

Foods and other factors that can trigger headaches

Amines (cheese, choc)


nitrites (hotdogs)


vinegar, onions, monosodium gluctamate


fermented or marinated foods


caffeine


tomatoes, oranges, aspratame, nicotine, ice cream, alcohol, emotional stress, fatigue, drugs such as ergot containing preparations and monoamine oxidase inhibitors

Seizures

Abnormal, sudden, excessive discharge of neurons (electrical) within the brain

Epilepsy

Chronic seizure activity and indicates brain and CNS irritation

Causes of seizures

genetic, trauma, tumors, circulatory or metabolic disorders, toxicity, and infections

Status epilepticus

Rapid succession of epileptic spasms without intervals of consciousness

Partial seizures

Begin in specific region of cortex indicated by EEG

Simple focal seizures

does not involve loss of consciousness, sensory symptoms accompanied by motor symptoms.


ie pt may have abnormal movements such as jerking of a finger or stiffening of part of the body or may feel like they are floating

Complex focal seizures

patient loses consciousness for a few seconds. pyschomotor seizure with periods of altered behavior of which a pt is not aware.

Generalized seizures

both sides of the brain. loses consciousness for a few seconds to several minutes.. aura not present.

types of generalized seizures

tonic-clonic


absence


myoclonic


atonic

tonic clonic seizures

Grand mal seizure, most common


loss of consciousness and falling to ground, stiffening of the body for 10-20 secs (tonic phase) and subsequent jerking of the extremeties for another 30-40 seconds (clonic phase).


Cyanosis, excessive salivation, tongue or cheek biting, and incontinence may accompany the seizure


full recovery in several hours

Absence seizure

usually occurs only in children and rarely continues beyond adolescence. lasts seconds and individual may or may not lose consciousness. no loss or change in muscle tone occurs. brief staring spell that lasts for a few seconds.

Myoclonic seziures

characterized by sudden excessive jerking of he body or extremities. may fall to ground

Atonic seizure

drop attack. involves either tonic episode or sudden loss of muscle tone.

dx study of seizures

EEG


CBC,


CT MRI to rule out lesions

Prevention of seizures

wear helmets. improved perinatal and l&d care, practice good general health habits like diet and exercise

Safety during a seizure!

Maintain airway***


Protect pts head,turn pt to the side


if pt sitting, ease pt to the floor, loose constrictive clothing, do not restrain pt, do not place any objects in the pts mouth.

Other implications for pt having seizures

ABC


O2


suction preparation


turn pt to side


do not restrain


monitor for incontinence


adminster iv meds as prescribed


privacy


lifelong meds for chronic


avoid alcohol, stress, strobe lights


medic alert bracelet

Drug therapy for seizures

Phenytoin (dilantin)


carbamazepine (Tegretol)


Phenobarbital


Depakote

What are common side effects of antiseizure meds?

diplopia, drowsiness, ataxia, mental slowing


Do not_______antiseizure meds abruptly

d/c

Therapeutic level of phenytoin (Dilantin)

10-20 mcg/ml

therapeutic levels of carbamazepine (tegretol)

3-14 mcg/ml

phenobarbital therapeutic levels

15-40 mcg/ml

Common side effect of long term phenytoin (Dilantin) use

gingival hyperplasia

gingival hyperplasia

excessive growth of gingival tissue

Other meds for seizures

short acting antiseizure drugs-lorazepam (ativan) and diazepam (Valium)

Multiple sclerosis

Chronic, progressive, degenerative disorder of CNS characterized by disseminated demyelination of nerve fibers of brain and spinal cord

Influential factors of MS

geography, ethnicity

What climate has increases prevalance of MS

temp between 45-65 degress of latitude, Northern US, Canada, and Europe

Cause of MS

unknown.

onset of MS

gradual, insidious w/ vague symptoms intermittently

dx of MS

no definitive dx test for MS. based mainly on hx and s/s


mri of brain and spinal cord may show plaques, inflammation, atrophy, and tissue breakdown and destruction

Assessment of MS

Fatigue/weakness


Ataxia (loss of full control of body movements)


vertigo


tremors, spascity of lower extremeties


paresthesias


blurred vision, diplopia, nystagmus


dysphagia,


decreased perception to pain, touch and temp


bowel and bladder distrubances


abnormal reflexes


emotional changes


memory changes and confusion

Nursing interventions for MS

Energy conservation


place an eye patch on eye for diplopia


regular bladder/bowel evacuation


encourage independence


exercise


assistive devices


avoid fatigue, extremes of heat/cold and infection


low fat, high fiber high protein high K diet


high fluid intake


Drug therapy for MS

No cure, symptom relief


Corticosteroid-tx acute excerbations


Immunomodulators (ie B interfereon) used to modify disease progression and prevent relapse


Drug alert for MS

Rotate injection sites, assess for depression/suicidal ideations, wear sunscreen/protective clothing, flu like symptoms

How is spasticity tx in MS

With antispasmodic drugs.

When pt has acute exacerbation of MS what safety measures to keep in mind?

Prevent major complications of immobility. such as resp and UTI and pressure ulcers

Parkinsons disease

Chronic, progressive, neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia) increased muscle tone (rigidity), tremors at rest and gait disturbances.

Etiology of Parkinsons

unknown. depletion of dopamine which interferes with the inhibition of excitatory impulse resulting in a dysfunction of the extrapyramidal system

Where does degeneration of dopamine producting neurons occur in Parkinsons disease?

Substantianigra of midbrain

Symptom of Parkinsons disease do not occur until ___ of neruons in substantia nigra are lost

80%

What is the triad of PD?

Tremors, rigidity, and bradykinesia

Tremors in PD

First sign


Pill rolling because thumb and forefinger appear to move in a rotaryfashion as if rolling a pin or coin, can involve diaphragm, tongue, lilpds or jaw.

Rigidty in PD

Second sign. Increased resistance to passive motion when the limbs are moved. Cogwheel rigidity, intermittent catches in movement of cogwheel when joint is moved passively.


Jerky quality


Complaints of muscle soreness

Bradykinesia in PD

Particularly evident in the loss of automatic movements and extreme slonwess of movements and reflexes


Lacks spontaneous activity (stooped posture)


Mask face


Drooling of saliva


Shuffling gait


Slow old man

Non motor symptoms of PD

Depression, anxiety, apathy, fatigue, pain, constipation, impotence, short term memory, sleep problems, difficulty staying asleep at night, restless, sleep, nightmares, drowsiness, sudden sleep onset during the day

Complications of PD

Weakness, dementia, neuropsychiatric problems, dysphagia.

Dx of PD

Based on hx and clinical features. firm dx can only be made when at least two of the three signs of the classic triad are present

Nursing implications of PD

High-calorie, high-protein, high-fiber diet, fluid intake 2000 mL/day. rock back and forth to intiate movement, firm mattress and position patientprone w/outa pillow to facilitate proper posture, avoid complications such as fractures and falls, meds,high vitamin B6, avoid monoamine oxidase inhibitors will precipitate HTN.

Drug therapy for PD

Carbidopa/Levidopa-Often first drug to be used


Converted to dopamine in the basal ganglia


Effective for akinetic symptoms


Bromocriptine (Parlodel)-directly stimulates dopamine receptors, when more moderate to severe s/s Sinemet is added

Drug alert for Carbidopa/Levidopa

Monitor for s/s of dyskinesia-effects may be delayed for several weeks to months. report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands or legs, mental changes palpitations, N/V, difficulty urinating.

Drug alert for Bromocriptine (Parlodel)

Monitor for orthostatic hypotension esp following first dose. Notify physician if severe headache develops that does not let up or continues to get worse

Myasthenia Gravis

Autoimmune disease of the neuromuscular junction characterized by fluctatuing weakness of certain skeletal muscle groups

Etiology of myasthenia gravis

Antibodies attack acetycoline.

What is detectable in serum of pt with myasthenia gravis

Anti-AChR antibodies

S/S of myasthenia gravis

Weakness/fatigue


Difficulty chewing/swallowing


Dysphagia


Ptosis


Diplopia


Weak, hoarse voice


Difficulty breathing


diminished breath sounds


Resp paralysis and failure

What muscles are most involved in myasthenia gravis

Moving the eyes, eyelids, chewing, swallowing ,speaking and breathing

What to monitor with pt with myasthenia gravis

VS, speech/swallowing abilities to prevent aspiration, encourage pt to sit up while eating, assess muscle status, conserve strength, avoid stress

Drug therapy for myasthenia gravis

Antibholinesterase drugs prolong action of Ach and facilitates transmission of impulses to the neuromuscular junction


Pyridostigmine (Mestinon)

Atrophic Lateral Sclerosis

Lou Gehrigs Disease. Progressive degenerative disease involving the loss of motor neurons. Sensory and autonomic systems are not involved and mental status changes do not result. Muscle weakness and atrophy until flaccid tetraplegia. Resp muscles atrophy leads to resp compromise, pneumonia and death.

Cure for amyotrophic lateral sclerosis

None, tx is symptomatic

S/S amyotrophic lateral sclerosis

resp difficulty, fatigue while talking, muscle weakness, and atrophy, tongue atrophy, dysphagia, weakness of arms and hands, dysarthria