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66 Cards in this Set
- Front
- Back
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simple partial seizures
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-generally without impairment of consciousness
-affect motor, special sensory, somatosensory (tingling), autonomic |
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complex partial seizures
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-with impairment of consciousness
-affect cognitive, affective, psychosensory, psychomotor (automatisms) |
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what to do with a seizures
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-So What People Pull To Teach Children In Olympics Science
-start timing it -what is moving? -position of head? -position of eyes? -top to bottom? -type of activity? -consciousness? -incontinence? -oxygen necessary? -suction necessary? |
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drug therapy for primary generalized tonic-clonic seizures
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-valoproic acid (Depakote)
-Lamotrigine (Lamictal) -Topiramate (Topamax) |
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drug therapy for partial seizures
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-phenytoin (Dilantin) : gingival hyperplasia
-Levetiracetam (Keppra) |
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drug therapy for absence seizure
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-valproic acid (depakote)
-lamotrigine (lamictal) |
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drug therapy for atypical absence, myoclonic, atonic seizure
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-valproic acid
-lamotrigine -topiramate |
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status epilepticus
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-prolonged more than 5 min or another seizure within 30 mins
-IV Lorazepam (Ativan) -life threatening if not stopped |
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types of injuries of brain damage
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-primary: due to initial damage
-secondary: damage after initial insult (usually due to bleeding; can also be ischemia) |
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manifestations of scalp wounds
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-tend to bleed heavily
-big portals for infection |
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manifestations of skull fractures
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-usually have localized, persistent pain
-fractures of the base of the skull causes: bleeding from nose or ears, battle's sign, halo sign |
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manifestations of brain injury
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-altered LOC (first to check)
-signs are often dramatic (pupils, neuro, vital signs, headache, seizures) |
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concussion
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-a temporary loss of consciousness with no apparent structural damage
-can't sleep (check LOC every hour) -get CT right away and then later |
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contusion
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-more severe injury with possible surface hemorrhage
-longer period of unconsciousness with more symptoms of neurologic deficits and changes in vital signs than concussion |
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diffuse axonal injury
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-widespread axon damage in the brain seen with head trauma
-pt. develops immediate coma |
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epidural hematoma
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-an emergency situation, go straight to OR
-classic signs: have injury, become unconscious, then pt. seems fine, but then suddenly becomes unconscious again -reason: it's an arterial bleed (initially bleeds and it's tamponadic where the bleeding stops, then starts bleeding again) -treatment: burr holes or craniotomy (reduce ICP, remove clot, stop bleeding) |
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subdural hematoma
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-this is venous
-more people die of subdural than epidural because it can be really slow with no symptoms for a while |
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acute subdural hematoma
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-symptoms develop over 24-48 hours
-if you do a CT right away, you won't see anything -requires immediate craniotomy and control of ICP |
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subactue subdural hematoma
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-symptoms develop over 48 hours to 2 weeks
-requires immediate craniotomy and control of ICP |
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chronic subdural hematoma
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-develops over weeks to months
-causative injury may be minor and forgotten -treatment is evacuation of the clot |
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intracerebral hemorrhage
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-treatment: supportive care, control of ICP, fluids, electrolytes, antihypertensive
-craniotomy or craniectomy to remove clot and control hemorrhage (may not be able to get to it so hard to treat) |
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interventions for head injury pts
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-ongoing assessment and monitoring is vital
-30 degrees HOB -potential ARDS |
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raccon eyes
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-are always bilateral
-develop 2 to 3 days after a closed head injury that results in basilar skull fracture |
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coup contre-coup damage
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-brain hits in the front and the back
-person is only hitting one thing and brain moves without head moving back |
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myasthenia gravis (MG)
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-considered pyramidal because it is voluntary
-autoimmune disease of neuromuscular juntion -antibodies against Ach receptors -relationship with thymus and hyperthyroidism |
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diagnosis of MG
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-oat cell carcinoma (Eaton-Lambert syndrome): rapid small cell growth from cigarette smoking that can mimic or even cause MG
-tensilon test -RA, SLE, PM -eletromyography (EMG) of muscles used to see if amplitude of muscle response decreases (positive if decr) |
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tensilon test
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-give cholinesterrase inhibitors: edrophonium (tensilon) or neostigmine bromide (prostigmin)
-MG will get dramatically better |
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cholinergic crisis weakness
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-usually caused by too much medication of MG, pyridostigmine (mestinon)
-will not improve with tensilon -will see muscle twitching around face and eyes (fasciculations) -antidote to tensilon is atrophine sulfate |
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treatment of MG
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-treatment are for symptoms
-give anticholinesterases or cholinergic drugs -give corticosteroids, prednisone -give immunosuppressive -plasmapheresis (getting rid of the antibodies) -thymectomy (may take up to 2 years to induce remission) |
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nursing care of MG
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-careful assessment
-repiratory priority -eyes (if patching, change every 2 to 3 hours or will lose vision in the unpatched eye) |
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cardinal symptoms of PD
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-muscle rigidity
-bradykinesia (very slow movement) -tremor (may be non-intentional tremor so stop with sleep and intention) -postural instability |
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basal ganglia functions
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-muscle tone is inhibited
-voluntary movements is refined |
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cerebellum functions
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-keeps from overshooting
-moves from one skill to another -predict how to approach -control voluntary movement -maintain equilibrium |
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dopamine
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-from substantia nigra and transmitted to basal ganglia
-dopamine modifies action of Ach which allows control over voluntary movement |
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acetylcholine
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-produced in basal ganglia
-transmit excitatory message |
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parkinson's disease
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-widespread degeneration (breakdown and wearing down) of substantia nigra which is part of basal ganglia
-causes decreased amount of dopamine which causes more excitatory neuronal activity -loss of ability to refine voluntary movement; prevents controlling or initiating voluntary movement -excessive prespiration (a cholinergic acytlcholine mediated) -may be dementia later |
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signs and symptoms of PD
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-fatigue (starts out with this)
-tremor -rigidity (cogwheel, lead pipe total resistance) -mask like faces -drooling -micrographia -dysphonia (difficulty speaking) -shuffling gait -propulsive gait (can't start and can't stop) -forward flexion posture |
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treatment of PD
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-anticholinergics (cogentin, artine)
-monoamine oxidase inhibitor (selegiline) -dopamine agonists (bromocriptine, cabergoline, pergolide, pramipexole, ropinirole) -symmetrel (anti-viral drug) works on extra-pyramidal symptoms -dopamine (levodopa with carbidopa, sinemet) -tricyclic antidepressants (elavil) |
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surgeries of PD
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-stereotactic pallidotomy (oldest; going in to get rid of the symptoms)
-deep brain stimulation -fetal implantation |
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multiple sclerosis (MS)
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-a progressive immune-related demyelination disease of the CNS
-heat and cold intolerant -impaired bowel and bladder, verbal, thought processes, sexual dysfunction |
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medical mangement of MS
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-disease-modifying therapies
-symptom management of muscle spasms, fatigue, ataxia, bowel and bladder control |
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4 types of MS
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-relapsing-remitting (most common)
-primary progressive -secondary progressive -progressive-relapsing |
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mobility and sensation
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-spinal cord and nerves play a major role
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spinal cord injuries (SCI)
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-primary
-secondary: damage to from swelling, ischemia and hypoxia, and nerve cell death (thought that secondary can be reversible if treated 4-6 hours) |
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concussion in SC
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-there's vibration, a force
-some trauma but pt. is likely to have a full recovery -often have loss of function but only temporary (24-48 hrs) |
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contusions in SC
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-bruises that damage blood vessels, leaking
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areas of spine where it is more at risk for damage
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-where spine is more flexible
-c5~c7, t12, l1 |
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vertebral disk
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-a shock absorber as primary purpose
-acts as a ligament (holds together) and helps with mobility -these can buldge and pinch on nerves |
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types of fractures of SC
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-simple
-compression -comminuted (bone is broken in several places) |
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what needs to happen at the scene of SCI?
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-rapid assessment
-immobilize (flat board) -extricate from situation -stabilize |
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acute management with meds with SCIs
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-steroids (methopracexolone) to decrease inflammation and swelling
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in the acute phase, when is surgery indicated?
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-when cord is compressed
-when there's fragments of vertebral bone -with penetration injury |
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classification of SCI
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-level (cervical, thoracic, lumbar, sacral)
-degree (complete, incomplete, or partial) -mechanism (the force or object, flexion, extension, rotation) |
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primary mechanisms of injury
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-hyperflexion
-hyperextension -vertical compression -excessive rotation -penetrating injuries |
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spinal shock
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-loss of neurologic injury that's temporary below the level of injury
-loss of reflexes in spinal cord that's temporary |
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neurogenic shock
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-loss of autonomic nervous system function below the level of injury
-have dangerously low drop in BP due to failure of vasoconstriction or pooling of blood in vessels (give ADH drug vasopressin to keep fluid in body) |
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autonomic dysreflexias
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-acute emergency (the first 7 to 10 days are critical)
-usually happens at T6 or above -happens when autonomic nervous system's responses are exaggerated -"i have a pounding headache," "i feel impending doom," incr in BP, sweating, nausea, nasal congestion, bradycardia -usually happens when there's a noxious stimuli that makes person uncomfortable |
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nursing intervention for AD
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-first: sit the pt. up and dangle their legs (bring BP down)
-call medical team -rapid assessment -loosen tight clothing -assess for full bladder or constipation |
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leading cause of death in pt's with SCI
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-respiratory problems (pneumonia, PE, atelectasis)
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back pain
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-spinal stenosis is a narrowing of the spinal canal that usually happens at age 50
-can be from trauma or infection -lower back pain (L4 or L5) -with low back pain, may also have cervical pain |
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spinal cord tumor
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-most are in the thoracic area
-will have pain -treatment is first surgery, second is radiation |
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amyotrophic lateral sclerosis (ALS)
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-aka Lou Gehrig's disease
-has to do with mobility and sensation -adult onset |
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characterization of ALS
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-muscle weakness, fatigue
-difficulty swallowing, breathing -drooling -twitches, spasticity -problem of degenerating motor neurons (but does not affect you cognitively) |
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causes of ALS
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-unknown cause
-there's a 10% genetic predisposition |
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diagnostic findings of ALS
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-there is no test that will definitively tell you
-base it regarding the symptoms -sometimes will do a muscle biopsy |
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treatment of ALS
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-no specific treatment
-some medications like rizoule (the only FDA approved) for spasticity -hospitalization for acute problems like respiratory problems |
