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221 Cards in this Set
- Front
- Back
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Benzodiazepinmes
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inhibit nerve transmission in the brain, decreases seizure activity.
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Diazepam ( Valium)
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is drug of choice for status epilepticus
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Give Valium at a push rate of
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1 mg/min. Do not dilute
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Lab effects of CNS depressants
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Decreased: WBC, RBC and Platelets
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CNS depressants used to
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induce sleep, control seizures
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Side effects of Barbituates and CNS depressants
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sedation, “hang-over” effect, dizziness, unsteady gait, hypotension, nightmares
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Toxic levels of the barbiturates can be
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lethal
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Toxic levels of barbiturates side effects are
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bradycardia, respiratory depression, ataxia, slurred speech, confusion, extreme weakness
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Primidone (Mysoline)
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can cause acute psychosis
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Anticonvulsants used to
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control seizure activity
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Lab effects of Anticonvulsants
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Decreased WBC, RBC and platelets. Increased LFT
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Hydantoins are the
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most frequently prescribed for seizure control
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Side effects of the hydantoins
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unsteady gait, restlessness, bradycardia, hypotension, Nystagmus (abnormal eye movements), gingival hypertrophy, slurred speech with toxicity
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For Gingival hyperplasia
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brush the teeth three times daily for dental hygiene
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Valproid acid (Depakene, Depakote, Depacon) causes
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CNS depressioin. If daily dose ordered, give at bedtime
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Carbamazepine (Tegratol) will cause
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drowsiness and photosensitivity In some clients
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Additional Hydantoins
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Ethotoin (Peganone), Mephenytoin (Mesantoin) used for neuropathic pain, Fosphenytoin (Cerebyx), Ethosuximide (Zarontin), Felbamate (Felbatol), Gabapentin (Neurontin), Lamotrigine (Lamictal) also used for Bipolar pts, Levetiracetam (Keppra), Oxycarbazepine (Trileptal), Topiramate (Topamax) also used for weight control, Trimethadione (Tridione), Zonisamide (Zonegran)
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Dompaminergic agents
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used primary to tx symptoms associatd with Parkinson’s disease.
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Muscle rigidity seen in Parkinson’s pts is due to lack of
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dopamine
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Carbidopa/Levodopa (Sinemet) therapy results seen within
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2 – 3 weeks of starting therapy. Some clients may not see improvement for 6 months. Take with meals to reduce N&V
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Carbidopa/Levodopa (Sinemet) therapy side effects
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Choreiform movements , Dystonic movements
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Choreiform movements are
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involuntary muscular twitching of the limbs or facial muscles
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Dystonic movements are
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muscle spasms of tongue, jaw, eyes and neck
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Selegiline (Carbex, Eldepryl) can cause
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MAOI – induced hypertensive crisis
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Amatadine (Symmetrel) can cause
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pronounced orthostatic hypotension and increased risk off infection
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Additional agents
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Bromocriptine (Parlodel), Carbidopa (Lodosyn), Entacapone (Comtan), Levodopa (Dopar, Larodopa), Pergolide (Permax), Pramipexole (Mirapex), Ropinirole (Requip), Tolcapone (Tasmar)
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Central Acting Anticholinergics
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used in the tx of other symptoms in Parkinson’s Disease, such as excessive sweating, salivation, and orthostatic hypotension.
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Central Acting Anticholinergic meds side effects
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SLUDGE DECREASED
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SLUDGE
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* salivation, *lacrimation, *Urination, *defecation, *GI upset, *Emesis
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While taking Cogentin (Benztropine)
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pt should avoid driving or operating machinery
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Additional Central acting Anticholinergics
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Biperiden (Akineton), Diphenhydramine (Benadryl), Procyclidine (Kemadrin) , Trihexyphenidyl (Artane)
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Cholinasterase inhibitors
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used to tx Alzheimer’s Disease
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Cholinergic agents used to
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tx Myasthenia Gravis and to diagnose MG
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When used to tx MG
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administering 30 minutes before meals will promote chewing and swallowing, thus improving pt’s nutritional status.
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Cholinergic and Cholinasterase inhibitors
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Endrophonium ( Tensilon), Neostigmine (Prostigmin), Pyridostigmine (Mestinon), Physostigmine (Antillirium), Rivastigmine tartrate (Exelon)
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Migraine agents used that are Adrenergic Blockers
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Clonidine HCI (Catapress), Egotamine (Cafatine, Cafergot), Propanolol (Inderal), Sumatriptan (Imitrex)
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Migraine agents used that are Serotonin agonist
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Almotriptan(Axert), Naratriptan(Amerge), Rizatriptan(Maxalt), Sumatriptan (Imitrex), Zolmitriptan (Zomig)
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Psychomotor stimulants
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Amphetamine, Dexmethylphenidate (Focalin), Dextroamphetamine sulfate (Dexedrine), Methamphetamine (Desoxyn), Methylphenidate (Concerta, Metadate, Ritalin), Pemoline (Cylert)
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Methylphenidate (Concerta, Metadate, Ritalin) also used as
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appetite stimulant in the elderly
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Frontal lobe responsible for
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insight, judgment, and planning, personality, memory, concentration and motor control of speech.
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Aphasia and personality changes are due to changes in
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the frontal lobe
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Speech center is in the
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left frontal lobe in most people
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Temporal lobe is
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responsible for hearing, language and comprehension
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Test temporal lobe by testing
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recall of memories, and evaluation of speech and hearing problems.
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Occipital lobe responsible for
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vision
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Changes in vision can show defects in
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occipital lobe
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Cerebellum is responsible for
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balance, equilibrium and coordination.
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Test cerebellum function by
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observing gait changes and running the foot down the leg and watch balance
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Reticular activating system
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responsible for level of consciousness
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Limbic system
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responsible for feelings and emotions
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Brain stem
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responsible for vital functions , observe vital signs to monitor
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Left side of brain
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responsible for language (LEFT FOR LANGUAGE)
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Right side of brain
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responsible for judgement
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Cranial Nerves and their functions
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* I Olfactory (Smell), * II Optic (Vision), *III Oculomotor (eye movements), *IV Trochlear (eye movements), *V Trigeminal (innervates the cornea), *VI Abducens (eye movements), * VII Facial (smile), *VIII Acoustic (hearing, vestibular), *IX Glossopharyngeal (swallow), * X Vagus (swallow), *XI Spinal (shrug shoulders), *XII Hypoglossal (extends the tongue)
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Parkinson’s Disease is
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chronic progressive disorder that is characterized by joing and muscle rigidity, bradykinesis, tremors and abnormalities in posture.
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The chemical imbalance in Parkinsons’ Disease is
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not enough dopamine and normal amount of acetylcholine. Onset is gradual usually after 50 years of age.
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General clinical manifestation in Parkinsons
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dysarthia with poor articulation in speech, Mask like expression, Pill rolling, Non-intention termors of the upper limbs which occur at rest or may occur with voluntary movements, sometimes with the head being involved, Side to side twitching, Pill rolling aggrevated by stress.
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Bradykinesis
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loss of normal arm swing with walking, decreased blinking, loss of ability to swallow, blank expression, difficulty initiating movements
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Use Passive ROM
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with acute illness in Parkinson’s.
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Stooped posture
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shuffling, propulsive gait
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Muscle rigidity
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increased resistance with passive movement, cog wheel, jerky slow movements.
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Parkinson’s Treatments
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Caribidopa/Levodopa (Sinemet) used frequently. Bulk forming products, high fiber and stool softeners to promote bowel function. Avoid use of laxatives.
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Parkinson’s Interventions
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Raised toilet seat to increase independence, maintain muscle function during acute illnesses such as pneumonia, use POM.
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Multiple Sclerosis
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a chronic disease which affects the brain and spinal cord and leads to a wide variety of symptoms including weakness and difficulties with coordination and speech.
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MS is considered to be
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autoimmune disease.
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MS often presents with
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visual disturbances such as diplopia and blurred vision due to optic nerve lesions
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MS symptoms involving motor dysfunction
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usually begins in one or more extremeties, typically occurs on one half of the body or in the lower extremeties with weakness progressing to spastic paralysis.
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Fatigue is precipitated or exacerbated by
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high or warm temperatures
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Bowel and Bladder dysfunction occurs in
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90% of MS patients , high fiber and fluid promoted to avoid constipation and urinary problems
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MS is more common in
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women
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MS progression is not
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“orderly”
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Drug Therapy for MS
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ACTH, Cortisone, Cytoxan, Immunosuppresent drugs
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Spinal cord injuries
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compression injuries will have pain at level of compression
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Disability in spinal cord injuries
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based on location of the injury, most common in complete injury
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Cervical injuries
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loss of the use of arms and hand, may have shoulder use, C3 – C5, respiratory status a major concern. The cervical plexus innervates the diaphragm.
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Thoracic injuries
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lose control of cough and normal bowel function. T1 injury has normal biceps function (work on arm strength), T3 injury can do personal hygiene independently.
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Lumbar
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Lose control of bladder, legs and feet
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Paraplegia is the paralysis of
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lower part of the body
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Qaudriplegia is the paralysis of
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all four extremeties.
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Central cord syndrome is an
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acute cervical injury of the central cord. It is the most common incomplete lesion of the spinal cord.
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Central cord syndrome shows
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greater motor loss in the upper extremities as compared to the lower one, Loss of sensation below the level of injury is variable.
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Anterior cord syndrome is
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the anterior part of the cord is damaged due to certain type of injury.
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Anterior cord syndrome function lost
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motor, pain and temperature sensations below the level of injury
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Anterior cord syndrome function present
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proprioception and coarse sensations below the level of injury.
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Brown-Sequard is
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hemisection of the cord.
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In Brown-Sequard on the same side of injury
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deficit of movement, loss of touch and vibration on that side.
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In Brown-Sequard on the opposite side of injury
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loss of pain and temperature
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Autonomic Dysreflexia
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triggered by bladder or bowel distention, restrictive clothing and skin stimulation such as pressure area or blanket across the toes. Presents as severe hypertension, bradycardia and headache.
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Autonomic Dysreflexia above the injury
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Vasodilation, flushed, warm, diaphoretic and distended neck veins.
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Autonomic Dysreflexia below the injury
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vasoconstriction, pale, cool, no sweating.
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Spinal shock
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hypotension is displayed, imperative to reverse ASAP.
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Permanent paralysis can occur if spinal cord is compressed for
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12 -24 hours.
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Areflexia
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characterizes spinal shock
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Clinical correlation and care of spinal cord injured clients includes
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Acute injuries tx with Solu-Medrol (100kg pt. = 3000 mg dose)
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Bladder spasms and reflex incontinence problem for spinal injuries
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caffeine in the diet can contribute to spasms, discourage caffeine intake.
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SCI (spinal cord injury) pts are prone to
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UTI’s. one of the most common causes of death in those with SCI due to UTI becoming sepsis. SCI patient prone to skin breakdown.
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SCI patients may have sexual relations but different due to the following
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men may have reflex erections and may not ejaculate. Women can have abductor spasms.
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Halo vests used for cervical injuries
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provides stability to the cervical spine, is heavy so limits pt. trunk flexibility. Carry correct wrench size in case of emergency, pin care daily, use of walker and rubber soled shoes may help prevent falls and injury.
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Myasthenia Gravis
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chronic autoimmune disease with varying degrees of weakness of the skeletal or voluntary muscles of the body due to deficiency of acetylcholine, often due to the production of autoantibodies that attack acetylcholine receptors.
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MG clinical Manifestations
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weakness of muscles innervated by the cranial nerves, Diplopia and ptosis common, Sleepy appearance due to facial muscle involvement, weakness increases during periods of activity and improves after periods of rest, bedrest often relieves symptoms.
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MG most severe complication
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respiratory failure
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MG treatments
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Cholinergic medications, may need to increase meds during periods of increased activity, (pyridostgmine *Mestinon) and (neostigmine *Prostigmin) are given. Steriods added if other meds are not effective.
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MG symptoms
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Bladder and respiratory infections are common recurring problem. Must use aspiration precautions with MG pts.
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Plasmapheresis
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used to separate plasma from the blood elements so the plasma proteins that contain the antibodies may be removed. May give temporary relief to clients with actual or impending respiratory failure.
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Thymectomy
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possible treatment and can be a cure.
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Tensilon Test is used
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to diagnose the disease and differentiate between cholinergic crises and MG crisis.
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Cholinegic crisis
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when pt is getting too much of the cholinergic medications used to treat MG. Will produce a Negative test
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MG crisis
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when pt. is not getting enough of the medications based on metabolic needs. Will produce a positive test.
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Clinical manifestations of increased ICP early indicators
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Changes in LOC, restlessness, irritability, confusion.
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ICP pupil changes
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unequal or slower, pinpoint, fixed and dilation as herniation occurs
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Cushings Triad
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Vitals are opposite of shock. Decreased pulse, irregular respirations, widening pulse pressure.
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ICP changes In motor response
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Decoriticate (good),Decerebrate (bad)
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ICP manifestations in infants
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sunset eyes, high pitched cry
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ICP temperature
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low grade with injury, hyperpyrexia with damage to or pressure on hypothalamus.
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Normal ICP
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5 – 15 mm3
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Nursing interventions
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HOB elevated 30 – 45 % , try not to restrain clients, Avoid narcotics due to change in LOC, Can also change pupil responses. Control hyperglycemia and fever which causes cerebral edema and increased ICP. Minimize stimuli. Restrict activities which inc. pressure in head. Don’t routinely suction.
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Pharmacological interventions to decrease or avoid ICP
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steroids (Prednison, Decadron *dexamethasone). Mannitol will be used to dec. fluid in brain and dec. ICP. Prophylactic antibiotics if a surgical client or CSF leakage and agents used to reduce secretions such as atropine or glycopyrrolate (Robinul)
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Mannitol duration of action
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12 hours, monitor uring output Q 1 hr.
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Anticonvulsants used in ICP
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to prevent and/or control seizures is phenytoin (Dilantin)
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In ICP monitor for CSF leakage
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test positive for glucose and gives a “halo” appearance on paper, increased risk for meningitis and can indicate a deteriorating condition.
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Maximize cerebral perfusion by monitoring
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CO2 levels. Alkalosis leads to vasoconstriction and dec. blood low. Control the respiratory rate.
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Herniation is the complication if ICP is not controlled
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pressure on the brain stem could lead to brain death. Pupils are unequal/pinpoint/dilated
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Craniotomy
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surgical procedure where part of skull is removed in order to access the brain.
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Craniotomy done for
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brain lesions or blood vessel abnormalities, traumatic brain injury, (TBI), and to implant brain stimulators to treat Parkinson’s and epilepsy. May be infratentorial or supratentorial approach for brain tumor.
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Head of bed elevation
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Supra is elevated for supratentorial, Supre = HOB elevated, Infra is flat for infratentorial. Infra = HOB flat.
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Hydrocephalus
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enlargement of the cranium caused by abnormal accumulation of CSF within the cerebral ventricular system resulting in an increase in head size and weight and an increase in ICP.
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Hydrocephalus interventions
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support head and neck, feed with HOB up, May need ventricular peritoneal shunt.
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Ventricular peritoneal shunt care
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shunt has delicate valves, do not pump the shunt unless ordered, this changes pressure in the ventricles. Do not place on side of shunt because pressure can cause skin breakdown. Need to do seizure precautions before and after the surgery, anticipate steroid use to decrease cerebral edema, HOB at 45 degrees with large pillow under the head and shoulders. Any sign of clear nasal drainage, notify physician ASAP.
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Seizures
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excessive activity in the cerebral cortex of the brain.
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Seizures are uncommon before
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age 2
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Convulsions are
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spasmodic muscle movements seen in those with seizures
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Tonic seizure is
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tight
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Clonic seizure is
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contraction
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Suction at bedside to help
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handle secretions
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May follow seizure
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postictal state
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May precede seizure
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aura
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Absence seizure
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petit mal has a short LOC. Minor hand face and eye movements.
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Absence seizures may be seen in
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kids and adolescents. Blank facial expressions may be seen.
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Myoclonic seizure
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brief, uncontrollable, jerking movements caused by muscle contraction.
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Partial seizure
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from part of brain, focal activity is seen.
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Tourette’s disorder
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inherited neuropsychiatric disorder with onset in childrhood and characterized by presence of multiple physical (motor) tics and at least one vocal (phonic) tic.
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Motor tics
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usually involve the head. Most frequent is eye blinking and tongue protrusion. May involve the torso and extremeties. Touching, squatting, hopping, skipping, retracing steps and twirling while walking may be seen.
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Verbal tics
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barks, grunts, yelps, clicks, snorts, sniffs and coughs.
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Coprolalia
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saying obscenities and is seen in a small number of cases.
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Cerebravascular accidents (CVA’s)
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reduction of blood flow to a part of brain structure due to occlusion of blood vessel by a clot or the rupture of a vessel as a result of hypertension or an abnormality of the vessel itself such as an aneurysm.
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Meds given in CVA’s
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Steriods may be given to decrease cerebral edema and decrease damage, H2 blockers to prevent peptic ulcers.
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Transient Ischemic Attacks (TIA’s)
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temporary episodes of neurological dysfunction.
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Thrombotic stroke
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slower onset of symptoms. Often related to Atherosclerosis.
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Embolic stroke
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sudden onset of symptoms, often related to A-fib and A-flutter.
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Hemorrhagic stroke
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usually a sudden onset of symptoms. Often related to hypertension.
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Causes of hemorrhagic strokes
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cerebral aneurysm, AV malformation, intracerebral hemorrhage, subarachnoid hemorrhage.
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Cerebral aneurysm
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growing aneurysm may present with minor headache, intermittent blurred vision, cranial nerve palsy or dilated pupils.
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Signs and symptoms of growing aneurysms are
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subtle
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Aneurysms larger than 10 mm in diameter have a
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50% chance of bleeding
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If aneurysms are leading put client
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on strict bedrest
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Grade II aneurysm is
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mild bleed in which client remains alert but has nuchal rigidity with possible neurological deficits, depending on area of bleed.
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Aneurysm precautions
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quite environment, don’t bend over, deep breathing, no coughing, no stimulants including visitors and caffeine, avoid valsalva such as straining or holding breath when getting out o bed.
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Arteriovenous malformation
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congenital abnormal communication between arterial and venous channels resulting from a failure to develop a capillary network in the embryonic brain.
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Clinical manifestations in arteriovenous malformation
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hemorrhage, seizures, headache and progressive neurologic deficits.
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Intracerebral hemorrhage
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bleeding into the subarachnoid space
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Manifestations of subarachnoid bleeds
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headache, nuchal rigidity and photophobia. Crainial nerve deficits especially CN II and sometimes IV an V, causing diplopia and blurred vision.
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Subarachnoid bleeds give
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nimodipine (Nimotop) which is a CCB.
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Rehabilitation is essential however
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NO ROM for the first 24 hours after a stroke.
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Will frequently see
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emotional lability with strokes.
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Hemiplegia
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total paralysis of one side of body usually occurring with stroke
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Hemiparesis
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is weakness or slight paralysis on one side of the body.
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Parasthesia
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an abnormal sensation such a burning or prickling usually caused by nerve damage. Paresthesia = prickling.
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Peripheral neuropathy
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painful condition of the nerves of the hands and feet due to damage of the peripheral nerves.
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Homonymous hemianopia
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loss of one half the visual field.
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Apraxia
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absence of purposeful movements in the absence of motor problems, ( Can’t make the X)
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Dysartthia
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difficulty articulating speech
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Dysphagia
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difficulty swallowing
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Dysphasia
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difficulty with speech and verbal comprehension
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Aphasia
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absence of speech (s for sound)
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Agraphia
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absence of ability to write
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Alexia
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absence of the ability to read (can’t read the Lexus)
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Meningitis
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inflammation of the meninges which are the protective membranes covering the brain and spinal cord.
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Kernig’s sign
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physical sign of meningitis. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. (they have difficulty Kicking out) (K for kernig)
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Brudzinski’s sign
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flexing the chin down to the chest causes pain and the client will pull the legs up into a fetal position. (Bothering them they curl up to the fetal position) (B for Brudzinski)
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Test the CSF by
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lumbar puncture
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Signs of bacterial meningitis
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Increased ICP , Cloudy CSF, Increased protein > 45 mg/l, Decreased Glucose < 45 mg / L.
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May see SIADH with
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fluid retention, cerebral edema, and dilutional hyponatremia.
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Bell’s Palsy
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unilateral inflammation of the facial nerve (cranial nerve VII), resolves in several weeks to months, affects movement of the eyelid, tearing and taste, mimics stroke.
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Nursing interventions in Bell’s Palsy
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chew on unaffected side, gently massage the face, wear dark glasses when out, use an eye patch at night to protect the eye.
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Trigeminal neuralgia
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inflammation of the trigeminal nerve causing extreme pain and muscle spasms in the face. Pain is present with stimulation such as brushing teeth and chewing food.
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Trigeminal neuralgia nursing interventions
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teach chewing foods easily, no extreme temperatures. Nerve injections with alcohol done and considered temporary measure that lasts 6 – 18 months
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Microvascular decompression of blood vessels at nerve root is
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surgical procedure done for trigeminal neuraligia. May recur in 30% of clients within 6 years of procedure. Nursing procedure is to treat these patients like a craniotomy after surgery.
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Guillian-Barre’
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acute, autoimmune disorder affecting the peripheral nervous system usually triggered by an acute infectious process (respiratory or gastrointestinal) in the 1-4 weeks before the onset of symptoms. It is occasionally triggered by vaccinations or surgery. Involves the cranial nerves which are part of the peripheral nervous system.
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Symptoms of Guillian-Barre’
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ascending paralysis, at risk for hypotension, hypertension and bradycardia, at risk for DVTs, at risk for respiratory failure, dysphagia will be seen, elevated protein in the CSF, treatable with plasmapheresis followed by immmunoglobulins and supportive care.
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Amyotrophic lateral sclerosis (ALS)
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progressive and usually fatal disorder caused by degeneration of the motor neurons. The disorder causes muscular weakness and atrophy throughout the body although mental function is usually spared. Dementia may result in certain situations.
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ALS presents with
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descending paralysis and is a permanent condition.
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Basilar skull fracture
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linear skull fracture at the base of the skull from a blow to the back of the head or sudden deceleration of the torso but not the head as in a motor vehicle crash. The fracture is between the occipital and temporal bones.
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Acceleration injury
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head in motion
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Deceleration injury
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head suddenly stops
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Basilar skull fracture manifestations
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bleeding from the ear, rhinorrhea, battle’s sign and raccoon eyes.
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Meniere’s disease
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disorder of the inner ear that can affect hearing and balance.
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Clinical manifestations of Meniere’s disease
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vertigo, tinnitus, and progressive hearing loss, usually in one ear. Caused by increase in volume and pressure of the endolymph of the inner ear.
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Nursing interventions in Meniere’s
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salt and fluid restrictions. Pt. should avoid sudden head changes.
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MRI
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no metal on client or in the room
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Myelogram
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monitor for signs of meningitis afterwards
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EEG
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use tincture of benzoin to get electrodes to stick if diaphorectic
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EMG
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needles inserted into the affected muscles during the test. Done to assess the electrical activity and determine whether symptoms are primarily musculoskeletal or neurological.
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Lumbar puncture and spinal tap
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give fluids for headache after spinal tap or spinal anesthetic. Leading over bedside table for adults, side lying and curled into a ball for children.
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Glucose levels in bacterial meningitis
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decreased.
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Level of Consciousness is best indicator of
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neurological status
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Confusion
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unable to think clearly and rapidly
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Disorientation
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unable to recognize place or person
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Obtunded
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sleeps unless aroused
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Stupor
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requires considerable amount of stimulation to arous
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Corneal reflex
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safest way to test is to use a drop of saline instead of a whisp of cotton, If absent, instill artificial tears PRN
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Hearing
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last sense to go
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Glasgow coma scale
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Maximum of 15, < 7 reflects coma state, < 5 organ donation should be discussed
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Assessed behaviors in GCS
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eye opening, most appropriate verbal response, Most integrated motor response
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Eye opening in GCS
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Spontaneous 4, to verbal stimulus 3, to pain 2, none 1
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Verbal response in GCS
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Oriented 5, confused 4, Inappropriate words 3, Incoherent 2, None 1
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Motor Response in GCS
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Obeys commands 6, Localizes pain 5, withdraws from pain 4, Flexion (decorticate)3, Extension (cerebrate) 2, None 1
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Babinski reflex
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should be positive in children under 2 yrs of age. Negative in all others. Positive indicates pyramidal tract disease where there is trouble with the relay of impulses. Bleed in the brain could have a positive response.
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Negative babinski is
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normal. Think of a baby. . . when you put your finger in theirs, they curl down and hold onto your finger. This is a normal response, it is a negative response.
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Moro reflex
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startle reflex which is normal in newborns and disappears between 3 – 4 months. If present longer, suspect neurological disease such as Cerebral palsy.
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Stepping reflex
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normal in newborns and disappears about 3 – 4 weeks at which time it is replaced by a more deliberate action
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Cremasteric reflex
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superficial reflex that tests L1 and L2. Stimulating the reflex is useful in emptying a spastic bladder after a spinal cord disruption above the sacral segment.
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