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178 Cards in this Set

  • Front
  • Back
abnormal episodes of motor, sensroy, autonomic, or psychic activity
seizures
what causes Szs
abnormal uncontrolled electrical discharge from cerebral neurons
being in one part of the brain
partial seizures
can often progress to complex szs
simple szs
affect the whole brain
generalized szs
recurring seizures
epilepsy
unknown cause
idiopathic
what causes epilepsy
unknown
causes of secondary seizures (4)
- brain tumor
- acute ETOH w/d
- electrolyte imbalance
- drugs
what are the risk factors for seizures (12)
- genetic predisposition
- acute febrile state
- head trauma
- cerebral edema
- abrupt cessation of drugs
- infection
- metabolic disorder
- exposure to toxins
- hypoxia
- acute drug/etoh w/d
- F&E imbalances
neuro connected
sodium
trigerring factors for seizures (8)
- increased Px activity
- hormonal shifts (adolesants)
- stress
- fatigue
- alcohol
- caffeine
- some chemicals
- medication
Dx procedures used to rule out cerebral mass (3)
- CT
-MRI
_EEG
can induce Szs during EEG
flashes of stobe light
what does sedation with Dx procedures do
alters brainwaves
should be done before and after procedure of EEG
washing of hair to remove oils,sprays, and glue
can be given with MRI/CT/EEG for Dx of Szs
precedex
restricted part or one hemisphere of brain
partial
bilateral involvement
generalized
simple partial szs charac (5)
- no impairment of conciousness
- may have aura
- Sx depend on area of brain
- alter. in finger/hand/mouth
- sensory alteration- smell/taste/sound/visual
beings in one area and spreads sequentially to adjacent muscles
jacksonian szs
some can often tell when they are going to have one by taste,sound,smell
aura
impaired consciousness and repetitive activities during event
complex partial
what are automatisms (4)
lip smacking
chewing
mumbling
fumbling with hands
what do complex partials have a postictial state of (2)
confusion
amnesia
what can complex partials evolve into
generalized tonic clonic
outcomes of complex partials
interfere with life
szs that can progress to complex
simple
typical tx for complex partials
more than one anticonvulsant
deep brain structures on both hemispheres
generalized szs
what are the types of generalized szs (5)
- absence (non convulsive)
- tonic
-clonic
-atonic
-tonic-clonic (convulsive)
have no loss of motor function
absence szs
very important with generalized szs
airway
character. of tonic-clonic szs (grande mal) (3)
- aura/no aura
- unconcious
- falls to ground
what happens in the tonic phase (6)
- sharp rhythmic muscle contractions
- rigid muscles include (diaphragm/chest)
- neck hyperextended
- all extremities extended
- breathing may cease/apnea
-postictial state
what are the rigid muscles in the tonic phase
diapragh and chest
generalized szs that never stop
status eptilipticus
charac. of tonic szs (3)
- sudden onset
- tonic extension/flexion of head/trunk and/or extremities
- other neuro abnormalities
what do tonic szs occur in relation to (3)
- drowsiness
- right after falling asleep
- right after awakening
tonic Sz have extenison/flexion of what (3)
- head
-trunk
-extremities
clonic szs charac (4)
- rhythmic motor jerking movements
- unilateral/ bilateral
- any age
- unusual
what happens in postictal state (4)
-may sleep
-confusion
-amnesia
- some incontinence
when are absence sxs dx
childhood
charac of absence szs (4)
- blank stare
- facial automatisms (blinking)
- impaired conciousness
- brief cessation of movement
-
what are the trigers for absence szs (2)
-hyperventilation
-photic stimuli
needed for emergencies with szs
oral airway are HOB
Sz care (10)
- observe aura
- observe beginning behavior/motor activity/eyes/ pupils
- dont force anything to PO
- note incontinence
- time Sz
- suction/02 available
- ordered meds
- loosen clothing/bedrails up
- document all
- note postural state
what should be noted with the postitical state in sz care (4)
- difficult to arouse
- confusion
- speech
-sleeps
Sz precautions to have in place (5)
- standby 02
- suction
- IV access
- side rails up
- bed in lowest position
what are the IV anticonvulsants (3)
- benzos (ativan)
- hydantoins ( dilantin/cerebyx)
- barbs (phenobarbital)
what is the 1st choice IV anticonvulsant
ativan ---lorazepam
longer acting IV anticonvulsant
barbituate (phenobarbital)
what are the PO anticonvul meds (8)
- clonazepam (klonopin)
- phenytoin (dilantin)
- lamotrigine (lamictal)
- valproic acid (depakene)
- carbamazepine (tregretol)
- ethosuximide (zarontin)
should be checked with PO anticonvul
liver function
when are hydantoins given
partial and generalized szs
effects of hydantoins (4)
- dilantin ( cardiac effects/ decreases effectiveness of birth control/ teratogenic)
- gingival hyperplasia
- decrease in plts and WBC
- Tfeeding decrease blood levels (10-20mcg/ml)
effects of dilantin (3)
- cardiac effects
- decreases effects of birth control
- teratogenic
important with hydantoins (4)
- difficult to give
-irritating
-give slowly
- oral care
charac of barbituates (3)
- tonic clonic and acute szs
- resp depression
- no antidote
charac of benzos (4)
- status epilepticus/absence/ maintenance
- consider 1/2 life of drug used
- resp depression
-antidote (flumenazol)
what type of szs are benzos used for (3)
-status epilepticus
-absence
-maintenance
what is drug of choice for status Epil.
ativan
SE of valproates (3)
- blood dyscrasias
- pancreatitis
-liver toxicity
valproates used for maintenance of what szs (3)
- tonic clonic
- partial
- psychomotor
needs to be done with valproates (2)
-cbc
-lab mtr
Sz mgnt (3)
-ketogenic diet
- surgery
- vagal nerve stimulators
what is a ketogenic diet
- high fat, low carbs, low protein to induce ketosis
why are ketogenic diets used
to induce ketosis
what does surgical mgnt involve with Szs
sepating brain hemispheres or removin epileptic foci
implant of an electirc stimulator above left collarbone with a 3 coil lead that wraps around left vagus nerve
VNS
where VNS generator pack implanted
chest or axilla
programming for VNS
two tiered
what are the types of programming for VNS (2)
- conti stimulation- 30 sec on 5 min off 24/7
- demand for szs- activated by pt or caregiver
how is demand for sz activated
by the pt or caregiver swiping a wand across the generator to activate the stimulus
complications of VNS (5)
coughing/swallowing/hoarseness
- infection
- bedding
- tingling
- hoarseness
when having an MRI what must one know
if VNS is present
nsg intervention for pt education (4)
- mtr antiepileptic drug levels
- maintain therapeutic levels
- possible drug interactions
- med alert bracelet
what is status epilepticus
cont' series of szs
what does status E result in (3)
- metabolic demands
-cerebral hypoxia
- resp arrest
what does status E occur from
- abrupt cessation of pharm tx
meds for tx of status E (3)
- diazepam (valium)
- lorazepam (ativan)
- fosphenytoin (cerebyx)
has a loading dose and cont/ infusion
cerebyx (fosphenytoin)
inflammation of the membranes and the fluid space surrounding the brain and spinal cord
meninigitis
types of meningitis (2)
- septic
-aseptic
cause of aseptic meningitis (4)
- viral infection
- lymphoma
- leukemia
- brain abscess
cause of spetic meningitis
- bacteria (step pneum, neisseria, meningitidis)
infectious process of the CNS (bacterial, viral, Tb)
infectious neuro disorders
common in young adults (dorm rooms, etc)
neisseria
what are the meningitis organisms in the imunosuppresed (5)
- strep pneu
- neisseria meninigitidis
-fungal-candida
- crytoccous
- mycobacterium TB
what is the easiet to tx (PCN)
neisseria
how does one transmit meningitis
catch the organism and then it crosses BBB in blood stream
clinical presentation of meningitis (8)
- fever
-nuchal rigidity (early)
- + Kernigs and Brudzinski
- photophobia
- rash (petechial/purpuric)
- Szs (pneumococcal)
- HA
-irritability
important with nuchal rigidity
dont move the head
involuntary raising of the knee
brudzinski
pain in mennigis
kernigs
complication of meningitis (7)
- brainstem herniation
- DIC
- meningococcemia
- septic shock
- SIADH (increased ICP)
-cerebral palsy (aftermath)
-hearing deficits)
cause of brainstem herniation
increased ICP
cause of meningococcemia
nieserria in blood stream
cause of septic shock
strep
help tp break up clots
fibrin split products
what is polymerase chain reaction (PCR)
a virus that should be pretx with antibiotics
dx of meningitis (8)
- LP
- CBC with diff
- CSF
- culture blood/urine
- rapid antigen testing
- PCR
- rectal swab
- if DIC- coag panel
what does rectal swab culture show
viral men
decrease fast with coag panel due to DIC
fibrinogen
done with CSF (4)
- cell count/diff
- protein
-glucose
-antigen testing
increased in CBC with diff with menig
WBC and neutros
present in CSF if bacterial
neutros
precautions for meningitis
contact airbourne and droplet
medical mgnt for meningitis (5)
- vaccincation HFLu, Spneu, and meninigococcal
- early IV abx
- Cipro for those exposed
- desamethasone
- tx for dehydration/ shock/sz
used to decrease hearing deficits
dexamethasone
who should be tx with nieserria
anyone in contact
nsg mgnt for meningitis (9)
- IV abx
- Sz precautions
- VS/neuro assess
- Daily wt/I&O
- Elec/ urine spec/ osmolarity
- isolation precaut.
- Tx those in contact
- hemodynamic mtr
- tx complicatons (HA, Sz)
what happens when dexamethasone is given prior to abx
inhibit cytokine cascade
scary with tx of menin
they look worse before they look better d/t breakdown
process of abx tx (3)
- rapid bacterial lysis
- release of bacterial cell wall membrane fragments
- increased inflam and ICP
viral with severe HA
aseptic menin
used for contacts with menin
cipro (chemoprophylaxis)
decreases with bacterial d/t what
glucose d/t bacterial eating it up
collection of infectious material within brain tissue
brain abscess
at increased with for brain abscess (2)
-immunocompromised
- otitis media/mastoiditis/sinusitis/dental infections
S&S of brain abscess (5)
- HA
-fever
- vomitting
- neurologica deficits
- ICP S&S
Dx of brain abscess
- MRI
-CT
how is CT performed for Dx of Menin
guided aspiration used to identify the causative organisms
medical mgnt for brain abscess (3)
-control ICP
- drain abscess
-abx/corticosteroids( edema)
nsg mgnt for brain abscess (3)
- neuro assess and responses to tx
- ensure pt safety
- provide supportive care
acute inflammation process of the brain tissues
encephalitis
causes of encephalitis (3)
- viral (herpes simplex)
-vector borne viral infec ( west nile)
- fungal infec
Dx of encephl (4)
- EEg
-LP
-cultures
- PCR
medical mgnt for encepal
- acyclovir for HSV
- amphotericin/antifungals
acyclovir charac (3)
- no bacteriostatic H2O
- 1 hr infusion
- mtr renal function
amphotericin charach (3)
- mix with D5W
- must use large filter (5mcron)
- start slow (hypotension/shock
what should be done with amphotericin
mtr Bp q 15 min,,, stay in room
encephalopathy with hepatic, metabolic, neurologic failure
reyes syndrom
what is reyes preceded by
viral infection
increased risk for reyes with what
ASA use
results of reyes (3)
- undetected metabolic disorder/toxins
- neuro deterioration
-liver failure
contains ASA
pepto
complications with reyes (3)
- blood sugar declines
- ammonia levels rise
- rise in cerebral edema (decrease LOC/szs)
-
dx for reyes (3)
- liver bx/scan
- ammonia level
-liver enzymes (ALT/SGPT)
tx for reyes (3)
- glucose
- anticonvulsants
- mtr coags
toxic to brain and causes encephalopathy
ammonia
issues with liver biopsy
bleeding
% of cancers that result in brain mets
20
tx for brain mets (7)
-palliative
- corticosteroids
-hyperosmotic diuretics
- chemo
- thrombosis (LMWH)
- pain control
- nutritional support
has little effect with mets
chemo
how are spinal cord tumors classified
by anatomic relation to spinal cord
intramedullary
within the cord
extramedullary/extradural
outside the dural membrane
presentation of spinal cord tumors (3)
- pain
-weakness
- loss of motor function/reflexes/sensation
used with spinal cord tumors to decrease CSF buildup
lumbar drains
what does tx of spinal cord tumor depend on
tumor and location
used with SC tumors to decrease compression
dexamethasone
classification of brain tumors based on what
- location
-characteristics
types of primary tumors (6)
- gliomas
- meningiomas (encapsulated)
- acoustic neruromas
- pituitary adenmoas
-angiomas
-metastatic
masses of abnormal blood vessels
angiomas
what is plasmaphoresis
removing of plasma containing antibodies, then returning cells
what are the blood therapies
-IVIG
-plasmaphoresis
should be done with IVIG (5)
-record lot #
- baseline VS
- epi/benadryl
- start slow and then increase
- know dose
complications of neuro oncologic disorders (4)
- increased ICP
- Szs
- hydrocephalus
- altered pituitary function
tx of hydrocephalis
shunts
what do manisfestations of neuro oncologic disorders depend on
- tissue infiltrated and compressed by the neoplasm
what tissues can become infiltrated with neuro oncologic disorders (3)
- dura
-around cranial nerves
-brain tissue
dx for GB
electromyelogram
important to watch with GB
resp involvement
what does GB often follow
resp or GI infection
breaks down with GB
myelin sheath
where does GB start
feet but may begin in hands
progression of GB
hours to weeks
length of GB
plateaus for 2-3wks and then recovery in 6-12mths
Dx of brain tumors (5)
- neuro exam
- CT
- MRI
- CSF study
- biopsy
done if mass is present with brain tumor
MRI
manifestations of brain tumors (4)
- sx of increased ICP
- HA in am
- vomitting
- visual disturbances
SE of acoustic neuroma (3)
- hearing
-tinnitus
- vertigo
Se of pituitary adenoma
hormonal effects
radiation therapy (2)
- external beam
- brachytherapy
tx for childrean
infratentorial
tx with adults
supratentorial
tx for guillain barre (3)
- supportive
- plasmaphoresis
-IVIG