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73 Cards in this Set
- Front
- Back
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What does a tension headache feel like?
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Bilateral tightening of a band around the head
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How do you treat tension headaches?
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Nonopiod analgesics alone or with sedatives, muscle relaxant, tranquilizer, or codeine
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How does a migraine feel?
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Recurring unilateral or bilateral throbbing pain
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What triggers migraines?
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Foods with amines like cheese and chocolate
Foods with nitrites like hot dogs, vinegar, onions, MSG, aspartame. Fermented foods, caffeine, oranges, tomatoes, nicotine, ice cream alcohol, stress fatigue. Family hx |
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What meds are used for migraines?
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triptans (e.g.sumatriptan (Imitrex) and Topamax (an antiseizure med), cardiac meds, antidepressants, Botox (takes months to work)
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How do "-triptan" meds work?
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Affect selected serotonin receptors, treating the primary cause of migraines. Vasoconstricts.
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Who should you not give Imitrex to?
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It vasoconstricts, so don't give it to those with cardiac, cerebrovascular, or peripheral vascular problems. May make HTN worse.
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What should I know about Topamax?
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Don't D/C abruptly b/c it can cause seizures, may take 3 months to work, drink plenty of fluids to avoid kidney stones
Used for seizures and migraine headaches (causes decreased electrical activity in the brain) |
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What do cluster headaches feel like?
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Repeated headaches for weeks or months around one eye, burning or sharp pain. Can last for months!
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Tx for cluster headaches...
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100% O2 at 6-8L for 10 min. Triptans (Imitrex)
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Tonic means...
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muscle contraction
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Clonic means...
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alternating contraction and relaxation of muscles
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How do you take care of a pt having a seizure?
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Maintain airway, observe, keep them out of harm's way.
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What is the concern in the postictal phase of a seizure?
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Aspiration. Put in recovery position and use suctioning.
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Metabolic causes of seizures...
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acidosis, electrolyte imbalances, hypoglycemia (BG <50), hypoxia, alcohol withdrawal, dehydration, water intoxication (upsets fluid and electrolyte balance)
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If a person has never had a seizure before and does not have any metabolic disturbances, think....
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brain tumor
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What happens with a tonic-clonic seizure?
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Body stiffens for 10-20 sec then jerks extremities for 30-40 sec.
Cyanosis, excessive salivation, tongue or cheek biting, incontinence |
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What happens with an absence seizure (petit mal)?
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Staring spell in kids precipitated by hyperventilation or flashing lights
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What type of seizure would a person wear a helmet?
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Atonic - drop attacks. Risk of head injury.
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What sort of seizures are automatisms associated with?
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Complex partial seizures
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What is an automatism?
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repetitive movement like lip smacking or continuing an activity before the seizure and not remembering it. May also be picking at clothing, bumbling with objects, or simply walking away.
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What is status epliepticus?
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One seizure after another that doesn't stop.
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What complications does status epilepticus cause?
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Ventilatory insufficiency, hyposemia, cardiac dysrhythmias, hyperthermia, systemic acidosis.
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How do we treat status epilepticus?
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Lorazepam or diazepam (Valium or Ativan) intranasal if you can't give it IV. B/c they are short acting, follow with phenobarbitol or phenytoin.
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Sudden Unexplained Death in Epilepsy is higher in...
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African Americans
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Teaching for Tegretol
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Don't take with grapefruit juice, report visual abnormalities, abrupt withdrawal may precipitate seizures
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Dilantin normal lab value
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10-20mcg/ml Toxicity includes abnormal eye movements, slurred speech, dizziness, drowsiness.
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Carbamazine (Tegretol) normal lab value
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5-12mcg/ml Toxicity includes drowsiness, staggering, slurred speech, vomiting
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Phenobarbitol normal lab value
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10-30mcg/ml Toxicity is bradycardia, bradypnea, hypotension, pulmonary edema, acute renal failure
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Ethosuximide (Zarontin) normal lab value
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40-100mcg/ml Toxicity: N/v Cns depression
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What kind of diet do seizure pt's get?
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ketogenic diet b/c it starves the brain of carbs
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Vagal nerve stimulation for seizures...
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Activate cranial nerve X with a magnet, wurgery q 5 yrs to replace battery. Side FX - hoarseness, dyspnea, cough, tingling in neck
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Autonomic signs of seizure...
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goosebumps, perspiration, moving up and down
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Acute Intervention for seizures...
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Observe and record the details of the exact time of onset, course, nature, and duration.
Don't restrain. Suction and O2 if needed. Maintain patent airway, but don't stick tongue depressor in the mouth. |
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Seizures...
Ineffective breathing pattern interventions... |
1. Position side lying to maximize ventilation potential.
2. Monitor RR and O2 status. 3. Identify obstruction and suction 4. Loosen tight clothing 5. Apply O2 |
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Seizures...
Risk for injury interventions... |
1. Keep suction, Ambu bag, oral or nasopharyngeal airways at bedside.
2. Padded side rails |
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MS results from...
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damage/scarring (gliosis) of myelin sheath
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Where does MS usually occur?
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Cooler climates like NE U.S.
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Risk factors for MS:
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Cool climate
Woman 20-40 years old Caucasian |
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What exacerbates MS?
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physical/emotional trauma, fatigue, INFECTION
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S/S of MS
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Affects all body systems:
Weakness/paralysis of the limbs, trunk, or head. Diplopia Scanning speech Paresthesias Patchy blindness (scotomas) Vertigo Tinnitus Attention deficit Lhermitte's sign |
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Lhermitte's sign is...
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Electric shock feeling that radiate's down the spine or in to the limbs with flexion of the neck.
Associated with MS. |
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CSF fluid in MS contains...
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Increased IgG or Lymphocytes and monocytes
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Radiology in MS...
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MRI detects sclerotic plaques as small as 3-4mm. Characteristic white-matter lesions scattered through the brain or spinal cord.
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Immunomodulators in MS...
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beta-interon (Betaseron, Avonex, Rebif) and glatiramer acetate (Copaxone)
Pt needs to perform self injection techniques and may have flu like symptoms in the start of therapy. |
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Aricept is used for...
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Dementia with MS and AD.
Maintain adequate hydration 2-3L/day and watch for orthostatic hypotension. |
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Ampyra...
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Used with MS. Enhances nerve conduction, so watch for seizures.
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MS:
Impaired physical mobility interventions... |
Use assistive deves like canes, walkers, or wheelchairs.
ROM and stretching for spasms and contracted muscles. |
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MS:
Impaired urinary elimination interventions... |
UTI's can exacerbate MS!
Drink lots of fluids to dilute the urine. Establish toileting routine. Intermittant cathetarization for retention (residual >50ml) |
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Complimentary therapy for MS...
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Excercise, especially H2O therapy to retrain muscles.
B12, vit C |
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MS diet...
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Gluten free, low-fat, raw veggies, high-protein, high roughage (for constipation)
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What is the Parkinsonian triad?
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1. Tremor
2. Rigidity 3. Bradykinesia |
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Patho of Parkinson's Disease
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Destruction of substantia nigra leads to loss of dopamine
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How do you help a person with diplopia?
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Put an eye patch on one eye
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There is an imbalance b/w _____ and _____ in Parkinson's disease. (2 neurotransmitters)
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acetylcholine and dopamine
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Posture, gait, and motor function in Parkinson's disease...
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Stooped, shuffline, and bradykinesia
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Drug of choice for Parkinson's...
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levodopa/carbidopa (Sinemet)
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Bromocriptine
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Used for Parkinson's. Dopamine receptor agonist.
Side FX: orthostatic hypotension Notify doc of severe headache that won't let up. |
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Name 2 anticholinergic meds
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Cogentin and Artane. Used for PD.
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What suffix do MAOI's have?
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-giline
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COMT inhibitors
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Used in PD.
Blocks enzyme that breaks down levodopa in peripheral circulation, thus prolonging the effect of Sinemet. -capone |
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What should alert the nurse to levodopa OD?
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Slow, writhing, continuous, involuntary movement of the neck (athetosis)
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PD dietary considerations..
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Roughage and fruit, bite sized pieces, 6 small meals/day less exhausting than 3 large. Absorption of levodopa impaired by protein, so limit protein, multivitamins and fortified cereals to the evening meal.
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PD interventions...
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2 blocks under back legs of chair to facilitate getting up.
Rugs and excess furniture removed to avoid stumbing. Ottoman to avoid dependant edema. Simplify clothing by using slip on shoes and Velcro hook and loop fasteners or zippers instead of buttons and hooks. Elevated toilet seat. |
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PD:
Impaired mobility interventions |
Assist pt to stand and rock body from side to side to stimulate balance.
Drop rice kernels and have pt step over them. Take one step back and 2 steps forward Lift toes when stepping |
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Neurotransmitter affected with Myasthenia Gravis
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Acetylcholine
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Patho of Myasthenia Gravis...
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Auto immune to Ach receptor sites and thymus gland abnormalities
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Myasthenia Gravis Assessment
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Progressive muscle weakness, poor posture, "peek sign", ptosis, diplopia, fatigue, incontinence
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What is the peek sign?
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In MG, the pt forces eyelid closure. Pt is unable to bury eyelashes and after 30 seconds, pt can't keep eyes fully closed.
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What test is diagnostic of Myasthenia Gravis?
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Tensilon test. Pt has improved muscle contractility after IV of Tensilon. It is anticholinesterase. Have atropine ready to counteract the effects of Tensilon.
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Nutritional support for MG...
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Schedule drugs so peak is at mealtime so they can eat better.
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MG drugs...
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Mestinon which is an anticholinesterase. It causes excessive salivation, GI upset, and excessive urination
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Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig's Disease) is caused by...
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progressive degeneration of motor neurons possibly due to abnormal metabolism of glutamate.
Precipitated by respiratory or GI infection in past couple weeks. |
