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109 Cards in this Set
- Front
- Back
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Tips on how to treat someone iwth Alzheimers Disease
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1.remain flexible, patient and calm
2.respond to the emotion not the behavior 3.don't argue or try to convince 4.use memory aids 5.acknowledge requests and respond to them 6.look for the reasons behind each behavior 7.consult a physician to identify any causes 8.explore various solutions 9.don't take the behavior personally 10.share your experience with others |
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What is a TIA?
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brief episodes of neurological dysfunction resulting
from focal cerebral ischemia not associated with permanent cerebral infarction. Brain ischemia - chest pain to the heart |
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What is stroke risk after TIA?
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Ten percent to 15% of patients
have a stroke within 3 months, with half occurring within 48 hours. |
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What is treatment for someone who has had a TIA?
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antiplatelet agents rather than oral anticoagulation are recommended to reduce the risk of
recurrent stroke and other cardiovascular events |
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What treatment reccommended for anti-platelent therapy?
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Aspirin (50 to 325 mg/d) monotherapy, the combination of aspirin and extended-release dipyridamole, and clopidogrel monotherapy
are all acceptable options for initial therapy, 2) The combination of aspirin and extended-release dipyridamole is recommended over aspirin alone |
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Shoudl stroke patients be treated with statins?
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Yes even if they do not have elevated LDL levels, LDL goals < 70 in high risk groups
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Can a primary care provider diagnose someone with epilepsy?
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No must be done by epilepsy specialist or neurologist
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How to treat someone with epilepsy
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1.Antiepileptic drugs (AEDs), such as carbamazepine, sodium valproate, lamotrigine, and oxcarbazepine monotherapy
2.Combination therapy of AEDs 3.Short-term benzodiazepine treatment 4.Psychological treatments 5.Referral for assessment for neurosurgical treatment 6.Intravenous (IV) lorazepam or diazepam for immediate treatment of generalised tonic-clonic status epilepticus 7.Fosphenytoin with electrocardiography (ECG) monitoring or phenytoin with electrocardiography monitoring or phenobarbital for sustained control if seizures continue in generalised tonic-clonic status epilepticus 8.Rectal diazepam |
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What should be monitored when someone is on anti-epileptic drugs?
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CBC and LFT
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How to treat epileptic when pregnant
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Give Folic Acid daily, Cannot take progesterone only BCP's when taking enzyme-inducing anti-epileptic drugs
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What is first line treatent for AED's?
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Carbamazepine, sodium valproate, lamotrigine and oxcarbazepine can all be regarded as first-line treatments for partial and secondary generalised seizures.
A: Sodium valproate and lamotrigine are drugs of choice for primary generalised seizures and should also be prescribed if there is any doubt about the seizure types and/or syndrome classification. |
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How to care for someone when they are having a seizure
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stay calm, don't hold a person down or try to stop, time seizure, clear area around person so they do not hurt themselves, loosen ties around neck, put something soft under head, turn him on side, do not put anything in the mouth, grand mal seizure is not a medical emergency
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How to diagnose Parkinson's Disease?
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There are no specific tests for parkinsons disease, based on at least two of the three cardinal symptoms of resting tremor, bradykinesis (slowness of movement), and rigidity, & asymmetrical onset the next step in diagnosis is to use your medical history taking and neuro exam skills to rule out alternative causes. Thirdly, “prove” the diagnosis by a positive response to treatment, remembering that resting tremor can be stubborn and less improved by medications . A realistic confirmation can be made by prescribing a single 25/100-mg Sinemet tablet at HS, increasing to a TID dose. Patients whose symptoms respond almost certainly have Parkinson’s disease.
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WHat is Parkinson's disease caused from?
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Lack of dopamine
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What are lifestyle measure that can be taken to help someone with Parkinson's Disease?
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Exercise is the first and foremost strategy for maintaining flexibility and mobility, and for its sense of mental control and accomplishment
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What drugs are used to treat Parkinson Disease?
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Drug therapy targets low central dopamine concentrationsPrecursor to dopamine (Levodopa)
– Stimulate dopamine receptor with direct dopamine agonists (Mirapex, Requip, etc) – Prevent metabolism of dopamine (COMT and MAO inhibitors) – Enhance release of dopamine (Amantadine) |
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What is initial drug of choice for treating Parkinsons Disease?
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Sinemet (Levodopa/Carbiodopa)
Greater effect on bradykinesiaand rigidity |
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Know what dopaminergic & cholinergic neurotransmittors with Parkinsons disease
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look up
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Parkinison Disease prevelance
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uncommon before age 40, usually after 40 move common after 60
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What is earlier sign of PD?
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`resting tremor - often in just one hand, s/s initially asymetric (essential tremor is usually symetric) restig tremor will go away when patient moves
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What see with gait disorder?
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slow
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What are other common s/s of Parkinsonism?
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late onset postural instability, decreased olfaction, micrographia (small script)
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What are the five stages of Parkinson Disease?
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1) purely unilateral 2) bilat disease of any magnitude 3) mild postural instabiity 4) sig postural instability 5) no independent walking
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Should traetment always be started early with Parkinsons Disease?
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Can wait as disease may be resistant to meds and they may want to save meds for later
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How to dose levodopa/carbiodopa
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1 - 25/100 3x day. sustained release has not shown to be any better
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Lower back exam - straight leg raise for nerve root impingement
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have pt lay on back and ask them to activitly lift leg by themselves. If has sciatica cannot lift leg over 30 w/o pain, then passively lift leg for pt and ask when they experience pain. Measure difference in angle from active to passive
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Braggart Stretch Test
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Pracitioner lift leg till pain then lower till no pain then forceably dorsiflex foot to see if pain reproducable
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Bow String Test
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Put pt ankle on shoulder and slightly flex knee and put pressure on back of knee to see if pain in back of thigh - shows tibial nerve root problems
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Hoover Test - for pt who says cannot move "right" or leg - measures how factual this statement is
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Have pt lay on back and put hands under both heels, ask pt to lift one leg at a time. Should feel counter weight of leg not being lifted. If feel no counter weight then leg could have nerve problems
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Test for sacroillitis: Pain deep inside buttocks. Gangsladn?
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if pain in right buttocks roll on left side (unaffected side) and have bend left leg towards body. Take right leg and stretch while straight backwards to try to reproduce pain in right buttucks
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Flamingo Test for sciatica?
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Have pt stand on one leg and see if causes pain.
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What labs to draw is suspect Alzheimer's ?
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look for anemias or folate deficiencies, thyroid fx, CMP
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What is mini Mental statis exam?
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Orientation to time 5 From broadest to most narrow. Orientation to time has been correlated with future decline.[4]
Orientation to place 5 From broadest to most narrow. This is sometimes narrowed down to streets,[5] and sometimes to floor.[6] Registration 3 Repeating named prompts Attention and calculation 5 Serial sevens, or spelling "world" backwards[7] It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.[8] Recall 3 Registration recall Language 2 Name a pencil and a watch Repetition 1 Speaking back a phrase Complex commands 6 Varies. Can involve drawing figure shown. |
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How often to measure blood levels for seizure meds?
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twice a year
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Seizure Patients
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Referral to neurologist, know what meds they are on to be aware of med interactions
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Look at spine conditions
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know difference of presentation of spinal stenosis, degenerative disc disease vs.
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Know when to do MRI on back pain
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Only if suspecting surgical condition or tumors
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How does a pt with spinal stenosis relieve pain
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Leaning forward opens up space in spine and relieves pressure on nerve
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Know what positive straight leg test is?
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on test - looking for sciaticia
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Look at MS
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Do not need treatment modalities - know s/s?
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What are physical findings consistent with degenerative lumbar spinal stenosis?
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Lumbar spinal stenosis should be considered in older patients presenting with a history of severe lower extremity pain which improves or resolves with sitting and postural abnormalities on physical examination such as a wide-based gait. Physical findings adding to this consideration include an abnormal Romberg test, thigh pain exacerbated with extension and neuromuscular deficits. Patients whose pain is not made worse with walking have a low likelihood of stenosis.
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What is best test if suspected spinal stenosis?
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MRI
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What are risk factors for stroke or TIA?
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hypertension, diabetes, hyperlipidemia, smoking, heavy alcohol, inactivity, metabolic syndrome, obesity, a-fib, acute MI, cardiomyopathy, carotid stenosis, valve disease
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What testing is recommended for low back pain
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x-rays. no MRI in first 6 weeks, flexion, extention testing of legs,
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What meds are recommended for low back pain?
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NSAIDS, or tylenol with CAD risk factors, Norepinephrine reuptake inhibitors for chronic LBP (A)Limited use (2 to 3 weeks) of opioids with longer periods for more invasive procedures (C)
Skeletal muscle relaxants as 2nd-line treatment in moderate to severe acute LBP not adequately controlled by NSAIDs (B) Skeletal muscle relaxants as 2nd- or 3rd-line treatments for acute radicular pain syndromes or acute post-surgical situations (I) Glucocorticosteroids for acute severe radicular pain syndromes (C) |
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What treatments are recommended for acute low back pain?
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aerobic exercise, strenghtening exercise, manipulation, massage, cold and heat application
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What is diagnositic criteria for alzheimers?
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memory impairment, & one or more of the below: aphasia (language disturbance), apraxia (impaired ability to carry out motor activities), agnosia (failure to recognize or identify objects) and/or disturbanc ein executive functioning. Gradual onset and continueing decline, Deficits not due to systemic conditions or stroke or parkinson's or hematoma, brain tumor
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What is diagnostic critera for vascular dementia?
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same as Alzehemiers, yet has focal neurologis s/s indicative of a stroke
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What else can cause dementia beside alzheimers and stroke?
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head trauma, chronic alcohol abuse,
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What are s/s of dementia?
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personality changes, memory loss, language disturbances, and problems with ADL's, pt usually not aware having problems - family or friends see it.
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Difference between aging cognitive loss and early dementia?
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aging memory loss manifests without signficatant other cognitive domains and not distrubance in ADL's
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What is stage 1 of Alzeimers disease?
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memory losos, time and spatial disorientation, poor judgement, personality changes, withdrawal or depression, perceptual disturbances
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What is stage 2 of Alzheimers Disease?
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memory worsens - recent and remote, increased aphasia, apraxia, hyperorality, disorientation, restlessness, irritability, loss of impulse control
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What seen in late stage Alzheimers?
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incontenince, loss of motor skills, decreased appetite, agnosia, apraxia, impaired communication, poss inability to recognize familiy, loss of self care abilities, impaired cognition, depressed immune system
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Average time of Alzheimers diagnose til death
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9 years
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What types of drugs treat Alzheimers?
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cholinesterase inhibitors and NMDA recepotor antagonists. & memantine for severe s/s - do not alter course, but can slow course
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How to help vascular dementia?
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control B/P, glycemic control, cholesterol, smoking and alcohol consumption may delay further progression
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What is apraxia?
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Forget how to perform tasks, loss of ability to execute or carry out tasks
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What can movement disorders & essential tremors be caused from?
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inherited, infectious, substance abuse, medication side effects, trauma, or idiopathic - symptoms worsen with stress or fatigue
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What to include with physical exam with movement disorders?
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description of movements, side of body affected, and whether movements occur when at rest or in motion. Test tendon reflexes, rombergs sign, babinskis's and do a cognitive test
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What diagnostics with essential tremors or movement disorders?
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CT or MRI, thyroid, exclude pheochomocoytoma. LFT's,
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Treatment for movement disorders?
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no cure only treat symptoms. Haldon and phenothiaziens
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What causes MS?
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autoimmune disease which immune system attacks myelin which surrounds and protects nerves - women more affected than men
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What are s/s of MS?
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mild initially, sensory s/s, optic neuritis, limb weakness, diplopia, hystagmus, unsteady gait. unexplaine fatigue, temp or heat sensitiviey, hx of bandlike sensation around the waist, muscle spasms, altered bowel or bladder fx
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What is clinical presentation of Parkinson's Disease?
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asymetric tremors (seen at rest and disappear with movement), rigidity and flexed posture, bradykinesia, loss of postural refelxes and difficulty initiating movement, reduction of spontaneious facial expression which responds to treatment with levodopa
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What are some complications of PD?
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depression, cognitive dysfunctio, sensory s/s of burning or tingling in affected extremity, fall risk,
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What foods can decrase absorption of levodopa?
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milk, meat.
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What are side effects of dopatime agonists?
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dizziness, confusion, halluciniations or delusional thinking
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What is common cause of seizure in elderly?
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Stoke
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Which seizures are more genetic in children?
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absence (petit mal), juvenille myclonic and generlized convulsive epliepsy - 1/3 of all seizures and affect entire brain - other types are focal seizures affects only portion of brain
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What is a seizure?
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a group of neurons that produce excessive electrical discharges in the brain
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What is a partial seizure
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focus on one hemisphere of the brain.
Simple partial seizures (consciousness not impaired) 1. With motor signs a. focal motor without march b. focal motor with march (Jacksonian) c. versive d. postural e. phonatory (vocalization or arrest of speech) 2. With somatosensory or special-sensory symptoms (simple hallucinations, e.g.,tingling, light flashes, buzzing) a. somatosensory b. visual c. auditory d. olfactory e. gustatory 3. With autonomic symptoms or signs (including epigastric sensation, pallor, sweating, flushing, piloerection, and pupillary dilatation) 4. With psychic symptoms (disturbance of higher cerebral function). These symptoms rarely occur without impairment of consciousness and are much more commonly experienced as complex partial seizures. a. dysphasic b. dysmnesic (e.g., d‚j... vu) c. cognitive (e.g., dreamy states, distortions of time sense) d. affective (fear, anger, etc.) e. illusions (e.g., macropsia) f. structured hallucinations (e.g., music, scenes) |
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What is a complex partial seizure?
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B. Complex partial seizures (with impairment of consciousness;
may sometimes begin with simple symptomatology) 1. Simple partial onset followed by impairment of consciousness a. with simple partial features (A.1.-A.4.) followed by impaired consciousness b. with automatisms 2. With impairment of consciousness at onset a. with impairment of consciousness only b. with automatisms C. Partial seizures evolving to secondarily generalized seizures (This may be generalized tonic-clonic, tonic, or clonic.) 1. Simple partial seizures (A) evolving to generalized seizures 2. Complex partial seizures (B) evolving to generalized seizures 3. Simple partial seizures evolving to complex partial seizures evolving to generalized seizures |
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What is a Generalized seizure?
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involvement of both hemispheres. Consciousness may be impaired and
this impairment may be the initial manifestation. Motor manifestations are bilateral. A. 1. Absence seizures a. impairment of consciousness only b. with mild clonic components c. with atonic components d. with tonic components e. with automatisms f. with autonomic components (b through f may be used alone or in combination) 2. Atypical absence May have: a. changes in tone that are more pronounced than in A.1 b. onset and/or cessation that is not abrupt B. Myoclonic seizures Myoclonic jerks (simple or multiple) C. Clonic seizures D. Tonic seizures E. Tonic-clonic seizures F. Atonic seizures (astatic) Combinations of the above may occur, e.g., B and F, B and D. |
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What is common cause of seizure in elderly?
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Stoke
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Which seizures are more genetic in children?
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absence (petit mal), juvenille myclonic and generlized convulsive epliepsy - 1/3 of all seizures and affect entire brain - other types are focal seizures affects only portion of brain
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What is a seizure?
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a group of neurons that produce excessive electrical discharges in the brain
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What is a partial seizure
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focus on one hemisphere of the brain.
Simple partial seizures (consciousness not impaired) 1. With motor signs a. focal motor without march b. focal motor with march (Jacksonian) c. versive d. postural e. phonatory (vocalization or arrest of speech) 2. With somatosensory or special-sensory symptoms (simple hallucinations, e.g.,tingling, light flashes, buzzing) a. somatosensory b. visual c. auditory d. olfactory e. gustatory 3. With autonomic symptoms or signs (including epigastric sensation, pallor, sweating, flushing, piloerection, and pupillary dilatation) 4. With psychic symptoms (disturbance of higher cerebral function). These symptoms rarely occur without impairment of consciousness and are much more commonly experienced as complex partial seizures. a. dysphasic b. dysmnesic (e.g., d‚j... vu) c. cognitive (e.g., dreamy states, distortions of time sense) d. affective (fear, anger, etc.) e. illusions (e.g., macropsia) f. structured hallucinations (e.g., music, scenes) |
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What is a complex partial seizure?
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B. Complex partial seizures (with impairment of consciousness;
may sometimes begin with simple symptomatology) 1. Simple partial onset followed by impairment of consciousness a. with simple partial features (A.1.-A.4.) followed by impaired consciousness b. with automatisms 2. With impairment of consciousness at onset a. with impairment of consciousness only b. with automatisms C. Partial seizures evolving to secondarily generalized seizures (This may be generalized tonic-clonic, tonic, or clonic.) 1. Simple partial seizures (A) evolving to generalized seizures 2. Complex partial seizures (B) evolving to generalized seizures 3. Simple partial seizures evolving to complex partial seizures evolving to generalized seizures |
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What is a Generalized seizure?
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involvement of both hemispheres. Consciousness may be impaired and
this impairment may be the initial manifestation. Motor manifestations are bilateral. A. 1. Absence seizures a. impairment of consciousness only b. with mild clonic components c. with atonic components d. with tonic components e. with automatisms f. with autonomic components (b through f may be used alone or in combination) 2. Atypical absence May have: a. changes in tone that are more pronounced than in A.1 b. onset and/or cessation that is not abrupt B. Myoclonic seizures Myoclonic jerks (simple or multiple) C. Clonic seizures D. Tonic seizures E. Tonic-clonic seizures F. Atonic seizures (astatic) Combinations of the above may occur, e.g., B and F, B and D. |
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What are risk factors for epilepsy?
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complicated pregnancy or childbirth, delayed childhood development, childhood diseases like meningitis adn enchephalitis, head trauma or loss of conscienceness, family hx of epilepsy.
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When should a pt go to the ER or prompt physian referral?
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1st seizure
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What to exclude when somone comes in with new - onset seizures?
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hypoglycemia, electrolytes abnormalities, or renal failure Hepatice failure. Alcohol and drug levels, trauma or tumor or stroke, arrhythmias or heart block
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What tests to order with new onset seizures?
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EEG, can do CT scans to look for structural abnormalities (large mass lesions) MRI for small lesions or changes, CBC, electrolytes, glucose mgso4, CA, BUN, creatinine, LFT, coag studies, tox screen UA and preg test
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What is status Epilepticus
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A continuous seizure for over 30 mintues - can be cuased from patients not taking the meds correctly
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How to manage epilepsy?
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50% patietns are controlled with meds, best to prevent a seizure, 25% somewhat controlled, 25% meds don't help. Most people are not treated if they present iwth one seizure as many do not have a reoccuring seizure unless they have an abnormal EEG or presence of underlying cause
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How to treat seizures with meds?
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always start with one med at a low dose and titrate up. If does not work add another med and titrate old med down after new med has been titrated up to effective dose. Can use 2 meds if seizures not controlled. Side effects with anti-seizure meds common
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How often to obtain bld levels of AED meds?
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At least yearly and need list of all other meds as some AED are protien bound which can alter med in bld if other protien bound drugs are used.
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What labs should be checked when on AEDs?
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CBC, LFT, & electrolytes
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Name common AED meds
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phenobarbital, phenytin (dilantin), Carbamazepine (tegrotol), Lamotrigine (Lamictal) Neurotin
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Define acute low back pain?
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lasting less than 3 weeks
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Define chronic low back pain?
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lasting > 7 weeks
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How is radicular or sciatic pain described?
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burning, sharp,intense, or stabbing pain evolving from lumbar or sacral area.
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What kinds of pain is suggestive of disc herniation?
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nerve root pain that radiates down one or both legs
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Where to see spinal stenosis pain?
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radiates to buttocks, pain d/t impede of cerebral spinal fluide and can be relieve by bending forward or sitting
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What to ask when presented with low back pain?
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onset, quality, quanity, severity, consistency, location, timing, aggravating or alleviating symptoms, associated symptoms, present status. Ask about recent injury, trauma, CA, recent lumbar puncture, infection, or chronic steriods
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How to assess low back pain with walking exercises?
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watch gait for foot drop, widenedn base of support,m joint instability or posture. See if can walk on heels (antibialis, L4) and on toew (gastorcnemiuis, S1)
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What else to asses with low back pain?
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motor strength - compare both sides, DTR's, sensation - pin prick & light touch, ROM
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How to manage low back pain?
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NSAIDS, - analgesia and control of inflammation, can add muscle relaxant if NSAIDS not working, meds only short term, key to improvement is mobilization adn activity.
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How long is bedrest indiction for low back pain?
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2-3 days then need to normal activities, use heat/ice, massage, exercises, PT, wear lumbar support, exercise necessary for healing
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What are 2 types of strokes?
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ischemic or hemorrhagic, ischemic most common, r/t from atherocllerotic disease where artery occulded with plaque or ischemic stoke can happen from embolism or rupture of plaque that travels to brain - area of brain then dies
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What is a TIA?
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transient ischemic attacks - small ischemic events. can be a precursor to a ischemic stroke not hemmorrhagic stroke
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Who is more likely to experience a stroke?
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women, hispanics and african americans
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What are risk factors for stroke?
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hypertension, age, smoker, carotid stenosis of more than 80%, a-fib, CHF, mitral stenosis, prosthetic heart valve, MI, drug abuse. contributing factors: obesity, sendentary lifestyle, elevated cholesterol
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What are some S/S of stroke?
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varies widley depending which artery is affected. loss of vision, weakness, numbness, language diff, cognitive difficulties,behavioral change, vertigo, balance problems
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What is seen in hemmorrhagic stroke that is usually not seen in ischemic stroke?
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headache, N/V, dizziness
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How to differentiate a TIA from a stroke?
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TIA s/s last under 24 hours.
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What tests to order when suspect stroke?
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CT scan, - with ischemic stroke may not show abnormalities until 12 hours or more, hemorrhagic stroke head scan abnormal
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How to manage a stroke?
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depends on presenting s/s, manage airway,usually B/P high to compensate and increase cerebral bld flow. Should stabilize in a couple of days, if presents w/i 3 hours of onset give thrombolytic therapy - goal to limit size of infarction, Those with TIA or minor stroke should be put on anti-platlet therapy, ASA sometimes coumadin if pt has A-fib, also can put on Plavix along iwth ASA
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