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110 Cards in this Set
- Front
- Back
most common type of pain |
headache |
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headache classified as what two categories |
primary or secondary |
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primary cause of headaches and examples |
cause is not a disease or medical condition ie tension, migraine, cluster |
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secondary headaches |
headaches caused by conditions such as sinus infection, neck injury or stroke |
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Prodrome |
Early s/s of impending disease, may last for severeal hours or days |
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what are two types of prodrome and examples |
neurogenic ie photophobia psychologic ie hyperactivity, irritability |
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aura |
immediately precedes the headache and may last for 10-30 minutes |
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What are symptoms of an aura |
bright lights, scotomas (patchy blindness), visual distortions such as zigzag lines, sensory-hearing voices or sounds that don't exsist, strange smells, motor-weakness, parallysis, feeling that limbs are moving |
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Most common type of headache |
tension |
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what headaches are more common in women |
tension, and migraine |
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site and quality of tension headache |
bilateral bandlike pressure "band squeezing the head", constant squeezing tightness |
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Duration of tension |
30 mins to 7 days |
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Do tension headaches have aura or prodrome? |
No prodrome May have aura such as photophobia or phonophobia. may reveal palpable neck and shoulder muscles, stiff neck |
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Dx studies of tension headache |
electromyography (emg) |
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drug therapy for tension headaches |
NSAIDs with or without sedatives, muscle relaxer, tranquilizer. |
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If taking aspirin what is the increased risk of |
upper gi bleed |
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what can happen with chrnoic and large doses of tylenol |
kidney damage and liver damage |
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age of onset of migraines |
20-30 y/o |
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quality and site of migraines |
usually unilateral. may switch sides. commonly anterior. usually throbbing, synchronous w/ pulse |
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duration of migraines |
4-72 hours |
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is migraine with or without aura more common |
without |
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triggering events of migraine |
food, hormonal fluctations, and stress. onset on awakening common |
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are there prodrome and auras in migraines? |
Yes they may be preceded. |
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What are some symptoms associated with migraine? |
N/V, irritability, sweating, "hibernate"-seek shelter from noise, light, odors, people, and problems. |
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Dx studies for migraine |
no specific test for migraines. if atypical r/t secondary may do a mri/ct |
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moderate complaints med for migraines |
ASA, NSAIDs, caffeine containing combo. |
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severe complaints med for migraines |
Triptans-Sumatriptan (Imitrex) |
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When should sumatriptan not be given? |
When a pt has hx of ischemic cardiac, cerebrovascular, or pheriphereal vascular, untrolled htn |
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additional meds that may be prescribed for migraines |
Topamax (antiseziure drug) BB, CCB, Botox, antidepressants (Elavil) |
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How long can it take for tx to work for migraines |
2-3 weeks |
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What to keep in mind when teaching a patient who is taking Topamax? |
Do not d/c abruptly-can cause seizures |
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What is something that a patient with any headache should do for tx of headaches and planning? |
Keep diary of headaches |
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Cluster headaches site and quality |
Unilateral, radiating up or down from one eye, severe bone-crushing |
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Who is cluster headaches more common is, how common are they? |
Men, rare |
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What might preciptate an attack of cluster headache? |
High altitudes with low o2 |
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Duration of cluster headaches |
few minutes to 3 hours |
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Time of onset of cluster headaches |
nocturnal, common on awakening. suddenly. |
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triggers of cluster headaches |
alcohol, strong odors, napping. |
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Associated symptoms of cluster headaches |
facial flushing or pallor, unilateral lacrimation, ptosis, rhinitis. sharp, stabbing head pain. pupil constriction |
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what nerve is in cluster headaches that cause the most pain |
trigeminal nerve (CN 5) |
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What dx studies may done for cluster headache? |
Hx, diary, CT/MRI to rule out aneurysm, tumor, infection |
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Tx for cluster headaches. |
Sudden onset make medication not as useful. acute tx is inhalation of 100% oxygen therapy x 10 minutes and can be repeated after a 5 minute rest. triptans are also effective. intranasal lidocaine is useful. prophylactic drugs-verapamil, lithium. |
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Most effective strategy in helping pts with headaches |
examine lifestyle, recognize stressful situations, and learn to cope with them more appropriately. daily exercise, relaxation periods. |
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Non drug therapy for tension headache |
massage and moist hot packs to neck and head |
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Non drug therapy for migraine headache |
quiet, dim light, enviornment |
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Avoid _________ and using ____________ may decrease headaches |
smoking, perfumes |
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Foods and other factors that can trigger headaches |
Amines (cheese, choc) nitrites (hotdogs) vinegar, onions, monosodium gluctamate fermented or marinated foods caffeine tomatoes, oranges, aspratame, nicotine, ice cream, alcohol, emotional stress, fatigue, drugs such as ergot containing preparations and monoamine oxidase inhibitors |
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Seizures |
Abnormal, sudden, excessive discharge of neurons (electrical) within the brain |
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Epilepsy |
Chronic seizure activity and indicates brain and CNS irritation |
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Causes of seizures |
genetic, trauma, tumors, circulatory or metabolic disorders, toxicity, and infections |
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Status epilepticus |
Rapid succession of epileptic spasms without intervals of consciousness |
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Partial seizures |
Begin in specific region of cortex indicated by EEG |
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Simple focal seizures |
does not involve loss of consciousness, sensory symptoms accompanied by motor symptoms. ie pt may have abnormal movements such as jerking of a finger or stiffening of part of the body or may feel like they are floating |
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Complex focal seizures |
patient loses consciousness for a few seconds. pyschomotor seizure with periods of altered behavior of which a pt is not aware. |
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Generalized seizures |
both sides of the brain. loses consciousness for a few seconds to several minutes.. aura not present. |
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types of generalized seizures |
tonic-clonic absence myoclonic atonic |
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tonic clonic seizures |
Grand mal seizure, most common loss of consciousness and falling to ground, stiffening of the body for 10-20 secs (tonic phase) and subsequent jerking of the extremeties for another 30-40 seconds (clonic phase). Cyanosis, excessive salivation, tongue or cheek biting, and incontinence may accompany the seizure full recovery in several hours |
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Absence seizure |
usually occurs only in children and rarely continues beyond adolescence. lasts seconds and individual may or may not lose consciousness. no loss or change in muscle tone occurs. brief staring spell that lasts for a few seconds. |
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Myoclonic seziures |
characterized by sudden excessive jerking of he body or extremities. may fall to ground |
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Atonic seizure |
drop attack. involves either tonic episode or sudden loss of muscle tone. |
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dx study of seizures |
EEG CBC, CT MRI to rule out lesions |
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Prevention of seizures |
wear helmets. improved perinatal and l&d care, practice good general health habits like diet and exercise |
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Safety during a seizure! |
Maintain airway*** Protect pts head,turn pt to the side if pt sitting, ease pt to the floor, loose constrictive clothing, do not restrain pt, do not place any objects in the pts mouth. |
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Other implications for pt having seizures |
ABC O2 suction preparation turn pt to side do not restrain monitor for incontinence adminster iv meds as prescribed privacy lifelong meds for chronic avoid alcohol, stress, strobe lights medic alert bracelet |
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Drug therapy for seizures |
Phenytoin (dilantin) carbamazepine (Tegretol) Phenobarbital Depakote |
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What are common side effects of antiseizure meds? |
diplopia, drowsiness, ataxia, mental slowing
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Do not_______antiseizure meds abruptly |
d/c |
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Therapeutic level of phenytoin (Dilantin) |
10-20 mcg/ml |
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therapeutic levels of carbamazepine (tegretol) |
3-14 mcg/ml |
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phenobarbital therapeutic levels |
15-40 mcg/ml |
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Common side effect of long term phenytoin (Dilantin) use |
gingival hyperplasia |
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gingival hyperplasia |
excessive growth of gingival tissue |
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Other meds for seizures |
short acting antiseizure drugs-lorazepam (ativan) and diazepam (Valium) |
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Multiple sclerosis |
Chronic, progressive, degenerative disorder of CNS characterized by disseminated demyelination of nerve fibers of brain and spinal cord |
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Influential factors of MS |
geography, ethnicity |
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What climate has increases prevalance of MS |
temp between 45-65 degress of latitude, Northern US, Canada, and Europe |
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Cause of MS |
unknown. |
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onset of MS |
gradual, insidious w/ vague symptoms intermittently |
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dx of MS |
no definitive dx test for MS. based mainly on hx and s/s mri of brain and spinal cord may show plaques, inflammation, atrophy, and tissue breakdown and destruction |
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Assessment of MS |
Fatigue/weakness Ataxia (loss of full control of body movements) vertigo tremors, spascity of lower extremeties paresthesias blurred vision, diplopia, nystagmus dysphagia, decreased perception to pain, touch and temp bowel and bladder distrubances abnormal reflexes emotional changes memory changes and confusion |
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Nursing interventions for MS |
Energy conservation place an eye patch on eye for diplopia regular bladder/bowel evacuation encourage independence exercise assistive devices avoid fatigue, extremes of heat/cold and infection low fat, high fiber high protein high K diet high fluid intake
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Drug therapy for MS |
No cure, symptom relief Corticosteroid-tx acute excerbations Immunomodulators (ie B interfereon) used to modify disease progression and prevent relapse
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Drug alert for MS |
Rotate injection sites, assess for depression/suicidal ideations, wear sunscreen/protective clothing, flu like symptoms |
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How is spasticity tx in MS |
With antispasmodic drugs. |
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When pt has acute exacerbation of MS what safety measures to keep in mind? |
Prevent major complications of immobility. such as resp and UTI and pressure ulcers |
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Parkinsons disease |
Chronic, progressive, neurodegenerative disorder characterized by slowness in the initiation and execution of movement (bradykinesia) increased muscle tone (rigidity), tremors at rest and gait disturbances. |
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Etiology of Parkinsons |
unknown. depletion of dopamine which interferes with the inhibition of excitatory impulse resulting in a dysfunction of the extrapyramidal system |
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Where does degeneration of dopamine producting neurons occur in Parkinsons disease? |
Substantianigra of midbrain |
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Symptom of Parkinsons disease do not occur until ___ of neruons in substantia nigra are lost |
80% |
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What is the triad of PD? |
Tremors, rigidity, and bradykinesia |
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Tremors in PD |
First sign Pill rolling because thumb and forefinger appear to move in a rotaryfashion as if rolling a pin or coin, can involve diaphragm, tongue, lilpds or jaw. |
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Rigidty in PD |
Second sign. Increased resistance to passive motion when the limbs are moved. Cogwheel rigidity, intermittent catches in movement of cogwheel when joint is moved passively. Jerky quality Complaints of muscle soreness |
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Bradykinesia in PD |
Particularly evident in the loss of automatic movements and extreme slonwess of movements and reflexes Lacks spontaneous activity (stooped posture) Mask face Drooling of saliva Shuffling gait Slow old man |
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Non motor symptoms of PD |
Depression, anxiety, apathy, fatigue, pain, constipation, impotence, short term memory, sleep problems, difficulty staying asleep at night, restless, sleep, nightmares, drowsiness, sudden sleep onset during the day |
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Complications of PD |
Weakness, dementia, neuropsychiatric problems, dysphagia. |
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Dx of PD |
Based on hx and clinical features. firm dx can only be made when at least two of the three signs of the classic triad are present |
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Nursing implications of PD |
High-calorie, high-protein, high-fiber diet, fluid intake 2000 mL/day. rock back and forth to intiate movement, firm mattress and position patientprone w/outa pillow to facilitate proper posture, avoid complications such as fractures and falls, meds,high vitamin B6, avoid monoamine oxidase inhibitors will precipitate HTN. |
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Drug therapy for PD |
Carbidopa/Levidopa-Often first drug to be used Converted to dopamine in the basal ganglia Effective for akinetic symptoms Bromocriptine (Parlodel)-directly stimulates dopamine receptors, when more moderate to severe s/s Sinemet is added |
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Drug alert for Carbidopa/Levidopa |
Monitor for s/s of dyskinesia-effects may be delayed for several weeks to months. report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands or legs, mental changes palpitations, N/V, difficulty urinating. |
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Drug alert for Bromocriptine (Parlodel) |
Monitor for orthostatic hypotension esp following first dose. Notify physician if severe headache develops that does not let up or continues to get worse |
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Myasthenia Gravis |
Autoimmune disease of the neuromuscular junction characterized by fluctatuing weakness of certain skeletal muscle groups |
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Etiology of myasthenia gravis |
Antibodies attack acetycoline. |
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What is detectable in serum of pt with myasthenia gravis |
Anti-AChR antibodies |
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S/S of myasthenia gravis |
Weakness/fatigue Difficulty chewing/swallowing Dysphagia Ptosis Diplopia Weak, hoarse voice Difficulty breathing diminished breath sounds Resp paralysis and failure |
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What muscles are most involved in myasthenia gravis |
Moving the eyes, eyelids, chewing, swallowing ,speaking and breathing |
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What to monitor with pt with myasthenia gravis |
VS, speech/swallowing abilities to prevent aspiration, encourage pt to sit up while eating, assess muscle status, conserve strength, avoid stress |
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Drug therapy for myasthenia gravis |
Antibholinesterase drugs prolong action of Ach and facilitates transmission of impulses to the neuromuscular junction Pyridostigmine (Mestinon) |
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Atrophic Lateral Sclerosis |
Lou Gehrigs Disease. Progressive degenerative disease involving the loss of motor neurons. Sensory and autonomic systems are not involved and mental status changes do not result. Muscle weakness and atrophy until flaccid tetraplegia. Resp muscles atrophy leads to resp compromise, pneumonia and death. |
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Cure for amyotrophic lateral sclerosis |
None, tx is symptomatic |
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S/S amyotrophic lateral sclerosis |
resp difficulty, fatigue while talking, muscle weakness, and atrophy, tongue atrophy, dysphagia, weakness of arms and hands, dysarthria |