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LSC-Ch 44 CNS-Brain
Nursing
| Question | Answer |
|---|---|
| Migraines | Episodic familiar disease, Pain behind eyes, Lasts longer than 4 hrs, mediated via trigeminal vascular system, blood vessels spasm at the base of the brain, muscles of scalp dilate |
| Migraine Phases | with Aura-just b4 migraine, migraine no aura, atypical migraine-menstraul & cluster PHASES: First or prodomal phase-cravings mood changes, Aura Phase, Headach PHase, Termination Phase, Postprodrome Phase - fatigue, irritable, muscle pain |
| Related Symptoms of Migraines | Site of pain, Photophobia, N&V, Scalp sensitivity, Impact: can loose several days work, activities, lost productivity-economic impact |
| Pain Management for Migraines | is GOAL. 3 R's Recognize symptoms, Respond (see dr.) Relieve Pain |
| Drug Therapy for Migraines | NSAIDS, Beta Blockers, Ergotamines, Triptans, Isometheptene Combo, Antiepileptics, Acetiminophin combined w/codeine |
| Interventions for Migraines | ID Triggers, CAT, Herbs, HA Diary, Alcohol, chocolate, nitrates in bacon, cheese, wines and meats, smoking, exercise, dequate rest/sleep, daily routine of activities |
| Cluster HA | Histamine cephalagia: less common than migraines, short duration,less than 4 hours occur in the spring & fall, brief unilateral pain, cause vasoreactivity & oxyhemoglobin desaturation, occur 8-24 hrs for 4-12 weeks, followed by absence for 9-12months |
| Interventions for Cluster HA | Drug therapy similar to migraines, don't use beta blockers, sunglasses, sit away from windows, O2 100% 7-10L/min for 15-30min, Prevention: Adequate rest, Surgical Sterotactic rhizotomy for chronic drug resistant cluster HA |
| Drug Therapy for Cluster HA | Migraine Drugs: triptans, ergatamines, NO beta blockers! (propanalol), Antieleptic meds, calcium channel blockers (verapamil), Lithium, Corticoids, Capsaicin Nasal Spray, Melatonin - for sleep cycle, Glucosamine, Opoids - short term |
| Tension HA | Neck & Shoulder muscle tenderness w/bilateral pain at base of skull & forehead, more than 4hrs, can be difficult to distinguish from migraine, may have N&V, and photophobia |
| Interventions for Tension HA | NSAIDS & Aceaminophen, Ibuprofen+Caffeine(200mg), muscle relaxants, Antiepileptic drugs(Depakote), antianxiety, antidepressant, opioids & barbituates-short term, CAT:Peppermint oil topically, massage, yoga, meditation |
| Epilepsy | 2 or more seizures leads to a diagnosis of epilepsy - abnormal sudden, excessive, uncontrolled electrical d/c of neurons in brain result in altered consciousness, motor, sensory ability and behavior |
| Seizures 3 Categories | Tonic clonic, Partial (focal), and Unclassified |
| Tonic Clonic Seizures | rigid than rhythmic jerking, clonic or tonic one without the other, absence-brief loss of consciousness, myoclonic-brief jerking, Atonic-akinetic-sudden loss of muscle tone - dropsy |
| Partial Seizures | COMPLEX-partial black out 1-3 min, automatisms - odd behavior-swearing, SIMPLE- Partial remains conscious, deja vu, perception of a smell or onset of pain, one sided movement of extremity, autonomic changes (HR, flushing) |
| Unclassified Seizures | Idiopathic, No known reason, Etiology: Multiple causes |
| Assessment of Seizures | How many, How long-look at clock, patten, aura?, Deep sleep-recovery phase, drugs, herbs head trauma, meds? Other medical conditions, EEG, CT, MRI, PET |
| Nursing Diagnosis for Seizures | Risk for Injury r/t seizure activity, Risk for Ineffective Breathing, Potential for status epilepticus |
| Drug Therapy Tonic-Clonic | Carbamazapine (Tegretol), Phenobarbital, Phenytoin (Dilantin), Primidone (Myosiline), Valproate (Depakote) |
| Drug Therapy Status Elipticus | Diazepam (Valium), Lorazepan (Ativan), Diastat(Valium rectal gel) |
| Drug Therapy Partial Seizure | Carbamazepine (Tegretol), Clorazepate dipotassium (Tranzene), Gagapentin (Neurontin), Lamotrigine (Lamictil), Levetiracetam (Keppra)-adjunct, Oxcarbazepine (Trileptal), and more |
| Drug Therapy Absence, (myoclonic-atonic) | Clonazepam (Klonopin), Divalproex (Depakote) |
| Management/Selection of Seizure Drugs | Start w/one drug at a time, if ineffective, increase dose or add another, Doses adjuncted to reach therapeutic blood levels and minimize GI side effects |
| Side Effects from Seizure Drug Therapy | In general, well tolerated, monitor Liver Enzymes, GI side effects |
| Teaching Key Points Seizure Meds | Drug/Drug & Drug/Food Interactions, Health teaching about disorder, *If stop drugs, may go into Status Epilepticus, Monitor serum drug levels, balance diet, proper rest, stress reduction, seizure diary, no driving 6mo-1yr, Avoid ETOH, |
| Care during Seizure | *Look at time, O2 & Suction equipment readily available, Saline lock for IV access, Side rails up & Padded or mattress on floor, No padded tongue blades, protect head |
| Status Epilpticus | Seizure >5min or repeated over course of 30 min damages brain cells, Last longer than 10 min can cause death, establish airway, intubation, IV Access, ABG's, Check what meds they are on |
| Vagal Nerve Stimulator | Surgical Mgmt of Seizures, Implanted like pacemaker under skin, electrode lead attached to L Vagus nerve connected to generator, activated by pt w/handheld magnet device when experience aura, seizure aborted, stim vagus nerve changes quality of voice |
| SE Of Vagal Nerve Stimulator | Hoarseness, cough, dyspnea, neck pain, dysphageia, avoid MRI's, microwaves, shortwave radios, ultrasound diathermy |
| Conventional Surgical Approach | Electrodes surgically implanted seizure is IDed, Hold Anticonvulsant meds, for complete or partial seizures |
| Meningitis | Viral-Most common, self limiting, M, M, Herpes simplex Herpes zoster, Fever, Photophobia, HA Myalgias, N&V, Symptomatic Tx FUNGAL-Cryptococcus Neoformans, mostly seen in AIDS patients |
| Bacterial Meningitis | High mortality rate - Medical Emergency, Meningococcal (Neisseria) more, Outbreaks in dense populations, Menomune Immunization, Haemophilus influena and pneumococcal have decreased due to immunizations |
| Predisposing Conditions for Bacterial Meningitis | Pneumonia, otitis media, acute sinusitis, skull fractures, chronic illness or infections |
| Symptoms of Bacterial Meningitis | rapid onset-contagious, high fever, chils, HA stiff neck- nucchal rigidity, N&V, Photophobia, Confusion and decreased LOC, Seizures, Meninococcal-red macular rash, + Kernig's and Brudzinski's signs |
| + Kernig's Sign | Flex leg at hip and knee, if pain or possible spasm of the leg, and resists further extension, you can assume that meningitis has occured |
| + Brudzinski's sign | Hips will flex when neck is lifted |
| Diagnostic studies for Meningitis | Labs -CSF Culture and Sensitivity, WBC, ChestXR, Sinuses or mastoids, CT or MRI with increased ICP and brain abscess or hydrocephalus |
| Bacterial Meningitis CSF Findings | Appearance: Cloudy, WBC's: Increased, Protein: Increased, Glucose: Decreased, CSF Pressure: Elevated |
| Viral Meningitis CSF Findings | Appearance: Clear, WBC's: Increased, Protein: Slightly elevated, Glucose: Most often normal, may be decreased, CSF Pressure: Varies |
| Meningitis Interventions | Standard Precautions Dropet Precautions (3ft), Monitor I&O (Increased CSF), Airway Management, VS, Quiet Environment, Isolation if Bacterial |
| Accurate Monitoring for Meningitis | Neuro checks q4hrs, Monitor for increased CSF, Perform Cranial Nerve Assessment - Hydrocephalus |
| Drug Treatment for Meningitis | Broad Spectrum Antibiotics-early tx reduces mortality to <15%, IV Antibiotics x2wks: Vncomycin, Anticonvulsants, Tx for those in close contacts: Rifampin, Cipro, Rocephin |
| Complications of Meningitis | Septic Emboli: Watch circulation in hands, clots form in the hands Neuro checks in hands, Medical Emergency - can loose hands, Notify MD, Septic Shock, Coagulation disorders, ARDS (Adult Respiratory Distress Syndrome) Death |
| Encephalitis | Inflammation of brain tissue effecting cerebrum, brainstem & meninges, Most common are Viral: Arbovirus (West Nile), Enteroviruses(chicken pox), Herpes Simplex I(cold sores, high mortality rate) Amebae found in water & contaminated soil |
| Symptoms of Encephalitis | Come on more gradually than meningitis: fever, stiff neck, N/V, Chane in LOC, Motor dysfunction, fatigue, and seizures |
| Additional Assessments for Encephalitis | Cranial Nere Assessments, Symptoms of increased ICP, monitor for Cushing's Response, Brain herniation and death |
| Interventions for Encephalitis | Acyclovir for herpes encephalitis (give b4 coma), Dark Room, Supportive Cares: Pain Mgmt, Nutrition, positioning, skin care, hygeine, B/B Program, Dulcolax supposatories |
| Education/Prevention Tips for Encephalitis | Avoid areas wih mosquitos or ticks, Long clothing and use insect repellent, older adults more susceptible |
| Outcome of Encephelitis | 35% Recover w/no deficits, Permanent debilitating neurological deficits, Physical, cogitive, LTC, Death |
| Parkinson's Disease | Affects Posture, Gait, Motor, Speech, Autonomic Dysfunction, Psychosocial |
| Assessment for Parkinson's | Motor Ability Changes, Rigidity-early, Mask like facial expression, Drooling, difficulty swallowing, slow shuffling gait, pill rolling of hands, soft low voice, No Dx Tests, No prevention or cure |
| Nursing Diagnosis For Parkinson's | Impaired Physical Mobility, Risk or Falls, Risk for Self Care Deficit, Risk for Impaired Verbal Communication, Chronic COnfusion, Risk for Imbalanced Nutrition |
| Interventions for Parkinson's | Drug Therapy is cornerstone of tx, Goal is to maximize a person's functional ability by using drugs w/min long term side effects, pt and family education essential proper admin of meds and monitoring for SE |
| Dopamine Agonists (PD) | Dopamine Agonists(3-5yrs) Levodopa* Sinemet: combo levodopa & carbidopa initial drug of choice, must be given EXACTLY on time, Others: Pramipexole (Mirapex), Apomorphine (Apokyn), ROtigotine (Neupro) Transderm patch |
| Adverse Effects of Dopamine Agonists (PD) | Orthostatic Hypotension, Sleepiness & Drowsiness, Hallucinations, Not Preferred for Older Adults |
| COMT Inhibitors (PD) | Block Enzymes that inactivates dopamine, Entacapone (Comtan), used in combo w/levodopa Stalevo: Combo of both |
| MAO-B Inhibitors (PD) | Early mild symptoms, Entacoapone (Comtan) Selergiline (Deprenyl, Eldepryl)-w/Levodopa Psych problems |
| Dopamine Receptor Antagonist (PD) | Bromocriptine (Parlodel)- when other drugs are no longer effective or early course of tx, Used w/ Sinemet, Decreases dyskinesias |
| Antiviral Drugs (PD) | Amatadine (Symmetrel), given w/Sinemet, Decreases Dyskinesias |
| Anticholinergic Drugs (PD) | Benstropine (Cogentin) Procyclidine (Kemardrin) Avoid in older adults- Confusion |
| Adverse Effects of Long Term Drug Therapy for PD | Tolerance and wearing off, Alternating good and bad periods, Tx: Reduce Dose, Change drugs, Take a Drug Holiday (10 Days), TOXICITY: Delirium, Confusion, Cognitive Impairment, Hallucinations |
| Interventions for Parkinson's | Exercise & Ambulation-keep mobile as long as possible, Self Care Mgmt-ADL's as possible, Injury Prevention*, Nutrition- Calcium, Vit. K, dysphagia prevention, Increased Calorie, Frequent small meals, Intentional Tremor Safety, Monitor wt loss |
| Communications and Psychosocial Support Interventions for Parkinson's | COmmunication: Strengthen muscles of mouth, slower speaking, reduce environmental noise, repeat non understandable words, communication board, Psychosocial Support: Social worker, Emphasize abilities over disabilities, palliative care |
| Surgical Interventions for Parkinson's | Stereotactic Pallidotomy, Thalamotomy, Deep Brain Stim, Fetal Tissue Transplantation |
| Alzheimer's Disease | Chronic Progressive degeneratve disease, Structural Changes, growth of plaques & Neurons tangle, w/aging brain decreases in size, enlargement of ventricles & changes in sulci & gyri accelerated in AD |
| Causes of Cognitive Impairment in the Older Adult (Rule out) | Vascular insufficiency, infections, MI's, Dysrhthmias, Pulmonary infection, pneumonia, electrolyte imbalance, misuse of Rx meds, Nutritional deficiencies, environmental factors, Psychological factors |
| Stage I Mild Alzheimer's | Independent ADL's, No social/employment problems initially, denies, forgets names, misplaces household things, Short term memory Loss, subtle changes in personality & behavior, loss of initiative, less engaged in social, decreased smell |
| Stage II Moderate Alzheimer's | Impairment of all cognitive functions, money problems, disorientation to time, place & event, possible depression, agitated, Increasingly dependent ADL's, visuospatial deficits, speech & language deficits, less talkative, less vocabulary, aphasic |
| Stage III Late Stage Alzheimer's | Completely incapacitated, bedridden, total dependent ADL's, Motor & Verbal skills lost, general & focal neurological deficits, agnosia (loss of facial recognition) |
| Apraxia | inability to use objects correctly |
| Aphasia | Inability to speak or understand speech |
| Anomia | Inability to find words |
| Agnosia | Loss of sensory comprehension |
| Diagnostic Tests for Alzheimer's | No Labs, Definitive Dx on Autopsy-neurofibrillary tangles & plaques, CT or PET scan, MRI to rule out other neurological disease, |
| Nursing Diagnosis for Alzheimer's Patients | Chronic confusion r/t disease, Risk for Injury r/t wandering/elder abuse, Disturbed Sleep patterns, Compromised Family Coping & Caregiver Role Strain |
| Interventions for Chronic Confusion | Memory Activities, cog stim/memory training, structure environment, prevent overstim/agitation, provide consistency & routine, orientation & validation, promote Independence in ADL's, promote b/b continence, assist w/facial recognition, promote commun. |
| Drug Therapy for AD | Cholinesterase inhibitors: donepezil (Aricept), Galantamine (Reminyl), Rivastigmine (Exelon) NMDA Recetor Antagonists-newer Memantine (Namenda) taken early on to decrease the progression |
| Other Drugs for AD | Anti depressants SSRI's: Paroxetine (Paxil), Sertaline (Zoloft), Psychotropic drugs: chemical restraints last resort - Haldol |
| CAT Minimize Agitation | Vitamine E, Ibuprofen, Estrogen, Melatonin, Art, Massage, Dance & Music Therapy |
| Nursing Dx: Risk For Injury (AD) | Establish day/night patterns, discourage daytime napping, establish bedtime ritual, tx & meds scheduled to promote undisturbed sleep |
| Nursing Dx: Compromised family coping/caregiver strain (AD) | Maintain realistic expectations, take each day at one time, try to find the positives, use humor, use resources, explore alternative care, advance directives, set time away for yourself, use relaxation techniques |
| Huntington's Disease | Heredity disorder transmitted as an autosomal dominant trait at conception, single gene disorder caused by a mutation in the HD gene on chrom 4, Autosomal dominant (1 gene develops disorder), |
| Two main Symptoms of Huntington's Disease | Progressive mental status deterioration, Choreiorm Movements (rapid & jerky) St. Vidas Dance |
| Stages of HD | StageI: onset of neurological/psychological symptoms StageII: Increased dependence on others for care, agitation, hallucination, psychotic delusions, Stage III: loss of independent function |
| Collaborative Mgmt of HD | No known cure or tx, only way to prevent is to prevent pregnancies, genetic counseling, speech language, dieticians, pt/ot, home hlth care, social workers |
Created by:
ginabeana
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