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Neuro (Chpt 41 & 42)

Chapter 41 Nervous System Assessment

QuestionAnswer
Seizures - Abnormal electrical discharge in part or all of brain - Altered state of cerebral function
Epilepsy seizure triggers Flashlights Odor Fatigue Hypoglycemia Fever Constipation Hormonal changes
Generalized seizures Involves activation of both hemispheres - most common type
Simple partial seizures - No loss of consciousness
Simple partial seizures - Recurrent muscle contractions on one part of body - Abnormal sensations or hallucinations - Tachycardia, flushing, hypotension, hypertension
Complex partial seizures - Impaired consciousness - Automatisms- repetitive, non-purposeful activity (I.e. Lip smacking) - May be preceded by aura - Amnesia afterwards
Absence seizure (petit mal) - In children: - Sudden brief cessation of all motor activity lasting 5-10 sec - Blank stare - Unresponsive - Occasional or up to 100 times a day
Tonic-clinic (grand mal) - May begin with aura - Seizure begins with loss of consciousness; falling to floor
Tonic phase - Muscle contractions, rigid muscles, legs and arms extended (opisthotonos) - Jaw clenched; incontinence and breathing cessation, cyanosis - Lasting 15 sec - up to one minute
Clonic phase - Alternating contraction/relaxation in extremities; hyperventilation - Eyes roll back, patient froths at mouth - May last longer - Entire seizure lasts 60-90 seconds
Postictal phase - Slowly regains consciousness - Headache, muscle ache, fatigue, amnesia - May sleep several hours after - Check for possible injury (biting tongue, fractures, head injury
Status epilepticcus Prolonged or repetitive seizures with only short periods in between (5 min)
Status epilepticcus - Effect is hypoxia, acidosis, hypoglycemia, hyperthermia - IV push (Ativan or diazepam (Valium); repeat 10 min if needed - May be followed with phenytoin (Dilantin) slow IVPB for longer control
Anti epileptic drugs (AEDs) pg 1366-67 - May have to use combination of medications to achieve goal - Type of medication based upon type of seizures
Phenobarbital Given for extreme sedation
Phenytoin (Dilantin) Several undesired side effects - Gingival hyperplasia - use soft toothbrush and floss - Demineralization of bones - maintain calcium levels
General side effects of AEDs -Blurred vision - Nystagmus (rapid eye movement) - Slurred speech - Confusion/cognitive slowing - Ataxia (impaired coordination)
Teachings for epileptics - Periodic lab for therapeutic levels - Do not discontinue - Wear medic-alert tag - Avoid hazardous activities
Driving privileges re-instated Seizure-free for 2 years and letter for physician
How long does migraine headaches last? 4-72 hours
Migraine headache triggers - Stess, excitement, fatigue, rapid blood sugar changes - Foods: chocolate, aged cheese, alcohol, artificial sweeteners, MSG, caffeine - Menstrual cycle, hypertension, fever
Prophylactic daily medications - Beta blockers - Calcium channel blockers - Tricyclics antidepressants or SSRI antidepressants
Abortive medications (stops migraine) - Sumatriptan (Imitrex) binds with serotonin receptors: oral, SQ, nasal spray - Ergotamine - causes vasoconstriction ( caution with coronary disease/HTN, limited amount allowed; report chest pain)
Created by: pdimple