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Neuro (Chpt 41 & 42)
Chapter 41 Nervous System Assessment
| Question | Answer |
|---|---|
| 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
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