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EXAM 4 - MED SURG
Seizures & Migraines
| Term | Definition |
|---|---|
| Cranial Arteritis | Inflammation of cranial arteries. Inflammation causes a severe headache in temporal region. Often experiences symptoms of fatigue, malaise, weight loss, and fever. Also often has heat, redness, swelling, and tenderness or pain over involved artery. |
| Migraine Headaches | Unilateral pain in the head that may or may not be accompanied by an aura. Pain is often debilitating |
| Cluster Headache | Unilateral, come on in groups of one to eight, daily. Excruciating pain localized to the eye and orbit and radiates to facial and temporal regions. Attacks can last 15 minutes to hours. Often described as a penetrating pain |
| Tension Headaches | Steady, constant feeling of pressure that begins in the forehead, temple, or back of the neck. It is often bandlike or may be described as a weight on top of the head |
| Aura | Subjective sensation that immediately precedes a migraine headache consisting a breeze, odor, or light |
| Medical Management of Migraines | Acetaminophen, Aspirin, NSAIDs. Ergot Derivatives or Triptans. Ergot Derivatives cause vasoconstriction and are associated with sometimes severe systemic vasoconstrictive effects. Triptans are a newer class of SSRI that cause CNS vasoconstriction but are not associated with as many adverse systemic effects. |
| Primary Headache | No organic cause can be identified. Includes migraines, tension, and cluster types |
| Migraine Triggers | Sleep deprivation, oral contraceptives, lights, stress and depression |
| Migraine Interventions | Dark, quiet environments, keep head elevated, take medication, get a massage. |
| Secondary Headache | Naprosyn, Acetaminophen, Sumatriptan (Imitrex) |
| Premonitory Phase of Migraines | Symptoms that occur hours or days before a migraine headache. Symptoms include depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea, or constipation. |
| Headache Phase of Migraines | It is severe and incapacitating and is often associated with photophobia (light sensitivity), phonophobia (sound sensitivity), or allodynia (abnormal perception of innocuous stimuli) may also include nausea and vomiting. |
| Postdrome Phase of Migraines | Pain gradually subsides, but patients may experience tiredness, weakness, cognitive difficulties, and mood changes for hours or days. Muscle contraction in the neck and scalp is common, with associated muscle ache and localized tenderness. Physical exertion may exacerbate the headache pain. During this phase patients may sleep for extended periods |
| Aura Phase of Migraines | May be a variable in patients with migraines. Characterized by focal neurologic symptoms such as visual disturbances (flashing lights) Normally only effects half of visual field. May also include tingling and numbness of the lips, face, or hands. Mild confusion, slight weakness of an extremity, drowsiness, dizziness. |
| Generalized Seizures | Effect both sides of the brain. Includes Absence seizures, and tonic-clonic seizures |
| Absence Seizures | Often call petit mal seizures, can cause rapid blinking or just stare into space for a few seconds |
| Tonic-Clonic Seizures | Often called grand mal seizures, can make a person cry out, lose consciousness, fall to the ground, have muscle jerks or spasms. The person may feel tired after the seizure |
| Complex Focal Seizures | can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes. |
| Simple Focal Seizures | affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell. |
| Secondary Generalized Seizures | begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure. |
| Unknown Seizures | Epileptic spasms - Motor, Nonmotor, Awareness (can be aware, impaired awareness, unknown awareness, or unclassified awareness) |
| Focal Seizures | Thought to originate within one hemisphere of the brain. Also called partial seizures. Include simple focal, complex focal, and secondary generalized |
| Causes of Seizure Disorders | Strokes, hypoxemia, vascular insufficiency, fever, hypertension, electrolyte imbalance, hypoglycemia, exposure to toxins, brain tumors, alcohol withdrawal, allergies, head injury, infections. |
| Treatment of Seizure Disorders | Antiepileptic Drugs, surgery to remove part of the brain, ketogenic diet, vagal nerve stimulator, and neurostimulation system |
| Neurosurgery in Seizure Disorders | Removes the part of the brain responsible for causing the seizures. Often reserved for those that result from intracranial tumors, abscesses, cysts, or vascular anomalies |
| Vagal Nerve Stimulator (VNS) | May be implanted under the clavicle for adults and adolescents with focal seizures |
| Neurostimulation System RNS) | Surgically implanted device with electrodes that sense and record brain electivity |
| Seizure | Is the sudden, uncontrolled electrical disturbance in the brain. Causes changes in behavior, movements, feelings, and/or LOC |
| Epilepsy | Group of syndromes characterized by unprovoked recurring seizures that occur more than 24 hours apart. |
| Safety Precautions in Patients with Seizure Disorders | Complications include injuries, hypoxia, aspiration, vomiting, etc. Place the patient on their side. Perform suctioning as needed. Keep bed in lowest position, two-three side rails up and padded. Protect head with pad/pillow. Loosen constrictive clothing and eyeglasses. Push aside any furniture. DO NOT restrain the paint, put anything in their mouth, or pry open jaw |
| Status Epilepticus | Major potential complication. Characterized by prolonged seizure activity. Series of generalized seizures that occur without full recovery of consciousness between attacks. Can result in cardiac dysrhythmias, hypoxia, and even death |
| Causes of Status Epilepticus | Interruption of anticonvulsant medication, fever, concurrent infection, or other illness |
| Status Epilepticus Medications | Diazepam (Valium), lorazepam (Ativan), or fosphenytoin is given slowly in an attempt to halt seizures immediately |
| Phenytoin (Dilantin) | a traditional antiepileptic drug, is most widely used first line to treat seizures by selective inhibition of sodium channels. Side effects include nystagmus, gingival hyperplasia, and rash. Phenytoin is teratogenic and should only be used in pregnant women when no other safe therapy is available.history of tonic clonic or psychomotor seizures - monitor for hyperplasia of gum tissue (See dentist), - increase calcium (osteoporosis) |
| Antiepileptic Drugs | Require plasma drug level monitoring- used as a guide for dosage adjustments. For therapy to be effective, patient adherence is crucial. |
| Barbiturates (phenobarbital) | this will control seizures (NOW BLACK BOX WARNINGS) -- Do not take in pregnancy - Use 2 contraceptives -- given later with status epilepticus. monitor closely for suicidal ideation |
| Diazepam (Valium) | given first in status epilepticus - stop having seizures - BLACK BOX WARNING - not with other opioids, or CNS depressants. |
| Gabapentin (Neurontin) | used with partial seizures and off label uses such as alcohol withdrawal, fibromyalgia |
| Valproate (Depakote) | BLACK BOX WARNING - Monitor for signs of pancreatitis and wean off. This med is teratogenic. Check for signs of bleeding and bruising as altered bleeding times may occur |
| Seizure Medications | Barbiturates (phenobarbital), benzodiazepines (diazepam), gamma-aminobutyric acid structural analogs (gabapentin), hydantoins (phenytoin), iminostilbenes (carbamazepine), and adjuvant antiepileptic medications (valproate, levetiracetam, topiramate) |
| Topiramate (Topamax) | Toxic effects: nephrolithiasis |
| Lamotrigine (Lamictal) | Toxic effects: Steven-Johnson Syndrome |
| Felbamate (Felbatol) | Toxic effects: aplastic anemia, hepatoxicity |
| Carbamazephine (Tegretol) | Toxic effects: severe skin rash, blood dyscrasias, hepatitis. monitor for aplastic anemia and agranulocytosis |
| Treatment of Cluster Headaches | involves subcutaneous sumatriptan and oxygen. It is important to note that although oxygen may be effective in some patients, repeated or frequent use in a short period of time should be avoided. Evidence has shown that the frequency of cluster headaches may increase in some patients with overuse of oxygen. Ergot derivatives, lidocaine, and octreotide are also effective in the treatment |
| Treatment of Tension Headaches | entails the use of nonpharmacologic methods, such as rest, relaxation techniques, or stress-reduction strategies as well as medication. Pharmacologic treatment includes acetaminophen, aspirin, and nonsteroidal anti-inflammatory agents. |
| Abortive Treatment in Migraine Headaches | The administration of medications to treat the symptoms of a current migraine. Includes Nonsteroidal anti-inflammatory agents, acetaminophen–aspirin with caffeine medication, the ergot alkaloids, and the triptans (serotonin receptor [5-HT1B and 5-HT1D] agonists). |
| Preventative Treatment in Migraine Headaches | Administration of medications to prevent the development of a migraine. |
| The Overall Goal of Treatment in Migraines | Reduce the frequency, severity, and disability. |
| Initial Treatment of Migraine Headaches | The administration of triptans subcutaneously. In addition, intravenous metoclopramide and prochlorperazine are also used in eligible adults who present to an emergency department with acute migraine. Metoclopramide has been shown to be highly effective in relieving migraine-associated symptoms. |
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