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Ms. Glutting Neuro exam 2

Type of seizure caused by head trauma, metabolic or electrolyte imbalance (renal failure, hyponatremia, infection) Acquired or secondary epilepsy
Type of seizure most often a result of unknown cause Idiopathic or primary epilepsy
Seizure that causes loss of consciousness Generalized
Seizure that does not result in loss of consciousness Partial
Group of abnormal cells that initiates seizures epileptogenic focus
Listed seizures all have something in common- Focal motor, jacksonian, sensory simple partial seizure No loss of consciousness
Seizure that displays a twitching of the hand or face only. It involves only the part of the brain that controls the part of the body affected. Focal Motor seizure
Seizure that involves adjacent areas of the motor cortex, affecting a greater portion of the body. seizure that begins in hand and marches up to the shoulder Jacksonian
Seizure that prod. sensory phenomena: numbness, tingling, bright flashing lights, in field of vision sensory seizure, focus is in the occipital area
Type of seizure beginning with an aura or sensation. Rising from the epigastric region, odor, visual disturbance, deja vu. Lip smacking Psychomotor, pick at clothes, person unaware of activity. It is referred to a complex partial seizure. Lasts 1-2 minutes No LOC
Define generalized seizure Involves entire brain, activated at once. Loss of consciousness
seizure that lasts 5-30 seconds, generally begins in childhood and may disappear by puberty Petit mal (absence seizure) may only stare into space, stop talking.
A petit mal/absence seizure may occur up to how many times in a day 100; will exhibit learning problems.
Seizure lasting longer than 30 minutes Status epilepticus
Tx for status epilepticus Airway, oxygen, valium, dilantin (long term) IV ativan
type of seizure that has levels Generalized tonic clonic (grand mal)
First stage of grand mal seizure 1- sudden LOC
Second stage of grand mal 2- tonic phase
S/S of grand mal tonic phase entire body stiffens, including diaphram, throat muscles contract, air is pushed out. RR interrupted, may become cyanotic. Eyes open wide, pupils fixed/dilated. Lasts 30-60 sec.
tonic phase is also known as pre-ictal phase
Stage of grand-mal that exhibits rhythmic, jerky contractions. Relaxed body muscles; especially extremities. incontence, biting of lips/tongue. RR sonorous, excess saliva. lasts 2-5 minutes Clonic/ictal phase. relaxed/unresponsive afterward won't remember episode
Stage of grand mal that involves involuntary jerk or contraction of major muscles. May be thrown to the floor Myoclonic seizure.
Stage of grand mal that involves complete loss of muscle tone, pt drops to floor but regains awareness by the time they drop. Resumes activity immediately. Atonic seizure "drop attack"
Normal level of dilantin? How is it sent from pharmacy? 10-20, may have load dose up to 1K Sent unmixed, it will precipitate in bag if premixed.
Max Mg/Minute for dilantin? no more than 50mg/minute
Nursing considerations for Dilantin? Teaching in reference to side effects? Teach patient that liver enzymes will need to be monitored. SE: Can cause hirsutism, gingival hyperplasia.
AST normal level? ALT " " AST- 5-40 ALT- 7-56
converted into fasphenytoin in system cerebrex
The metabolism of dilantin will be increased by what substance? alcohol
how would the nurse administer dilantin? What equipment needed? Filter needed, only hang with NS, cardiac monitor will also be needed.
4 s's stat stic suction siderails up siderail pads
Med that causes a lot of blood dyscrasias Felbetol
If seizure is located on the left side what will be seen? Speech is affected
If seizure is on the Right side what will be seen? recognition/have to think about what they say before they say it
common symptoms of MS muscle spasticity, neurogenic bladder, parethesias, cerebellar ataxia, fatigue, weakness, numbness, difficulty in coordination, loss of balance
Diagnostics to determine MS include a CSF exam that will find ____ antibodies. IgG
Right or Left sided stroke? spatial-perceptual deficits Right
Right or left sided stroke? Denies/minimizes problems Right
Right or left sided stroke? Rapid performance/short attention span Right
Right or left sided stroke? Impulsive Right
Right or left sided stroke? Impaired judgement Right
Right or left sided stroke? Impaired time concepts Right
Right or left sided stroke? Impaired speech/language aphasias Left
Right or left sided stroke? Impaired Right/Left descrimination Left
Right or left sided stroke? Slow performance/cautious Left
Right or left sided stroke? Aware of deficits, depressed/anxious Left
Right or left sided stroke? Impaired language, math comprehension Left
Meds used for ischemic stroke? TPA, Heparin/platelet inhibs. Ticlid, Plavix, Persantine, Lovenox, Fragmin
Meds used for hemorrhagic stroke? Nimodipine (Nimotop)
Dilantin is given to a stroke victim when..... After seizure to prevent more seizures from occurring, will NOT be given prophylacticly before a seizure
When will BP drugs be given in presence of a stroke? ONLY if 220 or more or if MAP is 130+ Don't want hypotension to occur
TX for those who are in the process of a Hemorrhagic stroke, what med and when is it given? Nimodipine (nimotop) Ca channel blocker, decreases vasospasm, minimizes tissue damage. GIVEN WITHIN 96 HOURS
Important info regarding admin of TPA? USE? NSG assessment? Used to establish blood flow, prevent cell death in a ischemic stroke. Given in the 1st 3-4.5 hours after symptoms begin, not after. Know LSN. No TPA unless BP is 185/110 or less. Do all sticks/NG, etc, before TPA admin Assess for cerebral bleed
IV fluids to avoid in acute stroke TX? Glucose level preferred? Water, Glucose containing Glucose level, no higher than 140 and in norm range
Inability to recognize and object by sight, touch, or hearing agnosia
Side of brain affected by stroke in which patient may exhibit unilateral neglect Right; known as spatial-perceptual alteration
Things appear smaller than they are micropsia
Loss of vision in half of each visual field. homonymous hemaniopsia
Which stroke? Deficits such as slurred speech, numbness, tingling goes away within 24 hours of onset. caused by temporary disturbance of blood to the brain TIA lasts minutes to hours
which stroke? Onset and disappearance of focal neuro deficit within days. Lasts longer than 24 hours, minimal to no lasting deficit RIND Reversible ischemic neuro deficit
Stroke? Progresses 12-24 hours, progressive deterioration of neuro status, residual effects possibly permanent PS; progressive stroke or Stroke in evolution
Stroke? Severe in character, condition stabilizes but neuro deficit remains. No further deterioration after 2-3 days usually has permanent deficits CS- completed stroke
Disturbance in muscular control of speech dysarthria
Cannot name an object anomia
When asked to speak cannot coordinate movement of lips/tongue but may be able to do so when left alone. applies to any motor movement apraxia
Repetition of one idea or response perservation
Motor or expressive aphasia. Pt demonstrates difficulty expressing self through spoken/written word. Speech slow, nonfluent, effortful. Can understand verbal/written word. Aware of problem Brocas aphasia, frontal lobe; dominent hemisphere
receptive aphasia, injury to temporal lobe of dominant hemisphere. PT unable to comprehend written/verbal. Brain unable to interpret sounds heard, pt has fluent speech/norm rhythym but uses incorrect words. makes up own words. May not realize deficit. Wernickes aphasia
Combo of expressive/receptive aphasia, little of communication system intact. trouble interpreting and expressing. Extensive deficits to both sides of brain. Emotional deficits. Global aphasia
Immunomodulator given for control of disease in MS, patients will be taught to give their own injections. Betaseron
anticholinergics, pro-banthine and ditropan would be given to treat what complication of MS? spastic bladder; urinary frequency and urgency
Drugs given for urinary retention in MS> Urecholine and Prostigmine cholinergics
Med given for parasthesias and ataxia in MS? (select all) A. Tegretol B. Dilantin C. Klonopin D. Neurontin E. TPA A,B,C,D all are anticonvulsants
Daclofen, Valium, and Dangrium would be given to control ____________ in MS. muscle spasm
First drug given in PD? and why Dopamine receptor agonists, parlodel,permax, mirapex, requip Sinamet added as disease progresses
Drug that increases the release of dopamine from storage sites. Symmetrel
Patient teaching for Levodopa Avoid food high in Vit B , affects absorption. if taken with high protein meal it will lose its effect. Will only be useful for 3-5 years.
Nutritional teaching for PD patient? *Adequate roughage/fruit to avoid constipation *Cut food into small bite sized pieces, serve on warming plate *Six small meals a day is best
Mestinon and Prostigmin are Anticholinerase medications given for MG tx. Patient teaching? Meds need to be taken on time.
Crisis in MG that results in too little Ach available, respiratory muscles cannot maintain adequate respirations. Usually result of under medication, stress, infection or trauma. S/S acute respiratory distress, unable to swallow/speak Which crisis? Myasthenic
Crisis when there is too much Ach available, constant action potential is generated, fatiguing the respiratory muscles. From over medication. S/S will be muscle weakness, respiratory distress but also will exhibit GI symptoms: N/V, diarrhea, bradycardia. Cholinergic
Spinal cord injury most common in cervical cord. Motor weakness/sensory loss present in upper/lower extremities but mainly upper Central cord
Injury resulting from acute compresion of anterior portion of spinal cord often a flexion injury. S/S motor paralysis, loss of pain/temp sensation below injury. anterior cord, compromised blood flow to anterior cord. posterior not injured so sense of touch, position, vibration, motion is intact.
damage to 1/2 spinal cord characterized by loss of motor function and position, vibratory sense. Ipsilateral paralysis. Loss of pain/temp senstation below lesion Often caused by penetrating injury Brown-Sequard
S/S of what disorder? *Severe hypertension (300/160 with bradycardia) *severe throbbing ha *nasal stuffiness *blurred vision *goosepimples and pallor below injury *profuse swelling, flushing above level of injury autonomic dysreflexia
Nsg TX for autonomic dysreflexia? *raise HOB 90 degrees; decreasing BP *notify MD *ck for irritation: distended bladder, fecal impaction *reposition
What six things determine brain death? *unreceptive/unresponsive to painful stimuli *no movement after MD observes for an hour (continuously)/No breathing after 3 minutes off respirator *No reflex, including brain stem *Flat EEg *all tests repeated in 24 hours
What conditions are excluded when determining brain death? Hypothermia, CNS depression r/t drugs; barbituates
Created by: purpleapple87
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