Unit 2: Nursing care of clients with neurosensory disorders
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| Headaches (Pg. 113) | Acute, chronic, temporary, life threatening
-Primary (no cause, i.e. migraines, cluster)
-Secondary (from organic cause; i.e. brain tumor)
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| Risk factors for migraines or cluster headaches: | Alcohol, env't allergies
Intense odors, bright lights, meds
Fatigue, sleep deprivation, depression, emotional/physical stress, anxiety
Menstrual cycles/OC use
Foods with tyramine, MSG, nitrites, milk
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| Migraine headaches (Pg. 113) -S/s | Photophobia & phonophobia (sensitive to sounds)
Nausea/vomit
Stress/anxiety
Unilateral pain, often behind the ear/eye
-health & fan hx
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| Classifying migraines: | Categories & stages
-With aura
-Without aura
-Atypical
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| Migraine w/ aura: -Stages | Prodromal stage, aura stage, second stage, third stage
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| What is the prodromal stage of an aura? (Pg. 114) | Awareness of findings for hours to days before onset: irritability, depression, food cravings, diarrhea/constipation, frequent urination
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| What is the aura stage? | Develops over minutes to an hour
-neuro findings* numb,tingles of mouth, lips, face, hands
-visual disturbances; light flashes/bright spots
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| Second stage? | Severe, incapacitating, throbbing headache over several hours
-nausea/vomit/drowsiness/vertigo
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| Third stage? | (4-72 hours), headache is dull
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| Migraine w/o aura: How is pain aggravated? Uni or bilateral? common symptoms? how long? | Physical activity aggravates pain
Unilateral, pulsating
Photo/phono phobia, nausea/vomit (one or more)
4-72 hours long, AM, PMS, stress, dehydration
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| Atypical migraine: | >72 hrs
Neuro symptoms longer than 7 days
Ischemic infarct may be seen on neuro imaging
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| Nursing care for migraines: (Pg. 114) env't, hob, meds | Cool, dark, quiet env't
HOB ^ 30
Meds
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| Meds for mild migraines: | NSAIDs (ibuprofen, naproxen), acetaminophen (tylenol), OTC advil migraine capsules
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| Metoclopramide (Reglan) | Antiemetics for nausea/vomit
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| Meds for severe migraines: Triptan preparations | Produce a vasoconstrictive effect (Pg. 115)
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| Severe migraine meds: Ergotamine preparations | W/ caffeine (cafergot)
-Narrow BVs & reduce inflammation
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| Preventive therapies for headaches: | NSAIDs w/ beta blocker, CCB, beta-adrenergic blocker or AED
-check pulse
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| What are the three R's? | Recognize symptoms
Respond & seek provider
Relieve pain & symptoms
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| Foods w tyramine that can be triggers: | Pickles, caffeine, beer, beer/wine, aged cheese, artificial sweeteners, nuts
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| Meds that can induce migraines: | Ranitidine, estrogen, nitroglycerin, nifedipine
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| Cluster headaches: (Pg. 116) | Brief episode of intense, unilateral, non throbbing pain lasting 30 min to 2 hr
-Can radiate to the forehead, temple, cheek
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| When do they occur? | Daily at about the same time for 4-12 weeks
Followed by a period of remission for up to 9-12 months
-No warning signs
-less common than migraines
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| What seasons are cluster more frequent in? | Spring & fall
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| S/s: gender, age, eyes/nose, eyes, color, walking | Men
20-50 yrs
Tearing eyes w runny nose/congestion
Facial sweating
drooping eyelid & eyelid edema
Miosis
Facial pallor
Nausea/vomit
Pacing, walking, sitting, rocking activities
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| Meds (Pg. 116) | See meds for migraines
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| What may be helpful at the onset of the headache? | Home oxygen therapy 7-10 l/min for 15-30 min
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