Chapter 41 Nervous System Assessment
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Seizures | - Abnormal electrical discharge in part or all of brain
- Altered state of cerebral function
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| Epilepsy seizure triggers | Flashlights
Odor
Fatigue
Hypoglycemia
Fever
Constipation
Hormonal changes
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| Generalized seizures | Involves activation of both hemispheres - most common type
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| Simple partial seizures | - No loss of consciousness
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| Simple partial seizures | - Recurrent muscle contractions on one part of body
- Abnormal sensations or hallucinations
- Tachycardia, flushing, hypotension, hypertension
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| Complex partial seizures | - Impaired consciousness
- Automatisms- repetitive, non-purposeful activity (I.e. Lip smacking)
- May be preceded by aura
- Amnesia afterwards
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| 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
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| Tonic-clinic (grand mal) | - May begin with aura
- Seizure begins with loss of consciousness; falling to floor
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| 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
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| Clonic phase | - Alternating contraction/relaxation in extremities; hyperventilation
- Eyes roll back, patient froths at mouth
- May last longer
- Entire seizure lasts 60-90 seconds
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| Postictal phase | - Slowly regains consciousness
- Headache, muscle ache, fatigue, amnesia
- May sleep several hours after
- Check for possible injury (biting tongue, fractures, head injury
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| Status epilepticcus | Prolonged or repetitive seizures with only short periods in between (5 min)
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| 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
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| 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
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| Phenobarbital | Given for extreme sedation
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| Phenytoin (Dilantin) | Several undesired side effects
- Gingival hyperplasia - use soft toothbrush and floss
- Demineralization of bones - maintain calcium levels
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| General side effects of AEDs | -Blurred vision
- Nystagmus (rapid eye movement)
- Slurred speech
- Confusion/cognitive slowing
- Ataxia (impaired coordination)
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| Teachings for epileptics | - Periodic lab for therapeutic levels
- Do not discontinue
- Wear medic-alert tag
- Avoid hazardous activities
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| Driving privileges re-instated | Seizure-free for 2 years and letter for physician
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| How long does migraine headaches last? | 4-72 hours
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| Migraine headache triggers | - Stess, excitement, fatigue, rapid blood sugar changes
- Foods: chocolate, aged cheese, alcohol, artificial sweeteners, MSG, caffeine
- Menstrual cycle, hypertension, fever
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| Prophylactic daily medications | - Beta blockers
- Calcium channel blockers
- Tricyclics antidepressants or SSRI antidepressants
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| 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)
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