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Headache Medications
- acetylsalicylic acid (aspirin)
- acetaminophen
- Triptans (Selective Serotonin receptor agonists)
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Triptans
- Selective Serotonin Receptor agonist
- Relieve pain and Nausea, vomiting, photophobia
- eletriptan ( Replax)
- almotriptan ( Axert)
- frovatriptan (Frova)
- naratriptan (Amerge)
- rizatriptan (Maxalt)
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
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Migraine headache (prophylactic) medications
- Beta-adrenergic blockers
- Tricyclic antidepressants
- Selective Serotonin reuptake inhibitors
- Calcium channel blockers
- Thiazides
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Neuropathic Pain
- Includes postherpetic neuralgia, phantom pain diabetic neuropathies and trigeminal neuralgia.
- Pain is intractable (unbearable & does not respond to tx)
- Chronic / deliberating prevents ADL’s
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Neuropathic Pain Assessment
- Highly subjective
- Behavioral signs of pain & stress
- Chang in ability to perform ADL’s
- Muscle weakness / waisting
- Vasomotor responses (flushing)
- Abnormalities of spinal reflexes
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Neuropathic Pain Dx Tests
- Electrical Stimulation
- Phychological testing
- Myelogram (back or neck pain)
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Neuropathic pain medical mgmt (non surgical)
- Tens and spinal cord stimulation
- Acupuncture
- Nerve block
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Neuropathic Pain Surgical Management
- For intractable pain
- neurectomy – surgical removal of nerve segment
- rhizotomy – cutting of nerve root of the spine
- cordotomy – disables selected pain-conducting tracts in the spinal cord
- (Complications on cordotomy- postural hypotension, feeling heat/cold, motor, bowel function, temporary edema leading to temp. paralysis or leg weakness.)
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Neuropathic Pain Medications
- Anticonvulsants
- gabapentin (Neurontin)
- carbamazepine (Tegretol)
- Nonopioid analgesics
- acetaminophen
- NSAID’s
- Acetylsalicylic acid
- Antidepressants
- amitriptyline
- imipramine (Tofranil-PM)
- nortriptyline (Pamelor)
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Neuropathic Pain Inter. / Teaching
- Comfort measures
- Assist in positioning
- Stool softener ,high fiber, prune juice (prevent straining)
- Encourage fluids 2000ml
- Plan sleeping hrs & rest periods
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Increased Intracranial Pressure (ICP)
- Sudden, rapid progression, requires surgical intervention.
- May lead to death if not treated and reversed.
- Occurs in pt’s with brain tumor, hemorrhage, anoxic brain injury and toxic/viral encephalopathy’s.
- As pressure rises, cerebral blood flow decreases and inadequate perfusion of the brain occurs.
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ICP Signs
- Diplopia
- Personality changes
- Changed in ability to think
- Nausea
- Pain
- Headache (coughing, straining at stool, stooping)
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ICP Symptoms 1
- Change in LOC (earliest sign)
- Disorientation
- Restlessness
- Lethargy
- Pupils react sluggishly
- Anisocoria – Unequal pupils
- Ipsilateral pupil – affecting the same side as the lesion
- Blown pupil – Fixed dilation of one or both pupils.
- Cushing’s Response –wide pulse pressure & Bradycardia
- Abnormal breathing
- Stertorous (snorelike)
- Cheyne-Stokes
- Ataxic- Irregular/random/with occasional pauses
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ICP Symptoms
- Thermoregulatory center failure
- Decreased motor function
- Babinski reflex
- Hyper-reflexia
- Rigidity
- Posturing (herniation in upper part of brain stem)
- decorticate – arms flexed
- decerebrate – rigid extension & hyperpronation forearms
- Projectile vomiting & Hiccups (Compression of vagus nerve)
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ICP Diagnostic Tests
- CT
- MRI
- EEG
- ICP measurement
- Transracial Doppler
- Cerebral Angiography
- PET
- Internal measuring devices
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ICP Medical Management
- Surgery to remove tumor.
- Drug therapy to reduce pressure
- Ensuring adequate oxygenation
- Endotracheal intubation
- ABG’s and oxygen therapy
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Surgical Management
- craniotomy- bone flap removed and replaced
- craniectomy – bone flap removed and not replaced allowing room for expansion.
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ICP Medications
- Osmotic diuretics
- Mannitol,
- Loop Diuretics
- Furosemide (Lasix)
- Bumetanide (Bumex)
- Corticosteroids
- dexamethasone (Decadron)
- Anticonvulsants
- Phenytoin (Dilantin)
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ICP Interventions
- Elevate HOB 30-45 degrees
- Avoid flexion of hips, neck, waist
- Avoid rotation of head
- Avoid isometric exercises
- Use hypothermia blanket
- Suctioning when necessary 10seconds only w/100% oxygen before &after
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Epilepsy or seizures
Group of neurologic disorders characterized by recurrent episodes of convulsive seizure, sensory disturbances, abnormal behavior, LOC or all of these
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In the United stated it is estimated that approximately ______ people suffer from active epilepsy, with _________ new cases diagnosed each year.
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Epilepsy is associated with_____________ uncontrolled _______________ in the neurons of the brain resulting in sudden violent, involuntary ________________ of a group of muscles
- Proximal
- Electrical charges
- Contraction
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Causes of Seizures
- Trauma
- Infection
- Tumor
- Alcohol intox
- Hypoglycemia
- Electrolyte imbalance
- Barbiturate withdrawal
- Water intox
- Vascular disturbances
- ¾ of cases are idiopathic
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Types of Seizures
- Tonic-Clonic - Grand Mall
- Absence – Petit Mall
- Psychomotor – Automatism
- Jacksonian – Focal
- Myoclonic –
- Akinetic –
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Aura
A sensation or emotion that may precede an attach of migraine or epileptic seizure
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Postictal period
Rest period after a seizure. Patient may be groggy, disoriented, have a headache, muscle aches, sleepy, may experience amnesia.
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Status epilepticus
- When full consciousness is not regained between seizures.
- Medical emergency
- May cause permanent damage or death
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Epilepsy or Seizure interventions
- Protect fr injury & aspiration Observe / record activity
- Never leave alone
- Turn head to side to maintain the airway
- Loosen clothing around neck
- Do not restrain or place objects in mouth
- Suction and oxygen after seizure
- Pad side rails
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Multiple Sclorosis (MS)
- Degenerative, autoimmune disorder. t cells attack the body then myeling damage occurs.
- Maybe from a viral infection early in live.
- Chronic, progressive deterioration in some remissions and exacerbations in others
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Demyelination
- The myelin sheath and the sheath cells are destroyed, causing an interruption or distortion of nerve impules
- Distributed randomly in the white matter of the brainstem, spinal cord, optic nerves and the cerebrum.
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MS Signs & Symptoms
- 1. Diplopia - double vision
- 2. Scotomata - spot befor eyes
- 3. Blindness
- 4. Weakness or numbness
- 5. Fatgue
- 6. Emotional instability
- 7. Bowel/Bladder problems
- 8. Verigo
- 9. Ataxia (uncoordiated movement)
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MS Dx Tests
- No definitive Dx test
- Dx based on history & clinical manifestations
- 1. MRI - presence of lesions over time
- 2. CSF - gamma T cells (initial phase), Increase in lymphocyts and monocytes
- 3. CT scan - enlargement of cerebral ventricles.
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MS Medical Management
- 1. Adrenocoritotropic hormone & coticosteroids: reduce edema and inflamation at demyelination site
- 2. For spasms: Diazepam, Dantrolene, Baclofen
- 3. Immunomodulating drugs: Betasron, Avonex,Copaxon
- 4. Immunosuppressant drugs: Navantrone to reduce both B and T lymphocytes.
- 5. Pro-Banthine: for urinary frequency & urgency
- 6. Cholinergic drugs: antispasmodic, better urinay flow
- 7.UTI prophylaxis: Bactrim, Spectra, Macrodantin
- 8. Self-Catheterization
- 9. Enourage fluids
- 10. Stool softener and prune juice for constipation.
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MS Nursing Interventions
- High fiber and adequate fluids
- High protein & vitamin supplements
- Obese, dietitian for low calorie diet
- Frequent turning
- Exercise not to fatigue (spasticity & coordination)
- Daily rest periods
- Stablize gate- lean towards less involved side
- Avoid hot baths - increases weakness
- Refer pt & fam. to support group.
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Parkinsons (PD)
- A syndrom that consists of bradykinesia, rigidity, tremor, and impaired postural reflexex
- Damage or lose of dopamine-producing cells in the midbrain leads to depletion of dopamine that influences the initiation, modulationn and clompletion of movement and regulates unconscious autonomic movements.
- Drug induced parkinsonism- dopamine receptors in the brain are blocked.
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Causes of PD
- Genetics
- Type A encephalitis
- Intoxication of carbon Monoxide
- Intocation of Manganese
- Drugs: Haldol, Thorazine Methyldopa
- Reduced estorgen levels
- Exposure to industrial metals and chemicals
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PD commonly occures after the age of
50
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PD is more common in men or women
Men
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Dopamine
A neurotransmitter that is essential for functioning of the extramidal motor system including control of posture, support and voluntary motion.
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Tremor
- More prominent at rest but disappears whe the pt moves
- Pill rolling
- Initially minimal becomes more pronounced in later stages.
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Rigidity
- Increased resistence to passive motion when limbs are moved through their range of motion.
- Is a jerky quality when the joint is moved (cogwheel rigidity)
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Bradykinesia
- Evident in the loss of automatic movements and lack of spntaneous activity ( Autonomic movements include blinking, swing the arms while walking, swallowing saliva, facial expressions, and minor posturl adjustments)
- Features include: stooped posture, masked face, drooling and shuffling gait
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Dx tests for PD
- No firm Dx test
- 2 signs of the classic triad: tremor, rigidity & bradykinesia.
- Confimation: positive response to low-dose of antiparkinson med. (Carbidopa-levodopa, Sinemet)
- CT scan- cerebral atrophy
- EEG- minimal slowingof brain electircal activity
- UGI- decreased motility
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Dyskinesia
abnormal involuntary movement
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Drug Holiday
When all drugs are withdrawn for a time because their effectiveness has decreased or have side effects from prolonged use.
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Medical Management for PD
- Drugs:
- - carbidopa-levodopa (Sinemet)
- - levodopa (Dopar)
- with prolonged treatment side effects such as dyskinesia may occure and decreased medication effectiveness. Hospitalization my be helpful during a drug holiday. Meds are then restarted offen at smaller doses.
- Aspiration can occur when meds are restarted
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Surgury for PD
- Ablation therepy: Destroys portion of the brain
- Deep Brain Stimulation: electrods are placed in the brain and connected it to a generator placed in the upper chest.
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Nursing Interventions for PD
- Lay on firm bed without pillow- prevent spine from bending forward
- Hold hands behind the back when walking
- Use a chair that propels them to an upright position
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Nutrition for PD Patients
- avoid malnutrition and constipation
- Appetizing foods that can be easily chewed & swallowed
- Ample time for eating, avoid frustration, encourage independence
- Aspiration precaution- as disease advances
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Teaching for PD patient
- Take medications as scheduled
- Good skin care and keeping active
- Proper ambulation and postitioning demonstrations
- Proper feeding techniques
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