- Bilateral, band-like pressure at base of skull
- Constant squeezing tightness
- Cycles for years
- 30min-7 days
- palpable neck and shoulder muscles, stiff neck, tenderness
- Unilateral, may switch sides, commonly anterior
- Throbbing, with pulse
- Periodic, cycles of months to years
- 4-72 hours
- Unilateral radiating up or down from one eye
- Severe, bone crushing pain
- Months or years inbetween
- Occur during 2-12 week period, last 5min-3hr
- Nocturnal, facial flushign or pallor, unilateral lacrimation, ptosis and rhinitis
- Generalized tonic-clonic and partial seizures
- Do not take with grapefruit juice
- Pt report visual abnormalities
- Abrupt withdrawal may precipitate seizures
- Can cause bone marrow suppression, anemia, leukopenia
- Also used for bipolar, trygeminal neuralgia
- Treats all major seizure types
- GI effects - N/V
- Can cause pancratitis or hepatomegaly
- Used for migraines also
- Oldest seizure drug, barbiturate, treats all seizures
- Lethargy, depression, learning impairment
- Physical dependence, pregnancy and withdrawal are concerns
- Can intefere with Vitamin D and K
- Tonic clonic and partial
- Metabolized by liver
- Can be given IV, used to treat dysrhythmias
- Therapeutic level of 10-20
- Adverse: nystagmus, ataxia, diplopia, cognitive impairment
- Gingival hyperplasia, rash
- Also used for postherpatic neuralgia
- Can cause peripheral edema, ataxia
- Viral/infectious, autoimmmune - affects myelin sheath
- Fatigue, weakness, numbness, difficulty with coordination, diploplia in early stages.
- Remission while pregnant.
- Interferon, Avonex, Copaxone
- Methotrexate - also used in RA
- Symmetrel, tegretol, BACLOFEN
- Dopamine deficiency, destruction and degeneration of nerve cells at basal ganglia.
- Drug induced sx from Haldon, lithium, aldomet
- Infections, chemical/environmental exposure
- Bradykinesia, tremors, rigiditiy, head forward/shuffling gait.
- Levodopa/Carbodopa, symmetrel (dopamine agonist, given with sinemet for dyskinesia), Parlodel - orthostatic hypoTN, headache. Anticholinergics.
- Autoimmune - affects myoneural juncion.
- Skeletal muscle fatigue, diplopia, ptosis
- Precipitated by stress, pregnancy,menses, hypokalemia
- Tensilon test
- Acute exacerbation of symptoms resulting in major muscular weakness and inability to maintain respiratory function.
- Can be caused by infection, surgery, emotional stress.
- S/sx- sweating, excess salivation, constricted pupils, difficulty chewing and swallowin, abd pain.
- Pt should be intubated, resp status monitored
- Tensilon improves condition but will worsen if pt in CHOLINERGIC CRISIS
Amyotrophic Lateral Sclerosis, ALS, Lou Gehrig's
- Degeneration of motor neurons, primarily in brainstem and spinal cord.
- Upper extremity weakness, dysarthria, dysphagia, trapped in body.
- Treated with Riluzole
- Progessive, hereditary, autosomal dominant genetic disorder.
- Excess abnormal movements, decreased intellect, emotional problems, progression leads to constant twisting and uncontrollable movements and facial movements, grimacing.
- Treat symptoms, Haldol blocks dopamine receptors.
Abd cramps, blurred vision, bowel or bladder incontinence, increased pulse and decrease urine output, restlessenss, increased salivation, dyspnea.
Central cord syndrome
- Damage to central cord areas
- Motor and sensory loss to UE and LE
Functional levels with various spinal cord injuries, cervical
- C1-3- often fatal, movement in neck and above
- C4- sensation and movement in neck and above, may be able to breath without respirator
- C5- full neck, partial shoulder, back,biceps, gross elbow, unalbe to roll over or use hands, decreased respiratory reserves
- C6- shoulder and upper back abduction and rotation at shoulder full biceps to elbow flexion, wrist extansion weak grasp of thumb, decreased respiratory reserve
- C7-8- triceps to elbow extension, finger extensors and flexors, good grasp with decreased strength, decreased respiratory reserve
Functional level of spinal cord injuries, thoracic and lumbar
- T1-6- full innervation of upper extremities, back, essential intrinsic muclse of hands, full strength and dexterity of grasp, decreased trunk stability, decreased resp reserve
- T6-12 - Full, stablethoracic muscles and upper back, functional intercostals, resultin in increased resp reserve
- L1-2 - varying control of legs and pelvis, instability of lower back.
- L3-4 - quardriceps and hip flexors, absence of hamstring function, flail ankles.
Spinal cord shock
- Can happen immediately after or up to 72 hours post injury.
- Temporary loss or dysfunction of spinal reflex.
- Loss of control with higher centers.
- Loss of sensation, absence of reflexes
- Bowel and bladder dysfunction.
- Occurs primarly in cord lesions.
- Hypotension and bradycardia.
- Loss of vasomotor tone caused by injury.
- SNS causes vadoilation, venous pooling, decreaed CO
- hypotension, bradycardia.
- Hyperreflexia as recovery porgreses.
- Can occur with injuries at T6 or higher, occurs after spinal shock resolves.
- Severe HTN, pounding headache, bradycardia (30-40 bpm)
- Elevate HOB 45 degrees, treat with dopamine, porcardia, beta blockers, methylprednisolone (not in penetrating injuries, cautions in elderly due to renal impact), Anticholinergics - ditropan, detrol, Alpha-Adrenergic blockers- hytrin, cardura, Antispasmodic- Baclofen
Guillane Barre syndrome
Ascending - most severe, weakness and paresthesias begin in lower extremities and progress upward to include legs, trunk, arms and cranial nerves.
Descending- weakness starts in face, jaw, SCM and tongue, larynx and pharynx and progressess down limbs, affects respiratory system, shallow resp, breathless with speech.
- inflammation or renal parenchma, most often caused by bacterial infection, also caused by obsruction, rerograde, frequent eps of pyelonephritis, also fungi/protozoa or viruses.
- S/sx of fever, chills, blood in urine, mild fatigue, n/v, dysuria, flank pain.
- Treat with IV abx, urinary analgesics (pyridium, orange piss)
- Caused by strep, viral inf, bronchitis, pneumonia, mumps, varicella.
- S/sx of HTN, elevated BUN and Cr, edema in hands and fingers, periorbital edema, protein/RBC and RBC casts in urine. Fluid in lungs, decreased output, azotemia, increased specific gravity. GFR below 50.
- Tx with rest, sodium and fluid restriction, diuretics, antiHTN, limit protein, broad spectrum ABX.
Acute renal failure
- Sudden and almost complete loss of kidney function, can be hours do days. Failure to excrete nitrogenous waste products.
- S/sx- azotemia, uremia, oliguria.
Contributin factors of ARF
- tubular necrosis- most common cause
- Infection - most common cause of death
- Hpovolemaia, hypotension, heart failure, kidney/renal obstruction.
- Decreased blood flow/ischemia.
- S/sx- hypotension, tachycardia, decreased urine output, lethargic, slighlty elevated Bun and Cr.
- Caused by hemorrhage, dehydration, CHF
- Actual kidne damage caused by imflammatory or innumologic processes.
- S/sx- anemia, edema, hypertension, JVD, crackles in lungs
- Caused by tubular necrosis, injury
- Obstruction of urine collecting system.
- Caused by cancer, BPH, sotnes, strictures, renal calculi.
Chronic renal failure.
Progressive, irreversible loss of kidney function, GFR or less than 60 for 3 months. Inability to concentrate urine.
CRF Stage 1
- Normal BUN and Cr.
- GFR over 90, healthy tissue compensating for damaged tissue
CRF Stage 2
- kidney damage with GFR 25% of normal, 60-89.
- BUN and Cr increased, azotemia, polyuria, nocturia, increased specific gravity.
CRF Stage 3
Moderate decrease in GFR, 30-59
CRF Stage 4
Severe GFR decreased, 15-29
CRF Stage 5
- Renal failure, uremia
- GFR less than 15
- Severe azotemia, uremia, hyperkaliemia, hyponatremia, hperphosphatemia, anemia can occur, metabolic acidosis, decreased erythropoetien, 1.010 specific gravity.
S/sx of CRF
- Decreased GFR, retendion of fluids
- Disrupted creatinine, excreion, BUN elevated
- Sodium elevated
- hyperkalemia - K of 7-8 before dialysis, causes dysrhythmias
- Kussmaul, low calcium, HTN, hyperlipidemia, LOC, uremic encephalopathy, pururites, uremic frost (deosits of urine crystals on skin. RAAS activated.
- ACE inhibitors- can cause hyperkalemia
- digoxin for heart
- restricted phosphate and protein (to pt tolerance)
- Restrict fluids