Care for pt w/neurological disorders

  1. Problems with the brain
    • Headaches
    • it is a diffused pain in various parts of the head with the pain not confined to the area of distribution of nerve
    • Primary: margraine,tension and cluster
    • Secondary: brain tumor, infection
  2. Assessment of Headaches
    • Questions to ask: PRSQT?
    • - start, alleviating/aggrevating factors, quality,
    • Ask about triggers:
    • - smells, lights, parfum, stress, diet, lack of sleep, dehydration, caffiene
    • Headache diary
    • - what were u doing before it started
    • - how long
    • - how it feels
    • prevent, proactive, propholatic meds
    • sometimes we can eliminate triggers
  3. Questions
    • time
    • character
    • cause
    • response
    • state of health between attacks
  4. Headache assessment
    • consider dx other than primary h/a if 'red flag' present call MD
    • S- systemic symptoms- goes beyond h/a ie fever, diarrehea
    • N- neurologic symptoms- chx (new) seeing double
    • O- onset- immediate, delay
    • O- older than 50 or younger than 5
    • P- previous h/a different patterns- different from what you experienced before
  5. Management of h/a prevention
    • A- a full night of sleep ie 6-8 hrs have a good pattern
    • B- breakfast, lunch and dinner
    • C- caffeine, alcohol limits- sometimes alcohol is used as therapy
    • D- decrease stress
    • E- exercise- release endorphines keeps blood flowing serotonin
    • F- fluids
  6. Migraine h/a
    • chronic, episodic disorder of complex symptoms usually lasting 4-72 hrs
    • risk:
    • familial- 80%
    • women- r/t estrogen
    • hx of anxiety or depression
    • and other chronic diseases
  7. migraine triggers
    • menstrual cycle
    • bright lights glare
    • stress, anger
    • depression, fatigue
    • food/beverage
    • (aged cheese, chocolate, nuts, cured meats, nitrate containing food such as processed meats, and monosodium glutamate (MSG), nutrasweet
    • alcohol esp red wine
    • caffeine
    • overuse/withdrawl
    • certain drugs
    • distrupted sleep
    • skipped meals
    • odors, smoke
    • dehydration
    • pain (back, chronic)
  8. Patho of migraine h/a
    • unknown
    • neurological, chemical, inflammatory
    • inflammatory: vascular perman, vasospasms, chx in blood flow
    • release of chemical mediators
    • stimulates noscios? receptor- pain receptor
    • mediated in the brain
    • blood vessels in the brain overract to a trigger- spasms of the arteries
    • arterial constriction and decrease in cerebral blood flow
    • cerebral hypoxia may occur
    • platelte clump together and serotonin is releases
    • other arteries dilate triggers of prostagladins and other substances that inc sensitivity to pain
  9. other theories for patho of migraine
    • incr glutamate in brain
    • cortical spreading depression
    • - impulses neuro chemical
  10. clinical manifestation of migraine h/a
    • often unilateral pulsating pain
    • mod-severe pain intensity
    • last b/w 4-72 hrs
    • usually proceeding by a trigger
    • associated with n/v, photophobia, phonophobia
    • aggrav: normal activity- like ADL's
    • may have aura- neurological symptoms
    • - can feel it coming on
  11. Phrases of migraine
    • Prodrome phrase= hours/days before a migraine feel it, visual, sensory
    • aura or no aura phrase- not all have this but it could be few secs to hour visual, auditory, sensory- feel it before it happens
    • headache phrase- extricuating pain can interfere with adl's
    • recovery phrase- pain subside, fatigue
  12. Nx management of migraine
    non pharm
    • quiet, dark room
    • - make pt comfortable
    • - relaxation techniques
    • - HOB 30 degree
    • - recognize triggers and cope
    • - cognitive behavioral therapy
    • - pt education- national h/a foundation
  13. Migraine pharm
    • abortive/rescue therapy
    • - acetaminophen, NSAIDS (mild drugs)
    • - OTC agents (anti inflam, aspirin, caffiene- becareful vasospasms)- excederine migraine- caffiene activates more tylenol work better. becare ful cause too much caffeine can cause more vasospasms
    • - triptan preps (Imitrix)
    • MOA: SSR agonist - serotonin receptors chx decr vasospasms, dec pain
    • S/E: vasocontriction, mindful of HTN, MI contraindicated
    • NI: teach to take as soon as you feel h/a
    • inj SC
    • Nasal w/nausea- works 10-15mins
    • oral- 30 mins
  14. More pharm migraine
    • abortive/rescue therapy
    • - Erotamine preps (Ergomar, Cadergot)
    • MOA- act on smooth muscles of cranium, dec vasospasms and pain
    • S/e: fatigue and weakness
    • NI: take early
    • adjuncts: antiemtics and anti anx- lorazapam, ativan, CNS gaba
  15. migraine pharm tx
    preventative or prophylactive management
    • if patient has 3-4 migraines/month affecting life- should be on preventative therapy
    • beta blocker- dec vasospasms, vasodilator
    • Ca channel blocker- not as effective as BB but if can't tolerate it- dec vasospasms
    • anti seizure meds- (topamax, neurotonin)
    • antidepressants- elavil
    • - hx of depression works with topamax unknown
    • ace inhi
  16. Tension h/a
    • most common type of chronic long duration h/a last 30 mins to 7 days
    • dull, pressing, tightening non pulsatile pain
    • usually bilateral location
    • does not worsen with activity
    • nausea not involved
    • may have photo/phonophobia
    • episodic or chronic
  17. PAtho tension type h/a
    • patho unclear
    • one theory: that is results from sustained tension of the muscles of the scalp and neck which can be associated with both emotional and physical stress, poor posture, fatigue
  18. management of tension h/a
    • assessment
    • non pharm management
    • acetaminophen, NSAIDS
    • fiorcet (tylenol, caffeine, butabital)- used for migraine, barbituate muscle relaxation
    • amitriptyline (TCA)
    • muscle relaxants
    • anticonvulsants (depakote) prevention
    • beta- titrate up, se fatigue, report dizziness, syncope
  19. Cluster H/a
    • unilaterial, acute onset
    • pain: intense, severe piercing
    • come in clusters of 1-8 daily at same time/d
    • accompanied by watering of the eye, eyelid swelling, ptosis and nasal congestion
    • each attack last 15 mins- 3 hours
    • paces, irritable
    • suicide h/a
    • waking you up at night
    • resovles and then may come back again
  20. patho of clusters
    • not fully understood
    • vasoreactivity and inflammation of nerves
    • changes in trieminal neve or facial
    • structural chx and overractive hypothalamus
    • changes in SNS
    • r/t to nerves
  21. tx of cluster h/a
    • prevention
    • - non pharm
    • - ca channel blockers- DOC
    • - prednisolone- steriod HD inflamm of nerve branches
    • - Ergotamine pr s/e: episodic give at first sign of h/a s/e is cardiac
    • acute:
    • -tx- 100% O2 for 15 - 20 mins to achieve vasocontrition??- decr vasospasms/contriction
    • - imitrex sc
Card Set
Care for pt w/neurological disorders
aching pain