Neurological disorders

  1. Ketogenic diet? what is it for?
    Is a special high fat, low carb diet with special measurements of calories, fluids and proteins. 

    Usually prescribed by a physician when epilepsy is not responding to seizure medications. Body uses fat as main source of energy and it has been proven to help prevent seizures.
  2. Risk factors for Stroke?
    • Smoking
    • age
    • sex
    • ethnicity
    • drinking too much alcohol
    • sedentary 
    • HTN
    • High cholesterol
    • diabetes
  3. S&S of stroke
    Acute numbness/weakness of arm, face, leg, confusion, dysphasia/aphasia, vision changes and dizziness.
  4. Prevention of strokes?
    • eat healthy-decrease saturated fats
    • Maintain healthy weight-exercise
    • Don't smoke
    • limit alcohol use
    • Manage other health conditions-diabetes/cholesterol/HTN
  5. Normal range of ICP? and total volume of blood or csf?
    • 10-20mm hg
    • CSF: 75ml
    • Blood: 75ml
  6. Few reasons for increased ICP?
    • Increased brain volume: tumors,
    • Increased cerebral blood volume: hemorrhage, trauma/hematoma
    • Obstruction of CSF outflow: build up of CSF in ventricles-requires a shunt
    • Cerebral edema: too much water/low sodium, hypertensive crisis, cytotoxic/hypoxic event may trigger inflammation and lead to further swelling.(meningitis/stroke)
  7. Cushings triad related to acute ICP?
    • Brady cardia
    • widening pulse pressures Systolic increases/ dystolic decreases.
    • Cheynes-stokes respirations
  8. Early S&S of ICP
    • AMS
    • Visual changes
    • motor weakness
    • anisocoria 
    • restlessness
  9. Later S&S of ICP
    • Coma
    • hyperthermia
    • decorticate/decerebate posturing 
    • loss of brain stem reflexes
    • Positive Babinski sign: big toe flexes other toes fan out.
  10. Complications of ICP
    • Brain stem herniation
    • diabetes insipidus-decreased ADH
    • SIADH-Too much ADH
  11. Steps of ICP management
    • CSF drainage-sedation-chemical paralysis-hyperosmolar therapy
    • Hyperventilation PAco2 <35 -hypothermia 33-35 celcius-barbs-decompressive craniotomy
  12. Nursing interventions of ICP
    • Assess: pupils, LOC, motor and sensation, respiratory pattern.
    • Monitor: ABG
    • Maintain: HOB at 15-30 degrees.
    • Administer: medications appropriately for condition (mannitol / furosemide)
  13. CO2 and ICP relationships
    elevated PaCO2 leads to cerebral vasodilation due to lack of O2 going to brain-this increases cerebral blood flow leading to further ICP.

    • Decreased PaCO2 leads to hypocapnoeic Vasoconstriction due to a change in PH. This causes a decrease in blood flow to the brain that decreases ICP, but can cause some cerebral ischemia. 
    • Intermittent hyperventilation for ICP
  14. Types of stroke?
    Ischemic: thrombotic (atherosclerosis) or an embolism

    Hemorrhagic: Aneurysum, AVM-arteriovenous malformation, bleeding from injury, HTN, anticoagulant.
  15. TIA?
    • transient ischemic attack- "mini" stroke
    • lasts 1-2 hours depending
    • Does not cause tissue to die
  16. Medical interventions for ischemic strokes
    Fibrinolytic therapy: tPA-tissue plasminogen activator-within 4.5 hours 

    endovascular interventions: stents, embolectomy, endarterectomy
  17. Nursing care for ischemic stroke
    • Monitor for ICP
    • maintain BP within acceptable range (140-150 systolic)
    • ongoing pharm therapy: anticoagulants, smooth muscle relaxants, calcium channel blocker, antiseizure medications.
  18. arteriovenous malformation (AVM)
    congenital absence of capillary networks leading to leakage of blood to surrounding tissue.
  19. AVM treatments
    • Surgery (microsurgery)
    • Radiosurgery (sterotactic radiotherapy) Beams of radiation to choke off blood supply to AVM
    • embolization (endovascular surgery) same procedure as diagnostic angiogram-they close one or more of the blood vessels, normally used in conjuction with microsurgery. 
    • conservative medical management.
  20. Risks for bleeding in hemorrhagic stroke?
    • trauma 
    • falls
    • coumadin
    • aspirin
    • liver disorder with decrease in clotting factors.
  21. Diagnostic tests for stroke?
    • CT or CT w/ Angiograph
    • bleeding times
    • ECG  for cardiac issues
  22. Medical interventions for hemorrhagic stroke
    • 30-40% chance of death initially
    • treated with neurosurgery or neurosurgery with interventional radiology
    • Control BP
  23. Nursing care for hemorrhagic stroke
    Monitor for ICP, signs of hemorrhage

    Provide O2 and post-op care
  24. Behavioral changes of Left hemisphere
    • Slow-cautious 
    • anxiety w/ new tasks
    • depression
    • sense of guilt/ worthleness
  25. Behavioral changes of right hemisphere
    • impulsiveness
    • lack of awareness
    • consistent smile
    • overestimation of abilities
  26. Expressive aphasia?
    Brocas area of the brain-difficulty speaking or trouble finding words
  27. Receptive aphasia?
    Wernickes area of the brain-difficulty understanding spoken or written words
  28. Dysarthria?
    Difficulty articulating a sentence: meaningless speech
  29. Cerebral angiograph?
    helps to find blockages in blood vessels of the neck and head. They will inject a contrast dye in order to get a better picture.
  30. Electrocephalography (EEG)?
    Checks for abnormal brain activity-checks brain waves. Mainly used to diagnosis seizure activity.
  31. Computerized tomography (CT) or CAT scan-Computerized axial tomography
    Uses x-rays to create cross sections of the body.
  32. Magnetic resonance imaging (MRI)
    Uses a magnetic field and pulses of radio wave energy to create images of organs and structures within the body. Gives different information then a CT/x-ray/ ultrasound.
  33. Lumbar puncture
    Used to assess the CSF to check for meningitis

    • Key differences between Viral and bacterial
    • Cloudy appearance vs clear appearance.
    • Increased WBC for both
    • proteins will be slightly elevated
  34. Meningitis
    • Inflammation of the meninges due to viral (herpes, measles, mumps) or bacterial and possible fungal.
    • S&S: headache, AMS possible, phonophobia, photophobia, neck stiffness, high fever, N/V, muscle aches. 
    • Bacterial may have petechiae on trunk or extremities.
  35. Enchephalitis
    • inflammation of the brain tissue: cerebrum, brainstem, cerebellum.
    • Usually caused by viruses that travel to the CNS-causing inflammation which leads to neuronal damage.
    • similar S&S as meningitis
  36. Multiple sclerosis (MS)
    • Degeneration of the myelin sheath of the neurons. autoimmune disease-antibodies attack own myelin. 
    • Blurred or double vision
    • Thinking problems
    • Clumsiness or a lack of coordination
    • Loss of balance
    • Numbness
    • Tingling
    • Weakness in an arm or leg.
    • heat sensitivity
    • neuropathic pain
    • impaired cognitive ability
    • tremors
  37. Herniated nucleus pulposus
    • Gel surrounding the intervertebral disc bulges or herniates through bands of fibrous tissue.
    • This leads to compression on spinal nerve roots, vascular structure and spinal cord. leads to pain a neuro symptoms.
  38. HNP risk factors and treatments
    • Risk factors: repetitive bending, twisting, lifting, weak abdominal muscles, poor body mechanics.
    • Treatments: Bedrest, PT, TENS unit, pain meds, Laminectomy, fusion of unstable vertebrae
  39. Spinal cord injury (SCI)
    • Complete and incomplete injury one with complete deficits and the other with partial.
    • Can lead to Autonomic dysreflexia-which can lead to uncontrolled HTN-and stroke
  40. Key features of Autonomic dysreflexia
    • Severe headche
    • HTN
    • bradycardia
    • flushing above injury
    • pale extremities below injury
    • piloerection
    • apprehension
  41. Primary epileptic seizure
    defined as 2 or more seizures, chronic. May be caused by an imbalance of neurotransmitters (GABA)
  42. Non-epileptic seizure(secondary)
    • commonly the result of tumor or trauma.
    • Other examples-alcohol withdrawal, high fever, hypoxia, drug intoxication/poisoning, electrolyte imbalance, hypoglycemia.
  43. Types of seizures
    • partial: starts in a specific part of the brain with focal discharges.
    • generalized: affects the whole brain from beginning of seizure to end.
  44. Subtypes of partial seizures
    • Simple: patient doesn't lose consciousness (myoclonic)
    • Complex: patient has impaired consciousness (absence)
  45. Depending on where the partial seizure is located we'll have different S&S
    • Temporal: hearing, memory, sound, smell, emotions-emotional changes most common
    • Frontal: long-term memory, speech (Brocas), taste-jacksonian march: abnormal movement of hand and it progresses up the arm.
    • Parietal: interpret touch, sensation, texture, size, spatial relationships.-tingling of one side of body/warmth
    • Occipital: vision-changes or seeing flashing lights.
  46. Complex partial sizures
    • impaired consciousness for 1-3 mins (syncope)
    • unaware of env; amnesia
    • occurs anywhere in brain, but most common in temporal lobe
    • characterized by automatisms
  47. Partial seizures can progress to?
    A generalized seizure
  48. Subtypes of generalized seizures*
    • non-convulsive: absence (petit mal)
    • Convulsive: Tonic-clonic (grand mal)
  49. Absence (petit mal)-characteristics
    • change in consciouness 
    • rolling eyes, blank stare, day dreaming, slight mouth movements.
    • can have up to 100 a day brain return to normal without issue.
    • can progress to tonic clonic
  50. Myoclonic seizure
    • sudden, brief jerking of muscle groups
    • aka: akinetic seizure
  51. Generalized clonic tonic seizure (grand mal) characteristics?
    • syncope-with full body tonic phases and clonic phases as the individual experiences  muscle spasms.
    • cyanosis, tongue biting, apnea, incontinence can occur. lasts up to 5 mins commonly
  52. Complications of seizures
    • memory loss
    • brain damage if seizure prolonged
    • risk for hypoxia, vomiting, aspiration, persistent metabolic disorders
  53. nursing process if your patient seizes
    • not time of seizure
    • protect head
    • maintain airway/O2
    • prevent aspiration-lateral recumbent-suction
    • use padded rails
    • loosen constrictive clothing
    • blood draws and check BG/temp.
  54. Postictal phase after tonic clonic
    effects after the seizure-confusion, drowsy, fatigued, muscle pain, weakness, headache. takes mins-hours to regain consciouness
  55. Common medications for seizures
    can they cure seizure?
    • phenytoin
    • klonopin 
    • tegretol
    • depakote
    • neurontin 
    • ativan
    • no they're ment to control 50-60% efficacy.
    • 20-35% of patients with seizure do not get relief from seizures.
  56. Toxicity S&S of phenytoin, phenobarbital and gabapentin
    phenytoin: nystagmus, ataxia, confusion, nausea, slurred speech and dizziness

    phenobabital: confusion, drowsiness, dyspnea, slurred speech, staggering

    Gabapentin: confusion, depression, ataxia, drowsiness, altered reflexes, paraesthesia.
  57. Other interventions for seizure control?
    • Vagus nerve stimulation
    • lobectomy-surgical resection of seizure area in brain
    • corpus callostomy: surgeon sections anterior 2/3 of corpus callosum to prevent neuronal discharge.
  58. Parkinson's disease
    • degeneration of dopamine receptors in the brain called substantia nigra where dopamine is created. This leads to less dopamine in the brain.
    • dyskinesia, dysphagia, unsteady gait, whole body fatigue, impaired speech, tremors, shakiness.
  59. Nursing process
    • assessment 
    • nursing diagnosis
    • planning
    • interventions
    • evaluate/reassess
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Neurological disorders