Long term memory is referred to as?
"Where did you go to high school?"
Recent memory is referred to as?
"what did you have for lunch?"
When doing a mini memory status - asking to repeat a list of words is referred to as?
A state of cognition that is acute, sudden, and reversible?
A state of cognition that is progressive, degenerative, and irreversible?
Abnormal motor movement seen in a patient with lesions that interrupt corticospinal pathways?
Babinski's sign should not be positive after the age of?
Testing with hot/cold, pin prick, light touch is what kind of testing?
Testing physical movements and strength is what kind of testing?
Loss of sensation on the opposite side of the body?
Loss of sensation on the same side of the body?
Why do we start with the least painful area and proceed to the most painful area?
If start with pain then entire test will be thrown off and focus on pain
A test done to visualize the cerebral circulation of arteries and veins in the brain?
Patient care preparation for cerebral angiography:
- allergic to contrast media
- N/V recently? medicate to prevent aspiration
- NPO 4-6H
- Head immobilization
- do not move during procedure
- warm sensation when dye goes in
- let us know if any pain during procedure
- assess and document neuro, v/s, circ checks
Patient care post-procedure for cerebral angiography?
- check dressing for bleeding and swelling around site
- ice pack to site
- keep extremity straight and immobilized
- maintain pressure dressing for 2 hours
- Circ checks (skin color, temp, pulses, cap refill)
- assess v/s and neuro
- increase fluid unless contraindicated
Why do we hydrate before, after, and during contrast meduim?
prevent damage to kidneys
What labs should we test before and trend with contrast medium?
- electrolytes - after because peeing a lot
PET scan for brain preparation?
- Very important that they hold caffeine, alcohol, and tobacco…
- Don’t give glucose solutions – glucose and oxygen metabolism
- During procedure – may be blind folded and ear plugs
- May be asked to perform different mental functions
- Can be anxiety provoking, especially for older adults
What are some S/S of increased intracranial pressure?
- Decreased LOC
- pupil changes
- **DO NOT LAY THEM DOWN**
LP not done if a patient is suspected of having or has?
- Increased Intracranial Pressure
- Rash or infection
(SNS) sympathetic nervous system response findings:
- HR up
- Contractility enhanced
- Respiratory rate up
- LOC up
- Pupils dilate
(PNS) Parasympathetic nervous system response findings:
- Pupils constrict
- Lungs reduce intake
- HR lower
S/S of a migraine HA?
- Visual disturbances – highly associated
- Last 4-72 hours
- Throbbing and unilateral
Triggers of migraine HA?
- red wine
sensitivity to light
sensitivity to noise?
Encourage patients to keep a diary of what?
- Migraine HA
- Response to medication
- Quality, intensity, nature of HA
S/S of Atypical HA
- HA lasts longer than 72H
- 5 phases
In atypical migraines this phase contains cravings, mood changes
In atypical migraines this phase contains visual changes, flashing lights, or diplopia
In atypical migraines this phase contains actual HA
In atypical migraines this phase contains intensity of HA decreases
In atypical migraines this phase contains patient fatigue, irritable, muscle pain
Name the 5 phases of atypical migraines:
- Prodromal phase
- Aura phase
- HA phase
- Termination phase
- Postprodrome phase
What is the priority of care for patients with migraine?
Drug alert patient teaching for taking beta-blockers or calcium channel blockers?
- Take pulse
- Report bradycardia
- Report SOB, fatigue
Drug alert for patients taking triptans?
- take as soon as migraine symptoms start
- report chest pain or discomfort
- use birth control
- flushing, tingling, hot sensation (common side effects)
- do not take with SSRI or St. John's wort
S/S of cluster HA
- 30M - 2H
- intense unilateral pain (spring/fall)
- ipsilateral tearing
- eyelid edema
- facial swelling
- miosis (constriction of pupils)
Treatment of cluster HA?
- high flow O2
- decrease light and noise
S/S of tonic-clonic seizures?
- lasts 2-5 min
What do we do in a seizure?
- Lay on side
- Move things away
- Protect head
- Record time started and ended and what happened before, record observed
- Don’t put anything in their mouth
- Padded side rails
- O2 and bag, valve, mask
- Bed very low
- IV access
Chronic, recurring seizures (two or more seizures, unprovoked)
Risk factors for developing seizures:
- Head trauma
- Febrile state for infants and children
- Increased intracranial pressure
- Toxins – leather tanning and rubber
- Brain tumors
- Anticonvulsant meds d/c or not on time
Triggers contributing to seizures?
- flashing lights
- certain chemicals (smells)
- intense activity
Treatment for staticus epilepticus
- Ativan (benzodiazepines) to stop seizure
- Phenytoin (Dilantin) to ensure they don’t have another
Nursing safety priority action alert for seizure precautions:
- oxygen, suction, airway equipment ready
- IV access with saline lock
Patient and family education for Epilepsy
- drug therapy info
- no OTC meds without checking with provider
- f/u with providers
- medical alert bracelet
- make sure family/caregiver knows how to care in seizure
- follow state laws regarding driving
- avoid alcohol and excessive fatigue
- epilepsy foundation for info
Best practice for patient safety during a seizure
- protect from injury
- nothing in mouth
- turn pt to side
- loosen clothing
- maintain airway and suction secretions
- don't restrain
- record time seizure starts and ends
Critical rescue in status epelipticus
- establish airway
- notify RRT, provider
- administer O2 as indicated
- IV access
What is the pathophysiology of Parkinson's?
- decreased production of dopamine
- or too much acetylcholine
What is the treatment for Parkinson's?
- increase dopamine
- reduce acetylcholine
How is Parkinson's diagnosed?
- based on symptoms
- r/o other things
What are the 4 cardinal signs of Parkinson's?
- muscle rigidity
- Bradykinesia or akinesia
- Postural instability
Safety concerns for Parkinson's?
What are aspiration precautions and difficulty chewing?
- Thickened liquid
- HOB 30
- Chin tuck
- Small bites of food
- Risk for malnutrition – dense, high protein
Best practice for patient safety and quality care for the patient with Parkinson's
- allow extra time for pt to respond to questions
- admin meds promptly and on schedule
- provide meds for pain, tingling, PRNcollaborate with PT, OT
- allow pt time to perform ADL's
- implement interventions for constipation, pressure ulcers, contractures
- late morning activities
- teach to speak clearly and slowly
- monitor swallowing and eating
- provide high-protein, high calorie foods
- recognize that Parkinson's affects body image
- assess for depression and anxiety
- assess for insomnia or sleepiness
Alzheimers (dementia) is different from delirium because:
Risk factors for developing Alzheimers (dementia):
- Head injury
- Herpes zoster and simplex
- Age (65+)
Prevention for Alzheimers
- Healthy life-style
- balanced diet
- folate and B12
Early (mild), Stage I Alzheimer's key features:
- independent in ADL's
- no social or employment problems initially
- denies presence of symptoms
- forgets names; misplaces household items
- short-term memory loss, difficulty recalling new info
- subtle changes in personality and behavior
- loss of initiative, less engaged in social
- mild impaired cognition
- decreased performance, especially under stress
- unable to travel alone to new destinations
- decreased sense of smell
Middle (moderate), Stage II Alzheimer's key features:
- Impairment of all cognitive functions
- problems with handling or unable to handle finances and money
- disorientation to time, place, and event
- possible depression, agitated
- increasingly dependent in ADL's
- visuospatial deficits, gets lost
- speech and language deficits
- wandering, trouble sleeping
Late (severe), Stage III Alzheimer's key features:
- completely incapacitated, bedridden
- totally dependent in ADL's
- motor and verbal skills lost
- general and focal neurologic deficits
- agnosia (loss of facial recognition)
Important things to know about Huntington's Disease
- Autosomal dominent
- Neuro and behavioral symptoms
- Cog decline
- Dementia and choreiform movements – rapid, jerky movements
- Imbalance of inhibitory and excitatory neurotransmitters
- No cure
Rapid, jerky movements in the limbs, trunk, and facial muscles:
What is the pathophysiology of Multiple Sclerosis?
Demylenation of neurotransmitters – inflammation of the myelin or immune system attack (autoimmune disorder)
What are some things that cause exacerbations of MS?
- lack of sleep
What are the causes of MS?
- women more than men
- 20-40 yo's
What are the key features of MS?
- muscle weakness and spasticity
- intention tremors
- dysmetria (inability to direct limb movement)
- numbness or tingling (paresthesia)
- hypalgesia (decreased sensitivity to pain)
- dysarthria (slurred speech)
- scotomas (chg in peripheral vision)
- decreased visual and hearing acuity
- tinnitus and vertigo
- bowel and bladder dysfunction
- alteration in sexual fx, impotence
- cognitive changes
On an LP what will be seen for diagnosing MS?
- elevated protein
- normal WBC
Guillain barre looks the same on LP
Quick key features of MS (hallmark signs)
- sensation and motor function difficulty
- hyper-response to DTR's
- overactive bladder
Key features of Amyotrophic Lateral Sclerosis (ALS)
- tongue atrophy
- weakness of hands and arms
- beginning muscle atrophy of arms
- fasciculations of face or tongue
- difficulty controlling crying or laughing
- nasal quality of speech
- dysarthria (slurred speech)
- fatigue while talking
- stiff or clumsy gait
- abnormal reflexes
Quick clinical features of ALS?
- muscle atrophy worsens with time
- flaccid paralysis = respiratory compromise
- planning important - DNR?
Key features of Guillain-Barre syndrome?
- ascending paralysis
- ascending muscle weakness in legs
What is the pathophysiology of Guillain-Barre syndrome?
- demyelination of myelin sheath
- nerve transmission interrupted
What is the primary treatment for Guillain-Barre syndrome?
IGg or plasmaphoresis
What are the nursing concerns with Guillain-Barre syndrome?
- assess frequently Q1H
- DTR's diminished = respiratory compromise = flaccid paralysis
What is the pathophysiology of Myasthenia Gravis?
antibodies block, alter or destroy receptors at acetylcholine at neuromuscular junction
What are some causes of Myasthenia Gravis?
- Thymus gland
S/S of Myasthenia Gravis?
- Weakness of skeletal muscles throughout the body
- Weakness occurs during activity and Improves during periods of rest
How is Myasthenia Gravis diagnosed?
- Tensilon test (edrophonium)
- NCV/EMG, CT, MRI
- Antibody titer for acetylcholine
During Tensilon (edrophonium) test what does it test and what should we have on hand?
- give IV drug and if it briefly relieves symptoms then helps to DX
- SHOULD HAVE ATROPINE READY TO GO - this test can cause cardiac dysrhythmias
In this type of crisis with not enough anticholinesterase med – will see HTN
In this type of crisis with too much anticholinesterase med – will see hypotension
What do we need to make sure to educate the patient when taking pyridostigmine for Myasthenia Gravis?
- must wait to eat 45min-1h later to prevent aspiration
- Med dosage changed all the time
- Monitor effectiveness – the purpose of the drug – monitor swallowing, eating better, weight going up
Patient and family education for patients with Myasthenia Gravis:
- keep drugs and water at bedside if weak in am
- wear a watch with an alarm function to remind
- post drug schedule so others know it
- plan strenuous activities when drug peaks
- keep secure supply of drugs in car or work
- check before using any OTC meds
What do we teach family members of Myasthenia Gravis about respiratory?
- learn resuscitation procedures
- bag, suction, O2 equipment in home
- teach family members how to use
What are some causes of trigeminal neuralgia?
- dental work may cause
- usually 50+
What are s/s of trigeminal neuralgia?
- excruciating pain
- facial twitching
Treatment for trigeminal neuralgia?
- nerve block