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Define trigeminal neuralgia.
Neuropathy of cranial nerve 5 with intense pain in CN-5 dermatome distribution. Abrupt onset of paroxysms of excruciating pain, burning, knife-like, or lightning-like shock in the lips, gums, cheek, forehead, or side of nose. Twitching, grimacing, blinking, and tearing may occur during an attack.
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Precipitating events for trigeminal neuralgia flairup.
Chewing, toothbrushing, hot/cold blast of air to face, washing face, yawning, talking, and especially touch and tickle.
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Trigeminal neuralgia medications.
- Antiseizure drugs such as carbamazepine (Tegretol), phenytoin (Dilantin), valproate (Depakene), carbazepine (Trileptal), gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax).
- Tegretol is first drug of choice, acts on Na+ channels, decreases neuronal repolarization and firing.
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Trigeminal neuralgia and nursing concerns:
Nutrition status, hygiene (especially oral), and behavior (withdrawal). Degree of pain and its effects on lifestyle, drug history, emotional state, and suicidal ideation.
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Define Bell's palsy.
- Disruption of one side of CN-7 facial nerve with absence of any other disease, resulting in one-sided face droop
- Etiology unknown, but virus suspected (HSV around/behind ear)
- Benign, usually full recovery after 6 months
- Residual droop may persist
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Treatment for patient with Bell's palsy.
- Moise heat, gentle massage, electrical stimulation, exercises
- Corticosteroids (prednisone) started immediately; once improvement is demonstrated, taper off over 2-week period
- If HSV (70% of cases), use acyclovir (Zovirax)
- Avoid cold drafts (trigeminal sensitivity/pain)
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Define Guillain-Barre syndrome.
- Cell-mediated immunologic reaction directed at peripheral nerves
- Often preceded by viral infection, trauma, surgery, viral immunizations, or HIV (stimulation of immune system)
- Affects peripheral nervous system, results in segmental demyelination, edema, and inflammation of nerves
- Loss of neurotransmission to periphery
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Guillain-Barre clinical manifestations:
- Weakness in lower extremities (distally more severe)
- Paresthesias (numbness/tingling) followed by paralysis
- Hypotonia (reduced muscle tone)
- Areflexia (lack of reflexes)
- If autonomic system involvement (e.g., CN-10), orthostatic hypotension, hypertension, bradycardia, heart block, asystole, bowel/bladder dysfunction, diaphoresis, respiratory failure
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Define spinal shock (spinal cord injury).
Decreased reflexes, loss of sensation, flaccid paralysis below level of injury. Lasts days to months, masks postinjury neurologic function.
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Define neurogenic shock (spinal cord injury).
- Loss of vasomotor tone, hypotension, bradycardia, loss of sympathetic nervous system, peripheral vasodilation, venous pooling, deceased cardiac output. Associated with cervical or high thoracic injury
- Atropine for bradycardia
- Dopamine for hypotension
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Classifying spinal cord injuries.
- Mechanism of injury - flexion, hyperextension, flexion-rotation, extension-rotation, compression; flexion-rotation most unstable (ligament tears)
- Level of injury - skeletal (vertebral) level, neurologic (cord) level
- Degree of injury - 1st affects vertebral column (fracture/dislocation); 2nd affects anterior or posterior ligaments, compression of spinal cord; 3rd affects spinal cord and roots, concussion,contusion, compression, laceration by fracture/dislocation, penetrating missiles
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Spinal cord injury, functional loss:
- C1-C4: Tetraplegia, loss of all motor and sensory function neck down, loss of respiration, no bowel or bladder control
- C5: Tetraplegia, can control head, shoulders, clavicle, portions of forearms, not intercostal muscles, no bowel or bladder control
- C6: Tetraplegia, can control head, shoulders, arms, palms of hands and thumbs
- C7-C8: Tetraplegia, triceps and grasp present
- T1-T6: Paraplegia, control shoulders, upper arms, chest, hands, no bowel or bladder function
- T7-L4: Paraplegia, can use leg braces and crutches, swing gait; lower levels have increased balance
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Autonomic dysreflexia:
- Cause: Rise in blood pressure, sometimes fatal; occurs with cord lesions above T6; sympathetic nervous system (fight/flight) sends signals to brain, brain cannot return signal stating to turn off sympathetic response; can result in stroke, MI, or status epilepticus
- Signs & symptoms: Severe HTN, severe HA, bradycardia, sweating above injury, goosebumps, blurred vision, nausea, vomiting
- Interventions: Raise head of bed; remove possible source of stimulation; monitor BP, administer antihypertensives (per MD orders); call MD if needed
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Spinal cord injury - acute nursing care:
- Maintain optimal respiratory function
- Maintain optimum CV function
- Maintain F & E balance
- Maintain immobilization & spinal cord alignment
- Prevent immobility complications
- Prevent urinary complications
- Maintain bowel elimination
- Monitor temp
- Observe for/prevent infection
- Observe for/prevent stress ulcers
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