-
ictal phase
full sz. (phase name)
-
NI's for sz.
- have O2 nearby
- document
- safety
-
postictal phase
- period of recovery
- takes nrg
-
absence sz.'s (petit mal)
- children to adolescent
- brief staring spell
- occur after precipitating event (flashing lights, hyperventilation)
- untreated - up to 100x/day
-
Bell's palsy affects what nerve
facial nerve VII
-
how treat Bell's palsy
- corticosteroids
- analgesics
- nerve stim.
-
peripheral facial paralysis (bell's palsy) s/s
- initial pain around ear
- flaccidity on affected side of face
-
sz def
interruption of norm brain fxn, the result of unctrl'ed electrical discharge of neurons
-
epilepsy def
recurring szs caused by chronic underlying condt
-
simple partial szs
- simple motor or sensory phenomena
- no loss of awareness
-
Guillain barre stats
- adults
- both genders
- 85% recover w/in 2 yrs
-
Guillain barre - how fast? starts where?
- acute, sudden onset
- rapidly progressive
- potentially fatal
- starts in legs and moves up
-
aural/prodromal phase
sensory warning or sign preceding sz
-
-
NIs guillain barre
- assess resp fxn
- monitor ascending paralysis via CN
-
sz treatment options other than meds
- vagal nerve stim.
- hemispherectomy
- corpus callosum separation
-
tonic clonic szs (grand mal)
- combination tonic phase (stiffen) and clonic (jerking)
- 30-120 sec
- loss of consciousness
- cyanosis, drooling, tongue biting, incontinence
- bilateral and symmetrical
-
complex partial sz
- loss of awareness
- motor, automatisms (taste, smell, feeling, tick)
-
guillian barre physiology
- loss of myelin and inflamm. of affected nerves
- prevents neurotransmission to PNS
-
-
antisz drugs
- phenobarbital
- dilantin
- tegratol
- depakene
- neurontin
- lamictal
- topamax
- depakote
- klonopin
- keppra
- ativan
- valium
-
status epilepticus def, time?
- sz lasting 10+ min
- no return of consciousness between szs
- potentially fatal b/c no O2, bcp nrg
-
skull contains what 3 things
-
TBI stats
- 1.4 million/yr in USA
- 50,000 die immediately
- 235,000 hospitalized
-
measure ICP if GCS score is...
8 or below
-
ventriculostomy
catheter goes into skull
-
#1 cause (and other causes) of TBI
- #1 MVA
- recreational
- sports injuries
- falls
- work accidents
- assault/firearms
-
normal vs. elevated ICP
- 0-15 mmHg = normal
- greater than 15 mmHg = elevated
-
commonly dxed neuralgic condt
trigeminal neuralgia
-
women over 40 are at risk for...
trigeminal neuralgia (2x the risk)
-
s/s trigeminal neuralgia
intense facial pain with refractory periods, often triggered by chewing, teeth brushing, hot/cold, yawning, washing face, talking
-
how treat trigeminal neuralgia (V)
- anticonvulsants
- nerve blocks
- pain meds
- rhizotomy - needle placed into trigeminal rootlets
-
myasthenia gravis def.
- autoimmune disease of the neuromuscular junction
- antibodies attack acetylcholine receptor sites
-
MG - antibodies attack what
acetylcholine receptor sites
-
MG stats
- low prevalence (14 per 100,000)
- more common in women 20-30 yrs
- affects both sexes equally in older yrs
-
MG - treatable?
Yes, good prognosis
-
Tensilon does what
used to dx MG - symptoms get better if pt has MG and is given this
-
s/s MG
- FLUCTUATING WEAKNESS OF SKELETAL MUSCLES
- -eyelid/extraocular muscles involved
- -chronic fatigue
- -facial expressions, chewing, swallowing
-
what drugs help manage MG
- anticholinesterase agents
- corticosteroids
- immunosuppressants
-
if pt has MG and is given anticholinesterase agents, names of drugs...
- Neostigmine (Prostigmin)
- Pyridostigmine (Mestinon)
-
if pt has MG and is given corticosteroids, names of drugs...
prednisone
-
if pt has MG and is given immunosuppressants, names of drugs...
- Azathioprine (Imuran)
- Cyclophosphamide (Cytoxan)
-
Myasthenic crisis triggered by
- infection
- surgery
- stress
- meds too low
-
Myasthenic crisis def. and what complication may result
acute exacerbation that may lead to resp. emergency
-
Cholinergice crisis def
- too much medication
- similar to myasthenic crisis
-
how differentiate between myasthenic crisis and cholinergice crisis
Give pt tensilon. If symptoms get better, it's myasthenic. If symptoms worse, it's cholinergice
-
assess what w/ MG pt
- resp status
- muscle strength
- coping ability
- fatigue
- body parts affected
-
RN should plan for what w/ MG pt
- normal muscle endurance
- avoid complications
- maintain quality of life
-
RN should implement what w/ MG pt
- avoid fatigue
- maintain adequate ventilation
- education
-
RN should evaluate what w/ MG pt
- minimal side effects to meds
- maintain optimal muscle fxn
- minimal complications
-
Treatments for MG
- thymectomy
- plasma exchange (plasmaphoresis)
- immune globulin therapy
-
Basal ganglia does what
- generates dopamine
- helps with smooth, coordinated activities like dance, play instrument, etc.
-
Parkinson's disease (PD) physiology
- disease of the basal ganglia
- degenerates dopamine production in the midbrain (substantia nigra) which then disrupts dopamine to acetylcholine balance in the basal ganglia
-
extrapyramidal motor system needs what to fxn
balance is needed for it to fxn
-
PD symptoms occur when ___% of neurons are lost
80%
-
PD cause
- unknown, but possibilities include--
- herbicides
- pesticides
- well water
- familial
- virus
- chem poisoning
- seen more with copper miners
- certain medications
- illegal drug use
-
PD onset
gradual, progressive
-
PD stats
- more common in men (3:2)
- dx increases with age (50s and 60s +)
-
3 parts of "Triad of Parkinson's"
- tremor
- rigidity
- bradykinesia
-
tremor part of triad of parkinsons looks like what
- hand tremor - pill rolling
- more prominent at rest
-
rigidity part of triad of parkinsons looks like what
- slow, jerky mvmts - "cogwheel rigidity"
- increased resistance to passive motion
-
bradykinesia part of triad of parkinsons looks like what
- slow mvmt
- loss of automatic mvmts such as blinking, facial expressions and swallowing
- stooped posture
- masked face
- drooling
- shuffling gate
- difficulty starting a mvmt
-
how PD pts die?
complications of the disease, not the disease itself
-
complications of PD
- skin breakdown
- risk for inf
- decreased mobility
- contractures
- constipation
- falls
- dysphagia
- drooling
- depression
- altered speech
- incontinence
- dementia
-
antiparkinsons drugs do what in body
correct the imbalance of neurotransmitters
-
how does Carb/Lev work?
Levodopa has domamine in it; Carbidopa stops the levodopa from being metabolized too quickly
-
antiparkinsons drugs (KNOW)
- Carb/Lev (Sinamet)
- Requip
- Mirapex
- Permax
- Parlodel
- Amandine (Symmetrel)
- Anticholinergic drugs -- like...
- Artanem
- Cogentin
- Akineton
- Benadryl
-
what's an antiparkinsons and antiviral med?
Amandine (Symmetrel)
-
anticholinergic drugs to what in the body
block cholinergic receptors therby helping with dopamine/acetylcholine balance
-
anticholinergic drugs given for PD - name four
- Artanem
- Cogentin
- Akineton
- Benadryl
-
surgical procedures to manage PD symptoms
- deep brain stimulation
- ablation
- transplantation
-
ablation (done for PD) def; name 2 types of; L/O
- destruct certain parts of basal ganglia
- Pallidotomy (globus pallidus of the basal ganglia)
- Thalamotomy
-
transplantation (to manage PD symptoms) means what
- it's experimental
- use fetal neural tissue to add dopamine-producing cells
-
NIs for PD
- promote adequate nutrition/diet
- optimize psychosocial wellbeing
- encourage INDEPENDENCE in fxning
- promote physical activity
- refer to therapies
- avoid complications (contraxures, constip)
- patient safety (ambulation interventions)
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