brain problems

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  1. Migraine headache
    • chronic, episodic disorder with multiple subtypes
    • more frequent in women
  2. Stages of migraines
    • prodrome - mood change
    • aura phase
    • headache phase - can last hours to days; typically unilateral
  3. Pathophysiology of migraines
    • not completely understood
    • inflammation
    • substance P released
    • affects trigeminal nerve
    • vasodilation
  4. Interventions for migraines
    • recognize migraine symptoms
    • see a health care provider
    • relieve pain and associated symptoms
  5. Abortive drug therapy for migraines
    • alleviating pain during early aura phase or soon after headache has started
    • Imitrex
    • caffeine
  6. Preventive therapy for migraines
    • if suffering from more than 2 a month, preventive therapy needs to be initiated
    • beta blockers
    • calcium channel blockers
    • elavil
    • treat HTN - headaches generally decrease
    • antiseizure meds
    • prevent triggers - no tyramine, hysterectomy
    • antiinflammatories - high dose ibuprofen for mild migraines
    • reglan, phenergen for nausea
  7. CAM therapies for migraines
    • yoga, meditation, massage, exercise, biofeedback, relaxation, pressure points
    • acupuncture
    • herbs
    • reduce tension/stress
  8. Cluster headache
    • more frequent in men
    • unknown cause but attributed to vasoreactivity and oxyhemoglobin desaturation
    • histamine cephalalgia
    • unilateral, radiating to forehead, temple or cheek
    • ipsilateral tearing of the eye, rhinorrhea, ptosis and miosis
  9. Therapy for cluster headaches
    • same drugs as for migraines
    • sunglasses
    • oxygen via face mask
    • avoid precipitating factors - anger; excitement
    • possible surgical management
  10. Tension headache
    • neck and shoulder muscle tenderness and bilateral pain at base of skull and in forehead
    • head pain without associated symptoms
  11. Treatment for tension headache
    • non-opioid analgesics, muscle relaxants, occasional opioids
    • ibuprofen + caffeine
    • prophylactic similar to migraine treatment
  12. Seizure
    • abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain
    • may result in alteration of consciousness, motor or sensory ability and/or behavior
  13. Epilepsy
    • two or more seizures experienced by a person
    • chronic disorder with recurrent, unprovoked seizure activity
    • may be caused by abnormality in electrical neuronal activity and/or imbalance of neurotransmitters
  14. Biggest concerns when a seizure occurs?
    • brain tumor
    • head injury
  15. Types of seizures
    • generalized
    • partial
    • unclassified
    • primary or idiopathic epilepsy
    • secondary
  16. Generalized seizures
    • both cerebral hemispheres affected
    • tonic/clonic
    • absent seizures
    • myoclonic
    • atonic
    • extreme exhaustion
  17. Myclonic
    brief jerking in seizure
  18. Atonic
    loss of muscle tone and client falls down in seizure
  19. Partial seizure
    starts in one part of the brain but it can spread
  20. Primary or idiopathic epilepsy
    • not associated with any identifiable brain lesion
    • cause is often unknown
  21. Secondary seizure
    results from an underlying brain lesion - most commonly a tumor or trauma
  22. Seizure risks
    • metabolic disorders
    • acute alcohol withdrawal
    • electrolyte disturbances - especially sodium
    • heart disease
    • high fever
    • stroke
    • substance abuse
  23. Status epilepticus
    • prolonged seizure lasting more than 5 minutes or repeated seizures over course of 30 min
    • airway/breathing is top priority
    • medical emergency
    • ABGs
    • IV push lorazepam, diazepam
    • Loading dose of IV phenytoin - no warfarin with phenytoin
  24. Non-surgical management of seizures
    • antiepileptic drugs
    • - dilantin
    • - tagertol
    • - neurontin
    • - draw peak and trough often
    • teach compliance - same time each day and to keep lab appointments
    • define triggers
    • wear a medical alert bracelet
  25. Seizure precautions
    • oxygen and suctioning equipment readily available
    • saline lock
    • siderails up at all times
    • possibly padded siderails
    • bed locked and in lowest position
    • no tongue blades during seizure!!
  26. Seizure management
    • simple partial - observe client and document seizure
    • turn patient on side during generalized tonic-clonic seizure and turn head to prevent aspiration
    • cyanosis is usually self limiting
    • do not restrain
  27. Acute seizure management
    • lorazepam
    • diazepam
    • diastat
    • IV phenytoin
  28. Surgical management of seizures
    • vagal nerve stimulation
    • conventional - cut between hemispheres - last resort
    • anterior temporal lobe resection
    • partial corpus callostomy
  29. Meningitis
    • inflammation of meninges that surround the brain and spinal cord
    • dorm living = high risk
  30. Viral meningitis
    • usually self limiting and patient has complete recovery
    • not a lot of treatment
    • most common cause is Herpes 2
    • patient on droplet precautions
  31. Bacterial meningitis
    • potentially life threatening
    • antibiotics
    • immunizations prevent it
    • most common causes are S. pneumonia and N. meningitis
  32. Physical assessment/clinical manifestation of meningitis
    • headache, N/V, fever, photophobia, increased ICP
    • Nuchal rigidity and positive Kernig's and Brudzinski's signs
    • seizure
    • decreased mental status
    • focal neurologic deficits
  33. Brudzinski's sign
    • have patient lay down and flex their neck
    • if their legs flex in response the test is positive
  34. Kernig's sign
    • patient laying down flat
    • flex knee
    • if there is pain on knee extension the test is positive
  35. Labs for meningitis
    • CSF analysis
    • CT scan
    • Blood cultures - sugar low in bacterial; protein high in viral
    • Counterimmunoelectrophoresis
    • CBC
    • X-ray
  36. Drug therapy for meningitis
    • Broad spectrum antibiotics
    • hyperosmolar agents to shift fluid out of brain
    • anticonvulsants
    • steroids
    • prophylaxis for those in contact with infected patient
  37. Encephalitis
    • inflammation of brain tissue and surrounding meninges
    • caused by virus, bacteria, fungi or parasites - West Nile virus
    • degeneration of neurons of cortex
    • hemorrhage, edema, necrosis, small lacunae develop in cerebral hemispheres
    • confusion
    • possible persistent neuro problems after recovery
  38. Interventions for encephalitis
    • prompt recognition and treatment of signs of cerebral edema, hemorrhage and necrosis of brain tissue
    • patent airway
    • VS - widened pulse pressure, bradycardia
    • safety measures
    • quiet room
    • HOB up
  39. Parkinson disease
    • progressive neurodegenerative disease
    • 3rd most common neurological disorder in older adults
    • tremor, rigidity, bradykinesia or akinesia
    • imbalance between dopamine and Ach (not enough dopamine)
  40. Assessment for Parkinson's
    • fatigue
    • slight tremor
    • problems with manual dexterity
    • rigidity
    • changes in facial expression
    • uncontrolled drooling
    • dementia
    • changes in voluntary movement
    • excessive perspiration
    • orthostatic hypotension
    • pill rolling
    • mask like face
    • staring eyes
    • no specific diagnostic tests
  41. Drug therapy for Parkinson's
    • dopamine agonists
    • COMTs
    • MAO-B inhibitors
    • dopamine receptor antagonists
  42. Drug toxicity risk in Parkinson's therapy
    • long term therapy often causes delirium, cognitive impairment, decreased effectiveness of meds or hallucinations
    • reduce the dose or change meds/frequency of administration
    • take "drug holiday"
  43. Management of Parkinson's
    • exercise, ambulation
    • self-management/care
    • injury prevention
    • nutrition - swallow therapy
    • communication
    • psychosocial support
    • possible surgical management
  44. Alzheimer's
    • chronic, progressive, degenerative disease that accounts for 60% of dementia occurring in 65 or older
    • loss of memory, judgment and visuospatial perception
    • change in personality
    • increasing cognitive impairment, severe physical deterioration and death from complications of immobility
  45. Structural changes in brain for Alzheimer's
    • neurofibrillary tangles
    • neuritic plaques
    • vascular degeneration
    • changes in neurotransmitters
    • increased amounts of beta amyloid - abnormal protein
  46. Manifestations of Alzheimer's
    • changes in cognition
    • alterations in communication and language abilities
    • changes in behavior, personality and judgment
    • changes in self-care skills
  47. Interventions for Alzheimer's
    • answer patient's questions honestly
    • assess and treat other medical problems
    • provide cognitive stimulation and memory training
    • structure environment to increase functioning
    • prevent overstimulation
    • orientation/validation therapy
    • promote self-management
    • promote bowel/bladder continence
    • assist with facial recognition
    • promote communication
  48. Drug therapy for Alzheimer's
    • Donepezil (Aricept)
    • Abilify
    • Namenda
    • antidepressants
    • psychotropic drugs
  49. Preventing injury for Alzheimer's
    • cope with restlessness/wandering
    • patient identification bracelet
    • register in safe return program
    • frequent walks and structured activities to reduce wandering
    • SAFETY
    • minimize agitation
    • display positive affect
    • calm movements
    • offer diversions
  50. Interventions to help the caregiver for an Alzheimer's patient
    • encourage family to seek legal counsel regarding patient competency, need to obtain guardianship or durable power of attorney, when necessary
    • make caregivers/family aware of own health and stress resulting from new responsibilities for care
  51. Interventions for disturbed sleep patters in Alzheimer's
    • re-establish day-night pattern by providing activity and exercise during day
    • establish before bedtime ritual
    • adjust treatment and medication schedule to provide for uninterrupted sleep
    • give mild antianxiety agent or hypnotic
  52. Huntington disease
    • hereditary disorder transmitted as an autosomal dominant trait at time of conception
    • movement disorder characterized by both neurologic and behavioral symptoms
    • gradual clinical onset of progressive mental status changes leading to dementia and choreiform movements in the limbs, trunk, and facial muscles
    • three stages - each lasting about 5 years over an average of 15 years of the disease
  53. Management of Huntington disease
    • no known cure or treatment
    • genetic counseling
    • antipsychotic agents or monamine depleting agents used to manage movement abnormalities that are disabling or interfere with ADLs
    • medications to treat depression, anxiety and OCD behaviors
Card Set
brain problems
brain problems
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