C P

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Tottie25
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146635
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C P
Updated:
2012-04-13 13:52:24
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part 2 starting with seizures
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  1. Seizures
    is a single event of abnormal electriccal discharge in the brain resulting in an abrupt and teporary altered state of cerebral function
  2. Epilepsy
    a chronic disorder of abnormal, recurring, ecessive and self-terminating electrical discharge from neurons

    more than one seizure without a cause

    time range of seizures can range from mins to years
  3. Seizures and Epilepsy
    Are they the same?
    not all seizures are considered epilepsy

    but epilepsy people have seizures
  4. Seizures

    Cased by:* primary and secondary
    P- Idiopathic: don't know why
  5. Seizures Cased by:

    primary and *secondary
    S- Acquired: Head injuries, CNS Infections, Brain tumors, Birth Trauma, Metabolic disorders (renal failure), Alcohol withdrawal, Electrolyte problems – inc or dec sodium, Heart disease, Medications – some meds can cause seizures, High fevers in kids (especially under the age of five years old)
  6. Seizures

    Goal
    Control seizures activity

    EEG technology
  7. Seizure

    Prevention
    • monitor high risk pregnancies
    • control lead poisoning
    • prevent childhood diseases – get immunized; measles and mumps can cause high temperatures which can lead to seizures
    • prevent head injuries – wear seatbelts and helmets
  8. Generalized

    Two kind
    *tonic-clonic
    absence
    Tonic-clonic (grand mall)- are the most common type of seizure in adults, a warning aura may precede, sudden loss of consiousness and sharp tonic muscle contractions
  9. Tonic-clonic

    Tonic phase
    sudden loss of consciousness and sharp tonic muscle contrations
  10. Tonic-clonic

    Clonic phase
    • follows the tonic phase
    • alternating contractions and relaxation of the muscles in all the extremities along with hypervenilation
  11. Post icatal phase:
    is altered state of consciousness that a person enters after experiencing a seizure usually lasts between 5-30mins to hours
  12. Generalized
    Two kind
    tonic-clonic
    *absence
    • Petit mal- a sudden brief cessation of all motor activity accompanied by a black stare and unrresponsiceness
    • more common in children, but adults get them too
    • typically last only about 5-10 sec, but some last 30sec
    • movements such as eyelid fluttering or automatisms such as lip smacking may occur during an absent seizure
    • vary from occasional episods to several hundred per day
  13. Parital Seizures

    *Complex
    Simple
    • Complex partial seizures- memory, awarness, or consciousness impaired
    • may engage in repetivitive, nonpurposeful activity, such as lipsmacking, aimless walking, or picking at clothing
  14. Parital Seizures

    Complex
    *Simple
    • memory, awareness and consciousness preserved
    • the motor portion of the cortex is affected, causing recurrent muscle contractions of the face or a contralateral part of the body, such as a hand or finger
    • (Deja Vu)
  15. Status epilepticus
    • can develop during seizue activity
    • the seizure activity becomes continuous, with only very short periods of calm between intense and persistent seizures
    • can be any type of seizure, but usually are tonic-clonic
    • A. airway B. assessment C. prevent injury D. emergency meds (Versed, Valium, Ativan)
  16. Occurrence of seizures –

    Vary in frequency
    • Absence – can happen 100 X daily
    • Tonic-Clonic – can happen every few weeks or once in a lifetime
  17. Seizure

    Attacks precipitated by:
    • Excitement – wedding, prom
    • Anger
    • Menstruation
    • Fatigue
    • Some meds (e.g., Demerol) can lower pt seizure threshold (liver has problem metabolizing the med either due to lack of an enzyme or a build-up of the med in the system); the seizure may be secondary to taking the med
    • Brain tumors/scar tissue in brain
  18. Document history
    • Journal
    • how often, frequency, how long the seizure lasts, what was going on around the pt at the time it happened
  19. Treatment during a Seiure attack

    Prevent from
    • Injury
    • don't restrain, can cause harm
    • assure safety, what's around the pt
    • loosen tight clothing especially around the neck
    • call 911
  20. Seizure

    Observe and record
    • Look at watch to time seizure
    • Notice what part of body the seizure started/involved (e.g., arm or just hand, leg, whole body [tonic-clonic], top half, right side, etc)
    • did pt appear to lose consciousness?; did pt make eye contact?
    • note skin color – does it look like pt is suffering O2 deprivation?
    • respiration – is pt breathing?
    • Did pt go thru stages (e.g., stiff to jerking or just jerking with no stiffness)?
  21. Seizure

    Maintain Privacy
    • people tend to gather around someone who is having a seizure
    • do crowd control; pull curtain; keep pt covered when possible
    • pt doesn’t want everyone seeing their wet pants from incontinence
  22. Seiures

    Nursing diagnoses
    • risk for airway clearance/risk for aspiration
    • risk for injury
    • anxiety/depression
    • social isolation
    • disturbed sensory preceptural: visual
    • low self-esteem
  23. Pt might need life-style adjustments
    • if pt can pinpoint seizure triggers he/she can try to avoid them (e.g. flashing lights from video games)
    • Pt does better with regular routine
    • Get adequate sleep
    • Don’t drink alcohol
    • Eat a nutritional diet
    • Wear Medic Alert jewelry if hx of seizures
    • driving and employment
  24. Seizures

    Drugs
    • control 50-60% if properly prescribed and taken, may need combination
    • Usually continue for life
  25. Seizures
    Drug
    Side effects
    suicidal thoughts and behavior
  26. Seizure
    Drug side effects:
    Dilantin
    rash, skin darker (females)

    gingival hyperplasia
  27. Peripheral Nervous system disorders

    Trigeminal neuralgia
    description
    • also called tic douloureux, is a chronic disease of the trigeminal cranial nerve (v) that causes unilateral excruciating facial pain
    • more common in women than in men
    • occuring most often in middle or late adult life
  28. Peripheral Nervous system disorders
    Trigeminal neuralgia

    Cause
    • Unknown
    • unilateral excuciating facial pain
    • the nerve has 3 division: the ophthalmic, the maxillary, and mandibular
  29. Peripheral Nervous system disorders
    Trigeminal neuralgia

    S/S
    • severe facial pain occurring from brief seconds to several minutes long hundreds of times a day
    • Recurring several times a year
    • Usually unilateral (one-sided)
    • Pain can be set off by sensory contact (e.g., touching, talking, eating, change in temperature, cold rain hitting face, brushing teeth, etc)
    • Can go into spontaneous remission for several years and pt is free of pain
  30. Peripheral Nervous system disorders
    Trigeminal neuralgia

    meds
    • the drug most useful in controlling the pain is the tricylic anticonvulsant carbamazepine (Tegretol)
    • if ineffective there is other meds
    • Dilantin, Neurontin, Lioresal
    • side effects: dizziness, nausea, and drowsiness
  31. Peripheral Nervous system disorders
    Trigeminal neuralgia

    Surgery
    • if meds do not control the pain, surgical procedures may be performed, including various types of rhizotomy, the surgical severing of a nerve root.
    • blood vessel may be putting pressure on or irritates the nerve, so the surgeon puts fat (subQ tissue) between nerve and vessel
  32. Peripheral Nervous system disorders
    Trigeminal neuralgia

    Nursing Diagnosis
    • Acute Pain
    • Risk for altered Nurition: less than body requirments
    • knowledge Deficit
  33. Peripheral Nervous system disorders
    Bell's Palsy

    Description
    • also called facial paralysis
    • a disorder of the cranial nerve VII (7) which is a MOTOR nerve
    • most commonly effects pt ages 20-60 years
    • effects men and women equally
    • causes one-sided facial paralysis (effects only FACE not body)
    • cause unknown, some MD’s think it may be related to a branch of the Herpes Simplex Virus
  34. Peripheral Nervous system disorders
    Bell's Palsy

    S/S
    • sudden onset and almost always involves one side of the face
    • pain behind the ear or along the jaw may precede the paralysis
    • pt initially notices numbness or stiffness of one side of the face that distorts the appearance
  35. Peripheral Nervous system disorders
    Bell's Palsy

    Prognosis
    • majority of pt will fully recover but it might take several weeks to several months
    • some pts have residual paralysis for life
  36. Peripheral Nervous system disorders
    Bell's Palsy

    Meds
    • there are no meds for this
    • some MDs use steroids (short-term) to reduce inflammation and swelling
    • antiviral (acyclovir) w/an anti-inflammitory (prednisone) limiting nerve damage
  37. Peripheral Nervous system disorders
    Bell's Palsy

    Nursing Care
    • Usually not admitted to hospital
    • Prevent injury-wear patch at night to keep eye clean r/t not being able to blink, wear sunglasses during the day r/t un-reactive pupil, may need artifical tears r/t can’t blink
    • Maintain nutrition, Easy to bite tongue/cheek, Pt isn’t aware food is caught in effected cheek, Eat soft food
  38. Peripheral Nervous system disorders
    Neuropathies

    most common
    Diabetic Neuropathies- is a disease of the kidneys characterized by the presence of albumin in the urine
  39. Peripheral Nervous system disorders
    Neuropathies

    types
    Polyneuropathy

    mononeuropathy

    Visceral (autonomic)
  40. Peripheral Nervous system disorders
    Neuropathies

    Polyneuropathy
    • effecting more than one nerve
    • Distal paresthesias - (numbness and tingling)
    • odd feelings; sensations is just not “normal”
    • Pain - including aching, burning (yet feels frozen), feelings of cold – most of the time
    • Altered or impaired sensation – pt doesn’t have normal feeling in those extremities anymore
  41. Peripheral Nervous system disorders
    Neuropathies

    Mononureopathy
    are isolated peripheral neuropathy that affect a single nerve (carpal tunnel, shingles, eye nerve, diabetic femoral neuropathy)
  42. Peripheral Nervous system disorders
    Neuropathies

    Visceral (autonomic)
    • lack of blood flow to some of the autonomic nervous system
    • Sweating – excessive or unable to
    • Gastrointestinal - eat food, but it sits in stomach r/t to slowed peristalsis
    • Sexual dysfunction – can’t get or keep erections r/t decrease blood flow; Viagra won’t help
  43. Peripheral Nervous system disorders
    Neuropathies

    Collaborative managment of peripheral disorders
    • Always wear properly fitting shoes when walking everywhere (including in home) to avoid stepping on things (i.e., pin, nail, splinter);
    • don’t want impaired skin integrity – IV antibiotics won’t get to the affected area r/t poor circulation
    • Have shoes fitted properly; don’t want blisters; wear for short periods of time while breaking them in
    • Assess skin on feet daily for sores, etc.; have a mirror on the floor so can inspect easily § Have toenails professionally trimmed (podiatrist)
    • Avoid use of corn plaster (acid to burn off corn can damage skin)
    • Check temperature of water with hand or thermometer before stepping into it

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