-
Left Brain duties
- Language
- Writing
- Reading
- Listening
- Calculation
- Logic
- Analysis
- Sequence
- SHORT TERM MEMORY
-
Right Brain duties
- Creativity
- Conseptual
- Inovation
- Idea
- Image
- Color
- Music/Art
- Dimension
- Emotion
- Daydreaming
- LONG-Term Memory
-
_____ are now believed to play a key role in recurring seizures
Astrocytes
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Chronic disorder of frequent seizure activity
Epilepsy
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Prevention of seizures
- Avoid stress, lack of sleep, emotional upset, and alcohol
- avoid precipitating stimuli
- comply with medication regimen
- learn relaxation techniques
-
Tonic Phase:
- Muscles become rigid, stiffens arms and legs
- Loss of consciousness, fall to ground
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Clonic Phase
- Rhythmic jerking of extremities
- Loss of bowel or bladder, frothing at mouth
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Post ictal phase:
Wake up exhausted and don't know what is going on
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One thing to remember when patient starts to have a seizure:
Time it!
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What should you have for patient with seziures
- Side rail padded with pillows and blankets
- Suction
- Untie all restraints if they have them
-
Absence seizure
- Petite mal seizure: common in childern
- Brief, only few seconds
- Hard to catch
- Typically seen as blank staring then return to baseline but no memory of this
- Lip smack, tap hands
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Partial complex seizure
- Loss of consciousness characteristic automatisms followed by amnesia when seizure is complete,
- One arem, one leg, one hand all at once
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Simple Partial seziure
- Remains conscious, reports an aura
- Will have unilateral movement, odd sensations, autonomic or psychic symptoms
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Seizure diagnosic tests
- Electrolyte panel
- history and physical
- mri and mra (inject dye, blood vessels)
- EEG-neuron activity
- Drug screens
- spinal tap with CSF analysis
- Skull xrays
- ct scan
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Seizures: Medical Management
- Antiepileptic drugs
- Client and family education
- seizure precautions
- monitoring drug levels
- surgical management: Vagal nerve stimulator or surgical excision of area
-
Seizures Nursing Interventions
- Injury prevention during seizure
- Monitor thearpeutiv drug levels on meds
- Maintain ABC's oxygen as need
- Monitor start, duration, characteristic of seizure, and post
- Note if aura or other circumstances lead to seizure
- Protect patient by padded side rails, bed in low postiton
- lossen clothing if possible
- Monitor vitals post seizure including neurological
- Maintain iv access
- minimize stimuli that may trigger
- Turn on side once done, suction out secretions, o2 sat
- Padded tongue blade, suction, oral airway always bedside
- Orient to surrounding post seizure
- educate peers on seizure first aid
- Monitor side effects on medication and compliance with meds
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Complications of seizures
- Status epilepticus: Prolonged seizure activity over 5 minutes long or repeated seizure in short period of time with a few seconds in between
- Neurological emergency: must be treated immediately
- Monitor ABC's: will respiratory arrest
- IV MEDICATIONS: Valium, Ativan, Dilantin
- Diastat Gel: rectal gell
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Types of Ischemic strokes
- Thrombotic
- Embolic - clot in artery, usually carotid
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Types of hemmorhagic strokes
- Hypertensive strokes
- AVM ruptures-arterial venous malformation, asymptomatic
- Aneurysm-subarchnoid hemmorage (3-5 ccs of blood)
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How many mins of no blood flow for brain tissue to die
3
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Watershed affect
- Opposite side of the brain
- Stroke on right side of the brain, symptoms on the left
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FAST
- Facial weakness
- Arm weakness
- Speech difficulties
- Time is brain
-
Aphagia receptive
Cant understand
-
Aphagia expressive
can understand but cant say it
-
Eye problems with stroke
- only part of your eye works, (eat outside food on plate)
- abnormal pupil response or size in one eye
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Stroke: Right brain damage
- Paralyzed left side: hemiplegia
- Left-sided neglect
- Spatial-perceptual defects
- Tends to deny or minimize problems
- Rapid performance, short attention span
- Impulsive, safttey problems
- impaired judgement
- imparied time concepts
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Stroke: Left brain damage
- Right sided hemiplegia
- imparied speecch/language, aphagias
- imparied right/left discrimination
- slow performance, cautious
- Aware of deficits, depression, anxiety
- Imparied comprehension related to language, math
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Diagnostic testing for strokes
- history and physical
- mri and mra
- ct scan
- carotid doppler
- arteriography and angiography
- ultrasound: heart and carotid, legs
- CBC- wont show alot
- chemistery and lipid profiles
- bleeding studies- pt, ptt, inr ( if increased bleed into brain)
- blood glucose
- CSF tests- lumbar puncture
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Strokes Medical Mangement
Anticoagulants:
- Heparin
- Plavix
- Aspririn
- Coumadin
- Lovanox
-
Strokes medical management
Antiseizure medications
Dilantin, Kepra
-
Strokes medical management
Hyperosmolar medications
- Manitol- iv
- reduces swelling in brain
-
Thrombolytic therapy: for acute ischemic stroke
- Should be in the first 90min of stroke to up to 3 hours of onset
- Rt-PA Retavase (streptokinase)
- Must be watched carefully
- Must have bleeding stidies monitored
- Watch for bleeding, bruising, changes in neurological status (better or worse)
-
Strokes medical management
Antiplatelets
- Reduce platelet adhesions
- Plavix
- Persantine
- Ticlid
-
Strokes medical management
Surgeries
- Surgical clipping an avm or putting a coil graft in the weak vessel, AV bypass
- Surgical embolectomy or evacuation of crainal bleed
- Carotid endarterectomy- thromblic, routo-router the carotid
- then graft it , can stroke out! Watch BP
- If Bleed- Burr hole to decrease pressure
-
Early signs of increasing intercrainal pressure
- The patient may become lethargic, talkative or quiet, or restless and irritable.
- trouble remembering things, experience a change in personality, or complain of nausea and vomiting. Symptoms may progress to confusion or diminished responsiveness. hemiparesis or new-onset seizures.altered respiratory pattern, unequal pupils, and sluggish pupillary response to light (early signs
-
Late signs of increased intercrainail pressure
- fixed, dilated pupils;
- decorticate or decerebrate posturing;
- loss of gag reflex;
- loss of corneal reflex;
- bradycardia
- increased systolic blood pressure,
- widened pulse pressure,
- and slowed heart rate.
- Irregular respiratory patterns may develop, and the patient's temperature may rise.
-
Stroke
Nursing interventions
- Frequent Neurological Assessment- note any motor changes, glasgow coma scal, progression or improvement in cognitive deficit, paralysis or blindness
- Assess for Neglect or hemianopsia
- Montitor labs, PT, PTT, INR, and CBC if on blood thinners
- Vital sign monitoring (BP key)
- AFib
- Dysphagia precautions
- monitor for aspiration (if do, modified barium swallow)
- ability to do adls
- Monitor for signs of increased intracranial pressure (ICP) for 72 hours ( highest time of risk)
- Seizure precautions
- Assess ability to speak or comprehend
- Sensory disturbances
- Coping mechanisms
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Health teaching
Stroke
- Medications, side effects, BP meds, and monitoring
- Home health needs and referals
- physical therapy assessment
- psychosocial -assess for depression
- Occupational therapy assessment
- safety assessment
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Complications of stroke
- Aspirations
- increases intercrainal pressure
- seizures
- coma
- death
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Signs and symptoms of TIA
- blurred vision
- diplopia (double vision)
- Blindness unilaterally
- Transient weakness/numbness of extremities
- Ataxia
- vertigo
- aphasia
- dysarthria - cant move
- Can last only a few min -24 hours
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Preventive therapy and drug therapy for migraines
- Ha at least 2-3 montths
- NSAID: Naproxen
- Beta-adrenergic blocker: propanolol (inderal)
- Tricyclic or ssri: Imitrex
- Antiepileptic drugs: Depakene
-
Migrane Abortive therapy
- Alleviating pain in aura phase
- asa and acetaminophen
- ERGOTAMIN derivatives
- Nsaids
- triptans-
- GET IT BEFORE IT STARTS!
-
What should people with Migrains avoid eating
- Eliminate tyramine- containing product:
- -chocolate
- Nuts
- alcoholic bevv
- aged cheeses
- beveragaes with caffine
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Cluster headache S&S
- Facial swelling
- miosis
- pallor
- increased IOP
- Increased temp
-
drug therpay for cluster headaches
- Same for migranes
- 100% o2 in a sitting position for 15 min
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Nursing management for headaches
- history and physical
- bed time and waking time
- lifestyle changes
- wear sunglassess
- sit away from windows: reduces glare
- pain assesssments
- education on sleep-wake cycle
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