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- acetylsalicylic acid (aspirin)
- Triptans (Selective Serotonin receptor agonists)
- Selective Serotonin Receptor agonist
- Relieve pain and Nausea, vomiting, photophobia
- eletriptan ( Replax)
- almotriptan ( Axert)
- frovatriptan (Frova)
- naratriptan (Amerge)
- rizatriptan (Maxalt)
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
Migraine headache (prophylactic) medications
- Beta-adrenergic blockers
- Tricyclic antidepressants
- Selective Serotonin reuptake inhibitors
- Calcium channel blockers
- Includes postherpetic neuralgia, phantom pain diabetic neuropathies and trigeminal neuralgia.
- Pain is intractable (unbearable & does not respond to tx)
- Chronic / deliberating prevents ADL’s
Neuropathic Pain Assessment
- Highly subjective
- Behavioral signs of pain & stress
- Chang in ability to perform ADL’s
- Muscle weakness / waisting
- Vasomotor responses (flushing)
- Abnormalities of spinal reflexes
Neuropathic Pain Dx Tests
- Electrical Stimulation
- Phychological testing
- Myelogram (back or neck pain)
Neuropathic pain medical mgmt (non surgical)
- Tens and spinal cord stimulation
- Nerve block
Neuropathic Pain Surgical Management
- For intractable pain
- neurectomy – surgical removal of nerve segment
- rhizotomy – cutting of nerve root of the spine
- cordotomy – disables selected pain-conducting tracts in the spinal cord
- (Complications on cordotomy- postural hypotension, feeling heat/cold, motor, bowel function, temporary edema leading to temp. paralysis or leg weakness.)
Neuropathic Pain Medications
- gabapentin (Neurontin)
- carbamazepine (Tegretol)
- Nonopioid analgesics
- Acetylsalicylic acid
- imipramine (Tofranil-PM)
- nortriptyline (Pamelor)
Neuropathic Pain Inter. / Teaching
- Comfort measures
- Assist in positioning
- Stool softener ,high fiber, prune juice (prevent straining)
- Encourage fluids 2000ml
- Plan sleeping hrs & rest periods
Increased Intracranial Pressure (ICP)
- Sudden, rapid progression, requires surgical intervention.
- May lead to death if not treated and reversed.
- Occurs in pt’s with brain tumor, hemorrhage, anoxic brain injury and toxic/viral encephalopathy’s.
- As pressure rises, cerebral blood flow decreases and inadequate perfusion of the brain occurs.
- Personality changes
- Changed in ability to think
- Headache (coughing, straining at stool, stooping)
ICP Symptoms 1
- Change in LOC (earliest sign)
- Pupils react sluggishly
- Anisocoria – Unequal pupils
- Ipsilateral pupil – affecting the same side as the lesion
- Blown pupil – Fixed dilation of one or both pupils.
- Cushing’s Response –wide pulse pressure & Bradycardia
- Abnormal breathing
- Stertorous (snorelike)
- Ataxic- Irregular/random/with occasional pauses
- Thermoregulatory center failure
- Decreased motor function
- Babinski reflex
- Posturing (herniation in upper part of brain stem)
- decorticate – arms flexed
- decerebrate – rigid extension & hyperpronation forearms
- Projectile vomiting & Hiccups (Compression of vagus nerve)
ICP Diagnostic Tests
- ICP measurement
- Transracial Doppler
- Cerebral Angiography
- Internal measuring devices
ICP Medical Management
- Surgery to remove tumor.
- Drug therapy to reduce pressure
- Ensuring adequate oxygenation
- Endotracheal intubation
- ABG’s and oxygen therapy
- craniotomy- bone flap removed and replaced
- craniectomy – bone flap removed and not replaced allowing room for expansion.
- Osmotic diuretics
- Loop Diuretics
- Furosemide (Lasix)
- Bumetanide (Bumex)
- dexamethasone (Decadron)
- Phenytoin (Dilantin)
- Elevate HOB 30-45 degrees
- Avoid flexion of hips, neck, waist
- Avoid rotation of head
- Avoid isometric exercises
- Use hypothermia blanket
- Suctioning when necessary 10seconds only w/100% oxygen before &after
Epilepsy or seizures
Group of neurologic disorders characterized by recurrent episodes of convulsive seizure, sensory disturbances, abnormal behavior, LOC or all of these
In the United stated it is estimated that approximately ______ people suffer from active epilepsy, with _________ new cases diagnosed each year.
Epilepsy is associated with_____________ uncontrolled _______________ in the neurons of the brain resulting in sudden violent, involuntary ________________ of a group of muscles
- Electrical charges
Causes of Seizures
- Alcohol intox
- Electrolyte imbalance
- Barbiturate withdrawal
- Water intox
- Vascular disturbances
- ¾ of cases are idiopathic
Types of Seizures
- Tonic-Clonic - Grand Mall
- Absence – Petit Mall
- Psychomotor – Automatism
- Jacksonian – Focal
- Myoclonic –
- Akinetic –
A sensation or emotion that may precede an attach of migraine or epileptic seizure
Rest period after a seizure. Patient may be groggy, disoriented, have a headache, muscle aches, sleepy, may experience amnesia.
- When full consciousness is not regained between seizures.
- Medical emergency
- May cause permanent damage or death
Epilepsy or Seizure interventions
- Protect fr injury & aspiration Observe / record activity
- Never leave alone
- Turn head to side to maintain the airway
- Loosen clothing around neck
- Do not restrain or place objects in mouth
- Suction and oxygen after seizure
- Pad side rails
Multiple Sclorosis (MS)
- Degenerative, autoimmune disorder. t cells attack the body then myeling damage occurs.
- Maybe from a viral infection early in live.
- Chronic, progressive deterioration in some remissions and exacerbations in others
- The myelin sheath and the sheath cells are destroyed, causing an interruption or distortion of nerve impules
- Distributed randomly in the white matter of the brainstem, spinal cord, optic nerves and the cerebrum.
MS Signs & Symptoms
- 1. Diplopia - double vision
- 2. Scotomata - spot befor eyes
- 3. Blindness
- 4. Weakness or numbness
- 5. Fatgue
- 6. Emotional instability
- 7. Bowel/Bladder problems
- 8. Verigo
- 9. Ataxia (uncoordiated movement)
MS Dx Tests
- No definitive Dx test
- Dx based on history & clinical manifestations
- 1. MRI - presence of lesions over time
- 2. CSF - gamma T cells (initial phase), Increase in lymphocyts and monocytes
- 3. CT scan - enlargement of cerebral ventricles.
MS Medical Management
- 1. Adrenocoritotropic hormone & coticosteroids: reduce edema and inflamation at demyelination site
- 2. For spasms: Diazepam, Dantrolene, Baclofen
- 3. Immunomodulating drugs: Betasron, Avonex,Copaxon
- 4. Immunosuppressant drugs: Navantrone to reduce both B and T lymphocytes.
- 5. Pro-Banthine: for urinary frequency & urgency
- 6. Cholinergic drugs: antispasmodic, better urinay flow
- 7.UTI prophylaxis: Bactrim, Spectra, Macrodantin
- 8. Self-Catheterization
- 9. Enourage fluids
- 10. Stool softener and prune juice for constipation.
MS Nursing Interventions
- High fiber and adequate fluids
- High protein & vitamin supplements
- Obese, dietitian for low calorie diet
- Frequent turning
- Exercise not to fatigue (spasticity & coordination)
- Daily rest periods
- Stablize gate- lean towards less involved side
- Avoid hot baths - increases weakness
- Refer pt & fam. to support group.
- A syndrom that consists of bradykinesia, rigidity, tremor, and impaired postural reflexex
- Damage or lose of dopamine-producing cells in the midbrain leads to depletion of dopamine that influences the initiation, modulationn and clompletion of movement and regulates unconscious autonomic movements.
- Drug induced parkinsonism- dopamine receptors in the brain are blocked.
Causes of PD
- Type A encephalitis
- Intoxication of carbon Monoxide
- Intocation of Manganese
- Drugs: Haldol, Thorazine Methyldopa
- Reduced estorgen levels
- Exposure to industrial metals and chemicals
PD commonly occures after the age of
PD is more common in men or women
A neurotransmitter that is essential for functioning of the extramidal motor system including control of posture, support and voluntary motion.
- More prominent at rest but disappears whe the pt moves
- Pill rolling
- Initially minimal becomes more pronounced in later stages.
- Increased resistence to passive motion when limbs are moved through their range of motion.
- Is a jerky quality when the joint is moved (cogwheel rigidity)
- Evident in the loss of automatic movements and lack of spntaneous activity ( Autonomic movements include blinking, swing the arms while walking, swallowing saliva, facial expressions, and minor posturl adjustments)
- Features include: stooped posture, masked face, drooling and shuffling gait
Dx tests for PD
- No firm Dx test
- 2 signs of the classic triad: tremor, rigidity & bradykinesia.
- Confimation: positive response to low-dose of antiparkinson med. (Carbidopa-levodopa, Sinemet)
- CT scan- cerebral atrophy
- EEG- minimal slowingof brain electircal activity
- UGI- decreased motility
abnormal involuntary movement
When all drugs are withdrawn for a time because their effectiveness has decreased or have side effects from prolonged use.
Medical Management for PD
- - carbidopa-levodopa (Sinemet)
- - levodopa (Dopar)
- with prolonged treatment side effects such as dyskinesia may occure and decreased medication effectiveness. Hospitalization my be helpful during a drug holiday. Meds are then restarted offen at smaller doses.
- Aspiration can occur when meds are restarted
Surgury for PD
- Ablation therepy: Destroys portion of the brain
- Deep Brain Stimulation: electrods are placed in the brain and connected it to a generator placed in the upper chest.
Nursing Interventions for PD
- Lay on firm bed without pillow- prevent spine from bending forward
- Hold hands behind the back when walking
- Use a chair that propels them to an upright position
Nutrition for PD Patients
- avoid malnutrition and constipation
- Appetizing foods that can be easily chewed & swallowed
- Ample time for eating, avoid frustration, encourage independence
- Aspiration precaution- as disease advances
Teaching for PD patient
- Take medications as scheduled
- Good skin care and keeping active
- Proper ambulation and postitioning demonstrations
- Proper feeding techniques