Neuro 2

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Neuro 2
2013-11-10 16:36:07

N172 Neuro 2
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  1. What causes ALS?
    it is a degeneration and demyelination of MOTOR neurons of the spinal cord and brainstem causing the muscles they connect to to weaken, experience atrophy and then die
  2. S/S of ALS
    • Weakness/paresis that starts distally then moves to trunk
    • dysphagia
    • dysarthria
    • emotion labiality, but not dementia
    • Respiratory compromise
  3. To sum up ALS the person will experience....
    • progressive weakness
    • muscle wasting
    • spasticity
    • paralysis
    • respiratory compromise
  4. Why does a person with ALS have dysphagia and dysarthria?
    cuz theres progressive atrophy of the tongue and facial muscles
  5. What does the person with ALS have respiratory compromise?
    Cuz muscles of the trapezius and sternocleidomastoid atrophy.....this can lead to PNA and death
  6. What happens to a person with ALS ability to go to the bathroom?
    bowel and bladder stay in tact, but the person will need a way to communicate to you they need to use the restroom-blink
  7. If you have a dysfunction of upper motor neurons you will have problems with....
    • spastic/weak muscles
    • loss of voluntary movements
  8. If you have a dysfunction of lower motor neurons you will have problems with
    • flaccid muscles
    • paralysis
    • atrophy
    • twitching
    • breathing problems
  9. Who usually gets ALS?
    men between 40-70....death occurs within 3 years
  10. Two major problems with ALS
    Respiratory failure and aspiration
  11. As a nurse it is very important to manage these things in a person with ALS
    • maintain an open airway
    • provide adequate nutrition minimizing risk for aspiration
    • speak early about end of life
    • get an AD in place
  12. First medications used on a person with ALS?
  13. Why is Baclofen given to a patient with ALS?
    It is a muscle relaxer
  14. Why is Rilutek given to a patient with ALS?
    How do you take it?
    What do you monitor?
    It will extend their survival time so they can attend an important even. 

    • 50mg/2x day on an empty stomach
    • Monitor LFT's
  15. What does a person with ALS usually die from?
    respiratory infection
  16. What is a seizure?
    a paroxysmal(sudden), uncontrolled electrical discharge of neurons in the brain that interrupts normal function
  17. What's epilepsy?
    a chronic disorder of recurrent seizures
  18. Who is most likely to get epilepsy?
    Poor African American Males
  19. What makes a person at high risk for Epilepsy?
    • if you have 1 parent with epilepsy
    • if you have Alzheimers disease with a stroke
  20. What typically causes seizures if you are 2-20 years old?
    • birth injury
    • infection
    • trauma
    • genetic factors
  21. What typically causes seizure if you are 20-30 years old?
    • structural lesions
    • trauma
    • brain tumor
    • vascular disease
  22. What typically causes seizures if you at over 50?
    • stroke
    • brain tumor
  23. How can you be screwed when it comes to families and seizures?
    Everyone has a different seizure threshold which is inherited.

    Seizure threshold is activated by trauma, disease or fever
  24. What's generalized seizure?
    a seizure that involves the entire brain

    person has a loss of consciousness for a few seconds to several minutes
  25. Gliosis
    scar tissue in the brain that is oftenly a common area where epileptic activity arises
  26. What are the effects of seizures on the brain?
    increased metabolic demand requiring 4x as much glucose and oxygen....if unmet cellular destruction can occur
  27. 4 stages of a seizure
    • prodroma
    • aural
    • ictal
    • postictal
  28. prodromal seizure phase
    signs or activity that precede a seizure
  29. aural seizure phase
    a sensory warning prior to seizure
  30. ictal seizure phase
    full seizure
  31. postictal seizure phase
    period of recover after the seizure....usually sleepy and not talking
  32. Tonic Clonic seizure
    used to be Grand Mal

    • loss of consciousness
    • pt. falls to ground and stiffens up (tonic) for 10-20 seconds then jerks around (clonic) for another 30-40 seconds
  33. What are the s/s of a tonic clonic seizure?
    • cyanosis
    • excessive salivation
    • tongue or cheek biting
    • incontinence
  34. Absence seizure
    usually occurs in kids.....can have up to 100/day

    seen as a staring spell so can go unnoticed

    **usually grow out of by adolesence
  35. What usually precipitates an absence seizure?
    • hyperventilation
    • flashing lights
  36. Myoclonic Seizure
    sudden excessive jerking of the body or extremities causing the person to hurl themselves to the ground
  37. Atonic Seizure
    Drop ATTACK

    • tonic episode or paroxysmal loss of muscle tone
    • consciousness usually returns with ground contact

    **wear protective helmet
  38. Simple partial seizure
    doesn't involve loss of consciousness and lasts less than 1 minute
  39. Complex partial seizure
    can involve a variety of behavioral, emotional and affective and cognitive functions

    Lasts more than 1 min....then person has postictal confusion
  40. What is the most common partial seizure?
    What happens?

    person lip smacks, picks or does some sort of repetitive motion
  41. How do you describe a seizure?
    • onset
    • duration
    • frequency
    • postictal state
  42. If a person has a seizure disorder make sure you find out....
    • birth and development history
    • seizure history....precipitating factors, antecedent events, seizure description
  43. What is the starting point test for seizure diagnosis?
    lumbar puncture of CSF
  44. What two electrolytes can trigger seizures?
    hyponatremia and hypoglycemia
  45. Medications for seizures do what?
    control seizures, but don't cure disorder

    stabilize nerve cell membranes preventing spread of the epileptic discharge
  46. Drug therapy for seizures is based on....
    • type
    • frequency
    • cause....of seizures
  47. 4 things to know about Keppra for seizures
    • dosage is based on weight
    • educate patient to know why it is important to not miss meds
    • stopping abruptly can trigger a seizure
    • must be weaned with dr. assistance
  48. If a person is on Dilantin for seizures don't....
    have them on D5 for IV....icicles
  49. Important info about anti seizure meds:
    • abrupt withdrawl can cause seizure
    • to go off you must be seizure free for 2-5 yrs
    • have a normal EEG
  50. Common seizure med side effects:
    • diplopia
    • drowsiness
    • ataxia
    • mental slowing
    • skin rash
    • gingiva (hyperplasia)
    • blood dyscrasias
    • liver/kidney issues
  51. If you think a person has a toxic level of ant seizure meds you can check them bye....
    • checking eyes for nystagmus
    • check hand and gait coordination
    • cognitive fxn
    • general alertness
  52. Dilantin S/E
    • gingival hyperplasia
    • hirsutism
  53. What is gingival hyperplasia?
    How do  you minimize it?
    excessive growth if gingival tissue

    good dental hygiene with brushing and flossing and dental visits
  54. What's hirsutism?
    excessive hair on a woman
  55. What do you do for a patient who is having a seizure?
    • protect from injury....especially the head
    • turn on side to keep airway open
    • have O2 and suction available in patients room
    • emotional support for patient
  56. Monitoring a person during/after seizure
    • Note time of onset, duration of seizure, precipitating factors, aura if any
    • Note body parts involved...pupil size, reactivity, respirations, cyanosis
    • Incontinence
    • Salivation
    • LOC during and after seizure
  57. After a seizure....
    • check arousability
    • Neuro check (Glascow Coma)
  58. Postictal state lasts how long and what will the person be like?
    • 30-90 min
    • confused
    • exhausted
    • asleep
    • sore muscles
    • weak
    • aphasia
    • inability to maintain airway if not arousable
  59. Status Elipticus
    ongoing continuous seizure activity without return to consciousness between seizures

    Medical Emergency!!!
  60. Why is status elepticus a medical emergency
    • the brain is using more than it is supplied which can cause:
    • Permanent brain damage
    • ventilator insufficiency
    • hypoxemia
    • cardiac dysrhythmias
    • hyperthermia
    • systemic acidosis
  61. Rapid acting IV anti seizure meds
    • Ativan
    • Valium
    • Propofol (Dr. admin only)

    Will be followed by long acting drugs like Phenytoin
  62. When can a person get their drivers license back once they are seizure free?
    6 mo. 1 yr seizure free
  63. Phenytoin affects what commonly used medication?
  64. Which anti seizure meds need peak and trough blood tests?
    • Keppra
    • Phenobarbital
    • Phenytoin
  65. Vagal Nerve Stimulation for seizures
    • electrode implanted in neck that delivers electrical impulses to nerve which prevent seizures
    • patient activates device with magnet when seizure is sensed
  66. AEIOU for seizures
    • Alcohol
    • Epilepsy
    • Infection/Inflammation
    • Overdose
    • Underdose
  67. TIPS for seizures
    • Trauma
    • Ischemia
    • Psychiatric
    • Stroke
  68. What's Parkinsons?
    chronic progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement
  69. 4 signs of Parkinsons
    • bradykinesia
    • rigidity
    • tremors at rest
    • Gait disturbance
  70. What is the problem with Parkinsons?
    person has low dopamine and an imbalance with ACh
  71. Who's at risk to get Parkinsons? is inherited
  72. Chemically induced Parkinsonism is associated with
    • CO
    • Maganese
  73. Drug induced Parkinsons
    • it is temporary...but will see it when a patients on
    • Lithium
    • Haldol
    • Thorazine
  74. Which illicit drug use can cause Parkinsons symptoms?
    Amphetamines and Methamphetamines
  75. What does dopamine do?
    allows for smooth movements....not enough in Parkinsons
  76. People with Parkinsons will have problems with
    • hand tremors/pill rolling
    • akinesia
    • respiratory problems
    • difficulty swallowing/chewing
    • soft voice
    • poor balance
    • gait disturbance/diminished arm swing
  77. Common non motor symptoms of Parkinsons
    • depression
    • anxiety
    • apathy
    • fatigue
    • pain
    • constipation
    • impotence
    • short term memory impairment
    • sleep disorder
  78. 40% of patients with Parkinsons have
  79. What happens with eating with a parkinsons patient?
    • swallowing becomes more difficult so...
    • malnutrition
    • aspiration
    • PNA
  80. What Parkinsons meds can only be used for less than 3 years?
    • Levodopa
    • Carbidopa
    • Parlodel
    • Requip
  81. S/E of Dopaminergic meds for Parkinsons
    • arrhythmias
    • dyskinesia
  82. Dopamanergics for Parkinsons relieve which symptoms?
    • Bradykinesia
    • Tremors
    • Rigidity
  83. What can Benadryl do for a Parkinsons patient?
    decrease tremors and rigidity
  84. Why are people with Parkinsons a fall risk?

    How do I help?
    they freeze while walking...

    • teach them to consciously think about stepping over imaginary lines on the floor
    • drop rice kernels and step over them
    • rock from side to side
    • lift toes when stepping
    • take one step backwards and 2 steps fwd
  85. When do you do surgery for Parkinsons?

    no response to meds or have developed sever motor complications

    • Ablation
    • Deep brain stimulation
    • Transplantation of fetal neural tissue
  86. How should a person with Parkinsons eat?
    • 6 small meals
    • bite sized foods
    • easy to chew and swallow
  87. Person with Parkinsons has decreased mobility causing
    • constipation
    • ankle edema
    • contractures
  88. Person with general debilitation from Parkinsons is at risk for
    • PNS
    • UTI
    • Skin breakdown
  89. Orthostatic hypotension puts a person at risk for....
  90. People with Parkinsons will probably die from....
    • PNA
    • Septic from skin breakdown infection
    • fall
  91. What's Guillain Barre?
    an acute possibly fatal inflammation that destroys the myelin sheath of nerve impulses caused by and immune response (bacterial/viral)
  92. Pathological process of Guillain Barre
    starts at ascending or descending....ends up with respiratory compromise

    but will plateau  then the person recovers 4-6 months later....up to 95% full recovery
  93. What is overtaxed with GB?
    T cells
  94. Why can you take a CSF sample to dx GB?
    cuz it will show protein levels.  Myelin sheath is a protein which will show up in the CSF when it is degenerated

    Normal is 15-45mg/dL
  95. Signs of Ascending GB
    weakness and numbness with respiratory compromise
  96. Signs of Descending GB
    • weakness with bulbar muscles
    • descends to limbs then the respiratory muscles
    • muscle atrophy
    • DVT
    • Pulmonary emboli
    • skin breakdown
    • nutritional deficiencies
  97. Options for treating GB
    • Sandoglobulin
    • Plasmapheresis
  98. Key management for a person with GB
    • Vital Capacity (<800)
    • ABG
    • Ventilator
    • TCDB
    • Oral Care
    • PNA?
  99. Who is at risk for getting GB?
    Person with a URI or GI infection in past 1-3 weeks.
  100. Complications of GB
    • respiratory failure from paralysis of thoracic area
    • respiratory/UTI infections
  101. Things to monitor for with GB
    • Respiratory failure
    • Aspirations
    • Urinary output
    • monitor for illeus
    • immobility
    • infection
    • communication
  102. Encephalitis
    inflammation of the brain tissue and often the meninges caused by a virus, bacteria, fungi or parasites
  103. Patho of encephalitis
    Virus/bacteria enters brain to blood stream to nerves causing inflammation and degredation of neurons and demylenization of axons causing hemorrhage, edema and increased ICP
  104. Clinical manifestations of Encephalitis
    • fever
    • N/V
    • headache
    • vertigo
    • confusion
    • personality changes
    • seizures
  105. What happens if you don't treat encephalitis?
    Increased ICP
  106. Nursing care for a person with Encephalitis
    • frequent neuro checks
    • assess for signs of ICP increase
    • Systolic BP, decreased HR
    • maintain patent airway
    • HOB at 30
  107. What causes Trigeminal Neuralgia?
    compression of blood vessels from chronic irritation of CN #5 at the root entry zone causing an increase in firing of sensory fibers
  108. S/S of Trigeminal Neuralgia

    • It is unilateral.
    • It comes and goes
  109. What triggers Trigeminal Neuralgia?
    • touch
    • brushing teeth
    • shaving
    • eating
    • talking
    • exposure to cold or wind
  110. What medications are given to patients with Trigeminal Neuralgia?

    • Anti Seizure meds....
    • Tegretol, Dilantin, Valproate

    acts on sodium channels decreasing neuron firing
  111. If a persons on Tegretol, Dilantin or Valproate what labs do I need to check periodically?
    • CBC
    • LFT
  112. Keep in mind for a patient with Trigeminal Neurologia....
    • Pt. may neglect their hygiene
    • Encourage to perform hygiene tasks during peak analgesia times
    • Eat foods high in protein and calories, easy to chew
  113. What is an odd problem with Trigeminal Neurologia....what do I do to help?
    corneal reflex....

    artificial tears or eye shield
  114. Bell's Palsy
    Inflammation of CN #7 (facial) usually caused by herpes
  115. Clinical Manifestations of Bell's Palsy
    • fever
    • tinnitus
    • drooping mouth/drooling
    • loss of tearing
  116. Complications of Bell's Palsy
    • psychologic withdrawl
    • malnutrition/dehydration
    • corneal abrasions
  117. Medication used immediately to treat Bell's Palsy
  118. Special considerations for people with Bell's Palsy
    • artificial tears
    • eye shield?
    • wear shield or tape eye shut at night
  119. Name an antiviral medication to treat herpes
  120. What is a patient given to decrease cerebral edema?
  121. What is commonly given to patients to prevent or control seizures
  122. What is given to patients to control hyperthermia and headache
  123. Artificial Tear Medication