chapter 44

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alicia0309
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308727
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chapter 44
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2015-09-29 07:00:00
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chapter 44 neuro test
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  1. what are the types of generalized seizures and what is unique about each one?
    • Clonic: contractions and relaxation (Muscle Jerking)
    • Tonic: Loss of Consciousness with increase in muscle tone (Muscle Rigidity)
    • Tonic-Clonic: 2-5 mins, Loss of Consciousness, muscle rigidity and muscle jerking
    • Absence: Brief, Daydreaming, most common in children, will not respond to touch, Pt not aware
    • Myoclonic: Brief jerking/Stiffening, may affect only 1 side
    • Atonic: Sudden loss of muscle tone, Brief followed by confusion, Drug resistant (MAY FALL)
  2. Complex Partial Seizures
    • Loss of consciousness with involuntary behaviors
    • Post Seizure Amnesia (reorient the pt)
  3. Simple Partial Seizure
    • Remains Conscious
    • Aura (see color or certain smell)
    • Autonomic changes (Change in HR, Flushing, Abdominal upset (WATCH FOR ASPIRATION)
  4. Unclassified Seizures
    No Known Reason
  5. Triggers for seizure activity
    • increased physcilar activity
    • emotiional stress
    • fatigue
    • sleep deprevation
    • Rapid change in temp for children
  6. Primary/Idiopathic
    not associated with identifiable cause
  7. secondary
    • underlying cause
    • if you fix the problem the seizures will go away
  8. Assessment for Seizure
    How Many, How Long, How Often, PAttern, Aura, underlying issue, medications/drugs or herbs
  9. diagnostics for seizures
    • EEG
    • CT Scan
    • MRI, PET (tumor can cause Seizure)
    • Labs done to identify metabolic disorders
  10. seizure precautions
    • Side Rails up
    • NO tongue blades
    • they will need Oxygen, Suction equip near bed, Patent IV access, turn them to their side to prevent aspiration (vomit or secretions).
    • ALWAYS HAVE AIRWAY AND SUCTIONING NEAR PT
  11. Interventions for seizures
    • Medications (take everyday)
    • Acute seizure
    • AIRWAY
    • IV in the forearm not AC
    • IV Ativan, Dilantin, Valium
    • Can also use Gel Diazepam
    • Make sure they are safe and don't move them
    • Never give coumadin and Dilantin together
    • Stop Tube feeds for Dilantin 1-2 Hours before and after
    • Secondary Seizure - treat underlying cause
  12. Educate pt to never stop seizure meds abrupty
    Never Give Dilantin and Coumadin Together
    HOLD tube feeding 1-2 hours before and after Dilantin
  13. Status Epilepticus
    • Medical Emergency!!
    • LOSS OF AIRWAY
    • seizures lasting longer than 10mins may cause death
    • caused by sudden withdrawl of seizure meds, drug or ETOH withdrawl, infections,head trauma, metabolic disturbances
  14. Tonic-Clonic Status Epilepticus
    • Brain Damage is a Concern
    • Hypoxia, Hypotension, Cardiac dysrhythmias, increased lactic acid causes body to be in acidotic state muscle breakdown causes increased levels of myoglobin which is very hard on the kidneys
  15. Intervention for Tonic-Clonic Status Epilepticus
    • Ativan (IV push over 4 mins)
    • Dilantin (IV)
    • Cerebyx (can be given in place of Dilantin)It does not cause as  much cardiovascular problems and you dont have to hold tube feedings
  16. Surgical Management for Simple/Complex Partial Seizures
    • Vagal Nerve Stimulator (complications; hoarsness, cough, dyspnea, neck pain, dysphagia)
    • CONTRAINDICATED for Generalized seizures
    • Avoid MRI, Microwave, shortwave radios
  17. when ar econventional surgical procedures used?
    • when VNS and medications do not control complex partial seizures
    • identify the part of the brain causing the seizure and if possible take it out.
    • Pre-Op: MRI, SPECT, PET, WADA, neuropyschological
  18. What is WADA
    • assess the hemosphere laterilization 
    • inject amobarbitol (short acting anesthia) into the 
    • it will show how the surgery will affect language and memory
  19. Conventional Surgical Procedure for Tonic-Clonic and Atonic Seizures
    • Partial Corpus Callostomy
    • prevents the passing between the 2 hemispheres (NOT common)
  20. after any seizure surgery what should be assessed?
    • Speech def
    • Language def
    • ability to swallow
  21. menningitia
    • headache caused by inflammation in menniges
    • can be viral, bacterial or fungal
    • S/S: Fear, photophobia, URI, Headache, Myalgias, N/V, 
    • Tx:  treat symptoms while waiting on cultur to com back
  22. Cryptococcus Neoformans Menningitis
    • fungal cause
    • Most experience Headache and N/V
    • treatment: IV antifungal and treat symptoms
  23. Menigococcal Meningitis
    • life threatening often in 24 hours
    • contagious
    • outbreaks are common
  24. Interventions for meningitis
    • ABC --- Neuro Satus
    • Cranial Nerves
    • BROAD SPECTRUM ABX
    • antiepileptic meds
    • Q4 Vascular checks
    • give
  25. Typical manifestations of Encephalitis
    • Headache, Fever, N/V, Stiff Neck
    • Additional Manifestations:
    • change in mental status, photophobia, phonophobis, joint pain,  tremors, seizure caused by increased ICP
  26. Interventions for Encephalitis
    • educate people to protect themselves against mosquito
    • ZOVIRAX in antiviral drug on choice for herpes encephalitis
    • No specific Tx for arbovirus/enteroviruses
    • Supportive Care for ICP and immobility
    • MONITOR mental status, make sure airway is clear, elevate HOB to help decreased ICP

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