NeuroAdult2

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Author:
madelynlee
ID:
68945
Filename:
NeuroAdult2
Updated:
2011-02-25 21:04:00
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neurological neuro nursing
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Description:
Neurological alterations across the lifespan part 2
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  1. ictal phase
    full sz. (phase name)
  2. NI's for sz.
    • have O2 nearby
    • document
    • safety
  3. postictal phase
    • period of recovery
    • takes nrg
  4. absence sz.'s (petit mal)
    • children to adolescent
    • brief staring spell
    • occur after precipitating event (flashing lights, hyperventilation)
    • untreated - up to 100x/day
  5. Bell's palsy affects what nerve
    facial nerve VII
  6. how treat Bell's palsy
    • corticosteroids
    • analgesics
    • nerve stim.
  7. peripheral facial paralysis (bell's palsy) s/s
    • initial pain around ear
    • flaccidity on affected side of face
  8. sz def
    interruption of norm brain fxn, the result of unctrl'ed electrical discharge of neurons
  9. epilepsy def
    recurring szs caused by chronic underlying condt
  10. simple partial szs
    • simple motor or sensory phenomena
    • no loss of awareness
  11. Guillain barre stats
    • adults
    • both genders
    • 85% recover w/in 2 yrs
  12. Guillain barre - how fast? starts where?
    • acute, sudden onset
    • rapidly progressive
    • potentially fatal
    • starts in legs and moves up
  13. aural/prodromal phase
    sensory warning or sign preceding sz
  14. status epilepticus drugs
    • ativan
    • valium
  15. NIs guillain barre
    • assess resp fxn
    • monitor ascending paralysis via CN
  16. sz treatment options other than meds
    • vagal nerve stim.
    • hemispherectomy
    • corpus callosum separation
  17. tonic clonic szs (grand mal)
    • combination tonic phase (stiffen) and clonic (jerking)
    • 30-120 sec
    • loss of consciousness
    • cyanosis, drooling, tongue biting, incontinence
    • bilateral and symmetrical
  18. complex partial sz
    • loss of awareness
    • motor, automatisms (taste, smell, feeling, tick)
  19. guillian barre physiology
    • loss of myelin and inflamm. of affected nerves
    • prevents neurotransmission to PNS
  20. generalized sz disorders
    • tonic clonic
    • absence szs
  21. antisz drugs
    • phenobarbital
    • dilantin
    • tegratol
    • depakene
    • neurontin
    • lamictal
    • topamax
    • depakote
    • klonopin
    • keppra
    • ativan
    • valium
  22. status epilepticus def, time?
    • sz lasting 10+ min
    • no return of consciousness between szs
    • potentially fatal b/c no O2, bcp nrg
  23. skull contains what 3 things
    • brain
    • blood
    • CSF
  24. TBI stats
    • 1.4 million/yr in USA
    • 50,000 die immediately
    • 235,000 hospitalized
  25. measure ICP if GCS score is...
    8 or below
  26. ventriculostomy
    catheter goes into skull
  27. #1 cause (and other causes) of TBI
    • #1 MVA
    • recreational
    • sports injuries
    • falls
    • work accidents
    • assault/firearms
  28. normal vs. elevated ICP
    • 0-15 mmHg = normal
    • greater than 15 mmHg = elevated
  29. commonly dxed neuralgic condt
    trigeminal neuralgia
  30. women over 40 are at risk for...
    trigeminal neuralgia (2x the risk)
  31. s/s trigeminal neuralgia
    intense facial pain with refractory periods, often triggered by chewing, teeth brushing, hot/cold, yawning, washing face, talking
  32. how treat trigeminal neuralgia (V)
    • anticonvulsants
    • nerve blocks
    • pain meds
    • rhizotomy - needle placed into trigeminal rootlets
  33. myasthenia gravis def.
    • autoimmune disease of the neuromuscular junction
    • antibodies attack acetylcholine receptor sites
  34. MG - antibodies attack what
    acetylcholine receptor sites
  35. MG stats
    • low prevalence (14 per 100,000)
    • more common in women 20-30 yrs
    • affects both sexes equally in older yrs
  36. MG - treatable?
    Yes, good prognosis
  37. Tensilon does what
    used to dx MG - symptoms get better if pt has MG and is given this
  38. s/s MG
    • FLUCTUATING WEAKNESS OF SKELETAL MUSCLES
    • -eyelid/extraocular muscles involved
    • -chronic fatigue
    • -facial expressions, chewing, swallowing
  39. what drugs help manage MG
    • anticholinesterase agents
    • corticosteroids
    • immunosuppressants
  40. if pt has MG and is given anticholinesterase agents, names of drugs...
    • Neostigmine (Prostigmin)
    • Pyridostigmine (Mestinon)
  41. if pt has MG and is given corticosteroids, names of drugs...
    prednisone
  42. if pt has MG and is given immunosuppressants, names of drugs...
    • Azathioprine (Imuran)
    • Cyclophosphamide (Cytoxan)
  43. Myasthenic crisis triggered by
    • infection
    • surgery
    • stress
    • meds too low
  44. Myasthenic crisis def. and what complication may result
    acute exacerbation that may lead to resp. emergency
  45. Cholinergice crisis def
    • too much medication
    • similar to myasthenic crisis
  46. how differentiate between myasthenic crisis and cholinergice crisis
    Give pt tensilon. If symptoms get better, it's myasthenic. If symptoms worse, it's cholinergice
  47. assess what w/ MG pt
    • resp status
    • muscle strength
    • coping ability
    • fatigue
    • body parts affected
  48. RN should plan for what w/ MG pt
    • normal muscle endurance
    • avoid complications
    • maintain quality of life
  49. RN should implement what w/ MG pt
    • avoid fatigue
    • maintain adequate ventilation
    • education
  50. RN should evaluate what w/ MG pt
    • minimal side effects to meds
    • maintain optimal muscle fxn
    • minimal complications
  51. Treatments for MG
    • thymectomy
    • plasma exchange (plasmaphoresis)
    • immune globulin therapy
  52. Basal ganglia does what
    • generates dopamine
    • helps with smooth, coordinated activities like dance, play instrument, etc.
  53. Parkinson's disease (PD) physiology
    • disease of the basal ganglia
    • degenerates dopamine production in the midbrain (substantia nigra) which then disrupts dopamine to acetylcholine balance in the basal ganglia
  54. extrapyramidal motor system needs what to fxn
    balance is needed for it to fxn
  55. PD symptoms occur when ___% of neurons are lost
    80%
  56. PD cause
    • unknown, but possibilities include--
    • herbicides
    • pesticides
    • well water
    • familial
    • virus
    • chem poisoning
    • seen more with copper miners
    • certain medications
    • illegal drug use
  57. PD onset
    gradual, progressive
  58. PD stats
    • more common in men (3:2)
    • dx increases with age (50s and 60s +)
  59. 3 parts of "Triad of Parkinson's"
    • tremor
    • rigidity
    • bradykinesia
  60. tremor part of triad of parkinsons looks like what
    • hand tremor - pill rolling
    • more prominent at rest
  61. rigidity part of triad of parkinsons looks like what
    • slow, jerky mvmts - "cogwheel rigidity"
    • increased resistance to passive motion
  62. bradykinesia part of triad of parkinsons looks like what
    • slow mvmt
    • loss of automatic mvmts such as blinking, facial expressions and swallowing
    • stooped posture
    • masked face
    • drooling
    • shuffling gate
    • difficulty starting a mvmt
  63. how PD pts die?
    complications of the disease, not the disease itself
  64. complications of PD
    • skin breakdown
    • risk for inf
    • decreased mobility
    • contractures
    • constipation
    • falls
    • dysphagia
    • drooling
    • depression
    • altered speech
    • incontinence
    • dementia
  65. antiparkinsons drugs do what in body
    correct the imbalance of neurotransmitters
  66. how does Carb/Lev work?
    Levodopa has domamine in it; Carbidopa stops the levodopa from being metabolized too quickly
  67. antiparkinsons drugs (KNOW)
    • Carb/Lev (Sinamet)
    • Requip
    • Mirapex
    • Permax
    • Parlodel
    • Amandine (Symmetrel)
    • Anticholinergic drugs -- like...
    • Artanem
    • Cogentin
    • Akineton
    • Benadryl
  68. what's an antiparkinsons and antiviral med?
    Amandine (Symmetrel)
  69. anticholinergic drugs to what in the body
    block cholinergic receptors therby helping with dopamine/acetylcholine balance
  70. anticholinergic drugs given for PD - name four
    • Artanem
    • Cogentin
    • Akineton
    • Benadryl
  71. surgical procedures to manage PD symptoms
    • deep brain stimulation
    • ablation
    • transplantation
  72. ablation (done for PD) def; name 2 types of; L/O
    • destruct certain parts of basal ganglia
    • Pallidotomy (globus pallidus of the basal ganglia)
    • Thalamotomy
  73. transplantation (to manage PD symptoms) means what
    • it's experimental
    • use fetal neural tissue to add dopamine-producing cells
  74. NIs for PD
    • promote adequate nutrition/diet
    • optimize psychosocial wellbeing
    • encourage INDEPENDENCE in fxning
    • promote physical activity
    • refer to therapies
    • avoid complications (contraxures, constip)
    • patient safety (ambulation interventions)

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