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Type of seizure caused by head trauma, metabolic or electrolyte imbalance (renal failure, hyponatremia, infection)
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Type of seizure most often a result of unknown cause
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NeuroB
Ms. Glutting Neuro exam 2
| Question | Answer |
|---|---|
| Type of seizure caused by head trauma, metabolic or electrolyte imbalance (renal failure, hyponatremia, infection) | Acquired or secondary epilepsy |
| Type of seizure most often a result of unknown cause | Idiopathic or primary epilepsy |
| Seizure that causes loss of consciousness | Generalized |
| Seizure that does not result in loss of consciousness | Partial |
| Group of abnormal cells that initiates seizures | epileptogenic focus |
| Listed seizures all have something in common- Focal motor, jacksonian, sensory | simple partial seizure No loss of consciousness |
| Seizure that displays a twitching of the hand or face only. It involves only the part of the brain that controls the part of the body affected. | Focal Motor seizure |
| Seizure that involves adjacent areas of the motor cortex, affecting a greater portion of the body. seizure that begins in hand and marches up to the shoulder | Jacksonian |
| Seizure that prod. sensory phenomena: numbness, tingling, bright flashing lights, in field of vision | sensory seizure, focus is in the occipital area |
| Type of seizure beginning with an aura or sensation. Rising from the epigastric region, odor, visual disturbance, deja vu. Lip smacking | Psychomotor, pick at clothes, person unaware of activity. It is referred to a complex partial seizure. Lasts 1-2 minutes No LOC |
| Define generalized seizure | Involves entire brain, activated at once. Loss of consciousness |
| seizure that lasts 5-30 seconds, generally begins in childhood and may disappear by puberty | Petit mal (absence seizure) may only stare into space, stop talking. |
| A petit mal/absence seizure may occur up to how many times in a day | 100; will exhibit learning problems. |
| Seizure lasting longer than 30 minutes | Status epilepticus |
| Tx for status epilepticus | Airway, oxygen, valium, dilantin (long term) IV ativan |
| type of seizure that has levels | Generalized tonic clonic (grand mal) |
| First stage of grand mal seizure | 1- sudden LOC |
| Second stage of grand mal | 2- tonic phase |
| S/S of grand mal tonic phase | entire body stiffens, including diaphram, throat muscles contract, air is pushed out. RR interrupted, may become cyanotic. Eyes open wide, pupils fixed/dilated. Lasts 30-60 sec. |
| tonic phase is also known as | pre-ictal phase |
| Stage of grand-mal that exhibits rhythmic, jerky contractions. Relaxed body muscles; especially extremities. incontence, biting of lips/tongue. RR sonorous, excess saliva. lasts 2-5 minutes | Clonic/ictal phase. relaxed/unresponsive afterward won't remember episode |
| Stage of grand mal that involves involuntary jerk or contraction of major muscles. May be thrown to the floor | Myoclonic seizure. |
| Stage of grand mal that involves complete loss of muscle tone, pt drops to floor but regains awareness by the time they drop. Resumes activity immediately. | Atonic seizure "drop attack" |
| Normal level of dilantin? How is it sent from pharmacy? | 10-20, may have load dose up to 1K Sent unmixed, it will precipitate in bag if premixed. |
| Max Mg/Minute for dilantin? | no more than 50mg/minute |
| Nursing considerations for Dilantin? Teaching in reference to side effects? | Teach patient that liver enzymes will need to be monitored. SE: Can cause hirsutism, gingival hyperplasia. |
| AST normal level? ALT " " | AST- 5-40 ALT- 7-56 |
| converted into fasphenytoin in system | cerebrex |
| The metabolism of dilantin will be increased by what substance? | alcohol |
| how would the nurse administer dilantin? What equipment needed? | Filter needed, only hang with NS, cardiac monitor will also be needed. |
| 4 s's | stat stic suction siderails up siderail pads |
| Med that causes a lot of blood dyscrasias | Felbetol |
| If seizure is located on the left side what will be seen? | Speech is affected |
| If seizure is on the Right side what will be seen? | recognition/have to think about what they say before they say it |
| common symptoms of MS | muscle spasticity, neurogenic bladder, parethesias, cerebellar ataxia, fatigue, weakness, numbness, difficulty in coordination, loss of balance |
| Diagnostics to determine MS include a CSF exam that will find ____ antibodies. | IgG |
| Right or Left sided stroke? spatial-perceptual deficits | Right |
| Right or left sided stroke? Denies/minimizes problems | Right |
| Right or left sided stroke? Rapid performance/short attention span | Right |
| Right or left sided stroke? Impulsive | Right |
| Right or left sided stroke? Impaired judgement | Right |
| Right or left sided stroke? Impaired time concepts | Right |
| Right or left sided stroke? Impaired speech/language aphasias | Left |
| Right or left sided stroke? Impaired Right/Left descrimination | Left |
| Right or left sided stroke? Slow performance/cautious | Left |
| Right or left sided stroke? Aware of deficits, depressed/anxious | Left |
| Right or left sided stroke? Impaired language, math comprehension | Left |
| Meds used for ischemic stroke? | TPA, Heparin/platelet inhibs. Ticlid, Plavix, Persantine, Lovenox, Fragmin |
| Meds used for hemorrhagic stroke? | Nimodipine (Nimotop) |
| Dilantin is given to a stroke victim when..... | After seizure to prevent more seizures from occurring, will NOT be given prophylacticly before a seizure |
| When will BP drugs be given in presence of a stroke? | ONLY if 220 or more or if MAP is 130+ Don't want hypotension to occur |
| TX for those who are in the process of a Hemorrhagic stroke, what med and when is it given? | Nimodipine (nimotop) Ca channel blocker, decreases vasospasm, minimizes tissue damage. GIVEN WITHIN 96 HOURS |
| Important info regarding admin of TPA? USE? NSG assessment? | Used to establish blood flow, prevent cell death in a ischemic stroke. Given in the 1st 3-4.5 hours after symptoms begin, not after. Know LSN. No TPA unless BP is 185/110 or less. Do all sticks/NG, etc, before TPA admin Assess for cerebral bleed |
| IV fluids to avoid in acute stroke TX? Glucose level preferred? | Water, Glucose containing Glucose level, no higher than 140 and in norm range |
| Inability to recognize and object by sight, touch, or hearing | agnosia |
| Side of brain affected by stroke in which patient may exhibit unilateral neglect | Right; known as spatial-perceptual alteration |
| Things appear smaller than they are | micropsia |
| Loss of vision in half of each visual field. | homonymous hemaniopsia |
| Which stroke? Deficits such as slurred speech, numbness, tingling goes away within 24 hours of onset. caused by temporary disturbance of blood to the brain | TIA lasts minutes to hours |
| which stroke? Onset and disappearance of focal neuro deficit within days. Lasts longer than 24 hours, minimal to no lasting deficit | RIND Reversible ischemic neuro deficit |
| Stroke? Progresses 12-24 hours, progressive deterioration of neuro status, residual effects possibly permanent | PS; progressive stroke or Stroke in evolution |
| Stroke? Severe in character, condition stabilizes but neuro deficit remains. No further deterioration after 2-3 days usually has permanent deficits | CS- completed stroke |
| Disturbance in muscular control of speech | dysarthria |
| Cannot name an object | anomia |
| When asked to speak cannot coordinate movement of lips/tongue but may be able to do so when left alone. applies to any motor movement | apraxia |
| Repetition of one idea or response | perservation |
| Motor or expressive aphasia. Pt demonstrates difficulty expressing self through spoken/written word. Speech slow, nonfluent, effortful. Can understand verbal/written word. Aware of problem | Brocas aphasia, frontal lobe; dominent hemisphere |
| receptive aphasia, injury to temporal lobe of dominant hemisphere. PT unable to comprehend written/verbal. Brain unable to interpret sounds heard, pt has fluent speech/norm rhythym but uses incorrect words. makes up own words. May not realize deficit. | Wernickes aphasia |
| Combo of expressive/receptive aphasia, little of communication system intact. trouble interpreting and expressing. Extensive deficits to both sides of brain. Emotional deficits. | Global aphasia |
| Immunomodulator given for control of disease in MS, patients will be taught to give their own injections. | Betaseron |
| anticholinergics, pro-banthine and ditropan would be given to treat what complication of MS? | spastic bladder; urinary frequency and urgency |
| Drugs given for urinary retention in MS> | Urecholine and Prostigmine cholinergics |
| Med given for parasthesias and ataxia in MS? (select all) A. Tegretol B. Dilantin C. Klonopin D. Neurontin E. TPA | A,B,C,D all are anticonvulsants |
| Daclofen, Valium, and Dangrium would be given to control ____________ in MS. | muscle spasm |
| First drug given in PD? and why | Dopamine receptor agonists, parlodel,permax, mirapex, requip Sinamet added as disease progresses |
| Drug that increases the release of dopamine from storage sites. | Symmetrel |
| Patient teaching for Levodopa | Avoid food high in Vit B , affects absorption. if taken with high protein meal it will lose its effect. Will only be useful for 3-5 years. |
| Nutritional teaching for PD patient? | *Adequate roughage/fruit to avoid constipation *Cut food into small bite sized pieces, serve on warming plate *Six small meals a day is best |
| Mestinon and Prostigmin are Anticholinerase medications given for MG tx. Patient teaching? | Meds need to be taken on time. |
| Crisis in MG that results in too little Ach available, respiratory muscles cannot maintain adequate respirations. Usually result of under medication, stress, infection or trauma. S/S acute respiratory distress, unable to swallow/speak Which crisis? | Myasthenic |
| Crisis when there is too much Ach available, constant action potential is generated, fatiguing the respiratory muscles. From over medication. S/S will be muscle weakness, respiratory distress but also will exhibit GI symptoms: N/V, diarrhea, bradycardia. | Cholinergic |
| Spinal cord injury most common in cervical cord. Motor weakness/sensory loss present in upper/lower extremities but mainly upper | Central cord |
| Injury resulting from acute compresion of anterior portion of spinal cord often a flexion injury. S/S motor paralysis, loss of pain/temp sensation below injury. | anterior cord, compromised blood flow to anterior cord. posterior not injured so sense of touch, position, vibration, motion is intact. |
| damage to 1/2 spinal cord characterized by loss of motor function and position, vibratory sense. Ipsilateral paralysis. Loss of pain/temp senstation below lesion Often caused by penetrating injury | Brown-Sequard |
| S/S of what disorder? *Severe hypertension (300/160 with bradycardia) *severe throbbing ha *nasal stuffiness *blurred vision *goosepimples and pallor below injury *profuse swelling, flushing above level of injury | autonomic dysreflexia |
| Nsg TX for autonomic dysreflexia? | *raise HOB 90 degrees; decreasing BP *notify MD *ck for irritation: distended bladder, fecal impaction *reposition |
| What six things determine brain death? | *unreceptive/unresponsive to painful stimuli *no movement after MD observes for an hour (continuously)/No breathing after 3 minutes off respirator *No reflex, including brain stem *Flat EEg *all tests repeated in 24 hours |
| What conditions are excluded when determining brain death? | Hypothermia, CNS depression r/t drugs; barbituates |
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