Ms. Glutting Neuro exam 2
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| Type of seizure caused by head trauma, metabolic or electrolyte imbalance (renal failure, hyponatremia, infection) | Acquired or secondary epilepsy
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| Type of seizure most often a result of unknown cause | Idiopathic or primary epilepsy
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| Seizure that causes loss of consciousness | Generalized
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| Seizure that does not result in loss of consciousness | Partial
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| Group of abnormal cells that initiates seizures | epileptogenic focus
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| Listed seizures all have something in common- Focal motor, jacksonian, sensory | simple partial seizure No loss of consciousness
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| 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
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| 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
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| Seizure that prod. sensory phenomena: numbness, tingling, bright flashing lights, in field of vision | sensory seizure, focus is in the occipital area
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| 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
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| Define generalized seizure | Involves entire brain, activated at once. Loss of consciousness
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| 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.
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| A petit mal/absence seizure may occur up to how many times in a day | 100; will exhibit learning problems.
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| Seizure lasting longer than 30 minutes | Status epilepticus
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| Tx for status epilepticus | Airway, oxygen, valium, dilantin (long term) IV ativan
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| type of seizure that has levels | Generalized tonic clonic (grand mal)
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| First stage of grand mal seizure | 1- sudden LOC
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| Second stage of grand mal | 2- tonic phase
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| 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.
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| tonic phase is also known as | pre-ictal phase
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| 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
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| Stage of grand mal that involves involuntary jerk or contraction of major muscles. May be thrown to the floor | Myoclonic seizure.
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| 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"
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| 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.
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| Max Mg/Minute for dilantin? | no more than 50mg/minute
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| 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.
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| AST normal level? ALT " " | AST- 5-40
ALT- 7-56
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| converted into fasphenytoin in system | cerebrex
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| The metabolism of dilantin will be increased by what substance? | alcohol
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| how would the nurse administer dilantin? What equipment needed? | Filter needed, only hang with NS, cardiac monitor will also be needed.
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| 4 s's | stat stic
suction
siderails up
siderail pads
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| Med that causes a lot of blood dyscrasias | Felbetol
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| If seizure is located on the left side what will be seen? | Speech is affected
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| If seizure is on the Right side what will be seen? | recognition/have to think about what they say before they say it
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| common symptoms of MS | muscle spasticity, neurogenic bladder, parethesias, cerebellar ataxia, fatigue, weakness, numbness, difficulty in coordination, loss of balance
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| Diagnostics to determine MS include a CSF exam that will find ____ antibodies. | IgG
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| Right or Left sided stroke? spatial-perceptual deficits | Right
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| Right or left sided stroke? Denies/minimizes problems | Right
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| Right or left sided stroke? Rapid performance/short attention span | Right
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| Right or left sided stroke? Impulsive | Right
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| Right or left sided stroke? Impaired judgement | Right
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| Right or left sided stroke? Impaired time concepts | Right
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| Right or left sided stroke? Impaired speech/language aphasias | Left
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| Right or left sided stroke? Impaired Right/Left descrimination | Left
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| Right or left sided stroke? Slow performance/cautious | Left
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| Right or left sided stroke? Aware of deficits, depressed/anxious | Left
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| Right or left sided stroke? Impaired language, math comprehension | Left
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| Meds used for ischemic stroke? | TPA, Heparin/platelet inhibs. Ticlid, Plavix, Persantine, Lovenox, Fragmin
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| Meds used for hemorrhagic stroke? | Nimodipine (Nimotop)
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| Dilantin is given to a stroke victim when..... | After seizure to prevent more seizures from occurring, will NOT be given prophylacticly before a seizure
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| 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
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| 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
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| 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
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| IV fluids to avoid in acute stroke TX? Glucose level preferred? | Water, Glucose containing
Glucose level, no higher than 140 and in norm range
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| Inability to recognize and object by sight, touch, or hearing | agnosia
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| Side of brain affected by stroke in which patient may exhibit unilateral neglect | Right; known as spatial-perceptual alteration
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| Things appear smaller than they are | micropsia
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| Loss of vision in half of each visual field. | homonymous hemaniopsia
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| 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
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| 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
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| Stroke? Progresses 12-24 hours, progressive deterioration of neuro status, residual effects possibly permanent | PS; progressive stroke or Stroke in evolution
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| Stroke? Severe in character, condition stabilizes but neuro deficit remains. No further deterioration after 2-3 days usually has permanent deficits | CS- completed stroke
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| Disturbance in muscular control of speech | dysarthria
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| Cannot name an object | anomia
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| 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
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| Repetition of one idea or response | perservation
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| 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
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| 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
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| 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
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| Immunomodulator given for control of disease in MS, patients will be taught to give their own injections. | Betaseron
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| anticholinergics, pro-banthine and ditropan would be given to treat what complication of MS? | spastic bladder; urinary frequency and urgency
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| Drugs given for urinary retention in MS> | Urecholine and Prostigmine cholinergics
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| 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
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| Daclofen, Valium, and Dangrium would be given to control ____________ in MS. | muscle spasm
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| First drug given in PD? and why | Dopamine receptor agonists, parlodel,permax, mirapex, requip
Sinamet added as disease progresses
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| Drug that increases the release of dopamine from storage sites. | Symmetrel
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| 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.
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| 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
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| Mestinon and Prostigmin are Anticholinerase medications given for MG tx. Patient teaching? | Meds need to be taken on time.
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| 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
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| 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
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| Spinal cord injury most common in cervical cord. Motor weakness/sensory loss present in upper/lower extremities but mainly upper | Central cord
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| 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.
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| 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
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| 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
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| Nsg TX for autonomic dysreflexia? | *raise HOB 90 degrees; decreasing BP
*notify MD
*ck for irritation: distended bladder, fecal impaction
*reposition
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| 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
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| What conditions are excluded when determining brain death? | Hypothermia, CNS depression r/t drugs; barbituates
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