Med-Surg Exam 2: Neurological

Seizure

abrupt, abnormal, excessive and uncontrolled electrical discharges of neurons in the brain that can cause alterations in motor and sensory ability and/or behavior

Epilepsy

chronic, recurring, 2 or more seizures without medical cause

Seizure & Epilepsy Risk Factors

• genetic predisposition

• acute febrile state (children, very high fever in adults)

• infection

• toxins

• tumor

• electrolyte imbalance (sodium)

• substance withdrawal (alcohol)

Tonic-Clonic

initial tonic phase (stiffness), then 1-2 minutes of clonic jerking, ending in a confused postictal phase

patient can experience hypoxia, apnea/irregular breathing or incontinence

Tonic

stiffness only

Clonic

rhythmic jerking of only

Myoclonic

brief jerking of only extremities

Atonic (drop attack)

loss of muscle tone sometimes resulting in falling

Absence

sudden loss of consciousness with no significant motor movement

Complex Partial (focal)

involuntary automatisms (repetitive behaviors), loss of consciousness, amnesia

Simple Partial (focal)

no alterations in consciousness, unusual sensations

During Seizure Care

• Protect from injury

• Position then laterally to preserve airway clearance

• Prepare suction

• Emergency medication (diazepam)

• Document (movement and duration)

  • Status epilepticus: seizure lasting more than 5 minutes or having 2+ back to back with no recovery period

Postictal Care

• Reorient

• Vital signs (tachycardic, decreased O2/respirations)

• Maintain safe positioning

• Assess for injury

Seizure Medications

Antiepileptics:

• Phenytoin (no contraceptives, warfarin, alcohol; take at same time daily; risk for tolerance development)

Benzos:

• Diazepam (emergencies)

Parkinson's Disease

• degeneration of the dopamine-producing neurons in the substantia nigra

• depletion of dopamine and an uninhibited overstimulation of acetylcholine in the basal ganglia

Parkinson's Risk Factors

over 50 yrs, workplace hazards, chronic antipsychotic use, genetic predisposition

Parkinson's Assessment

tremor, muscle rigidity, bradykinesia (slow movement), postural instability

Parkinson's Medications

Dopaminergics (levodopa-carbidopa)

• crosses into the brain and converts into dopamine

Dopamine Agonists (bromocriptine, ropinirole)

• used in conjunction with dopaminergics

Anticholinergics (benztropine)

• control tremors and muscle rigidity, used early on in diagnosis

Parkinson's Complications

aspiration risk, aspiration pneumonia, altered cognition (dementia, memory deficits), urinary tract retention, depression, skin breakdown

Primary headache

no identifiable cause

• types: migraine (with or without aura), tension and cluster

Secondary headache

identifiable cause

• tumor, aneurysm

Headache Risk Factors

• Alcohol

• Environmental allergies

• Intense odors, bright lights, overuse of medications

• Fatigue, sleep deprivation, stress, anxiety

• Hormones

• Foods with tyramine, nitrates or dairy

  • items on a charcuterie board

Headache Assessment/Findings

• photophobia and phonophobia (light + sound sensitivity)

• nausea and vomiting

• unilateral pain (behind one eye)

• aura (seen in migraines)

Headache Treatments

• abortive agents (taken at symptom onset to stop progression)

• preventive/prophylactic medications (taken routinely to reduce frequency and severity)

 

Hemorrhagic Stroke

due to bleeding from a ruptured artery or a ruptured aneurysm leading to ischemia from an increase in intracranial pressure (ICP)

Ischemic Stroke

most common (87%)

due to a blockage of circulation in the brain (blood clot or embolus) leading to ischemia

Stroke Risk Factors

• cerebral aneurysm

• arteriovenous (AV) malformation

• ethnicity

• age

• family history

Stroke Signs and Symptoms (hemispheres)

Left Hemisphere: language, math, analytical thinking

Right Hemisphere: visual and spatial awareness, proprioception

Common Stroke Symptoms

• Hemiplegia (paralysis)

• Hemiparesis (weakness)

• Aphasia (inability to speak or understand language)

• Agnosia (inability to recognize familiar objects)

• Agraphia (inability to write)

• Behavioral Changes (cautious, depression, anger, frustration, poor impulse control)

• Ataxia (decreased coordination/loss of balance)

• Apraxia (inability to perform simple commands)

• Visual changes/hemianopsia (loss of depth perception, visual fields, in one eye or both)

Hemorrhagic Stroke Treatments

stop bleeding, decrease ICP to ultimately stop ischemia

• surgical intervention (craniotomy)

• interventional radiology (angiography)

Ischemic Stroke Treatments

restore blood flow, remove clot to ultimately stop ischemia

• t-PA (alteplase): 4 hours from onset or last known normal

Stroke Medication

Thrombolytics, anticoagulants, antiplatelets (plavix), antiepileptics, antihypertensives

• monitor effectiveness, side effects, complications, labs

Stroke Precautions

aspiration, fall risk, seizure

Transient Ischemic Attack (TIA)

brief interruption of cerebral blood flow

• manifests with stroke symptoms; all symptoms resolve within 1- 24 hours

• waring sign (more likely to have a stroke afterward)