Headache, Seizure, Dementia, Alzhimers

Symptomatic/Preventive therapies Headache

Drugs, Yoga, Biofeedback, Cognitive-Behavioral and Relaxation therapy

Drug Therapy: Tension-type headache

• Symptomatic
—Mild-moderate- Aspirin, Acetaminophen, NSAID w/ caffeine, sedative, muscle relaxant
• Preventive (Antidepressants/Antiseizure)

Drug therapy: Migraine headache Symptomatic

Mild to moderate- NSAID, Aspirin, or Caffeine-containing Analgesics

Drug therapy: Migraine headache Moderate

Triptans (sumatriptan) First line
• Affect selected serotonin receptors
• Reduce inflammed cerebral blood vessels
• Produce vasoconstriction-safety alert

Drug therapy: Cluster headache

Symptomatic: Triptans

Assessment Headache

Hx: Seizures, cancer, stroke, trauma, asthma, Allergies, mental illness, stress, Menstruation, exercise, food, bright lights, noxious stimuli
• Meds
• Surgery, Other Tx

Specific details Headache

• Location
• Type of pain
• Onset
• Frequency
• Duration, time of day
• Related to outside events

Objective data Headache

• Anxiety/Apprehension
• Diaphoresis, Pallor, Unilateral flushing w/ Cheek Edema, Conjunctivitis

Nursing diagnoses Headache

• Acute pain
• Lack of knowledge

- Inability to cope with daily stresses

Goals Headache

• Decreased/No pain
• Understand triggering events and Tx
• Positive coping strategies
• Increased quality of life, Decreased disability

Implementation Headache

• Effective therapy may help
—Examine daily routine
—Recognize stressful situations
—Learn to cope appropriately
• Daily exercise, relaxation periods, and socializing, yoga, meditation

Nursing Management Headache

• Teach Preventive Tx
• Encourage quiet, dim environment
• Massage, Moist Hot packs help TTH
• Teach to Avoid triggers—Food (chocolate, cheese, hot dogs), Odors (gasoline, perfumes)

Evaluation Headache (Expected outcomes)

• Satisfaction with pain management
• Drug and Nondrug measures to manage pain

Seizures

• Determined by site of electrical disturbance

• Prodromal phase-sensations/behaviors
• Aural phase-sensory warning each time
• Ictal phase-seizure itself (1st symptom)
• Postictal phase-recovery

Tonic-clonic seizures

• Loss of consciousness and falling to ground
• Body stiffens (tonic) with subsequent jerking of extremities (clonic)
• Cyanosis, Excess salivation, Tongue or Cheek Biting, Incontinence

Postictal phase TC

Muscle soreness, fatigue
• Asleep several hours
• May not feel normal for Hours/Days
• No memory of seizure

Status Epilepticus

Continuous seizure activity or seizures recur in rapid succession without return to consciousness between seizures
• Lasts longer than 5 min
• Neurologic Emergency
• Any seizure type

Status epilepticus causes brain to use

More energy than supplied
• Neurons exhausted and cease to function
• Permanent brain damage may result

Convulsive status epilepticus

• Most common
• Prolonged or repeated TC seizures
• Can lead to Fatal Respiratory insufficiency, Hypoxemia, dysrhythmias, HYPERthermia, systemic acidosis

Unconscious Pt at GREATEST risk

Nursing Diagnoses Seizures

• Impaired breathing
• Difficulty coping
• Risk for fall injury

Planning Seizures (Injury Free)

• Teach about seizures risks, drug plan
• Assess, record details
• Assess, position Pt, give antiseizure drugs
• Appropriate referrals
• Collaborates with physical, occupational, respiratory therapist

Implementation Seizures

• Teach to avoid excess alcohol, fatigue, sleep loss

• Prevention is MAJOR goal of Tx

Observe and record seizure, SAFETY ALERT

• Open/Maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor
• Don’t restrain Pt or put objects in mouth
• Pad side rails prevents injury
• May require positioning, suctioning, oxygen after seizure
—Place suction equipment, bag-valve-mask, O2 at Bedside

Drug therapy Seizure

• Phenytoin (Dilantin), Carbamazepine (Tegretol), Divalproex (Depakote)
• Safety alerts, Side effects, Contraindications, etc.
• Adherence to drug plan, what to do if missed dose
• Teach family members emergency management

Emotional support and use of coping mechanisms to

Adjust to personal limitations imposed by seizure
• Medical alert bracelets
• Referrals to agencies and organizations

Dementia

• Deficit in intellectual functioning
• Includes memory, orientation, attention, concentration problems
• Devastating consequences for patient and caregiver

• Affects functional ability, ability to work, fulfill responsibilities, perform ADLs
• High risk for INJURY, impaired nutrition, social isolation

Depression Dementia

• Often mistaken for one another, older adults especially
• Manifestations: sadness, difficulty concentrating, fatigue, apathy, despair, inactivity
• Severe depression leads to poor Concentration/Attention which leads to impaired function/Memory
• Together can indicate intellectual deterioration

Life span increases, More Dementia Dx

• Alzheimer’s disease (AD) most common ; 60% to 80%
• In 2018, 5.7 million Americans over age 65 are living with AD
• By 2050, this may increase to 14 million

Dementia Causes

• Neurodegenerative disorders-
Alzheimer’s disease (AD)
• Vascular diseases-HTN, DM, Stroke

Alzheimer’s disease

• Chronic, progressive, neurodegenerative brain disease
• 11% of people age 65 and older
• Approximately 1/3 people over age 85
• Early-onset AD less than or equal to 65 years old
• Late-onset AD greater than 65 years old

Alzheimer’s disease Fatality

• Death 4 to 8 years after Dx
• 6th leading cause of death in U.S.
• Can’t be prevented or cured or slowed

Gender differences Alzheimer’s

• Men—higher incidence of vascular dementia
• Women
—2/3 of people dx with AD are women
—More likely to develop AD due to longer life
—Twice as many die each year from AD

Cultural and Ethnic Health Disparities

• Older Blacks 2x more likely, older Hispanics are 1.5x more likely to have AD
• Increased risk due to health, lifestyle, socioeconomic variations
• Increased incidence of CV disease and DM may related to increased prevalence in Blacks/Hispanics

Family history is an important risk factor Alzheimer’s

• Those with first degree relative (parent or sibling) with dementia more likely to have AD
• Higher risk w/ more than 1 relative

Pathologic changes precede manifestations at least 15 years

The Alzheimer’s Association 10 warning signs

• Memory loss affects job skills
• Difficulty performing familiar tasks
• Problems with language
• Disorientation (time, place)
• Poor judgment
• Problems with abstract thinking
• Misplacing things
• Mood or behavior change
• Personality change
• Loss of initiative

Nursing Diagnoses AD

• Confusion
• Risk for injury
• Altered perception

Goals AD

• Maintain functional ability as long as possible
• Safe environment
• Minimize injury
• Address personal care needs
• Maintain dignity

Overall goals for caregivers AD

• Reduce caregiver stress
• Personal, emotional, and physical health
• Cope with long-term effects of caregiving

AD patients hospitalized for other problems can precipitate:

• Worsening dementia
• Delirium development

Inability to communicate symptoms places responsibility on caregiver and health care professionals

• Close observation for safety
• Need frequent reorientation and reassurance
• Consistent nursing staff may decrease anxiety/Disruptive behaviors

Sundowning AD

• Type of Agitation; unclear cause
• Pt more confused, agitated in late afternoon/Evening
• Could be disruption of circadian rhythms
• Other potential causes: Pain, Hunger, Noise, Unfamiliar Environment, Meds, Low lighting, Fragmented sleep

Restlessness or agitation are often

Pt’s way of responding to precipitating factor
• Pain- dementia pain assessment
• Frustration
• Temperature extremes
• Anxiety risks

Risks AD

• Fall Injury
• Ingesting dangerous substances
• Wandering-Silver alerts
• Injury to Others/Self w/ sharps
• Burns
• Unable to respond to crisis

Expected outcomes AD

• Be at highest level of cognitive ability
• Perform basic ADLs living by self /Assistance, as needed
• Maintain safety, minimize injury
• Stay in Restricted area during Ambulation/Activity