Seizure/Chronic & Neurodegenerative Disorders: Alzheimer's & Parkinson's

What is WDL for HEENT, Neuro/Cog, Respiratory, Genitourinary for a Head to Toe Assessment for seizures?

• HEENT: Symmetrical at rest w/movent

• Neuro/Cog: A&O x4, clear speech, follows commands, purposeful motor response

• Respiratory: Reg. rate, depth & pattern, SpO2 in target

• Genitourinary: Continent

What is abnormal findings for HEENT, Neuro/Cog, Respiratory, Genitourinary for a Head to Toe Assessment for seizures?

• HEENT: Asymmetrical, rhythmic twitching

• Neuro/Cog: ALOC, disorientation, altered or absent speech, does not follow commands

• Respiratory: altered rate, depth and pattern, SpO2 low

• Genitourinary: Incontinent

What are the most common causes of seizures?

• Na+ imbalance or brain injury (stroke, surgery, TBI)

What does the type of seizure determine?

• The type of seizure determines medication management- not all seizure meds treat all types of seizures

What does aura mean regarding seizures?

• precursor to seizure

• ex: hearing sounds, unusual smells, tastes, feelings

What does post-ictal mean?

• Period of time/state of patient following a seizure

• Pt is post-ictal following a seizure

What SHOULD you DO and NOT DO for seizure precautions?

• DO turn patient to the side (prevent aspiration) and keep airway clear (no hand in mouth) → if we don’t turn we risk aspiration of oral secretions

• DO protect patient from injury (surrounding area) → put padding around, expecially protecting the head

• DO NOT hold patient down

• DO NOT force anything into patients’ mouth

• DO loosen any restrictive clothing

• DO record start and end time of seizure and characteristics

• also have suction set up for oral secretions (only thing acceptable in pt’s mouth)

What does post seizure/post-ictal look like?

• Sleepy, disoriented (could last minutes, hours, days)- brain just took a beating electrically

• Headache

• May not communicate verbally at all (may or may not have eyes open)

• May take many hours to return to baseline

What are seizures?

• sudden electrical firing of neurons in brain

  • change in function and behavior

  • impaired awareness

• Experienced by those w/epilepsy

What are the two major categories of seizures?

• Generalized seizures

• Focal seizures

What are precautions in everyday life for seizures?

• Drowning

• Burns

• Climbing stairs and ladders

• Driving

What are symptoms and then the precaution you would do in hospitals for seizures?

• Cardiac dysfunction or O2 deprivation: full resuscitation equipment at bedside

• Staring-spells: bag and mask for O2 at bedside

• Jerking of body and extremities: seizure pads on rails of bed

• Aspiration: suction at bedside

• Falling: bed placed close to ground w/side rails up

What is treatment for seizures?

• accurate diagnosis is crucial

• determine best pharmacologic managment

• determine triggers: alcohol, sleep deprivation, stress, lights/patterns

What is patient teaching and nursing interventions for seizures?

• Epilepsy is a chronic disorder: repeated, unprovoked seizure activity occurs

• Medication teaching

• Proper follow up, including lab draws: consider SDOH

• Medication interactions/lifestyle (heights, swimming)

• Medical alert, include family/friends

• State law: driving, operating machinery ??

• Usually need to stay on meds for life

What is the specific medication teaching for seziures?

• Meds must be taken EVERY DAY- same time- compliance is crtitical

• This must be a priority if nurse is managing med admin

• More than one med is often needed

• Manage SE’s

What is Alzheimer’s Disease?

• irreversible dementia caused by nerve cell death, loss of acetylcholine and brain atrophy

• pathophysiology: unknown, some types linked to genetic mutations

• Loss of neurons → brain atrophy

• Loss of neurons → loss of synapses and acethycholine

What are the two hallmarks of Alzheimer’s Disease?

• Beta Amyloid Plaques accumulate outside neurons → interferes with nerve stimulation

• Tau proteins accumulate inside neurons to form neurofibrilary tangles → interferes with conduction → death of neurons

INSERT REST OF NOTES HERE

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What is ADHD?

• Attention- Deficit Hyperactivity Disorder

What are symptoms of ADHD?

• Easy distractibility

• Failure to recieve instructions properly

• Inability to focus on one task at a time

• Difficulty remembering

• Loss/misplacement of personal items

• Excessive talking or interrupting

• Inability to sit still

• Impulsiveness

• Sleep disturbance

What does ADHD affect in pt’s lives?

• Affects ability to learn/school functioning

• Impacts friendships

• About 70% of children w/ADHD are treated w/meds

• More men than women (3:1)

• Causes self-esteem issues, diminished social success

• May “self-medicate” with alcohol, durgs esp later in life

• Pharmacotherpay with stimulant medications

What is methylphenidate/how does it work?

• CNS stimulant for ADHD

• “Concerta, Ritalin, etc”

• Activates the RAS in the brain, releases dopamine and norepinephrine, “sympathomimetic”

• Someone directing traffic with thoughts in brain

What are the uses for methylphenidate?

• ADHD

• Narcolepsy

• Obesity treatment

What are the admin isntructions for methylphenidate?

• SR tablets must be swallowed WHOLE

• Controlled substance- requires special Rx

What are the adverse effects for methylphenidate?

• Increased HR, high BP, liver toxicity

• High abuse potential, locked up

What is Bipolar Disorder?

• AKA “Manic Depression”

• Alternating epidsodes of mani and depression (cycles of extremes of mood)

  • Mania is opposite of depression, can last days to weeks

What are Mania (bipolar disorder) symptoms?

• Inflated self esteem or grandiosity (thoughts or plans that are larger than life)

• Decreased need for sleep

• Increased talkativeness

• Flight of ideas (not staying on one topic)

• Distracted or increased goal-directed activity (spend great deal of time making this one grandios idea happen)

• Excessive involvement in pleasurable activities (shopping, sex, unsound business deals)

What is the treatment for bipolar disorder?

• “mood stabilizers” - even out highs and lows

• Some antiseizure drugs work well

• Some antipsychotic medications work well

• Traditional medication is lithium but not udes as much bc there are better drugs

What are the problems with lithium for bipolar disorder?

• Narrow therapeutic index (need levels checked frequently)

• Acts like sodium in body so need to monitor lithium levels every 4-5 days (mk sure no electrolyte abnormalities)

• Overdoes requires hemodialysis and supportive care

What is the class and uses for olanzapine (Zyprexa)?

• Class: atypical antipsychotic (even though used for bipolar disease)

• Uses: schizophrenia (psychotic disorder) and bipolar 1 disorder

  • sometimes used in hospital for acute delierium/hospital psychosis

What is the MOA for olanzapine (Zyprexa)?

• Binds to dopamine and serotonin receptors. Leads to a decrease in positive Uplifted/manic) symptoms in patients, including hallucinations, delusions, disorganized speech, thought and behavior.

• Can have rapid short term effects

What are adverse effects for olanzapine (Zyprexa)?

• Drowsiness (most common)

• Weight gain

• Decreased insulin sensitivity! Monitor blood glucose levels

• Can cause dopamine blockade- increased risk of dyskinesia (disjointed movements) and extrapyramidal symptoms (drug-induced movement disorders that affect muscle tone, posture, and involuntary control)

What is the class and uses for lithium (Lithobid)?

• Class: anti-schizophrenic, mood stabilizer, anti-inflammatory properties

• Uses: bipolar 1 disorder, adjunct for refractory (responsive to treatment) depression in pts w/mood disorders (those who who been treated for mood disorders and have depression from it)

What is the MOA for lithium (Lithobid)?

• not sure, increases inhibitory neurotransmitters and decreases excitatory neurotransmitters in the brain

• Depends on lithium blood levels for how long it takes to work

What are the adverse effects for lithium (Lithobid)?

• amount of salt (sodium) in your body influences the effects of this medication, and this medication can increase salt loss from the body

• QT prolongation (affect on heart rhythm, puts you at risk for VTAC)

• Hand tremor

What do you need to be aware of with lithium?

• Narrow therapeutic index! Needs levels to monitor drug, do not use salt substitute- need the sodium from salt

• Watch for toxicity: ringing of ears, loss of coordination, diarrhea, vomiting, serotonin syndrome

What is the nursing care for lithium?

• take same time each day in morning, enoucrage salt-steady diet, drink plenty of fluids but avoid caffeinated beverages (they dehydrate)

• educate pt on toxicity signs and symptoms

• ensure lithium levels are ordered and being drawn

What is Serotonin Syndrome?

• Condition where you have high high level of serotonin in body that causes altered mental status

• Can occur with lithium toxicity, with SSRIs, SSRI and MAOI

• AMS- altered mental status

• Hyperthermia

• Sweating

• Myoclonus (arrhythmic muscle twitching), occular clonus (pupils bounce)

• Rigidity (rhabdo)

• Diarrhea

• Restlessness

What is depression?

• Difficulty sleeping or excessive sleeping

• Tired = without energy

• Abnormal eating

• Inability to concentrate or make decisions

• Feelings of despair, guilt and misery, lack of self-worth

• Avoiding psychosocial and interpersonal interactions

• Lack of interest in personal appearance or sex

• Delusions or hallucinations

What are the different types of depressions?

• Situational (something bad happens)

• Post-partum

• Seasonal affective disorder

• Psychotic depression

How do antidepressants work?

• Enhance or stabilize mood

• May be prescribed for other disorders (phobias, panic, anxiety, etc.)

• Most meds for depression are associated with weight gain!

• Takes several weeks to see full effects

What is the major BBW for antidepressants?

• Closely monitor adults and children taking antidepressants for warning signs of suicide! Weekly or even daily checks may be required util mood begins to elevate which could take as long as 12 weeks.

• Children and adolescents are more at risk for this tan adults

What is for setraline (Zoloft)?

• Antidepressant- SSRI

• “Selective Serotonin Re-Uptake Inhibitor”

What is the MOA for sertraline (Zoloft)?

• prevents the reuptake of serotonin from the synapses which leads to increased levels of serotonin (feel good neurotransmitter)

What are the administration alerts for sertraline (Zoloft)?

• Abrupt discontinuation can cause withdrawal symptoms (N/V, agitation, tremor, and seizures)- taper off!

• See BBW for antidepressants

What are the side effects of sertraline (Zoloft)?

• Decreased libido (sex drive) (70% of both men and women)

• Weight gain

What is the class and uses/actions for bupropion (Wellbutrin)?

• Class: atypical antidepressant

• Uses/Actions: used for treatment of depression and to assist in smoke cessation. Off-label use in children for ADHD

What is the MOA for bupropion (Wellbutrin)

• not well understood, known to inhibit reuptake of norepinephrine and dopamine weakly

• full effect not seen until 4 weeks of therapy

What are side effects for bupropion (Wellbutrin)?

• many but most serious

  • Lowered seizures threshold (not good for those with epilepsy)

  • Worsening of suicidal ideation

  • Weight loss

What are MAOI’s?

• Monoamine oxidase inhibitors

• Terminate the action of neurotransmitters such as dopamine, norepinephrine, epinephrine and dopamine

• Due to low safety margin- used only when SSRI’s or other meds have not worked

• Serious food/drug interactions, sepcially food with tyramine (form of amino acid tyrosine)

  • When taken with tyramine-containgin foods, there is a sudden release of norepinephrine which leads to acute hypertension accompanied by stiff neck, headache, flushing, palpitations, diaphoresis, and nausea

  • Pt’s should be taught to avoid foods that contain tyramine: avocado’s bananas, cheese, yogurt, alcohol, deli meats, raisins or papaya

What is the class and uses for methylprednisolone (Solumedrol)?

• Class: corticosteroid

• Uses: anti-inflammatory or immunosuppressive

What is the MOA for methylprednisolone (Solumedrol)?

• modifies protein synthesis to inhibit leukocyte infiltration at inflammation site, interfere with the function of mediators of inflammatory response and suppress humoral immune responses

What adverse effects for methylprednisolone (Solumedrol)?

• Long term use: Kaposi’s sarcoma

• Myopathy (muscle break down overtime, imparing protein synthesis which impaires ability to rapir and grow muscle), impaired wound healing, osteoporosis

• Risk of infection- have close eye on sources of infection

• Hyperglycemia (increased insulin resistance)

• Mood swings/irritability