Diaz exam 4

primary headache

primary headache

no underlying cause

secondary headache

underlying structural problems (stroke, tumor, meningitis, encephalitis)

tension headache

constant pressure pain (wraps around) and sensitive to light

cluster headache

unilateral pain around the eye

migraines

mood changes, fluid retention, increased urinary output, excessive uncontrolled yawing, food cravings, aura, confusion, exhaustion

headache diagnosis

history and physical. blood tests, lumbar puncture, CT/MRI to identify causes

headache treatment

treat underlying cause! NSAIDs (anti-inflammatories), Analgesics, Muscle relaxants, sedatives, antidepressants

status migrainous

unable to attain headache relief (more than 72 hours). Inpatient treatment needed

Gliomas brain tumor

originate in the cerebrum and are found mainly in the frontal lobes

Meningiomas brain tumor

most common primary brain tumor and presents around 40-70 years of age

Oligodendrogliomas brain tumor

slow growing tumors that do not spread to surrounding tissue

Acoustic neuroma brain tumor

benign, slow growing tumor that compress the cranial nerves

pituitary tumor

benign tumor found in the anterior lobe of the pituitary causing hyper secretion of pituitary hormones

Cushing’s triad

widened pulse pressure, bradycardia, and irregular respirations

brain tumor output

increased urine output may indicate increased ICP

to decrease cerebral edema

give glucocorticoids (dexamethasone)

brain tumor nursing actions

replace fluids, elevate head of bed, administer stool softener, administer antipileptic

seizures manifestations

rhythmic jerking and loss of consciousness to apparent daydreaming (absent)

seizures diagnosis

EEG

Tonicity

stiffening of muscles

clonicity

jerking and twitching

seizures medications

Antiepileptic medications: Levetiracetam (keppra), topiramate (topamax), phenytoin (dilantin), valproate (depilate), and more

acute meningitis

bacterial cause with quick symptom onset

chronic meningitis

onset of weeks to months with duration greater than 4 weeks

meningitis clinical manifestations

over/chills, headache, altered mental status, photophobia, nausea/vommiting, Brudzinski’s and Kernig’s signs

Brudzinski’s sign

as the neck is flexed, there is stretch on the inflamed meninges, and the knees flex involuntarily to decrease the pain caused by the stretching of the meninges

Kernig’s signs

as the hip and knees are flexed and then straightened, there is pain in the hamstring secondary to stretching of the inflamed meninges

Encephalitis

acute inflammation of the brain (in cerebrum, brainstem and cerebellum)

Encephalitis manifestations

fever, neurological deficits, headache, photophobia/phonphobia, nuchal rigidity

Encephalitis diagnosis

lab tests (CBC, electrolytes, inflammation markers)

lumbar puncture (CSF evaluation)

EEG

CT scan/MRI

Encephalitis medications

Antivirals

Acyclovir and Ganciclovir

Encephalitis nursing actions

elevate bed 30-45 degrees to facilitate venous drainage and minimize ICP

Parkinson’s disease

loss of dopamine-producing Bain cells.

decrease dopamine in the brain→ uninhibited acetylcholine → decreased movement, resting tremors

Parkinson’s disease manifestations

resting tremors, muscle rigidity, stooped posture, slowness

Parkinson’s disease medications

Dopamine-receptor agonists: Carbidopa-Levodopa (sinemet)*

Anticholinergics: reduce tremor and drooling

Parkinson’s disease diagnosis

1. temors, rigidity, bradykineasia

2. Gag and swallow

3. Mobility

4. Bowel and bladder function

Alzheimer’s disease

forgetfulness, loss in the ability to complete tasks

Alzheimer’s disease vs Parkinson’s disease dementia

Monroe-kellie doctrine

the sum of the volumes of brain, CSF, and intracranial blood is constant, so an increase in one should cause a decrease in one, or both, of the remaining two

stroke risk factors

hypertension, smoking, hypercholesterolemia, drug use, older than 55

Ischemic stroke

sudden blockage of cerebral blood vessel. reduce blood supply

left middle cerebral artery syndrome

weakness of the right face, arm, leg

decreased sensation on the right side of the body

right homonymous hemianopia (loss of vision in right temporal field)

Dysphasia (Broca’s vs Wernicke’s)

Broca’s (expressive) aphasia

difficulty expressing thoughts and to make errors in speech that they cannot detect

Wernicke’s (receptive) aphasia

inability to process speech input in the brain, causing errors in speech that patient is unaware of

Right Middle cerebral artery syndrome

weakness of the left face, arm, and leg

decrease sensation of left side

left homonymous hemianopia (loss of vision in left temporal field)

Basilar artery syndrome

dizziness

ataxia

tinnitus (ringing in the ears)

nausea/ vommiting

weakness on one side

Ischemic stroke diagnosis

ct scan, MRI, Carotid duplex, Echocardiogram, laboratory tests

Ischemic stroke medications

recombinant tissue plasminogen activator (rt-PA)