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Key Concepts from Video Transcript

Seizures

  • Uncontrolled, sudden, excessive discharge of neurons in the brain.
  • Manifestations:
    • Behavior changes
    • Loss of consciousness
    • Rhythmic jerkiness of extremities
    • Daydreaming
    • Staring
    • Subtle body movements
    • Brief loss of consciousness
  • Myoclonic seizures: sudden jerks/twitches of arms and legs.
  • Atonic seizures (drop attacks): sudden collapse.
  • Tonic-clonic seizures (grand mal).
  • Drugs: gabapentin, lamotrigine, pregabalin, clonazepam are given for seizures. Need to get liver checked every 6 months as they can cause liver toxicity. Also important to never stop taking the medication abruptly, even with side effects and to consult with the provider first.

Nursing Safety for Seizures

  • Equipment in the room for patients at risk:
    • Suction (for after the seizure)
    • Side rails
    • Oxygen
  • During a seizure:
    • Do not suction.
    • Do not force anything into their mouth.
    • Gently lower them to the floor or bed if they are standing.
    • Turn them to the side.
    • Record the start and end time of the seizure.
    • Priority is safety.
    • Loosen clothing.
  • Status epilepticus: Two or more seizures without full recovery in between; this is a medical emergency.
    • Priority: ABC (Airway, Breathing, Circulation).
    • Intubation may be needed.
    • Medications: Lorazepam (Ativan), midazolam (Versed) IV for immediate control.
    • High dose propofol may be needed in ICU.
    • Continuous EEG monitoring.

Parkinson's Disease

  • Caused by the substantia nigra not producing enough dopamine.
  • Slow, progressive disorder affecting movement.
  • Symptoms:
    • Frozen movements
    • Rigidity
  • Stage five is advanced, with patients bedridden.
  • Treatment:
    • Drugs
    • Physical therapy (PT)
    • Occupational therapy (OT)
    • Speech therapy
    • Rehab
  • Patients are slow and have cognitive difficulties.
  • Morning stiffness is common, so schedule appointments later in the day.
  • Medications: Carbidopa-levodopa (Sinemet), Mirapex. Other nontraditional/alternative therapies and communication methods.
  • Communication board may be useful due to comprehension problems, not hearing problems.
  • Diet: High protein, high calorie diet with supplements; finger foods are helpful.
  • Complications: depression, anxiety, impaired cognition, insomnia.

Multiple Sclerosis (MS)

  • Onset: 20-50 years.
  • Immune system attacks the brain and spinal cord, damaging the myelin sheath which transmits messages, causing a chronic neurological disorder.
  • Symptoms: numbness, weakness, vision loss (partial or complete), tingling/pain, electric shock sensations.
  • Types of MS exist.
  • Risk factors exist.
  • Diagnosis: no specific test; based on history, physical, and neurological assessment.
  • No cure: treatment focuses on symptom control, improving recovery from attacks, reducing the number of attacks, and slowing disease progression.
  • Plasmapheresis may be used.
  • Common complications include muscle stiffness/spasms, paralysis (especially legs), bowel/bladder/sexual dysfunction, mental status/memory loss problems.

Transient Ischemic Attack (TIA)

  • Can affect both men and women and has various causes.
  • Etiology: Genetics, chronic diseases, deficiencies, medications, caffeine, alcohol, and pregnancy.
  • Symptoms: concentration difficulties, memory loss, poor sleep, inability to finish tasks.
  • TIA occurs when there is not good blood supply to the brain.
  • Risk factors: age > 60, blood pressure >= 140/90 (consistent), unilateral weakness, duration of symptoms (longer duration = higher stroke risk).
  • Vision changes: blurred vision, diplopia, hemianopsia (affects half the visual field - tunnel vision).
  • Motor function: weakness, facial droop, arm/leg weakness, impaired hand grasp.
  • Ataxia: Lack of muscle control and coordination - unsteady gait, unsteady balance, inability to walk.
  • Sensory: Numbness to the face, hand, arm and leg. Remember to test cranial nerves.
  • Dizziness.
  • Aphasia: Speech problems; cannot talk at all, cannot express themselves, cannot understand.
  • Dysarthria: Slurred speech due to muscle weakness/paralysis.
  • Treatment:
    • Surgery to remove plaque
    • Stent placement
    • Antiplatelet drugs (aspirin, Plavix)
    • Blood pressure management
    • Diabetes management
    • Lifestyle changes: smoking cessation, healthy diet, physical activity.

Stroke

  • Two types: ischemic and hemorrhagic.

Ischemic Stroke

*   Emboli or thrombus obstructs blood flow, leading to anoxia and tissue death.

Hemorrhagic Stroke

*   Rupture of a vessel or aneurysm due to high blood pressure.
  • Three main risk factors: hypertension, cardiovascular disease, diabetes.
  • Embolic stroke: clot breaks off and travels to the brain.
    • Can happen suddenly.
    • Thrombolytic stroke: thrombus causes narrowing of the artery; symptoms develop slowly.
    • Headache, dizziness, weakness, paralysis, numbness, visual disturbance and difficulty walking are possible.
    • Patient remains conscious and has hypertension.
  • Hemorrhagic stroke: bleeding inside the brain.
    • Severe headache, neck rigidity, rapid onset, complete hemiplegia (paralysis on one side of the body).
    • Patient can quickly go into a coma.
    • Emergency surgery may be required.
  • FAST acronym:
    • Facial droop
    • Arm weakness
    • Speech difficulty
    • Time to call 911.

Common Issues Stroke Can Cause

  • Hemiparesis (weakness one side of body) or hemiplegia (paralysis one side of body).
  • Vision loss: diplopia, depth perception loss, impaired visual perception of horizontal and vertical planes.
  • Homonymous hemianopsia: visual loss in the same half of the visual field of each eye.
    • Patient teaching: scan the environment by turning the head to compensate for vision loss.
  • Aphasia, dysphasia.
    • If there is no gag reflex, keep the patient NPO, and modify the provider.
    • Begin initially test them with water, if they cough you stop.
    • The speech therapist will do the bigger test.
  • EKG, CT, MRI can be used as well.
  • Carotid bruit: turbulence heard over carotid artery suggesting narrowing (auscultate with stethoscope).

Tissue Plasminogen Activator (tPA) and Stroke

  • tPA (alteplase) is a medication that dissolves blood clots and can only be used for ischemic stroke.
    • It is a clot buster.
    • Must be given within 3-4.5 hours of symptom onset.
    • It is the only approved drug for acute ischemic stroke.
  • Difference between heparin/Lovenox and tPA:
    • Heparin/Lovenox prevent future clots, but do not break down existing clots.
  • Before administering tPA, draw baseline labs, perform complete physical assessment, insert Foley catheter if needed, and start any necessary IVs.
    • Avoid invasive procedures after tPA administration.
  • Explain the procedure to the patient and obtain consent.
  • Administer tPA IV over 60 minutes.
  • Monitor the patient closely, assessing LOC and vital signs every 10-15 minutes.
  • Maintain blood pressure below 185/110 mm Hg.
  • Avoid inserting any tubes or lines while the medication is running.
  • Side effects: severe headache or severe hypertension.
    • Keep patient on bed rest for at least 24 hours.
    • Follow up with CTA (CT scan with contrast).
  • Later on, we want to have Blood pressure to be normal.
  • Treat with Normothermia, meaning we don't want them to be too hot and too Increase the ICP. Anticoagulants can be given, heparin and warfarin, aspirin. They can also use calcium channel blockers, and stool softeners.

Surgical Management of Hemorrhagic Stoke

  • Ligation of the vessel or clips to stop bleeding.
  • Mesh to redirect blood flow away from malformed vessel.
  • Patient teaching: lifestyle changes and medication adherence.

Nursing Interventions

  • Watch for decreased LOC, changes in motor or neurosensory function, pupillary changes, respiratory difficulty, development of visual or perceptual defects or aphasia. Watch as well for restlessness, confusion, difficulty following commands, and headaches in case of ICP increase.
  • We don't want them to strain and Excessive coughing, vomiting, lifting, fever. Modify to them a diet while speaking to the dietitian.
  • Place the food on the unaffected side of the mouth, and make sure the patients ware his glasses in the left side. Make sure they get food after swallowing.

Cataracts

  • Lens is transparent and made of protein and fluids; light goes through it.
  • With age or other factors, proteins clump together, causing cloudiness of the lens that blocks light.
  • Types: senile (aging), congenital (inherited), or secondary (trauma, UV light, diabetes).
  • Risk factors: Age, trauma, toxins, corticosteroids, diabetes, hypoparathyroidism, Down syndrome, chronic sunlight exposure.
  • Leads to: retinitis, glaucoma, retinal detachment.
  • Symptoms: Unable to discriminate perceive colors, especially dark blue and black. Diplopia, reduced visual acuity, absence of red reflex, white cloudy pupil.
  • Vision testing, central/peripheral vision assessment, slit lamp examination, ophthalmoscope.
  • Surgery is done when cataracts affect ADLs, especially driving.
  • Preoperative eye drops (mydriatics) are prescribed to be used, as well as to no take asprin for risk of bleeding.

Post Operative

  • Don't drive. Mild eye itching is fine, and the eyes will get a litter red, also slight swelling is expected, but notify to the provider just in case it gets too bad.
  • Head of the bed should be 30 to 45 degrees. On the post operative we position him on the back or to the non operative side as well. Put things such as belongings from the unaffected said, a wearing eye patch, especially at night. Side rails may be needed and help them go into the bathroom. Notify the provider of sudden sharp pain, bleeding, discharge of green discharge. Avoid bending from the waist, lifting objects more than 10 pounds, sneezing, coughing, blowing the nose, straining, and Vomiting

Glaucoma

  • Drainage canal (angle) blocks aqueous humor drainage, leading to increased intraocular pressure (IOP) that damages the optic nerve (cranial nerve II), resulting in vision loss.
  • Increased IOP due to inadequate drainage or overproduction of aqueous humor.
  • Painless vision loss, often starting with peripheral vision.
  • Risk factors: age, hypertension, cardiovascular disease, diabetes, obesity, medications (antihistamines, anticholinergics), African American ethnicity.
    *

Types of Glaucoma

Primary Open Angle Glaucoma

*   Most common, genetic link, slow fluid drainage, increased IOP slow loss and painless.

Angle Closure/Closed Angle Glaucoma

*   Rare medical emergency requiring surgery to avoid blindness. Acute onset. Symptoms include severe eye pain and headaches.
  • Medication Temolol is a betal blocker and could cause Dizziness/Asthma. Teaching here will be that if the patient has asthma can cause bronchospasm because of the Temolol medication and its given for increase of IOp, not for other diseases.
  • Surgery cannot be cured, but can be mantained with medication the surgery. It is a lifelong treatment which is needed.

Post Operative

  • Hard to put in the drops or ointments by themselves. Is important to use good hand washing. And if they miss a drop do not double dose it and do not lay on the eye which was impacted. Lay down on the other side.

  • We have them to also know the inner canthus put put pressure when putting on the eyes for less reabsorption of medication so the body doesn't absorb it much when put inside the eye. Signs of infection are: Do not stop any medications without notifying the provider, and then make sure take your medications in a timely manner.