Care of patients with problems of the Central Nervous System

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Categories of Migraines

migraines with aura, migraines without aura, atypical migraines

atypical migraines

less common and include menstrual and cluster migraines

prodrome phase

patient has specific symptoms such as food cravings or mood changes

aura phase

generally involves visual changes, flashing lights, or diplopia (double vision)

headache phase

may last a few hours to few days

termination phase

intensity of headache decreases

postprodrome phase

patient is fatigued, irritable, muscle pain

typical migraine symptoms

unilateral, fronto-temporal, throbbing pain in head often is worse behing one eye or ear. accompanies by sensitive scalp, anorexia, photophobia, phonophobia, and nausea with or without vomiting.

priority for care of patient having migraines is...

pain management

cluster headache

most common chronic short-duration headache with pain lasting less than 4 hours

tension headaches

most common type of chronic long-duration headache with pain lastine more than 4 hours

seizure

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within th ebrain that may result in a change in LOC, motor or sensory ability, and or behavior

epilepsy

two or more seizure experienced by a person, it is a chronic disorderin which repeated unprovoked seizure activity occurs

tonic-clonic seizure

lasts 2-5 minutes beginning with a tonic phase that causes stiffening or rigidity of the muscles, and immediate loss of consciousness, clonic or rhythmic jerking of all extremities follows

absence seizure

brief periods of loss of consciousness and blank staring as though the person is daydreaming, the person's eyes may flutter

myoclonic seizure

brief jerking or stiffening of the extremities that may occur singly or in groups, lasting for just a few seconds

atonic (akinetic) seizure

patient has a sudden loss of muscle tone, lasting for seconds, followed by postictal (after the seizure) confusion. in most cases, these seizures cause the patient to fall, which may result in injury.

complex partial seizure

LOC or "black out" for 1-3 minutes. the patient is unaware of environment and may wander at the start of seizure. after seizure patient may experience amnesia. temporal lobe is most involved

simple partial seizure

remains conscious throughout the episode. patient often reports an aura before seizure. patient may have one-sided movement of an extremity, change in heart rate, skin flushing, and epigastric discomfort

unclassified/idiopathic seizure

occur for no reason and do not fit into general classifications

seizure precautions

be sure oxygen and suctioning equipment with an airway are readily available, maintain iv acess, siderails up at all times

meningitis

inflammation of the meninges that surround the brain and spinal cord

viral meningitis (outcome) is ..

usually self-limiting and the patient has a complete recovery

bacterial meningitis (outcome) is...

potentially life threatening

Viral meningitis

most common type, results from measles, mumps, herpes simplex, and herpes zoster, and other viral infections. No organisms are obtained in the CSF, clinical manifestations include: fever, phototopia, headache, myalgias, nausea

Fungal meningitis

most common in AIDS patients.

Bacterial meningitis

medical emergency with mortality rate of 25%, occurs in areas of high population density in fall or winter, causes formation of exudate

key features is patient's with meningitis

change in LOC, disorientated to person, place, time, abnormal eye movements, shortened attention span, behavior/personality changes, severe headaches, generalized muscle aches, fever and chills, nausea, vomiting, tachycardia, red macular rash

most important nursing intervention for patients with meningitis

accurate monitoring and recording of their neurologic status, vital signs, vascular assessment

encephalitis

inflammation of brain tissue and often the surrounding meninges, affectin gthe cerebrum, brainstem, and cerebellum

causes of encephalitis

always caused by a viral infection elsewhere in the body (ex. west nile)

patho of encephalitis

virus infades brain tissue via bloodstream. inflammation extends over cerebral cortex causing degeneration of neurons of the cortex. demyelination of axons occurs, this leads to hemmorhage, edema, necrosis, and development of cavities in cerebral hemispheres

clinical manifestations of encephalitis

high fever, changes in mental status, motor dysfunction, focal neurological deficits, phototopias, fatigue, symptoms of increasing ICP

signs and symptoms of ICP

widened pulse pressure, bradycardia, and irregular respirations

Nursing intervention for encephalitis

maintain a patent airway to prevent the development of atelectasis or pneumonia which can lead to further brain hypoxia

Parkinson's disease

is a progressive neurodegenerative disease that is the third most common neurologic disorder of older adults

Parkinson's disease is characterized by four cardinal symptoms:

tremor, rigidity, bradykinesia or akinesia, and postural instability.

causes of Parkinson's

genetic or environmental

Alzheimer's disease

chronic, progressive, degenerative disease that accounts for 60% of dementias occurring in people older than 65 years old

Huntington's Disease

hereditary disorder transmitted as an autosomal dominant trait at the time of conception. This movement disorder causes both neurologic and behavioral symptoms

when do symptoms of HD begin?

between 35-50 years of age

two main symptoms of HD:

progressive mental status changes, leading to dementia, and choreiform movements (rapid, jerky movements)

In HD there is a decrease in the amount of:

GABA

clinical manifestations of HD:

chorea, poor balance, hesitant or explosive speech, dysphagia, impaired respiration, and bowel and bladder incontinence. mental status changes include decreased attention span, poor judgement, memory loss, personality changes, and dementia

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