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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