Neuro MDCIV EXAM 1 CONCEPT
GUIDE
●Migraine signs/symptoms, medications and action of meds, dietary
restrictions
oFirst phase (prodromal) several hours to days before onset; will experience irritability, depression, food cravings, diarrhea, constipation, frequent urination. Development of an
aura that may last no longer than an hour, commonly last 10-30 minutes.
⮚Pain, visual disturbances, flashing lights, lines or spots, shimmering, zigzag lights
⮚Can also have some neuro such as: numbness, tingling of lip or tongue, confusion, aphasia, vertigo, unilateral weakness, drowsiness.
oSecond phase active migraine; severe, incapacitating, throbbing headache (this gets worse over several hours) accompanied by nausea, vomiting, drowsiness, and vertigo.
⮚unilateral, frontotemporal, throbbing pain in the head is often worse behind one eye or ear within an hour
oThird phase (4-72 hrs) dull HA; pain and aura subside, muscle ache, contraction of head and neck muscles, physical activity
worsen pain.
oOther migraines:
⮚visual migraine: an aura without pain experienced by an older adult.
⮚Common migraines: a migraine without an aura are considered a common migraine
-pain is aggravated by physical activity.
- unilateral, pulsating pain with one or more s/s present (photophobia, phonophobia, nausea, vomiting)
-lasts 4-72 hrs
-often occurs: morning, during stress, w/ premenstrual tension, or fluid retention
⮚Atypical migraine: (aka migrainous) lasts longer than 72 hrs.
⮚Migrainous infarction: neurologic symptoms are not reversed within 7 days; ischemic infarct noted on
neuroimaging (STROKE following migraine, rare)
oMeds to tx: Abortive or preventative Rx.
⮚Abortive
●Mild migraine: Acetaminophen, NSAIDS, antiemetics (aid in N/V), Excedrinhas acetaminophen, ASA and caffeine (caffeine causes vasoconstriction)
●Severe migraine: Triptan(vasoconstriction) Sumatriptan(imitrex) (vasoconstriction), don’t give to pt w/cardiac issues, this Rx causes chest pain. Relpax, Amerge and Axert cause the same vasoconstriction.
-Ergotamine- vasoconstriction & reduces inflamm. Cafergot(can be given orally or rectally, take at start of HA). Dihydroergotamine
⮚Preventative
●NSAIDS, Beta Blockers, Ca channel blockers, (reduces activity of neurons).
●Topiramate (Topamax)-antiepileptic
●Nortriptyline- used in low doses to prevent or reduce migraines
●OnabotulinumtoxinA (Botox) - for older adults w/ chronic migraines
oDietary restrictions- keep a diary to figure out foods, foods rich in tyramine, such as fermented cheese, beer, nuts, msg, pickled foods.
⮚know your triggers and avoid that food; no tyramine-
containing foods!
●Seizure, phases and treatment, interventions
oSeizures are abrupt, abnormal, excessive, and uncontrollable
electrical discharge of neurons within the brain that can cause alterations in the level of consciousness and or changes in motor or sensory ability and or behavior.
oCauses: high fever, CNS infection, hypoglycemia, ETOH withdrawal, acid-base imbalance, hypoxia, brain tumor, etc.
oTriggers: stress, trauma, overexertion, fatigue, caffeine, flashing lights
oPrimary seizure (idiopathic): no identifiable brain lesion or cause found, genetics may play a role. -- epilepsy
oSecondary seizures: the following may trigger a seizure: metabolic disorders, acute alcohol withdrawal, electrolyte disturbance, high fever, stroke, head injury, heart disease.
oEpileptic seizures have 3 categories:
⮚Generalized:
●Tonic-clonic- lasts 2-5 min. Tonic (stiffening of muscle & loss of consciousness may bite tongue or become incontinent) then clonic (1-2 min.of recurrent jerking motion of extremities),postictal may cause fatigue, acute confusion, sleepiness
●Tonic: 30 sec. - several min.; increase in muscle tone, loss of consciousness & autonomic symptoms occur (apnea, salivation, vomit)
●Clonic: muscle contraction and relaxation. may last several minutes
●Myoclonic: brief twitches, jerking or stiffening of
extremities, occurs in one area or in groups of muscles; lasts just a few sec.
●Absence seizure : loss of consciousness for a few seconds. blank staring, lip smacking, clothes picking (daydreaming)
●Atonic or akinetic: sudden loss of muscle tone, lasting for sec. followed by postictal confusion.
●status epilepticus : repeated seizure activity
within 30 min./ or a single seizure lasting
longer than 5 minutes (treat w/ benzo)
⮚Partial or focal/ local seizures: only one cerebral hemisphere
●Complex: pt is unaware; associated behaviors.. lip
smacking, picking at clothes, etc.; impaired consciousness for several min.; may start to wander, may have amnesia after the seizure, psychomotor behavior is affected
●Simple partial: remains conscious! experiences aura, or deja vu, offensive smell, sudden onset of
pain. may have one-sided movement of an extremity, unusual sensations
⮚Unclassified: half of all seizures, causes unknown
●idiopathic seizures- do not fit into any other category
oPhases & treatment:
⮚Preictal phase- this is before the seizure occurs and they
may see an Aura before the encounter (may be squiggly lines, altered vision/hearing, deja vu, sudden weird smell/taste, dizzy) ; try to prevent seizure from happening in this stage.
●if pt knows they are about to have a seizure, lay them down and on their side, protect their head
⮚Seizure (ictus)- ensure safety and turn pt on left side, do not put anything in mouth. Loosen restrictive clothing. Suction if possible, provide privacy.
⮚Postictal- maintain side lying position, suction and
apply o2 if needed, check vitals, pt may be tired,
confused, sleepy; try to determine trigger if not
already known
oMedical interventions:
⮚Primary: usually successfully managed through drug therapy
●Antiepileptic drugs (AED)- carbamazepine, phenytoin, valproic, oxcarbazepine, lamotrigine,
gabapentin, topiramate
●phenobarbital
●medications introduced one at a time & doses adjusted until they control seizures
⮚Secondary: remove or treat underlying cause
oGeneral instructions for room safety: seizure precautions
⮚O2 + suction
⮚pad side rails for pt safety
⮚patient should have IV access (heplock)
⮚suction ready at bedside
⮚monitor medication therapeutic level
oActive seizure interventions
⮚protect the pt from injuring themselves
⮚position pt to provide patent airway
⮚move furniture/ clear the area, hold head in lap if on the floor
GUIDE
●Migraine signs/symptoms, medications and action of meds, dietary
restrictions
oFirst phase (prodromal) several hours to days before onset; will experience irritability, depression, food cravings, diarrhea, constipation, frequent urination. Development of an
aura that may last no longer than an hour, commonly last 10-30 minutes.
⮚Pain, visual disturbances, flashing lights, lines or spots, shimmering, zigzag lights
⮚Can also have some neuro such as: numbness, tingling of lip or tongue, confusion, aphasia, vertigo, unilateral weakness, drowsiness.
oSecond phase active migraine; severe, incapacitating, throbbing headache (this gets worse over several hours) accompanied by nausea, vomiting, drowsiness, and vertigo.
⮚unilateral, frontotemporal, throbbing pain in the head is often worse behind one eye or ear within an hour
oThird phase (4-72 hrs) dull HA; pain and aura subside, muscle ache, contraction of head and neck muscles, physical activity
worsen pain.
oOther migraines:
⮚visual migraine: an aura without pain experienced by an older adult.
⮚Common migraines: a migraine without an aura are considered a common migraine
-pain is aggravated by physical activity.
- unilateral, pulsating pain with one or more s/s present (photophobia, phonophobia, nausea, vomiting)
-lasts 4-72 hrs
-often occurs: morning, during stress, w/ premenstrual tension, or fluid retention
⮚Atypical migraine: (aka migrainous) lasts longer than 72 hrs.
⮚Migrainous infarction: neurologic symptoms are not reversed within 7 days; ischemic infarct noted on
neuroimaging (STROKE following migraine, rare)
oMeds to tx: Abortive or preventative Rx.
⮚Abortive
●Mild migraine: Acetaminophen, NSAIDS, antiemetics (aid in N/V), Excedrinhas acetaminophen, ASA and caffeine (caffeine causes vasoconstriction)
●Severe migraine: Triptan(vasoconstriction) Sumatriptan(imitrex) (vasoconstriction), don’t give to pt w/cardiac issues, this Rx causes chest pain. Relpax, Amerge and Axert cause the same vasoconstriction.
-Ergotamine- vasoconstriction & reduces inflamm. Cafergot(can be given orally or rectally, take at start of HA). Dihydroergotamine
⮚Preventative
●NSAIDS, Beta Blockers, Ca channel blockers, (reduces activity of neurons).
●Topiramate (Topamax)-antiepileptic
●Nortriptyline- used in low doses to prevent or reduce migraines
●OnabotulinumtoxinA (Botox) - for older adults w/ chronic migraines
oDietary restrictions- keep a diary to figure out foods, foods rich in tyramine, such as fermented cheese, beer, nuts, msg, pickled foods.
⮚know your triggers and avoid that food; no tyramine-
containing foods!
●Seizure, phases and treatment, interventions
oSeizures are abrupt, abnormal, excessive, and uncontrollable
electrical discharge of neurons within the brain that can cause alterations in the level of consciousness and or changes in motor or sensory ability and or behavior.
oCauses: high fever, CNS infection, hypoglycemia, ETOH withdrawal, acid-base imbalance, hypoxia, brain tumor, etc.
oTriggers: stress, trauma, overexertion, fatigue, caffeine, flashing lights
oPrimary seizure (idiopathic): no identifiable brain lesion or cause found, genetics may play a role. -- epilepsy
oSecondary seizures: the following may trigger a seizure: metabolic disorders, acute alcohol withdrawal, electrolyte disturbance, high fever, stroke, head injury, heart disease.
oEpileptic seizures have 3 categories:
⮚Generalized:
●Tonic-clonic- lasts 2-5 min. Tonic (stiffening of muscle & loss of consciousness may bite tongue or become incontinent) then clonic (1-2 min.of recurrent jerking motion of extremities),postictal may cause fatigue, acute confusion, sleepiness
●Tonic: 30 sec. - several min.; increase in muscle tone, loss of consciousness & autonomic symptoms occur (apnea, salivation, vomit)
●Clonic: muscle contraction and relaxation. may last several minutes
●Myoclonic: brief twitches, jerking or stiffening of
extremities, occurs in one area or in groups of muscles; lasts just a few sec.
●Absence seizure : loss of consciousness for a few seconds. blank staring, lip smacking, clothes picking (daydreaming)
●Atonic or akinetic: sudden loss of muscle tone, lasting for sec. followed by postictal confusion.
●status epilepticus : repeated seizure activity
within 30 min./ or a single seizure lasting
longer than 5 minutes (treat w/ benzo)
⮚Partial or focal/ local seizures: only one cerebral hemisphere
●Complex: pt is unaware; associated behaviors.. lip
smacking, picking at clothes, etc.; impaired consciousness for several min.; may start to wander, may have amnesia after the seizure, psychomotor behavior is affected
●Simple partial: remains conscious! experiences aura, or deja vu, offensive smell, sudden onset of
pain. may have one-sided movement of an extremity, unusual sensations
⮚Unclassified: half of all seizures, causes unknown
●idiopathic seizures- do not fit into any other category
oPhases & treatment:
⮚Preictal phase- this is before the seizure occurs and they
may see an Aura before the encounter (may be squiggly lines, altered vision/hearing, deja vu, sudden weird smell/taste, dizzy) ; try to prevent seizure from happening in this stage.
●if pt knows they are about to have a seizure, lay them down and on their side, protect their head
⮚Seizure (ictus)- ensure safety and turn pt on left side, do not put anything in mouth. Loosen restrictive clothing. Suction if possible, provide privacy.
⮚Postictal- maintain side lying position, suction and
apply o2 if needed, check vitals, pt may be tired,
confused, sleepy; try to determine trigger if not
already known
oMedical interventions:
⮚Primary: usually successfully managed through drug therapy
●Antiepileptic drugs (AED)- carbamazepine, phenytoin, valproic, oxcarbazepine, lamotrigine,
gabapentin, topiramate
●phenobarbital
●medications introduced one at a time & doses adjusted until they control seizures
⮚Secondary: remove or treat underlying cause
oGeneral instructions for room safety: seizure precautions
⮚O2 + suction
⮚pad side rails for pt safety
⮚patient should have IV access (heplock)
⮚suction ready at bedside
⮚monitor medication therapeutic level
oActive seizure interventions
⮚protect the pt from injuring themselves
⮚position pt to provide patent airway
⮚move furniture/ clear the area, hold head in lap if on the floor
