Exam 1 Med surg Galen
Describe a Migraine - ANSWER-Unilateral, supra and retro orbital, pulsating or
throbbing, worse with movement, sensitivity with light and sounds
Cluster - ANSWER-Lancinationg or stabbing, 5-30 minutes. Extreme pain
Migraine Pathophysiology - ANSWER-Pathophysiology - Not entirely clear.; theories?
Prevalence: May be seen in children and adults; Among children more common in boys;
among adults more common in women.
History of patient with migraine: Otherwise healthy, usually female in 30's
Individualized triggers (stress, smells, foods, hormones, menses)
Tyramine rich foods- chocolate, cheeses, beer, wine, cigar, sweet and low.
Treatment for Migraine - ANSWER-Vasoconstriction works the best, irritation of the 5th
cranial nerve, Estrogen hormone can causes migraines.
Migraine Manifestations - ANSWER-Manifestations
Pain: Usually unilateral, supra/retro-orbital, pulsating. Worse with movement.
Accompanied by non-h/a symptoms: N/V, photophobia, phonophobia,
Aura: (20% of cases):
What are the three main types of headaches? - ANSWER-Migraine, Tension, Cluster
Steps to Pain Assessment - ANSWER-Provoking
Quality
Radiation
Severity
Time
Provoking - ANSWER-has anything made it better or worse
Quality - ANSWER-Sharp, dull, achy, throbbing
Radiation - ANSWER-Does it radiate to another part of the body
Severity - ANSWER-Pain scale, 1-10 scale, intense pain, Other symptoms: N/V,
photophobia
Time - ANSWER-how long has it been going on? how long does it usually last?
Tension Headache - ANSWER-Bandlike, tightness
,Migraine Interventions - ANSWER-Pain management
Symptom management
Ex. Pitch black, turn off all the lights, N/V causes dehydration
Migraine Drug Therapy - ANSWER-APAP/Caffeine/ Butabital (Fioricet)
NSAIDS : Naprosyn
CCBs and Beta- Blockers (Preventative therapy) : Verapamil
Triptans and ergotamine's: Sumatriptan and Cafergot
Anticonvulsants (Preventative therapy): Topiramate
Botox Injections (monthly)
Magnesium
Migraine Complementary and alternative therapies - ANSWER-Acupuncture, Yoga,
Stress reduction activities, Supplemental mag, Distraction sometimes works.
Pound acronym - ANSWER-P:Pulsating
O:Duration
U: Unilateral location
N: N/V
D: Disabling
Epilepsy - ANSWER-Chronic disorder with two or more seizures experienced by the
client.
Epilepsy Assessment - ANSWER-Inquire about the seizure activity, frequency,
precipitating factors, aura (pre-ictal phase).
Family history
Collateral medical conditions (hx stroke, HTN, TBI, drug/alcohol abuse)
Seizure risk factors - ANSWER-V: Vascular
I: Infection or Inherited conditions
T: Trauma
A: Alzheimers/Autoimmune
M: Metabolic derangements
I: Idiopathic
N: Neoplasm
S: pSychiatric
Epilepsy Triggers - ANSWER-Sleep deprivation
Stress
Alcohol/ Alcohol Withdrawl
MSG
pg 878 Chart 42-9
, Aura - ANSWER-Seizures often preceded by an aura; it is unique to that patient, not
every patient has them.
Somatic: rising epigastric sensation
Hallucinations: Visual, gustatory, olfactory
Halos, Zig-zags, h/a, paresthesias, psychiatric phenomenon, deja-vu
Epilepsy Partial: - ANSWER-Partial (also called focal or local seizures): Occurs in a
specific part of the brain. May be characterized by automatism or tic. Ex: Jerk, reflex, lip
smacking (complex)
Epilepsy Simple: - ANSWER-Client does not consciousness. Localized
jerking/movement. Strange sensations. Autonomic symptoms.
Focal awareness they do not lose consciousness.
Epilepsy Complex - ANSWER-Involves altered LOC; may or may not have total loss of
consciousness. Automatisms. Patient may wander at start or have amnesia after. Most
common among older adults and difficult to diagnose bc symptoms appear similar to
those of dementia, psychosis, or neurobehavioral disorder, esp post-ictal.
Generalized epilepsy - ANSWER-Affects brain as a whole, bilateral seizure; we
differentiate them based on how they appear while observing them.
absence epilepsy - ANSWER-(petit mal): Generalized seizure involving sudden, brief
loss of consciousness. Usually diagnosed in children. Appears as if they are staring off
into space. Lasts seconds.
tonic-clonic epilepsy - ANSWER-"Grand mal." Stereotypical body convulsions. Lasts
minutes, involves muscle rigidity and convulsions. Tonic=stiffening, Clonic=jerking
Myoclonic Epilepsy - ANSWER-Brief muscle jerks, lasts seconds
Atonic (akinetic) Seizure (drop seizure) - ANSWER-Involves brief loss of tone. May be
confused with Fainting.
Acute Seizure Management (Observation) - ANSWER-History (if reported)
Look for underlying cause!
Record time sz began and ended.
Duration
Types of movements
Ongoing seizure observations
Post-ictal assessment - often involves reorientation.
Patient safety
If the client is sitting or standing, place the client on the floor
Continual assessment of the ABCs
Describe a Migraine - ANSWER-Unilateral, supra and retro orbital, pulsating or
throbbing, worse with movement, sensitivity with light and sounds
Cluster - ANSWER-Lancinationg or stabbing, 5-30 minutes. Extreme pain
Migraine Pathophysiology - ANSWER-Pathophysiology - Not entirely clear.; theories?
Prevalence: May be seen in children and adults; Among children more common in boys;
among adults more common in women.
History of patient with migraine: Otherwise healthy, usually female in 30's
Individualized triggers (stress, smells, foods, hormones, menses)
Tyramine rich foods- chocolate, cheeses, beer, wine, cigar, sweet and low.
Treatment for Migraine - ANSWER-Vasoconstriction works the best, irritation of the 5th
cranial nerve, Estrogen hormone can causes migraines.
Migraine Manifestations - ANSWER-Manifestations
Pain: Usually unilateral, supra/retro-orbital, pulsating. Worse with movement.
Accompanied by non-h/a symptoms: N/V, photophobia, phonophobia,
Aura: (20% of cases):
What are the three main types of headaches? - ANSWER-Migraine, Tension, Cluster
Steps to Pain Assessment - ANSWER-Provoking
Quality
Radiation
Severity
Time
Provoking - ANSWER-has anything made it better or worse
Quality - ANSWER-Sharp, dull, achy, throbbing
Radiation - ANSWER-Does it radiate to another part of the body
Severity - ANSWER-Pain scale, 1-10 scale, intense pain, Other symptoms: N/V,
photophobia
Time - ANSWER-how long has it been going on? how long does it usually last?
Tension Headache - ANSWER-Bandlike, tightness
,Migraine Interventions - ANSWER-Pain management
Symptom management
Ex. Pitch black, turn off all the lights, N/V causes dehydration
Migraine Drug Therapy - ANSWER-APAP/Caffeine/ Butabital (Fioricet)
NSAIDS : Naprosyn
CCBs and Beta- Blockers (Preventative therapy) : Verapamil
Triptans and ergotamine's: Sumatriptan and Cafergot
Anticonvulsants (Preventative therapy): Topiramate
Botox Injections (monthly)
Magnesium
Migraine Complementary and alternative therapies - ANSWER-Acupuncture, Yoga,
Stress reduction activities, Supplemental mag, Distraction sometimes works.
Pound acronym - ANSWER-P:Pulsating
O:Duration
U: Unilateral location
N: N/V
D: Disabling
Epilepsy - ANSWER-Chronic disorder with two or more seizures experienced by the
client.
Epilepsy Assessment - ANSWER-Inquire about the seizure activity, frequency,
precipitating factors, aura (pre-ictal phase).
Family history
Collateral medical conditions (hx stroke, HTN, TBI, drug/alcohol abuse)
Seizure risk factors - ANSWER-V: Vascular
I: Infection or Inherited conditions
T: Trauma
A: Alzheimers/Autoimmune
M: Metabolic derangements
I: Idiopathic
N: Neoplasm
S: pSychiatric
Epilepsy Triggers - ANSWER-Sleep deprivation
Stress
Alcohol/ Alcohol Withdrawl
MSG
pg 878 Chart 42-9
, Aura - ANSWER-Seizures often preceded by an aura; it is unique to that patient, not
every patient has them.
Somatic: rising epigastric sensation
Hallucinations: Visual, gustatory, olfactory
Halos, Zig-zags, h/a, paresthesias, psychiatric phenomenon, deja-vu
Epilepsy Partial: - ANSWER-Partial (also called focal or local seizures): Occurs in a
specific part of the brain. May be characterized by automatism or tic. Ex: Jerk, reflex, lip
smacking (complex)
Epilepsy Simple: - ANSWER-Client does not consciousness. Localized
jerking/movement. Strange sensations. Autonomic symptoms.
Focal awareness they do not lose consciousness.
Epilepsy Complex - ANSWER-Involves altered LOC; may or may not have total loss of
consciousness. Automatisms. Patient may wander at start or have amnesia after. Most
common among older adults and difficult to diagnose bc symptoms appear similar to
those of dementia, psychosis, or neurobehavioral disorder, esp post-ictal.
Generalized epilepsy - ANSWER-Affects brain as a whole, bilateral seizure; we
differentiate them based on how they appear while observing them.
absence epilepsy - ANSWER-(petit mal): Generalized seizure involving sudden, brief
loss of consciousness. Usually diagnosed in children. Appears as if they are staring off
into space. Lasts seconds.
tonic-clonic epilepsy - ANSWER-"Grand mal." Stereotypical body convulsions. Lasts
minutes, involves muscle rigidity and convulsions. Tonic=stiffening, Clonic=jerking
Myoclonic Epilepsy - ANSWER-Brief muscle jerks, lasts seconds
Atonic (akinetic) Seizure (drop seizure) - ANSWER-Involves brief loss of tone. May be
confused with Fainting.
Acute Seizure Management (Observation) - ANSWER-History (if reported)
Look for underlying cause!
Record time sz began and ended.
Duration
Types of movements
Ongoing seizure observations
Post-ictal assessment - often involves reorientation.
Patient safety
If the client is sitting or standing, place the client on the floor
Continual assessment of the ABCs
