Term
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Definition
Abnormal, sudden excessive discharge of electrical activity within the brain,
Result of brain or CNS irritation
Exact mechanism is not fully understood |
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Term
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Definition
| abnormal, violent, involuntary contraction or series of contractions of the muscles, manifestation while having a seizure |
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Term
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Definition
| chronic disorder characterized by seizures |
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Term
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Definition
Brain tumor
Meningitis
Metabolic disorder
Alcohol withdrawal
Electrolyte disturbance |
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Term
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Definition
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Term
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Definition
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Term
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Definition
Tonic-Clonic (Grand Mal)
Absence (Petit Mal)
Myoclonic
Atonic |
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Term
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Definition
Usu lasts 2-5 min
Begins with Tonic phase characterized by rigidity of muscles
Clonic portion-rhythmic jerking of all extremities
Occasionally only tonic or clonic features occur, these seizures are classified by what part is seen
A cry is normal |
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Term
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Definition
More common in children
Brief periods of loss of consciousness
Blank staring
Returns to baseline immediately
Can be several in a row or one at a time no real pattern
Don't remember what is going on during but are not tired during |
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Term
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Definition
Brief jerking or stiffening usually of a limb (arm most common)
Contractions may be symmetric or asymmetric can be one arm or both.
May happen singularly or in groups
Can be awake or out of it |
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Term
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Definition
Sudden loss of muscle tone
Called a drop seizure the head just drops (seen in infants)
Lasts for only a few seconds
Followed by confusion
Usually several in a row
Usually in the neck can be total body as well |
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Term
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Definition
Complex
Look like they are conscious
Black out for 1-3 min
Automatisms- lip smacking, picking at clothes
Simple
Remain conscious
Often report aura
Changes in heart rate, skin flushing, epigastric discomfort |
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Term
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Definition
½ of all seizure activity
Occurs for no known reason
Doesn’t fit into any classification |
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Term
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Definition
Prolonged seizures-more than 5 minutes
Repeated seizures-over 30 minutes
Usually grand maul seizures
A neuro emergency that needs to be treated ASAP |
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Term
| Possible causes of Status epilepticus |
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Definition
Sudden withdrawal of AEDs
Infections
Acute alcohol withdrawal
Head trauma
Cerebral edema
Metabolic disturbances |
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Term
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Definition
Notify HCP immediately
Airway, O2
May have apnia during seizure
IV access
Valium or Ativan – drugs of choice to stop seizure
Dilantin- used to keep a recurrence from happening |
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Term
| Untreated related to Status epilepticus |
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Definition
Hypoxia
Hypotension
Hypoglycemia
Cardiac dysrhythmias
Lactic acidosis |
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Term
| Precipitating Factors for Seizures |
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Definition
Increased physical or emotional stress
Increased physical activity
Excessive fatigue
Alcohol or caffeine consumption
Certain foods or chemicals
Bright lights
Setting in front of video games for long periods |
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Term
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Definition
| no underlying brain problem usually inherited, age-related |
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Term
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Definition
| result from underlying brain pathology |
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Term
| NURSING ACTIONS for seizures |
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Definition
Support ABCs -no bite sticks
Observe, document, and time the length
Turn on side, or head to side
Remove harmful objects- Do not restrain
Cyanosis-normal, may use oxygen, suction
After seizure: vs, neuro checks, rest
Antiepileptic drugs (AEDs)-Anticonvulsants
Take meds on time and how prescribed to keep therapeutic blood level AEDs are very expensive |
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Term
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Definition
| confused hard to arouse may sleep for hours. After this they may complain of sore muscles and fatigue. |
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Term
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Definition
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Term
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Definition
Inflammation of the arachnoid and pia mater of the brain and spinal cord
Bacterial(septic)-most often seen ; Viral (aseptic)-self-limiting full recovery
Fungal & Protozoal not as common
Organisms enter CNS thru bloodstream via the blood/brain barrier
Penetrating trauma
Surgical procedures
Ruptured cerebral abscess |
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Term
| Most common organisms causing bacterial meningitis: |
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Definition
Haemophilus influenzae
Streptococcus pneumoniae
Neisseria meningitidis |
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Term
| when is Meningitis seen most often |
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Definition
| Seen most often in fall/winter- due to upper resp. infections |
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Term
| Observations indicating presence of Meningitis |
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Definition
| Early: mild lethargy, memory changes, short attn span, bewilderment, personality and behavior changes, severe HA, myalgia, N/V, fever, chills, tachycardia |
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Term
Meningitis
As disease progresses |
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Definition
LOC deterioration, becomes increasingly stuporous
Photophobia, ptosis, or opthalmoplegia
Facial paresis, difficulty hearing |
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Term
| Indicators of meningeal irritation: |
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Definition
Nuchal rigidity- rigid neck very painful
Positive Kernig’s sign-knee to 90 deg, then extend if postive it will hurt
Positive Brudzinski’s sign-flex head and neck if you bring the head up the knees with draw up and it will hurt |
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Term
| Neuro assessment with Meningitis |
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Definition
At least every 4 hours-esp of s/s of Increased ICP
Complete cranial nerve testing-poss cranial nerve involvement
Urinary incontinence-secondary to IICP
a rash is commonly seen from peticial rash to ecomsis |
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Term
Meningitis
Vascular assessment |
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Definition
| Temp, color, pulses, cap refill |
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Term
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Definition
Antibiotics – vanco
Hyperosmolar agents
Steroids and anticonvulsants |
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Term
| People in close contact to meningitis treated prophylactically with |
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Definition
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Term
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Definition
Isolation
For 1st 24 hours
Check policy and procedures for type needed
Seizure precautions |
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Term
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Definition
Acetaminophen or codeine
Elevate HOB 30 degrees
Bed linens and gown nonrestrictive
Quiet,dark environment
Freq position changes,moist heat, back rubs |
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Term
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Definition
Analysis of CSF
Cell count and protein
Glucose concentrations, C&S, gram stain studies
Counterimmunoelectrophoresis (CIE)
Determine presence of viruses or protozoa in CSF
Done if antibiotics already started
Complete blood count (CBC)
WBC
Electrolyte
Glucose
You CSF with bacterial meningitis
Low glucose hi protein hi white blood cells
You have to get your culture then start meds (brod sepc)
After results are back from culture you change meds if needed. |
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Term
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Definition
Inflammation of brain parenchyma(tissue) and often meninges
Affects
Cerebrum
Brain stem
Cerebellum
Incidence: 1 in 200,000 |
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Term
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Definition
Viral (most often), bacteria, fungi, or parasites
Virus gains access to CNS, invades brain tissue, causes inflammation
Inflammation extends over cerebral cortex, white matter, and meninges
Degeneration of neurons, demyelination of axon
Hemorrhage, edema, necrosis, IICP, death
Arthropod vectors transmit it (ie mosquito) |
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Term
Encephalitis
Signs & Symptoms |
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Definition
Fever
N/V
Stiff neck
Changes in LOC
Mental status changes
Motor dysfunction
Focal neurologic deficits |
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Term
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Definition
Patent airway
VS and neuro checks
HOB elevated
Acyclovir for herpes encephalitis |
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Term
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Definition
Progressive, degenerative disease
Myelin sheath is damaged causing an inflammatory response
Damaged myelin removed by astrocytes, forms scar tissue (plaque)
Impulses still transmitted but not as effective
White fiber tracts of brain and spinal cord are usually affected |
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Term
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Definition
| Mild attacks, minimal or no disability |
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Term
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Definition
| Increasingly freq attacks, periods of remission-return to baseline |
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Term
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Definition
| No periods of remission, doesn’t return to baseline |
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Term
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Definition
| Gradual neurologic deterioration without remission |
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Term
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Definition
| Gradual, may or may not have acute relapses |
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Term
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Definition
| Exact cause unknown; may be viral, immunologic, or genetic |
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Term
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Definition
| Tx: exercise, steroids, immnunosuppresives, adjunctive drug therapies, alternative therapies |
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Term
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Definition
Muscle weakness & spasticity
Fatigue
Intention tremors
Dysmetria
Paresthesia
Hypalgesia
Ataxia
Dysarthria
Dysphagia |
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Term
Multiple Sclerosis
STATISTICS |
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Definition
STATISTICS
One of leading causes of neurologic disability in persons 20-40 years
App. 500,000 in U.S. affected
Women slightly higher than men, pregnancy may exacerbate
Seen more often in colder climates
Incidence in 1st degree relatives: 15 X greater |
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Term
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Definition
Debilitating, neurologic disease affecting motor ability
Acetylcholine transmits excitatory messages
Dopamine is produced in the substantia nigra, inhibits the function of acetylcholine
Degeneration of substantia nigra-decrease production of dopamin
Decreases inhibition of acetylcholine
Lose ability to refine voluntary movement |
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Term
| Parkinson’s Disease Stages |
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Definition
Separated into stages according to symptoms and degree of disability
Stages
Initial-unilateral limb, minimal weakness, hand and arm trembling
Mild-bilateral limb, masklike facies, slow shuffling gait
Moderate-postural instability, increased gait disturbances
Severe disability-akinesia, rigidity
Complete ADL dependence |
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Term
| Parkinson’s Disease Signs |
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Definition
Cardinal signs
Tremor
Rigidity
Bradykinesia
Postural instability
Other
Gait abnormalities
“Pill rolling”
Mask-like facies
Speech problems
Autonomic dysfunctin
Psychosocial difficulties |
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Term
Parkinson’s Disease
Statistics |
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Definition
Symptoms usually appear after age 50
Can occur as early as 30
4th most common neurodegenerative disease
3rd most common in older adults
50,000 new cases each year
Affects men more than women
Affects nearly 1% of population over 60 |
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Term
Amyotrophic Lateral
Sclerosis (ALS) |
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Definition
Lou Gehrig’s Disease
Progressive degenerative disease involving the motor system
Atrophy of hands, forearms, and legs
Sensory and autonomic nervous systems are not involved,no mental status changes
Excess of glutamate covering the motor neuron leading to destruction of nerve cell |
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Term
Amyotrophic Lateral
Sclerosis (ALS)
Clinical Manifestations |
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Definition
Fatigue while talking
Tongue atrophy
Dysphagia & dysarthria
Weakness of the hands & arms
Incoordination
Fasciculations of the face
Nasal quality of speech
Disease progresses to muscle atrophy/weakness, flaccid quadriplegia, resp muscles involved, resp compromise, pneumonia, death |
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Term
Amyotrophic Lateral
Sclerosis (ALS)
STATISTICS |
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Definition
Usual age of onset: 40-70
More prevalent in men
Death usu occurs within 3-5 years after onset of symptoms
No: cause, cure, tx, pattern of progression, or prevention
Rilutek-neuroprotective effect in early stages
Symptomatic tx and rehab |
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Term
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Definition
| Hereditary disorder transmitted as an autosomal dominant trait at the time of conception |
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Term
| Huntington’s Disease stages |
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Definition
Gradual onset, three stages
1. Onset of neurologic or psychologic symptoms
2. Increasing dependence on others for care
3. Loss of independent function
Decrease in excitatory neurotransmitters, uninhibited motor activity |
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Term
Huntington’s Disease
Manifestations |
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Definition
Choreiform movements
Poor balance
Hesitant or explosive speech
Dysphagia
Impaired respiration
Bowel/bladder incontinence
Emotional disturbance |
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Term
| Huntington’s Disease statistics |
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Definition
Offspring of parent w/disease=50%
Men and women equally affected, usu 35-45 years of age
25,000 have disease, 20,000 to 50,000 carriers
Genetic counseling
Management is symptomatic |
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Term
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Definition
Autoimmune attack and demyelination of the peripheral nerves and some cranial nerves
Acute inflammatory process, varying degrees of motor weakness and paralysis
Dispersion of impulses, slow conduction velocities, or conduction block
Antecedent event precipitates clinical presentation
Schwann cell is spared allowing remyelination |
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Term
Guillian-Barré Syndrome
Key Features |
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Definition
Ascending symmetric muscle weakness leading to flaccid paralysis without muscle atrophy
Decreased or absent deep tendon reflexes (DTRs)
Respiratory compromise/failure
Loss of bowel and bladder control
Ataxia
Sensory manifestations
Cranial nerve manifestations
Autonomic manifestations |
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Term
Guillian-Barré Syndrome
ACUTE COURSE |
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Definition
Initial Period: 1-3 weeks
Begins with onset of 1st symptoms
Ends when no further destruction noted
Plateau Period
Several days-2 weeks
Recovery Phase
4-6 months
Remyelination and axonal regeneration
60-75% recover completely |
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Term
Guillian-Barré Syndrome
CHRONIC COURSE: 20-25% of cases |
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Definition
Axonal injury
Never fully recover |
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Term
| Guillian-Barré Syndrome cause |
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Definition
| Cause is obscure, hx of acute illness, trauma, surgery, or immunization 1-4 wks before onset |
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Term
| Guillian-Barré Syndrome risk factors |
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Definition
| URI, GI illness, CMV, vaccinations (swine influenza) |
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Term
| Guillian-Barré Syndrome treatment |
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Definition
| Airway mgmt, immunoglobulins, plasmapharesis |
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Term
Guillian-Barré Syndrome
STATISTICS |
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Definition
1 to 2 cases per 100,000
Age: 16-25 or 45-60
Men more susceptible
Higher incidence in Caucasians than other groups |
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Term
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Definition
“Grave muscle weakness”
Chronic, neuromuscular, autoimmune disease
Decrease in # and effectiveness of ACh receptors at neuromuscular junction
Nerve impulses are not transmitted to skeletal muscle
No evidence of CNS or PNS disease or muscle atrophy
Characterized by remissions & exacerbations |
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Term
Myasthenia Gravis
Key Features |
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Definition
Progressive muscle weakness – improves with rest
Poor posture
Ocular palsies
Ptosis
Weak or incomplete eye closure
Diplopia
Respiratory compromise
Loss of bowel and bladder control
Fatigue
Sensory manifestations |
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Term
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Definition
Precipitating event remains unclear
Thymus gland usually abnormal
Virus might injure thymus cells
Strong assoc. w/ hyperthyroidism
Not hereditary, small familial incidence |
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Term
| Myasthenia Gravis treatment |
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Definition
| anticholinesterase, corticosteroid, immuno-suppressant, plasmapharesis, thymectomy |
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Term
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Definition
Tensilon Test
Inhibits breakdown of ACh
Myasthenic Crisis
Undermedication or other event
Cholinergic Crisis
Overmedication |
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Term
Myasthenia Gravis
STATISTICS |
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Definition
60,000 have MG
Peak age of onset: 20-40 years
Can occur from age 10 to 70
Women affected more frequently than men
Develop disease at an earlier age |
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