Term
| The 3 types of primary HA are? |
|
Definition
migraine, tension, cluster
b/c these are not caused by a disease process |
|
|
Term
| Which is the most common type of HA? |
|
Definition
|
|
Term
| Tension HA can last how long? |
|
Definition
|
|
Term
| Describe the pain of a tension HA. (Location, type, etc.) |
|
Definition
-bilateral with a pressing/tightening quality
-usually mild to moderate
-can be episodic or chronic
-not aggravated by physical activity |
|
|
Term
| What characteristics are NOT present with tension HA that are present with other types of HA? |
|
Definition
-no NV
-no aura
-may involve sensitivity to light |
|
|
Term
| What is the most effective diagnositc tool for tension HA? |
|
Definition
-careful pt history
-if HA is present during exam may present with resistance to passive movements of the neck and head |
|
|
Term
| Describe the location of migraine HA |
|
Definition
| -most commonly a unilateral throbbing pain originating at the temple |
|
|
Term
| What are risk factors for developing migraines? |
|
Definition
-family history
-low level of education
-low socioeconomic status
-high workload
-frequent tension HA |
|
|
Term
| What usually causes a migraine and what preceeds it? |
|
Definition
-usually caused by a triggering event specific to each pt
-usually preceeded by an "aura", the pt will know it is coming |
|
|
Term
| Name some specific triggers of migraine HA |
|
Definition
| hormones, head trauma, physical exertion, fatigue, stress, drugs, chocolate, cheese, oranges, tomatoes, onions, alcohol (esp red wine) |
|
|
Term
| Describe characteristics of a migraine aura |
|
Definition
| -patchy blindness, bright lights, visual distortions, seeing zig zag lines, hearing sounds that aren't there, strange smells, motor weakness |
|
|
Term
| What is the time frame of a migraine? |
|
Definition
|
|
Term
| What diagnostic tool is used for migraines? |
|
Definition
-pt history
-radiologic tests may be done if a secondary HA is suspected to rule out another cause |
|
|
Term
|
Definition
| a rare form of HA, that involve repeated HAs over a period of weeks to months that then have a remission period |
|
|
Term
| Which nerve is involved with cluster HA? |
|
Definition
|
|
Term
| Describe the pain of a cluster HA? |
|
Definition
-unilateral, originates behind the eye possibly the side of the head or jaw
-is a sharp, stabbing pain as opposed to the throbbing pain of a migraine |
|
|
Term
| How long does the actual pain of each individual cluster HA last? |
|
Definition
|
|
Term
| How frequently can cluster HAs occur? |
|
Definition
-from every other day up to 8 times a day
-usually occuring at the same time each day
-this happens anywhere from 2 weeks to 3 months |
|
|
Term
| What physical signs might a person with a cluster HA have? |
|
Definition
| swelling around the eye, tearing, facial flushing or pallor, nasal congestion, constriction of the pupil |
|
|
Term
| What is the only dietary trigger of a cluster HA? |
|
Definition
|
|
Term
| What is the diagnositic tool used for cluster HA? |
|
Definition
|
|
Term
| What is the drug class of choice for a tension HA? |
|
Definition
-nonopioid analgesic
-aspirin / tylenol possibly in combination with a sedative, muscle relaxant, tranquilizer, or codeine |
|
|
Term
| What are the possible side effects of long term use of aspirin and tylenol? |
|
Definition
-aspirin: possible upper GI bleed and coagulation abnormalities
-tylenol: chronic use can cause kidney damage and large doses can cause liver damage esp when mixed with alcohol use |
|
|
Term
| What drug class is Imitrex? |
|
Definition
|
|
Term
| What is the mechanism of action of Imitrex? |
|
Definition
| affect selected serotonin receptors, causes vasoconstriction |
|
|
Term
| Is Imitrex abortive or preventive? |
|
Definition
| abortive, taken at the first sign of a migraine |
|
|
Term
| When is Imitrex contraindicated? |
|
Definition
pt with heart disease d/t Imitrex causing constriction of the coronary arteries
-pt would be at risk for MI, cardiovascular thrombosis, and CVA |
|
|
Term
| Name 2 drugs used in the prevention of migraines |
|
Definition
|
|
Term
| Name the drug classes used as abortive treatment for migraines |
|
Definition
| -nonopioid analgesics, opioids, antiinflammatories, corticosteroids, muscle relaxants |
|
|
Term
| Name the drug classes used for preventive treatment of migraines |
|
Definition
| antidepressants, SSRI, beta blockers, calcium channel blockers, antiseizure, Botox |
|
|
Term
| What is the treatment of an acute cluster HA? |
|
Definition
| -100% oxygen at a rate of 6-8L/min for 10 mins, can be repeated after a 5 min rest; Imitrex may also be used |
|
|
Term
| Name prophylactic drugs used with cluster HA |
|
Definition
verapril, lithium, ergotamine, divalproex, or NSAIDs
-lidocaine intranasally |
|
|
Term
| Cluster HA may be caused by decreased oxygen during flying. What medicine can be taken prior to flying to prevent this? |
|
Definition
|
|
Term
| Name some possible precipitating factors of MS |
|
Definition
| infection, physical injury, emotional stress, excessive fatigue, pregnancy, and a poorer state of health |
|
|
Term
| What is the primary neuropathologic condition associated with MS? |
|
Definition
| autoimmune reaction orchestrated by autoreactive T cells, which may be triggered by a virus |
|
|
Term
| Why is MS difficult to diagnosis initially? |
|
Definition
Initially the myelin sheaths are attacked but the nerve fiber is unaffected. The myelin is capable of regenerating and the this causes a remission.
The pt may notice weakness but the symptoms disappear and this leads to a delay in diagnosis |
|
|
Term
| What replaces the myelin sheath as it is damage by the autoimmune T cell response? |
|
Definition
scar tissue
-which forms hard sclerotic plaques in multiple areas of the CNS slowing nerve impulses |
|
|
Term
| In MS the destruction of what leads to total lose of function? |
|
Definition
|
|
Term
| The onset of MS is characterized by? |
|
Definition
exacerbations and remissions
-each exacerbation causes more damage and scar tissue to the myelin sheath leading to progressively worsening symptoms |
|
|
Term
|
Definition
-weakness/paralysis of limbs, trunk, or head; diplopia, scanning speech.
-numbness and tingling, patchy blindness, blurred vision, vertigo, tinnitus, decreased hearing, and chronic neuropathic pain
-nystagmus, ataxia, dysarthria, dysphagia, severe fatigue |
|
|
Term
| What is Lhermitte's sign? |
|
Definition
| transient sensory symptom of MS described as an electric shock radiating down the spine or into the limbs with flexion of the neck |
|
|
Term
| How are the elimination patterns affected by MS? |
|
Definition
-Constipation is common as opposed to bowel incontinience
-the bladder can be spastic or flaccid:
spastic: uninhibited, small capacity with urgency usually resulting in incontinience or dribbling
flaccid: hypotonic, large capacity b/c there is no urge to void leading to retention |
|
|
Term
|
Definition
| primarily from history and clinical manifestations; MRI may show grow numbers of lesions over time |
|
|
Term
| What drug classes are used in treating acute exacerbations of MS? |
|
Definition
| corticosteroids; such as ACTH, methylprednisone, and prednisone |
|
|
Term
| What drug class is used to modify progression and prevent relapses of MS? |
|
Definition
| immunomodulators; such as interferon |
|
|
Term
| What kind of diet is recommended for pts with MS? |
|
Definition
| low-fat, gluten free, high in raw vegetables, high-protein, supplementary vitamins; though there is no evidence of any dietary benefits |
|
|
Term
| What are the most common triggers of MS exacerbations? |
|
Definition
| infections, trauma, immunizations, postpartum period, stress, FATIGUE, AND CLIMATE CHANGES |
|
|
Term
| What is one of the first subtle changes noticed in the pt with Parkinson's Disease? |
|
Definition
|
|
Term
| What are the 4 Cardinal Signs of Parkinson's disease? |
|
Definition
- Tremor (begins in fingers, progresses)
- Muscle rigidity
- Bradykinesia (slow movement)
- Postural inability
|
|
|
Term
| The symptoms of Parkinson's are exacerbated by a deficiency of what? |
|
Definition
|
|
Term
| What is the term given to pts with Parkinson's when tremors first appear in their fingers? |
|
Definition
|
|
Term
| Muscle rigidity is a cardinal sign of Parkinson's, what are the 3 classifications? Describe. |
|
Definition
-Gogwheel: rhythmic interruption of muscle movement
-Plastic: mildly restrictive movement
-Lead Pipe: total resistance to movement |
|
|
Term
| What is a "drug holiday" for the Parkinson's pt? |
|
Definition
| a period of time, usually about 10 days, where all Parkinson's meds are stopped to decrease the risk of toxicity |
|
|
Term
| How does Levadopa help the pt with Parkinson's? |
|
Definition
| Levadopa replaces dopamine, reducing the severity of symptoms |
|
|
Term
| Describe the posture and gait of the pt with Parkinson's? |
|
Definition
| forward lean, reduced swinging arms, rigidity and tremoring of the head and hands, slow shuffling steps |
|
|
Term
| What makes the tremor of a pt with Parkinson's worse? |
|
Definition
| it is more prominent at rest, and is aggravated by stress or concentration |
|
|
Term
| How are automatic movements affected in the Parkinson's pt? |
|
Definition
| involuntary movements such as blinking the eyes, swinging arms while walking, swallowing saliva, facial self-expression are impaired |
|
|
Term
| What are some common complications of early to mid Parkinson's? |
|
Definition
| depression, anxiety, apathy, fatigue, pain, constipation, impotence, and short term memory loss |
|
|
Term
| What are some common side effects of end stage Parkinson's? |
|
Definition
| dyskinesias (involuntary movements), weakness, akinesia (total immobility), dementia, hallucinations, psychosis |
|
|
Term
| How is Parkinson's diagnosed? |
|
Definition
| history, clinical manifestations, low dopamine levels |
|
|
Term
| What is the benefit of Sinemet in the treatment of Parkinson's? |
|
Definition
| Sinemet, when used with Levadopa, helps more of the Levadopa reach the brain allowing more to be converted to dopamine; some MDs believe the benefits wear off over time |
|
|
Term
| What are the benefits of exercise for the pt with Parkinson's? |
|
Definition
| decrease muscle atrophy, contractures, and constipation |
|
|
Term
| What are the signs of Levadopa overdose? |
|
Definition
| NV, hypotension, also a slow, writhing, continuous, involuntary movement of the neck |
|
|
Term
| What are some nursing interventions to make life easier for the pt with Parkinson's? |
|
Definition
| using upright chairs with arms and placing small blocks under the back legs, remove excess furniture, an ottoman can be used to reduce ankle edema, use a raised toilet |
|
|
Term
| What special consideration should be taken when scheduling acitivites for the pt with Myasthenia Gravis? |
|
Definition
| skelatal muscle weakness is resolved by a period of rest, so activites should be planned for in the morning when first waking or for a time after a planned nap can be taken |
|
|
Term
| Which trunk muscles are affected by Myasthenia Gravis? |
|
Definition
usually the proximal, not distal muscles
(neck, shoulder, and hip) |
|
|
Term
| Which muscles are most commonly affected by Myasthenia Gravis? |
|
Definition
eyelid muscles or extraocular muscles
(facial mobility and expression can be impaired as well as chewing, swallowing, and speech) |
|
|
Term
| What are some things that can preceed an exacerbation of Myasthenia Gravis? |
|
Definition
| stress, pregnancy, menses, illness, trauma, temperature extremes, hypokalemia |
|
|
Term
| What is the major concern of a pt in Myasthenic crisis? |
|
Definition
this crisis can bring weakness to muscles involved in swallowing and breathing; leading to aspiration, resp insufficiency, and resp infection
-brought on by infection, surgery, emotional distress, drug overdose or insufficiency |
|
|
Term
| What invasive procedures can be used for pts with Myasthenia Gravis? |
|
Definition
| removal of the thymus, plasmapheresis is used when in crisis or prior to surgery when corticosteroids must be avoided |
|
|
Term
| Name some drug classes that are contraindicated for pts with Myasthenia Gravis |
|
Definition
aminoglycoside antibiotics, beta blockers, psychotropic drugs
|
|
|
Term
| Death from ALS usually occurs when after diagnosis? |
|
Definition
|
|
Term
| Describe the cognitive effects of ALS |
|
Definition
| none; the pt remains cognitively intact |
|
|
Term
| What is the usual cause of death with ALS? |
|
Definition
| resp infection secondary to compromised resp function |
|
|
Term
| What can be done to delay muscle wasting associated with ALS? |
|
Definition
| endurence type exercises for the trunk and lims |
|
|
Term
| What does a Tensilon Test differeniate? |
|
Definition
| Myasthenic crisis from cholinergic crisis |
|
|
Term
| What result of a Tensilon test would indicate Myasthenic crisis? |
|
Definition
| IV Tensilon is given, if the pt shows improved muscle contractility (within 5 mins) it is a myasthenic crisis; if no improvement is seen the pt is in cholinergic crisis |
|
|
Term
| What pattern does paralysis progress in Guillain-Barre Syndrome? |
|
Definition
| begins at the feet and works its way up |
|
|
Term
| What is the most serious complication of Guillain Barre? |
|
Definition
resp failure
most pts may require intubation and vent support |
|
|
Term
| How is Guillain Barre diagnosed? |
|
Definition
| history (recent GI or resp infection) and clinical manifestations; after 7-10 days CSF will show elevated protein levels with a normal cell count |
|
|
Term
| What is the most common bacteria associated with preceeding Guillain Barre? |
|
Definition
| Campylobactor jejuni; a GI bug |
|
|
Term
| Why are pt with Guillain Barre able to make a recovery? |
|
Definition
| the paralysis is caused by demyelination of nerves causing impulses to stop; after the disease has fully progressed and begins to fade the nerves are able to regenerate the myelin; though recovery can take months to years |
|
|
Term
| Why are enteral feedings used with Guillain Barre instead of TPN? |
|
Definition
| Since the pt will make a recovery it is essential to keep the GI system stimulated |
|
|
Term
| What time of the day is the pain worst for pt with Guillain Barre? |
|
Definition
|
|
Term
| What drug class is used for pain in pts with Guillain Barre? |
|
Definition
|
|
Term
| Describe the use of plasmapheresis with Guillain Barre |
|
Definition
| can be used in the first 2 weeks after diagnosis, reduces hospital stay, length of time on vent and time to resume walking |
|
|
Term
| Describe the use of IV antibodies with Guillain Barre |
|
Definition
| same effect as plasmapheresis but is safer and immediately available |
|
|
Term
| What does the 3 week mark represent in the treatment of Guillain Barre? |
|
Definition
| at this point plasmapheresis, IV antibodies, and corticosteroids have little effectiveness |
|
|
Term
| Bells palsy is an inflammation of what cranial nerve? |
|
Definition
|
|
Term
| Bells palsy can result in permanent weakness but usually completely resolves how quickly? |
|
Definition
|
|
Term
| What symptoms accompany the inital Bells Palsy? |
|
Definition
| an outbreak of herpes vesicles around the ear and pain, also fever, tinnitus, and hearing deficit |
|
|
Term
| What drug is used in the treatment of Bells Palsy? |
|
Definition
| Prednisone; when the drug is no longer needed it is tapered off over a 2 week period |
|
|
Term
| What are some nursing interventions for eye care of the pt with Bells Palsy? |
|
Definition
| eye drops to moisten; taping or covering the eye for sleep |
|
|
Term
| What is the main symptom with Trigeminal Neuralgia? |
|
Definition
|
|
Term
| Describe the pain of Trigeminal Neuralgia |
|
Definition
| unilateral, excrutiating, sharp, gets better but never goes away completely |
|
|
Term
| What drug class can be used to reduce pain of Trigeminal Neuralgia? |
|
Definition
|
|
Term
| What precipitates an episode of pain of Trigeminal Neuralgia? |
|
Definition
| light cutaneous stimulation of a specific point on the face; can be from chewing, brushing teeth, hot or cold blast of air, washing face, yawning, smiling, or talking |
|
|
Term
| How long are nerve blocks effective in relieving pain of Trigeminal Neuralgia? |
|
Definition
|
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