generalized (tonic-clonic)

partial (2 types: simple and complex)

partial seizure

(simple)

(complex)

involves excessive electrical discharge of only A PART of the brain

simple = usually WITHOUT loss of consciousness

complex = usually WITH loss of consciousness

postictal state

when does it occur and name some s/s the pt might report?

AFTER a seizure

pt may report H/A, sore muscles, extremity weakness, fatigue, depression

SAFETY (get to safe position away from things that may hurt the pt, loosen restrictive clothing/items, pad hard surfaces including siderails)

AIRWAY (protect pt from possible obstruction - keep O2 and suction ready at bedside, if possible positon pt on side w/ head flexed forward)

1. document the events leading to and occuring during and after the seizure (include duration of seizure)

2. put the pt on their side

3. assess airway (make sure it is patent)

4. reorient the pt

5. calm the pt if agitated

6. maintain seizure precautions (suction and oral airway at bedside, padded siderails)

1. immediate infection precautions until 24 hrs after administration of antibiotic

2. immediate administration of IV antibiotic (usually PCN or cephalosporin)

3. monitor for s/s of increasing ICP

4. treat symptoms (dehydration/shock w/ IV fluids, seizures w/ phenytoin, fever then reduce body temp)

5. assess neurological status and vitals frequently

well recognized signs: nuchal rigidity, positive Kernig's sign, positive Brudzinski's sign, photophobia

Other signs include: H/A w/ fever (initial symptom), altered LOC, seizures

initial symptoms: H/A w/ fever, nuchal rigidity, confusion

other symptoms depend on where in the brain the inflammation is located

1. polymerase chain reaction (PCR) (standard test for EARLY diagnosis of HSV-1 encephalitis)

2. neuroimaging studies (ie. MRI) 

3. EEG

4. lumbar puncture for CSF examination (reveals high opening pressure, low glucose, and high protein levels)

1. EARLY administration of ACYCLOVIR (for HSV encephalitis) (slow IV administration and adequate hydration to prevent crystallization of the medication in the renal tubules)

2. assess neurological status and vitals frequently

3. monitor BUN and creatinine (increasing) and hourly urinary output (decreasing) (to assess renal complications related to acyclovir therapy)

4. provide comfort measures for H/A (dim lights, reduce noise, administer analgesics (avoid opiates bc they mask neuro symptoms))

immune-mediated, PROGRESSIVE, demyelinating disease that impairs transmission of nerve impulses in the CNS

(affects Schwann cells so there is NO remyelination)

unilateral visual loss (typically preceded or accompanied by orbital pain that increases with eye movement (acute optic neuritis)), fatigue, depression, weakness, limb (typically legs) numbness, difficulty in coordination, loss of balance, pain

other symptoms depend on where the damage occurs

there is NO CURE

1. disease modifying medications are used to reduce the frequency and duration of a relapse, and the number and size of plaques (these meds require injection) (IV methylprednisolone is the key medication in treating acute relapse in the RR course)

2. treat symptoms

1. promote physical mobility w/ moderate exercise (including frequent short rest periods)

2. prevent injury w/ gait training, assistive devices, and pressure ulcer prevention

3. bladder and bowel training

4. enhancing communication and managing swallowing difficulties (w/ a speech therapist)

5. improving sensory and cognitive fxn (including emotional lability) (can be done in a multitude of ways)

6. improving home management w/ modifications that help the pt maintain their independence

7. promoting sexual fxn

autoimmune disorder that affects the neuromuscular junction bc of a reduction in acetycholine receptor sites that are needed for sustained muscular contraction

primarily a MOTOR disorder

initial manifestation usually involves the ocular muscles (ie. diplopia (double vision) and ptosis (drooping of the eyelids)

other symptoms include: weakness of the muscles of the face and throat (laryngeal involvement can cause dysphonia (voice impairment) and increases the risk of choking and aspiration) and generalized weakness (can affect diaphragm and ability to breathe)

acetylcholinesterase test w/ edrophonium chloride (acetylcholinesterase inhibitor)

CONFIRMED diagnosis if there is an immediate improvement in muscle strength after administration

pyridostigmine bromide (anticholinesterase med)

(important for this med to be administered ON TIME to maintain stable blood levels; delays may exacerbate muscle weakness)

PRIORITY is EDUCATION

1. Educate pt on importance of taking medication on time

2. Teach pt aspiration precautions (plan meals around peak effects of anticholinesterase med, rest before meals, eat easy to swallow foods, have suction available, sit upright)

3. Teach pt how to protect the eye (patching the eye closed)

4. Educate on importance of energy conservation and strategies to conserve energy

Automimmune attack on the peripheral nerve myelin ONLY

(spares Schwann cells which allows for remyelination)

rapid progression

the nerves that control the diaphragm and intercostal muscles can be affected resulting in respiratory failure (immediate mechanical ventilation required)

1. maintaining respiratory fxn (IS, chest physiotherapy, suction, mechanical ventilation)

2. enhance physical mobility and VTE prophylaxis (paralyzed extremities are supported in functional positions, passive ROM exercises are performed at least 2X daily, position changes and padding under bony prominences, anticoagulants, SCDs and compression stockings, adequate hydration)

3. provide adequate nutrition (IV fluids and TPN)

4. improve communication (picture cards or an eye blink system, speech therapist)

5. decrease fear and anxiety (relaxation and distraction techniques, multidisciplinary team should maintain a positive atmosphere)

1. early administration of corticosteroid therapy (prednisone) (diminishes severity and prevents or minimizes denervation, relieves pain)

2. relief of pain and prevention of muscle atrophy w/ analgesics, application of heat, and electrical stimulation

3. protection of eye from injury (protective shield and eye ointment at night to prevent injury while sleeping, wrap around sunglasses or goggles to decrease excessive evaporation from the eye)

cardinal s/s = TRAP

Tremor

Rigidity

Akinesia/bradykinesia (no or decreased body movement)

Postural disturbances (head forward, propulsive/shuffling gait)

1. administration of antiparkinsonian meds (ie. Levodopa) and sometimes deep brain stimulation (requires surgical implantation)

2. improving mobility w/ a progressive program of daily exercises (walking/swimming/biking, stretching and ROM exercise, PT, postural exercise, special walking techniques)

3. enhancing self-care activities (assistive or adaptive devices to compensate for functional disabilities)

4. improving nutrition and enhancing swallowing

5. improving bowel elimination (set up a bowel routine, increase fluids, eat foods w/ moderate amounts of fiber)

6. improving communication (speak slowly, face the listener, exaggerate pronunciation, use short sentences, take deep breaths before speaking, speech therapist)

PROGRESSIVE

initially subtle memory loss, small difficulties w/ cognitive fxn, and depression

as it progresses there is a greater decline in memory of familiar daily actions or things, inability to formulate concepts or think abstractly, behavior becomes impulsive, and there is a change in personality

can lead to speaking and mobility problems and will eventually need help with all ADLs

1. support cognitive fxn (limit environmental stimuli, regular routine, memory aids and cues, clear and simple explanations, clocks/calendars to orient to time, active participation in events)

2. promote safety (remove fall hazards and install hand rails, adequate lighting, driving prohibited, smoking and outside activities require supervision, wear a form of identification, secure doors to the outside)

3. support of the burdened caregiver

4. promote self-care in activities as long as possible (simple, achievable, adapted tasks)

5. reduce anxiety and agitation (emotional support, familiar and noise-free environment)

6. improving communication

7. promoting socialization and intimacy

8. promoting adequate nutrition

9. provide balanced activity and rest

chief s/s include a gradual onset of asymmetric, progressive limb weakness and fatigue

other s/s depend on the location of the affected motor neurons (ie. cranial nerves = difficulty talking, swallowing, and breathing)

NO specific therapy exists

1. Riluzole (med showed modest improvement in survival)

2. treatment of symptoms and rehabilitative measures

3. provide adequate nutrition (enteral feedings w/ aspiration and swallowing difficulties)

4. respiratory management (noninvasive positive-pressure ventilation (NIPPV), tracheotomy and other invasive ventilation procedures)

5. encouragement to complete a living will to preserve their autonomy in decision making