Seizures
The nurse knows that a tonic-clonic is what type of seizure?
What is a generalized seizure?
The post ictal phase a patient will become very drowsy.
The nurse knows that daily exercise with MS helps...
Decrease spasticity, reduce contracture, and improve gait and coordination.
Important to teach to AVOID strenuous exercise. Allow frequent rest periods!
The nurse knows the reason for a medication holiday is...
What is preventing medication tolerence?
The nurse knows that this will appear on an MRI for a client with MS?
What are bright sports of demyelinated lesions. MRI is an effective diagnostic tool for MS!
The nurse knows these medications are used in the treatment of Parkinson's Disease...
MOST common: levodopa-carbidopa (SINEMET)
•Dopaminergic
•Levodopa- Carbidopa ( Sinemet)
•Convert to dopamine in the brain increasing the levels
•Carbidopa à Helps decrease the amount of peripheral metabolism of levodopa so more is available for the brain.
•“Wearing off phenomenon” can indicate they need to adjust dosages of take a “ Medication holiday”
•Administration times are strict to decrease the amount of time the periods of poor mobility
•Within 5 to 10 years, most patients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements), including facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. The patient may experience an on–off syndrome, in which sudden periods of near-immobility (“off” effect) are followed by a sudden return of effectiveness of the medication (“on” effect).
•Anticholinergic Therapy
•Help control tremors and rigidity
•Trihexyphenidyl hydrochloride (Artane)
•Benztropine mesylate (Cogentin)
•Antiviral Therapy
•Stimulate the release od dopamine and prevent reuptake
•Amantadine hydrochloride (SYMMETREL)
•Dopamine Agonists
•Activate release of dopamine
•Bromocriptine mesylate (Parlodel)
•Ropinirole hydrochloride (Requip)
•Pramipexole (Mirapex)
•Monoamine Oxidase Inhibitors (MAOIs)
•Increase dopamipine levels and helps prevent the “wearing off “ effect when taking with levodopa
•Selegiline
•Rasagiline Zydis selegiline HCl
•Catechol-O-methyltransferase (COMT) inhibitors
•Limits the breakdown of levodopa making it more availble to the brain
•Entacapone (Comtan)
The patient is speaking unintelligently with no loss of consciousness, is having abnormal hand or mouth movements, and may experience unpleasant sounds, sight, odor or tastes.
What is a simple partial seizure?
What is a complex partial seizure?
Impairment of consciousness (different from simple)
May be motionless or move automatically by inappropriately: Lip smacking or picking of clothing. (Different from simple)
May experience extreme emotions: Fear, anger, elation. (Different from a simple)
This type of MS acute attacks with full recovery or with sequelae and residual deficit upon.
What is Relapsing Remitting MS?
How is primary progressive different? They will have progressive disability from onset
Nurse knows that a client is diagnosed with PD based on...
What is there are no definitive diagnostic procedures?
Diagnosis is based on clinical manifestations of the patient having 2 of the 4 cardinal manifestations...
TREMERS, RIGIDITY, AKINESIA/BRADYKINESIA and POSTURAL DISTURBANCES.
The nurse should teach this information about a CT scan....
Computed Tomography Scanning (CT Scan)
•Can be done with or without dye (Iodine based dye, assess for allergies, monitor for reaction, assess kidney function before and after, labs and urinary output) Need to have an IV before going if using dye (20g above the wrist)
•Lay still during the test à It is quick a few minutes
The nurse knows that these medications will help treat symptoms of muscle spasms of MS...
What are Antispasmodics?
•Baclofen
•Dantrolene
•Tizanidine
•Benzodiazepines (Diazepam and Clonazepam)
What other medications help with MS symptoms?
The nurse knows that the post ictal phase refers to...
What is the period after the seizure?
How will the patient present during the post ictal phase? very drowsy
What does ictal mean?
The nurse knows these are common relapse triggers...
Viruses, emotional stress, fatigue, overexertion, temperature extremes, hot showers or baths, pregnancy.
So, what would you teach your patient?
The nurse knows to provide these nursing interventions based on the patient's deficit...
What is...
•Improve mobility
•A progressive program of daily exercise will increase muscle strength, improve coordination and dexterity, reduce muscular rigidity, and prevent contractures that occur when muscles are not used.
•PT is often consulted
•Need to consciously think about standing up straight, lifting their feet and may practice marching in place
•Worry about balance à Falling forward or backwards
•Think fall safety!
•Enhancing self-care
•May need adaptive devices to complete ADLs and transfer à OT
•Improving bowel elimination
•weakness of the muscles used in defecation, lack of exercise, inadequate fluid intake, and decreased autonomic nervous system activity
•Bowel schedule, water and fiber. à Raised toilet seats maybe needed to get on and off easier.
•Improving nutrition
•Can be a slow process à Keep food warm
•Dry mouth from medication, difficulties chewing and swallowing and dysphagia à Risk for aspiration
•Build up silver wear/weighted utensils, stabilized plate, a non-spill cup à OT
•Enteral feeding maybe required
•Monitor daily weights
•Enhancing swallowing
•poor head control, tongue tremor, hesitancy in initiating swallowing, difficulty in shaping food into a bolus, and disturbances in pharyngeal motility
•A semisolid diet with thick liquids is easier to swallow than solids; thin liquids should be avoided.
•The patient is taught to place the food on the tongue, close the lips and teeth, lift the tongue up and then back, and swallow.
• The patient is encouraged to chew first on one side of the mouth and then on the other. To control the buildup of saliva, the patient is reminded to hold the head upright and make a conscious effort to swallow.
•Improving communication
•Their low-pitched, monotonous, soft speech requires that they make a conscious effort to speak slowly, with deliberate attention to what they are saying. The patient is reminded to face the listener, exaggerate the pronunciation of words, speak in short sentences, and take a few deep breaths before speaking.
•Supporting coping abilities
•Patients often feel embarrassed, apathetic, inadequate, bored, and lonely. These feelings may be due, in part, to physical slowness and the great effort that even small tasks require. The patient is assisted and encouraged to set achievable goals (e.g., improvement of mobility).
• A planned program of activity throughout the day prevents too much daytime sleeping as well as disinterest and apathy.
The nurse will teach the client this information pertaining to an MRI...
What is...
•Magnetic Resonance Imaging (MRI)
•Can be done with or with out dye (gadolinium-based dye à Non iodine based Less risk to the kidneys)
•No metal can be on the patient ( Hair clips, jewelry, medication patches, credit cards)
•No metal equipment can be brought in the room ( Oxygen tanks *aluminum ones are compatible, stethoscopes etc.)
•Claustrophobia à Sedation à Must lay still, could take an hour or more
•Make MRI tech aware of implanted devices (Pacers, Deep brain stimulators, joint hardware, heart valves , aneurysm clips, cochlear implants * may not work again if the go in with them in”
•The machine is loud: They play music in headphones
The nurse knows that MS disease-modifying therapy medication work by...
Calming the immune system. Decrease autoimmune activity.
Examples:
•Interferon beta-1a and interferon beta-1b
•Glatiramer acetate
•Natalizumab & Ocrelizumab
•Mitoxantrone
•Methylprednisolone
The nurse knows that continuous seizure lasting greater than 5 minutes or 2 sequential seizures without full recovery of consciousness is considered...
What is Status Epilepticus?
Teach never abruptly stop AED medications!
What medication is used to treat this condition?
Benzodiazepines: (Remember PAM... Lorazepam, Diazepam, Midazolam
The nurse that these are signs and symptoms consistent with MS...
What is...
Eye: Unilateral vision loss, orbital pain, blurred vision, diplopia, nystagmus, scotomas (patchy blindness)
Fatigue, depression, muscle weakness and spasticity, limb numbness, poor coordination, ataxia, pain, paresthesia, dysphagia, dysarthria, cognitive impairment, bladder and bowel dysfunction, sexual dysfunction
The nurse would expect to assess which signs and symptoms of Parkinson's Disease...
What are tremors (resting), pill rolling, rigidity, akinesias/bradykinesia, stooped posture, masklike face, shuffling gait, monotonous speech
The nurse know that these labs will be ordered for a client who sustained a seizure...
What are electrolyte levels, blood glucose level, drug screening, serum concentration of antiepileptic drugs?
Why?
•Complete metabolic panel (CMP)
•Electrolytes
•Sodium 135-145 * High or Low increases risk for seizure
•Calcium 8.8-10.4 mg/dL * Low increases risk for seizures
•Blood Glucose
•70-100
•Protein (Total and Albumin)
•BUN (blood urea nitrogen) and creatinine
•ALP (alkaline phosphatase)
•ALT (alanine transaminase)
•AST (aspartate aminotransferase)
•Drug Screening
•Cocaine, and Ethanol levels
•0.3–0.4%, marked intoxication
•0.4–0.5%, alcoholic stupor
•≥0.5%, alcoholic coma
•Serum Concentration of AED
•Phenytoin 10-20mg/L
The nurse knows that this medication is for acute management of status epilepticus.
What are benzodiazepines?
Lorazepam, Diazepam, Midazolam
**used during an active seizure to stop seizure activity.
Remember the AED are not used for acute seizure activity!
The nurse knows to perform what interventions during a seizure.
What is loosen clothing, place patient on their side, protect the patient's head, have the bed in the lowest position in or lower to the ground to protect from injury, note the time the seizure started.
Goal is to stop the seizure as quickly as possible, ensure adequate cerebral oxygenation, and maintain patient in a seizure free state
•Lower them to the ground
•No head injuries please
•Long term use of AED can lead to bone demineralization à Increase risk for fractures à Prevent falling when possible
•Maintain ABC
•Turn them on their side & Suction the airway
•Intubation maybe required in some situation like status epilepticus
•Provide oxygen and monitor SPO2
•Protect patient from injury
•Protect the head
•Loosen constrictive clothing, remove glasses
•Do NOT restrain the patient
•Do NOT put anything in their mouth
•Remove pillows and raise the side rails
•Establish an IV line
•Lorazepam (Ativan), diazepam (vallium) , midazolam (Versed) à Benzodiazepines
•If the patient has a low blood glucose à Dextrose maybe given IV
The nurse knows that the cause of multiple sclerosis is...
What is the immune system attacking the myelin sheath of the axon of the neuron?
This interrupts nerve conductions.
The plaque lesions are visible on MRI (remember the bright spots showing the demyelinated lesions)
The nurse knows that the pathophysiology of Parkinson's Disease is...
What is decreased levels of dopamine? (This is an inhibitory neurotransmitter?
This leaves increase in the excitatory neurotransmitter acetylcholine.
There is NO DEFINATIVE TEST FOR PD! Based only by the patient's signs and symptoms!
The nurse knows that teaching for an Electroencephalogram (EEG) involves...
•Physician may request the patient be sleep deprived the night before or that an antiseizure medications, sedatives, stimulants be withheld 24-48 hours before the test
•Patients to lie still à Sedation is not typically used because it will alter brain wave activity
•Patient may be asked to purposefully hyperventilate for 3-4 minutes or have bright flashing lights for photic stimulation à Try to provoke abnormal electrical discharges in the brain
•No caffeine, need to wash hair so that the electrodes stick
The nurse knows these medications are used long term to prevent seizures. These medications cannot be used in status epilepticus.
What are antiepileptic drugs (AED)?
Teach compliance is important!
Examples:
•Levetiracetam (Keppra)
•Phenytoin (Dilantin) Normal blood levels 10-20
•Phenobarbital (Nembutal)
•Primidone (Mysoline)
•Valproate (Depakote)
•Lacosamide (Vimpat)
•Lamotrigine (Lamictal)
•Topiramate (Topamax)
•Carbamazepine (Tegretol)
•Gabapentin (Neurontin )
•Zonisamide (Zonegran)