Seizures
What is the difference between a focal (partial) and generalized seizures?
What is:
- Generalized seizure involves the whole brain
- Partial (focal) seizures involves one hemisphere
Describe the pathophysiology of parkinson's. What exactly is happening?
What is a progressive, neurodegenerative disease that causes motor dysfunction? It involves the loss of dopamine-producing brain cells in substantia nigra of the basal ganglia --> loss of dopamine.
Describe the pathophysiology of myasthenia gravis?
What is an acquired, autoimmmune neuromuscular junction disorder that results in the body's immune system attacking healthy cells.
Describe the pathophysiology of Guillain Barre' Syndrome.
What is an autoimmune process that results in demyelination and occurs in the peripheral nervous system following a viral or bacterial infection?
Describe the pathophysiology of multiple sclerosis compared to ALS.
What is:
MS: chronic neurological condition in which nerves of CNS degenerate due to demyelination
ALS: degeneration of upper and lower motor neurons
What are the four phases of a seizure? Describe them.
What is:
1. Prodromal phase - precedes seizures signs or activity
2. Aural phase - sensory warnings
3. Ictal phase - seizure phase
4. Postictal phase - recovery phase
Parkinson's is a chronic, progressive neurodegenerative disorder. What is the pneumonic for the classic symptoms and what does each stand for?
What is TRAP?
T- tremors
R- rigidity
A- akinesthesia
P- postural instability
One of the characteristic features of myasthenia gravis is the fluctuating weakness of skeletal muscles. Describe how this muscle weakness changes throughout the day.
What is:
- Muscles are strongest in the morning and become exhausted with continued use. Muscle weakness is worst at the end of the day.
How does Guillain Barre difference from multiple sclerosis?
What is:
Guillain Barre- demyelination in the PNS
Multiple sclerosis - demyelination in the CNS.
What is the definitive diagnosis for multiple sclerosis?
What is at least two separate symptomatic events or MRI changes in at least two separate locations?
What is the difference between a simple focal and complex focal seizure?
What is:
Simple focal - pt is alert and conscious but experiences unusual feelings and sensations
Complex focal - loss of consciousness, pt eyes are open, movements seem purposeful but can't interact with others
Patients who have parkinson's often have postural instability. As a result, they are unable to stop themselves from moving forward or backward. To test this, a nurse would perform what type of test?
What is a pull test?
(Examiner stands behind the patient and gives a tug backward on the shoulder, causing the patient to lose their balance and fall backwards).
What is the diagnostic test used for diagnosis? How exactly does it work and what would you see?
What is a tensilon test? You should see increased muscle strength after IV administration. The medication is an anticholinesterase agent (blocks breakdown of Ach).
In Guillain Barre, there is the development of symmetrical ascending motor weakness and paralysis. What is the pattern specifically?
What is starts in the feet and extends to the trunks and arms? (Or starts in the toes and then goes).
What is the classic sign of ALS?
You are the nurse taking care of a patient who has an epileptic disorder. Your nurse tells you need to set up seizure precuations. What actions should you take?
What is:
- Bed in lowest position
- Suction equipment at bedside & O2
- Oral airway at bedside
- Ensure IV access
- Pad the lining of the bed
What is the primary drug used in treatment of parkinson's? What teaching do you provide when a patient takes this medication?
What is Sinemet (Levadopa-Carbidopa)?
Teach the patient to take without food and may need to take vitamin B6.
You are the nurse caring for a patient who is undergoing a tensilon test. What medication should you have on standby the counteract the effects of edrophonium?
What is atropine?
IVIG - administration of immunoglobins
Plasmapheresis - removal of antibodies or filtering of the blood.
What often is the first sign of multiple sclerosis?
What is blurred or double vision, red-green color discoloration, even blindness of one eye?
Seizure Medications
A) You have a patient on dilantin. What is the therapeutic drug level? What side effects do you monitor for?
B) You have a patient is having status epilepticus. What medications do you give?
A) TL is 10-20 mcg/dL ; SE - gingival hyperplasia & hirsutism
B) Lorazepam (Ativan) & Diazapam (Valium)
You are the nurse caring for a patient with parkinson's. What actions do you take to promote safety in the care of this patient?
What is:
- Elevate HOB to decrease risk of aspiration
- Suction equipment at bedside
- Teach patient to take short deliberate steps with feet somewhat apart
Differentiate between myasthenic crisis and cholinergic crisis.
What is:
Myasthenic crisis - exacerbation of weakness that causes an episode of respiratory failure. If tensilon test given --> improved strength
Cholinergic crisis - r/t excessive anticholinesterase medications. If tensilon test given --> muscle weakness continues
You are the nurse caring for a patient hospitalized with Guillain Barre. What are some nursing implications when caring for this patient?
What is:
- Perform frequent respiratory assessments
- Perform frequent pain assessments
- Establish a means for communication
- Frequent turning and ROM exercises
What is the definitive diagnosis for ALS?
What is clinical manifestations of both upper and lower motor neuron damage?
Upper = spasticity
Lower = flaccidity