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Neurological Function Part 2 2


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What is a seizure?
paroxysmal, uncontrolled electrical discharges of neurons in the brain that interrupt normal function.
What is epilepsy?
Spontaneously recurring seizures.
What is the pathophysiology of a seizure?
anything that interrupts the normal chemical or electrical processes in teh brain may cause one.
What does the "trigger" of a seizure do?
causes a group of neurons to start firing (depolarizing).
What happens after the neurons are triggered?
the impulse spreads from one neuron to another and spreads throughout brain.
What are some possible causes of this trigger?
Can be infectious process with build up of wastes in brian; scar tissue; brain tumor. Scar from trauma or congenital defect; chemical wasted - urea, ammonia, acidosis; change in electrical activity with high fever; sudden withdrawal from CNS depressants. Most cases are idiopathic.
What is "kindling"?
the saying that seizures cause seizures.
Why is it so important to gain early seizure control?
Repetitive electrical discharges cause permanent changes in neuron excitabililty - epilepsy.
What is the clinical presentation of a Generalized seizure?
entire brain is affected at the onset; activity is bilateral and synchronous, like every neuron in brain fired at same time.
What is the clinical presentation of a Grand Mal or Tonic-clonic seizure?
Loss of consciousness. Tonic phase - 10-20 seconds.
Clonic phase - 1-3 minutes
OFten incontinent
Afterward may be very sore and sleepy.
How severe can the muscle contractions in a Grand Mal seizure be?
severe enough to break bones.
What is the clinical presentation of a petit mal seizure?
Typical absence seizures -
look like daydreaming
Brief staring for a few seconds, are unaware of environment during seizure.
Can be precipitated by bright lights.
Rarely continues beyond adolescence.
What are the clinical manifestations of an Atypical Absence?
Brief staring spell with other behavior (automatism) as confusion - tic - some repetitive behavior.
What are the clinical manifestations of a Myoclonic Seizure?
Can be inherited
No loss of consciousness
Sudden jerking movements
Bigger problem when wake up in am.
What are the clincal manifestations of an Akinetic/Atonic Seizure?
Akinetic - loss of motion
Atonic - loss of muscle tone.
Loss of consciousness is very brief if at all.
Sudden loss of movement/muscle tone
Atonic - more problematic - fall down with lost muscle tone.
What are the clinical manifestations of a Partical Seizure?
Also called focal seizures because activity begins in a specific area of brain and therefore the seizures have particular activity associated with that area - may or may not spread to other areas.
What special symptom do these have warning that they may progress to involve the entire brain so seizure becomes like a Grand Mal?
An Aural.
Is it possible for these seizures to leave transient neurlogical deficits?
What is a Simple Partial?
Also called Jacksonian, Focal Motor, Focal Sensory
Usually no loss of consciousness
Last 1 minute or less
Have motor (local jerks), sensory (hears bells, has hallucinations), or autonomic component.
What is a Complex Partial?
Temporal Lobe seizure or Psychomotor Seizure.
Lasts 1+ minute
Have alteration in consciousness, afterward confusion and no recall of seizure.
Episodic inappropriate behavior ex: wring hands
No sensory component.
What are Partial Seizures?
also called focal seizures because activity begins in a specific area of the brain and therefore the seizures have particular activity associated with that area.
Do Partial seizures spread to other areas?
They may or may not.
Is there a warning prior to these seizures?
Yes, an aura.
Can these seizures progress to involve the entire brain?
Yes, the seizure can become like a grand mal seizure.
What kind of neurological deficits can these seizures leave?
transient neurological deficits.
What are characteristics of a Simple Partial seizure?
Usually no loss of consciousness.
Lasts 1 minute or less.
Have motor (local jerks), sensory (hears bells, has hallucinations), or autonomic component.
What are some other names for Simple Partial seizures?
Jacksonian, Focal Motor, Focal Sensory.
What are some characteristics of a Complex Partial seizure>
Last 1+ minute
Have alteration in consciousness, afterward confusion and no recall of seizure.
Episodic Inappropriate behavior (wringing hands).
No sensory component.
What are some other names for Complex Partial Seizures?
Temporal Lobe seizure, Psychomotor seizure.
What is Tourette Syndrome like?
Atypical absensce seizure
How are seizures dx?
Most important is an accurate description of the seizure.
EEG, Arteriogram. Ask questions of family or others who saw it.
What are some questions to ask those who witnessed seizure?
When did it start?
Any specific signs?
What did seizure look like?
How did it progress?
How long did it last?
How long does it take pt. to return to regular LOC?
Is an EEG sufficient to dx. seizure?
No, must have a visual of seizure as well.
What can medications do for seizure control?
They stabilize cell membranes
Why is it important to know what kind of seizure a person had?
To know what medication to use on them.
What are the primary drugs for grand mal and partial seizures?
Dilantin(drug of choice in prevention also)
Phenobarbital(not used as much, mostly sedates pt.)
What drugs are used for petit mal, akinetic, and myoclonic seizures?
Dalproic - petit mal

CNS depression
GI upset
Drowsiness, decreased alertness is biggest complaint.
Mental slowness
Decreased coordination
Clumsiness - drop things
What does mild nystagmus indicate?
Confirms drug is being taken.
What are some other side effects of seizure meds?
Hypertrophy of gums
Skin rashes
Blood dyscrasias
Can anticonvulsants be stopped abruptly?
No - that may precipitate seizures > status epilepticus
When can pt. be weaned off of anticonvulsants?
After pt. seizure free for 3-5 years can see if pt. can do without.
What is status epilepticus?
rapid, repeating seizures or a single seizure which lasts more than 4 minutes.
What is the drug of choice to treat status epilepticus?
What are some complications and problems from status epilepticus?
Body using a lot of O2 and glucose which can cause brain damage, hyperthermia, cardiac dysrhythmias.
How can you manage these problems?
Treat with O2 and anticonvulsants.
What can Dilantin be mixed with?
NS only IV push, anything else would cause precipitation in the tubing
How fast can you give Dilantin
50 mg per minute.
What should be watched for when giving Dilantin?
Watch for cardiac dysrhythmias, hypertrophy of gums, gingivitis.
What seizure precautions should be taken for those at risk?
Pad siderails.
IV access - secured well
Suction should be set up in room
no padded tongue blades
What is the goal during a seizure?
protect the pt. from injury; loosen tight clothing, remove harmful objects, protect head,DO NOT RESTRAIN, remain with pt.
Careful observations and notes.
What could happen if you restrain a pt during a seizure?
They could dislocate joints, break bones.
What are the nursing considerations following a seizure?
Ensure pt. airway. Turn to side and allow to rest.
What is a teaching plan for pt. and family?
How to handle seizures
Take meds as prescribed
Proper diet, rest, exercise
Avoid fatigue, loss of sleep.
Avoid alcohol intake
Med alert tag
It is dangerous not to tell anyone about epilepsy.
What are some lifestyle changes for someone with epilepsy?
No driving until seizure free for 1 year.
Employment problems RT safety.
Social stigma > isolation
What is the Rehabilitation Act of 1973?
It prevents discrimination.
What can State Vocational Rehabilitation office can help with?
Job hunting, retraining, and medical costs.
What is MS?
May be an autoimmune disorder with a genetic predisposition.
After what events is there an increased dx of MS?
after pregnancy, severe injury, excessive fatigue.
Probably viral -body produces antibodies that attack in response.
Who does MS primarily effect?
Young adults - onset 20-4- years old.
females twice as often as males.
whites of Northern European descent.
Born and live (0-15 yrs.) at 45 degrees to 65 degrees latitude. (North US and Southern Canada)
What is the patho of MS?
Inflammation of the myeline sheath (speeds conduction)of the nerve fibers > conduction slows.
Is the nerve itself damaged in MS?
No, just the myelin sheath which can be regenerated, then symptoms disappear.
What can happen to nerve fibers with a severe episode of MS.
Nerve fiber itself can be destroyed because MS affects nerve fibers in CNS which cannot be regenerated. Results in permanent neuro deficits.
What are the clinical findings of MS?
Depends on which nerve fibers are affected:
Ataxia - difficulty walking
Weakness or paralysis or spasticity
Double Vision
Blurred Vision, nystagmus
Vertigo, Tinnitus
Hearing loss
Dysarthria, dysphagia
Emotional instability
Urinary retention or incontinence > if problem is spinal
Bowel problems probably constipation > nerves above S2
Does not affect intellectual function.
Can you have periods of exacerbation and remission with MS?
What are the 4 types of MS?
Relapsing/remitting - always go back to normal functioning.
Primary Progressive - Continuous and slow with no periods of remission.
Secondary Remission - pregression of symptoms.
How is MS dx?
Based on hy and symptoms. No definitive test. Dx by exclusion. CSF may show abnormal antibodies during an acute exacerbation. Can see nerve damage on MRI.
What is treatment for MS?
No specific cure. Treat generally with: antiinflammatory drugs, immunosuppressants (Imuran and Cytoxan)
Plasmapheresis - take plasma with antibodies out give cells back.
Anticholinergic/Cholinergic used to treat bladder problems.
What is care aimed at?
dealing with anxiety and depression. Teach to avoid stress, have good diet, safety precautions. Deal with physical limitations as they appear.
What are some major problems and cause of death in MS?
Respiratory infections
urinary infections
decubitus ulcers.
What antiinflammatory drugs are used?
start with prednisone, then methylprexate, interferon, avenox. Copaxine ? stimulates specific cells in immune response.
What is Parkinson's disease?
lack of dopamine.
What parts of the brain are involved with Parkinson's?
Substantia nigra - part of basal ganglia that produces dopamine. This disease process destroys that part of brain so there is a decrease in dopamine.
What does dopamine do?
Counteracts acetylcholine.
What can cause damage to basal ganglia?
Trauma, aging
What clinical signs of Parkinsons are there? How many must be present for a dx of Parkinsons?
How much of substantia nigra is destroyed before s/s appear?
Which is the most common symptom?
Rigidity - increase resistance to passive motion. Results in jerky movement - cogwheel rigidity -muscle weakness from fatigue and look clumsy. Respiratory muscles become most fatigued. Speech gets softer as talking as tire out.
What is bradykinesia?
Means "slow motion". Refers to way person with Parkinsons lose involuntary automatic movements that allows them to maintain coordination and balance.
What are some examples of bradykinesia?
Eye blinking, swallowing saliva, facial expressions, arms swinging when walking, remaining upright. Drool alot, eyes get dry, can't walk and talk at same time.
What is the least common symptom of Parkinsons?
tremors - occur in only 50% of pts. Pill rolling at rest.
What are some complications of Parkinson's?
Dysphagia - difficutly swallowing due to lack of motor control and rigidity of muscles.
Decreased mobility - rigidity of muscles and fatigue.

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