Tension Headache vs Migraine

Tension Headache

• Causes are unknown but potentially related to stress, anxiety, depression, or caffeine.
• Diagnosis involves electromyography (EMG) and a headache diary.
• Symptoms include bilateral, band-like pain described as dull and creating pressure, sometimes with photophobia.
• Treatment for active tension headaches includes aspirin, NSAIDs, acetaminophen, and muscle relaxants.

Migraine

• Causes are unknown, with triggers including hormones, environment, stroke, or head injury.
• Diagnosis is aided by a headache diary.
• Symptoms include unilateral, pounding pain, nausea, vomiting, photophobia, and possibly an aura.
• Treatment for active migraines include adrenergic blockers (ergotamine, dihydroergotamine), NSAIDs, serotonin receptor agonists (almotriptan, eletriptan, rizatriptan, sumatriptan).
• Combination medications like aspirin/acetaminophen/caffeine, and CGRP antagonists such as lasmiditan (Reyvow) can be given.
• Encourage caffeine consumption for patients.
• Migraine medications are vasoconstrictors, counteracting vasodilation in the head.
• Triggers include bright light, stress, menstrual cycles, and foods with MSG and tyramines.
• Advise patients to rest in dark, quiet environments.

Cluster Headache

• Involves cranial nerve 5, causing sharp pain around the eye, occurring in episodic clusters.
• Causes are unknown; triggers are alcohol, caffeine, tyramines, and strong odors.
• Diagnosed using a headache diary and imaging.
• Symptoms include sharp, unilateral pain around the eye, swelling, tearing, nasal congestion, miosis, and agitation, lasting 15 minutes to 3 hours.
• Treatment for active cluster headaches include adrenergic blockers, serotonin receptor agonists, and high-flow (7-12 liters) 100% oxygen.
• Preventative treatments involve adrenergic blockers, anti-seizure drugs (gabapentin, topiramate), corticosteroids, lithium, verapamil, or nerve ablation.
• Cluster headaches are more common in the spring and fall.

Primary vs Secondary Headaches

• Primary headaches are not caused by an underlying disease or medical condition.
• Secondary headaches are caused by a disease, such as a sinus infection or brain tumor.

Multiple Sclerosis (MS)

• Degenerative disorder of the CNS characterized by demyelination of neurons.
• It is chronic, progressive, and noncontagious.
• Onset typically occurs between ages 20-50, with a slow and gradual progression.
• Commonly caused by autoimmune response or viral infection.
• Disseminated demyelination of nerve fibers in the brain and spinal cord.
• First symptom is typically vision-related, such as blurred or double vision, or blindness in one eye.
• Characterized by episodic flare-ups.
• Risk factors include autoimmune conditions, genetics; decreased vitamin D intake increases risk, with T cells potentially crossing the blood-brain barrier and attacking myelin sheaths.
• Diagnosed via MRI with contrast of the brain and spinal cord, and CSF analysis, looking for plaques and atrophy (at least 2 inflammatory demyelinating lesions in at least 2 different locations).
• First sign is often a change in vision.
• Patients may be heat intolerant and have poor bowel control.
• Spasticity can occur (MS hug: stiff intercostals).
• No cure exists.
• Treatment focuses on symptomatic relief such as anticholinergics, TCAs, and selective potassium channel blockers for nerve conduction, steroids for active flares, Botox, plasma exchange, or surgery.
• Avoid live vaccines.
• Important to maintain balanced exercise, rest, and minimize caffeine intake, a well-balanced, high-fiber diet, and lifestyle changes.

Parkinson's Disease

• Chronic, progressive neurodegenerative disorder characterized by bradykinesia, rigidity, tremor at rest, and gait changes.
• Risk factors/causes include traumatic brain injuries, low dopamine, excess acetylcholine, and Lewy bodies in the brain.
• Secondary Parkinson's can result from exposure to chemicals, metals, or drug-induced factors.
• Low dopamine levels and Lewy bodies are found in the brain.
• Early symptoms are mild tremors and rigidity, with a flattened affect.
• Later symptoms include a shuffling gait, tremors, pill-rolling, and cogwheel rigidity (jerky movements).
• Complications include aspiration, hypotension, falls, dyskinesia (involuntary movements), and weakness, potentially leading to a bedridden state.
• Treatments include carbidopa/levodopa to help dopamine cross the blood-brain barrier.
• Rivastigmine or donepezil is used for dementia, while anticholinergics help with tremors and rigidity.
• TRAP: Tremors, Rigidity, Akinesia, Postural instability.
• Beginning stages: mild tremor, slight limp.
• Later stages: shuffle gait, loss of postural reflexes.
• Complications: Increased motor symptoms, weakness, neurological problems.
• Diagnosis is based on history and clinical manifestations, requiring presence of 2 of the 4 main manifestations.
• Asymmetric onset is typical.
• Confirmation involves a positive response to antiparkinsonian drugs.
• Antiparkinsonian drugs either enhance or release the supply of dopamine (dopaminergic) or block the effects of overactive cholinergic neurons (anticholinergic).
• Drug doses are carefully adjusted to avoid paradoxical intoxication (worsening symptoms from excessive dopaminergic drugs).
• Nutrition therapy includes small, frequent meals due to potential malnutrition, and considering that B6 vitamin can impair levodopa.
• Key nursing care focuses on maintaining good health, encouraging independence & removing rugs/furniture, simplifying clothing, elevated toilet seats and ottoman use.

Bell's Palsy

• Caused by lower motor neuron lesion of cranial nerve VII, potentially from infection, trauma, hemorrhage, meningitis, or tumor.
• Acute, temporary facial paresis.
• Diagnosed with a CT scan showing swelling of facial nerve 7.
• Can last from 2 weeks to 6 months.
• Symptoms include facial drooping, puffy cheeks, dysphagia, malnutrition.
• Causes are unknown, but theory is reactivation of herpes virus leading to inflammation and nerve compression.
• Recovery prognosis is 2 weeks to 6 months.
• Clinical manifestations: lower motor facial weakness, droopy eyelid and corner of the mouth, facial drooping.
• Altered taste, hearing loss, problems eating.
• Diagnostics: physical exam, CT, MRI, blood test, EMG.
• Management: Symptomatic relief, prevents complications, protect impacted eye, oral steroids and antivirals.
• Interventions: pain management, protect eye from cold, eye protection.
• Nurse educates to chew on unaffected side and provide support.
• Encourage facial exercises to prevent muscle tone loss.
• Protect the eyes from dryness and injury.
• Promote frequent oral care.
• Instruct the client to chew on the unaffected side.

Myasthenia Gravis

• Autoimmune disease of skeletal muscle weakness that worsens with activity.
• T cells attack acetylcholine receptor sites.
• Rest provides recovery.
• Symptoms include fluctuating skeletal muscle weakness that worsens with use and improves with rest, and ptosis (drooping eyelids).
• Causes include insufficient acetylcholine secretion, excessive cholinesterase secretion, and unresponsiveness of muscle fibers to acetylcholine.
• Diagnostics are initiated via the edrophonium test, EMG, history, physical exam, and CT to check the thymus.
• Drug therapy includes anticholinesterase drugs, corticosteroids (prednisone) to suppress the immune response, immunosuppressants, and FcRn inhibitors.
• Maintain airway.
• Encourage foods easy to chew or swallow, and monitor continuously with pulse oximetry due to respiratory infections.
• Assist with ADLs to prolong strength, and teach about adherence and side effects.

Edrophonium Test

• Used to distinguish between myasthenic and cholinergic crisis.
• If symptoms intensify, the crisis is cholinergic, keep atropine sulfate available as an antidote.
• If muscle strength improves, the client is in myasthenic crisis; improvement is evident in 30-60 seconds, lasting 4-5 minutes.

Alzheimer's Disease

• Irreversible neurodegeneration with atrophied brain.
• Early onset occurs before age 60; late onset after age 60.
• Gradual loss of connections between neurons, neuron death, and brain atrophy, impacting various brain parts.
• Cause: family history, head trauma, plaques, lifestyle, diabetes, hypertension, smoking, hypercholesterolemia.
• Signs/Symptoms: changes in cognitive function (memory loss, disorientation).
• Diagnosis: clock drawing test, Mini-MSE, Montreal Cognitive Assessment, Mini-Cog, CT/MRI (brain atrophy), PET scan (assesses brain glucose metabolism), official brain biopsy.
• Family history is primary risk factor, head trauma, hypertension, obesity, smoking, and hypercholesterolemia.
• Diagnosed with official brain biopsy.
• CT/MRI shows atrophy of brain, and PET scan assesses brain glucose metabolism.
• Mini cog test and Mini Mental Exam can be administered.
• Treated with donepezil, rivastigmine, galantamine, and memantine.
• Depression is treated with fluoxetine or sertraline.
• Antipsychotics can be used for agitation and aggressiveness.
• Plaques develop in the brain as a part of aging.
• Nursing involves redirection, distraction, reassurance, safety measures, nutrition due to swallowing risk, and memory aids in early stages.

Dementia

• Treatment may reverse certain causes unlike Alzheimer's Disease.
• Decline in functioning in one or more cognitive domains.
• Causes: Stroke, vascular fibrosing, Lewy body dementia, Parkinson's induced dementia, Alzheimer's, systemic and immune disorders.
• Signs and Symptoms: Gradual neurological decline, vascular caused dementia can be sudden onset.
• Diagnosis: Psychological, physical and neurological health history, CBC, LFT, ETOH test, RBC folate, CT/MRI of head, PET scan.
• Treat the underlying cause.
• Preventative: decrease lipid levels, control diabetes, hypertension, stop smoking, and control dysrhythmias.
• "Mixed dementia" involves 2 or more types of dementia occurring simultaneously.
• Preventative, hypertension, diabetes, smoking, dysrhythmias

Delirium

• State of confusion that develops quickly, often during hospitalization.
• Etiology: reduced brain oxygen and impaired utilization, rarely caused by a single factor.
• Risk factors: Increased age, hypertension, alcohol use; dementia is a leading risk factor.
• Develops over a 2- to 3-day period.
• Can be caused by sleep deprivation, electrolyte imbalance, severe infections, prescribed sedatives, or opioids.
• Clinical manifestations: reduced ability to focus, memory impairment, rapid speech, irritability, agitation, and insomnia.
• Diagnosis: CAM table studies: BUN, creatinine level, electrolytes, and oxygen saturation.
• Nursing interventions reduce environmental stimuli, promote early mobility, use clocks, calendars, lists, avoid restraints, relaxation techniques, and reorientation.
• Treat non-pharmacologically first! if severe agitation use Antipsychotics and monitor side effects.
• Haloperidol (Haldol) and Risperidone (Risperdal) are antipsychotics.
• Side effects: Widen the QT interval; contraindicated in people with heart issues.
• Short-acting benzodiazepines require cautious use as they may worsen delirium.

Sprains

• Ligament tears.

Strains

• Excessive stretching of a muscle and its fascial sheath involving a tendon.
• Manifestations: pain, edema, decreased function, and bruising.
• Recovery: Usually 3-6 weeks.
• Nursing: RICE (rest, ice, compression, and elevation).

Fractures

• Disruption or break in the continuity of bones.
• Classified as closed or open, complete or incomplete.
• Clinical manifestations: edema, swelling, pain, tenderness, and loss of function.
• Cast care involves moving and assessing distal joints.
• Monitor for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse.
• Two treatment methods: external and internal fixation.
• External Fixation: ensure clean/taught, wires are attached to external rods. Applies traction, compresses fragments, and immobilizes reduced fragments.
• Internal Fixation: inside the body with rods, etc.
• Central and peripheral muscle relaxers are given in drug therapy.
• Carisoprodol and Methocarbamol.
• Tetanus is given for open fractures when immunization status is unknown.
• Cephalosporins can be administered.
• Fracture reduction aligns bones together (closed reduction is nonsurgical manual realignment; open reduction is through surgery).
• Traction applies pulling force to an injured extremity to attain realignment, with countertraction pulling in the opposite direction.
• Buck’s (extension) skin traction alleviates muscle spasms and immobilizes a lower limb by maintaining a straight pull with weights.
• Skin traction is used for 48-72 hours until surgery is possible, using tape, boots, or splints directly on the skin.
• Skeletal traction is used long term to keep injured bones and joints aligned; the HCP inserts a pin or wire into the bone.
• Balanced suspension traction requires correct patient position with constant traction forces, typically using the patient's body weight for counter-traction.
• Cast Immobilization and Stabilize.
• Cast care: no direct pressure on cast during the drying period, perform neurovascular checks, no getting cast wet, ice for 24 hr after cast gets placed, call hcp if swelling pain, discoloration of distal tissues
• External fixation uses metal pins and wires attached to external rods, applying traction and reducing fragments.
• External fixation is used for complex fractures and attempts to save extremities that may have required amputation.
• Internal fixation is surgical realignment of bony fragments using devices like pins, plates, rods, and screws.
• Nutrition is crucial: 2000 to 3000 ml per day, and adequate protein, calcium, vitamin D, potassium, magnesium, and phosphorus.
• Central and peripheral muscle relaxants: (carisoprodol, cyclobenzaprine, methocarbamol, tetanus and diphtheria (open!!! When immunization is unknown)
• Complications involve infections and compartment syndrome, and Venous thromboembolism.
• Compartment syndrome causes tissue damage due to swelling and increased pressure in a muscle compartment, cap refill is long.
• Venous thromboembolism occurs due to venous stasis.
• Treatment for VTE includes anticoagulant drugs for 10-14 days, anti-embolism measures, and exercises.
• FAT embolism involves systemic fat globules from a fracture distributed into tissues and organs.
• Symptoms of fat embolism: chest pain, tachypnea, cyanosis, dyspnea, petechiae.
• Patients exhibit symptoms 24-48 hours post-injury.
• Lab values include fat cells in blood, urine, or sputum, oxygen saturation is less than 60 mmHg, and decreased platelets.
• Rhabdomyolysis results in dark red-brown urine.
• Lab draw for kidney
• Assess urinary output
• Nursing care for immobilization: Reposition or heat or massage to relieve muscle spasms.

Hip Fractures

• Caused by severe direct trauma or falls.
• Clinical manifestations: external rotation, muscle spasm, severe pain, or tenderness.
• Interprofessional care: immobilization with Buck's traction for 24-48 hours.
• Never flex the hip more than 90 degrees or adduct the hip.
• Buck's traction is a type of skin traction applied to the hip to reduce muscle spasm and immobilize the fracture, but does not allow for healing to begin.

Arthroplasty

• Total hip arthroplasty is reconstruction or replacement of a joint to relieve pain and correct deformity.
• Indicated for joint deterioration.
• Caused most likely by a fall
• Diagnosis: xray, s/s short leg extendes rotated pain loss function, tx bucks traction
• Pre op skin assessment and alignment needed
• NO SQUAT AT 90 DEGREES

Total Knee Arthroplasty

• Indicated for severe cartilage deterioration with unrelieved pain and instability.
• Post-op: the knee is immobilized in extension with compression, and ROM workouts promote 90-degree flexion.
• The knee needs to be extended, isometric quad workouts, compression dressing, and straight leg raises.
• Anticoagulants needed postoperatively, as is patient teaching on meds, VTE risk, hydration, and early mobility.
• Ambulatory patient's need ROM workouts, ambulation, avoid high-impact activities, take vitamins, calcium, and bisphosphonates to decrease bone loss.

Osteomyelitis

• Severe infection of the bone, bone marrow, and surrounding tissue.
• Risk factors: older age, hemodialysis, IV drug use, sickle cell disease.
• Acute osteomyelitis is an initial infection of less than one month's duration.
• Systemic manifestations of acute osteomyelitis: constant bone pain worsens with activity and is unrelieved with rest, swelling, tenderness, and warmth to the site, and restrictive movement.
• Systemic: fever, night sweats, restlessness.
• Chronic osteomyelitis: infection lasting longer than one month, with lessened systemic manifestations and more common local signs of infection (pain, swelling, edema).
• Bone or soft tissue biopsy: used to diagnose infection).
• WBC count and wound cultures can identify infection.
• Acute management includes IV antibiotic therapy (3-6 months), followed by oral agents.
• Chronic: surgical removal of poorly perfused tissue and dead bone, extended use of antibiotics.
• Cultures and bone biopsy needed before antibiotics.
• Nursing management includes frequent assessments and emotional support.
• Foot drop: develop if not taken care of or supported by hip or boot, adherence to treatment plan can take 6-1yr to heal fully

Osteomalacia

• Soft bones and bow legs, similar rickets, growth plates are closed.
• Low vitamin D levels that impact the GI tract's ability to absorb.
• Caused by limited sun, pregnancy, and liver disease.
• Symptoms: bone pain, muscle weakness, pain at night, and common fractures.
• Labs show low vitamin D
• A diet rich in eggs, meat, fish, and milk needed.
• 20 minutes of sunlight each day, combined with weight-bearing exercise.

Osteoporosis

• Chronic, progressive metabolic bone disease marked by low bone mass and deterioration of bone tissue, leading to fragile bones.
• Results from loss of calcium and phosphorus salts, where bone resorption accelerates as bone formation slows.
• Risk factors: older age, female, low body weight, family history, smoking, low calcium and vitamin D diets, postmenopausal status, sedentary lifestyle.
• Bone resorption accelerates as bone formation slows
• Inhibits bone resorption
• Common sites of fractures with kyphosis often seen in the spine, hips and wrist
• Manifestations: most common in the spine, hips, wrists, back pain, kyphosis, and dowager's hump.
• Diagnosis: xray and lab studies; dexa scan shows bone density.
• Nursing, and interprofessional management: proper nutrition, exercise, quit smoking, decrease alcohol intake, BISPHOSPHONATES, lower risk by weight bearing exercise.
• High calcium and D intake.
• Milk, cheese, sardines, salmon almonds are indicated.
• Calcium meds should be taken empty stomach, twice a day, at least 20 mins of sun.
• Bisphosphonates inhibit bone reabsorption and slow remodeling.
• Interventions: remove hazards, use side rails, personal care to reduce injuries, gentle ROM, and a diet high in protein, calcium, vitamins C and D, and iron, avoid alcohol and coffee.

Osteoarthritis

• Slowly progressive, noninflammatory disease of the synovial joints, with gradual loss of articular cartilage and bony outgrowths or spurs at joint margins.
• Results in bone build-up and loss of articular cartilage, impacting weight-bearing joints.
• Manifestations: joint pain during joint use. As disease progresses, resting doesn't help, joint stiffness after rest, crepitation.
• Pain worsens with joint use; in early stages, rest relieves pain, while later stages involve pain with rest and trouble sleeping.
• Diagnostics involve bone scans or CT scans.
• Interprofessional care has no cure.
• Management: pain is huge here, pain and inflammation need good nutrition is key (up calcium and vitamin D).
• Drugs used: topical agents, corticosteroid injections.
• Surgery needed cases of unmanaged pain, loss of joint function, or increased dependence in self-care.
• Alternative therapy: Acupuncture, massage, tai chi, and nutritional supplements.
• Nursing management: patient should quit smoking.
• Ensure correct use of assistive devices and principles of joint protection
• Avoid large pillows under the knees because it can cause CONTRACT

Rheumatoid Arthritis

• Chronic autoimmune disease that causes inflammation of the connective tissue in synovial joints.
• Symptoms are bilateral and often impact small joints.
• Fatigue, anorexia, weight loss, stiffness, specific joint pain.
• Rheumatoid nodules develop in 50% of RA patients.
• Impacts every body system.
• Swan neck deformity in fingers.
• Sjörgen's dry eyes, photosensitivity.
• Extra-articular manifestations include atherosclerosis, rheumatoid nodules, Felty syndrome, and depression.
• Felty Syndrome: enlarged spleen and low WBC result in RF infection.
• Diagnose: lab test for RF levels, history and physical findings, criteria for diagnosis is joint involvement, and synovial fluids, increased C-RP levels.
• The treatment: drug therapy (methotrexate, sulfasalazine, hydroxychloroquine, leflunomide) along with nonbiologic disease-modifying antirheumatic drugs or biologic response modifiers.
• Focus the interventions on rest, joint protection and a balance in work and test.
• Smoke cessation is imperitive.
• Drugs: slow disease progression and decreases risk of joint deformity.
• Methotrexate, Sulfasalazine, Hydroxychloroquine, and Leflunomide are drugs used to treat.
• Nsaids and tumor necrosis factor inhibitors.
• DMARDS; irreversible changes can occur in the first year, slow disease progression and decreses risk of joint deformity
• Methotrexate, Sulfasalazine, Hydroxycholoroquine and Leflunomide are used.
• Biologic response modifiers: help eliminate the inflammatory response.
• Nursing includes rest: rest avoids total bed rest, but modify activities to avoid overexcertion and fatigue, good body alignment.
• Protect the joints: modify to put less stress of joints
• Cold treatments for 10-15 mins, several times a day.
• Hot moist treatments relieve chronic stiffness (never exceed 20 mins at a time).
• Exercise includes daily gentle ROM exercises to keep joints functional.

Gout

• Arthritis resulting from hyperuricemia with uric acid crystals accumulating in joints.
• Occurs acutely in one or more joints (mostly the big toe) with swelling and inflammation =crazy high pain.
• Uric acid levels above normal range
• Kidneys cannot excrete uric acid which leads to build up.
• Diagnosis: uric acid levels, the GOLD STANDARD is synovial fluid aspiration.
• Must avoid foods in HIGH purines to increase the flares.
• Normal uric acid levels: 2.7-8.5.
• Monitor serum uric acid regularly ,diet restricts with protein.
• Joint aspirate can be examined.
• Treatment: colchine (is antiinflammatory gives pain relief) and allopurinol maintenance.
• NSAIDs add ontop for pain management.
• Xanthine oxidase Inhibitor
• Allopurinol
• Febuxostat
• Maintenance doses helps and decreases prod of uric acid. Allopurinol is most common
• Drink 2-3 L of fluid per day, limit alcohol and high-purine foods, supportive joint care.
• Restricts the meat, wine, aged cheese.

Systemic Lupus Erythematosus (SLE)

• Multisystem inflammatory autoimmune disease with connective tissue and fibrin deposits on organs.
• Can manifest in the integumentary, musculoskeletal, renal, and nervous systems.
• Symptoms include butterfly rash, photosensitivity, skin atrophy, muscle weakness, erythema of palms, and morning stiffness.
• Vascular lesions can appear anywhere with a risk factor increases with stroke and hypertension.
• Labs to be tested Monitor blood urea nitrogen and creatine levels.
• Treatment, Anti Malarial, Antieproxymeds Dapsone, Corticosteroids, Immunosuppressives, anticoagulants, Tacrolimus for butterfly rash, treat fever.
• Treat fever as well
• Diagnosed based on distinct criteria, variety abnormalities in blood, antibodies in 97%, testing for ant dna antibodies.
• Treat antieproxymeds dapsone, corticosteroids, immunosuppressives, anticoaulgants, and treatmenrt topical tacrilimus for butterfly rash
• Interprofessional care manages active disease with NSAIDs, corticosteroids, anticoagulants, and topical immunomodulators.
• Treatment: Dapsone.
• Patients on long-term NSAID therapy should be monitored for GI and renal effects.
• Major challenge to manage acute disease, nsaids, corticosteroids, anticoagulants, topical immunomodulators.
• Treatment Dapsone which treats fever
• SLE impacts all systems (commonly joints skin and membrane).
• Monitor for antibody bloods
• Avoid live vaccienes due to suppressed immunity.
• Can use antimalarial agents (hydroxychloroquine and chloroquine, often used to treat fatigue and skin and joint problems.
• These suppress the immune system but do not cause immunosuppression.
• Should have eye examinations every 6 to 12 months.

Fibromyalgia

• Widespread nonarticular musculoskeletal pain associated with fatigue and tender points; potentially caused by abnormal interpretation of nociceptive pain.
• Patients cannot differentiate between joint and muscle pain; more prevalent in women.
• Diagnosis involves identifying trigger points, fibro fog, symptom severity index (SSI) over 5, and widespread pain index score greater than 7.
• Symptoms Widespread pain of the muscles for 3+ months, fatigue, trigger pain.
• Clinical manifests: stiffness, fatigue, restless leg syndrome, difficulty menstruation, wide spread burning pain it fluctuates through the day, fibro fog, overwhelmed when dealing with multiple tasks, restless leg syndrome, diff swallowing, menstruation is hard,
• Treatment : drug therapy for chronic widespread pain,
• Pregabalin (Lyrica), Duloxetine (Cymbalta), Milnacipin (Savella), Low-dose tricyclic antidepressants (TCAs), SSRIs, or benzodiazepines. Are medications give. Along with Muscle relaxants
• Therapy involves relaxation, stretching, good nutrition, gentle workouts, hot and cold packs.

Seizure Disorder (Epilepsy)

• Recurring seizures (2 or more, 24 hours apart) without an underlying problem.
• Caused by: stroke, brain tumors, TBI, low and high glucose levels, lack of sleep, alcohol withdrawal.
• Characterized by location of the disturbance.
• Generalized seizures can be motor (tonic-clonic), with loss of consciousness, body stiffening (tonic), jerking extremities (clonic), cheek biting, incontinence, salivation, cyanosis, and postictal phase (muscle soreness and fatigue).
• Ask to put arms up while standing to test
• Generalized onset seizures can be non-motor (absence), mainly in kids (girls)
• Focal onset seizures (partial), either motor or non-motor, aware or unaware.
• Concious and alert, unusual feelings, localized twitching.
• Impaired awareness involves loss of consciousness but eyes open, with no interaction, and no memory post-seizure.
• Unkown Onset can occurs
• Status epilepticus: continuous seizure activity or when seizures recur without return to consciousness (longer than 5 mins)
• May cause permanent brain damage due to excessive energy demand.
• Sudden death from epilepsy (SUDEP) mostly linked to tonic-clonic seizures.
• Causes depression.
• EEG for diagnosing as this helps determine seizure types.
• Magentoencephalography with EEG has greater sensitivity in detecting small magnetic fields.
• Diagnosis of new onset, obtain CBC, serum chemistries, liver and kidney function, urine analysis with new onset ct vs mri.
• May do cerebral angiography, SPECT, MRA, and PET in some situations.
• Ensure you maintain the airway, put on side, place oxygen.
• Keto diet helps with seizures.
• Treatment with these types on medication : Antiepileptic drugs
• Don't stop antiseizure meds abruptly
• Side effects: vision changes, drowsiness, ataxia, and mental slowness.
• Tonic clonic and focal: Phenytoin (monitor liver function and gingival hyperplasia), Carbamazepine, Divalproex.
• Generalized onset and non motor seizue use Ethosuximide, Divalproex and Clonazepam.
• Focal use: Lyrica (use when treatment is not successfully controlled with one med), Levetiracetam, Lamotrigene, Carbemazepine.
• Status epilepticus is rapidly treated with IV lorazepam (Ativan) or diazepam.
• Untrolled use surgery (vagal nerve stimulation may increase BF to brain areas) and Responsive neurostimulation.
• Ketogenic diet helps control seizures
• Biofeedback helps patient with teaching how to maintain a brain.
• Seizure precautions involve padded side rails, availability of oxygen, suction, IV, and airway equipment.

Stroke

• Includes ischemic (thrombotic or embolic; lack of O2 to brain due to a blood clot or put on blood thinner) and hemorrhagic (intracerebral, subarachnoid; bleeding into the brain, NEVER place on blood thinners) types.
• Risk factors: Age doubles after 55 and family history.
• Modifiable risk factors include HTN, heart disease, smoking, obesity, poor diet, drug and alcohol use, metabolic syndrome.
• A history of transient ischemic attack increases stroke risk due to ischemia without infarction.
• Ischemic stroke types: thrombotic and embolic.
• Thrombotic: inadequate blood flow due to cerebral artery occlusion, most common from is injury to blood vessel wall; makes clot.
• Embolic stroke: embolus lodges and occludes a cerebral artery, warning signs are less common, patient is usually concious.
• Hemorrhagic stroke involves bleeding into the brain (subarachnoid spaceor ventricles).
• Hypertension is the most common cause of hemorrhagic stroke.
• Cerebral aneurysm can cause a bleed.
• Silent killer
• High mortality rate
• Related to location of the stroke
• Motor ability
• Communication
• Affect.
• Elmination and incontinence
• Language ability
• The effect of stroke depends on location and extent of brain damage.
• Manifestations:
• Left side: language and slower performance, along with comprehension.
• Right side: impulsiveness
• Aphasia, dysphagia, dysarthria, homonymous hemianopsia, agnosia, and apraxia.
• MRI or CT scans are first steps to determine if it is hemorrhagic or ischemic.
• Need to get done Spinal tap r/o meningitis, and cardiac assessment.
• Prevention relies on healthy lifestyle choices to manage modifiable risk factors such as HTN.
• Ischemic stroke care: blood thinners to manage airway and vitals along side reducing disability,
• TPA to break down clots, antiplatelet drugs like asprin, and statins.
• Hemorrhagic stroke: Control Hypertension control to systolic of less than 160, Ca++ channel blocker (Nimodipine) to decrease vasospasm, Craniotomy.
• Left brain damage will probs be memory and language vs Right is impulsive and fast.
• Assessment: Neurologic problems, Risk for Aspiration, and Risk for injury.
• Nursing; Monitor rhythm as this causes DVT ( immobility for all above issues).
• Maintain normal breathing circulation ( patients battle conscienceness deacreased gag reflex, and will need oxygen)
• Focus is on managing mobilty, rom, spints, and assess skin breakdown. GI: constipation, may require stool softener, physical activity to promo ex, also intake at least 1800-2000 a day.
• Provide support and education,