brain & spinal cord disorders

• seizures: erratic misfiring of electricity throughout the brain
• types of seizures: colonic-tonic (general seizure), absence (loss of consciousness), and jacksonian (focal; just one part of the brain affected)
• non epileptic seizures may be caused by: trauma, surgery, brain tumors, stroke, illness, fever, sodium imbalances
• clinical manifestations of seizures: ranges from rhythmic jerking and loss of consciousness to apparent day dreaming
• status epilepticus: seizure activity lasting longer than 5 minutes or two or more seizures without full recovery of consciousness
• treatment for status epilepticus?


  diazepam/lorazepam
• medical treatment of seizures: antiepileptic medications (gabapentin, depakote, dilantin, and phenobarbital)
• depakote and dilantin both have very narrow therapeutic levels and drug levels need to be drawn before administration
• complications of seizures: injury or death due to seizure in dangerous situation (swimming, driving, or head injury from hitting head on ground)
• physical assessment of seizures: neuro (prior and after seizure), seizure management, airway, vital signs, seizure, presence of aura (smell, feeling, visions; tells patient the seizure is about to occur)
• labs for seizures: drug levels if on seizure medications (phenytoin; dilantin)
• seizure management during the seizure: note the time the seizure started and the duration, move all hard objects out of the way (lower pt to the floor if standing or sitting), if safe position the patient on the side with pillow/blanket under head, NEVER put anything in the mouth, apply oxygen if safe, do NOT restrain, all 4 side rails up and padding
• seizure management post seizure: take vitals, clean the patient (may be incontinent), have suction ready and available, and document the details and treatment
• interventions for seizures: maintain suction at patients bedside (prior to any seizure occurring), have oxygen available, safety measures (all 4 bed rails should be up), maintain IV access, and document specifics of seizure
• teaching for seizures: medication regimen, medic alert bracelet, driving restrictions
• parkinsons: loss of dopamine producing brain cells; decreased dopamine in the brain
• clinical manifestations of parkinsons: resting tremors, muscle rigidity, slowness of movement (bradykinesia), loss of movement (akinesia), mask like face (very little movement or expression), excessive drooling (unable to control the muscles in the mouth), and freeze spells
• medical treatment for parkinsons: anticholinergics (decreases tremors), dopamine receptor agonists (LEVADOPA - CARBIDOPA)
• surgery for parkinsons: stereotactic pallidotomy (cut areas of the brain to decrease the tremors but does NOT cure)
• complications of parkinsons: falls (body is starting to deteriorate)
• physical assessment of parkinson: tremors, rigidity, bradykinesia, gag and swallow (HIGH risk for aspiration), mobility, bowel and bladder function (incontinence, constipation; bladder is a muscle)
• interventions for parkinsons: implement safety precautions, facilitate nutritional intake (need more calories with muscles constantly moving), elevate HOB, suction equipment at bedside, encourage patients to participate in self care activities, communication strategies
• why are communication strategies an important intervention for parkinsons?

  they will eventually lose the ability to speak and they need a plan for when that happens
• teaching for parkinsons: medication compliance, safety precautions, and psychosocial support
• alzheimers: decrease in neurotransmitters
• risk factors for alzheimers: family history, head trauma
• clinical manifestations of alzheimers: loss of ability to complete tasks, forgetfulness that progresses with time, short term memory decline (long term stays mostly intact), cognitive impairment, inability to handle personal finances, inability to self manage medications (forgets), motor and verbal skills decline (they forget how to speak or walk)
• medical treatment for alzheimers: physical and emotional support, medications to INCREASE Ach (DONEPEZIL; delays the progress of disease)
• complications of alzheimers: infection (pneumonia and UTIs), falls, malnutrition (forgets to eat)
• physical assessment of alzheimers: assessment of cognitive and physical function; NOT alert and oriented; clock assessment
• interventions for alzheimers: weight, I&Os (offer fluids, they wont remember to drink/eat), bowel and bladder function, skin, ADLs, environment and safety (dressing properly), coping, encourage/assist with feeding, implement safety measures (locked facilities), implement routine toileting practices, provide clock and calendar, speak calmly, provide diversionary activities (distract them), and provide emotional support (especially in early stages)
• teaching for alzheimers: teach families how to provide care, label dangerous substances, monitoring systems, referral assistance (long term care)
• multiple sclerosis (MS): breakdown of myeline sheath; involves brain and spinal cord
• higher incidence of MS in young females in the northern (colder) regions
• clinical manifestations of MS: numbness or weakness, partial or complete vision loss, double or blurred vision, tingling or pain, electric shock sensations with head movement, tremor, fatigue, dizziness (**)
• medical treatment of MS: autoimmune disorder so need to suppress the immune system; beta interferons, corticosteroids, plasma exchange (removes auto antibodies)
• complications of MS: muscle stiffness or spasm (muscles arent getting communication from the brain), paralysis, problems with bladder bowel and sexual function, mental status change, depression (situational depression), and seizures
• physical assessment of MS: neuromuscular function (NEED to know baseline), vision/eye movement, skin integrity, ability to perform ADLs, bowel and bladder function (one of the first things to start going; end up with a chronic foley catheter)
• interventions for MS: encourage ROM, implement safety measures, patch eye daily as needed (patients with double vision, cover one eye to help with it)
• teaching for MS: rest periods, clinical manifestations of exacerbation, visual scanning (looking all around them before moving due to vision loss), check water temperature, maintain ideal body weight, and review disease progress and prognosis (may need a wheelchair and then recover and then need it again)