Maryville University NURS 620 Exam 3 (Final Exam) Outline: Main Topics

Exam 3 (Final Exam) Outline: Main Topics

NEURO

Seizure Disorders: sudden involuntary time limited alteration in behavior including change in
motor activity, function, consciousness or sensation… p. 122 Dunphy
 Simple partial seizure: when no loss of consciousness, (partial seizures are those which
first clinical and EEG changes indication activation of a system of neurons limited to
ONE part of cerebral hemisphere.
 Complex partial seizure: impaired consciousness, aberrations of behavior may occur
“automatisms”
 *simple partial seizures evolve to generalized seizures, complex partial seizures evolve to
generalized, simple partial seizures evolving to complex partial seizures to generalized
seizures.
 Generalized seizure: may be convulsive or non convulsive,
 A. absence seizures (petit mal), or atypical absence seizures
 B. myoclonic seizures
 C. clonic seizures
 D. tonic clonic seizure (grand mal)
 E. Atonic seizures (astatic seizures)
 Absence seizure
 Sudden onset, interruption of ongoing activities, blandk stare and poss. Looking
upward w rotation of eye. If talking; will stop, if chewing; will stop, activity will
stop for about 30 second
 Tonic-clonic or grand mal seizure:
 Most frequently encountered of the generalized seizures. There is sudden, sharp
tonic contraction of muscles, stridor or a cry, pt falls to ground in tonic state. Pt
lies rigid and during this state, tonic contractions inhibits respiration and cyanosis
may occur. Tongue may be bitten, incontinence may occur, tonic stage then gives
way to clonic convulsive movements lasting a variable period of time.
 Myoclonic jerks: sudden onset brief shock-like contractions which may be generalized of
confined to the face and trunk or one or more extremities, may occur mostly during sleep

Seizures: Diagnostic tests and medications
 Blood work: CBC with diff, BS, electrolytes, LFTs, UA, drug screen
 Other: EEG, CT scan, MRI, possible LP
 Single anticonvulsants: Tegreto./Carbamazepine, Dilantin/Phenytoin,
Levetriracetam/Keppra
 TYPE 2 DRUGS: phenobarbital, Depakote/Valproate, Benzodiazepines

Seizures: Education: Encourage support groups, smoking cessation,
 Frequency of medication monitoring :
 Safety issues
 Swimming precautions; warn friends! 1000X risk GREATER to drown during bath, 70X
greater risk drowning while swimming
 Cooking precautions: turn pot handles inward, DO NOT lock bathroom doors, install
automatic shut off devices on faucets, use microwave and back burners to avoid burns

,  Driving restrictions: discussed at length!, each state has different lawn of governing and
granting DL. Feds bar anyone w hx of seizures from being licensed to drive in interstate
trucking to protect public.
 Advantages of service dog: pre warning, for safety awareness, able to move away from
hard hot surfaces.
*Trigeminal Neuralgia: 3 branches, sharp electric pain, tx w/ Carbamazepine(tegretol),
Neurontin, TCA’s
Multiple Sclerosis (MS)
4 types of MS
1. Relapsing-remitting type: acute attacks with full recover or some residual deficits
between episodes.
2. Primary progressive type: steady dz progression w poss. Some plateaus and remissions
3. Secondary progressive type: combination of the prior two types.
4. Progressive-relapsing type: progression of dz including relapses and remissions with or
w/o recovery on a steady downhill course, with the relapsing-remitting variety, in which
the dz progression may stop at any one point.

MS Good Prognostic Indicators
 Minimal disability after 5 years of onset
 Complete and rapid remission of initial symptoms
 Onset at age 35 or younger
 Only one symptom during first year
 Brief duration of most recent exacerbation
 Long first remission

MS Poor Prognostic Indicators
 Late onset
 Chronic progressive course
 Motor symptoms
 Polysymptomatic onset
 Vertigo

MS: Signs and Symptoms
 Visual symptoms, possible trigeminal neuralgia
 Limb weakness
 Easy fatigability
 Dysarthria
 Incoordination of limbs and trunk
 Bladder symptoms
 Paresthesia
 Attention deficits

MS: Management
Principles of management—no known cure
 Delay progression of the disease
 Manage chronic symptoms
 Treat acute exacerbations
MS: Medications

,  Corticosteroids for acute exacerbations: (Depo-Medrol; monitor as it masks infection, glaucoma,
cateracts, hypo K and hypo Calciumia, HTN, psych disorder, myopathy, osteoporosis, dermal
atrophy, increased cranial pressure)
 Natalizumab for relapsing-remitting type (Tysabri, monitor ofr multifocal leukoencephalopathy)
 Antispasmodics or implantable drug infusion pump
 Meds to manage tremors
Tegretol(carbamazepine)
Clonazepam (Klonopin)
Primdone (mysoline)

 Pain management—acute and chronic pain, Dunphy says: MS pts experience pain in form of
unpleasant sensations or overt pain. Can assume many forms. Acute pain includes: trigeminal
neuralgia, Lhermitte’s sign, paroxysmal burning, extremity pain and tonic spasms.
 Acute pain can be managed and treated w carbamazepine (tegretol), Phenytoin(Dilantin,
or Valpoate (Depakote).
 Chronic Pain: dysesthetic pain in extremities, chronic back and leg spasms. Use
Amitriptiline(Elavil), Carbamazapime (Tegretol), Valproate (Depakote) may be used.

Parkinson’s Disease (PD): Levodopa is used because the body uses it to replace Dopamine and
PD: 6 cardinal features
1. Tremor at rest
2. Rigidity
3. Bradykinesia (slow body movements) or hypokinesia (decreased body movements)
4. Flexed posture
5. Loss of postural reflexes
6. “Freezing” phenomenon
PD: Signs and Symptoms
Major manifestations form the mnemonic TRAP
 Tremor
 Rigidity
 Akinesia or bradykinesia
 Postural disturbances
PD: Management
 The principle of management is to control the symptoms
 Meds: antichonlinergics-Cogentin, Artane, Dopamine Agonists: Mirapex, Requip, Dopamine-
receptor agonists: Pergolide
 When to start neuroprotection?
 When DX is made (somewhat controversial, but want to protect neurons from
further damage and delay progression ASAP)
 Use the UPDRS to monitor patient’s response,
 I: eval mentation, behavior mood
 II self eval of ADL including speech swallow writing, dressing hygiene,
falling salivating turning wlking cutting food
 III clinical scored monitored motor eval
 Iv: complications of therapy
 V: Hoen and Yahr scale (generalized)
 1. Unilateral involvement only
 2. Bilateral without impairment of balance