NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
Nursing 231 – Test #2 Study
Guide Monroe Kelly
principle
» Headaches «
1. Types of Headaches
Tension muscular, migraines, vascular and cluster neurological
a. Migraines Headaches, recurrent episodic attacks of head pain
Characteristics
• Pain (throbbing, unilateral)
• Nausea
• Sensitivity to light
• Based on the patient’s history, physical, neurological, and psychological assessment
• Pain is unilateral, frontotemporal, throbbing pain behind one eye or ear
Diagnosis
• Atypical, sudden, severe, presence of neurological deficits, or over 50
• 2 Onset
•
Meningitis, CSF leak, cerebral aneurysm, brain tumor
•
Prolonged H/A
• Sinusitis, opioid dependence/withdrawal, caffeine withdrawal, overuse of OTC meds
Tests
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
MRI or CT scan
• Blood tests (CBC, anticoag tests for brain bleed)
• Lumbar puncture (nursing consideration: supine position and hydration to minimize spinal
leak headache)
• EEG – nursing consideration- adhesive – use aspirin epilepsy.com
Contributing factors
•
Familial
•
Occurs more in women (associated with menstrual cycles as trigger)
•
Stress or change in weather
•
Drugs
•
Hypoglycemia
•
Exercise
•
Diet – caffeine, red wine, monosodium glutamate (MSG)
• Assessment
o Assess the client to see what category of migraine they experience
o Migraines with and without aura
o Phases of migraine
o Premonitory/Prodromal phase
o Aura vision change
o Vital Signs
o Pain
o ADLs
o Photophobia, nausea, vertigo, and aura
o Nutritional status
o Headache History
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
o Triggers
o Preventative measures
•
• REMEMBER SNOOPY acronym for HEADACHE
RED FLAGS 3 R’s recognize respond relieve
Interventions
• Pain management
• Teach patient to take meds during aura phase or early onset (NSAIDS,
ibuprofen for mild migraines)
• Severe migraines: triptan preparations, ergotamine derivatives as needed
(SHOULD NOT TAKEN BOTH TOGETHER)
• Teach patient about rebound headaches
• Complementary therapy: yoga, meditation, massage, exercise, acupuncture
Medications for Migraines (abortive vs chronic)
Nonspecific analgesics
Acetaminophen, 3g per day livertoxic OTC worry, N/V,
distended abdomen Nsaids kidney toxic. Take with food
Butalbital
Ibuprofen
Naproxen –
Saint Johns
wort 3 g’s
Ergot preg X
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
Antihypertensive medications- beta blockers (propranol) and calcium channel blockers
(amplodipine) are used to prevent vasoconstriction or vasodilation in the cerebral blood
vessels
Antiepileptic Drugs (AEDs): Lisa specifically mentioned Topiramate and Valproic
acids (anticonvulsant and GABA increase)
Do we have to know Side effects? Topiramate, seizure and
migraine med. can increase body temperature and decrease
sweating, leading to life-threatening dehydration, This medication
can rarely cause a serious metabolic problem (high amount of
ammonia in the blood), especially if you are also taking valproic
acid.
a. Phenytoin (Dilantin, anti-seizure. Slows down
chemical msgs in brain)
2. Triptans/Antimigraine
Drugs Antimigraine (serotonin agonists; also
called triptans)
Triptan Preparations vasoconstriction, decreased pain 20-60 min, increase Bp,
drowsiness, cardiovascular diseases caution anxiety, muscle pain
a. Sumatriptan (Imitrex)
i. Serotonin syndrome change in mental status.
Hold med. Symptomatic management (ie. cool
blanket and APAP for hyperthermia, IVF for
hypotension)
Stimulates 5-HT (5-hydroxytryptamine receptors) receptors in cerebral arteries,
causing vasoconstriction and reducing headache symptoms
Reduces the production of inflammatory neuropeptides
Contraindicated in patients with actual or suspected ischemic heart disease,
cerebrovascular ischemia, hypertension, and peripheral vascular disease; patients taking
SSRI, St. John wort patients:
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
Nursing 231 – Test #2 Study
Guide Monroe Kelly
principle
» Headaches «
1. Types of Headaches
Tension muscular, migraines, vascular and cluster neurological
a. Migraines Headaches, recurrent episodic attacks of head pain
Characteristics
• Pain (throbbing, unilateral)
• Nausea
• Sensitivity to light
• Based on the patient’s history, physical, neurological, and psychological assessment
• Pain is unilateral, frontotemporal, throbbing pain behind one eye or ear
Diagnosis
• Atypical, sudden, severe, presence of neurological deficits, or over 50
• 2 Onset
•
Meningitis, CSF leak, cerebral aneurysm, brain tumor
•
Prolonged H/A
• Sinusitis, opioid dependence/withdrawal, caffeine withdrawal, overuse of OTC meds
Tests
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
MRI or CT scan
• Blood tests (CBC, anticoag tests for brain bleed)
• Lumbar puncture (nursing consideration: supine position and hydration to minimize spinal
leak headache)
• EEG – nursing consideration- adhesive – use aspirin epilepsy.com
Contributing factors
•
Familial
•
Occurs more in women (associated with menstrual cycles as trigger)
•
Stress or change in weather
•
Drugs
•
Hypoglycemia
•
Exercise
•
Diet – caffeine, red wine, monosodium glutamate (MSG)
• Assessment
o Assess the client to see what category of migraine they experience
o Migraines with and without aura
o Phases of migraine
o Premonitory/Prodromal phase
o Aura vision change
o Vital Signs
o Pain
o ADLs
o Photophobia, nausea, vertigo, and aura
o Nutritional status
o Headache History
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
o Triggers
o Preventative measures
•
• REMEMBER SNOOPY acronym for HEADACHE
RED FLAGS 3 R’s recognize respond relieve
Interventions
• Pain management
• Teach patient to take meds during aura phase or early onset (NSAIDS,
ibuprofen for mild migraines)
• Severe migraines: triptan preparations, ergotamine derivatives as needed
(SHOULD NOT TAKEN BOTH TOGETHER)
• Teach patient about rebound headaches
• Complementary therapy: yoga, meditation, massage, exercise, acupuncture
Medications for Migraines (abortive vs chronic)
Nonspecific analgesics
Acetaminophen, 3g per day livertoxic OTC worry, N/V,
distended abdomen Nsaids kidney toxic. Take with food
Butalbital
Ibuprofen
Naproxen –
Saint Johns
wort 3 g’s
Ergot preg X
, NURSING STUDY GUIDE
MONROE KELLY PRINCIPLE
100% CORRECT
DOWNLOAD TO
SCORE A
Antihypertensive medications- beta blockers (propranol) and calcium channel blockers
(amplodipine) are used to prevent vasoconstriction or vasodilation in the cerebral blood
vessels
Antiepileptic Drugs (AEDs): Lisa specifically mentioned Topiramate and Valproic
acids (anticonvulsant and GABA increase)
Do we have to know Side effects? Topiramate, seizure and
migraine med. can increase body temperature and decrease
sweating, leading to life-threatening dehydration, This medication
can rarely cause a serious metabolic problem (high amount of
ammonia in the blood), especially if you are also taking valproic
acid.
a. Phenytoin (Dilantin, anti-seizure. Slows down
chemical msgs in brain)
2. Triptans/Antimigraine
Drugs Antimigraine (serotonin agonists; also
called triptans)
Triptan Preparations vasoconstriction, decreased pain 20-60 min, increase Bp,
drowsiness, cardiovascular diseases caution anxiety, muscle pain
a. Sumatriptan (Imitrex)
i. Serotonin syndrome change in mental status.
Hold med. Symptomatic management (ie. cool
blanket and APAP for hyperthermia, IVF for
hypotension)
Stimulates 5-HT (5-hydroxytryptamine receptors) receptors in cerebral arteries,
causing vasoconstriction and reducing headache symptoms
Reduces the production of inflammatory neuropeptides
Contraindicated in patients with actual or suspected ischemic heart disease,
cerebrovascular ischemia, hypertension, and peripheral vascular disease; patients taking
SSRI, St. John wort patients:
