Week 8 180

Bulges in blood vessels caused by a weakness in the blood vessel wall

The brain and the spinal cord

Spinal and cranial nerves as well as the autonomic nervous system and the somatic nervous system

Consists of the sympathetic, parasympathic, and enteric nervous systems

Sensory: afferent (sending signals to the brain)
Motor: efferent (sending signals from the brain)
*Controls the body's movement and sensation

One of the four lobes of the cerebrum, responsible for cognitive processes, language, and motor function

One of the four lobes of the cerebrum, responsible for understanding language, and sensory information processing

One of the four lobes of the cerebrum, responsible for interpreting sensory information

One of the four lobes of the cerebrum, responsible for interpreting visual information

It is responsible for intellectual activities. It is divided into a left and right hemisphere and four lobes (frontal, temporal, parietal, and occipital)

Contains roughly 80% of all the brain's neurons and regulates voluntary motor movement and balance
-Constantly receives information about the body's joints, tendons, and muscles, which allows voluntary movement of extremities and completion of skilled movements

Connects the cerebrum to the cerebellum and spinal cord and is responsible for the body's vital functions.
-Consists of the midbrain, pons, and medulla oblongata
-Most of the cranial nerves emerge from the brainstem

Located at the bottom of the brain stem and responsible for all autonomic functions

Located within the vertebral column and is responsible for sending commands and sensory information between the brain and peripheral body

Part of the nervous system responsible for the digestive system

"fight or flight" response
-Increase heart rate and blood pressure, halt gastrointestinal peristalsis, and induction of glycogenolysis
-Regulation of the immune system by innervating the thymus, spleen, and lymph nodes

A primary headache that is recurrent, presents unilaterally and usually with throbbing or pulsing pain, vomiting, nausea, and photosensitivity

-Occur because of abnormal and unregulated electrical impulses in the brain's gray matter which interrupts the normal function of the brain
-The unregulated electrical impulses are a result of the excitation of some cerebral neurons and then spread to larger groups of neurons
-The number of neurons affected determines how intense or widespread the seizure is

A chronic condition that consists of recurrent seizures

-Generalized: also called grand mal or tonic-clonic; characterized by two stages, loss of consciousness followed by violent muscle contractions
-Focal: Odd experiences where awareness is maintained
-Unknown

-Structural abnormalities: may be genetic and present from birth or may be acquired from conditions such as stroke, trauma, or cancer
-Genetic etiology: chromosomal or gene abnormalities
-Infection: one of the most common causes of seizures; more common with meningitis and encephalitis, but can occur with any infection

-Podromal
-Early ictal or aura
-Ictal
-Postictal

-First phase
Client may experience anxiety, mood changes, and difficulty sleeping

-Second stage
Client may experience strange tastes, smells, or feelings, such as deja vu or excitement

-Third phase spanning from the time of the first manifestation until seizure activity ends

Muscle contractions during seizure activity

Alternating muscle contraction and relaxation during seizure activity

Present with a loss of muscle tone and consciousness, which can result in the client falling if they are standing

Maintains consciousness and partial awareness and brief muscle contractions or jerks
-May experience only one or a series

Benzodiazepines such as lorazepam, diazepam, and midazolam

Levetiracetam or barbiturates

-Often called a mini stroke
-A neurological dysfunction that occurs when the flow of blood to the brain is temporarily blocked

-Slurred speech
-Dizziness
-Headache
-Blurred or double vision
-One-sided weakness
-Aphasia
-FAST

F: Facial drooping - weakness or asymmetry of face
A: Arm weakness - numbness or weakness in one arm
S: Speech disturbance - slurring of speech
T: Time to call 911/activate stroke protocol - if one or more of these three manifestations are present

Muscle weakness on one side of the body

Loss of one-half of one's visual field, caused by a disruption in the central nervous system

-Prevent stroke or another TIA
-Initiating antiplatelet medication therapy

Occur when embolisms or plaques block arteries that supply the brain

Occurs when a blood vessel in the brain leaks or ruptures causing increased pressure on the brain

-Left hemiparesis and hemisensory loss
-Right visual field loss (hemianopsia)
-Aphasia

-Right hemiparesis and hemisensory loss
-Left visual field loss (hemianopsia)

A neurological condition that causes involuntary, inappropriate crying or laughing

Medications administered to break up or dissolve blood clots and improve blood through arteries or veins; also called thrombolytic

A build-up of cerebrospinal fluid within the brain which may cause increased pressure within the head

Mild, moderate, or severe
-GCS score 13-15=mild injury (sometimes referred to as a concussion)
-GCS score 9-12=moderate injury
-GCS score less than 8=severe injury

Injury occurs at the moment of the initial injury because of contact with the head or brain by a blunt or penetrating force

-Occurs hours or even days after initial injury
-Results from inflammation, vasospasm, and ischemia within the tissues

A mild head injury that may or may not cause temporary loss of consciousness and has manifestations including headache, blurred vision, fatigue, and amnesia of the event that caused the injury

A degenerative, progressive condition primarily caused by the gradual loss of cells in the substantia nigra of the brain. Manifestations include tremors, slow movement, stiffness, and problems with balance

Example: sumatriptan (imatrex)
-Causes vasoconstriction in large intracranial arteries
-Relieves migraines but does not prevent them

Example: sumatriptan (imatrex)
-May cause dizziness or drowsiness
-Notify provider immediately if chest tightness occurs during use
-Do not break or crush PO tablets

Example: sumatriptan (imatrex)
-Latex allergy (subcut route only)
-Patients with ischemic heart disease
-Uncontrolled hypertension
-Stroke or TIA

-Usually used for patients with migraines who have not responded to NSAIDs or other treatments
-Promotes prolonged vasoconstriction by stimulating alpha-adrenergic and serotonergic receptors

-Pregnancy/lactation

Chest pain, abdominal pain, paresthesia in extremities, gangrene

-Balance loss
-Eyesight changes
-Face drooping
-Arm weakness
-Speech difficulty
-Time to call 911

Total paralysis

Decreased sensation and spasticity (muscle stiffness)

-Right side
-Inability to recognize faces

-Right side
-Uncontrolled emotional outbursts

-Left side
-Language deficit which may be expressive or receptive

-Left side
-Difficulty swallowing

-Caumadin
-Interferes with synthesis of vitamin K-dependent clotting factors

Caumadin
-Contraindicated in pregnancy
-Effective levels reached within 3-5 days
-Assess for signs of bleeding
-Educate the patient about vitamin K rich foods (green foods, eggs)

PT and INR

-Paralysis in arms, trunk, and legs
-May be unable to breathe, cough, control bowel and bladder without assistance
-Requires 24-hour care

-Usually impacts trunk and lower extremities
-Little to no control of bowel and bladder but can manage voiding with equipment

-Impact to hips and legs
-Little to no control of bowel and bladder but can manage voiding with equipment
-Patients with sacral injuries can most likely walk

-Partial: some feeling or sensation below the level of injury
-Complete: all feeling and movement below the level of the injury is lost

Paralysis of the legs and lower body

Paralysis below the neck that affects the arms and legs

Increasing the amount of dopamine or decreasing the amount of acetylcholine in the brain

-Stooped posture
-Slow, shuffling, and propulsive gait
-Tremors/pill-rolling tremor of the fingers
-Muscle rigidity (rhythmic interruption, mildly restrictive, total resistance to movement)
-Bradykinesia/akinesia
-Masklike expression
-Autonomic findings (orthostatic hypotension, flushing, diaphoresis)
-Difficulty chewing and swallowing

Carbidopa/Levodopa (sinemet)

Examples: Carbidopa/Levodopa (sinemet)
-Levodopa converts dopamine in the CNS
-Carbidopa prevents destruction of levodopa
-Onset within 10-15 minutes

Examples: Carbidopa/Levodopa (sinemet)
-Do not use with non-selective MAO inhibitors
-High-protein meals impair medication effects
-Monitor for GI upset, behavioral changes, impulsivity
-"wearing off effect" may occur after dose wears off

Pramipexole (mirapax)

Example: Pramipexole (mirapax)
-Decreases tremor and rigidity by stimulating dopamine receptors in the brain

Example: Pramipexole (mirapax)
-May be taken with dopaminergic medications
-May induce drowsiness or sleep attacks
-Orthostatic hypotension may occur; teach patient to change positions slowly
-Monitor for new or increasing compulsive behavior or signs of psychosis

Changes to the brain vasculature disrupts oxygen supply to brain cells

Deposits of protein block communication between neurons

-Rare form seen in clients who are less than 60
-Increase in proteins, causing loss of neurons
-Affecting frontal and temporal lobes with changes in behavior, language, and emotions

Inhibits acetylcholinesterase and makes more acetylcholine available
-Enhances cognition but does not cure Alzheimer's disease

-Takes weeks for efficacy to become apparent
-May cause dizziness
-Notify provider if nausea, vomiting, diarrhea, or changes in stool color occur

Binds to N-methyl-D-aspartate (NMDA) receptor sites, preventing the binging of glutamate, and excitatory neurotransmitter
-Increase in cognitive functioning may take months

-May cause dizziness
-Decrease dose in patients with kidney impairment

Enhances cognitive ability by inhibiting cholinesterase (reversible)

-Monitor for contact dermatitis after transdermal use, if observed switch to oral route
-May cause dizziness
-Notify health care professional of medication regimen before treatment or surgery

Manages hallucinations and delusions associated with Parkinson's disease psychosis

-Increased risk for mortality in older adults treated for psychosis related to dementia
-Risk for QT interval prolongation
-Two tablets once daily with or without food

A rare condition that occurs when the pituitary gland located at the base of the brain, is damaged due to severe blood loss during or after childbirth

-Inability to breastfeed
-Absense of menstrual periods
-Fatigue
-Low blood pressure
-Growth hormone deficiency
-Adrenal insufficiency

A surgical procedure that involves delivering a baby through an abdominal incision (laparotomy) and a uterine incision (hysterotomy)

-Infection
-Bleeding
-Longer recovery times compared to vaginal births

-Labor dystocia
-Fetal distress
-Abnormal fetal positioning
-Placental complications

-Employing cognitive and age-appropriate language
-Understanding the dynamics of the patient's family
-Assessing the patient's development stage

Patients are completely unaware of their surroundings, and it is a time of maximal parental anxiety

-Patients experience maximum stranger and separation anxiety
-Children in this age group are unable to understand processes and explanations
-They may exhibit significant postoperative emotional upset and behavior regression
-These patients are also vulnerable to magical thinking

Patients begin to understand processes and explanations however, their fear of separation remains, and they are concerned about body integrity

-Patients tolerate separation and understand processes and explanations
-May interpret everything in a literal sense
-May fear waking up during surgery or not waking up at all
-Adolescent patients are independent
-May have issues regarding self-esteem and body image
-As they are developing sexual characteristics, they may fear the loss of dignity and have a fear of the unknown