Oxcarbazepine

iminostilbene - antiepileptic

partial and secondary generalized seizures

most common adverse effects = headache, dizziness and nausea

phenobarbital

bartbiturate - antiepileptic

schedule IV controlled substance

widely used for status epilepticus

control of febrile seizures

less commonly used for prevention 

most common adverse effect = sedation

once-a-day dosing

phenytoin (Dilantin)

Hydantoin

used as 1st line antiepileptic drug for many years

tonic-clonic and partial seizures

most common adverse effects = lethargy, abnormal movements, mental confusion and cognitive changes

valproic acid

unspecified antiepileptic

generalized seizures (absence, myoclonic and tonic-clonic)

most common adverse effects - drowsiness, nauses, vomiting, tremor, weight gain and transient hair loss

Carbamazepine

iminostilbene - antiepileptic

2nd most prescribed

1st line treatment for partial and generalized tonic-clonic seizures

may worse myoclonic or absense seizures

ethosuximide

succinimide - antiepileptic

uncomplicated absense seizures

Most common adverse effects = GI and CNS effects

gabapentin (Neurontin)

Miscellaneous antiepileptic

adjunct treatment of partial seizures and prophylaxis of partial seizures

CNS and GI symptoms

most commonly used for neuropathic pain

pregabalin

micellaneous antiepileptic

adjunct thearpy for partial seizures

most commonly used for neuropathic pain

CNS effects

lamotrigine

micellaneous antiepileptic

adjunct therapy for partial seizures with or w/o secondary generalization

CNS effects

tiagabine

micellaneous antiepileptic

adjunct therapy for partial seizures

CNS and GI symptoms

warm phase of peripheral nerve trauma

extremity is warm and skin appears flushed or rosy

cold phase of peripheral nerve trauma

after 2-3 weeks the skin appears cyanotic, mottled, or reddish-blue, feels cool compared to unaffected extremity 

2 classifications of drugs that tend to dry the eye and increase IOP

Antihistimines and decongestants

exophthalmos

protrusion of the eye

enophthalmos

sunken appearance of the eye

consensual response

constriction of both pupils when light is shown into just one eye

hyperopia

farsightedness

refractive error

light focues behiind the retina

myopia

nearsightedness

refractive error

light focuses in front of the retina

presbyopia

impaired near vision in middle aged and older adults

loss of elasticity of the lens

retinopathy

non-inflammatory eye disorder

leading cause of blindness

strabismus

both eyes do not focus simultaneously

eyes appear crossed

Cataract

increased opacity of the lens

most common eye disorder

glaucoma

intraocular structural damage resulting from increased IOP

Macular Degeneration

blurred central vision 

progressive degeneration of the center of the retina

PERRLA

Pupils equal, round, reactive to light and accomodation 

Epilepsy

2 or more unprovoked seizures 

acute symptomatic seizures

acute injury

i.e., head trauma or menigitis 

remote symptomatic seizures

without an immediate cause, but with an identifiable prior brain injury

i.e., hypoxia, stroke etc.

cryptogenic seizures

no clear cause

idiopathic seizures

genetic in origin

partial seizures

simple or complex

simple partial seizures

remain conscious 

Aura

can involve just one extremity 

complex partial seizure

loss of consciouness 1-3 min

will not remember the seizure

may begin with an Aura

may have automatisms 

Primary seizure

no underlying cause

secondary seizure

has underlying cause and you should treat the underlying cause

febrile seizure

typically occurs in infants and small children

lasts seconds to minutes

temp usually greater than 102 

usually occurs on 1st day of fever

pseudo seizure

always takes place in public 

acting out related to stress/anxiety

attention seeking behavior

status epilepticus 

medical emergency

longer than 5 min. or repeated seizures over a course of 30 minutes

types of genrealized seizures

tonic-clonic

tonic

clonic

absense

atonic

myoclonic

characteristics of generalized seizures

Loss of consciousness

impairment of motor funciton

no Aura

occur at anytime

interval between them = min, hours, weeks or even years

Tonic - clonic seizure

most dramatic

tonic phase - eyes roll up, loss of consciouness, fall if standing, 10-30 seconds, stiffness 

clonic phase - intense jerking, 30-50 seconds

no recollection of the event

absence seizures

sudden onset

brief loss of consciousness

blank stare

automatisms

usually 20+ events daily

last 5-10 seconds

will not remember event

atonic seizures

sudden, momentary loss of muscle tone

severe episodes = falls to ground face first

myoclonic seizures

sudden, brief contractions of a muscle or group of muscles

may occur singly or repeatively 

tonic seizures

sudden onset of increased tone

falls if standing

average duration = 10 seconds

clonic seizures

loss of consciouness 

decreased tone followed by jerking movements

1-several minutes

most useful tool for evaluating a seizure disorder

EEG

refractory seizures

the persistence of seizures despite adquate trials of 3 antiepileptic meds alone or in combination 

1st line drug of choice for in-hospital management of status epilepticus

IV diazepam or larazepam (Ativan)

2 vitamins that need to be taken with pehnobartbial or pheytoin 

Vitamin D and Folic acid

seizure precautions

safety first

airway

suction equipment

oxygen

IV access

siderails up

# 1 nursing diagnosis for seizures

risk for injury

treatment of peripheral neuropathy

treat the underlying cause

clinical manifestations of peripheral neuropathy

Motor = muscle weakness

Sensory = loss of sense of touch

"stocking glove effect"

paresthesias, aching, burning, shooting pain, "cold feet"

Nursing interventions are focused on ____(3)_____ for cognitive disorders

protecting pt. dignity 

preserving functional status

promoting well being

3 main cognitive disorders

delirium

dementia

amnestic disorder (don't learn about yet)

delirium 

distrubance of consciousness and a change in cognition that develop over a short period of time

4 cardinal features of delirium

acute onset and fluctuating course

inattention

disorganized thinking

distrubance of consciousness

Order of loss of orientation in delirium

time --> place --> person

illusions

errors in perception of sensory stimuli

can be explained to pt. 

hallucinations

false sensory stimuli

cannot be explained to pt.

autonomic signs seen in delirium

tachycardia, sweating, flushed face, dilated pupils and elevated blood pressure

# 1 nursing diagnosis for delirium 

Risk for Injury

SAFETY!!!

(fear is another common one)

overall outcome for pt. with delirium 

that pt. will return to the premorbid level of functioning 

dementia 

progressive deterioration of cognitive functioning and global impairment of intellect w/ no change in consciousness

AD = #1 dementia 

primary dementia 

irreverisble 

progressive

not secondary to any other disorder

secondary dementia

occurs as a result of some other pathological process

ocular dexter

right eye

Ocular sinister

Left eye

ocular uterque

both eyes

emmetropia 

perfect retraction of the eye

miosis 

papillary constriction

Mydraisis

papillary dilation 

age related functional changes of the eye

lens yellows

accomodation gradually lost

near point increases

far point decreases

color perception decreases

IOP increases <-- hint hint

Dry macular degeneration 

ischemic/blocked retinal capillaries

most common

diabetics 

wet macular degeneration 

increased growth of capillaries that leak

nursing concerns for pt's with visual impairments 

# 1 = safety

How well are they functioning?

Change in ADLs?

Most common type of hallucinations

auditory 

The four A's of schizophrenia

affect - expressions

associative looseness

autism - has a world that is the pt's (it is real to them)

ambivalence - cannot decide one way or the other

positive symptoms of schizophrenia

hallucinations

delusions

neologism - made up words

associative looseness

Negative symptoms of schizophrenia

apathy

lack of motivation

anhedonia - no pleasure

poor though processes

3 phases of schizophrenia

1. Acute - hospital setting

2. stabilization - group home, half-way house or nursing home

3. maintenance - prevents relapse

types of delusions

control

ideas of reference

persecution

grandeur

somatic

erotomatic

jealousy

anticonvulsants

prevent or reduce the severity of epileptic or other convulsive seizures

antiepileptic drugs

prevent or reduce the severity of epilepsy and different types of epileptic seizures, not just convulsive seizures

3 classes of antiepileptic drugs

barbiturates

hydantoins

iminostibenes

( and valproic acid )

3 major pharmacologic effects of antiepileptics 

increase threshold of activity in the motor cortex

acts to limit spread of a seizure discharge from its origin

decrease the speed of a nerve impulse within a given neuron 

commmon causes of status epilepticus 

sudden withdrawal from antiepileptic drugs

infections

acute alcohol or drug withdrawal

head trauma

cerebral edema

metabolic disturbances

apraxia 

inability to use objects correctly

aphasia 

inability to speak or understand language

anomia 

inability to find words

agnosia 

loss of sensory comprehension 

traumatic relocation syndrome 

over-reaction to any change by becomign excessively aggressive or abusive 

reality orientation 

appropriate for early AD or dementia 

validation therapy 

appropriate for moderate to severe AD or dementia

-staff member recognizes and acknowledges the pt's feelings and concerns

Raise the Siderails???

yes/no for Dementia ???

yes/no for seizures???

AD or dementia = no

Seizures = yes

Pharmacodynamics 

Biochemical and physiological effects of drugs on the body, which include the mechanisms of drug action and it's effect

Pharmacokinetics

the actions of the body on the drug

communication 

an interactive process between 2 or more people who send and recieve messages to one another

2 main principles that can guid the communication process during nurse-patient interview

clarity and continuity 

Therapeutic communication techniques

Using silence

active listening

listening with empathy

clarifying techniques

asking open and closed ended questions that elicit a patient response

clarifying techniques 

paraphrasing

re-stating

reflecting

exploring

non-therapeutic communication techniques

giving pre-mature advice

minimizing feelings

falsely reassuring

making value judgments

asking excessive questions

giving approval, agreeing

disapproving, disagreeing

changing the subject

attending behaviors

eye contact - culturally influenced

body language

intimate - 0-18 in.

personal - 18-40 in.

social - 4-12 ft.

public - 12 ft. or more

vocal quality

verbal tracking