MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT, Exams of Nursing

Download MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT and more Exams Nursing in PDF only on Docsity! MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A Migraine Assessme nt  It is important that the patient characterize the headache by describing the duration, quality, and location of the pain. The presence or absence of any precipitating factors, or triggers, and the age at onset should be established. The presence of associated symptoms, such as nausea, vomiting, and photophobia, should be explored  A medication profile is essential and should include medications that have been tried in the past for headache control. If OTC medications are taken, the number used per month should be identified because patients may not view OTC drugs as medications.  A targeted physical examination is important in ruling out harmful secondary headache pathologies and confirms any information given in the history. 12 The examination findings in primary headache disorders are usually within normal limits. o Key aspects of the physical examination include a cardiopulmonary and complete neurologic assessment with a major focus on the following: ▪ • Funduscopic and pupillary assessment • ▪ Auscultation of the carotid and vertebral arteries • ▪ Mental status examination • ▪ Palpation of the head, neck, and temporal arteries • ▪ Evaluation for any neck stiffness, focal weakness, sensory loss and gait • ▪ Vital signs  Problem findings include: Onset of headache after the age of 50 years ▪ • Asymmetry of pupillary responses ▪ • Decreased deep tendon reflexes ▪ • Headache described as “the worst ever experienced” ▪ • Personality change ▪ • Onset of a new or different headache ▪ • Onset of a headache that progressively worsens MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A ▪ • Papilledema ▪ • Painful temporal arteries Diagnosis  The use of diagnostic studies depends on the results of the history and physical examination.  If the diagnosis is not clear or the history or physical findings are cause for concern, diagnostic studies should be used to distinguish primary headache from a secondary condition. Treatment  Nonpharmacologic measures attempt to control the headache without medication. These methods include behavior modification, biofeedback, acupressure, management of headache triggers, and a wellness program.  Preventive therapy is appropriate for patients if they are unable to deal with their attacks, they experience more than four headaches a month, or the attacks are prolonged and refractory to medicine. Preventive therapy is given daily and, if successful, will decrease headache intensity and frequency  For example, a connection has been shown between epilepsy and migraine; therefore anticonvulsants, such as divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax), can be used to control migraine  A patient with cold hands, Raynaud phenomenon, or hypertension may do well with calcium channel blockers, such as diltiazem (Cardizem) and amlodipine (Norvasc), which cause vasodilation and decrease blood pressure. o • A beta blocker, such as propranolol (Inderal) or atenolol, may be chosen for the patient with palpitations caused by mitral valve prolapse or panic disorders and should be avoided in those with asthma. MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A  Because dementia has no single standard test and is a disease of exclusion, the diagnostic evaluation should determine whether the patient has a reversible condition that may be contributing to or causing cognitive decline. The most important tests include a complete blood count (CBC), thyroid-stimulating hormone (TSH) concentration, vitamin B12 and folate levels, and a metabolic screen. Medications that have MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A measurable levels, such as digoxin, carbamazepine (Tegretol), theophylline, and divalproex sodium (Depakote), should be measured.  Imaging studies are useful in identifying mass lesions, vascular lesions, or infections but do not confirm a diagnosis of dementia. All guidelines recommend a baseline brain imaging study; a non–contrast-enhanced computed tomography (CT) scan is adequate. However, many providers prefer magnetic resonance imaging (MRI) because of its better resolution for patients with primary attentional or frontal temporal syndromes or if subcortical pathology or stroke is suspected. Treatment  Management of dementia depends on the stage of the disease.The goal of management includes treatment of all correctable factors that may impair cognition to improve daily functioning and to delay disability. Activities that promote and enhance cognition and social engagement are to be encouraged.  Although studies of vitamin E use in patients with Alzheimer disease have had mixed results, supplementation with 2000 IU of vitamin E daily is reasonable to consider in appropriate patients.  Two classes of drugs are currently approved by the U.S. Food and Drug Administration to treat the cognitive symptoms of dementia: the cholinesterase inhibitors and N-methyl- D-aspartate (NMDA) receptor antagonists. The cholinesterase inhibitors include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). These drugs can be used for the treatment of mild to moderate dementia for both Alzheimer disease and for patients with vascular dementia. The choice between them is based on cost, mode of delivery (patch, pill, or liquid), individual patient tolerance, and provider experience; efficacy appears to be similar. Memantine (Namenda) is an NMDA receptor antagonist that can be used in combination with a cholinesterase inhibitor for those with moderate to severe disease. Although these medications do not alter the course of dementia, they have been shown to delay or to slow worsening of symptoms. MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A  Depressive symptoms have traditionally been treated with antidepressants, even if the patient does not meet the criteria for major depression. In general, selective serotonin reuptake inhibitors (SSRIs) are preferred as the class of medications to use. Citalopram has been shown to improve other neuropsychiatric symptoms such as agitation and may be useful at doses not exceeding 20 mg/day.  what disease is this Treatment for? Just got home from work and would like to help? Study guide??  Dementia the disease name is listed right beside the assessment and each disease is followed by assessment, diagnosis and treatment Delirium  Assessment  In an attempt to identify the precipitating medical condition, a thorough review of systems and a comprehensive physical examination should be undertaken. This may be difficult, however, if the patient is unable to answer questions or to follow even simple commands. A detailed history from family members or other caregivers becomes critical in identifying the onset and development of symptoms and in establishing a sudden change in affect, cognition, or behavior. A neurologic examination is necessary to exclude trauma and focal signs suggestive of a central nervous system disturbance (e.g., traumatic brain injury, tumor, stroke, seizure).  Careful observation of the patient's gait, level of consciousness, speech, appearance, and interactions with others can be most helpful in establishing a diagnosis. Mental status testing is important to establish the degree of cognitive impairment but may have to be modified if the patient is unable to cooperate with the examination.  Assessment tools that have been developed specifically for the diagnosis of delirium include the Delirium Rating Scale–revised version 15 and the Confusion Assessment Method (Table 192-1). The Confusion Assessment Method is now the most widely used tool for evaluation of the presence of delirium. A delirium severity tool (CAM-S) has been developed and allows clinicians to monitor the patient's changing symptoms over time. 17 MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A often without, preceding loss of consciousness [1,44]. These symptoms may be apparent immediately after the head injury or may appear several minutes later [45]. It is important to emphasize that the alteration in mental status characteristic of concussion can occur without loss of consciousness. o Neurologic assessment — Patients should be asked to describe the incident in as much detail as they can, including the events leading up to the injury, and those that immediately followed it. This history can assess the degree of amnesia associated with the concussion. Symptoms should be specifically elicited; a symptom checklist, such as the one used in the Standardized Assessment of Concussion (SAC), can be helpful (table 2). An evaluation of mental status is required. Simple questions of orientation have inadequate sensitivity to detect mild TBI after head injury [62]. The mental status examination should include an assessment of short-term memory as well as attention and concentration. While standardized examinations can be used in this regard, most have not been validated for concussion diagnosis in the absence of a baseline score  Finally, a neurologic examination should include at minimum an assessment of cranial nerves III through VII (extraocular movements, pupillary reactivity, face sensation, and movement) as well as limb strength and coordination and gait.  Diagnosis  Cat scan may be done per current ct criteria. Some lab work can rule out other issues such as bleeding, etc in the acute setting. Dx of PCS is usually later and done purely on clinical basis  Treatment  Patients may be discharged home if observation is available and instructions are given on proper patient evaluation. • Patients with mild TBI and a negative head CT are also able to be discharged home with appropriate discharge instructions.  Patients should also be informed about the post-traumatic or postconcussion syndrome, which is not life- MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A threatening but may disable a patient for weeks to months to even years. Symptoms may include headache, tinnitus, memory loss, dizziness, giddiness, poor concentration, emotional lability, irritability, nervousness, disturbed sleep, fatigue, and decreased libido. Symptoms last for 2 to 6 weeks in most cases but can be present for longer. Treatment consists of rest, reassurance, and analgesics. It is also extremely important that patients return to work as soon as possible, even if a reduced workload is necessary. Athletes who are MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME, TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED DOWNLOAD TO SCORE A diagnosed with a concussion, however, should not be permitted to return to physical activity until the concussion has resolved Traumatic brain injury Assessment  The patient with head trauma can fluctuate from being awake and alert to being comatose and in respiratory distress. The initial evaluation should follow the standard protocol developed for all trauma patients. The patient's circulation, airway, and breathing and the cervical spine must be evaluated and stabilized. The initial observation should focus on the patient's level of consciousness, oxygen saturation, vital signs, and determination of GCS score. The extremities should be examined for injuries and symmetric movement. A quick but thorough neurologic examination is necessary to assess brain injury, focal deficits, and stability of the patient. The neurologic examination should include mental status, memory, concentration, cranial 220nerves, motor strength and tone, deep tendon reflexes, and, when possible, finger-to-nose test, deep tendon reflexes gait, and Romberg test. The skull must also be examined for fractures, penetrating injuries, lacerations, or CSF drainage. Clinical signs of skull fracture include raccoon sign (bruising around the orbit), Battle sign, and blood in the external auditory canal. It is also important to perform repeated neurologic examinations to determine whether the patient's condition is stable, improving, or deteriorating. However, normal neurologic examination findings do not eliminate the possibility of brain injury. The severity of injury and prognosis are indicated by the amount of retrograde or post-traumatic amnesia. Diagnosis  Pulse oximetry and continuous vital signs. • o Cervical spine x-ray examination, because patients with head injury can have an associated cervical spine fracture. o • Non-enhanced head CT scan or x-ray study is indicated for: o • Patients with a depressed or deteriorating level of consciousness, skull