Chapter 23 Care of Patients with Brain Disorders

oligodendroglioma brain tumor

-location: cerebral white matter in frontal, parietal, temporal and occipital lobes -characteristics: malignant, seizure, headache, focal neurologic deficits

astrocytoma brain tumor

-location: cerebrum -characteristics: most common glioma, malignant, subdivided into 4 grades depending on how likely to spread

meningioma brain tumor

-location: dura, external to brain tissue -characteristics: slow growing, benign,

glioblastoma multiforme brain tumor

-location: frontal and temporal lobe -characteristics: malignant, rapid growth, invasive, resistant to usual therapy, disruption of tumor blood supply which makes it difficult to deliver drugs to tumor

ependymoma brain tumor

-location: lining of ventricular system -characteristics: malignant, intracerebral tumors more common in children, spinal tumors more common in adults, seizures, s/s of increased ICP

metastatic brain tumor

-location: n/a -characteristics: malignant, mostly from breast, lung, kidney, thyroid and prostate carcinomas

cerebrovascular attack/CVA (stroke, brain attack) risk factors

-modifiable: smoking, using cocaine or other drugs, excessive alcohol use, heart disease (especially afib), diabetes, sickle cell disease, unhealthy diet, htn, high cholesterol, sedentary lifestyle, TIAs, oral contraceptives or HRT, obesity, atherosclerosis -nonmodifiable: age older then 65, heredity, prior stroke, race (african americans, hispanics, american indians and alaska natives have higher risk), gender (higher in women)

nursing management phases of pt with stroke

-phase 1: initial care -phase 2: rehabilitation efforts -phase 3: continuity of care

focal seizure classifications

-simple focal: -complex partial and automatisms: -partial seizures that become generalized

aneurysm

abnormal ballooning of an artery wall, can be congenital or caused by a weakening of the artery wall from chronic htn

encephalitis etiology and pathophysiology

acute inflammation of brain (serious and sometimes fatal), protect against mosquitoes and ticks (transmit disease), less common then meningitis, meningitis can progress to this when meninges and brain tissue is involved (meningoencephalitis), can occur with meningeal irritation and as a complication from chickenpox, measles and mumps, postviral encephalitis is an immune mediated disorder following the end of the viral infection by 2-12 days, herpes simplex 1 is common cause of non vector transmitted encephalitis, cytomegalovirus encephalitis is a complication in AIDS pts, once virus crosses blood brain barrier and enters neutral cells it disrupts normal neural function causing hemorrhage and inflammation in gray matter, severity can be mild or fatal, most common types of viral encephalitis in U.S. are caused by herpes simplex 1, west nile and enteroviruses, western equine encephalitis is seen in june and july,

focal seizures

affects only one part of the brain leading to localized sx

postictal assessment

after a patent airway is ensured length of time before regaining awareness, presence of lethargy, confusion, headache, speech impairment or muscle soreness, whether there was an aura before the seizure began, effects of the seizure on the pts vitals

seizures etiology

brain injury from a stroke, pressure from a brain tumor, infectious diseases with high fever, ESRD with uremia, toxicity, epilepsy, tetanus, sx of underlying illness, acidosis, electrolyte imbalance, hypoglycemia, hypoxia, water intoxication, alcohol or barbiturate withdrawal and high temp in children, can also occur anytime the brain is deprived of oxygen

epilepsy pathophysiology

chronic disturbance of the nervous system characterized by various types of persistent seizures that are the result of abnormal electrical activity of the brain, characterized by recurring seizures thought to be caused by a group of abnormal neurons firing spontaneously resulting in excessive excitation or loss of inhibition

bells palsy tx

close or patch over affected eye, artificial tears, corticosteroids (ineffective if delayed for more then 7 days), acyclovir, most recover completely within 6wks-3mo, can recur

brain disorders: brain abscess

collection of purulent material in a cavity within the brain, usually caused by bacterial infection thats traveled from the gums, teeth, sinus, ear or mastoid region to the brain, can form from bacteria introduced at the time of any type of head injury or cranial surgery, if not treated ICP will rise as abscess size increases, tell pts who get sinus infections with purulent drainage to seek tx if sx last more then a few days, antibiotics used to eradicate abscess, surgery may be required to drain abscess or relieve ICP

stroke complications: seizures

common complication because neural pathways are interrupted when blood flow is blocked or theres irritation of cerebral cortex from intracerebral bleed, type of seizure depends on area of brain involved and extent of intracerebral bleed or blockage of blood flow, generalized seizure may occur, treat with antiseizure meds

complications of brain tumors: seizures

common with primary and metastatic brain tumors, usually focal and treated with anticonvulsant meds, may be first clinical sign of brain tumor or occur during course of disease

arteriovenous malformation/AVM

congenital abnormality thats a tangled mass of malformed thin walled dilated vessels that form an abnormal communication between the arterial and venous systems, can leak causing intracerebral hemorrhage, vasospasms often occurs after intracerebral bleeding leading to ischemia of brain tissue and more neurologic impairment

meningitis expected outcomes, planning and implementation

conserve strength of pt, prevent seizures, promote healing, prevent infection using standard and droplet precautions, keep room quiet and dimly lit, allow as much rest as possible, mouth care q2h, monitor I&O, prevent dehydration, report excessive vomiting, frequent orientation if confused, support and reassure pt and family to reduce fear, once acute stage is over pt can gradually resume former activities,

generalized seizures: tonic

continued contraction of all muscles, body becomes rigid, loss of consciousness

epilepsy tx

control or eliminate cause, antiepileptic drugs, pt teaching, ketogenic diet, biofeedback, surgery, implanted vagus nerve stimulator,

The nurse who is caring for a patient following a stroke performs passive range-of-motion exercises on the patient. The patient asks why these exercises are so important. Which response by the nurse is accurate? a) "This helps the patient believe she is making some progress." b) "This helps overcome mood swings and crying spells." c) "This helps prevent fatigue from worsening." d) "This helps to strengthen and retrain muscles."

d) "This helps to strengthen and retrain muscles."

What is considered a nonmodifiable risk factor for a CVA? a) Weight b) Hypertension c) Elevated blood glucose d) Age

d) Age

A patient has been diagnosed with a cerebral neoplasm. What are the symptoms of a cerebral neoplasm? a) Long-term memory loss and paralysis b) Loss of muscle strength and paresthesia c) Grand mal seizure activity and facial paralysis d) Severe headache that wakes patient and visual problems

d) Severe headache that wakes patient and visual problems

When providing care to a patient on warfarin (Coumadin) therapy, intake of ________ is contraindicated. a) beets b) grape juice c) oranges d) cranberry juice

d) cranberry juice

bacterial meningitis causes

death more commonly, severe condition

bacterial meningitis etiology and pathophysiology

inflammation of the membranes covering the brain and spinal cord caused by an infectious agent (viruses, fungi, bacteria), fungal meningitis occurs mostly in pts with AIDS, meningitis immunization recommended, membranes become infected from infectious agents carried through bloodstream to membranes or brain tissue can become affected as infection in an area in the brain spreads, infection can spread from spinal cord or sinuses to the brain, infectious organisms enter the cranial vault by the bloodstream, through an opening in the skull from a head injury or surgery and by accidental introduction of infectious agents into the spinal canal during spinal puncture, commonly follows an upper respiratory infection, bacteria causing meningitis include strep pneumoniae or neisseria meningitidis (in children causative organism is haemophilus influenzae type B), organisms that cause meningitis produce bacterial toxins that damage the blood brain barrier increasing vascular permeability and cause cerebral edema which increases ICP, can cause permanent neurologic damage or death

brain tumor etiology

may begin in brain itself or begin in meninges, cranial nerves or pituitary gland, neoplasms within the confines of the skull are space occupying lesions and create problems of increasing ICP by compressing adjacent tissues

generalized seizure: absence

may last only a few seconds, onset is sudden, no aura or warning, no postictal sx, tend to affect children between ages 5-12 and disappear during pubert -s/s: twitching around eyes and mouth, remains standing or sitting and appears to have had no more then a lapse of attention or a moment of absentmindedness

brain disorders: cluster headaches

more common in men, not as common as migraines, causes the most severe headache pain, pain is abrupt onset usually lasting 30-90mins, may start during sleep, may recur several times a day, clusters usually last 2-3mo, idiopathic but trigeminal nerve is implicated, vasodilation occurs causing headache, believed that its caused by dysfunction of biological clock mechanisms of hypothalamus, alcohol can trigger -s/s: severe unilateral orbital, supraorbital or temporal pain accompanied by redness of conjunctiva of eye, tearing, nasal congestion, dripping nose, facial swelling, pupil constriction, ptosis (drooping) of eyelid, restlessness, paces, sensitive to touch -dx: hx, CT, MRI, angiography -tx: analgesics, oxygen by face mask, triptans, internasal lidocaine, oral ergotamine,

stroke prevention

surgical procedures, medical management of diseases that predispose person to CVA, angioplasty with stent placement, aneurysms and AVMs can be surgically corrected if found before rupture, medical preventative measures are aimed at eliminating or managing conditions that predispose a person to stroke, manage afib, control and manage htn, tx of heart disease, congenital heart defects, cardiac dysrhythmias and atherosclerosis, teach pts to seek assistance immediately when signs of stroke occur and it will decrease neurologic deficit, aspirin, antiplatelet drugs

trigeminal neuralgia tx

surgery, anticonvulsants, muscle relaxant, ablation (removal or destruction of body part or its function), microvascular decompression, rhizotomy (destruction of spinal nerve root), radiofrequency thermocoagulation, mechanical balloon compression, chemical injection, radiosurgery, peripheral neurectomy, nerve blocks

encephalitis tx

symptomatic with general supportive measures, maintain cardiac and respiratory function, maintain pts strength, promote healing, prevent complications, herpes encephalitis treat with antiviral IV acyclovir, measures to prevent seizures, high fever, delirium or altered LOC

bells palsy etiology

weakness or paralysis of muscles supplied by facial nerve, usually affects one side of face, usually occurs in people older then age 30, typically affects right side of face, believed to be caused by edema and ischemia that compress the facial nerve, herpes simplex 1 and herpes zoster, stress, exposure to cold and pregnancy most often in third trimester

clinical cues for brain infection

whenever a pt is admitted with sx of brain infection check skin thoroughly and question pt about recent hx of herpes lesions, if you find any or are told they were present within past several days notify provider immediately, herpes encephalitis can be fatal if not treated early (spreads from neural tissue to the CNS and can occur from reactivation of latent virus, if not treated before coma occurs death is almost certain)

medulloblastoma brain tumor

-location: cerebellum -characteristics: malignant, more common in children, alteration in balance and coordination

hemangioblastoma brain tumor

-location: cerebellum -characteristics: made up of blood vessels, contained within a cyst, produce erythropoietin, causes high number of circulating RBCs

bells palsy s/s

*numbness and partial or total paralysis of facial muscles suddenly or over a few days*, taste disturbance, eyelid on affected side loses its blink reflex, mouth droops, drooling

bacterial meningitis s/s

*sudden onset of fever, severe persistent headache thats aggravated by moving the head*, nuchal rigidity (pain and stiffness in neck when flexed), brudzinski sign, kernig sign, exaggerated deep tendon reflexes, irritability, photophobia, hypersensitivity of skin, (meningococcal meningitis accompanied by petechial rash covering chest and extremities, seizures, n/v), mental confusion, delirium, seizures, (deafness, paralysis, visual defects usually dont occur if dx and treated early)

acoustic neuroma brain tumor

-location: 8th cranial nerve -characteristics: benign, hearing loss, tinnitus, loss of balance, headache

generalized seizure classifications

-absence -myoclonic -clonic -tonic -tonic clonic -atonic -infantile spasms: usually caused by increased temp

Nursing care of a patient who just had a seizure includes which nursing intervention(s)? (Select all that apply.) 1. Assess for injuries. 2. Check the glucose level. 3. Reassure and reorient the patient. 4. Provide uninterrupted periods of sleep and rest. 5. Provide a 24-hour sitter.

1. Assess for injuries. 2. Check the glucose level. 3. Reassure and reorient the patient. 4. Provide uninterrupted periods of sleep and rest.

Intracranial tumors may be treated by several modes of therapy. What types of therapy are you likely to see? (Select all that apply.) 1. Insertion of tiny radioactive particles into the tumor 2. High oral doses of iron for 5 days, followed by a selenium infusion 3. Brain surgery where most or all of the tumor is removed 4. Chemotherapy through a reservoir that is placed between the scalp and the skull to get past the blood-brain barrier

1. Insertion of tiny radioactive particles into the tumor 3. Brain surgery where most or all of the tumor is removed 4. Chemotherapy through a reservoir that is placed between the scalp and the skull to get past the blood-brain barrier

A 21-year-old man complains of a sudden onset of fever, severe headache, and stiffness of the neck. You note a petechial rash over the chest and extremities. Which nursing action(s) would be appropriate? (Select all that apply.) 1. Institute Standard Precautions and droplet precautions. 2. Administer antibiotics as prescribed. 3. Maintain a quiet and dimly lit patient room. 4. Encourage active range-of-motion exercises. 5. Administer narcotic analgesics for headache and neck pain.

1. Institute Standard Precautions and droplet precautions. 2. Administer antibiotics as prescribed. 3. Maintain a quiet and dimly lit patient room.

Which are true regarding a stroke? (Select all that apply.) 1. Timing of treatment is important. 2. A fibrinolytic drug will be given. 3. Clinical signs and symptoms determine if the stroke ischemic or hemorrhagic. 4. A CT scan should be done within 20 minutes of arrival at the hospital. 5. It may occur as a complication of atrial fibrillation.

1. Timing of treatment is important. 4. A CT scan should be done within 20 minutes of arrival at the hospital. 5. It may occur as a complication of atrial fibrillation.

A patient has had a cerebrovascular accident. You assess the patient's readiness for transfer to another level of care. The patient continues to have agnosia and apraxia. These clinical findings indicate that the patient would: 1. require assistance with undertaking activities of daily living. 2. demonstrate independence in performing ordinary tasks. 3. prompt self to complete sequential tasks. 4. not understand verbal communication.

1. require assistance with undertaking activities of daily living.

You are providing care to a 60-year-old patient with trigeminal neuralgia, and you identify that pain is the priority problem. You anticipate: 1. assessing the level of pain based on facial expressions. 2. administering an anticonvulsant class of medication. 3. placing warm cloths on the face. 4. preparing the patient for surgery.

2. administering an anticonvulsant class of medication.

A man and his wife are sitting in their pajamas in the living room when the man cries out. He attempts to rise from his chair, but he falls when he discovers that the left side of his body has become paralyzed. The left side of his mouth and his left eye are drooping. What should his wife do? 1. Help him stand and walk to the car. She can drive him to the hospital because it is only 3 miles away. He will receive care more immediately than if the wife calls an ambulance. 2. Sit with him for an hour to see if his condition resolves. If it worsens, she should transport him to the hospital. 3. Call 911 immediately. The emergency team will be able to assess him, give supportive care, and transport him. 4. Assess his pulse and breathing. If he is in no immediate cardiac distress, she can help him change into street clothes before driving him to the hospital.

3. Call 911 immediately. The emergency team will be able to assess him, give supportive care, and transport him.

You determine that the appropriate problem statement for a patient with status epilepticus is Potential for injury due to seizure activity. An appropriate expected outcome would be: 1. Everyone will stay calm during the episodes. 2. The caregiver will stay with the patient during the episodes. 3. The patient will be free from any injuries associated with the seizures. 4. Standing orders will be obtained to medicate acute seizure episodes.

3. The patient will be free from any injuries associated with the seizures.

A patient is admitted to the urgent care center for complaints of an abrupt onset of severe headache. Clinical history indicates that symptoms started during sleep and recurred several times during the day. These symptoms suggest: 1. brain tumor. 2. migraine. 3. cluster headaches. 4. tension headaches.

3. cluster headaches.

Which patient statement indicates a need for further teaching on the prevention of seizures? 1. "I need to avoid situations that could potentially trigger a seizure." 2. "Alcohol can lower the seizure threshold." 3. "I must avoid becoming overly fatigued and should pace activities." 4. "I am less likely to have seizures during menstruation."

4. "I am less likely to have seizures during menstruation."

A patient who has epilepsy is to take phenytoin (Dilantin). What is an important teaching point that the LPN/LVN should include regarding this medication? a) The patient should have periodic drug levels drawn. b) The patient should regulate the dosage according to need. c) The patient should take the medication with juice containing vitamin C. d) The patient should take an extra dose of the medication before exercising.

a) The patient should have periodic drug levels drawn.

When reviewing the patient's medical record, you note a history of aphasia. When caring for the patient, you anticipate the patient likely has a) minimal speech activity. b) difficulty swallowing. c) difficulty speaking. d) altered vision in the left eye.

a) minimal speech activity.

epilepsy dx includes

EEG, H&P, MRI, 2 unprovoked seizures that are greater than 24hrs apart

TIA dx includes

EEG, MRI, CBC, check o2 levels

signs of stroke acronym FAST

Facial drooping, Arm weakness, Speech difficulty, Time to call 911

The classic three symptoms associated with encephalitis are a) stiff neck, photophobia, and lethargy. b) headache, fever, and nausea. c) vomiting, photophobia, and malaise. d) lethargy, fever, and anorexia.

a) stiff neck, photophobia, and lethargy.

stroke dx

MRI, EEG, brain scans, cerebral angiogram, transcranial doppler flow study, carotid artery doppler study, glutamate blood level tests, lumbar puncture

dilantin medication

check for liver damage, do liver function studies, watch for gum hyperplasia, see dentist every 3-6mo, stop tube feeding 2hrs before and after giving med

The nurse is providing teaching to a group of patients regarding CVA (stroke). The patients demonstrate an understanding of the teaching when listing which factors as being the possible cause of a stroke? Select all that apply. a) Cerebral thrombosis b) Cerebral encephalitis c) Cerebral hemorrhage d) Meningococcal meningitis e) Atherosclerosis of the arteries in the head and neck

a) Cerebral thrombosis c) Cerebral hemorrhage e) Atherosclerosis of the arteries in the head and neck

You are assigned to provide care for a patient who has a brain tumor. The nursing care plan includes the following diagnoses. Which of them is of the highest priority? a) Pain related to cerebral edema b) Impaired memory related to damaged cells from increased intracranial pressure c) Disturbed personal identity related to inability to work d) Anxiety related to prognosis

a) Pain related to cerebral edema

The physician prescribes medications to the patient to prevent seizure activity. Which medication will meet these criteria? a) Phenytoin (Dilantin) b) t-PA (Alteplase) c) Clopidogrel (Plavix) d) Aspirin (Ecotrin)

a) Phenytoin (Dilantin)

biofeedback techniques

aimed at teaching pt to maintain certain brain wave frequency thats not susceptible to seizure activity

foods that may trigger a migraine

alcohol, caffeine, chocolate, artificial sweeteners, monosodium glutamate, citrus fruits, meats with nitrates (bacon, salami, etc), salt, foods containing tyramine (peanuts, raisins, vinegars, soy sauce, aged cheese, yogurt, sour cream, chicken liver, sausage, bananas, avocados, pickled herring, fresh baked bread, pork, beans)

stroke pt implementation

amount of activity permitted a stroke pt during the initial acute stage depends on cause of stroke, if theres danger for continued hemorrhage from ruptured artery and resultant increase ICP physical activity will be limited, when theres no danger of further damage to the brain the pt is encouraged to become active as soon as condition is stabilized, consult speech therapist for swallowing study and devise a plan to improve swallowing, be sure pt has had evaluation to ensure intact swallowing before feeding orally, prevent complications by low molecular weight heparin injections and sequential compression stockings to prevent DVT, skin care to minimize risk for skin breakdown, PT and splinting to prevent contractures and spasticity, measures to prevent falls, to reduce recurrence of stroke identify risk factors and teaching begins to modify them

bacterial meningitis tx*

antibiotics that cross through blood brain barrier (anerobic and aerobic)

stroke nursing management

assess for risk of falls, institute preventions for falls, assess pain regularly, nutritional and dysphagia screening completed within 24hrs of pt being alert and awake, fatigue is a big problem so working with them to relearn walking, dressing or other activities keep session short and allow adequate rest periods between activities

The patient reports to the emergency department within minutes of the onset of symptoms consistent with a CVA. The physician is considering prescribing t-PA. Based on your understanding, this medication must be started within _____ hour(s) of the onset of symptoms. a) 1 b) 3 c) 4 d) 6

b) 3

The patient is being tested for herpetic encephalitis. Which finding in the cerebrospinal fluid will support the diagnosis? a) Moderately reduced white blood cell count and an increase in protein b) A slight elevation in white blood cell count and normal glucose level c) A normal glucose level and a marked decrease in protein levels d) A moderately increased white blood cell count and an elevated glucose level

b) A slight elevation in white blood cell count and normal glucose level

A patient has had a left-sided cerebrovascular accident (CVA). Which condition does the nurse expect the patient to have as a result of the CVA? a) Ataxia b) Aphasia c) Dyslexia d) Quadriplegia

b) Aphasia

The nurse obtaining an admission history for a patient recovering from a CVA finds a medication history including aspirin (Ecotrin). What should alert the nurse to a possible adverse effect of this drug? a) Nausea b) Epistaxis c) Hyperactivity d) Abdominal distention

b) Epistaxis

The patient has speech deficits after a suspected cerebrovascular accident (CVA). Based on your knowledge, which area of the brain has likely been affected by the attack? a) The parietal lobe b) The frontal lobe c) The occipital lobe d) The temporal lobe

b) The frontal lobe

The LPN/LVN is talking with a patient, who has epilepsy, when he begins having a tonic-clonic (grand mal) seizure. Which assessment(s) should the LPN/LVN make? Select all that apply. a) What the patient had eaten prior to the seizure. b) What the patient was doing prior to the seizure. c) What time the seizure began and how long it lasted. d) Whether body movements are unilateral and symmetrical. e) Which direction the patient's eyes turned during the seizure.

b) What the patient was doing prior to the seizure. c) What time the seizure began and how long it lasted. d) Whether body movements are unilateral and symmetrical. e) Which direction the patient's eyes turned during the seizure.

trigeminal neuralgia dx

based on pts hx and chief complaint and on tests to rule out a cerebellopontine angle tumor affecting the nerve, no test to confirm dx, no observable pathologic changes

generalized seizures: tonic clonic

begin with bilateral jerks of extremities, loss of consciousness, incontinence, danger of biting tongue, in postictal phase pt is confused and drowsy

ketogenic diet

beneficial in younger pts with difficulty controlled generalized seizures, provides sufficient calories from fats and proteins but produces a acidotic state that prevents seizure activity,

subarachnoid hemorrhage

bleeding in the brain below the arachnoid causing rapid onset of neurologic deficit, severe headache and LOC, the subarachnoid space is the location of CSF circulation, bleeding into the subdural space results in blood circulating through brain and spinal dural sac causing irritation and inflammation, a leaking cerebral aneurysm may cause severe headache or if bleeding is slower theres a more gradual progression of headache, neck stiffness and other neurologic signs such as blurred vision

complications of brain tumors: intracerebral hemorrhage

bleeding into the brain may occur as the tumor erodes blood vessels, depending on condition of pt, size of tumor and prognosis various measures to stop bleeding and reduce ICP is used

stroke assessment/data collection acute phase

breathing and respiratory rate, LOC, determine extent to which neurologic functions have been affected, use stroke scale to evaluate deficits, assess for hemiplegia and aphasia (aphasia usually indicates ischemia of left side brain cells accompanied by right sided hemiplegia), assess functional abilities to plan rehab goals, assessment and intervention for incontinence, immobility, aphasia, delirium, confusion and altered LOC, assess for ongoing new signs of neurologic impairment since stroke is at risk for recurrence

transient ischemic attack/TIA

brief interruption in blood flow by narrowed arteries and vascular occlusion by small emboli or vasospasm, also caused by recreational drugs that constrict vessels, warning of more serious neurologic event, risk of permanent brain injury if ischemia lasts less then 1hr, get thorough hx, defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction

The patient with trigeminal neuralgia asks the nurse if there is anything she can do to prevent future episodes of the disorder. Which response by the nurse is correct? a) "It is best if you speak with your physician about this condition." b) "Unfortunately, there is little you can do to prevent future episodes of pain." c) "Drinking very cold or hot liquids is frequently a trigger, so you should avoid both." d) "Surgery is the only form of treatment that will prevent this condition from recurring."

c) "Drinking very cold or hot liquids is frequently a trigger, so you should avoid both."

A patient is diagnosed with Bell's palsy. The patient is tearful and asks whether he will ever be the same. What response by the nurse is indicated? a) "Ask your physician." b) "You will have a complete recovery." c) "Most patients have a full recovery with time." d) "There is no way to be sure."

c) "Most patients have a full recovery with time."

The nurse is providing patient teaching to a 23-year-old female who has recently been diagnosed with epilepsy. The nurse should educate the patient that seizures are most likely to occur at which time in the patient's menstrual cycle? a) At the time of ovulation b) 1 week after menstruation c) At the time of menstruation d) 1 week before menstruation

c) At the time of menstruation

A patient is admitted to a rehabilitation facility following a brain injury that has resulted in dysphagia. While observing the patient and his wife, the nurse determines further instruction is necessary if which activity is performed? a) The patient sips from a cup rather than using a straw. b) The patient sits in his chair for 45 minutes after each meal. c) The patient tilts his head back when trying to swallow solid foods. d) The patient's wife places a teaspoon of food in the patient's mouth at a time.

c) The patient tilts his head back when trying to swallow solid foods.

TIA dx and tx

carotid duplex ultrasound, blood tests, MRI, EEG, angioplasty procedure with stent implantation or carotid endarterectomy, diet, lifestyle modification, meds to prevent platelet aggregation

viral meningitis

caused by enteroviruses, arboviruses, HIV and herpes simplex, disease is self limiting and managed symptomatically, more mild then bacterial meningitis, full recovery typically in 7-10 days but sometimes residual effects occur such as persistent headaches, mild mental impairment and lack of coordination

dangers of cocaine or methamphetamine use

causes vasoconstriction and brain ischemia, causes hemorrhage, causes a fivefold increase in the incidence of stroke (this incidence has greatly increased in young adults)

bacterial meningitis can cause

cell death of tissues, hypoxemia, hypoxia of tissues, septicemia, loss of blood flow to hands and feet leading to gangrene and death or amputation

stroke s/s

depend on location of clot or bleed and type of event that caused stroke, weakness (hemiparesis), paralysis (hemiplegia), difficulty or inability to speak or understand (dysarthria or aphasia), difficulty with vision, loss of balance or poor coordination (ataxia), decreased LOC, confusion, incontinence, increased ICP from bleeding into brain or edema around necrotic tissue -motor function deficits: mobility, respiratory function, swallowing, speech, gag reflex, self care abilities, flaccid muscle tone or spasticity, hyperreflexia -language disorders: expression and comprehension of spoken and written words, aphasia, dysphagia, dysarthria -emotional responses: crying, frustration, outbursts -memory and judgment: ability to learn -spatial perceptual deficits: may cause pt to neglect input from affected side of body (unilateral neglect), teach them to attend to body parts on affected side to prevent injury, homonymous hemianopsia (blindness in part of visual field of both eyes), difficulty judging distances, agnosia (inability to recognize an object by sight, touch or hearing), difficulty doing ordinary tasks, apraxia (inability to carry out learned sequential movements on command) making it difficult to regain independence -bladder and bowel incontinence: constipation, immobility, weak abdominal muscles, dehydration, diminished response to defecation reflex, inability to express needs, difficulty managing clothing,

brain tumor s/s

depend on location, may appear gradually or if its highly malignant fast growing type may appear suddenly, personality changes, disturbance in judgment and memory, loss of muscular strength and coordination, difficulty speaking clearly, headache awakening, vomiting, visual problems, signs of increased ICP, seizure activity

epilepsy tx includes

dilantin (teach pt specialized gum care, go to dentist frequently, gum hyperplasia, period blood tests for liver damage)

phase 3 stroke management continuity of care

discharge and referrals, visiting nurse, continued rehabilitation, can be cared for at home if family is available, sometimes placed in long term care if care is complex and beyond family capability,

protect against mosquitoes and ticks

during mosquito season wear repellant and protective clothing, prevent water from standing in containers around the home and property to discourage breeding, avoid being outdoors at dusk and night when insects are more likely to be out, use repellant and protective clothing in wooded areas, inspect skin for ticks after being outside

vaga nerve stimulation therapy

electrodes are placed around the vagus nerve and a connecting wire is tunneled under the skin to connect to the stimulator which is placed under the skin in the chest, the device acts as a pacemaker and provides small electric current for 30secs every 5mins that stimulates the brain to interrupt seizures

viral meningitis dx

examine CSF fluid to confirm, CBC shows increased lymphocytes, PCR test to detect virus specific DNA and RNA can dx CNS viral infection

trigeminal neuralgia planning and implementation

expected outcomes regarding pain control and triggers, instruct about expected actions and adverse side effects of meds, assess bone marrow and for hematologic reactions, assess for skin eruptions, monitor blood count and liver function for drug toxicity, assess for transient drowsiness, nausea, weakness and fatigue when taking baclofen, after surgery tell pt to avoid rubbing eye or exposing themself to foreign objects because the normal protective corneal reflex is no longer functional, should wear protective goggles when theres possibility of getting dust and debris in eyes and should blink eyes often to cleanse surface, dissection of second or third branches creates a risk for potential damage to oral mucosa and teeth (postop ice is applied to cheek for 3-4hrs), pt cant feel hot liquids and foods and can be burned, could bite inside of mouth without knowing or may have dental caries that wont cause pain, implement good oral hygiene and periodic dental exams,

another name for tonic clonic seizure

febrile seizure

status epilepticus tx

focused on supporting vitals and preventing injury, intubation and respiratory support, benzos

assessments of pts with TIA

get assessment of NIH stroke scale within 10mins of arrival, CT scan within 25mins of arrival and interpreted within 45mins, thrombolytic therapy administered within 1hr of arrival (period to initiate tx is within 4.5hrs of the onset of sx)

assessment seizures and epilepsy

get hx on kind of seizures they experience, if they have an aura before a seizure, what meds theyre taking and what measures are known to help prevent or assist during a seizure and after, assess triggers for seizures such as hyperventilation, bright lights, alcohol, drugs, fluid and electrolyte imbalance, lack of sleep and emotional stress, when caring for a pt during an acute illness observe them for tremors, unexplained sensory or motor changes, mental changes that indicate confusion or disorientation and restless or agitated behavior, in many cases a change in neurologic status of a pt can signal the possibility that a seizure may occur

brain abscess s/s

headache, fever, lethargy, confusion

viral meningitis s/s

headache, fever, photophobia, stiff neck

when seizures occur watch for

how long it lasted, movements, when it ended, what happened before, when it started, urinary incontinence, symmetrical or asymmetrical movements, what parts of body involved, where in body it began, which way eyes are moving, which side head turns, whether pt screams or cries out as it begins, evidence of repetitive movements (lip smacking, pill rolling, chewing, grimacing, tapping), evidence of vomiting, frothing at mouth or bleeding, if pt becomes cyanotic or apneic, level of awareness of pt, changes in skin color or profuse sweating

epilepsy dx

hx and actual s/s observed during seizure, thorough physical exam and tests, EEG, MRI, dx is made when metabolic abnormalities such as electrolyte imbalance, toxins, infection or other reversible causes are ruled out and 2 unprovoked seizures occur more then 24hrs apart

stroke complications: hydrocephalus

if blood has leaked into the ventricular system it interferes with resorption of CSF causing hydrocephalus, more common with subarachnoid hemorrhage, prevent increased ICP by shunting fluid out of the brain,

stroke complications: extension of hemorrhage or rebleed

if initial sx were caused by a leaking cerebral aneurysm rupture is a danger until the aneurysm is repaired, watch closely for neurologic signs and LOC to detect deterioration of pts condition because of further bleeding and raise in ICP, keep pt quiet and reduce outside stimuli

cerebrovascular attack/CVA (stroke, brain attack) pathophysiology

interruption of blood flow to a specific part of the brain, can happen hemorrhagic or ischemic, 2 mechanisms of strokes are cerebral ischemia and intracerebral hemorrhage, most common cause of stroke is cerebral ischemia -cerebral ischemia: ischemia of cells causes cellular necrosis and infarct, ischemia can be caused by vessel spasm, cerebral thrombosis (formation of clot in a cerebral artery) and embolus (traveling clot, fat, bacteria or tissue debris that lodges in a vessel occluding it) -intracerebral hemorrhage: blood vessel ruptures and leaks into brain tissue or an aneurysm or arteriovenous malformation in the brain leaks or ruptures, sustained htn can weaken blood vessels and lead to vessel rupture without aneurysm formation, bleeding may be within brain tissue or within the meningeal layers or both, bleeds occurring within brain tissue cause tissue damage, inflammation and swelling leading to increased ICP, caused by pressure on a blood vessel, aneurysm or arteriovenous malformation

generalized seizures

involve both sides of the brain and usually the whole body if motor sx are present, characterized by bilateral synchronous electrical discharges in the brain, no warning or aura, pt quickly loses consciousness and is unconscious for few seconds to several minutes

status epilepticus

irreversible brain damage, 5mins or more constant seizure, death can occur

cerebrovascular attack/CVA (stroke, brain attack) etiology

leading cause of disability and 5th leading cause of death, 34% of cases occur in people younger then 65

pituitary adenoma brain tumor

located in pituitary gland

generalized seizures: atonic

loss of body muscle tone that results in nodding of the head, weakness of knees or total collapse and falling, usually remains conscious

generalized seizures: clonic

loss of consciousness

bacterial meningitis dx*

lumbar puncture looking for CSF (will be milky including WBCs, protein and decreased glucose)

bacterial meningitis dx

lumbar puncture/spinal tap, examine CSF for number and type of organism present, gram stain to identify causative organism, CT scan, blood tests to rule out other disorders that mimic meningitis, blood cultures

phase 1 stroke management initial care

maintain adequate airway, establish baseline data regarding vitals, LOC, neuromuscular function and neurologic status, preserve joint and muscle function, prevent complications that may interfere with rehabilitation

stroke tx

maintain open airway, IV meds and IV fluids, antihypertensives, temp control, alteplase, systemic tissue plasminogen activator, other meds, surgery, remove constricting clothes around neck, turn pt on side to prevent aspiration, dont move pt during stroke until ambulance arrives, reassure pt, elevate head to reduce ICP, give oxygen, intubation, mechanical ventilator, assess for hypoglycemia, use NIH stroke scale, obtain ECG and CT scan, draw blood for labs, rtPA used to dissolve clots and emboli in ischemic stroke (must be given within 3-4.5hrs of onset of sx), if pt meets criteria for thrombolysis rtPA is given IV bolus and rest of dose is infused over 1hr, percutaneous mechanical thrombectomy may be considered within 6hr of sx onset, aspirin, anticoagulants, if tPA is given dont give anticoagulants or antiplatelets for 24hrs (not given to anyone with a known risk of bleeding or has had an intracerebral bleed), antihypertensives, nimodipine, nifedipine, hypertonic saline, sedation, analgesic, monitor and control blood glucose levels, CT perfusion, angiography scans, thrombectomy using devices inserted percutaneously to trap and remove clot can be used up to 8hrs after onset of ischemic stroke, clot aspiration,

implementation seizures and epilepsy

maintain therapeutic blood levels of anticonvulsant meds, verify what meds the pt takes and when last dose was taken, nursing care involved immediate care during and after a seizure and long term management and control of seizures and psychosocial implications, when witnessing a seizure stay with the pt, call for assistance and remain calm, make sure environment is safe with padded siderails and headboard, never try to pry open the pts mouth or insert something into it once the jaw is clamping down because teeth may be broken and the airway can become obstructed, dont attempt to move the pt during a seizure, protect the head from injury by placing a rolled blanket or coat under it, turn their head to the side, remove glasses, dont restrain pt, loosen garments around the neck, give oxygen if possible, provide privacy if possible, afterwards check 02 sat, glucose levels and assess for injury, stay with pt until theyre completely conscious, when theyre conscious reassure and reorient them, allow rest and sleep after seizure, provide psychosocial support (most states allow resumption of driving when a pt has been seizure free for 1 year),

brain tumor tx

surgery (if tumor is in cerebrum a craniotomy is performed, a window flap of scalp and bone is cut and pulled down the dura is opened and tumor is removed, tumor in or near cerebellum are removed through an incision under the occipital bone), radiation, chemo

brain disorders: migraine headache

more common in women, thought to arise in nervous system altering constriction and dilation of cerebral vessels producing sx -s/s: attacks usually occur irregularly and may begin with an aura such as visual disturbances, pain usually begins on one side of the head and described as throbbing, often accompanied by n/v, sx may last for 4-72hrs, light or sound cause irritation and sensitivity -tx: intervention for acute pain, lie in dark quiet odor free room with eyes closed, cold compress to eyes, temples or occiput areas and find foods or other substances that trigger a migraine, complementary and alternative therapy (biofeedback, acupuncture, relaxation therapy, lifestyle adjustments, CoQ10, vitamin B2, magnesium, butterbur root extract, feverfew), if migraines occur at time of menses hormone therapy may be used, botox injected into neck and shoulder may help

brain disorders: headaches

most common cause of complaints of pain, commonly caused by allergy and related sinus problems or by tension or theyre vascular in origin, pain can be severe or minor, persistent headache requires testing to rule out organic problems such as anemia, brain tumor or cerebral aneurysm, can be caused by arthritis, cervical spondylitis and temporomandibular joint syndrome, tx for severe recurrent headaches begins with determining the cause and identify factors that precipitate the headache, mild headaches are usually relieved by rest and mild analgesic

brain disorders: tension headache

not as severe, quite common -s/s: neck stiffness, limited ROM of neck -tx: analgesics, muscle relaxants, tension reducing meds, relaxation techniques, massage, yoga, biofeedback

assessment/data collection for meningitis

note specific s/s, subjective and objective data relevant to each of pt care problems that accompany the disease such as seizures, elevated body temp, n/v, pain, increased ICP, fluid and electrolyte imbalance, ongoing neuro assessment for monitoring signs of increased ICP, changes in condition and response to tx each shift,

west nile infection sx*

nuchal rigidity and fever

trigeminal neuralgia assessment/data collection

observe pt between acute attacks to help identify clues to confirm presence of disorder, pts may not want to wash their face or shave, pt will guard their face or hold it immobile to avoid an attack, pt is sensitive to any contact with face and will indicate area of pain by pointing but never touching it, because chewing can provoke an attack pt may be susceptible to nutritional deficit, encourage small frequent feedings consisting of food thats moderately warm

complications of brain tumors: hydrocephalus

obstruction of CSF flow may require placing a shunt to reduce CSF pressure and prevent increased ICP, shunt tube is placed in a ventricle of the brain and attached to a valve system that opens when the pressure from fluid rises to drain excess CSF from the ventricles to the peritoneal cavity or into the atrium of the heart where its absorbed

focal seizures

only affect one part of the brain leading to localized sx

causes of bacterial meningitis

opening in skull from head injury, skull fx, surgery, spinal procedure, inner ear infection, spina bifida

seizure pt avoid*

overwhelming stress and fatigue, caffeine and flashing lights

focused assessment of a pt with a brain infection

perform each shift for areas including neuro check for increasing ICP including headache and LOC, stiff neck or paralysis, temp and monitor temp trend, electrolyte and fluid imbalance, skin turgor, mucous membranes, condition of lips, I&O, GI assessment, bowel sounds, distention, constipation, diarrhea, n/v, IV access site, skin condition, psychosocial concerns

encephalitis complications

permanent neurologic disabilities, problems with walking, paralysis, cognition, memory and self care, about 65% of survivors have long term problems

pts with hemiplegia

place call bell on unaffected side

brudzinski sign

place hand behind pts head and with other hand on chest gently flex pts neck forward by moving their chin toward the chest (positive if flexion of knees and hips when you flex the neck)

interventions to assist the pt to eat without aspirating

plan 30min rest and relaxation period before meals, allow time for relaxed meal, serve food cold or well warmed (lukewarm is difficult to swallow), serve food in consistency as ordered (some find semisolid easier to swallow), avoid giving PB, syrup, bananas, rice, popcorn, toast or crackers, keep containers for liquid more then 2/3 full so they dont have to tilt their head too much to drink

stroke pt planning/goals

planning for specific goals must take into account the pts previous lifestyle, age, general health or illness status and specific problems of care

brain tumor nursing management

routine neurologic assessments, ability to perform ADLs, pain assessment and control, help pt and family communicate fears and cope with situation,

ketogenic diet prevents

seizures

warning signs of stroke

sudden weakness, numbness, tingling or loss of feeling in face, arm or leg, sudden trouble seeing in one or both eyes, sudden confusion, slurred speech, trouble talking or difficulty understanding what others are saying, sudden severe headache for no known reason, sudden trouble walking, dizziness or feeling of spinning, loss of balance or coordination, blackouts

phase 2 stroke management rehab efforts

plans for rehabilitation should begin the moment the pt is admitted, various members of health care team collaborate with pt and family to help revolve physical and psychosocial problems, pts who have had strokes can be prone to rapid mood swings and spontaneous weeping, rehab and plans for self care are most important, proper positioning, ROM exercises for affected limbs, adequate nutritional and fluid I&O, prevention of pressure ulcers, use of devices to keep extremities in anatomic position, measures directed toward maintaining normal body functions until pt can do it on their own, teach pts how to deal with homonymous hemianopsia, teach pts with unilateral neglect to bathe both sides of body, show how to dress affected side first, weakened extremity must be positioned in correct alignment when pt moves, sling may be used to prevent shoulder subluxation of affected upper extremity, instead of feeding them every item let them hold finger foods suggesting they feed it themselves, dont hurry pt when chewing or let them chew to the point of exhaustion, provide privacy when eating due to it being difficult and messy, check mouth after meals for pocketing, have them brush teeth, wash face and hands and brush hair for arm/shoulder exercise, praise small accomplishments, keep in mind they become fatigued quickly when doing self care activities, maintain pts dignity, be patient and accepting

kernig sign

position pt supine, flex hip and knee at 90 degrees, slowly extend knee, (positive if pain behind knee)

encephalitis dx

presence of virus in CSF or bloodstream, PCR tests DNA and RNA levels in CSF allow early dx, MRI, PET, EEG, brain biopsy, herpes encephalitis shows elevated WBC, increase in protein and normal glucose levels

status epilepticus

prolonged partial or generalized seizure activity of 5mins or more without recovery between attacks, rapid unrelenting series of convulsive seizures without intervening periods of consciousness and an absence of respiration, irreversible brain damage can occur if the seizures arent controlled, medical emergency usually caused by abruptly stopping antiseizure meds

bells palsy dx

pt hx, exclusion of other neurologic or muscular disorders and lyme disease, if pt asked to raise eyebrows, eyebrow on affected side wont move, if pt asked to smile the face becomes distorted because the affected side of the mouth and face wont move normally

migraine medication safety alert

pts who take triptans for migraines shouldnt take antidepressants or mood disorder meds that are SSRIs or SNRIs because it increases serotonin levels which can be life threatening (sx of serotonin syndrome: restlessness, hallucinations, loss of coordination, tachycardia, rapid changes in BP, hyperthermia, overactive reflexes, n/v/d)

stroke deficits of right sided brain damage

quick and impulsive behavior, short attention span, neglects left side, easily distracted, left sided hemiplegia

trigeminal neuralgia/tic douloureux etiology and pathophysiology

rare facial pain syndrome related to pressure on the nerve root caused by abnormal loop of an artery or vein (in rare cases pressure caused by tumor or lesion of blood vessel), MS can be a factor, considered idiopathic, commonly affects people older then age 60, involves one or more branches of 5th cranial/trigeminal nerve, 3 branches of this nerve are mandibular, ophthalmic and maxillary, production of pain pain may be result of demyelination caused by compression of nerve leading to cross talk between nerves,

meningitis immunization

recommended for students entering college, encouraged for adults living in communal situation, spreads quickly when people are in proximity such as classrooms or dorms

pts with bacterial meningitis interventions*

reduce stimuli by turning lights off, dark quiet environment, look for impaired extraocular movements from increased ICP

epilepsy surgical tx

remove epileptic focus by focal cortical resection

trigeminal neuralgia s/s

severe facial pain described as sharp and intense lasting for 1-2mins located along pathway of one of the branches of the trigeminal nerve, pain localized to one side of face, can extend from midline of face across cheek and jaw to the ear, attacks usually triggered by exposure to drafts, light touch or vibration, drinking cold or very hot liquids, chewing, brushing hair, shaving or washing face, pain causes brief muscle spasm of facial muscles (the tic), between flare ups pt may experience no pain or dull ache,

most common sx of brain tumor*

severe headache that awakens you

pts with dysphagia how to prevent aspiration

sit up straight, tilt your head slightly forward, place 1tsp of food in mouth at a time, place food on unaffected side of mouth, place chin on chest and swallow wait a few seconds then swallow again, refrain from taking liquids and solids at same time, sip from cup or glass, dont use straw, remain upright 45-60mins after eating

brain tumor dx

skull xray, MRI, CT scan, PET scan,

stroke deficits of left sided brain damage

slow and cautious behavior, speech problems, aphasia, difficulty following verbal commands, apraxia, difficulty performing simple tasks, right sided hemiplegia

things to ask a person when signs of stroke occur

smile noting facial droop or asymmetry, hold arms out straight with palms up watching for arm drift, repeat a sentence or repeat what you say noting abnormal speech pattern (FAST: Facial drooping, Arm weakness, Speech difficulty, Time to call 911)

clinical clues meningitis

spinal fluid appears milky as a result of increased number of WBCs suspended in the fluid, CSF also has presence of protein and decreased amount of glucose

scotoma

spots in front of eyes during migraine

bacterial meningitis tx

successful tx and prevention of permanent disability depend on early recognition and prompt tx, antibiotics (common if 2 are used, IV followed by oral for 10 days), dexamethasone (with antibiotics, decreases inflammation, give prior to first dose of antibiotics to prevent damage from intense inflammatory reaction caused by substances released from bacteria killed), anticonvulsives, analgesics, acetaminophen, death occurs in about 25% of cases

bacterial meningitis s/s

sudden fever, severe headache, nuchal rigidity, brudzinki sign (positive if hip and knee flexes), kernig sign, rash starting on chest and spreads, *look for sepsis (sx: decreased BP, increased HR, edema, fever, hypoxemia, hypoxia, decreased urine output, begins with infection and ends with MODS or death, call doc)*

encephalitis s/s

sudden or insidious, behavioral and personality changes, decreased LOC, *stiff neck, photophobia, lethargy*, neurologic impairment (caused by direct infection of neural cells), *seizures, acute confusion, flaccid paralysis* (CNS signs usually appear 1-4hrs after onset of other sx), lethargy may progress to coma, altered mental status, motor or sensory deficits, speech or movement disorder, herpes simplex encephalitis may exhibit flulike sx that rapidly progress,

TIA s/s

sudden weakness or numbness on one side of body, slurred speech, inability to talk, visual disturbances (blindness, double vision), confusion, diminished coordination, inability to balance, headache (generally last no more then 1hr and resolve without residual deficits)

nursing implications for meds used for seizure control

take exactly as prescribed, can cause sedation, drowsiness and lethargy so warn about driving or operating machinery, dont drink alcohol or use other CNS depressants, dont stop taking meds abruptly, check interactions with other meds, avoid anticoagulants, oral contraceptives, digoxin, aspirin, antibiotics, antacids and folic acid, get blood work every 1-3mo, have narrow therapeutic range so toxicity occurs if too much of drug is taken, pt should be under close supervision of provider, can produce sx such as fever, leukopenia, gingival hyperplasia and rash, meds have toxic side effects such as ataxia, drowsiness, nausea, sedation and dizziness

CVA pt global aphasia*

talk to them slow rate, give instructions one step at a time, use flashcards with pictures

TIA affects

the brain, could be a warning sign that a stroke is coming

reasons for CVA

thrombosis or hemorrhage

observations to make during a seizure

time the seizure began and the time it ended, what the pt was doing just before the seizure, where in the body the seizure began/what parts of the body are involved, which way the eyes are moving/constrict or dilate/deviate to left or right or roll upward, which side the head turns toward, whether the pt cries out or screams as seizure begins, evidence of repetitive movements (lip smacking, chewing, grimacing, tapping, pill rolling), whether movements are bilateral and symmetrical, incontinence, vomiting, frothing at the mouth or bleeding, whether the pt becomes cyanotic or apneic, changes in skin color or profuse perspiration

education for pts with epilepsy

tx and side effects of anticonvulsant therapy, triggers for seizures and how to avoid them, necessity of taking meds daily and as close to the same time each day as possible, greatest risk for seizure is not taking meds, handling a missed dose or inability to retain meds, not using OTC or other prescribed meds without consulting provider, schedule lab work, need for medical alert bracelet, necklace or wallet card, resources available in community for assistance, need for proper nutrition, dangers of erratic meals, avoiding alcohol and excessive fatigue, relaxation therapy for stress reduction, danger of swimming alone, refrain from driving or operating heavy machinery until seizures are well controlled, understand nature of their disorder, purpose of meds and side effects, signs of toxicity that should be reported, understand compliance with prescribed regimen to prevent recurring seizures, assist in developing coping mechanisms to deal with psychosocial impact -for women: risk of seizure during menses, necessity of consulting provider before becoming pregnant -for family: what to do in event of seizure, how to protect pt during seizure (assist to floor, protect head, loosen clothes, turn to side), when medical assistance is necessary

seizure classification 3 key features

type of seizure at onset, awareness during the seizure and motor or other sx present

TIA sx resolve

usually within 1hr, at risk for CVA

postictal phase after seizure

watch for lethargy, confused, drowsy