Module 10 Part 2

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Altered Mental Status
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1

Seizures: What?

* Brief disruption in the brain's electrical functions*

2

Tonic-Clonic Seizure: Petit mal or Grand mal

-Grand mal

- both brain hemispheres

3

Tonic-Clonic Seizure: S/s

Duration

-LOC, depressed respiration, tongue biting, Loss of bodily function

-Several seconds to minutes

-Post-ictal Period: ALOC min-hrs

4

Absence Seizures: Describe

Whats the hint?

duration?

-Petite mal

- "day dreaming" **hint**

- No LOC or post-ictal period

- usually 10-20 sec

-"person has full awareness after seizure but not during"

5

Absence Seizures: MC in what pt?

MC in children

6

Simple Partial Seizure: Describe

(bagels)

-usually due to isolated impulse in brain

- start suddenly & brief 60-120sec

- "still aware of whats going on. Smells bagels but no bagels around?

7

Simple Partial Seizure: Affects

-motor, sensory, autonomic, psychological

- consciousness is maintained& usually event is remembered in detail

8

Complex Partial Seizure: Often preceded by what?

Often preceded by a seizure aura (light headed, dizzy, halucination, confused)

9

Complex Partial Seizure: Is the person aware of whats happening?

-Not aware of whats happening and wakes up confused

10

Complex Partial Seizure: If you address the patient will you get a response?

No

11

Complex Partial Seizure: Impaired awareness

pt normally walks, but action was not planned

12

Complex Partial Seizure: Often seen after what event? and what can it progress to?

Brain injury, trauma or infection

Can progress to tonic-clonic seizure

13

Depression: Classification

5 days or more for 2 wk period everyday

14

Depression: SIGECAPS

Sleep

Interest

Guilty Feelings

Energy low

Concentration low

Appetite high or low

Psychomotor function low

Suicidal thoughts

15

Depression: Causes

NT deficiency

situational

drug induced

16

Depression: Tx

Therapy

Meds: valuate every 6 months if on anti-depressants

17

Schizophrenia: Causes

Familial

Genetic + Environment

18

Schizophrenia: S/s

-MC onset age

-Hallucinations: auditory, visual, tactile

-Paranoia

-MC 16-30yrs

- Onset rarely in children & after 45 yrs

19

Schizophrenia: Testing

-Clinical

-R/O other "physical" causes- drug abuse

20

Schizophrenia: Over production or underproduction of what NT?

Overproduction of dopamine

21

B1 Thiamine Function

Production of ATP

If low death and damage of neurons

22

What Syndrome is associated with low B1 Thiamine?

Wernicke-Korsakoff Syndrome

23

Wernicke-Korsakoff Syndrome: What?

Loss of brain function due to B1 thiamine deficiency

24

Wernicke-Korsakoff Syndrome: AKA what and why?

Aka " Wet Brain" - Alcoholism inhibits B1 absorption

25

Wernicke: What is affected?

Movement - irreversible

26

Korsakoff: What is affected?

Memory formation and bizarre behavior

- acute onset of memory impairment -amnesia

27

Wernicke-Korsakoff Syndrome: Causes

- Alcoholism

- Aids, Wt loss procedures

- POW's

- Hyperemesis gravidarum (extreme N/V)

28

Wernicke-Korsakoff Syndrome: S/s

**know on exam**

**confabulations: make up info they cant remember; pt believes what they are saying - not lying

**Eye twitch: Visual (Nystagmus)

-Coordinatio & memory changes

-Anterograde amnesia: Trouble forming new memories(long term black out)

29

Wernicke-Korsakoff Syndrome: Testing

- Low Thiamine (B1)

- Liver function test (confirm alcoholism)

- Pregnancy test

- TSH, T3, T4

- MRI may show tissue changes; not needed usually

30

Wernicke-Korsakoff Syndrome: Tx

-High dose of B1; stops destruction but does not repair damage

31

Stroke: What is it?

*decrease O2 to brain*

32

Stroke: Causes

-Ischcemic: thrombus/embolus

- Hemorrhagic: Dissected Aneurysm, subarachnoid hemorrhage

- TIA: "mini stroke" Due or a full on stroke soon

33

Stroke: Risk Factors

-HTN, Smoking(increase50%)

-Polycythemia, thrombocytothemia

-increase cholseterol(or decrease HDL-high density lipoprotein)

-Congestive heart disease, A-Fib, Pneumonia

34

Stroke: S/s

-Difficulty: walking, talking, vision, memory

- HA, Paresthias, Paralysis

35

Stroke: Testing

S-T-R-O-K-E

-CT/MRI, Carotid US

Speech

Tingling

Remember

Off-balance

Killer-Headache

Eyes

36

What disease is associated with too little of what NT?

Parkinsons: low dopamine

37

Parkinson's Disease: Physiology

*depletion of dopamine resulting in hypertonia(tremor & rigidity) & Akinesia*

-Loss of substantia nigradopamine - producing neurons

- Too much cholinergic activity in basal ganglia

38

Parkinson's Disease: S/s

-Always bilateral, but may involve only one sided early on

- Pill rolling: resting tremor

- Rigidity: cogwheel

-Bradykinesia/Akinesia

-Shuffling Gait: festinating gait

39

Parkinson's Disease: What happens in the basal ganglia

Not enough dopamine is being released

40

Parkinson's Disease: Tx

Levadopa: *Activation of cental dopamine receptors*

- Peripheral(outside dopamine receptor: N/V

- Dopa Decarboxylase Inhibitor(DDCI): Carbidopa cannot cross blood brain barrier

prevents peripheral conversion of levadopa to dopamine

41

Parkinson's Disease: Dopamine boosting drugs

increase dopamine, balance acetylecholine