Headache (Management and Medication) Seizure( Mgt) CVA(Mgt) Aneurysm and AV mal.

(mgt) Meningitis( mgt) Encephalitis/ Brain abscess ( Mgt) Hydrocephalus (mgt) and (surgery) Head Trauma (Mgt and surgery) Uper motor neuron and Lower motor neuron (Mgt) Low back Pain (Mgt) Spinal cord tumor (Mgt) Spinal cord Injury (Mgt) Brain Tumor (Mgt) Trigeminal nerve (mgt) Bell s palsy (Mgt) Guillian Barre syndrome (Mgt) HLS (Mgt) Parkinsons Disease (Mgt) Myasthenia Gravis (mgt) Multiple sclerosis (mgt) Amniotropic Lateral sclerosis (mgt) 3 slides each disease Look for the management and pathophysiology. Ubrahan ni tanan management and patho.

HEADACHE
Management:

The patient needs to be reassured. Avoidance of any precipitating dietary factors (e.g. chocolate cheese) may be helpful. For patients taking oral contraceptives, changing the brand or stopping the drug may be required. During an attack: Antiemetics are often required to allow ingestion of other drug such as simple analgesics (e.g. paracetamol) or stronger analgesics (e.g. codeine-containing drugs). Attacks may be terminated by the use of 5-HT agonists. Ergotamine is now rarely used , because of more frequent side effects management: 1-stop drug abrupt or gradual 2-replacement with NSAIDs DHESTEROIDS TRIPTANS METACLOPRAMIDE CHLORPROMAZINE TCAs Ms RELAXANTS 3-relaxation techniques, biofeedback & reassurance4-Botulinum toxin A

Pathophysiology of migraine Genetic predisposition Channelopathy Cortical neuronal hyper excitability Cortical spreading depression Brain stem activation Trigeminal vascular activation

SEIZURE
Medical Management 1.Antiepileptic drugs (AEDs) may be used singly or in combination to increaseeffectiveness, treat mixed seizure types, and reduce adverse effects. 2. A wide variety of adverse reactions may occur, including hepatic and renal dysfunction,vision disturbances, drowsiness, ataxia, anemia, leukopenia, thrombocytopenia, psychoticsymptoms, skin rash, stomach upset, and idiosyncratic reactions. Surgical Management 1.Surgical treatment of brain tumor or hematoma may relieve seizures caused by these. 2.Temporal lobectomy, extratemporal resection, corpus callosotomy, or hemispherectomy may be necessary in medically intractable seizure disorders. Nursing Management 1.Monitor the entire seizure event, including prodromal signs, seizure behavior, andpostictal state. 2.Monitor complete blood count, urinalysis, and liver function studies for toxicity causedby medications. 3.Provide safe environment by padding side rails and removing clutter. 4.Place the bed in low position. 5.Do not restrain the patient during seizure. 6.Do not put anything in the patients mouth during seizure.

7. Maintain a patent airway until the patient is fully awake after a seizure. 8. Provide oxygen during the seizure if the patient becomes cyanotic. 9. Place the patient on side during a seizure to prevent aspiration. 10. Protect the patients head during the seizure. 11. Teach stress reduction techniques that will fit into the patient s lifestyle. 12. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation. 13. Encourage the patient to determine existence of triggering factors for seizures, such as skipped meals, lack of sleep, and emotional stress. 14. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check-ups, and visual examinations. 15. Encourage patient to follow a moderate lifestyle routine, including exercise, mental activity, and nutritious diet.

PATHOPHYSIOLOGY OF SEIZURE: NERVOUS SYSTEM

ETIOLOGY

PREDISPOSING FACTORS - an electrical disturbance - idiopathic (genetic,in the nerve cells in one developmental defects)section of the brain, causing - acquired(hypoxemia,them to emit abnormal, vascular insufficiency,recurring, uncontrolled, fever (childhood), headinjury,electrical discharges hypertension, CNSinfections,metabolic and toxicconditions,brain tumor, drug andalcoholwithdrawal, and allergies) CELLULAR/ METABOLIC CHANGESGROSS ANATOMICAL PHYSICAL CHANGESPHYSIOLOGIC MANIFESTATION - when the integrity of the neuronal cell - involuntary movements may spread- epigastricsensations, pallor,membrane is altered, the cell begins firing centrally and involve the entire limb, includingsweating,flushing, goose fleshwith increased frequency and amplitude. one side of the face and

lower extremities. (piloerection),pupillary dilation,When the intensity discharges reaches thethe client also may exhibit changes in posture tachycardia,and tachypnea.threshold, the neuronal firing spreads toor spoken utterances