Nursing Tips: Nervous

After a tonic-clonic seizure, a patient enters the "postictal phase," and may exhibit confusion, sleepiness, or agitation.

The most common seizure disorder in children is febrile seizures.

When performing a Snellen exam for visual acuity, an adult should stand 20 feet away from the chart, but a child should stand 10 feet from the chart.

A patient reporting a loss of central vision should be evaluated for macular degeneration.

Acetaminophen, a non-opioid analgesic, can cause hepatotoxicity in high doses. 

A child with meningocele or myelomeningocele is at risk for injury due to the exposed spinal cord. Cover the sac with sterile, saline-moistened, non-adherent dressing. Place infant prone with the hips flexed.

A child with meningitis is likely to have a fever, headache, nausea, vomiting, irritability, nuchal (neck) rigidity, photophobia, and + Kernig's and Brudzinski's signs. 

A key finding in Huntington's Disease is chorea, which is a type of abnormal and excessive involuntary movement. Tetrabenazine may be given to treat this symptom.

A key side effect of phenytoin (an anti-seizure medication) is gingival hyperplasia. Educate patients to maintain regular dental checkups.

A child with a head injury is at risk for elevated intracranial pressure (ICP). Nursing care to decrease ICP includes reducing hypercapnia by hyperventilating the patient, avoiding oral suctioning, keeping the HOB at 30 degrees, and keeping the head in a neutral/midline position.

A child with ADHD may be treated with CNS stimulants such as amphetamine mixtures or methylphenidate. 

A child who presents with an abnormal tuft of hair, a dimple, or a birthmark on the spine should be evaluated for spina bifida occulta, a form of spina bifida. Report these findings to the provider.

A child who appears to be frequently "day dreaming" or often exhibits blank staring, eye fluttering, lip smacking, or picking at clothes should be evaluated for absence seizures.

Key signs/symptoms of Autism: Lack of eye contact Repetitive motions/actions Delayed speech and language skills Strict adherence to routines Unusual eating or sleeping habits Digestive problems.

Extrapyramidal side effects (EPS) are common with Conventional Antipsychotics. Symptoms of EPS include: Dystonia, Parkinson's symptoms, Tardive dyskinesia, Akathisia.

Early signs of increased ICP in infants: irritability, high-pitched cry, poor feeding, “setting-sun” phenomenon, bulging fontanels, separation of cranial sutures.

Don't confuse clozapine with clonidine! Clonidine is an antihypertensive. Clozapine is an antipsychotic.

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Amitriptyline is a Tricyclic Antidepressant. "Amy tripped over a tricycle in the desert". Desert helps you remember anticholinergic side effects (urinary retention, constipation, dry mouth, blurry vision, photophobia, tachycardia)

ADHD medications cause decreased appetite and weight loss in children.

Diagnosis of meningitis is done by analyzing the patient's CSF (cerebrospinal fluid).

During a seizure, take these important nursing actions

If your patient has a halo traction device in place, make sure wrench/screwdriver are attached to the vest to release patient from the device in the event of an emergency.

Lithium is a mood stabilizer, used for Bipolar Disorder. Patients on lithium need adequate fluid and sodium intake! Diuretics, anticholinergics, NSAIDs are not recommended.

MAOIs are used to treat depression.

Important points about MAOIs: They interact with MANY other medications. Eating foods rich in tyramine can cause a hypertensive crisis. Foods rich in tyramine include aged cheese, avocados, bananas, red wine, salami/pepperoni, chocolate.

Valproic acid is an antiepileptic drug. Key side effect is hepatotoxicity! Carefully monitor liver lab values (ex: AST, ALT).

Sumatriptan is a medication used to treat migraines by causing vasoconstriction of the intracranial arteries. If a SUMO wrestler sits on your head, that will also cause vasoconstriction.

Zolpidem (Ambien) is used for insomnia. Zolpidem will help you catch some ZZZs...

Major risk factor for Reye's syndrome: Use of aspirin to treat fever associated with a viral infection.

Lithium: fine hand tremors are an EXPECTED side effect, coarse hand tremors indicate TOXICITY.

For patients taking SSRIs, watch for serotonin syndrome! Symptoms: agitation, hallucinations, fever, diaphoresis, tremors.

During a seizure, turn the patient to his/her side, loosen restrictive clothing, and DO NOT insert airway or restrain patient.