MIGRAINE HEADACHES
Barbara is a 35-year-old black female who comes to theemergency department (ED) with a severe headache that has lastedover 4 days. At triage, Barbara appears to be in acute distress.Unable to find a comfortable position, she is holding her head inher hands while rocking back and forth. Barbara’s vital signs onarrival are temperature 98.6° F, pulse 90. respirations 28. andblood pressure (BP) 214/129. Barbara describes paresthesia on theright side of her body with some tingling and weakness in the righthand. She has a right facial droop. Barbara also complains ofhaving had nausea and vomiting for this same 4-day period.
Triage Assessment, Acuity Level IV: Appears in acute distress,describes “worst headache. ” BP diastolic >l 15, andneurological deficits.
Barbara is brought immediately to the treatment area where shedescribes visual changes with streaking, flashing lines that beganwith the onset of her headache. Barbara states that her menses justfinished prior to the onset of this attack, a usual precursor forher headache. Barbara also shares that she has been feeling”depressed” since she separated from her husband 2 months ago.Barbara’s past medical history includes diagnosed migraineheadaches with almost monthly visits to the ED. Hypertension anddepression are also chronic problems for her.
Barbara’s current medications include hydrochlorothiazide(HCTZ), verapamil, nortriptyline, Reglan, Phenergan, and Demerol.She is allergic to Compazine (seizures), Stadoi and Thorazine(syncope), Inderal (rash), codeine and Dilaudid (nausea). Barbara’sphysical assessment is normal except for the described neurologicaldysfunctions.
Barbara is placed in a room that is darkened and away from themain flow of activity. She is started on an intravenous solution ofnormal saline at 250 ml/hr. While in the ED. Barbara receives atotal of 450 mg of meperidine with 150 mg of Vistaril, all givenintramuscularly, before any relief of her headache and symptoms isobtained. When Barbara is released from the ED. no prescriptionsare given to her and she is instructed to have a follow-up with herprivate neurologist.
QUESTIONS AND ANSWERS
1. What are migraine headaches?
2. How is the diagnosis of migraine headache achieved?
3. What nursing diagnoses should be considered in this patientpresentation?
4. What are the medical and nursing care measures for thepatient with a migraine headache?
SEIZURES
Mr. H. is a 44-year-old white male who arrives in the ED afterexperiencing a generalized tonoclonic seizure at home, witnessed byhis fiancée. The seizure occurred approximately 1 hr prior toarrival. Mr. H admits to a long history of alcohol (ethanol) abuseand has experienced previous withdrawal seizures, although hedenies any history of delirium tremens or blackouts. He waspreviously on phenytoin, but has not been on it “for a long time. “Mr. H. states he drank 4 quarts of beer the previous evening. He isanxious and tremulous, and ambulates with a cane. Vital signs attriage are BP 170/100, pulse 112, respirations 28, and temperature37.6°C (99.6°F). Mr. H. is oriented to person, place, and time. butdoes not recall the President of the United States or othersignificant current events. Strength, sensation. and cranial nervesare intact, and reflexes are normal. However. Mr. H. has severegait ataxia and minimal end-gaze nystagmus. Finger-to-nosecoordination is slightly dysmetric. Sclera arc injected, and thereare significant dental caries. The neck is supple and lungs aredear: heart sounds reveal an S4 gallop. The abdomen is soft andnon-tender, with no masses or organomegaly. .Mr. H. denies anyillicit drug use, but smokes two packs of cigarettes a day.
Triage Assessment, Acuity Level III: Recent seizure activityand recent ethanol ingestion with history of alcohol withdrawalseizures: tremors; ataxia.
When Mr. H. is brought to the treatment area, a 1000 mlsolution of 5% dextrose and 0.45% normal saline is started at 125ml/hr with additives of 1000 mg thiamine, 0.2 mg folic acid, and 2g magnesium sulfate. Labwork is drawn simultaneously for a completeblood count (CBC), differential, electrolytes, calcium, magnesium,amylase, bilirubin, prothrombin time (PT), partial thromboplastintime (PTT), and ethanol level. Mr. H. is placed on a stretcher withside rails up in a well-lighted, high-observation area of the ED. Avest restraint is applied.
QUESTIONS AND ANSWERS
1. What nursing diagnoses are applicable to thispatient?
2. What is the basis for Mr. H.’s seizure and otherneurological symptoms?
3. How can it be determined that Mr. H.’s seizure isethanol-related? Isn’t it possible that idiopathic
epilepsy, head trauma, or other drug toxicities could be thecause of the seizures?
4. What nursing interventions would be appropriate to initiatein this situation?
Transcribed Image Text from this Question
MIGRAINE HEADACHES QUESTIONS ANDERS NAME SELURES QUESTIONS AND ANS
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