Clinical Manifestation and Pathophysiology of Migraine

Clinical Manifestation and Pathophysiology of Migraine

Migraine   October 25, 2013

Clinical Manifestation of Migraine

Migraine is a chronic condition. Most of the migraine attacks are also accompanied with another headache. Migraine headache is often described as a severe headache, throbbing and attacking head on one side. Some pain is felt in the forehead, around the eyes and behind the head so obscure symptoms with another headache. Although most of the migraine attack on one side of the head, but often also found symptoms of migraine headaches on both sides of the head. Side of the head migraines too often turns on every time attack. Be careful when the affected side of the head is always the same, another possibility is the occurrence of a brain tumor. Patients with migraine often tormented in performing daily activities, especially when the attack occurred. Other accompanying symptoms of migraine include, nausea, vomiting, diarrhea, facial pallor, cold hands feet, and the patient will be sensitive to light and sound. Due to an increased sensitivity to light and sound then migraine sufferers had to lie in a quiet and dark room. Migraine attacks usually subside within 4 to 72 hours.

Nearly 70% had a family history of migraine. Most of the women. The first attack in the migraine usually starts during adolescence and young adulthood, and then tended to decrease at the age of 5 and 6 decades. Usually there is a triggering factor. Patients generally have a perfectionist personality, rigid, and impulsive.
The clinical features of migraine is usually a throbbing headache but unilateral and bilateral or switched sides. Migraine attacks typically 2-8 times per month, once the attack duration between 4-24 hours or longer isa, moderate-severe pain intensity, accompanying symptoms, among others,: nausea, vomiting, photophobia and / or phonophobia, pale face, vertigo , tinnitus, irritable. On migraine with aura, the symptoms prodromalnya is skotomata.teikopsia (fortification spectra), photophobia (light flashes) paresthesias and visual hallucinations exhausted, feeling tired, very hungry and feeling nervous / anxious.
Headaches often appear at the wake, but it can happen at any time.


Pathophysiology of Migraine

Signs and symptoms of migraine on the result of cerebral cortical ischemia varying degrees. Typical attack starts with a scalp artery vasoconstriction and retinal blood vessels and cerebral. Extracranial and intracranial blood vessels dilated, which causes pain and discomfort. Studies suggest that arterial dilatation hyperpermeable and cause local inflammation that sterilize, which causes pain in surrounding areas and arterial dilatation. The state aims to enable existing substances in the blood vessels (histamine, serotonin, plasmokinin) who participated in cleaning the inflammatory reaction.

Migraine attacks commonly activate the sympathetic nervous going. The meaning of the sympathetic nerve is the nerve that is part of the human nervous system is responsible for controlling the body's response to stress and pain. Increased sympathetic nervous activity in the intestine causes nausea , vomiting and diarrhea. Sympathetic activity will also lead to slow gastric emptying resulting in drug delivery to the small intestine to be absorbed will also be hampered. Barriers to drug absorption that is the problem for people with migraine when administered orally administered drug. Increased sympathetic activity also decreases the flow of blood so that the skin will appear pale and cold. Increased neural activity will also lead to increased sensitivity to light and sound.

There are various theories that explain the occurrence of migraine.

Vascular theory, disruptions vasospasm causing cerebral blood vessels constrict, causing brain hypoperfusion which began in the visual cortex and spread forward. Continued deployment of frontal headache and cause phase begins.

Theory of cortical spread depression, which in the migraine threshold value decreases neuronal excitation of neurons so easily happen, then apply shortlasting depolarization wave, by potassium - liberating depression ( decreased release of potassium ) that results in a prolonged period of depressed neurons. Furthermore, there will be deployment of depression that would suppress the activity of neurons as it passes through the cerebral cortex.

Theory of neovascular (trigeminovascular), the vasodilatory effect NOS activity and NO production would stimulate the trigeminal nerve endings in blood vessels, releasing CGRP (calcitonin gene related). CGRP binds to its receptor on mast cells and will stimulate spending meningens inflammatory mediators that lead to inflammation of neurons. CGRP is also working on the cerebral arteries and the smooth muscle that will lead to increased blood flow. In addition, CGRP will work on post junctional second order neurons site that acts as the transmission of pain impulses.

5 Types of Migraine

5 Types of Migraine

Migraine   October 25, 2013

Migraine is a recurrent headache is idiopathic, with pain attacks lasting 4-27 hours, usually one-sided, throbbing nature, moderate-severe pain intensity, the more intense by regular physical activity, can be accompanied by nausea, photophobia and phonophobia. Migraines can occur in children with pain more often bifrontal location.

1. Classic Migraine

Preceded by a visual aura, a scotoma, flash of light, vision fireflies or black and white stripes, or blurred vision for 10-20 minutes. Then comes the headache, throbbing, unilateral, which is more severe, lasts between 1-6 hours. Will usually subside within 6-24 hours but sometimes longer. Accompanying symptoms are often encountered are nausea, vomiting, photophobia, phonophobia, irritable and malaise.

Classic migraine attack can be divided into three phases, namely:

1). Aura phase

When migraine with aura is connected, the aura can be more than 30 minutes and can give sufficient time for the patient to determine which drugs would be used to prevent attacks in the. This period is the manifestation of the characteristics of sensory, particularly visual disturbances (glare).

Other symptoms may occur in the presence of:

1. Pins and needles
2. Itchy feeling on the face and hands
3. Confusion being
4. A little weak on the extremities
5. Dizziness

Period aura, is associated with vasoconstriction without pain that begins with early physiologic changes characteristic of classic migraine. Cerebral blood flow studies conducted during the headache phase of migraine attacks showed that all reduced cerebral blood flow throughout the brain, with a further loss of autoregulation and CO2 responsiveness damage.

2). Headache phase

At the time of initial symptoms began to diminish, these symptoms followed by unilateral headache (two-thirds of patients) and pulsed. Severe headache and was not able to make and is often associated with photophobia, nausea, and vomiting. Duration of this state varies, with the distance of a few hours in a day or all day.

3). Recovery phase

Is the period of muscle contraction neck and scalp are associated with local muscle pain and tension. Fatigue and exhaustion are common physical cause back pain headaches. During the post-headache phase, the patient may sleep for a long time.

2. Common Migraine

Headache arise without any prior prodromal visual aura as the classic migraine and usually lasts longer.

3. Association Migraine

At this migraine, headache accompanied by transient neurological deficits, for example in oftalmoplegik migraine, hemiplegic migraine, and migraine with aphasia. Deficit neurogis This usually occurs prior to or after the headache (migraine association) or in the absence of headache (migraine dissociation).

4. Complicated Migraine

At this migraine, neurological deficit arising will settle due to cerebral infarction. Therefore, the constrictor phase should not be given so as not to aggravate the infarction.

5. Status Migraine

Is a migraine attack that lasts more than 24 hours due to sterile inflammation around the blood vessels are dilated.

Non- Pharmacological Therapies for Constipation

Non- Pharmacological Therapies for Constipation

Constipation   October 22, 2013

Constipation is a condition in which a person's bowel movement difficulty with normal daily pattern. At each state of constipation, causes of constipation should be correctly identified in order to determine the therapeutic approach. Causes of constipation can be as diverse as a low fiber diet or due to the consumption of drugs hypothyroidism.

Constipation is generally regarded as the usual health problems, experienced by many people, and generally they do the treatment themselves. Problems many people experience constipation problems are usually associated with a low fiber diet. Constipation is also often wrongly understood by the general public. Society generally considers that a bowel movement every day is important for health. And assume that the bowel is not routine every day will contribute to the accumulation of toxins and lead to somatic complaints varied. This misunderstanding resulted in the use of laxatives are less rational society.

To assess the condition of constipation, required an assessment of the following variables:

1. Frequency of bowel movements. Someone would otherwise be constipated if bowel frequency magnitude less than 3 times a week in women and 5 times per week in men.
2. The size and consistency of stools. A person with constipation requires 25% more time than usual for the number of defecation and fecal or fewer.
3. Symptoms as the sensation of defecation incomplete.

The following are some factors or conditions can cause constipation:

1. Diseases of the gastrointestinal tract; irritable bowel syndrome, diverticulitis, gastrointestinal disease above the anal and rectal disease, hemorrhoids, tumors, hernia, intestinal volvulus, syphilis, tuberculosis, worm infections, limphogranuloma, hirscprung's Disease
2. Metabolic and endocrine disorders; diabetes mellitus with neuropathy, hypothyroidism, pheochromocytoma, hypercalcemia, enteric glucagon excess.
3. Pregnancy; Emphasis intestinal motility, increased fluid absorption from the large intestine, decreased physical activity, dietary changes, lack of fluid intake, low fiber diet, the use of iron salts.
4. Neurogenic; central nervous system disease, brain trauma, spinal injuries kordata, central nervous system tumors, cerebrovascular accident, Parkinson's disease
5. Psychogenic; Psychogenic to ignore / postpone the urge to defecate, psychiatric disease.
6. Use of certain drugs

Signs and Symptoms

1. Signs and symptoms that need to be considered in knowing whether a person is constipated or not:
2. Keep in mind the condition whether the patient complained of a lack of volume conditions stool during bowel movements, stomach feeling full, pain during bowel movements.
3. Signs and symptoms such as hard stools, small or dry. Abdominal discomfort, pain, cramps, nausea and vomiting, headache, and fatigue.

Non- Pharmacological Therapies for Constipation

High Fiber Diet
Nonpharmacologic therapy is first-line therapy in the treatment of constipation by making dietary modifications to increase the amount of fiber consumed. Fibers that are part of the vegetable that is not digested in the intestines will increase stool bulk, liquid stool retention, and increase stool transit in the gut. With fiber therapy is the increased frequency of bowel movements and decrease pressure on the colon and rectum.

Patients are advised to consume at least 10 grams per day of crude fiber. Fruit, vegetables and cereals are examples of food rich in fiber. Raw bran contains about 40% fiber. In addition there are also medicinal product which is the mass of fiber-forming agents such as hydrophilic colloids psylium, methylcellulose or polikarbofil which can produce effects similar to those of high-fiber foods are available in the preparation of tablets, powders or capsules.

Surgery
In some constipated patients required surgery. This is because the presence of colonic malignancy or gastrointestinal tract obstruction that required bowel resection. Besides surgery is also necessary in cases of constipation caused by pheokromositoma.

Biofeedback
Most of the patients of constipation due to pelvic floor dysfunction benefit from the electromyogram biofeedback therapy.

Nursing Care Plan for Acute Tonsillitis

Nursing Care Plan for Acute Tonsillitis

Nursing Care Plan   October 20, 2013

Tonsillitis is an inflammation of the tonsils. according to the stage, tonsillitis is divided into three stages, namely:

1. Acute tonsillitis
2. Membranous tonsillitis
3. Chronic tonsillitis

Acute Tonsillitis
Acute definition is an inflammation of the tonsils and sudden in onset.

Etiology

1. Group A Beta-Hemolytic Streptococcal.
2. Pneumococcus.
3. Staphylococcus.
4. Haemophilus influenzae.

Pathophysiology

1. Inflammation of the tonsils caused by a virus.
2. Resulted in the formation of exudate.
3. Cellulitis tonsils and surrounding areas.
4. Peritonsilar abscess formation.
5. Tissue necrosis.

Symptoms

1. Sore throat and dysphagia.
2. Patients do not want to eat or drink.
3. Malaise.
4. Fever.
5. Breath odor.
6. Otitis media is one of the originators.

Management

1. Bed rest.
2. Provision of adequate fluids and light diet.
3. Giving medications (analgesics and antibiotics).
4. If there is no progress then the alternative actions that can be done is surgery.

Preparation operations may be undertaken

1. Laboratory tests (hemoglobin, leukocytes, bleeding time).
2. Give an explanation to the client, treatment and care after surgery.
3. Fasting 6-8 hours before surgery.
4. Give antibiotics as prophylaxis.
5. Give premedication ½ hours before surgery.

Assessment

1. Medical history factors associated with the occurrence of tonsillitis supporters , as well as bio - psycho - socio - spiritual.

2. Circulatory
Palpitations, headache during position changes, decreased blood pressure, bradycardia, body felt cold, pale extremities appear.

3. Elimination
Changes in the pattern of elimination ( urinary incontinence ), abdominal distension, bowel sounds disappearance.

4. Activity / rest
There is a decrease in activity due to body weakness, loss of sensation or parese / plegia , tiredness, difficulty in recuperating from muscle cramps or spasms and pain. The reduced level of consciousness, decreased muscle strength, general body weakness.

5. Nutrition and fluids
Anorexia, nausea and vomiting due to increased ICP ( intracranial pressure ), impaired swallowing, and loss of sensation on the tongue.

6. Nervous system
Dizziness / syncope, headache, decreased visual field wider / blurred vision, decreased touch sensation, especially in the area of ​​the face and extremities. Comatose mental status, weakness in the extremities, muscle paralise face, aphasia, dilated pupils, decreased hearing.

7. Comfort
Tense facial expressions, headache, restlessness.

8. Breathing
Shortened breath, inability to breathe, apnea, apnea onset period in breathing patterns.

9. Security
Fluctuations of temperature in the room.

10. Psychological
Denial, disbelief, anguish, fear, anxiety.