Spring 2017, Volume 8, Issue 2
Mr. D is a 70-year-old man in a skilled nursing facility who has suffered a stroke. He complains to the nurse that he’s having difficulty with numbers. The nurse would like to know more about issues that patients have with numbers following a stroke, so she consults Nursing Reference Center Plus, keying in the word “math.” She retrieves the quick lesson “Acalculia.”
The nurse reads about acalculia, including risk factors, signs and symptoms, potential complications, laboratory tests, treatment goals and interventions. Based on the information in the quick lesson, the nurse takes Mr. D’s history and performs a neurologic examination. She promotes cognitive and memory rehabilitation, and emotional well-being. She educates Mr. D and his family about acalculia.
Note: The above-referenced quick lesson is freely accessible to all readers of the EBSCO Health Nursing Newsletter.
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare type of headache that differs from other intermittent headaches because it is accompanied by autonomic symptoms. SUNCT syndrome is characterized by intermittent, brief episodes of moderate to severe pain in the orbital, periorbital, and/or temporal region, usually on only one side of the head. The pain is typically perceived as burning, stabbing, or shooting and is accompanied by autonomic symptoms of conjunctival injection (i.e., redness of the sclera caused by dilation of blood vessels) and lacrimation (i.e., tearing). Other autonomic symptoms associated with SUNCT syndrome are nasal congestion, rhinorrhea, forehead diaphoresis, and facial and/or ear erythema.
The symptoms of SUNCT syndrome are often refractory to long-term medical management. There are reports in the medical literature of early improvement in symptoms in response to use of carbamazepine, prednisolone, and/or sumatriptan, but none of these medications have demonstrated sustained, long-term benefits. Better long-term symptom relief has been seen with use of newer anticonvulsant drugs and with nifedipine or verapamil in some patients. Lamotrigine is considered the drug of choice for symptom relief at this time. Gabapentin and topiramate are second-line choices. Surgical treatment has been attempted in patients whose symptoms are refractory to medical treatment. According to the literature, local block of the greater occipital nerve has been helpful in a few patients and deep brain stimulation of the occipital nerve and hypothalamus has shown improvement in two patients. Gamma knife radiosurgery is being investigated as a possible treatment for SUNCT syndrome. Education and emotional support are essential components of the treatment plan, as patients with SUNCT syndrome can experience recurrent, distressing symptoms that interfere with daily functioning and that are difficult to manage.
Please log in to Nursing Reference Center™ or Nursing Reference Center Plus to read the quick lesson on “SUNCT Syndrome.”
Recently the Evidence-Based Care Sheet "Sclerosis, Tuberous, in Children" was revised following review under the Systematic Literature Surveillance Program. New information of value to nursing practice was found in a meta-analysis on tuberous sclerosis in children.
The authors of the meta-analysis concluded that rapamycin and rapalogs significantly reduce the size of these tumors and can delay or eliminate the need for resection.
We invite you to log in to Nursing Reference Center or Nursing Reference Center Plus to read updated content as it becomes available.