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Download Neurology Ch. 65 - Porterville College
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Neurology Ch. 65 Management of patients with oncologic or degenerative neurologic disorders Brain Tumors Pathophysiology • Primary – Originating from the brain • Secondary – Originating outside the brain – Metastasis Brain Tumors • Malignant – Tend to become progressively worse – Anaplasia • Cell distortion – Invasive • Benign – No malignant or recurrent Brain Tumors • Presence of lesion • Compression of blood vessels • Ischemia • Edema • I-ICP Brain Tumors • Are brain tumors a disorder of the CNS, PNS or Both the CNS and PNS? A. CNS B. PNS C. Both CNS & PNS Primary-Brain Tumors Etiology • Unknown Brain Tumors Clinical manifestations • Depends on – Size – Location Brain Tumors 4 main S&S • I-ICP – – – – Cushing sign H/A Vomiting Visual disturbances • Seizures • Hydrocephalus • Alt Pituitary function • Cancer cells being attacked by immune system Brain Tumors Localized S&S • Frontal – Personality changes – Emotional changes • Occipital – Visual impairment – Visual hallucinations • Cerebellum – Impaired equilibrium – Impaired coordination Brain Tumors Diagnosis • CT • MRI Primary - Brain Tumors Medical management • Radiation • Chemotherapy • Pharmaceutical – Corticosteroids – Anti-convulsants • Surgery • Tug McGraw Secondary-Brain Tumor 3 treatment options • No treatment – Death < 1 month • Tx w/ corticosteroids only – Death < 2 months • Tx with radiation – Death 3-6 months Secondary-Brain Tumor Pharmacology • Corticosteroids – Dexamethasone – Prednisone • Osmotic Diuretic – Mannitol • Anti-convulsants – Dilantin • Morphine Brain Tumors Nursing Management • Aspiration • Alt. nutrition – Cachexia • Weak emaciate condition • • • • Neuro checks Photophobia Seizure precaution Anxiety Brain Tumors • • • What S&S are associated with frontal lobe, occipital lobe and cerebellum tumors? What diet would you expect a patient with brain cancer to be on? The S&S are associated with increase intracranial pressure? Brain Tumors • What are the difference between malignant tumors and benign tumors? • What does metastasis refer to? • What are risk factors of cancer? • What does remission mean or refer to? Parkinson’s Disease • First described by James Parkinson 1817 • A progressive brain disorder characterized by the degeneration of dopamine secreting neurons deep in the cerebral hemisphere in a part of the brain called the basal ganglia Parkinson’s Disease • Basal Ganglia – Controls movement • Dopamine – Inhibitory neurotransmitter in the basal ganglia • Acetylcholine – Excitatory neurotransmitter in the basal ganglia Parkinson’s Disease • Without dopamine, inhibitory influences are lost and excitatory mechanisms are unopposed • Neurons of basal ganglia are over stimulated • Excess muscle tone, tremors & rigidity Parkinson’s Disease • Is Parkinson's disease a disorder of the CNS, PNS or both the CNS & PNS? A. CNS B. PNS C. Both PNS & CNS Parkinson’s Disease Clinical manifestations • Onset – Abrupt • Age of on set – 60 • Men vs. Women – Men > women • First Symptom – Fine tremors in hands or feet Parkinson’s Disease 3 clinical signs • Tremors • Rigidity • Bradykinesia Parkinson’s Disease • Tremors – Resting tremor – i with activity – h tremor when… • Walking • Anxious – Sensation of heat – Calorie burning! Parkinson’s Disease • Rigidity – Stiffness • Neck • Trunk • Shoulders – Posture • • • • Head bowed Body bent forward Arms flexed Thumbs turned into palms • Knees bent (slightly) Parkinson’s Disease • Bradykinesia – Slow movement – Akinesia • Loss of movement • Esp face – Expressionless – Slow speech • Dysphonia – Dysphagia • Drooling Parkinson’s Disease • Bradykinesia – Gait • Shuffled • Festination – Fall forward d/t posture Parkinson’s Disease Diagnosis • S&S • Positive response to Levodopa Parkinson’s Disease Medical Management • h dopamine – (blood brain barrier) Parkinson’s Disease • Anti-Parkinsonian medications – Levodopa • Converts into dopamine in the basal ganglia • Works best in 1st few years of disease effectiveness wanes • S/E Dizzy (esp when first get up) get up slowly! Parkinson’s Disease • Anti-Parkinsonian medications – Sinemet • Prevents the breakdown of levodopa outside the brain Parkinson’s Disease Nursing Management • Assessment – Affect on ADL’s – Dysfunction – S/E of meds Parkinson’s Disease Nursing Management • Improving mobility – – – – – Exercise ROM Warm baths Massage PT • gait program Parkinson’s Disease Nursing Management • Enhancing Self-care – Encouragement – Adaptive devices – OT Parkinson’s Disease Nursing Management • Improving Bowel elimination – Constipation – – – – Bowel routine Fluids Fiber Raised toilet Parkinson’s Disease Nursing Management • Nutritional deficit – – – – – – Slow process Meds dry mouth Chewing & Swallowing Weights Supplement Dietician • FORK! Parkinson’s Disease Nursing Management • Enhance swallowing – Upright position – Semi-solid food – Thick liquids Parkinson’s Disease Nursing Management • Communication – Speak slow – Short sentences – Deep breath before speaking – SLP Parkinson’s Disease • • • • With PD it is known which neurotransmitter is lacking in the brain and scientists are able to duplicate this neurotransmitter. Why are we then unable to cure PD? PD type deterioration of the nerve cells of the brain reduces the amount of what neurotransmitter? Because of the inability to cure PD at this time, PD is frequently treated with which medications? What are the side effects of these meds? Parkinson’s Disease • To promote optimal functions, which activity could the nurse recommend as being beneficial to a patient with PD ? • What would be of value in helping a patient with PD communicate with the medical team? • Is PD a disease of the CNS, PNS or both? Parkinson’s Disease • During an assessment, what signs and symptoms can the nurse anticipate a patient with Parkinson’s to exhibit? • What nursing diagnosis would be priority for a patient with Parkinson’s? • Describe the muscle tone of a patient with Parkinson’s (medical terms) • What interventions can be used to address the issue of nonintention tremors? Huntington’s Disease • AKA – Huntinton’s Chorea • Pathophysology – Rare – Genetic • George Huntington Huntington’s Disease • The disease is characterized as degeneration of the cerebral cortex and the basal ganglia Huntington’s Disease – Which causes chronic progressive chorea • Bizzare involuntary dancelike movements – And mental deterioration – Ending in dementia and death • Loss of GABA (inhibitory neurotransmitter) Huntington’s Disease Clinical manifestations • Involuntary choreiform • Diminished during sleep • Facial tics/grimacing • Paranoia & hallucinations • Appetite – Ravenous • Emotions – Labile Huntington’s Disease Diagnosis • DNA testing Huntington’s Disease Medical management • No treatment • Meds to i tics – Chlorpromazine (Thorazine) • Meds to i hallucination, delusions, angry outbursts – Haloperidol (Haldol) • Anti-psychotics Huntington’s Disease Nursing Management • Family support • Diet • Ambulatory • Safety Huntington’s Disease • • • • • Is Huntington’s a disease of the CNS, PNS, or both? What dietary changes might be appropriate for a patient with Huntington’s disease? Describe the pathophysiology of Huntington’s disease. What is the etiology of Huntington’s disease? How is Huntington’s disease different from Parkinson’s disease? Huntington’s Disease • What medications are used to help with tics and uncontrolled movements associated with Huntington Chorea? • If a patient expresses suicidal thought, what are the correct nursing management interventions • Huntington’s Chorea is characterized by what (what does it look like)? • Name five nursing interventions for a patient with Huntington’s disease Amyotrophic Lateral Sclerosis Pathophysiology • Degenerative motor neuron disease that affects UMN & LMN lying within the brain, spinal cord and peripheral nerves • Lou Gehrig Amyotrophic Lateral Sclerosis • The myelin sheaths are destroyed and replaced with scar tissue Amyotrophic Lateral Sclerosis • Does not affect CN –3 –4 –6 • The patient is therefore able to – Blink – Move eye Amyotrophic Lateral Sclerosis • Cognition is left intact! Amyotrophic Lateral Sclerosis • Is ALS a disorder of the CNS, PNS or both the CNS and PNS? A. CNS B. PNS C. Both CNS & PNS Amyotrophic Lateral Sclerosis Etiology • Unknown • Men vs. Women – Men > Women Amyotrophic Lateral Sclerosis Clinical manifestations • Progressive muscle weakness • Atrophy • Spasity • Dysphagia • Dysarthria • Jaw Clonus • Tongue fasciculation Amyotrophic Lateral Sclerosis Clinical Manifestations • No sensory loss • Death within 5 years – Resp. failure – Bulbar paralysis Amyotrophic Lateral Sclerosis Diagnosis • S&S only – No dx screen Amyotrophic Lateral Sclerosis Medical Management • Baclofen (Lioresal) • Diazepan (Valium) – Spasticity • Mechanical Ventilator Amyotrophic Lateral Sclerosis Nursing Management • Respiratory • ADL’s • Nutritional support • Emotional support • Advanced directive Amyotrophic Lateral Sclerosis • • • • • • • Amyotrophic Lateral Sclerosis is manifested by what? What are the classic signs and symptoms of this disease? What are fasciculations? Amyotrophic lateral sclerosis effects UMN, LMN or both? CNS? PNS? Both? What is the treatment methodology for ALS? What is the pathophysiology of ALS? Herniated Disc • AKA – Ruptured disc – Slipped disc – Degenerative disc disease Herniated Disc • Anatomy – The interverterbral disc is a cartilaginous plate that forms a cushion between the vertebral body – Nucleus pulposus – Protrudes – Nerve compression Herniated Disc Etiology • Age • Trauma Herniated Disc Clinical Manifestations • Cervical – Location • C5-6 • C6-7 – Pain • Neck • Shoulder • ? Heart attack? Herniated Disc • Lumbar – Location • L4-5 • L5-S1 – Pain • Low back • Sciatica – Relieved with • Bed rest Herniated Disc Medical Management • Conservative - cervical – Immobilization • Collar – Isometric exercises – Pain relief • • • • Hot packs Analgesics Muscle relaxant med Anti inflammatory med Herniated Disc Medical Management • Conservative - lumbar – Bed rest • Firm mattress – Pain relief • • • • • Hot packs Analgesics Massage Muscle relaxant med Anti inflammatory med Herniated Disc Medical management • Surgery – lumbar – Turning • Log roll – Sitting • No sitting (except BR) – Complication • Failed Disc Syndrome Herniated Disc • • • • • • What are contributing factors to a Herniated disc? The center of the vertebral disc is called what? What are the most common sites for herniated disc? What is Sciatica? CNS? PNS? Both? What is the frustrating complication post surgery? Spinal Bifida Pathophysiology • Neural Tube defect • Incomplete closure of the vertebrae • 3 Levels – Spina Bifida Occulta – Meningocele – Myelomeningocele Spinal Bifida • Meningocele • Myelomeningocele Spinal Bifida Etiology • Folic acid deficiency during pregnancy – Esp 1st month Spinal Bifida Diagnosis • Ultrasound • h levels of fetal protein – Alpha fetoprotein Spinal Bifida • What food contain folic Acid? – – – – – – – – Greens Asparagus Broccoli Cauliflower Corn Green Beans or Peas Sweet Potato Cabbage or Coleslaw – – – – Black Beans Lentils Peas Peanuts • • • • • What deficit is associated with spina bifida? What diagnostic test is used to detect spina bifida invitro? Name three foods high in folic acid. Describe the difference between Spina Bifida occult, meningocele and myelomeningocele. CNS? PNS? Both?
