Degenerative Neurological Disorders

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Degenerative Neurological Disorders

  1. 1. Degenerative Neurological Disorders
  2. 2. Parkinson’s Disease <ul><li>4 th most common neurodegenerative disease </li></ul><ul><li>Most often idiopathic </li></ul><ul><li>Often presents in 5 th decade </li></ul><ul><li>Widespread degeneration of the substantia nigra </li></ul>
  3. 3. Review <ul><li>What are some of the suggested causes? </li></ul><ul><li>What neurotransmitter is affected? </li></ul><ul><li>What are the early signs? </li></ul><ul><li>What are the cardinal symptoms? </li></ul><ul><li>What will the individual manifest as the disease progresses? </li></ul><ul><li>How is the disease diagnosed? </li></ul>
  4. 4. Pharmacologic Therapy <ul><li>Actions </li></ul><ul><ul><li>↑ dopaminergic activity in corpus striatum </li></ul></ul><ul><ul><li>↓ excessive influence of cholinergic neurons on extrapyramidal tracts </li></ul></ul><ul><ul><li>Acts on neurotransmitter pathways </li></ul></ul><ul><li>Drug classes </li></ul><ul><ul><li>Dopaminergic </li></ul></ul><ul><ul><li>Anticholinergic </li></ul></ul><ul><ul><li>Dopamine agonista </li></ul></ul><ul><ul><li>MAOIs </li></ul></ul><ul><ul><li>Antiviral </li></ul></ul><ul><ul><li>COMTs </li></ul></ul><ul><ul><li>Antidepressants </li></ul></ul><ul><ul><li>Antihistamines </li></ul></ul>
  5. 5. Surgical Management <ul><li>Stereotactic Procedures </li></ul><ul><ul><li>Thalamotomy </li></ul></ul><ul><ul><li>pallidotomy </li></ul></ul><ul><li>Neural transplantation </li></ul><ul><li>Deep brain stimulation </li></ul>
  6. 6. Nursing Interventions <ul><li>Improving mobility </li></ul><ul><li>Enhancing self-care activities </li></ul><ul><li>Improving bowel elimination </li></ul><ul><li>Improving nutrition </li></ul><ul><li>Enhancing swallowing </li></ul><ul><li>Encouraging use of assistive devices </li></ul><ul><li>Improving communication </li></ul><ul><li>Supporting coping abilities </li></ul>
  7. 7. Amyotropic Lateral Sclerosis (ALS) <ul><li>Degenerative disease of unknown cause </li></ul><ul><li>Loss of motor neurons in anterior horns of spinal cord and the motor nuclei of the lower brain stem </li></ul><ul><li>Atropic changes seen in muscle fibers supplied by dying motor neuron cells </li></ul><ul><li>Can occur in both upper and lower motor neuron systems </li></ul>
  8. 8. Clinical Manifestations <ul><li>What will manifestations depend upon? </li></ul><ul><li>Chief symptoms: </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Progressive muscle weakness </li></ul></ul><ul><ul><li>cramps </li></ul></ul><ul><ul><li>Fasciculations </li></ul></ul><ul><ul><li>Incoordination </li></ul></ul>
  9. 9. Assessments and Diagnostics <ul><li>How is ALS diagnosed? </li></ul><ul><li>What diagnostic tests would you expect? </li></ul>
  10. 10. Management <ul><li>Supportive therapy </li></ul><ul><ul><li>Symptomatic </li></ul></ul><ul><ul><li>Rehabilitative </li></ul></ul><ul><li>What would be the goal of supportive therapy? </li></ul><ul><li>Durg Therapy: riluzole (Rilutek) </li></ul>
  11. 11. Questions <ul><li>Give some examples of medications for spasticity. </li></ul><ul><li>What is the expected outcome of this disease? </li></ul><ul><li>What care measures would you anticipate? </li></ul>
  12. 12. Degenerative Disk Disease <ul><li>Herniated (Ruptured) intervertebral disk: </li></ul><ul><li>“ rupture of the soft tissue that separates two vertebral bones into the spinal canal or adjacent spinal nerve roots. Herniation of intervertebral disks can cause back pain and, occasionally, loss of neurological function in the distribution of the affected nerves” </li></ul><ul><li>(Taber’s, p. 618) </li></ul>
  13. 13. Questions <ul><li>What do these terms mean? </li></ul><ul><ul><li>Radiculopthy </li></ul></ul><ul><ul><li>Sciatica </li></ul></ul><ul><ul><li>Spondylosis </li></ul></ul><ul><ul><li>What diagnostics would you expect? </li></ul></ul>
  14. 14. Management <ul><li>Medical– conservative treatment </li></ul><ul><li>Surgical— </li></ul><ul><ul><li>Discectomy </li></ul></ul><ul><ul><li>Laminectomy </li></ul></ul><ul><ul><li>Hemilaminectormy </li></ul></ul><ul><ul><li>Partial laminectomy or laminotomy </li></ul></ul><ul><ul><li>Discectomy with fusion </li></ul></ul><ul><ul><li>Foraminotomy </li></ul></ul>
  15. 15. Nursing Management <ul><li>What are the associated collaborative problems? </li></ul><ul><li>Care goals: </li></ul><ul><li>Relieving pain </li></ul><ul><li>Improve mobility </li></ul><ul><li>Monitoring and managing potential complications </li></ul>
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