Medical Surgical Nursing A Care of the Patient  With a Neurological Disorder
Anatomy and Physiology <ul><li>Central nervous system  (CNS) </li></ul><ul><ul><li>Brain </li></ul></ul><ul><ul><li>Spinal...
Anatomy and Physiology <ul><li>Neurons </li></ul><ul><ul><li>Transmitter cells </li></ul></ul><ul><ul><li>Carry messages t...
Anatomy and Physiology <ul><li>CNS: brain </li></ul><ul><ul><li>Cerebrum – lobe functions </li></ul></ul><ul><ul><li>Dienc...
Anatomy and Physiology <ul><li>PNS: Somatic (voluntary) </li></ul><ul><ul><li>31 pairs of spinal nerves  </li></ul></ul><u...
Anatomy and Physiology <ul><li>PNS: Autonomic (involuntary) </li></ul><ul><ul><li>Controls: </li></ul></ul><ul><ul><ul><li...
Neurological Assessment <ul><li>History </li></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Loss of function </li><...
Neuro Assessment <ul><li>Mental Status </li></ul><ul><ul><li>Orientation </li></ul></ul><ul><ul><li>Mood and behavior </li...
Neuro Assessment <ul><li>Level of consciousness </li></ul><ul><li>Glasgow Coma Scale  </li></ul><ul><ul><li>Eye opening </...
Neuro Assessment <ul><li>Language and Speech </li></ul><ul><ul><li>Aphasia </li></ul></ul><ul><ul><ul><li>Sensory </li></u...
Cranial Nerves <ul><li>I.  Olfactory </li></ul><ul><li>II.  Optic </li></ul><ul><li>III. Oculomotor </li></ul><ul><li>IV. ...
Neuro Assessment <ul><li>Motor Function </li></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Paresis </li></ul></ul>...
Neuro Assessment <ul><li>Sensory and Perceptual Status </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Touch </li></...
Neuro Assessment <ul><li>Blood and urine </li></ul><ul><li>ABG </li></ul><ul><li>Lumbar puncture </li></ul><ul><li>Imaging...
Neurological Problems <ul><li>Headache </li></ul><ul><ul><li>Vascular – migraine, cluster, hypertensive </li></ul></ul><ul...
Neurological Problems <ul><li>Increased Intracranial Pressure (IIP) </li></ul><ul><li>Occurs slowly or rapidly </li></ul><...
Assessment of IIP <ul><li>Subjective </li></ul><ul><ul><li>Diplopia </li></ul></ul><ul><ul><li>Personality change </li></u...
Assessment of IIP <ul><li>Objective </li></ul><ul><ul><li>Decreasing LOC </li></ul></ul><ul><ul><li>Hyperthermia </li></ul...
Assessment of IIP <ul><li>Diagnostic tests: </li></ul><ul><ul><li>CT scan, MRI </li></ul></ul><ul><ul><li>Close observatio...
Medical Management of IIP <ul><li>Craniotomy </li></ul><ul><li>Craniectomy </li></ul><ul><li>Tumor removal </li></ul><ul><...
Medical Management of IIP <ul><li>Medications </li></ul><ul><ul><li>Osmotic diuretics  - Mannitol </li></ul></ul><ul><ul><...
Nursing Care of the Patient With IIP <ul><li>Elevate HOB  </li></ul><ul><li>Neck in neutral position </li></ul><ul><li>Avo...
Neurological Disorders- Seizures <ul><li>Seizures  </li></ul><ul><ul><li>Disorderly neuron discharges in brain </li></ul><...
Seizures <ul><li>Generalized: </li></ul><ul><ul><li>Tonic-clonic –  grand mal </li></ul></ul><ul><ul><li>Absence - Petit m...
Seizures <ul><li>Causes: </li></ul><ul><ul><li>Hypoglycemia </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><l...
Seizure Medications <ul><li>Dilantin (Phenytoin) </li></ul><ul><li>Phenobarbital </li></ul><ul><li>Mysoline </li></ul><ul>...
Seizure Medications <ul><li>Nursing: </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Continue meds  </li></ul...
Seizures: Nursing Care <ul><li>Protect  </li></ul><ul><ul><li>Lower to the floor; pad side rails; pillow under head; don’t...
Degenerative Neuro Diseases <ul><li>Multiple Sclerosis </li></ul><ul><li>Parkinson’s Disease </li></ul><ul><li>Alzheimer’s...
Multiple Sclerosis <ul><li>Common degenerative neurological disease. </li></ul><ul><li>Myelin sheath is destroyed. </li></...
Multiple Sclerosis - Symptoms <ul><li>Subjective: </li></ul><ul><ul><li>Shakiness, difficulty walking </li></ul></ul><ul><...
Multiple Sclerosis - Symptoms <ul><li>Objective: </li></ul><ul><ul><li>Ataxia </li></ul></ul><ul><ul><li>Changes in behavi...
Multiple Sclerosis - Tests <ul><li>CSF </li></ul><ul><li>CT scan </li></ul><ul><li>MRI </li></ul>
Multiple Sclerosis-Treatment <ul><li>Meds: </li></ul><ul><ul><li>Anti inflammatory </li></ul></ul><ul><ul><ul><li>ACTH, So...
Multiple Sclerosis-Nursing Interventions <ul><li>Nutrition </li></ul><ul><li>Skin Care </li></ul><ul><li>Activity </li></u...
Parkinson’s Disease <ul><li>Unknown cause </li></ul><ul><li>Lack of dopamine. </li></ul><ul><li>Parkinsonism:  encephaliti...
Parkinson’s <ul><li>Symptoms include: </li></ul><ul><ul><li>Muscular tremors and rigidity </li></ul></ul><ul><ul><li>Emoti...
Parkinson’s Testing <ul><ul><li>No specific test to diagnose Parkinson’s </li></ul></ul><ul><ul><li>Diagnosis based on sym...
Parkinson’s – Medical Treatment <ul><li>Medications  </li></ul><ul><ul><li>Sinemet, Symmetrol, Levodopa or Cogentin </li><...
Parkinson’s – Nursing Care <ul><li>Prevent injury (fall or aspiration) </li></ul><ul><li>Prevent urinary retention and con...
Alzheimer’s <ul><li>Unknown cause, but genetic link </li></ul><ul><li>Very common; risk increases with age </li></ul><ul><...
Alzheimer’s - Symptoms <ul><li>1st– memory lapses, difficult word finding,  decreased attention span </li></ul><ul><li>2nd...
Alzheimer’s - Testing <ul><li>No definitive test </li></ul><ul><li>Family history  </li></ul><ul><li>Diagnosis: autopsy </...
Alzheimer’s – Medical Management <ul><li>Medication to treat symptoms </li></ul><ul><ul><li>Memory:Cognex, Aricept </li></...
Alzheimer’s – Nursing Care <ul><li>2 key points for all care: </li></ul><ul><ul><li>Prevent overstimulation </li></ul></ul...
Myasthenia Gravis <ul><li>Autoimmune disorder </li></ul><ul><li>Myoneural junction problem </li></ul><ul><li>Symptoms: </l...
Myasthenia Gravis - Treatment <ul><li>Medication </li></ul><ul><ul><li>to improve impulse transmission (Mestinon) </li></u...
Amyotrophic Lateral Sclerosis ALS – Lou Gehrig’s disease <ul><li>Motor neurons in brain stem and spinal cord degenerate </...
Huntington’s Disease Chorea <ul><li>Genetic </li></ul><ul><li>Onset at age 35-45  </li></ul><ul><li>Excessive involuntary ...
Huntington’s Disease <ul><li>Nursing interventions are palliative </li></ul><ul><ul><li>Give meds </li></ul></ul><ul><ul><...
Cerebrovascular Accident (CVA) <ul><li>Ischemia of brain tissue </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><l...
CVA – Contributing Factors <ul><li>Atherosclerosis </li></ul><ul><li>Heart disease </li></ul><ul><li>Kidney disease </li><...
Cerebral Thrombosis <ul><li>Most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><ul><li>Atheroclerosi...
Cerebral Embolism <ul><li>2nd most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><li>Heart disease <...
Cerebral Hemorrhage <ul><li>3rd most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><li>Hypertension ...
Transient Ischemic Attack <ul><li>Cerebrovascular insufficiency </li></ul><ul><li>Causes – same as CVA </li></ul><ul><li>W...
CVA - Assessment <ul><li>Motor changes </li></ul><ul><ul><li>Opposite side </li></ul></ul><ul><ul><li>Balance, coordinatio...
CVA Assessment <ul><li>Sensory Changes </li></ul><ul><ul><li>Aphasia =can’t speak or write </li></ul></ul><ul><ul><li>Agno...
CVA Assessment <ul><li>Cognitive changes </li></ul><ul><ul><li>denial </li></ul></ul><ul><ul><li>impaired memory, judgment...
CVA - Testing <ul><li>CT or MRI </li></ul><ul><li>Cerebral angiogram </li></ul><ul><li>CBC, PT, PTT, electrolytes </li></ul>
CVA – Medical Management <ul><li>Thrombolytic (“clot buster”) </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Antiplate...
CVA-Nursing Care <ul><li>Assess LOC </li></ul><ul><li>IV, NG, Foley, Vent.  </li></ul><ul><li>Nutrition </li></ul><ul><li>...
Trigeminal Neuralgia Tic Douloureux <ul><li>Trigeminal nerve – degeneration, pressure </li></ul><ul><li>Facial pain </li><...
Bell’s Palsy <ul><li>Facial nerve inflammation  </li></ul><ul><li>Unilateral weakness of facial muscles </li></ul><ul><li>...
Infection and Inflammation <ul><li>Meningitis </li></ul><ul><li>Encephalitis </li></ul><ul><li>Brain abscess </li></ul><ul...
Guillain-Barré - Polyneuritis <ul><li>Peripheral nerve disease </li></ul><ul><li>Prior infection; autoimmune response </li...
Meningitis <ul><li>Acute infection of the meninges </li></ul><ul><li>Viral or bacterial </li></ul><ul><li>Severe headache,...
Meningitis-Medical Management <ul><li>Diagnosed by LP </li></ul><ul><li>Medications  </li></ul><ul><li>Respiratory isolati...
Acquired Immunodeficiency Syndrome - AIDS <ul><li>AIDS dementia complex </li></ul><ul><li>Infection of CNS </li></ul><ul><...
Spinal Cord Trauma <ul><li>Complete cord injury – all voluntary movement below level of trauma is lost </li></ul><ul><li>A...
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Med Surg A Neuro Ppt

  1. 1. Medical Surgical Nursing A Care of the Patient With a Neurological Disorder
  2. 2. Anatomy and Physiology <ul><li>Central nervous system (CNS) </li></ul><ul><ul><li>Brain </li></ul></ul><ul><ul><li>Spinal cord </li></ul></ul><ul><li>Peripheral nervous system </li></ul><ul><ul><li>Somatic (voluntary) </li></ul></ul><ul><ul><li>Autonomic (involuntary) </li></ul></ul>
  3. 3. Anatomy and Physiology <ul><li>Neurons </li></ul><ul><ul><li>Transmitter cells </li></ul></ul><ul><ul><li>Carry messages to and from brain and spinal cord </li></ul></ul><ul><li>Glial cells </li></ul><ul><ul><li>Support and protect neurons </li></ul></ul><ul><ul><li>Produce cerebral spinal fluid </li></ul></ul>
  4. 4. Anatomy and Physiology <ul><li>CNS: brain </li></ul><ul><ul><li>Cerebrum – lobe functions </li></ul></ul><ul><ul><li>Diencephalon – thalamus, hypothalamus </li></ul></ul><ul><ul><li>Cerebellum – balance, coordination </li></ul></ul><ul><ul><li>Brain stem – midbrain, pons, medulla oblongata </li></ul></ul>
  5. 5. Anatomy and Physiology <ul><li>PNS: Somatic (voluntary) </li></ul><ul><ul><li>31 pairs of spinal nerves </li></ul></ul><ul><ul><li>12 pair of cranial nerves </li></ul></ul>
  6. 6. Anatomy and Physiology <ul><li>PNS: Autonomic (involuntary) </li></ul><ul><ul><li>Controls: </li></ul></ul><ul><ul><ul><li>Smooth Muscles </li></ul></ul></ul><ul><ul><ul><li>Cardiac Muscles </li></ul></ul></ul><ul><ul><ul><li>Glands </li></ul></ul></ul><ul><ul><li>Check and balance system: </li></ul></ul><ul><ul><ul><li>Sympathetic nervous system </li></ul></ul></ul><ul><ul><ul><li>Parasympathetic nervous system </li></ul></ul></ul>
  7. 7. Neurological Assessment <ul><li>History </li></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Loss of function </li></ul></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Numbness </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Personality change </li></ul></ul><ul><ul><li>Mood swing </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul>
  8. 8. Neuro Assessment <ul><li>Mental Status </li></ul><ul><ul><li>Orientation </li></ul></ul><ul><ul><li>Mood and behavior </li></ul></ul><ul><ul><li>General knowledge </li></ul></ul><ul><ul><li>Short term memory </li></ul></ul><ul><ul><li>Long term memory </li></ul></ul>
  9. 9. Neuro Assessment <ul><li>Level of consciousness </li></ul><ul><li>Glasgow Coma Scale </li></ul><ul><ul><li>Eye opening </li></ul></ul><ul><ul><li>Verbal response </li></ul></ul><ul><ul><li>Motor response </li></ul></ul>
  10. 10. Neuro Assessment <ul><li>Language and Speech </li></ul><ul><ul><li>Aphasia </li></ul></ul><ul><ul><ul><li>Sensory </li></ul></ul></ul><ul><ul><ul><li>Expressive </li></ul></ul></ul><ul><ul><ul><li>Global </li></ul></ul></ul>
  11. 11. Cranial Nerves <ul><li>I. Olfactory </li></ul><ul><li>II. Optic </li></ul><ul><li>III. Oculomotor </li></ul><ul><li>IV. Trochlear </li></ul><ul><li>V. Trigeminal </li></ul><ul><li>VI. Abducens </li></ul><ul><li>VII. Facial </li></ul><ul><li>VIII. Acoustic </li></ul><ul><li>IX. Glossopharyngeal </li></ul><ul><li>X. Vagus </li></ul><ul><li>XI. Spinal Accessory </li></ul><ul><li>XII. Hypoglossal </li></ul>
  12. 12. Neuro Assessment <ul><li>Motor Function </li></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Paresis </li></ul></ul><ul><ul><li>Flaccid </li></ul></ul><ul><ul><li>Spastic </li></ul></ul>
  13. 13. Neuro Assessment <ul><li>Sensory and Perceptual Status </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Touch </li></ul></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Proprioception </li></ul></ul><ul><ul><li>Unilateral neglect </li></ul></ul><ul><ul><li>Hemianopia </li></ul></ul>
  14. 14. Neuro Assessment <ul><li>Blood and urine </li></ul><ul><li>ABG </li></ul><ul><li>Lumbar puncture </li></ul><ul><li>Imaging </li></ul><ul><li>EEG </li></ul><ul><li>EMG </li></ul><ul><li>Carotid Duplex </li></ul>
  15. 15. Neurological Problems <ul><li>Headache </li></ul><ul><ul><li>Vascular – migraine, cluster, hypertensive </li></ul></ul><ul><ul><li>Tension – stress </li></ul></ul><ul><ul><li>Traction-inflammatory – infection, occlusion vessels </li></ul></ul>
  16. 16. Neurological Problems <ul><li>Increased Intracranial Pressure (IIP) </li></ul><ul><li>Occurs slowly or rapidly </li></ul><ul><li>May lead to brain stem herniation and death </li></ul>
  17. 17. Assessment of IIP <ul><li>Subjective </li></ul><ul><ul><li>Diplopia </li></ul></ul><ul><ul><li>Personality change </li></ul></ul><ul><ul><li>Thought processes change </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Nausea </li></ul></ul>
  18. 18. Assessment of IIP <ul><li>Objective </li></ul><ul><ul><li>Decreasing LOC </li></ul></ul><ul><ul><li>Hyperthermia </li></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Papilledema </li></ul></ul><ul><ul><li>Posturing </li></ul></ul><ul><ul><li>Wide pulse pressure </li></ul></ul><ul><ul><li>Bradycardia </li></ul></ul><ul><ul><li>Altered respirations </li></ul></ul><ul><ul><li>Pupils fixed & dilated </li></ul></ul>
  19. 19. Assessment of IIP <ul><li>Diagnostic tests: </li></ul><ul><ul><li>CT scan, MRI </li></ul></ul><ul><ul><li>Close observation </li></ul></ul><ul><ul><li>Craig’s screw </li></ul></ul>
  20. 20. Medical Management of IIP <ul><li>Craniotomy </li></ul><ul><li>Craniectomy </li></ul><ul><li>Tumor removal </li></ul><ul><li>Drainage of ventricles </li></ul><ul><li>Drainage of hematoma </li></ul><ul><li>Intubation </li></ul>
  21. 21. Medical Management of IIP <ul><li>Medications </li></ul><ul><ul><li>Osmotic diuretics - Mannitol </li></ul></ul><ul><ul><li>Corticosteroids - Decadron </li></ul></ul><ul><ul><li>Anticonvulsants - Dilantin </li></ul></ul><ul><li>Internal monitoring </li></ul>
  22. 22. Nursing Care of the Patient With IIP <ul><li>Elevate HOB </li></ul><ul><li>Neck in neutral position </li></ul><ul><li>Avoid flexion hips, waist and neck </li></ul><ul><li>Avoid isometric activity or Valsalva </li></ul><ul><li>Restrict fluids </li></ul><ul><li>Foley </li></ul><ul><li>Suctioning </li></ul><ul><li>O2 </li></ul><ul><li>Hypothermia blanket </li></ul>
  23. 23. Neurological Disorders- Seizures <ul><li>Seizures </li></ul><ul><ul><li>Disorderly neuron discharges in brain </li></ul></ul><ul><ul><li>Transitory </li></ul></ul><ul><ul><li>Different types affect body differently </li></ul></ul><ul><ul><li>Involuntary movement usually </li></ul></ul>
  24. 24. Seizures <ul><li>Generalized: </li></ul><ul><ul><li>Tonic-clonic – grand mal </li></ul></ul><ul><ul><li>Absence - Petit mal </li></ul></ul><ul><ul><li>Myoclonic </li></ul></ul><ul><ul><li>Atonic or akinetic </li></ul></ul><ul><li>Localized: (Focal) </li></ul><ul><ul><li>Partial (Jacksonian) </li></ul></ul><ul><ul><li>Psychomotor </li></ul></ul>
  25. 25. Seizures <ul><li>Causes: </li></ul><ul><ul><li>Hypoglycemia </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Electrolyte imbalance </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>IIP </li></ul></ul><ul><ul><li>Toxins </li></ul></ul>
  26. 26. Seizure Medications <ul><li>Dilantin (Phenytoin) </li></ul><ul><li>Phenobarbital </li></ul><ul><li>Mysoline </li></ul><ul><li>Tridione </li></ul><ul><li>Valium (Diazepam) </li></ul><ul><li>Depakene </li></ul><ul><li>Clonopin </li></ul><ul><li>Mesantoin </li></ul><ul><li>Neurontin </li></ul><ul><li>Lamictal </li></ul><ul><li>Felbatol </li></ul><ul><li>Cerebyx </li></ul>
  27. 27. Seizure Medications <ul><li>Nursing: </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Continue meds </li></ul></ul><ul><ul><li>Medic alert ID </li></ul></ul><ul><ul><li>Avoid alcohol, avoid driving, get adequate rest </li></ul></ul><ul><ul><li>If on Dilantin, instruct on oral hygiene </li></ul></ul>
  28. 28. Seizures: Nursing Care <ul><li>Protect </li></ul><ul><ul><li>Lower to the floor; pad side rails; pillow under head; don’t restrain </li></ul></ul><ul><ul><li>No bite block or padded tongue blade </li></ul></ul><ul><ul><li>Allow for post-ictal rest </li></ul></ul><ul><li>Prevent aspiration (airway) </li></ul><ul><ul><li>Turn side; loosen clothing around neck </li></ul></ul><ul><li>Document everything </li></ul>
  29. 29. Degenerative Neuro Diseases <ul><li>Multiple Sclerosis </li></ul><ul><li>Parkinson’s Disease </li></ul><ul><li>Alzheimer’s Disease </li></ul><ul><li>Myasthenia Gravis </li></ul><ul><li>Amyotrophic Lateral Sclerosis (ALS) </li></ul><ul><li>Huntington’s Disease (chorea) </li></ul>
  30. 30. Multiple Sclerosis <ul><li>Common degenerative neurological disease. </li></ul><ul><li>Myelin sheath is destroyed. </li></ul><ul><li>Symptoms vary. </li></ul><ul><li>Relapsing/remitting. </li></ul><ul><li>Usually ages 20-40. </li></ul>
  31. 31. Multiple Sclerosis - Symptoms <ul><li>Subjective: </li></ul><ul><ul><li>Shakiness, difficulty walking </li></ul></ul><ul><ul><li>Fatigue, muscle weakness </li></ul></ul><ul><ul><li>Numbness, tingling </li></ul></ul><ul><ul><li>Tinnitus </li></ul></ul><ul><ul><li>Visual problems </li></ul></ul><ul><ul><li>Difficulty chewing and speaking </li></ul></ul><ul><ul><li>Incontinent; impotent </li></ul></ul>
  32. 32. Multiple Sclerosis - Symptoms <ul><li>Objective: </li></ul><ul><ul><li>Ataxia </li></ul></ul><ul><ul><li>Changes in behavior & emotions </li></ul></ul><ul><ul><li>Nystagmus </li></ul></ul><ul><ul><li>Spasticity, tremors, dysphagia, facial palsy, speech impaired, fatigue </li></ul></ul><ul><ul><li>Incontinence </li></ul></ul><ul><ul><li>Impaired judgment </li></ul></ul>
  33. 33. Multiple Sclerosis - Tests <ul><li>CSF </li></ul><ul><li>CT scan </li></ul><ul><li>MRI </li></ul>
  34. 34. Multiple Sclerosis-Treatment <ul><li>Meds: </li></ul><ul><ul><li>Anti inflammatory </li></ul></ul><ul><ul><ul><li>ACTH, Solu Medrol, Prednisone </li></ul></ul></ul><ul><ul><li>Immuno Modifiers </li></ul></ul><ul><ul><ul><li>Avonex, Betaseron, Capoxone </li></ul></ul></ul><ul><ul><li>Muscle Relaxants </li></ul></ul><ul><ul><ul><li>Valium </li></ul></ul></ul>
  35. 35. Multiple Sclerosis-Nursing Interventions <ul><li>Nutrition </li></ul><ul><li>Skin Care </li></ul><ul><li>Activity </li></ul><ul><li>Control of environment </li></ul><ul><li>Emotional support </li></ul><ul><li>Patient teaching </li></ul>
  36. 36. Parkinson’s Disease <ul><li>Unknown cause </li></ul><ul><li>Lack of dopamine. </li></ul><ul><li>Parkinsonism: encephalitis, toxic chemicals, meds, drugs </li></ul>
  37. 37. Parkinson’s <ul><li>Symptoms include: </li></ul><ul><ul><li>Muscular tremors and rigidity </li></ul></ul><ul><ul><li>Emotional instability </li></ul></ul><ul><ul><li>Judgment defects </li></ul></ul><ul><ul><li>Heat intolerance </li></ul></ul><ul><ul><li>Mask-like facial appearance </li></ul></ul><ul><ul><li>Dysphagia and drooling </li></ul></ul>
  38. 38. Parkinson’s Testing <ul><ul><li>No specific test to diagnose Parkinson’s </li></ul></ul><ul><ul><li>Diagnosis based on symptoms </li></ul></ul>
  39. 39. Parkinson’s – Medical Treatment <ul><li>Medications </li></ul><ul><ul><li>Sinemet, Symmetrol, Levodopa or Cogentin </li></ul></ul><ul><ul><li>Less effective over time </li></ul></ul><ul><li>Surgery </li></ul><ul><li>Experimental </li></ul>
  40. 40. Parkinson’s – Nursing Care <ul><li>Prevent injury (fall or aspiration) </li></ul><ul><li>Prevent urinary retention and constipation </li></ul><ul><li>Patient teaching about medication </li></ul><ul><li>Patient and family support </li></ul>
  41. 41. Alzheimer’s <ul><li>Unknown cause, but genetic link </li></ul><ul><li>Very common; risk increases with age </li></ul><ul><li>Brain changes: </li></ul><ul><ul><li>plaques </li></ul></ul><ul><ul><li>tangled neurons </li></ul></ul><ul><ul><li>blood vessel degeneration </li></ul></ul><ul><ul><li>chemical changes </li></ul></ul>
  42. 42. Alzheimer’s - Symptoms <ul><li>1st– memory lapses, difficult word finding, decreased attention span </li></ul><ul><li>2nd – increased memory problems, disoriented to time, loses things, confabulates </li></ul><ul><li>3rd – total disorientation, apraxia, wanders </li></ul><ul><li>4th – severe impairment </li></ul>
  43. 43. Alzheimer’s - Testing <ul><li>No definitive test </li></ul><ul><li>Family history </li></ul><ul><li>Diagnosis: autopsy </li></ul>
  44. 44. Alzheimer’s – Medical Management <ul><li>Medication to treat symptoms </li></ul><ul><ul><li>Memory:Cognex, Aricept </li></ul></ul><ul><ul><li>Agitation: Mellaril, Haldol </li></ul></ul><ul><li>Supplements </li></ul><ul><ul><li>Folic Acid & Vitamin B12 </li></ul></ul><ul><ul><li>Low fat diet </li></ul></ul><ul><ul><li>NSAIDS </li></ul></ul>
  45. 45. Alzheimer’s – Nursing Care <ul><li>2 key points for all care: </li></ul><ul><ul><li>Prevent overstimulation </li></ul></ul><ul><ul><li>Provide structured, orderly environment </li></ul></ul><ul><li>Other concerns </li></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Family support and education </li></ul></ul>
  46. 46. Myasthenia Gravis <ul><li>Autoimmune disorder </li></ul><ul><li>Myoneural junction problem </li></ul><ul><li>Symptoms: </li></ul><ul><ul><li>ptosis, diplopia, </li></ul></ul><ul><ul><li>weakness, dysarthria, dysphagia, difficulty sitting up, respiratory distress </li></ul></ul>
  47. 47. Myasthenia Gravis - Treatment <ul><li>Medication </li></ul><ul><ul><li>to improve impulse transmission (Mestinon) </li></ul></ul><ul><ul><li>to suppress immune system (steroids, Cytoxan) </li></ul></ul><ul><li>Plasmapheresis </li></ul><ul><li>Respiratory support </li></ul><ul><li>Safety </li></ul>
  48. 48. Amyotrophic Lateral Sclerosis ALS – Lou Gehrig’s disease <ul><li>Motor neurons in brain stem and spinal cord degenerate </li></ul><ul><li>Brain’s messages don’t reach the muscles </li></ul><ul><li>Symptoms – weakness, dysarthria, dysphagia </li></ul><ul><li>No loss of cognitive function </li></ul><ul><li>No cure, death occurs in 2-6 years </li></ul>
  49. 49. Huntington’s Disease Chorea <ul><li>Genetic </li></ul><ul><li>Onset at age 35-45 </li></ul><ul><li>Excessive involuntary movements </li></ul><ul><li>Death in 10-20 years </li></ul><ul><li>No cure </li></ul>
  50. 50. Huntington’s Disease <ul><li>Nursing interventions are palliative </li></ul><ul><ul><li>Give meds </li></ul></ul><ul><ul><li>Provide for safety </li></ul></ul><ul><ul><li>Provide adequate diet </li></ul></ul><ul><li>Emotional support </li></ul><ul><li>Genetic counseling </li></ul>
  51. 51. Cerebrovascular Accident (CVA) <ul><li>Ischemia of brain tissue </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Thrombus </li></ul></ul><ul><ul><li>Embolus </li></ul></ul><ul><li>3 rd leading cause of death in the US </li></ul><ul><li>All ages, but usually elderly </li></ul>
  52. 52. CVA – Contributing Factors <ul><li>Atherosclerosis </li></ul><ul><li>Heart disease </li></ul><ul><li>Kidney disease </li></ul><ul><li>Hypertension </li></ul><ul><li>Obesity </li></ul><ul><li>High cholesterol </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>Stress </li></ul><ul><li>Sedentary </li></ul><ul><li>Diabetes </li></ul><ul><li>Oral contraceptives </li></ul><ul><li>Cocaine </li></ul>
  53. 53. Cerebral Thrombosis <ul><li>Most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><ul><li>Atheroclerosis </li></ul></ul></ul><ul><ul><ul><ul><li>↓ </li></ul></ul></ul></ul><ul><ul><ul><li>Thrombus </li></ul></ul></ul><ul><ul><ul><ul><li>↓ </li></ul></ul></ul></ul><ul><ul><ul><li>CVA </li></ul></ul></ul>
  54. 54. Cerebral Embolism <ul><li>2nd most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><ul><li>↓ </li></ul></ul></ul><ul><ul><li>Thrombus </li></ul></ul><ul><ul><ul><li>↓ </li></ul></ul></ul><ul><ul><li>Embolus </li></ul></ul><ul><ul><ul><li>↓ </li></ul></ul></ul><ul><ul><li>CVA </li></ul></ul>
  55. 55. Cerebral Hemorrhage <ul><li>3rd most common cause of CVA </li></ul><ul><li>Most often: </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><ul><li>↓ </li></ul></ul></ul><ul><ul><li>Ruptured cerebral blood vessel </li></ul></ul><ul><ul><ul><li>↓ </li></ul></ul></ul><ul><ul><li>CVA </li></ul></ul>
  56. 56. Transient Ischemic Attack <ul><li>Cerebrovascular insufficiency </li></ul><ul><li>Causes – same as CVA </li></ul><ul><li>Warning sign of impending CVA </li></ul>
  57. 57. CVA - Assessment <ul><li>Motor changes </li></ul><ul><ul><li>Opposite side </li></ul></ul><ul><ul><li>Balance, coordination, gait, proprioception </li></ul></ul><ul><ul><li>Glasgow Coma Scale </li></ul></ul>
  58. 58. CVA Assessment <ul><li>Sensory Changes </li></ul><ul><ul><li>Aphasia =can’t speak or write </li></ul></ul><ul><ul><li>Agnosia =can’t recognize familiar objects/people </li></ul></ul><ul><ul><li>Apraxia =can’t perform purposeful acts or use objects properly </li></ul></ul><ul><ul><li>Neglect Syndrome </li></ul></ul><ul><ul><li>Visual problems, including hemianopsia </li></ul></ul>
  59. 59. CVA Assessment <ul><li>Cognitive changes </li></ul><ul><ul><li>denial </li></ul></ul><ul><ul><li>impaired memory, judgment </li></ul></ul><ul><ul><li>can’t concentrate </li></ul></ul><ul><ul><li>disoriented </li></ul></ul><ul><ul><li>slow and cautious versus impulsive </li></ul></ul><ul><ul><li>depressed, anxious versus euphoric </li></ul></ul><ul><ul><li>angers quickly versus constantly smiling </li></ul></ul>
  60. 60. CVA - Testing <ul><li>CT or MRI </li></ul><ul><li>Cerebral angiogram </li></ul><ul><li>CBC, PT, PTT, electrolytes </li></ul>
  61. 61. CVA – Medical Management <ul><li>Thrombolytic (“clot buster”) </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Antiplatelet drugs </li></ul><ul><li>Aneurysm repair </li></ul><ul><li>Carotid endarterectomy </li></ul>
  62. 62. CVA-Nursing Care <ul><li>Assess LOC </li></ul><ul><li>IV, NG, Foley, Vent. </li></ul><ul><li>Nutrition </li></ul><ul><li>Encourage perform ADLs </li></ul><ul><li>Bladder and bowel training </li></ul><ul><li>ROM </li></ul><ul><li>Teaching and emotional support </li></ul>
  63. 63. Trigeminal Neuralgia Tic Douloureux <ul><li>Trigeminal nerve – degeneration, pressure </li></ul><ul><li>Facial pain </li></ul><ul><li>Medication, surgery </li></ul><ul><li>Avoid triggers </li></ul>
  64. 64. Bell’s Palsy <ul><li>Facial nerve inflammation </li></ul><ul><li>Unilateral weakness of facial muscles </li></ul><ul><li>Steroids, Zovirax, warm moist cloth, massage, facial exercises </li></ul>
  65. 65. Infection and Inflammation <ul><li>Meningitis </li></ul><ul><li>Encephalitis </li></ul><ul><li>Brain abscess </li></ul><ul><li>Guillain-Barré </li></ul><ul><li>Neurosyphilis </li></ul><ul><li>Poliomyelitis </li></ul><ul><li>Herpes zoster </li></ul><ul><li>AIDS </li></ul>
  66. 66. Guillain-Barré - Polyneuritis <ul><li>Peripheral nerve disease </li></ul><ul><li>Prior infection; autoimmune response </li></ul><ul><li>Weakness and paralysis, begins in extremities and works up </li></ul><ul><li>Respiratory failure may occur </li></ul>
  67. 67. Meningitis <ul><li>Acute infection of the meninges </li></ul><ul><li>Viral or bacterial </li></ul><ul><li>Severe headache, irritable, fever, delirium, N/V, neck stiffness </li></ul><ul><ul><li>Kernig’s sign </li></ul></ul><ul><ul><li>Brudzinski’s sign </li></ul></ul>
  68. 68. Meningitis-Medical Management <ul><li>Diagnosed by LP </li></ul><ul><li>Medications </li></ul><ul><li>Respiratory isolation </li></ul><ul><li>Cool, dark quiet room </li></ul><ul><li>Maintain hydration </li></ul><ul><li>Prevent injury </li></ul>
  69. 69. Acquired Immunodeficiency Syndrome - AIDS <ul><li>AIDS dementia complex </li></ul><ul><li>Infection of CNS </li></ul><ul><li>Dementia </li></ul><ul><li>Treatment depends on infection </li></ul><ul><li>Treat symptoms, maintain safety </li></ul>
  70. 70. Spinal Cord Trauma <ul><li>Complete cord injury – all voluntary movement below level of trauma is lost </li></ul><ul><li>Autonomic hyperreflexia </li></ul><ul><ul><li>stimulus </li></ul></ul><ul><ul><li>sympathetic nervous system response </li></ul></ul>
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