DEMYELINATING DISEASES Nurse Licensure Examination Review

MULTIPLE SCLEROSIS An auto-immune mediated progressive demyelinating disease of the CNS The myelin sheath is destroyed and replaced by sclerotic tissue (sclerosis)

An auto-immune mediated progressive demyelinating disease of the CNS

The myelin sheath is destroyed and replaced by sclerotic tissue (sclerosis)

MULTIPLE SCLEROSIS CAUSE- unknown Multiple factors- viral infection, environmental factors,geographic location and genetic predisposition Common in WOMEN ages 20-40

CAUSE- unknown

Multiple factors- viral infection, environmental factors,geographic location and genetic predisposition

Common in WOMEN ages 20-40

MULTIPLE SCLEROSIS PATHOPHYSIOLOGY Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission

PATHOPHYSIOLOGY

Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath

Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission

MULTIPLE SCLEROSIS PATHOPHYSIOLOGY The most common areas affected are Optic nerves and chiasm Cerebrum Cerebellum Spinal cord

PATHOPHYSIOLOGY

The most common areas affected are

Optic nerves and chiasm

Cerebrum

Cerebellum

Spinal cord

MULTIPLE SCLEROSIS CLINICAL MANIFESTATIONS 1. visual problems such as diplopia, blurred vision and nystagmus 2. motor dysfunction 3. Fatigue 4. Mental changes like mood swings, depression 5. spasticity

CLINICAL MANIFESTATIONS

1. visual problems such as diplopia, blurred vision and nystagmus

2. motor dysfunction

3. Fatigue

4. Mental changes like mood swings, depression

5. spasticity

MULTIPLE SCLEROSIS DIAGNOSTIC TESTS 1. MRI- primary diagnostic study 2. CSF Immunoglobulin G

DIAGNOSTIC TESTS

1. MRI- primary diagnostic study

2. CSF Immunoglobulin G

MULTIPLE SCLEROSIS NURSING INTERVENTIONS 1. Promote physical mobility Exercise Schedule activity and rest periods Warm packs over the spastic area Swimming and cycling are very useful

NURSING INTERVENTIONS

1. Promote physical mobility

Exercise

Schedule activity and rest periods

Warm packs over the spastic area

Swimming and cycling are very useful

MULTIPLE SCLEROSIS NURSING INTERVENTIONS 2. Prevent injuries Wide stance walking Use of walking aids Wheelchair

NURSING INTERVENTIONS

2. Prevent injuries

Wide stance walking

Use of walking aids

Wheelchair

MULTIPLE SCLEROSIS 3. Enhance bladder and bowel control Set a voiding schedule Intermittent bladder catheterization Use of condom catheter Adequate fluids, dietary fibers and bowel training program

3. Enhance bladder and bowel control

Set a voiding schedule

Intermittent bladder catheterization

Use of condom catheter

Adequate fluids, dietary fibers and bowel training program

MULTIPLE SCLEROSIS 4 . Manage speech and swallowing difficulties Careful feeding, proper positioning, suction machine availability Speech therapist

4 . Manage speech and swallowing difficulties

Careful feeding, proper positioning, suction machine availability

Speech therapist

MULTIPLE SCLEROSIS 5. Improve Sensory and Cognitive function Vision- use eye patch for diplopia Obtain large printed reading materials Offer emotional support Involve the family in the care

5. Improve Sensory and Cognitive function

Vision- use eye patch for diplopia

Obtain large printed reading materials

Offer emotional support

Involve the family in the care

MULTIPLE SCLEROSIS 6. Strengthen coping mechanism Alleviate the stress Referral to the appropriate agencies

6. Strengthen coping mechanism

Alleviate the stress

Referral to the appropriate agencies

MULTIPLE SCLEROSIS 7. improve self-care abilities Modify activities according to physical strength Provide assistive devices

7. improve self-care abilities

Modify activities according to physical strength

Provide assistive devices

MULTIPLE SCLEROSIS 8. promote sexual functioning Refer to sexual counselor

8. promote sexual functioning

Refer to sexual counselor

MULTIPLE SCLEROSIS MEDICAL MANAGEMENT Pharmacotherapy Interferons Immunomodulators Corticosteroids BACLOFEN for muscle spasms NSAIDS for pain

MEDICAL MANAGEMENT

Pharmacotherapy

Interferons

Immunomodulators

Corticosteroids

BACLOFEN for muscle spasms

NSAIDS for pain

Guillian-Barre’ Syndrome An auto-immune attack of the peripheral nerve myelin Acute, rapid segmental demyelination of peripheral nerves and some cranial nerves

An auto-immune attack of the peripheral nerve myelin

Acute, rapid segmental demyelination of peripheral nerves and some cranial nerves

Guillian-Barre’ Syndrome CAUSE: post-infectious polyneuritis of unknown origin commonly follows viral infection

CAUSE: post-infectious polyneuritis of unknown origin commonly follows viral infection

Guillian-Barre’ Syndrome PATHOPHYSIOLOGY Cell-mediated imune attack to the myelin sheath of the peripheral nerves Infectious agent may elicit antibody production that can also destroy the myelin sheath

PATHOPHYSIOLOGY

Cell-mediated imune attack to the myelin sheath of the peripheral nerves

Infectious agent may elicit antibody production that can also destroy the myelin sheath

Guillian-Barre’ Syndrome CLINICAL MANIFESTATIONS 1. Ascending weakness and paralysis 2. diminished reflexes of the lower extremities 3. paresthesia 4. potential respiratory failure

CLINICAL MANIFESTATIONS

1. Ascending weakness and paralysis

2. diminished reflexes of the lower extremities

3. paresthesia

4. potential respiratory failure

Guillian-Barre’ Syndrome NURSING INTERVENTIONS Maintain respiratory function Chest physiotherapy and incentive spirometry Mechanical vetnilator

NURSING INTERVENTIONS

Maintain respiratory function

Chest physiotherapy and incentive spirometry

Mechanical vetnilator

Guillian-Barre’ Syndrome NURSING INTERVENTIONS 2. Enhance physical mobility Support paralyzed extremities Provide passive range of motion exercise Prevent DVT and pulmonary embolism Padding over bony prominences

NURSING INTERVENTIONS

2. Enhance physical mobility

Support paralyzed extremities

Provide passive range of motion exercise

Prevent DVT and pulmonary embolism

Padding over bony prominences

Guillian-Barre’ Syndrome NURSING INTERVENTIONS 3. Provide adequate nutrition IVF Parenteral nutrition Assess frequently return o gag refelx

NURSING INTERVENTIONS

3. Provide adequate nutrition

IVF

Parenteral nutrition

Assess frequently return o gag refelx

Guillian-Barre’ Syndrome NURSING INTERVENTIONS 4. Improve communication Use other means of communication

NURSING INTERVENTIONS

4. Improve communication

Use other means of communication

Guillian-Barre’ Syndrome NURSING INTERVENTIONS 5. Decrease fear and anxiety Provide Referrals Answer questions Provide diversional activities 6. Monitor and manage complications DVT, Urinary retention, pulmonary embolism, respiratory failure

NURSING INTERVENTIONS

5. Decrease fear and anxiety

Provide Referrals

Answer questions

Provide diversional activities

6. Monitor and manage complications

DVT, Urinary retention, pulmonary embolism, respiratory failure

Guillian-Barre’ Syndrome MEDICAL MANAGEMENT ICU admission Mechanical Ventilation TPN and IVF PLASMAPHERESIS IV IMMUNOGLOBULIN

MEDICAL MANAGEMENT

ICU admission

Mechanical Ventilation

TPN and IVF

PLASMAPHERESIS

IV IMMUNOGLOBULIN

ALZHEIMER’S disease A progressive neurologic disorder that affects the brain resulting in cognitive impairments

A progressive neurologic disorder that affects the brain resulting in cognitive impairments

ALZHEIMER’S disease CAUSES: Unknown Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies

CAUSES:

Unknown

Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies

ALZHEIMER’S disease CLINCAL MANIFESTATIONS 1. Forgetfulness 2. Recent memory loss 3. Difficulty learning 4. Deterioration in personal hygiene 5. Inability to concentrate

CLINCAL MANIFESTATIONS

1. Forgetfulness

2. Recent memory loss

3. Difficulty learning

4. Deterioration in personal hygiene

5. Inability to concentrate

ALZHEIMER’S disease LATE CLINICAL MANIFESTATIONS 6. Difficulty in abstract thinking 7. Difficulty communicating 8. Severe deterioration in memory, language and motor function 9. repetitive action- perseveration 10. personality changes

LATE CLINICAL MANIFESTATIONS

6. Difficulty in abstract thinking

7. Difficulty communicating

8. Severe deterioration in memory, language and motor function

9. repetitive action- perseveration

10. personality changes

ALZHEIMER’S disease DIAGNOSTIC TEST Neurologic examination PET scan EEG, CT and MRI Other tests to rule out Vit B deficiencies and hypothyroidism Autopsy is the most definitive

DIAGNOSTIC TEST

Neurologic examination

PET scan

EEG, CT and MRI

Other tests to rule out Vit B deficiencies and hypothyroidism

Autopsy is the most definitive

ALZHEIMER’S disease Drug therapy 1. drugs to treat behavioral symptoms- antipsychotics 2. anxiolytics 3. Donepezil 4. Tacrine

Drug therapy

1. drugs to treat behavioral symptoms- antipsychotics

2. anxiolytics

3. Donepezil

4. Tacrine

ALZHEIMER’S disease Nursing Interventions 1. Support patient’s abilities 2. Provide emotional support

Nursing Interventions

1. Support patient’s abilities

2. Provide emotional support

ALZHEIMER’S disease Nursing Interventions 3. Establish an effective communication system with the patient and family Use short simple sentences, words and gestures Maintain a calm and consistent approach Attempt to analyze behavior for meaning

Nursing Interventions

3. Establish an effective communication system with the patient and family

Use short simple sentences, words and gestures

Maintain a calm and consistent approach

Attempt to analyze behavior for meaning

ALZHEIMER’S disease 4. protect the patient from injury Provide a safe and structured environment Requests a family member to accompany client if he wanders around Keep bed in low position Provide adequate lightning Assign consistent caregivers

4. protect the patient from injury

Provide a safe and structured environment

Requests a family member to accompany client if he wanders around

Keep bed in low position

Provide adequate lightning

Assign consistent caregivers

ALZHEIMER’S disease 5. Encourage exercise to maintain mobility

5. Encourage exercise to maintain mobility

PARKINSON’s Disease A slowly progressing neurologic movement disorder The degenerative idiopathic form is the most common form

A slowly progressing neurologic movement disorder

The degenerative idiopathic form is the most common form

PARKINSON’s Disease CAUSATIVE FACTORS: unknown Potential factors: genetics, atherosclerosis, free radical stress, viral infection, head trauma and environmental factors

CAUSATIVE FACTORS: unknown

Potential factors: genetics, atherosclerosis, free radical stress, viral infection, head trauma and environmental factors

PARKINSON’s Disease Pathophysiology Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia Clinical symptoms do not appear until 60% of the neurons have disappeared

Pathophysiology

Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia

Clinical symptoms do not appear until 60% of the neurons have disappeared

PARKINSON’s Disease CLINICAL MANIFESTATIONS 1. Tremor- resting, pill-rolling 2. Rigidity- cog-wheel, lead-pipe 3. Bradykinesia- abnormally slow movement 4. Dementia, depression, sleep disturbances and hallucinations 5. excessive sweating, paroxysmal flushing, orthostatic hypotension

CLINICAL MANIFESTATIONS

1. Tremor- resting, pill-rolling

2. Rigidity- cog-wheel, lead-pipe

3. Bradykinesia- abnormally slow movement

4. Dementia, depression, sleep disturbances and hallucinations

5. excessive sweating, paroxysmal flushing, orthostatic hypotension

PARKINSON’s Disease Medical management 1. Anti-parkinsonian drugs- Levodopa, Carbidopa 2. Anti-cholinergic therapy 3. Antiviral therapy- Amantadine 4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole anmd Pramipexole

Medical management

1. Anti-parkinsonian drugs- Levodopa, Carbidopa

2. Anti-cholinergic therapy

3. Antiviral therapy- Amantadine

4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole anmd Pramipexole

PARKINSON’s Disease Medical management 5. MAOI 6. Anti-depressants 7. Antihistamine

Medical management

5. MAOI

6. Anti-depressants

7. Antihistamine

PARKINSON’s Disease NURSING INTERVENTIONS 1. Improve mobility 2. Enhance Self- care activities 3. Improve bowel elimination 4. Improve nutrition 5. Enhance swallowing 6. Encourage the use of assistive devices

NURSING INTERVENTIONS

1. Improve mobility

2. Enhance Self- care activities

3. Improve bowel elimination

4. Improve nutrition

5. Enhance swallowing

6. Encourage the use of assistive devices

PARKINSON’s Disease NURSING INTERVENTIONS 7. improve communication 8. Support coping abilities

NURSING INTERVENTIONS

7. improve communication

8. Support coping abilities

EPILEPSY A group of syndromes characterized by recurring seizures CAUSES 1. idiopathic 6. brain tumors 2. Birth trauma 7. head Injury 3. perinatal infection 8. metabolic disorders 4. infectious disease 9. CVA 5. ingestion of toxins

A group of syndromes characterized by recurring seizures

CAUSES

1. idiopathic 6. brain tumors

2. Birth trauma 7. head Injury

3. perinatal infection 8. metabolic disorders

4. infectious disease 9. CVA

5. ingestion of toxins

EPILEPSY Recurring seizures may be classified as GENERALIZED or PARTIAL SEIZURES Generalized Seizures- cause a generalized electrical abnormality within the brain Partial seizures- these seizures arise from a localized part of the brain and cause specific symptoms

Recurring seizures may be classified as GENERALIZED or PARTIAL SEIZURES

Generalized Seizures- cause a generalized electrical abnormality within the brain

Partial seizures- these seizures arise from a localized part of the brain and cause specific symptoms

GENERALIZED SEIZURES 1. General Tonic-Clonic seizure- ( Grand mal ) characterized by loss of consciousness and alternating movements of the extremities 2. Absence Seizure ( Petit mal )- common in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares

1. General Tonic-Clonic seizure- ( Grand mal ) characterized by loss of consciousness and alternating movements of the extremities

2. Absence Seizure ( Petit mal )- common in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares

GENERALIZED SEIZURES 3. Myoclonic seizure- characterized by brief, involuntary muscular jerks of body extremities 4. Akinetic seizure- general loss of postural tone and a temporary loss of consciousness- a drop attack

3. Myoclonic seizure- characterized by brief, involuntary muscular jerks of body extremities

4. Akinetic seizure- general loss of postural tone and a temporary loss of consciousness- a drop attack

PARTIAL SEIZURES 1. Simple partial seizure- typically limited to one cerebral hemisphere 2. Complex partial seizure- begins with an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements

1. Simple partial seizure- typically limited to one cerebral hemisphere

2. Complex partial seizure- begins with an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements

Epilepsy DIAGNOSTIC TESTS 1. EEG 2. CT 3. MRI 4. LP 5. Angiography

DIAGNOSTIC TESTS

1. EEG

2. CT

3. MRI

4. LP

5. Angiography

Epilepsy Medical treatment 1. Anticonvulsants- most commonly phenytoin, phenobarbital and carbamazepine Ethosuximide and valproic acid for absence seizure 2. surgery

Medical treatment

1. Anticonvulsants- most commonly phenytoin, phenobarbital and carbamazepine

Ethosuximide and valproic acid for absence seizure

2. surgery

Epilepsy Nursing Intervention 1. Care of patients during seizure 2. care of patients after seizures 3. patient teaching

Nursing Intervention

1. Care of patients during seizure

2. care of patients after seizures

3. patient teaching

BELL’S PALSY Causes 1. infection 2. hemorrhage 3. tumor 4. local traumatic injury

Causes

1. infection

2. hemorrhage

3. tumor

4. local traumatic injury

BELL’S PALSY MANIFESTATIONS 1. Unilateral facial weakness 2. Mouth drooping 3. Distorted taste perception 4. Smooth forehead 5. Inability to close eyelid on the affected side 6. Incomplete eye closure 7. excessive tearing when attempting to close the eyes 8. Inability to raise eyebrows, puff out the cheek

MANIFESTATIONS

1. Unilateral facial weakness

2. Mouth drooping

3. Distorted taste perception

4. Smooth forehead

5. Inability to close eyelid on the affected side

6. Incomplete eye closure

7. excessive tearing when attempting to close the eyes

8. Inability to raise eyebrows, puff out the cheek

BELL’S palsy Diagnostic tests EMG Medical management 1. Prednisone 2. Artificial tears

Diagnostic tests

EMG

Medical management

1. Prednisone

2. Artificial tears

BELL’S palsy Nursing Interventions 1. Apply moist heat to reduce pain 2. Massage the face to maintain muscle tone 3. Give frequent mouth care 4. protect the eye with an eye patch. Eyelid can be taped at night 5. instruct to chew on unaffected side

Nursing Interventions

1. Apply moist heat to reduce pain

2. Massage the face to maintain muscle tone

3. Give frequent mouth care

4. protect the eye with an eye patch. Eyelid can be taped at night

5. instruct to chew on unaffected side

Trigeminal neuralgia Also called Tic Douloureux Painful disorder that affects one or more branches of the fifth cranial nerve CAUSES: repetitive pulsation of an artery as it exits the pons is the usual cause

Also called Tic Douloureux

Painful disorder that affects one or more branches of the fifth cranial nerve

CAUSES: repetitive pulsation of an artery as it exits the pons is the usual cause

Trigeminal neuralgia ASSESSMENT 1. Pain history 2. Searing or burning jabs of pain lasting from 1-15 minutes in an area innervated by the trigeminal nerve DIAGNOSTIC TESTS Skull x-ray or CT scan

ASSESSMENT

1. Pain history

2. Searing or burning jabs of pain lasting from 1-15 minutes in an area innervated by the trigeminal nerve

DIAGNOSTIC TESTS Skull x-ray or CT scan

Trigeminal neuralgia NURSING INTERVENTIONS 1. provide emotional support 2. encourage to express feelings 3. provide adequate nutrition in small frequent meals at room temperature

NURSING INTERVENTIONS

1. provide emotional support

2. encourage to express feelings

3. provide adequate nutrition in small frequent meals at room temperature

Myasthenia gravis A sporadic, but progressive weakness and abnormal fatigability of striated muscles which are exacerbated by exercise and repetitive movements

A sporadic, but progressive weakness and abnormal fatigability of striated muscles which are exacerbated by exercise and repetitive movements

Myasthenia gravis ETIOLOGY Autoimmune disease Thymoma Women suffer at an earlier age and are more affected

ETIOLOGY

Autoimmune disease

Thymoma

Women suffer at an earlier age and are more affected

Myasthenia gravis Pathophysiology: 1. Acetylcholine receptor antibodies interfere with impulse transmission 2. Follows an unpredictable course of periodic exacerbations and remissions

Pathophysiology:

1. Acetylcholine receptor antibodies interfere with impulse transmission

2. Follows an unpredictable course of periodic exacerbations and remissions

Myasthenia gravis CAUSE: autoimmune disorder that impairs transmission of nerve impulses ASSESSMENT FINDINGS Gradually progressive skeletal muscle weakness and fatigue Weakness that worsens during the day Ptosis, diplopia and weak eye closure Blank, mask-like facies Difficulty chewing and swallowing Respiratory difficulty

CAUSE: autoimmune disorder that impairs transmission of nerve impulses

ASSESSMENT FINDINGS

Gradually progressive skeletal muscle weakness and fatigue

Weakness that worsens during the day

Ptosis, diplopia and weak eye closure

Blank, mask-like facies

Difficulty chewing and swallowing

Respiratory difficulty

Myasthenia gravis DIAGNOSTIC TESTS 1. EMG 2. TENSILON TEST 3. CT scan 4. Serum anti-AchReceptor antibodies

DIAGNOSTIC TESTS

1. EMG

2. TENSILON TEST

3. CT scan

4. Serum anti-AchReceptor antibodies

Myasthenia gravis MEDICAL THERAPY Anticholinesterase drugs- pyridostigmine and neostigmine Corticosteroids Immunosuppresants Plasmapheresis Thymectomy

MEDICAL THERAPY

Anticholinesterase drugs- pyridostigmine and neostigmine

Corticosteroids

Immunosuppresants

Plasmapheresis

Thymectomy

Myasthenia gravis NURSING INTERVENTIONS 1. Administer prescribed medication as scheduled 2. Prevent problems with chewing and swallowing 3. Promote respiratory function 4. Encourage adjustments in lifestyle to prevent fatigue 5.maximize functional abilities

NURSING INTERVENTIONS

1. Administer prescribed medication as scheduled

2. Prevent problems with chewing and swallowing

3. Promote respiratory function

4. Encourage adjustments in lifestyle to prevent fatigue

5.maximize functional abilities

Myasthenia gravis 6. Prepare for complications like myasthenic crisis and cholinergic crisis 7. prevent problems associated with impaired vision resulting from ptosis of eyelids 8. provide client teaching 9. promote client and family coping

6. Prepare for complications like myasthenic crisis and cholinergic crisis

7. prevent problems associated with impaired vision resulting from ptosis of eyelids

8. provide client teaching

9. promote client and family coping

Meningitis Infection or inflammation of the meninges covering the brain and spinal cord. Caused by bacterial, viral and fungal agents

Infection or inflammation of the meninges covering the brain and spinal cord.

Caused by bacterial, viral and fungal agents

Brain Abscess A free or encapsulated collection of pus in the brain parenchyma Causes: usually secondary to another infection like- sinusitis, meningitis, dental abscess, mastoiditis, bacteremia and trauma

A free or encapsulated collection of pus in the brain parenchyma

Causes: usually secondary to another infection like- sinusitis, meningitis, dental abscess, mastoiditis, bacteremia and trauma

Encephalitis Intense inflammation of the brain tisssue with lymphocytic infiltration, cerebral edema, degeneration of brain cells and diffuse nerve cell destruction

Intense inflammation of the brain tisssue with lymphocytic infiltration, cerebral edema, degeneration of brain cells and diffuse nerve cell destruction

CNS infections ASSESSMENT FINDINGS Meningitis 1. fever, headache, vomiting 2. positive meningeal sings Brain abscess 1. headache, N/V, seizures, changes in LOC 2. Focal neurologic deficits

ASSESSMENT FINDINGS

Meningitis

1. fever, headache, vomiting

2. positive meningeal sings

Brain abscess

1. headache, N/V, seizures, changes in LOC

2. Focal neurologic deficits

CNS infections DIAGNOSTIC TESTS 1. CT scan 2. MRI 3. EEG MEDICAL TREAMENT 1. Antibiotics 2. Surgical drainage 3. Drugs to reduce increased ICP

DIAGNOSTIC TESTS

1. CT scan

2. MRI

3. EEG

MEDICAL TREAMENT

1. Antibiotics

2. Surgical drainage

3. Drugs to reduce increased ICP

CNS infections NURSING INTERVENTIONS 1. Frequent monitoring of neurologic status 2. Monitor intake and output 3. Administer antibiotics 4. Administer mild laxative to prevent constipation 5. maintain quiet environment

NURSING INTERVENTIONS

1. Frequent monitoring of neurologic status

2. Monitor intake and output

3. Administer antibiotics

4. Administer mild laxative to prevent constipation

5. maintain quiet environment

Neoplastic diseases A brain tumor is a localized intracranial lesion that occupies space within the skull Primary brain tumors originate from cells and structures within the brain.

A brain tumor is a localized intracranial lesion that occupies space within the skull

Primary brain tumors originate from cells and structures within the brain.

Neoplastic disease The cause of brain tumors is unknown The only risk factor accepted is radiation exposure to ionization rays

The cause of brain tumors is unknown

The only risk factor accepted is radiation exposure to ionization rays

Neoplastic disease CLINICAL MANIFESTATIONS 1. increased ICP Vomiting Headache. Especially early in the morning Vomiting Visual disturbances

CLINICAL MANIFESTATIONS

1. increased ICP

Vomiting

Headache. Especially early in the morning

Vomiting

Visual disturbances

Neoplastic disease 2. Localized symptoms Hemiparesis Seizures Mental status changes

2. Localized symptoms

Hemiparesis

Seizures

Mental status changes

Neoplastic disease DIAGNOSTIC TESTS 1. CT scan 2. MRI 3. PET 4. EEG

DIAGNOSTIC TESTS

1. CT scan

2. MRI

3. PET

4. EEG

Neoplastic disease MEDICAL MANAGEMENT Surgery Chemotherapy Radiotherapy

MEDICAL MANAGEMENT

Surgery

Chemotherapy

Radiotherapy

Neoplastic disease NURSING INTERVENTIONS 1. promote self-care independence 2. improve nutrition 3. relieve anxiety 4. enhance family processes 5. provide pre-operative and post-operative care 6. manage pain

NURSING INTERVENTIONS

1. promote self-care independence

2. improve nutrition

3. relieve anxiety

4. enhance family processes

5. provide pre-operative and post-operative care

6. manage pain