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Neurology Part 2
 

Neurology Part 2

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    Neurology Part 2 Neurology Part 2 Presentation Transcript

    • DEMYELINATING DISEASES Nurse Licensure Examination Review pinoynursing.webkotoh.com
    • MULTIPLE 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
    •  
    •  
    • 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
    • MULTIPLE SCLEROSIS
      • 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
    • MULTIPLE SCLEROSIS
      • 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
    • MULTIPLE SCLEROSIS
      • 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
    • MULTIPLE SCLEROSIS
      • 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
    • MULTIPLE SCLEROSIS
      • 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
    • MULTIPLE SCLEROSIS
      • 8. promote sexual functioning
      • Refer to sexual counselor
    • MULTIPLE SCLEROSIS
      • 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
    • Guillian-Barre’ Syndrome
      • 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
    •  
    • Guillian-Barre’ Syndrome
      • 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
    • 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
    • Guillian-Barre’ Syndrome
      • 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
    • 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
    • Guillian-Barre’ Syndrome
      • 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
    • ALZHEIMER’S disease
      • 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
    • 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
    • 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
    • ALZHEIMER’S disease
      • 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
    • 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
    • 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
    • ALZHEIMER’S disease
      • 5. Encourage exercise to maintain mobility
    • PARKINSON’s Disease
      • 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
    •  
    • 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
    •  
    • 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
    • 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
    • PARKINSON’s Disease
      • 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
    • PARKINSON’s Disease
      • 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
    •  
    • 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
    • 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
    • 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
    •  
    • 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
    • Epilepsy
      • 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
    • Epilepsy
      • 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
    •  
    • 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
    • BELL’S palsy
      • 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
    • 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
    •  
    • 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
    • Trigeminal neuralgia
      • 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
    • Myasthenia gravis
      • 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
    •  
    •  
    • 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
    • Myasthenia gravis
      • 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
    •  
    • 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
    • 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
    • Meningitis
      • 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
    •  
    • Encephalitis
      • 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
    •  
    • CNS infections
      • 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
    • 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.
    • Neoplastic disease
      • 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
    • Neoplastic disease
      • 2. Localized symptoms
      • Hemiparesis
      • Seizures
      • Mental status changes
    • Neoplastic disease
      • DIAGNOSTIC TESTS
      • 1. CT scan
      • 2. MRI
      • 3. PET
      • 4. EEG
    • Neoplastic disease
      • 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