NeurologyNeurology
Ch. 65Ch. 65
Management of patients withManagement of patients with
oncologic or degenerative neurologi...
Brain TumorsBrain Tumors
PathophysiologyPathophysiology
 PrimaryPrimary
 Originating from theOriginating from the
brainb...
Brain TumorsBrain Tumors
 MalignantMalignant
 Tend to becomeTend to become
progressively worseprogressively worse
 Anap...
Brain TumorsBrain Tumors
 Presence of lesionPresence of lesion 
 Compression of bloodCompression of blood
vesselsvesse...
Brain TumorsBrain Tumors
 Are brain tumors a disorder of the CNS, PNSAre brain tumors a disorder of the CNS, PNS
or Both ...
Primary-Brain TumorsPrimary-Brain Tumors
EtiologyEtiology
 UnknownUnknown
Brain TumorsBrain Tumors
Clinical manifestationsClinical manifestations
 Depends onDepends on
 SizeSize
 LocationLocati...
Brain TumorsBrain Tumors
4 main S&S4 main S&S
 I-ICPI-ICP
 Cushing signCushing sign
 H/AH/A
 VomitingVomiting
 Visual...
Brain TumorsBrain Tumors
Localized S&SLocalized S&S
 FrontalFrontal
 Personality changesPersonality changes
 Emotional ...
Brain TumorsBrain Tumors
DiagnosisDiagnosis
 CTCT
 MRIMRI
Primary - Brain TumorsPrimary - Brain Tumors
Medical managementMedical management
 RadiationRadiation
 ChemotherapyChemo...
 MRI showing pituitaryMRI showing pituitary
TumourTumour
 Tumor approachedTumor approached
through nasal cavitythrough n...
 Surface TumorsSurface Tumors
Meningiomas excised byMeningiomas excised by
microsurgical technique:microsurgical techniqu...
 Pre-Operative CT scan showing aPre-Operative CT scan showing a
big tumor on the surface of thebig tumor on the surface o...
Secondary-Brain TumorSecondary-Brain Tumor
3 treatment options3 treatment options
 No treatmentNo treatment
 Death < 1 m...
Secondary-Brain TumorSecondary-Brain Tumor
PharmacologyPharmacology
 CorticosteroidsCorticosteroids
 DexamethasoneDexame...
Brain TumorsBrain Tumors
Nursing ManagementNursing Management
 AspirationAspiration
 Alt. nutritionAlt. nutrition
 Cach...
Brain TumorsBrain Tumors
 What S&S are associated with frontal lobe,What S&S are associated with frontal lobe,
occipital ...
Brain TumorsBrain Tumors
 What are the difference between malignantWhat are the difference between malignant
tumors and b...
Parkinson’s DiseaseParkinson’s Disease
 First described by JamesFirst described by James
Parkinson 1817Parkinson 1817
 A...
Parkinson’s DiseaseParkinson’s Disease
 Basal GangliaBasal Ganglia
 Controls movementControls movement
 DopamineDopamin...
Parkinson’s DiseaseParkinson’s Disease
 Without dopamine,Without dopamine,
inhibitory influences areinhibitory influences...
Parkinson’s DiseaseParkinson’s Disease
 Is Parkinson's disease a disorder of theIs Parkinson's disease a disorder of the
...
Parkinson’s DiseaseParkinson’s Disease
Clinical manifestationsClinical manifestations
 OnsetOnset
 AbruptAbrupt
 Age of...
Parkinson’s DiseaseParkinson’s Disease
3 clinical signs3 clinical signs
 TremorsTremors
 RigidityRigidity
 Bradykinesia...
Parkinson’s DiseaseParkinson’s Disease
 TremorsTremors
 Resting tremorResting tremor
  with activitywith activity
 ...
Parkinson’s DiseaseParkinson’s Disease
 RigidityRigidity
 StiffnessStiffness
 NeckNeck
 TrunkTrunk
 ShouldersShoulder...
Parkinson’s DiseaseParkinson’s Disease
 BradykinesiaBradykinesia
 Slow movementSlow movement
 AkinesiaAkinesia
 Loss o...
Parkinson’s DiseaseParkinson’s Disease
 BradykinesiaBradykinesia
 GaitGait
 ShuffledShuffled
 FestinationFestination
...
Parkinson’s DiseaseParkinson’s Disease
DiagnosisDiagnosis
 S&SS&S
 Positive response toPositive response to
LevodopaLevo...
Parkinson’s DiseaseParkinson’s Disease
Medical ManagementMedical Management
  dopaminedopamine
 (blood brain barrier)(...
Parkinson’s DiseaseParkinson’s Disease
 Anti-ParkinsonianAnti-Parkinsonian
medicationsmedications
 LevodopaLevodopa
 Co...
Parkinson’s DiseaseParkinson’s Disease
 Anti-ParkinsonianAnti-Parkinsonian
medicationsmedications
 SinemetSinemet
 Prev...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 AssessmentAssessment
 Affect on ADL’sAffect...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 Improving mobilityImproving mobility
 Exerc...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 Enhancing Self-careEnhancing Self-care
 Enc...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 Improving BowelImproving Bowel
elimination –...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 Nutritional deficitNutritional deficit
 Slo...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 Enhance swallowingEnhance swallowing
 Uprig...
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management
 CommunicationCommunication
 Speak slowSpeak...
Parkinson’s DiseaseParkinson’s Disease
 With PD it is known which neurotransmitter isWith PD it is known which neurotrans...
Parkinson’s DiseaseParkinson’s Disease
 To promote optimal functions, which activityTo promote optimal functions, which a...
Parkinson’s DiseaseParkinson’s Disease
 During an assessment, what signs and symptomsDuring an assessment, what signs and...
Huntington’s DiseaseHuntington’s Disease
 AKAAKA
 Huntinton’s ChoreaHuntinton’s Chorea
 PathophysologyPathophysology
 ...
Huntington’s DiseaseHuntington’s Disease
 The disease isThe disease is
characterized ascharacterized as
degeneration of t...
Huntington’s DiseaseHuntington’s Disease
 Which causes chronicWhich causes chronic
progressive choreaprogressive chorea
...
Huntington’s DiseaseHuntington’s Disease
Huntington’s DiseaseHuntington’s Disease
Clinical manifestationsClinical manifestations
 Involuntary choreiformInvoluntar...
 My mom has sufferedMy mom has suffered
from this disease for 19from this disease for 19
years now. I never reallyyears n...
Huntington’s DiseaseHuntington’s Disease
DiagnosisDiagnosis
 DNA testingDNA testing
Huntington’s DiseaseHuntington’s Disease
Medical managementMedical management
 No treatmentNo treatment
 Meds toMeds to ...
Huntington’s DiseaseHuntington’s Disease
Nursing ManagementNursing Management
 Family supportFamily support
 DietDiet
 ...
Huntington’s DiseaseHuntington’s Disease
 Is Huntington’s a disease of the CNS, PNS, orIs Huntington’s a disease of the C...
Huntington’s DiseaseHuntington’s Disease
 What medications are used to help with tics andWhat medications are used to hel...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
PathophysiologyPathophysiology
 Degenerative motorDegenerative...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
 The myelin sheaths areThe myelin sheaths are
destroyed and re...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
 Does not affect CNDoes not affect CN
 33
 44
 66
 The pat...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
 Cognition is left intact!Cognition is left intact!
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
 Is ALS a disorder of the CNS, PNS or bothIs ALS a disorder of...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
EtiologyEtiology
 UnknownUnknown
 Men vs. WomenMen vs. Women
...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
Clinical manifestationsClinical manifestations
 Progressive mu...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
Clinical ManifestationsClinical Manifestations
 No sensory los...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
DiagnosisDiagnosis
 S&S onlyS&S only
 No dx screenNo dx screen
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
Medical ManagementMedical Management
 Baclofen (Lioresal)Baclo...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
Nursing ManagementNursing Management
 RespiratoryRespiratory
...
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
 Amyotrophic Lateral Sclerosis is manifested by what?Amyotroph...
Herniated DiscHerniated Disc
 AKAAKA
 Ruptured discRuptured disc
 Slipped discSlipped disc
 Degenerative disc diseaseD...
Herniated DiscHerniated Disc
 AnatomyAnatomy
 The interverterbral disc isThe interverterbral disc is
a cartilaginous pla...
Herniated DiscHerniated Disc
EtiologyEtiology
 AgeAge
 TraumaTrauma
Herniated DiscHerniated Disc
Clinical ManifestationsClinical Manifestations
 CervicalCervical
 LocationLocation
 C5-6C5...
Herniated DiscHerniated Disc
 LumbarLumbar
 LocationLocation
 L4-5L4-5
 L5-S1L5-S1
 PainPain
 Low backLow back
 Sci...
Herniated DiscHerniated Disc
DiagnosisDiagnosis
 MRIMRI
Herniated DiscHerniated Disc
Herniated DiscHerniated Disc
Medical ManagementMedical Management
 Conservative - cervicalConservative - cervical
 Immob...
Herniated DiscHerniated Disc
Medical ManagementMedical Management
 Conservative - lumbarConservative - lumbar
 Bed restB...
Herniated DiscHerniated Disc
Medical managementMedical management
 Surgery – lumbarSurgery – lumbar
 TurningTurning
 Lo...
Herniated DiscHerniated Disc
 What are contributing factors to a HerniatedWhat are contributing factors to a Herniated
di...
Spinal BifidaSpinal Bifida
PathophysiologyPathophysiology
 Neural Tube defectNeural Tube defect
 Incomplete closure ofIn...
Spinal BifidaSpinal Bifida
 MeningoceleMeningocele  MyelomeningoceleMyelomeningocele
Spinal BifidaSpinal Bifida
Spinal BifidaSpinal Bifida
  Spina bifida occultaSpina bifida occulta
Spinal BifidaSpinal Bifida
 Myelomeningocele must haveMyelomeningocele must have
a repair of the open neurala repair of t...
Spinal BifidaSpinal Bifida
EtiologyEtiology
 Folic acid deficiencyFolic acid deficiency
during pregnancyduring pregnancy
...
Spinal BifidaSpinal Bifida
DiagnosisDiagnosis
 UltrasoundUltrasound
  levels of fetal proteinlevels of fetal protein
...
Spinal BifidaSpinal Bifida
 What food contain folicWhat food contain folic
Acid?Acid?
 GreensGreens
 AsparagusAsparagus...
 What deficit is associated with spina bifida?What deficit is associated with spina bifida?
 What diagnostic test is use...
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Neurology Ch. 65 Management of patients with oncologic or ...

  1. 1. NeurologyNeurology Ch. 65Ch. 65 Management of patients withManagement of patients with oncologic or degenerative neurologiconcologic or degenerative neurologic disordersdisorders
  2. 2. Brain TumorsBrain Tumors PathophysiologyPathophysiology  PrimaryPrimary  Originating from theOriginating from the brainbrain  SecondarySecondary  Originating outside theOriginating outside the brainbrain  MetastasisMetastasis
  3. 3. Brain TumorsBrain Tumors  MalignantMalignant  Tend to becomeTend to become progressively worseprogressively worse  AnaplasiaAnaplasia  Cell distortionCell distortion  InvasiveInvasive  BenignBenign  No malignant or recurrentNo malignant or recurrent
  4. 4. Brain TumorsBrain Tumors  Presence of lesionPresence of lesion   Compression of bloodCompression of blood vesselsvessels   IschemiaIschemia   EdemaEdema   I-ICPI-ICP
  5. 5. Brain TumorsBrain Tumors  Are brain tumors a disorder of the CNS, PNSAre brain tumors a disorder of the CNS, PNS or Both the CNS and PNS?or Both the CNS and PNS? A.A. CNSCNS B.B. PNSPNS C.C. Both CNS & PNSBoth CNS & PNS
  6. 6. Primary-Brain TumorsPrimary-Brain Tumors EtiologyEtiology  UnknownUnknown
  7. 7. Brain TumorsBrain Tumors Clinical manifestationsClinical manifestations  Depends onDepends on  SizeSize  LocationLocation
  8. 8. Brain TumorsBrain Tumors 4 main S&S4 main S&S  I-ICPI-ICP  Cushing signCushing sign  H/AH/A  VomitingVomiting  Visual disturbancesVisual disturbances  SeizuresSeizures  HydrocephalusHydrocephalus  Alt Pituitary functionAlt Pituitary function  Cancer cells beingCancer cells being attacked by immuneattacked by immune systemsystem
  9. 9. Brain TumorsBrain Tumors Localized S&SLocalized S&S  FrontalFrontal  Personality changesPersonality changes  Emotional changesEmotional changes  OccipitalOccipital  Visual impairmentVisual impairment  Visual hallucinationsVisual hallucinations  CerebellumCerebellum  Impaired equilibriumImpaired equilibrium  Impaired coordinationImpaired coordination
  10. 10. Brain TumorsBrain Tumors DiagnosisDiagnosis  CTCT  MRIMRI
  11. 11. Primary - Brain TumorsPrimary - Brain Tumors Medical managementMedical management  RadiationRadiation  ChemotherapyChemotherapy  PharmaceuticalPharmaceutical  CorticosteroidsCorticosteroids  Anti-convulsantsAnti-convulsants  SurgerySurgery  Tug McGrawTug McGraw
  12. 12.  MRI showing pituitaryMRI showing pituitary TumourTumour  Tumor approachedTumor approached through nasal cavitythrough nasal cavity
  13. 13.  Surface TumorsSurface Tumors Meningiomas excised byMeningiomas excised by microsurgical technique:microsurgical technique: pre-oppre-op  Post-opPost-op
  14. 14.  Pre-Operative CT scan showing aPre-Operative CT scan showing a big tumor on the surface of thebig tumor on the surface of the brain compressing the brainbrain compressing the brain significantlysignificantly  Post Operative CT Scan showingPost Operative CT Scan showing successful removal of the tumorsuccessful removal of the tumor
  15. 15. Secondary-Brain TumorSecondary-Brain Tumor 3 treatment options3 treatment options  No treatmentNo treatment  Death < 1 monthDeath < 1 month  Tx w/ corticosteroidsTx w/ corticosteroids onlyonly  Death < 2 monthsDeath < 2 months  Tx with radiationTx with radiation  Death 3-6 monthsDeath 3-6 months
  16. 16. Secondary-Brain TumorSecondary-Brain Tumor PharmacologyPharmacology  CorticosteroidsCorticosteroids  DexamethasoneDexamethasone  PrednisonePrednisone  Osmotic DiureticOsmotic Diuretic  MannitolMannitol  Anti-convulsantsAnti-convulsants  DilantinDilantin  MorphineMorphine
  17. 17. Brain TumorsBrain Tumors Nursing ManagementNursing Management  AspirationAspiration  Alt. nutritionAlt. nutrition  CachexiaCachexia  Weak emaciate conditionWeak emaciate condition  Neuro checksNeuro checks  PhotophobiaPhotophobia  Seizure precautionSeizure precaution  AnxietyAnxiety
  18. 18. Brain TumorsBrain Tumors  What S&S are associated with frontal lobe,What S&S are associated with frontal lobe, occipital lobe and cerebellum tumors?occipital lobe and cerebellum tumors?  What diet would you expect a patient withWhat diet would you expect a patient with brain cancer to be on?brain cancer to be on?  The S&S are associated with increaseThe S&S are associated with increase intracranial pressure?intracranial pressure?
  19. 19. Brain TumorsBrain Tumors  What are the difference between malignantWhat are the difference between malignant tumors and benign tumors?tumors and benign tumors?  What does metastasis refer to?What does metastasis refer to?  What are risk factors of cancer?What are risk factors of cancer?  What does remission mean or refer to?What does remission mean or refer to?
  20. 20. Parkinson’s DiseaseParkinson’s Disease  First described by JamesFirst described by James Parkinson 1817Parkinson 1817  A progressive brainA progressive brain disorder characterized bydisorder characterized by the degeneration ofthe degeneration of dopaminedopamine secretingsecreting neurons deep in theneurons deep in the cerebral hemisphere in acerebral hemisphere in a part of the brain calledpart of the brain called thethe basal gangliabasal ganglia
  21. 21. Parkinson’s DiseaseParkinson’s Disease  Basal GangliaBasal Ganglia  Controls movementControls movement  DopamineDopamine  InhibitoryInhibitory neurotransmitter in theneurotransmitter in the basal gangliabasal ganglia  AcetylcholineAcetylcholine  ExcitatoryExcitatory neurotransmitter in theneurotransmitter in the basal gangliabasal ganglia
  22. 22. Parkinson’s DiseaseParkinson’s Disease  Without dopamine,Without dopamine, inhibitory influences areinhibitory influences are lost and excitatorylost and excitatory mechanisms aremechanisms are unopposedunopposed   Neurons of basal gangliaNeurons of basal ganglia are over stimulatedare over stimulated   Excess muscle tone,Excess muscle tone, tremors & rigiditytremors & rigidity
  23. 23. Parkinson’s DiseaseParkinson’s Disease  Is Parkinson's disease a disorder of theIs Parkinson's disease a disorder of the CNS, PNS or both the CNS & PNS?CNS, PNS or both the CNS & PNS? A.A. CNSCNS B.B. PNSPNS C.C. Both PNS & CNSBoth PNS & CNS
  24. 24. Parkinson’s DiseaseParkinson’s Disease Clinical manifestationsClinical manifestations  OnsetOnset  AbruptAbrupt  Age of on setAge of on set  6060  Men vs. WomenMen vs. Women  Men > womenMen > women  First SymptomFirst Symptom  Fine tremors in hands orFine tremors in hands or feetfeet
  25. 25. Parkinson’s DiseaseParkinson’s Disease 3 clinical signs3 clinical signs  TremorsTremors  RigidityRigidity  BradykinesiaBradykinesia
  26. 26. Parkinson’s DiseaseParkinson’s Disease  TremorsTremors  Resting tremorResting tremor   with activitywith activity   tremor when…tremor when…  WalkingWalking  AnxiousAnxious  Sensation of heatSensation of heat  Calorie burning!Calorie burning!
  27. 27. Parkinson’s DiseaseParkinson’s Disease  RigidityRigidity  StiffnessStiffness  NeckNeck  TrunkTrunk  ShouldersShoulders  PosturePosture  Head bowedHead bowed  Body bent forwardBody bent forward  Arms flexedArms flexed  Thumbs turned into palmsThumbs turned into palms  Knees bent (slightly)Knees bent (slightly)
  28. 28. Parkinson’s DiseaseParkinson’s Disease  BradykinesiaBradykinesia  Slow movementSlow movement  AkinesiaAkinesia  Loss of movementLoss of movement  Esp faceEsp face  ExpressionlessExpressionless  Slow speechSlow speech  DysphoniaDysphonia  DysphagiaDysphagia  DroolingDrooling
  29. 29. Parkinson’s DiseaseParkinson’s Disease  BradykinesiaBradykinesia  GaitGait  ShuffledShuffled  FestinationFestination  Fall forward d/t postureFall forward d/t posture
  30. 30. Parkinson’s DiseaseParkinson’s Disease DiagnosisDiagnosis  S&SS&S  Positive response toPositive response to LevodopaLevodopa
  31. 31. Parkinson’s DiseaseParkinson’s Disease Medical ManagementMedical Management   dopaminedopamine  (blood brain barrier)(blood brain barrier)
  32. 32. Parkinson’s DiseaseParkinson’s Disease  Anti-ParkinsonianAnti-Parkinsonian medicationsmedications  LevodopaLevodopa  Converts into dopamine inConverts into dopamine in the basal gangliathe basal ganglia  Works best in 1Works best in 1stst few yearsfew years of diseaseof disease  effectivenesseffectiveness waneswanes  S/E Dizzy (esp when firstS/E Dizzy (esp when first get up)get up)  get up slowly!get up slowly!
  33. 33. Parkinson’s DiseaseParkinson’s Disease  Anti-ParkinsonianAnti-Parkinsonian medicationsmedications  SinemetSinemet  Prevents the breakdown ofPrevents the breakdown of levodopa outside the brainlevodopa outside the brain
  34. 34. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  AssessmentAssessment  Affect on ADL’sAffect on ADL’s  DysfunctionDysfunction  S/E of medsS/E of meds
  35. 35. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  Improving mobilityImproving mobility  ExerciseExercise  ROMROM  Warm bathsWarm baths  MassageMassage  PTPT  gait programgait program
  36. 36. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  Enhancing Self-careEnhancing Self-care  EncouragementEncouragement  Adaptive devicesAdaptive devices  OTOT
  37. 37. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  Improving BowelImproving Bowel elimination –elimination – ConstipationConstipation  Bowel routineBowel routine  FluidsFluids  FiberFiber  Raised toiletRaised toilet
  38. 38. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  Nutritional deficitNutritional deficit  Slow processSlow process  MedsMeds  dry mouthdry mouth  Chewing & SwallowingChewing & Swallowing  WeightsWeights  SupplementSupplement  DieticianDietician  FORK!FORK!
  39. 39. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  Enhance swallowingEnhance swallowing  Upright positionUpright position  Semi-solid foodSemi-solid food  Thick liquidsThick liquids
  40. 40. Parkinson’s DiseaseParkinson’s Disease Nursing ManagementNursing Management  CommunicationCommunication  Speak slowSpeak slow  Short sentencesShort sentences  Deep breath beforeDeep breath before speakingspeaking  SLPSLP
  41. 41. Parkinson’s DiseaseParkinson’s Disease  With PD it is known which neurotransmitter isWith PD it is known which neurotransmitter is lacking in the brain and scientists are able to duplicatelacking in the brain and scientists are able to duplicate this neurotransmitter. Why are we then unable tothis neurotransmitter. Why are we then unable to cure PD?cure PD?  PD type deterioration of the nerve cells of the brainPD type deterioration of the nerve cells of the brain reduces the amount of what neurotransmitter?reduces the amount of what neurotransmitter?  Because of the inability to cure PD at this time, PD isBecause of the inability to cure PD at this time, PD is frequently treated with which medications?frequently treated with which medications?  What are the side effects of these meds?What are the side effects of these meds?
  42. 42. Parkinson’s DiseaseParkinson’s Disease  To promote optimal functions, which activityTo promote optimal functions, which activity could the nurse recommend as being beneficialcould the nurse recommend as being beneficial to a patient with PD ?to a patient with PD ?  What would be of value in helping a patient withWhat would be of value in helping a patient with PD communicate with the medical team?PD communicate with the medical team?  Is PD a disease of the CNS, PNS or both?Is PD a disease of the CNS, PNS or both?
  43. 43. Parkinson’s DiseaseParkinson’s Disease  During an assessment, what signs and symptomsDuring an assessment, what signs and symptoms can the nurse anticipate a patient withcan the nurse anticipate a patient with Parkinson’s to exhibit?Parkinson’s to exhibit?  What nursing diagnosis would be priority for aWhat nursing diagnosis would be priority for a patient with Parkinson’s?patient with Parkinson’s?  Describe the muscle tone of a patient withDescribe the muscle tone of a patient with Parkinson’s (medical terms)Parkinson’s (medical terms)  What interventions can be used to address theWhat interventions can be used to address the issue of nonintention tremors?issue of nonintention tremors?
  44. 44. Huntington’s DiseaseHuntington’s Disease  AKAAKA  Huntinton’s ChoreaHuntinton’s Chorea  PathophysologyPathophysology  RareRare  GeneticGenetic  George HuntingtonGeorge Huntington
  45. 45. Huntington’s DiseaseHuntington’s Disease  The disease isThe disease is characterized ascharacterized as degeneration of thedegeneration of the cerebral cortex and thecerebral cortex and the basal gangliabasal ganglia 
  46. 46. Huntington’s DiseaseHuntington’s Disease  Which causes chronicWhich causes chronic progressive choreaprogressive chorea  Bizzare involuntary dance-Bizzare involuntary dance- like movementslike movements  And mental deteriorationAnd mental deterioration   Ending in dementia andEnding in dementia and deathdeath  Loss of GABALoss of GABA (inhibitory(inhibitory neurotransmitter)neurotransmitter)
  47. 47. Huntington’s DiseaseHuntington’s Disease
  48. 48. Huntington’s DiseaseHuntington’s Disease Clinical manifestationsClinical manifestations  Involuntary choreiformInvoluntary choreiform  Diminished during sleepDiminished during sleep  Facial tics/grimacingFacial tics/grimacing  Paranoia &Paranoia & hallucinationshallucinations  AppetiteAppetite  RavenousRavenous  EmotionsEmotions  LabileLabile
  49. 49.  My mom has sufferedMy mom has suffered from this disease for 19from this disease for 19 years now. I never reallyyears now. I never really knew her realknew her real personality...but frompersonality...but from what I have heard, shewhat I have heard, she was wonderful…I lovewas wonderful…I love my mom very much, andmy mom very much, and I would give anything toI would give anything to have grown up with herhave grown up with her not being sick.not being sick.
  50. 50. Huntington’s DiseaseHuntington’s Disease DiagnosisDiagnosis  DNA testingDNA testing
  51. 51. Huntington’s DiseaseHuntington’s Disease Medical managementMedical management  No treatmentNo treatment  Meds toMeds to  ticstics  ChlorpromazineChlorpromazine (Thorazine)(Thorazine)  Meds toMeds to  hallucination,hallucination, delusions, angrydelusions, angry outburstsoutbursts  Haloperidol (Haldol)Haloperidol (Haldol)  Anti-psychoticsAnti-psychotics
  52. 52. Huntington’s DiseaseHuntington’s Disease Nursing ManagementNursing Management  Family supportFamily support  DietDiet  AmbulatoryAmbulatory  SafetySafety
  53. 53. Huntington’s DiseaseHuntington’s Disease  Is Huntington’s a disease of the CNS, PNS, orIs Huntington’s a disease of the CNS, PNS, or both?both?  What dietary changes might be appropriate forWhat dietary changes might be appropriate for a patient with Huntington’s disease?a patient with Huntington’s disease?  Describe the pathophysiology of Huntington’sDescribe the pathophysiology of Huntington’s disease.disease.  What is the etiology of Huntington’s disease?What is the etiology of Huntington’s disease?  How is Huntington’s disease different fromHow is Huntington’s disease different from Parkinson’s disease?Parkinson’s disease?
  54. 54. Huntington’s DiseaseHuntington’s Disease  What medications are used to help with tics andWhat medications are used to help with tics and uncontrolled movements associated withuncontrolled movements associated with Huntington Chorea?Huntington Chorea?  If a patient expresses suicidal thought, what areIf a patient expresses suicidal thought, what are the correct nursing management interventionsthe correct nursing management interventions  Huntington’s Chorea is characterized by whatHuntington’s Chorea is characterized by what (what does it look like)?(what does it look like)?  Name five nursing interventions for a patientName five nursing interventions for a patient with Huntington’s diseasewith Huntington’s disease
  55. 55. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis PathophysiologyPathophysiology  Degenerative motorDegenerative motor neuron disease thatneuron disease that affectsaffects UMNUMN && LMNLMN lying within the brain,lying within the brain, spinal cord andspinal cord and peripheral nervesperipheral nerves  Lou GehrigLou Gehrig
  56. 56. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis  The myelin sheaths areThe myelin sheaths are destroyed and replaceddestroyed and replaced with scar tissuewith scar tissue
  57. 57. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis  Does not affect CNDoes not affect CN  33  44  66  The patient is thereforeThe patient is therefore able toable to  BlinkBlink  Move eyeMove eye
  58. 58. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis  Cognition is left intact!Cognition is left intact!
  59. 59. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis  Is ALS a disorder of the CNS, PNS or bothIs ALS a disorder of the CNS, PNS or both the CNS and PNS?the CNS and PNS? A.A. CNSCNS B.B. PNSPNS C.C. Both CNS & PNSBoth CNS & PNS
  60. 60. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis EtiologyEtiology  UnknownUnknown  Men vs. WomenMen vs. Women  Men > WomenMen > Women
  61. 61. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis Clinical manifestationsClinical manifestations  Progressive muscleProgressive muscle weaknessweakness  AtrophyAtrophy  SpasitySpasity  DysphagiaDysphagia  DysarthriaDysarthria  Jaw ClonusJaw Clonus  Tongue fasciculationTongue fasciculation
  62. 62. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis Clinical ManifestationsClinical Manifestations  No sensory lossNo sensory loss  Death within 5 yearsDeath within 5 years  Resp. failureResp. failure  Bulbar paralysisBulbar paralysis
  63. 63. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis DiagnosisDiagnosis  S&S onlyS&S only  No dx screenNo dx screen
  64. 64. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis Medical ManagementMedical Management  Baclofen (Lioresal)Baclofen (Lioresal)  Diazepan (Valium)Diazepan (Valium)  SpasticitySpasticity  Mechanical VentilatorMechanical Ventilator
  65. 65. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis Nursing ManagementNursing Management  RespiratoryRespiratory  ADL’sADL’s  Nutritional supportNutritional support  Emotional supportEmotional support  Advanced directiveAdvanced directive
  66. 66. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis  Amyotrophic Lateral Sclerosis is manifested by what?Amyotrophic Lateral Sclerosis is manifested by what?  What are the classic signs and symptoms of thisWhat are the classic signs and symptoms of this disease?disease?  What are fasciculations?What are fasciculations?  Amyotrophic lateral sclerosis effects UMN, LMN orAmyotrophic lateral sclerosis effects UMN, LMN or both?both?  CNS? PNS? Both?CNS? PNS? Both?  What is the treatment methodology for ALS?What is the treatment methodology for ALS?  What is the pathophysiology of ALS?What is the pathophysiology of ALS?
  67. 67. Herniated DiscHerniated Disc  AKAAKA  Ruptured discRuptured disc  Slipped discSlipped disc  Degenerative disc diseaseDegenerative disc disease
  68. 68. Herniated DiscHerniated Disc  AnatomyAnatomy  The interverterbral disc isThe interverterbral disc is a cartilaginous plate thata cartilaginous plate that forms aforms a cushioncushion betweenbetween the vertebral bodythe vertebral body  Nucleus pulposusNucleus pulposus  ProtrudesProtrudes  Nerve compressionNerve compression
  69. 69. Herniated DiscHerniated Disc EtiologyEtiology  AgeAge  TraumaTrauma
  70. 70. Herniated DiscHerniated Disc Clinical ManifestationsClinical Manifestations  CervicalCervical  LocationLocation  C5-6C5-6  C6-7C6-7  PainPain  NeckNeck  ShoulderShoulder  ? Heart attack?? Heart attack?
  71. 71. Herniated DiscHerniated Disc  LumbarLumbar  LocationLocation  L4-5L4-5  L5-S1L5-S1  PainPain  Low backLow back  SciaticaSciatica  Relieved withRelieved with  Bed restBed rest
  72. 72. Herniated DiscHerniated Disc DiagnosisDiagnosis  MRIMRI
  73. 73. Herniated DiscHerniated Disc
  74. 74. Herniated DiscHerniated Disc Medical ManagementMedical Management  Conservative - cervicalConservative - cervical  ImmobilizationImmobilization  CollarCollar  Isometric exercisesIsometric exercises  Pain reliefPain relief  Hot packsHot packs  AnalgesicsAnalgesics  Muscle relaxant medMuscle relaxant med  Anti inflammatory medAnti inflammatory med
  75. 75. Herniated DiscHerniated Disc Medical ManagementMedical Management  Conservative - lumbarConservative - lumbar  Bed restBed rest  Firm mattressFirm mattress  Pain reliefPain relief  Hot packsHot packs  AnalgesicsAnalgesics  MassageMassage  Muscle relaxant medMuscle relaxant med  Anti inflammatory medAnti inflammatory med
  76. 76. Herniated DiscHerniated Disc Medical managementMedical management  Surgery – lumbarSurgery – lumbar  TurningTurning  Log rollLog roll  SittingSitting  No sitting (except BR)No sitting (except BR)  ComplicationComplication  Failed Disc SyndromeFailed Disc Syndrome
  77. 77. Herniated DiscHerniated Disc  What are contributing factors to a HerniatedWhat are contributing factors to a Herniated disc?disc?  The center of the vertebral disc is called what?The center of the vertebral disc is called what?  What are the most common sites for herniatedWhat are the most common sites for herniated disc?disc?  What is Sciatica?What is Sciatica?  CNS? PNS? Both?CNS? PNS? Both?  What is the frustrating complication postWhat is the frustrating complication post surgery?surgery?
  78. 78. Spinal BifidaSpinal Bifida PathophysiologyPathophysiology  Neural Tube defectNeural Tube defect  Incomplete closure ofIncomplete closure of the vertebraethe vertebrae  3 Levels3 Levels  Spina Bifida OccultaSpina Bifida Occulta  MeningoceleMeningocele  MyelomeningoceleMyelomeningocele
  79. 79. Spinal BifidaSpinal Bifida  MeningoceleMeningocele  MyelomeningoceleMyelomeningocele
  80. 80. Spinal BifidaSpinal Bifida
  81. 81. Spinal BifidaSpinal Bifida   Spina bifida occultaSpina bifida occulta
  82. 82. Spinal BifidaSpinal Bifida  Myelomeningocele must haveMyelomeningocele must have a repair of the open neurala repair of the open neural tube. Failure to repair maytube. Failure to repair may result in serious infectionresult in serious infection which would harm thewhich would harm the developing infant brain. Afterdeveloping infant brain. After the repair, many childrenthe repair, many children require the insertion of arequire the insertion of a device called a shunt to divertdevice called a shunt to divert the cerebral spinal fluid tothe cerebral spinal fluid to treat the hydrocephalus.treat the hydrocephalus. The Infant withThe Infant with MyelomeningoceleMyelomeningocele
  83. 83. Spinal BifidaSpinal Bifida EtiologyEtiology  Folic acid deficiencyFolic acid deficiency during pregnancyduring pregnancy  Esp 1Esp 1stst monthmonth
  84. 84. Spinal BifidaSpinal Bifida DiagnosisDiagnosis  UltrasoundUltrasound   levels of fetal proteinlevels of fetal protein  Alpha fetoproteinAlpha fetoprotein
  85. 85. Spinal BifidaSpinal Bifida  What food contain folicWhat food contain folic Acid?Acid?  GreensGreens  AsparagusAsparagus  BroccoliBroccoli  CauliflowerCauliflower  CornCorn  Green Beans or PeasGreen Beans or Peas  Sweet PotatoSweet Potato  Cabbage or ColeslawCabbage or Coleslaw  Black BeansBlack Beans  LentilsLentils  PeasPeas  PeanutsPeanuts
  86. 86.  What deficit is associated with spina bifida?What deficit is associated with spina bifida?  What diagnostic test is used to detect spinaWhat diagnostic test is used to detect spina bifida invitro?bifida invitro?  Name three foods high in folic acid.Name three foods high in folic acid.  Describe the difference between Spina BifidaDescribe the difference between Spina Bifida occult, meningocele and myelomeningocele.occult, meningocele and myelomeningocele.  CNS? PNS? Both?CNS? PNS? Both?

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