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Neurology Ch. 65 Management of patients with oncologic or ...

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    Neurology Ch. 65 Management of patients with oncologic or ... Neurology Ch. 65 Management of patients with oncologic or ... Presentation Transcript

    • Neurology Ch. 65 Management of patients with oncologic or degenerative neurologic disorders
    • Brain Tumors
      • Pathophysiology
      • Primary
        • Originating from the brain
      • Secondary
        • Originating outside the brain
        • Metastasis
    • Brain Tumors
      • Malignant
        • Tend to become progressively worse
        • Anaplasia
          • Cell distortion
        • Invasive
      • Benign
        • No malignant or recurrent
    • Brain Tumors
      • Presence of lesion 
      • Compression of blood vessels 
      • Ischemia 
      • Edema 
      • I-ICP
    • Brain Tumors
      • Are brain tumors a disorder of the CNS, PNS or Both the CNS and PNS?
      • CNS
      • PNS
      • Both CNS & PNS
    • Primary-Brain Tumors
      • Etiology
      • Unknown
    • Brain Tumors
      • Clinical manifestations
      • Depends on
        • Size
        • Location
    • Brain Tumors
      • 4 main S&S
      • I-ICP
        • Cushing sign
        • H/A
        • Vomiting
        • Visual disturbances
      • Seizures
      • Hydrocephalus
      • Alt Pituitary function
      • Cancer cells being attacked by immune system
    • Brain Tumors
      • Localized S&S
      • Frontal
        • Personality changes
        • Emotional changes
      • Occipital
        • Visual impairment
        • Visual hallucinations
      • Cerebellum
        • Impaired equilibrium
        • Impaired coordination
    • Brain Tumors
      • Diagnosis
      • CT
      • MRI
    • Primary - Brain Tumors
      • Medical management
      • Radiation
      • Chemotherapy
      • Pharmaceutical
        • Corticosteroids
        • Anti-convulsants
      • Surgery
      • Tug McGraw
      • MRI showing pituitary Tumour
      • Tumor approached through nasal cavity
      • Surface Tumors Meningiomas excised by microsurgical technique: pre-op
      • Post-op
      • Pre-Operative CT scan showing a big tumor on the surface of the brain compressing the brain significantly
      • Post Operative CT Scan showing successful removal of the tumor
    • Secondary-Brain Tumor
      • 3 treatment options
      • No treatment
        • Death < 1 month
      • Tx w/ corticosteroids only
        • Death < 2 months
      • Tx with radiation
        • Death 3-6 months
    • Secondary-Brain Tumor
      • Pharmacology
      • Corticosteroids
        • Dexamethasone
        • Prednisone
      • Osmotic Diuretic
        • Mannitol
      • Anti-convulsants
        • Dilantin
      • Morphine
    • Brain Tumors
      • Nursing Management
      • Aspiration
      • Alt. nutrition
        • Cachexia
          • Weak emaciate condition
      • Neuro checks
      • Photophobia
      • Seizure precaution
      • Anxiety
    • Brain Tumors
      • What S&S are associated with frontal lobe, occipital lobe and cerebellum tumors?
      • What diet would you expect a patient with brain cancer to be on?
      • The S&S are associated with increase intracranial pressure?
    • Brain Tumors
      • What are the difference between malignant tumors and benign tumors?
      • What does metastasis refer to?
      • What are risk factors of cancer?
      • What does remission mean or refer to?
    • Parkinson’s Disease
      • First described by James Parkinson 1817
      • A progressive brain disorder characterized by the degeneration of dopamine secreting neurons deep in the cerebral hemisphere in a part of the brain called the basal ganglia
    • Parkinson’s Disease
      • Basal Ganglia
        • Controls movement
      • Dopamine
        • Inhibitory neurotransmitter in the basal ganglia
      • Acetylcholine
        • Excitatory neurotransmitter in the basal ganglia
    • Parkinson’s Disease
      • Without dopamine, inhibitory influences are lost and excitatory mechanisms are unopposed 
      • Neurons of basal ganglia are over stimulated 
      • Excess muscle tone, tremors & rigidity
    • Parkinson’s Disease
      • Is Parkinson's disease a disorder of the CNS, PNS or both the CNS & PNS?
      • CNS
      • PNS
      • Both PNS & CNS
    • Parkinson’s Disease
      • Clinical manifestations
      • Onset
        • Abrupt
      • Age of on set
        • 60
      • Men vs. Women
        • Men > women
      • First Symptom
        • Fine tremors in hands or feet
    • Parkinson’s Disease
      • 3 clinical signs
      • Tremors
      • Rigidity
      • Bradykinesia
    • Parkinson’s Disease
      • Tremors
        • Resting tremor
        •  with activity
        •  tremor when…
          • Walking
          • Anxious
        • Sensation of heat
        • Calorie burning!
    • Parkinson’s Disease
      • Rigidity
        • Stiffness
          • Neck
          • Trunk
          • Shoulders
        • Posture
          • Head bowed
          • Body bent forward
          • Arms flexed
          • Thumbs turned into palms
          • Knees bent (slightly)
    • Parkinson’s Disease
      • Bradykinesia
        • Slow movement
        • Akinesia
          • Loss of movement
          • Esp face
            • Expressionless
        • Slow speech
          • Dysphonia
        • Dysphagia
          • Drooling
    • Parkinson’s Disease
      • Bradykinesia
        • Gait
          • Shuffled
          • Festination
            • Fall forward d/t posture
    • Parkinson’s Disease
      • Diagnosis
      • S&S
      • Positive response to Levodopa
    • Parkinson’s Disease
      • Medical Management
      •  dopamine
        • (blood brain barrier)
    • Parkinson’s Disease
      • Anti-Parkinsonian medications
        • Levodopa
          • Converts into dopamine in the basal ganglia
          • Works best in 1 st few years of disease  effectiveness wanes
          • S/E Dizzy (esp when first get up)  get up slowly!
    • Parkinson’s Disease
      • Anti-Parkinsonian medications
        • Sinemet
          • Prevents the breakdown of levodopa outside the brain
    • Parkinson’s Disease
      • Nursing Management
      • Assessment
        • Affect on ADL’s
        • Dysfunction
        • S/E of meds
    • Parkinson’s Disease
      • Nursing Management
      • Improving mobility
        • Exercise
        • ROM
        • Warm baths
        • Massage
        • PT
          • gait program
    • Parkinson’s Disease
      • Nursing Management
      • Enhancing Self-care
        • Encouragement
        • Adaptive devices
        • OT
    • Parkinson’s Disease
      • Nursing Management
      • Improving Bowel elimination – Constipation
        • Bowel routine
        • Fluids
        • Fiber
        • Raised toilet
    • Parkinson’s Disease
      • Nursing Management
      • Nutritional deficit
        • Slow process
        • Meds  dry mouth
        • Chewing & Swallowing
        • Weights
        • Supplement
        • Dietician
          • FORK!
    • Parkinson’s Disease
      • Nursing Management
      • Enhance swallowing
        • Upright position
        • Semi-solid food
        • Thick liquids
    • Parkinson’s Disease
      • Nursing Management
      • Communication
        • Speak slow
        • Short sentences
        • Deep breath before speaking
        • SLP
    • Parkinson’s Disease
      • With PD it is known which neurotransmitter is lacking in the brain and scientists are able to duplicate this neurotransmitter. Why are we then unable to cure PD?
      • PD type deterioration of the nerve cells of the brain reduces the amount of what neurotransmitter?
      • Because of the inability to cure PD at this time, PD is frequently treated with which medications?
      • What are the side effects of these meds?
    • Parkinson’s Disease
      • To promote optimal functions, which activity could the nurse recommend as being beneficial to a patient with PD ?
      • What would be of value in helping a patient with PD communicate with the medical team?
      • Is PD a disease of the CNS, PNS or both?
    • Parkinson’s Disease
      • During an assessment, what signs and symptoms can the nurse anticipate a patient with Parkinson’s to exhibit?
      • What nursing diagnosis would be priority for a patient with Parkinson’s?
      • Describe the muscle tone of a patient with Parkinson’s (medical terms)
      • What interventions can be used to address the issue of nonintention tremors?
    • Huntington’s Disease
      • AKA
        • Huntinton’s Chorea
      • Pathophysology
        • Rare
        • Genetic
      • George Huntington
    • Huntington’s Disease
      • The disease is characterized as degeneration of the cerebral cortex and the basal ganglia 
    • Huntington’s Disease
        • Which causes chronic progressive chorea
          • Bizzare involuntary dance-like movements
        • And mental deterioration 
        • Ending in dementia and death
      • Loss of GABA (inhibitory neurotransmitter)
    • Huntington’s Disease
    • Huntington’s Disease
      • Clinical manifestations
      • Involuntary choreiform
      • Diminished during sleep
      • Facial tics/grimacing
      • Paranoia & hallucinations
      • Appetite
        • Ravenous
      • Emotions
        • Labile
      • My mom has suffered from this disease for 19 years now. I never really knew her real personality...but from what I have heard, she was wonderful…I love my mom very much, and I would give anything to have grown up with her not being sick.
    • Huntington’s Disease
      • Diagnosis
      • DNA testing
    • Huntington’s Disease
      • Medical management
      • No treatment
      • Meds to  tics
        • Chlorpromazine (Thorazine)
      • Meds to  hallucination, delusions, angry outbursts
        • Haloperidol (Haldol)
      • Anti-psychotics
    • Huntington’s Disease
      • Nursing Management
      • Family support
      • Diet
      • Ambulatory
      • Safety
    • Huntington’s Disease
      • Is Huntington’s a disease of the CNS, PNS, or both?
      • What dietary changes might be appropriate for a patient with Huntington’s disease?
      • Describe the pathophysiology of Huntington’s disease.
      • What is the etiology of Huntington’s disease?
      • How is Huntington’s disease different from Parkinson’s disease?
    • Huntington’s Disease
      • What medications are used to help with tics and uncontrolled movements associated with Huntington Chorea?
      • If a patient expresses suicidal thought, what are the correct nursing management interventions
      • Huntington’s Chorea is characterized by what (what does it look like)?
      • Name five nursing interventions for a patient with Huntington’s disease
    • Amyotrophic Lateral Sclerosis
      • Pathophysiology
      • Degenerative motor neuron disease that affects UMN & LMN lying within the brain, spinal cord and peripheral nerves
      • Lou Gehrig
    • Amyotrophic Lateral Sclerosis
      • The myelin sheaths are destroyed and replaced with scar tissue
    • Amyotrophic Lateral Sclerosis
      • Does not affect CN
        • 3
        • 4
        • 6
      • The patient is therefore able to
        • Blink
        • Move eye
    • Amyotrophic Lateral Sclerosis
      • Cognition is left intact!
    • Amyotrophic Lateral Sclerosis
      • Is ALS a disorder of the CNS, PNS or both the CNS and PNS?
      • CNS
      • PNS
      • Both CNS & PNS
    • Amyotrophic Lateral Sclerosis
      • Etiology
      • Unknown
      • Men vs. Women
        • Men > Women
    • Amyotrophic Lateral Sclerosis
      • Clinical manifestations
      • Progressive muscle weakness
      • Atrophy
      • Spasity
      • Dysphagia
      • Dysarthria
      • Jaw Clonus
      • Tongue fasciculation
    • Amyotrophic Lateral Sclerosis
      • Clinical Manifestations
      • No sensory loss
      • Death within 5 years
        • Resp. failure
        • Bulbar paralysis
    • Amyotrophic Lateral Sclerosis
      • Diagnosis
      • S&S only
        • No dx screen
    • Amyotrophic Lateral Sclerosis
      • Medical Management
      • Baclofen (Lioresal)
      • Diazepan (Valium)
        • Spasticity
      • Mechanical Ventilator
    • Amyotrophic Lateral Sclerosis
      • Nursing Management
      • Respiratory
      • ADL’s
      • Nutritional support
      • Emotional support
      • Advanced directive
    • Amyotrophic Lateral Sclerosis
      • Amyotrophic Lateral Sclerosis is manifested by what?
      • What are the classic signs and symptoms of this disease?
      • What are fasciculations?
      • Amyotrophic lateral sclerosis effects UMN, LMN or both?
      • CNS? PNS? Both?
      • What is the treatment methodology for ALS?
      • What is the pathophysiology of ALS?
    • Herniated Disc
      • AKA
        • Ruptured disc
        • Slipped disc
        • Degenerative disc disease
    • Herniated Disc
      • Anatomy
        • The interverterbral disc is a cartilaginous plate that forms a cushion between the vertebral body
        • Nucleus pulposus
        • Protrudes
        • Nerve compression
    • Herniated Disc
      • Etiology
      • Age
      • Trauma
    • Herniated Disc
      • Clinical Manifestations
      • Cervical
        • Location
          • C5-6
          • C6-7
        • Pain
          • Neck
          • Shoulder
          • ? Heart attack?
    • Herniated Disc
      • Lumbar
        • Location
          • L4-5
          • L5-S1
        • Pain
          • Low back
          • Sciatica
        • Relieved with
          • Bed rest
    • Herniated Disc
      • Diagnosis
      • MRI
    • Herniated Disc
    • Herniated Disc
      • Medical Management
      • Conservative - cervical
        • Immobilization
          • Collar
        • Isometric exercises
        • Pain relief
          • Hot packs
          • Analgesics
          • Muscle relaxant med
          • Anti inflammatory med
    • Herniated Disc
      • Medical Management
      • Conservative - lumbar
        • Bed rest
          • Firm mattress
        • Pain relief
          • Hot packs
          • Analgesics
          • Massage
          • Muscle relaxant med
          • Anti inflammatory med
    • Herniated Disc
      • Medical management
      • Surgery – lumbar
        • Turning
          • Log roll
        • Sitting
          • No sitting (except BR)
        • Complication
          • Failed Disc Syndrome
    • Herniated Disc
      • What are contributing factors to a Herniated disc?
      • The center of the vertebral disc is called what?
      • What are the most common sites for herniated disc?
      • What is Sciatica?
      • CNS? PNS? Both?
      • What is the frustrating complication post surgery?
    • Spinal Bifida
      • Pathophysiology
      • Neural Tube defect
      • Incomplete closure of the vertebrae
      • 3 Levels
        • Spina Bifida Occulta
        • Meningocele
        • Myelomeningocele
    • Spinal Bifida
      • Meningocele
      • Myelomeningocele
    • Spinal Bifida
    • Spinal Bifida
      • Spina bifida occulta
    • Spinal Bifida
      • Myelomeningocele must have a repair of the open neural tube. Failure to repair may result in serious infection which would harm the developing infant brain. After the repair, many children require the insertion of a device called a shunt to divert the cerebral spinal fluid to treat the hydrocephalus.
      The Infant with Myelomeningocele
    • Spinal Bifida
      • Etiology
      • Folic acid deficiency during pregnancy
        • Esp 1 st month
    • Spinal Bifida
      • Diagnosis
      • Ultrasound
      •  levels of fetal protein
        • Alpha fetoprotein
    • Spinal Bifida
      • What food contain folic Acid?
        • Greens
        • Asparagus
        • Broccoli
        • Cauliflower
        • Corn
        • Green Beans or Peas
        • Sweet Potato
        • Cabbage or Coleslaw
        • Black Beans
        • Lentils
        • Peas
        • Peanuts
      • What deficit is associated with spina bifida?
      • What diagnostic test is used to detect spina bifida invitro?
      • Name three foods high in folic acid.
      • Describe the difference between Spina Bifida occult, meningocele and myelomeningocele.
      • CNS? PNS? Both?