medical surgical nursing

1. Alzheimer’s Disease
Alzheimer’s disease (AD) is a nonreversible type of dementia
that progressively develops over many years.
Dementia is defined as multiple cognitive deficits that impair
memory and can affect language, motor skills, and/or abstract
thinking.

2. Risk Factors
Advanced age
Genetic predisposition
Environmental agents (herpes virus, metal, or toxic waste)
Previous head injury
Sex (female)

3. Clinical manifestation
AD is characterized by
 Memory Loss,
 Problems With Judgment
 Changes In Personality
Forgetfulness
Difficulty in social or work situations
Loss of awareness of recent events and surroundings
movement is lost › Unrecognizable speech(at sever stage)

4. Investigation
 Genetic testing for the presence of apolipoprotein E can determine if late-
onset dementia is due to AD.
 There is no definitive diagnostic procedure, except brain tissue examination
upon death.
 Magnetic resonance imaging (MRI), computed tomography (CT) and
electroencephalogram (EEG) may be performed to rule out other possible
causes of findings

5. Medications
 Most medications for clients who have dementia attempt to target behavioral
and emotional problems, such as anxiety and depression.
 These medications include antipsychotics, antidepressants, and anxiolytics.
Clients receiving these medications should be closely monitored for adverse
effects.
 AD medications temporarily slow the course of the disease and do not work
for all clients.
 If a client fails to improve with one medication, a trial of one of the other
medications is warranted.

6. Nursing Care
 Assess cognitive status, memory, judgment, and personality changes.
 Provide a safe environment.
 Provide verbal and nonverbal ways to communicate with the client.
 Check the client’s skin weekly for breakdown.

7. Cont.…
 Offer varied environmental stimulations, such as walks, music, or craft
activities.
 Keep a structured environment and introduce change gradually (client’s
daily routine or a room change).
 Use a calendar to assist with orientation.
 Use short directions when explaining an activity or care the client
needs, such as a bath.

8. Cerebral Aneurysm
A cerebral aneurysm is a balloon-like out-pouching caused by a
congenital or developed weakness in a cerebral artery.
 Trauma, infection, or vessel wall lesions due to atherosclerosis
can all lead to the development of an aneurysm.
Increased pressure within the vessel lumen may cause the
aneurysm to rupture, causing significant intracranial bleeding

10. SIGNS AND SYMPTOMS
Asymptomatic until rupture
Very bad headache due to hemorrhage and increased intracranial
pressure
Decreased level of consciousness due to increased intracranial
pressure from blood accumulating within the brain

11. INTERPRETING TEST RESULTS
 CT scan shows the aneurysm unless it is very small.
 Diffusion/perfusion MRI or MRA (magnetic resonance angiography)
shows vessel structure.

12. Medical TREATMENT
Surgical repair of the aneurysm.
Administer corticosteroid drugs to reduce inflammation:
Administer anticonvulsant drugs to reduce seizure risk due to
irritation of brain:

13. NURSING INTERVENTION
 Monitor the patient’s neurological function for changes
typically use Glasgow Coma Scale or similar tool to grade response
to stimuli/
 Monitor vital signs for changes
 enlarged pulse pressure with bradycardia indicative of increased
intracranial pressure.
 Explain to the patient:
Needs for homecare.
When to call healthcare provider.

15. Hemiplegia
• Hemiplegia is total paralysis of the arm, leg, and trunk on the same
side of the body.
• Severe or complete loss of motor function on one side of the body.
• Hemiplegia is more severe than hemiparesis, wherein one half of
the body has less marked weakness.
• Hemiplegia may be congenital or acquired from an illness or stroke.

16. Causes
• Cerebrovascular Accident
(CVA)
• Thrombosis, Embolism or
hemorrhage
• Transient Ischemic Attack (TIA)
• Head Trauma
• Diabetes Mellitus
• Brain Tumor
• Infection
• Meningitis
• Vasculitis
• Acute necrotizing myelitis
• Hereditary disease

17. Signs & Symptoms
• Vary greatly from person to person.
 Difficulty with gait
 Difficulty with balance while standing or walking
 Having difficulty with motor activities like holding, grasping or
pinching
 Increasing stiffness of muscles
 Muscle spasms
 Difficulty with speech

18. Cont.…
 Difficulty swallowing food
 Significant delay during standing, smiling,
crawling or speaking
 The majority of children who develop hemiplegia also
have abnormal mental development.
 Behavior problems like anxiety, anger, irritability, lack of
concentration or comprehension
 Emotions — depression

19. Diagnosis
Clinical Examination
CT Scan Or Magnetic Resonance

20. Management
◾ Frequent change of the patient's position (every 2 hours),
and of the bed sheets.
◾ Frequent wash of the skin of the back and pressure points.
◾ Suction of nasal and pharyngeal secretions.
◾ Oxygen administration in case of comatose

21. Cont.…
Tube feeding;- giving fruit juices, milk and pureed food,
besides I.V. fluids, in comatose patients.
Catheterization to prevent bed sore and urine retention
by subcutaneous injection of anticoagulant and wearing
elastic stocks to prevent DVT.
Treat specific causes of Hemiplegia accordingly.

22. GUILLAIN - BARRE
SYNDROME

23. DEFINITION
• Guillain Barre syndrome is a rare disorder in
which body's immune system attacks nerves and
causes damage to the peripheral nerves.
• The nerve injury often causes muscle weakness,
cause paralysis and sensitivity problems,
including pain, tingling or numbness.

25. ETIOLOGY
• Bacterial infection(e.g. Campylobacter jejuni)
• Viral infection
• influenza virus
• Cytomegaly viruses
• Blood Transfusion
• Transplantation
• Preceding vaccination – Swine flu

26. Clinical Manifestations
• Hyporeflexia and weakness progress and may result in quadriplegia.
• Neuromuscular respiratory failure - demyelination of the nerves that
innervate the diaphragm and inter costal muscles results.
• Sensory dysfunction with abnormal proprioception, sensory ataxia can also
occur.
• Gloves and stocking paraesthesias with slight disturbances of sensibility.

27. • Weakness spreads to the arms and upper body.
• The weakness may increase until muscles cannot be used at all
and may result in paralysis.
• Inability to walk due to muscle weakness and paralysis.
• Difficult to speaking, chewing and swallowing, various muscles
required to form speech are weakened.

28. DIAGNOSIS
• Spinal tap (lumbar puncture). The fluid is tested for a type of
change that commonly occurs in people who have Guillain-Barre
syndrome.
• Electromyography. The electrodes measure nerve activity in the
muscles.
• Nerve conduction studies. Electrodes are taped to the
peripheral nerves. A small shock is passed through the nerve to
measure the speed of nerve signals.
• CSF analysis – elevated protein content upto 700 mg/dl. Normal-
15-45 mg/dl

29. MANAGEMENT
• Supportive care
• Ventiltory support
• Plasmapheresis (plasma exchange)– to remove
abnormal antibodies
• IV Immunoglobulin's – stop antibody damaging
cells.

30. NURSING MANAGEMENT
• Check for facial nerve paralysis.
• Inspect the patient’s face at rest and during conversation.
• Assess for any problems during swallowing, talking and chewing.
• Assess for any change in the vital signs.
• Maintaining respiratoryfunction.

31. Cont.…
 Mechanical ventilation
 Close monitoring and suctioning
 Enhancing physical mobility
 Providing adequate nutrition IV fluids and parenteral nutrition
 monitors for the return of bowel sounds gastrostomy tube assesses the return
of the gag reflex
 Monitoring and managing potential complications Thorough assessment of
respiratory function at regular intervals cardiac dysrhythmias, which
necessitate ECG monitoring

32. COMPLICATIONS
• Complications can also include:
– Persistent weakness, numbness, or other odd
sensations even after recovery
– Heart or blood pressure problems
– Pain
– Slow bowel or bladder function
– Blood clots and bedsores due to paralysis