Download - Neurology Ch. 65 Management of patients with oncologic or degenerative neurologic disorders
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?
A. CNSB. PNSC. 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
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?
A. CNSB. PNSC. 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 1st 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
Clinical manifestations• Involuntary choreiform• Diminished during sleep• Facial tics/grimacing• Paranoia &
hallucinations• Appetite– Ravenous
• Emotions– Labile
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?
A. CNSB. PNSC. 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
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
Etiology• Folic acid deficiency
during pregnancy– Esp 1st 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?