ms i alterations in neuroregulation student copy
TRANSCRIPT
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
1/47
Chronic Neurological Problems
Susan Greathouse RN BN MSN
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
2/47
Headache
Tension-type Bilateral location and press/tightening
qualityMigraine Recurring, unilateral or bilateral throbbing
pain, trigger, history
Cluster Repeated headaches for weeks or months
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
3/47
Seizure Disorders and
EpilepsySeizure is a paroxysmal, uncontrolledelectrical discharge of neurons in the
brain that interrupts normal functionEpilepsy is a condition in which aperson has spontaneously recurring
seizures caused by a chronic underlyingcause
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
4/47
Generalized Seizures
Prodromal phase
Aural phase
Ictal phase
Postictal phase
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
5/47
Metabolic Disturbances
Acidosis
Electrolyte imbalances
Hypoglycemia
Hypoxia
Alcohol and barbiturate withdrawalDehydration
Water intoxication
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
6/47
Generalized Seizures
Tonic-Clonic Cyanosis, excessive salivation, tongue or
cheek biting, incontinenceAbsence Brief staring spell
Atypical absence seizures Staring accompanied by other s&s
Other Types excessive jerk, falling
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
7/47
Partial Seizures
Partial focal seizures
Complex partial seizures
Temporal lobe absence
Automatism repetitive movements
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
8/47
Status Epilepticus
Ventilatory insufficiency
Hypoxemia
Cardiac dysrhythmias
Hyperthermia
Systemic acidosisTreated with Lorazepam or Diazepam
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
9/47
Drug Therapy
Antiseizure drugs (pg. 1538)
70% of the patients seizures are
controlled
Therapeutic ranges are guides fortherapy, not toxic ranges
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
10/47
Acute Intervention
Carefully observe and record details
Exact onset
Course and nature, duration
Autonomic signs
Maintain a patent airwayDo not restrain
Suction and oxygen if needed
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
11/47
Degenerative Diseases:
Multiple Sclerosis (MS)Results from damage/scarring of myelinsheath
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
12/47
MS Epidemiology
Incidence
58/100,000
More common in cooler climates
Women > men
Peak age of onset = 20-40
Race = Caucasian most likely to beaffected (90%)
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
13/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
14/47
MS Pathophysiology
Unknown trigger stimulates immuneresponse -> inflammatory response
->myelin sheath damage -> scar/plaqueformation -> nerve impulse interruption
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
15/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
16/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
17/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
18/47
Types of MS
Relapsing-remitting
Primary-progressive
Secondary-progressive
Progressive-relapsing
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
19/47
MS Assessment
History
Physical assessment
Motor changes Sensory changes
Cognitive changes
Psychosocial changesLabs
Radiology
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
20/47
MS Interventions
Exercise/physical therapy
Medications
Steroids Immunosuppressants
Immunomodulators
Cholinergics anticholinergics
Complementary therapies
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
21/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
22/47
Neurotransmitter Dysfunction:
Parkinsons DiseaseNeurotransmitter affected = Dopamine
Destruction of substantia nigra = loss of
dopamine
Pathophysiology
Movement = balance of ACh and DA
Loss of DA = loss of control of voluntarymuscles
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
23/47
Parkinsons Disease
Demographics50,000 new cases per year
Age = usually > 50
More common in men 3:2 ratio
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
24/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
25/47
Stages of Parkinsons Disease
Stage 1 = initial stage
Stage 2 = mild symptoms
Stage 3 = moderate symptoms
Stage 4 = severe disability
Stage 5 = complete dependence
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
26/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
27/47
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
28/47
Assessment of Parkinsons
Posture
Gait
Motor function
Speech
Autonomic dysfunction
Psychosocial issues
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
29/47
Parkinsons: Medical
InterventionsMedications Dopaminergics
Dopamine receptor agonists Anticholinergics
MAO inhibitors
COMT inhibitors
Physical and occupational therapy
Surgical management
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
30/47
Parkinsons: Nursing
InterventionsSafety
Medications
Ambulation
Communication
Nutrition
Support
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
31/47
Neurotransmitter Dysfunction:
Myasthenia Gravis (MG)Neurotransmitter affected = ACh
Pathophysiology
Auto-immune process: antibodies developed toACh receptor sites
Thymus gland abnormalities in 85% cases
Epidemiology
0.4/100,000
Women:men = 2-3:1
Peak age of onset = 20-30
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
32/47
Myasthenia Gravis
AssessmentPhysical Exam
Progressive muscleweakness
Poor posture Ocular palsies
Ptosis
Diplopia
Fatigue Loss of bowel/bladder
control
Labs
Ach receptorantibodies
Radiology
CXR, Chest CT
EMG
Tensilon test
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
33/47
Myasthenia Gravis
ManagementActivity Planning
Medications
Anticholinesterases Steroids
Immunosuppressantdrugs
Plasmapheresis
Respiratory support
Nutritional support
Communication
Eye protectionThymectomy
Education
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
34/47
Restless Legs Syndrome
Unpleasant sensory and motorabnormalities of one or both legs
Cause unknownPrimary family history
Secondary iron deficiency, renal
failure, polyneuropathy, DM, RA,pregnancy
Remove aggrevating factors drug tx.
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
35/47
Amyotrophic Lateral Sclerosis
(ALS) Lou Gehrigs
Pathophysiology
Progressive degeneration/death of motorneurons
Cause = unknown; ? abnormal
metabolism of glutamate
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
36/47
ALS Epidemiology
1.5/100,000
Men more than women 2:1
Age of onset = 40-70
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
37/47
ALS Assessment
Physicalassessment Fatigue while talking
Tongue atrophy
Dysphagia
Weakness ofhands/arms
Nasal quality ofspeech
Dysarthria
Labs = 0
Radiology = 0
Tests = 0Treatment
Experimental meds
Fluorouracil
Thalidomide
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
38/47
Huntingtons Disease
Genetic, autosomal dominant disorder
30-50 years
Deficiency of neurotransmitters Ach andgama-aminobutyric acid
Abnormal and excessive involuntary
movements (chorea)Gait deterioration, intellectual decline,psychotic behavior
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
39/47
Alzheimers Disease
Most common form of dementia, chronicprogressive, degenerative
5% of people 65-74
Diagnosed by presence ofneurofibrillary tangles, -amyloid
plaques, loss of connections betweencells and cell death at autopsy
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
40/47
AD Early Warning Signs
Memory loss
Deterioration in personal hygiene
Loss of ability to concentrate andmaintain attention
Altered or unpredictable actions
Dysphasia, apraxia, visual agnosia,dysgraphia
Aggression and tendency to wander
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
41/47
AD Drug Therapy
Cholinesterase inhibitors
Namenda
Management of behavior problems
Antipsychotic drugs
SSRI, TCA
Antiseizure
Hormones and herbs
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
42/47
Guillain-Barre Syndrome
(GBS)Pathophysiology
Segmental demyelination of motor neurons
Inflammatory response, typically followinga viral infection, acute illness, trauma,surgery, or vaccination
Auto-immune process: T-cells becomesensitized to myelin
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
43/47
GBS Epidemiology
1.9/100,000
Men = women
Age of onset = 30-50, higher rates inthose >50
More common in those with Hodgkins
disease, SLE, HIV
More common in Caucasians
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
44/47
GBS Physical Assessment
Motor
Ascendingsymmetric weakness
Decreased/absentdeep tendon reflexes
Respiratorycompromise
Loss ofbowel/bladdercontrol
Sensory
Paresthesias
PainCranial Nerve
Facial weakness
Dysphagia
Diplopia
Difficulty speaking
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
45/47
GBS Assessment
Autonomicdysfunction
Labile BP Cardiac
dysrhythmias
tachycardia
Labs
CSF
EMGRespiratory functionstudies
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
46/47
GBS Interventions
Medications
ACTH
ImmunoglobinsPlasmapheresis
Supportive
Pulmonary
Immobility Pain
Communication
ADLs
-
8/2/2019 MS I Alterations in Neuroregulation STUDENT COPY
47/47