neurology ch. 65 management of patients with oncologic or

Neurology Neurology Ch. 65Ch. 65

Management of patients with Management of patients with oncologic or degenerative oncologic or degenerative

neurologic disordersneurologic disorders

Brain TumorsBrain Tumors

PathophysiologyPathophysiology PrimaryPrimary

Originating from Originating from the brainthe brain

SecondarySecondary Originating outside Originating outside

the brainthe brain MetastasisMetastasis


MalignantMalignant Tend to become Tend to become

progressively worseprogressively worse AnaplasiaAnaplasia

Cell distortionCell distortion InvasiveInvasive

BenignBenign No malignant or No malignant or

recurrentrecurrent


Presence of lesion Presence of lesion

Compression of Compression of blood vessels blood vessels

Ischemia Ischemia Edema Edema I-ICPI-ICP


Are brain tumors a disorder of the Are brain tumors a disorder of the CNS, PNS or Both the CNS and CNS, PNS or Both the CNS and PNS?PNS?

A.A. CNSCNS

B.B. PNSPNS

C.C. Both CNS & PNSBoth CNS & PNS

Primary-Brain TumorsPrimary-Brain Tumors

EtiologyEtiology UnknownUnknown


Clinical Clinical manifestationsmanifestations

Depends onDepends on SizeSize LocationLocation


4 main S&S4 main S&S I-ICPI-ICP

Cushing signCushing sign H/AH/A VomitingVomiting Visual disturbancesVisual disturbances

SeizuresSeizures HydrocephalusHydrocephalus Alt Pituitary Alt Pituitary

functionfunction

Cancer cells being Cancer cells being attacked by attacked by immune systemimmune system


Localized S&SLocalized S&S FrontalFrontal

Personality changesPersonality changes Emotional changesEmotional changes

OccipitalOccipital Visual impairmentVisual impairment Visual hallucinationsVisual hallucinations

CerebellumCerebellum Impaired equilibriumImpaired equilibrium Impaired Impaired

coordination coordination


DiagnosisDiagnosis CTCT MRIMRI

Primary - Brain TumorsPrimary - Brain Tumors

Medical Medical managementmanagement

RadiationRadiation ChemotherapyChemotherapy PharmaceuticalPharmaceutical

CorticosteroidsCorticosteroids Anti-convulsantsAnti-convulsants

SurgerySurgery

Tug McGrawTug McGraw

MRI showing MRI showing pituitary Tumourpituitary Tumour

Tumor Tumor approached approached through nasal through nasal cavitycavity

Surface TumorsSurface TumorsMeningiomas Meningiomas excised by excised by microsurgical microsurgical technique: pre-optechnique: pre-op

Post-opPost-op

Pre-Operative CT scan Pre-Operative CT scan showing a big tumor on showing a big tumor on the surface of the brain the surface of the brain compressing the brain compressing the brain significantlysignificantly

Post Operative CT Scan Post Operative CT Scan showing successful showing successful removal of the tumorremoval of the tumor

Secondary-Brain TumorSecondary-Brain Tumor

3 treatment options3 treatment options No treatmentNo treatment

Death < 1 monthDeath < 1 month Tx w/ Tx w/

corticosteroids corticosteroids onlyonly Death < 2 monthsDeath < 2 months

Tx with radiationTx with radiation Death 3-6 monthsDeath 3-6 months

Secondary-Brain TumorSecondary-Brain Tumor

PharmacologyPharmacology CorticosteroidsCorticosteroids

DexamethasoneDexamethasone PrednisonePrednisone

Osmotic DiureticOsmotic Diuretic MannitolMannitol

Anti-convulsantsAnti-convulsants DilantinDilantin

MorphineMorphine


Nursing ManagementNursing Management AspirationAspiration Alt. nutritionAlt. nutrition

CachexiaCachexia Weak emaciate Weak emaciate

conditioncondition

Neuro checksNeuro checks PhotophobiaPhotophobia Seizure precautionSeizure precaution AnxietyAnxiety


What S&S are associated with What S&S are associated with frontal lobe, occipital lobe and frontal lobe, occipital lobe and cerebellum tumors?cerebellum tumors?

What diet would you expect a What diet would you expect a patient with brain cancer to be on?patient with brain cancer to be on?

The S&S are associated with The S&S are associated with increase intracranial pressure?increase intracranial pressure?


What are the difference between What are the difference between malignant tumors and benign malignant tumors and benign tumors?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 What does remission mean or refer

to?to?

Parkinson’s DiseaseParkinson’s Disease First described by First described by

James Parkinson 1817James Parkinson 1817 A progressive brain A progressive brain

disorder disorder characterized by the characterized by the degeneration of degeneration of dopaminedopamine secreting secreting neurons deep in the neurons deep in the cerebral hemisphere cerebral hemisphere in a part of the brain in a part of the brain called the called the basal basal gangliaganglia

Parkinson’s DiseaseParkinson’s Disease

Basal GangliaBasal Ganglia Controls movementControls movement

DopamineDopamine Inhibitory Inhibitory

neurotransmitter in neurotransmitter in the basal gangliathe basal ganglia

AcetylcholineAcetylcholine Excitatory Excitatory

neurotransmitter in neurotransmitter in the basal gangliathe basal ganglia


Without dopamine, Without dopamine, inhibitory influences inhibitory influences are lost and are lost and excitatory excitatory mechanisms are mechanisms are unopposed unopposed

Neurons of basal Neurons of basal ganglia are over ganglia are over stimulated stimulated

Excess muscle tone, Excess muscle tone, tremors & rigiditytremors & rigidity


Is Parkinson's disease a Is Parkinson's disease a disorder of the CNS, PNS or disorder of the CNS, PNS or both the CNS & PNS?both the CNS & PNS?

A.A. CNSCNS

B.B. PNSPNS

C.C. Both PNS & CNSBoth PNS & CNS



OnsetOnset AbruptAbrupt

Age of on setAge of on set 6060

Men vs. WomenMen vs. Women Men > womenMen > women

First SymptomFirst Symptom Fine tremors in Fine tremors in

hands or feethands or feet


3 clinical signs3 clinical signs TremorsTremors RigidityRigidity BradykinesiaBradykinesia


TremorsTremors Resting tremorResting tremor with activitywith activity tremor when…tremor when…

WalkingWalking AnxiousAnxious

Sensation of heatSensation of heat Calorie burning!Calorie burning!


RigidityRigidity StiffnessStiffness

NeckNeck TrunkTrunk ShouldersShoulders

PosturePosture Head bowedHead bowed Body bent forwardBody bent forward Arms flexedArms flexed Thumbs turned into Thumbs turned into

palmspalms Knees bent (slightly)Knees bent (slightly)


BradykinesiaBradykinesia Slow movementSlow movement AkinesiaAkinesia

Loss of movementLoss of movement Esp faceEsp face

ExpressionlessExpressionless

Slow speechSlow speech DysphoniaDysphonia

DysphagiaDysphagia DroolingDrooling


BradykinesiaBradykinesia GaitGait

ShuffledShuffled FestinationFestination

Fall forward d/t Fall forward d/t postureposture


DiagnosisDiagnosis S&SS&S Positive response Positive response

to Levodopa to Levodopa


Medical Medical ManagementManagement

dopaminedopamine (blood brain (blood brain

barrier)barrier)


Anti-Parkinsonian Anti-Parkinsonian medicationsmedications LevodopaLevodopa

Converts into Converts into dopamine in the dopamine in the basal gangliabasal ganglia

Works best in 1Works best in 1stst few few years of disease years of disease effectiveness waneseffectiveness wanes

S/E Dizzy (esp when S/E Dizzy (esp when first get up) first get up) get get up slowly!up slowly!


Anti-Parkinsonian Anti-Parkinsonian medicationsmedications SinemetSinemet

Prevents the Prevents the breakdown of breakdown of levodopa outside the levodopa outside the brainbrain


Nursing Nursing ManagementManagement

AssessmentAssessment Affect on ADL’sAffect on ADL’s DysfunctionDysfunction S/E of medsS/E of meds



Improving mobilityImproving mobility ExerciseExercise ROMROM Warm bathsWarm baths MassageMassage PTPT

gait programgait program



Enhancing Self-Enhancing Self-carecare EncouragementEncouragement Adaptive devicesAdaptive devices OTOT



Improving Bowel Improving Bowel elimination – elimination – ConstipationConstipation Bowel routineBowel routine FluidsFluids FiberFiber Raised toiletRaised toilet


Nursing ManagementNursing Management Nutritional deficitNutritional deficit

Slow processSlow process Meds Meds dry mouth dry mouth Chewing & Chewing &

SwallowingSwallowing WeightsWeights SupplementSupplement DieticianDietician

FORK!FORK!



Enhance Enhance swallowingswallowing Upright positionUpright position Semi-solid foodSemi-solid food Thick liquidsThick liquids



CommunicationCommunication Speak slowSpeak slow Short sentencesShort sentences Deep breath before Deep breath before

speakingspeaking SLPSLP


With PD it is known which neurotransmitter With PD it is known which neurotransmitter is lacking in the brain and scientists are able is lacking in the brain and scientists are able to duplicate this neurotransmitter. Why are to duplicate this neurotransmitter. Why are we then unable to cure PD?we then unable to cure PD?

PD type deterioration of the nerve cells of PD type deterioration of the nerve cells of the brain reduces the amount of what the brain reduces the amount of what neurotransmitter?neurotransmitter?

Because of the inability to cure PD at this Because of the inability to cure PD at this time, PD is frequently treated with which time, PD is frequently treated with which medications? medications?

What are the side effects of these meds?What are the side effects of these meds?


To promote optimal functions, which To promote optimal functions, which activity could the nurse recommend activity could the nurse recommend as being beneficial to a patient with as being beneficial to a patient with PD ?PD ?

What would be of value in helping a What would be of value in helping a patient with PD communicate with patient with PD communicate with the medical team?the medical team?

Is PD a disease of the CNS, PNS or Is PD a disease of the CNS, PNS or both?both?


During an assessment, what signs and During an assessment, what signs and symptoms can the nurse anticipate a symptoms can the nurse anticipate a patient with Parkinson’s to exhibit?patient with Parkinson’s to exhibit?

What nursing diagnosis would be What nursing diagnosis would be priority for a patient with Parkinson’s?priority for a patient with Parkinson’s?

Describe the muscle tone of a patient Describe the muscle tone of a patient with Parkinson’s (medical terms)with Parkinson’s (medical terms)

What interventions can be used to What interventions can be used to address the issue of nonintention address the issue of nonintention tremors?tremors?

Huntington’s DiseaseHuntington’s Disease

AKAAKA Huntinton’s ChoreaHuntinton’s Chorea

PathophysologyPathophysology RareRare GeneticGenetic

George HuntingtonGeorge Huntington


The disease is The disease is characterized as characterized as degeneration of degeneration of the cerebral cortex the cerebral cortex and the basal and the basal ganglia ganglia

Huntington’s DiseaseHuntington’s Disease Which causes chronic Which causes chronic

progressive chorea progressive chorea Bizzare involuntary Bizzare involuntary

dance-like movementsdance-like movements And mental And mental

deterioration deterioration Ending in dementia Ending in dementia

and deathand death Loss of GABA Loss of GABA

(inhibitory (inhibitory neurotransmitter)neurotransmitter)


Clinical manifestationsClinical manifestations Involuntary Involuntary

choreiformchoreiform Diminished during Diminished during

sleepsleep Facial tics/grimacingFacial tics/grimacing Paranoia & Paranoia &

hallucinationshallucinations AppetiteAppetite

RavenousRavenous EmotionsEmotions

LabileLabile

My mom has suffered My mom has suffered from this disease for from this disease for 19 years now. I never 19 years now. I never really knew her real really knew her real personality...but from personality...but from what I have heard, what I have heard, she was wonderful…I she was wonderful…I love my mom very love my mom very much, and I would much, and I would give anything to have give anything to have grown up with her grown up with her not being sick. not being sick.


DiagnosisDiagnosis DNA testingDNA testing


Medical managementMedical management No treatmentNo treatment Meds to Meds to tics tics

Chlorpromazine Chlorpromazine (Thorazine)(Thorazine)

Meds to Meds to hallucination, hallucination, delusions, angry delusions, angry outburstsoutbursts Haloperidol (Haldol)Haloperidol (Haldol)

Anti-psychoticsAnti-psychotics



Family supportFamily support DietDiet AmbulatoryAmbulatory SafetySafety

Huntington’s DiseaseHuntington’s Disease Is Huntington’s a disease of the CNS, Is Huntington’s a disease of the CNS,

PNS, or both?PNS, or both? What dietary changes might be What dietary changes might be

appropriate for a patient with appropriate for a patient with Huntington’s disease?Huntington’s disease?

Describe the pathophysiology of Describe the pathophysiology of Huntington’s disease.Huntington’s disease.

What is the etiology of Huntington’s What is the etiology of Huntington’s disease?disease?

How is Huntington’s disease different How is Huntington’s disease different from Parkinson’s disease?from Parkinson’s disease?


What medications are used to help What medications are used to help with tics and uncontrolled movements with tics and uncontrolled movements associated with Huntington Chorea?associated with Huntington Chorea?

If a patient expresses suicidal thought, If a patient expresses suicidal thought, what are the correct nursing what are the correct nursing management interventionsmanagement interventions

Huntington’s Chorea is characterized Huntington’s Chorea is characterized by what (what does it look like)?by what (what does it look like)?

Name five nursing interventions for a Name five nursing interventions for a patient with Huntington’s diseasepatient with Huntington’s disease

Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis

PathophysiologyPathophysiology Degenerative Degenerative

motor neuron motor neuron disease that affects disease that affects UMNUMN & & LMNLMN lying lying within the brain, within the brain, spinal cord and spinal cord and peripheral nervesperipheral nerves

Lou GehrigLou Gehrig


The myelin sheaths The myelin sheaths are destroyed and are destroyed and replaced with scar replaced with scar tissuetissue


Does not affect CNDoes not affect CN 33 44 66

The patient is The patient is therefore able to therefore able to BlinkBlink Move eyeMove eye


Cognition is left Cognition is left intact!intact!


Is ALS a disorder of the CNS, PNS Is ALS 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


EtiologyEtiology UnknownUnknown Men vs. WomenMen vs. Women

Men > WomenMen > Women



Progressive muscle Progressive muscle weaknessweakness

AtrophyAtrophy SpasitySpasity DysphagiaDysphagia DysarthriaDysarthria Jaw ClonusJaw Clonus Tongue fasciculationTongue fasciculation


Clinical Clinical ManifestationsManifestations

No sensory lossNo sensory loss Death within 5 Death within 5

yearsyears Resp. failureResp. failure Bulbar paralysisBulbar paralysis


DiagnosisDiagnosis S&S onlyS&S only

No dx screenNo dx screen


Medical Medical ManagementManagement

Baclofen (Lioresal)Baclofen (Lioresal) Diazepan (Valium)Diazepan (Valium)

SpasticitySpasticity Mechanical Mechanical

VentilatorVentilator



RespiratoryRespiratory ADL’sADL’s Nutritional supportNutritional support Emotional supportEmotional support Advanced directiveAdvanced directive


Amyotrophic Lateral Sclerosis is manifested Amyotrophic Lateral Sclerosis is manifested by what?by what?

What are the classic signs and symptoms of What are the classic signs and symptoms of this disease?this disease?

What are fasciculations?What are fasciculations? Amyotrophic lateral sclerosis effects UMN, Amyotrophic lateral sclerosis effects UMN,

LMN or both?LMN or 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?

Herniated DiscHerniated Disc

AKAAKA Ruptured discRuptured disc Slipped discSlipped disc Degenerative disc Degenerative disc

diseasedisease


AnatomyAnatomy The interverterbral The interverterbral

disc is a disc is a cartilaginous plate cartilaginous plate that forms a that forms a cushioncushion between between the vertebral bodythe vertebral body

Nucleus pulposusNucleus pulposus ProtrudesProtrudes Nerve compressionNerve compression


EtiologyEtiology AgeAge TraumaTrauma


Clinical Clinical ManifestationsManifestations

CervicalCervical LocationLocation

C5-6C5-6 C6-7C6-7

Pain Pain Neck Neck ShoulderShoulder ? Heart attack?? Heart attack?


LumbarLumbar LocationLocation

L4-5L4-5 L5-S1L5-S1

PainPain Low backLow back SciaticaSciatica

Relieved withRelieved with Bed restBed rest


DiagnosisDiagnosis MRIMRI


Medical ManagementMedical Management Conservative - Conservative -

cervicalcervical ImmobilizationImmobilization

CollarCollar Isometric exercisesIsometric exercises Pain reliefPain relief

Hot packsHot packs AnalgesicsAnalgesics Muscle relaxant medMuscle relaxant med Anti inflammatory medAnti inflammatory med


Medical ManagementMedical Management Conservative - Conservative -

lumbarlumbar Bed restBed rest

Firm mattressFirm mattress Pain reliefPain relief

Hot packsHot packs AnalgesicsAnalgesics MassageMassage Muscle relaxant medMuscle relaxant med Anti inflammatory Anti inflammatory

medmed


Medical Medical managementmanagement

Surgery – lumbarSurgery – lumbar TurningTurning

Log rollLog roll SittingSitting

No sitting (except No sitting (except BR)BR)

ComplicationComplication Failed Disc Failed Disc

SyndromeSyndrome


What are contributing factors to a What are contributing factors to a Herniated disc?Herniated disc?

The center of the vertebral disc is The center of the vertebral disc is called what?called what?

What are the most common sites for What are the most common sites for herniated disc?herniated disc?

What is Sciatica?What is Sciatica? CNS? PNS? Both?CNS? PNS? Both? What is the frustrating complication What is the frustrating complication

post surgery?post surgery?

Spinal BifidaSpinal Bifida

PathophysiologyPathophysiology Neural Tube defectNeural Tube defect Incomplete closure Incomplete closure

of the vertebraeof the vertebrae 3 Levels3 Levels

Spina Bifida Spina Bifida OccultaOcculta

MeningoceleMeningocele MyelomeningoceleMyelomeningocele


MeningoceleMeningocele MyelomeningoceleMyelomeningocele


Spina bifida Spina bifida occultaocculta

Spinal BifidaSpinal Bifida Myelomeningocele must Myelomeningocele must

have a repair of the open have a repair of the open neural tube. Failure to neural tube. Failure to repair may result in repair may result in serious infection which serious infection which would harm the would harm the developing infant brain. developing infant brain. After the repair, many After the repair, many children require the children require the insertion of a device insertion of a device called a shunt to divert called a shunt to divert the cerebral spinal fluid the cerebral spinal fluid to treat the to treat the hydrocephalus. hydrocephalus.

The Infant with The Infant with MyelomeningoceleMyelomeningocele


EtiologyEtiology Folic acid Folic acid

deficiency during deficiency during pregnancypregnancy Esp 1Esp 1stst month month


DiagnosisDiagnosis UltrasoundUltrasound levels of fetal levels of fetal

proteinprotein Alpha fetoproteinAlpha fetoprotein


What food contain What food contain folic Acid?folic Acid? GreensGreens AsparagusAsparagus BroccoliBroccoli CauliflowerCauliflower CornCorn Green Beans or PeasGreen Beans or Peas Sweet PotatoSweet Potato Cabbage or Cabbage or

ColeslawColeslaw

Black BeansBlack Beans LentilsLentils PeasPeas PeanutsPeanuts

What deficit is associated with spina What deficit is associated with spina bifida?bifida?

What diagnostic test is used to detect What diagnostic test is used to detect spina bifida invitro?spina bifida invitro?

Name three foods high in folic acid.Name three foods high in folic acid. Describe the difference between Spina Describe the difference between Spina

Bifida occult, meningocele and Bifida occult, meningocele and myelomeningocele.myelomeningocele.

CNS? PNS? Both? CNS? PNS? Both?

neurology ch. 65 management of patients with oncologic or

Health & Medicine

pnsare brain tumors

brain cancer

brain calledpart

malignant tumors

cerebellum tumors

benign tumors

cns pnsboth cns pns

increasethe ss