neurology ch. 65 management of patients with oncologic or degenerative neurologic disorders
TRANSCRIPT
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Neurology Ch. 65
Management of patients with oncologic or degenerative neurologic
disorders
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Brain Tumors
Pathophysiology• Primary– Originating from the
brain
• Secondary– Originating outside the
brain– Metastasis
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Brain Tumors
• Malignant– Tend to become
progressively worse– Anaplasia
• Cell distortion
– Invasive
• Benign– No malignant or
recurrent
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Brain Tumors
• Presence of lesion • Compression of blood
vessels • Ischemia • Edema • I-ICP
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Brain Tumors
• Are brain tumors a disorder of the CNS, PNS or Both the CNS and PNS?
A. CNSB. PNSC. Both CNS & PNS
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Primary-Brain Tumors
Etiology• Unknown
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Brain Tumors
Clinical manifestations• Depends on– Size– Location
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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
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Brain Tumors
Localized S&S• Frontal– Personality changes– Emotional changes
• Occipital– Visual impairment– Visual hallucinations
• Cerebellum– Impaired equilibrium– Impaired coordination
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Brain Tumors
Diagnosis• CT• MRI
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Primary - Brain Tumors
Medical management• Radiation• Chemotherapy• Pharmaceutical– Corticosteroids– Anti-convulsants
• Surgery
• Tug McGraw
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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
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Secondary-Brain Tumor
Pharmacology• Corticosteroids– Dexamethasone– Prednisone
• Osmotic Diuretic– Mannitol
• Anti-convulsants– Dilantin
• Morphine
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Brain Tumors
Nursing Management• Aspiration• Alt. nutrition– Cachexia
• Weak emaciate condition
• Neuro checks• Photophobia• Seizure precaution• Anxiety
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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?
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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?
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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
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Parkinson’s Disease
• Basal Ganglia– Controls movement
• Dopamine– Inhibitory
neurotransmitter in the basal ganglia
• Acetylcholine– Excitatory
neurotransmitter in the basal ganglia
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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
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Parkinson’s Disease
• Is Parkinson's disease a disorder of the CNS, PNS or both the CNS & PNS?
A. CNSB. PNSC. Both PNS & CNS
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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
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Parkinson’s Disease
3 clinical signs• Tremors• Rigidity• Bradykinesia
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Parkinson’s Disease
• Tremors– Resting tremor– with activity– tremor when…
• Walking• Anxious
– Sensation of heat– Calorie burning!
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Parkinson’s Disease
• Rigidity– Stiffness
• Neck• Trunk• Shoulders
– Posture• Head bowed• Body bent forward• Arms flexed• Thumbs turned into
palms• Knees bent (slightly)
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Parkinson’s Disease
• Bradykinesia– Slow movement– Akinesia
• Loss of movement• Esp face
– Expressionless
– Slow speech• Dysphonia
– Dysphagia• Drooling
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Parkinson’s Disease
• Bradykinesia– Gait
• Shuffled• Festination
– Fall forward d/t posture
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Parkinson’s Disease
Diagnosis• S&S• Positive response to
Levodopa
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Parkinson’s Disease
Medical Management• dopamine– (blood brain barrier)
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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!
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Parkinson’s Disease
• Anti-Parkinsonian medications– Sinemet
• Prevents the breakdown of levodopa outside the brain
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Parkinson’s Disease
Nursing Management• Assessment– Affect on ADL’s– Dysfunction– S/E of meds
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Parkinson’s Disease
Nursing Management• Improving mobility– Exercise– ROM– Warm baths– Massage– PT
• gait program
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Parkinson’s Disease
Nursing Management• Enhancing Self-care– Encouragement– Adaptive devices– OT
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Parkinson’s Disease
Nursing Management• Improving Bowel
elimination – Constipation– Bowel routine– Fluids– Fiber– Raised toilet
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Parkinson’s Disease
Nursing Management• Nutritional deficit– Slow process– Meds dry mouth– Chewing & Swallowing– Weights– Supplement– Dietician
• FORK!
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Parkinson’s Disease
Nursing Management• Enhance swallowing– Upright position– Semi-solid food– Thick liquids
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Parkinson’s Disease
Nursing Management• Communication– Speak slow– Short sentences– Deep breath before
speaking– SLP
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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?
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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?
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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?
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Huntington’s Disease
• AKA– Huntinton’s Chorea
• Pathophysology– Rare– Genetic
• George Huntington
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Huntington’s Disease
• The disease is characterized as degeneration of the cerebral cortex and the basal ganglia
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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)
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Huntington’s Disease
Clinical manifestations• Involuntary choreiform• Diminished during sleep• Facial tics/grimacing• Paranoia &
hallucinations• Appetite– Ravenous
• Emotions– Labile
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Huntington’s Disease
Diagnosis• DNA testing
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Huntington’s Disease
Medical management• No treatment• Meds to tics– Chlorpromazine
(Thorazine)• Meds to hallucination,
delusions, angry outbursts– Haloperidol (Haldol)
• Anti-psychotics
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Huntington’s Disease
Nursing Management• Family support• Diet• Ambulatory• Safety
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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?
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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
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Amyotrophic Lateral Sclerosis
Pathophysiology• Degenerative motor
neuron disease that affects UMN & LMN lying within the brain, spinal cord and peripheral nerves
• Lou Gehrig
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Amyotrophic Lateral Sclerosis
• The myelin sheaths are destroyed and replaced with scar tissue
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Amyotrophic Lateral Sclerosis
• Does not affect CN– 3– 4– 6
• The patient is therefore able to – Blink– Move eye
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Amyotrophic Lateral Sclerosis
• Cognition is left intact!
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Amyotrophic Lateral Sclerosis
• Is ALS a disorder of the CNS, PNS or both the CNS and PNS?
A. CNSB. PNSC. Both CNS & PNS
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Amyotrophic Lateral Sclerosis
Etiology• Unknown• Men vs. Women– Men > Women
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Amyotrophic Lateral Sclerosis
Clinical manifestations• Progressive muscle
weakness• Atrophy• Spasity• Dysphagia• Dysarthria• Jaw Clonus• Tongue fasciculation
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Amyotrophic Lateral Sclerosis
Clinical Manifestations• No sensory loss• Death within 5 years– Resp. failure– Bulbar paralysis
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Amyotrophic Lateral Sclerosis
Diagnosis• S&S only– No dx screen
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Amyotrophic Lateral Sclerosis
Medical Management• Baclofen (Lioresal)• Diazepan (Valium)– Spasticity
• Mechanical Ventilator
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Amyotrophic Lateral Sclerosis
Nursing Management• Respiratory• ADL’s• Nutritional support• Emotional support• Advanced directive
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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?
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Herniated Disc
• AKA– Ruptured disc– Slipped disc– Degenerative disc
disease
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Herniated Disc
• Anatomy– The interverterbral disc
is a cartilaginous plate that forms a cushion between the vertebral body
– Nucleus pulposus– Protrudes– Nerve compression
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Herniated Disc
Etiology• Age• Trauma
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Herniated Disc
Clinical Manifestations• Cervical– Location
• C5-6• C6-7
– Pain • Neck • Shoulder• ? Heart attack?
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Herniated Disc
• Lumbar– Location
• L4-5• L5-S1
– Pain• Low back• Sciatica
– Relieved with• Bed rest
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Herniated Disc
Medical Management• Conservative - cervical– Immobilization
• Collar
– Isometric exercises– Pain relief
• Hot packs• Analgesics• Muscle relaxant med• Anti inflammatory med
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Herniated Disc
Medical Management• Conservative - lumbar– Bed rest
• Firm mattress
– Pain relief• Hot packs• Analgesics• Massage• Muscle relaxant med• Anti inflammatory med
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Herniated Disc
Medical management• Surgery – lumbar– Turning
• Log roll
– Sitting• No sitting (except BR)
– Complication• Failed Disc Syndrome
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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?
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Spinal Bifida
Pathophysiology• Neural Tube defect• Incomplete closure of
the vertebrae• 3 Levels– Spina Bifida Occulta– Meningocele– Myelomeningocele
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Spinal Bifida
• Meningocele • Myelomeningocele
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Spinal Bifida
Etiology• Folic acid deficiency
during pregnancy– Esp 1st month
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Spinal Bifida
Diagnosis• Ultrasound• levels of fetal protein– Alpha fetoprotein
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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
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• 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?