Neurology Ch. 65

1
Neurology Ch. 65

• Management of patients with oncologic or
  degenerative neurologic disorders

2
Brain Tumors

• Pathophysiology
• Primary
• Originating from the brain
• Secondary
• Originating outside the brain
• Metastasis

3
Brain Tumors

• Malignant
• Tend to become progressively worse
• Anaplasia
• Cell distortion
• Invasive
• Benign
• No malignant or recurrent

4
Brain Tumors

• Presence of lesion ?
• Compression of blood vessels ?
• Ischemia ?
• Edema ?
• I-ICP

5
Brain Tumors

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

6
Primary-Brain Tumors

• Etiology
• Unknown

7
Brain Tumors

• Clinical manifestations
• Depends on
• Size
• Location

8
Brain Tumors

• 4 main SS
• I-ICP
• Cushing sign
• H/A
• Vomiting
• Visual disturbances
• Seizures
• Hydrocephalus
• Alt Pituitary function

• Cancer cells being attacked by immune system

9
Brain Tumors

• Localized SS
• Frontal
• Personality changes
• Emotional changes
• Occipital
• Visual impairment
• Visual hallucinations
• Cerebellum
• Impaired equilibrium
• Impaired coordination

10
Brain Tumors

• Diagnosis
• CT
• MRI

11
Primary - Brain Tumors

• Medical management
• Radiation
• Chemotherapy
• Pharmaceutical
• Corticosteroids
• Anti-convulsants
• Surgery

• Tug McGraw

12
Secondary-Brain Tumor

• 3 treatment options
• No treatment
• Death lt 1 month
• Tx w/ corticosteroids only
• Death lt 2 months
• Tx with radiation
• Death 3-6 months

13
Secondary-Brain Tumor

• Pharmacology
• Corticosteroids
• Dexamethasone
• Prednisone
• Osmotic Diuretic
• Mannitol
• Anti-convulsants
• Dilantin
• Morphine

14
Brain Tumors

• Nursing Management
• Aspiration
• Alt. nutrition
• Cachexia
• Weak emaciate condition
• Neuro checks
• Photophobia
• Seizure precaution
• Anxiety

15
Brain Tumors

• What SS are associated with frontal lobe,
  occipital lobe and cerebellum tumors?
• What diet would you expect a patient with brain
  cancer to be on?
• The SS are associated with increase intracranial
  pressure?

16
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?

17
Parkinsons 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

18
Parkinsons Disease

• Basal Ganglia
• Controls movement
• Dopamine
• Inhibitory neurotransmitter in the basal ganglia
• Acetylcholine
• Excitatory neurotransmitter in the basal ganglia

19
Parkinsons Disease

• Without dopamine, inhibitory influences are lost
  and excitatory mechanisms are unopposed ?
• Neurons of basal ganglia are over stimulated ?
• Excess muscle tone, tremors rigidity

20
Parkinsons Disease

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

21
Parkinsons Disease

• Clinical manifestations
• Onset
• Abrupt
• Age of on set
• 60
• Men vs. Women
• Men gt women
• First Symptom
• Fine tremors in hands or feet

22
Parkinsons Disease

• 3 clinical signs
• Tremors
• Rigidity
• Bradykinesia

23
Parkinsons Disease

• Tremors
• Resting tremor
• i with activity
• h tremor when
• Walking
• Anxious
• Sensation of heat
• Calorie burning!

24
Parkinsons Disease

• Rigidity
• Stiffness
• Neck
• Trunk
• Shoulders
• Posture
• Head bowed
• Body bent forward
• Arms flexed
• Thumbs turned into palms
• Knees bent (slightly)

25
Parkinsons Disease

• Bradykinesia
• Slow movement
• Akinesia
• Loss of movement
• Esp face
• Expressionless
• Slow speech
• Dysphonia
• Dysphagia
• Drooling

26
Parkinsons Disease

• Bradykinesia
• Gait
• Shuffled
• Festination
• Fall forward d/t posture

27
Parkinsons Disease

• Diagnosis
• SS
• Positive response to Levodopa

28
Parkinsons Disease

• Medical Management
• h dopamine
• (blood brain barrier)

29
Parkinsons 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!

30
Parkinsons Disease

• Anti-Parkinsonian medications
• Sinemet
• Prevents the breakdown of levodopa outside the
  brain

31
Parkinsons Disease

• Nursing Management
• Assessment
• Affect on ADLs
• Dysfunction
• S/E of meds

32
Parkinsons Disease

• Nursing Management
• Improving mobility
• Exercise
• ROM
• Warm baths
• Massage
• PT
• gait program

33
Parkinsons Disease

• Nursing Management
• Enhancing Self-care
• Encouragement
• Adaptive devices
• OT

34
Parkinsons Disease

• Nursing Management
• Improving Bowel elimination Constipation
• Bowel routine
• Fluids
• Fiber
• Raised toilet

35
Parkinsons Disease

• Nursing Management
• Nutritional deficit
• Slow process
• Meds ? dry mouth
• Chewing Swallowing
• Weights
• Supplement
• Dietician
• FORK!

36
Parkinsons Disease

• Nursing Management
• Enhance swallowing
• Upright position
• Semi-solid food
• Thick liquids

37
Parkinsons Disease

• Nursing Management
• Communication
• Speak slow
• Short sentences
• Deep breath before speaking
• SLP

38
Parkinsons 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?

39
Parkinsons 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?

40
Parkinsons Disease

• During an assessment, what signs and symptoms can
  the nurse anticipate a patient with Parkinsons
  to exhibit?
• What nursing diagnosis would be priority for a
  patient with Parkinsons?
• Describe the muscle tone of a patient with
  Parkinsons (medical terms)
• What interventions can be used to address the
  issue of nonintention tremors?

41
Huntingtons Disease

• AKA
• Huntintons Chorea
• Pathophysology
• Rare
• Genetic

• George Huntington

42
Huntingtons Disease

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

43
Huntingtons Disease

• Which causes chronic progressive chorea
• Bizzare involuntary dance-like movements
• And mental deterioration ?
• Ending in dementia and death
• Loss of GABA (inhibitory neurotransmitter)

44
Huntingtons Disease

• Clinical manifestations
• Involuntary choreiform
• Diminished during sleep
• Facial tics/grimacing
• Paranoia hallucinations
• Appetite
• Ravenous
• Emotions
• Labile

45
Huntingtons Disease

• Diagnosis
• DNA testing

46
Huntingtons Disease

• Medical management
• No treatment
• Meds to i tics
• Chlorpromazine (Thorazine)
• Meds to i hallucination, delusions, angry
  outbursts
• Haloperidol (Haldol)
• Anti-psychotics

47
Huntingtons Disease

• Nursing Management
• Family support
• Diet
• Ambulatory
• Safety

48
Huntingtons Disease

• Is Huntingtons a disease of the CNS, PNS, or
  both?
• What dietary changes might be appropriate for a
  patient with Huntingtons disease?
• Describe the pathophysiology of Huntingtons
  disease.
• What is the etiology of Huntingtons disease?
• How is Huntingtons disease different from
  Parkinsons disease?

49
Huntingtons 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
• Huntingtons Chorea is characterized by what
  (what does it look like)?
• Name five nursing interventions for a patient
  with Huntingtons disease

50
Amyotrophic Lateral Sclerosis

• Pathophysiology
• Degenerative motor neuron disease that affects
  UMN LMN lying within the brain, spinal cord and
  peripheral nerves

• Lou Gehrig

51
Amyotrophic Lateral Sclerosis

• The myelin sheaths are destroyed and replaced
  with scar tissue

52
Amyotrophic Lateral Sclerosis

• Does not affect CN
• 3
• 4
• 6
• The patient is therefore able to
• Blink
• Move eye

53
Amyotrophic Lateral Sclerosis

• Cognition is left intact!

54
Amyotrophic Lateral Sclerosis

• Is ALS a disorder of the CNS, PNS or both the CNS
  and PNS?
• CNS
• PNS
• Both CNS PNS

55
Amyotrophic Lateral Sclerosis

• Etiology
• Unknown
• Men vs. Women
• Men gt Women

56
Amyotrophic Lateral Sclerosis

• Clinical manifestations
• Progressive muscle weakness
• Atrophy
• Spasity
• Dysphagia
• Dysarthria
• Jaw Clonus
• Tongue fasciculation

57
Amyotrophic Lateral Sclerosis

• Clinical Manifestations
• No sensory loss
• Death within 5 years
• Resp. failure
• Bulbar paralysis

58
Amyotrophic Lateral Sclerosis

• Diagnosis
• SS only
• No dx screen

59
Amyotrophic Lateral Sclerosis

• Medical Management
• Baclofen (Lioresal)
• Diazepan (Valium)
• Spasticity
• Mechanical Ventilator

60
Amyotrophic Lateral Sclerosis

• Nursing Management
• Respiratory
• ADLs
• Nutritional support
• Emotional support
• Advanced directive

61
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?

62
Herniated Disc

• AKA
• Ruptured disc
• Slipped disc
• Degenerative disc disease

63
Herniated Disc

• Anatomy
• The interverterbral disc is a cartilaginous plate
  that forms a cushion between the vertebral body
• Nucleus pulposus
• Protrudes
• Nerve compression

64
Herniated Disc

• Etiology
• Age
• Trauma

65
Herniated Disc

• Clinical Manifestations
• Cervical
• Location
• C5-6
• C6-7
• Pain
• Neck
• Shoulder
• ? Heart attack?

66
Herniated Disc

• Lumbar
• Location
• L4-5
• L5-S1
• Pain
• Low back
• Sciatica
• Relieved with
• Bed rest

67
Herniated Disc

• Medical Management
• Conservative - cervical
• Immobilization
• Collar
• Isometric exercises
• Pain relief
• Hot packs
• Analgesics
• Muscle relaxant med
• Anti inflammatory med

68
Herniated Disc

• Medical Management
• Conservative - lumbar
• Bed rest
• Firm mattress
• Pain relief
• Hot packs
• Analgesics
• Massage
• Muscle relaxant med
• Anti inflammatory med

69
Herniated Disc

• Medical management
• Surgery lumbar
• Turning
• Log roll
• Sitting
• No sitting (except BR)
• Complication
• Failed Disc Syndrome

70
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?

71
Spinal Bifida

• Pathophysiology
• Neural Tube defect
• Incomplete closure of the vertebrae
• 3 Levels
• Spina Bifida Occulta
• Meningocele
• Myelomeningocele

72
Spinal Bifida

• Meningocele

• Myelomeningocele

73
Spinal Bifida

• Etiology
• Folic acid deficiency during pregnancy
• Esp 1st month

74
Spinal Bifida

• Diagnosis
• Ultrasound
• h levels of fetal protein
• Alpha fetoprotein

75
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

76

• 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?