Transcript Neurology Ch. 65 - Porterville College

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. CNS
B. PNS
C. Both CNS & PNS
Primary-Brain Tumors
Etiology
• Unknown
Brain Tumors
Clinical manifestations
• Depends on
– Size
– Location
Brain Tumors
4 main S&S
• I-ICP
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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
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Neuro checks
Photophobia
Seizure precaution
Anxiety
Brain Tumors
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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. CNS
B. PNS
C. 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
– i with activity
– h tremor when…
• Walking
• Anxious
– Sensation of heat
– Calorie burning!
Parkinson’s Disease
• Rigidity
– Stiffness
• Neck
• Trunk
• Shoulders
– Posture
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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
• h 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
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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
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Bowel routine
Fluids
Fiber
Raised toilet
Parkinson’s Disease
Nursing Management
• Nutritional deficit
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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
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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 dancelike 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 i tics
– Chlorpromazine
(Thorazine)
• Meds to i
hallucination, delusions,
angry outbursts
– Haloperidol (Haldol)
• Anti-psychotics
Huntington’s Disease
Nursing Management
• Family support
• Diet
• Ambulatory
• Safety
Huntington’s Disease
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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
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Is ALS a disorder of the CNS, PNS or both the
CNS and PNS?
A. CNS
B. PNS
C. 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
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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
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Hot packs
Analgesics
Muscle relaxant med
Anti inflammatory med
Herniated Disc
Medical Management
• Conservative - lumbar
– Bed rest
• Firm mattress
– Pain relief
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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
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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
• h levels of fetal protein
– Alpha fetoprotein
Spinal Bifida
• What food contain folic
Acid?
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Greens
Asparagus
Broccoli
Cauliflower
Corn
Green Beans or Peas
Sweet Potato
Cabbage or Coleslaw
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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?