Transcript Chapter 65 Management of Patients with Oncologic or Degenerative

Pathophysiologic Results of Neurologic
Oncologic Disorders
 Manifestations depend upon the tissues infiltrated and
compressed by the neoplasm
 Pathophysiologic events may include:
 Increase ICP
 Seizures
 Hydrocephalus
 Altered pituitary function
Oncologic Tumors
 Brain tumors
 Benign or malignant
 Classification is based upon location and histological
characteristics
 Types of primary tumors
 Gliomas (arises from glial cells)
 Meningiomas
 Acoustic neuromas (tumor of the eighth cranial nerve)
 Pituitary adenomas
 Angiomas—masses of abnormal blood vessels
 Metastatic tumors
Brain Tumors
 Symptoms are dependent upon the location and size of the
lesion and the compression of associated structures
 Manifestations:
 Localized or generalized neurologic symptoms
 Symptoms of increased ICP
 Headache
 Vomiting
 Visual disturbances
 Hormonal effects with pituitary adenoma
 Loss of hearing, tinnitus, and vertigo with acoustic neuroma
Diagnostic Evaluation
 Neurologic examination
 CT scan
 MRI
 Cytological study of cerebral spinal fluid
 Biopsy
Medical Management
 Specific treatment depends upon the type, location, and
accessibility of the tumor
 Surgery
 Goal is removal of tumor without increasing neurologic
symptoms or to relieve symptoms by decompression
 Radiation therapy
 External beam radiation
 Brachytherapy
 Chemotherapy
Spinal Cord Tumors
 Classified according to their anatomic relation to the
spinal cord
 Intramedullary: within the cord
 Extramedullary: extradural; outside the dural membrane
 Manifestations include pain, weakness, and loss of motor
function, loss of reflexes, loss of sensation
 Treatment depends upon type of tumor and location
 Surgical removal
 Measures to relieve compression: dexamethasone
combined with radiation
Parkinson’s Disease
 Associated with decreased levels of dopamine due to
destruction of cells in the substantia nigra in the basal
ganglia; this effects the neurotransmission of impulses
 Manifestations: tremor, rigidity, bradykinesia, postural
instability, depression and other psychiatric changes,
dementia, sleep disturbances,
 Medical management
 Pharmacologic treatment
 Surgical procedures
 Other therapies
Pathophysiology of Parkinson’s Disease
Treatment
 Levodopa
 Anticholinergics
 Amantadine hydrochloride (antiviral)
 Monoamine Oxidase Inhibitors (inhibit dopamine
breakdown)
Nursing diagnosis
 Impaired physical mobility related to muscle rigidity and
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motor weakness
Self-care deficits (feeding, dressing, hygiene, and toileting)
related to tremor and motor disturbance
Constipation related to medication and reduced activity
Imbalanced nutrition, less than body requirements, related
to tremor, slowness in eating, difficulty in chewing and
swallowing
Impaired verbal communication related to decreased
speech volume, slowness of speech, inability to move facial
muscles
Ineffective coping related to depression and dysfunction
due to disease progression
Alzheimer's Disease
 The most common cause of dementia
 A chronic, progressive, degenerative brain disorder
that effects 4.5 million people in the United States
 Research suggests oxidative stress plays a role in the
pathophysiology of this disease
Degenerative Disk Disease
 Most back problems are related to disk disease.
 Degenerative changes occur with aging or are the result of
previous trauma.
 In herniation of the intervertebral disk (ruptured disk),
the nucleus of the disk protrudes into the annulus (the
fibrous ring around the disk), with subsequent nerve
compression.
 Continued pressure may produce degenerative changes in
the nerves with resultant changes in sensation and motor
responses.
Normal Spinal Vertebral and
Ruptured Vertebral Disk
Clinical Manifestations
 A herniated disk with accompanying pain may occur
in any portion of the spine: cervical, thoracic (rare), or
lumbar.
 The clinical manifestations depend on the location,
the rate of development (acute or chronic), and the
effect on the surrounding structures.
 Low back pain with muscle spasms, followed by
radiation of the pain into one hip and down into the
leg (sciatica).
 Paresthesia
Management
 Treatment is usually conservative—rest and
medications.
 Surgery may be required.
 Discectomy: removal of herniated or extruded
fragments of intervertebral disk
 Laminectomy: removal of the bone between the spinal
process and facet pedicle junction to expose the neural
elements in the spinal canal; this relieve compression of
the cord and roots
 Hemilaminectomy: removal of part of the lamina and
part of the posterior arch of the vertebra
 Partial laminectomy or laminotomy: creation of a
hole in the lamina of a vertebra
Nursing Process: The Care of the Patient with
Cervical Diskectomy—Assessment
 Determining the onset, location, and radiation of
pain
 Assessing for paresthesia, limited movement, and
diminished function of the neck, shoulders, and
upper extremities
 Determine whether the symptoms are bilateral
 Cervical spine palpated to assess muscle tone and
tenderness
 Range of motion in neck and shoulders is
evaluated
 Health issues
 Patient education
Nursing Process: The Care of the Patient with
Cervical Diskectomy—Diagnoses
 Acute pain related to the surgical procedure
 Impaired physical mobility related to the postoperative
surgical regimen
 Deficient knowledge about the postoperative course and
home care management
Nursing Process: The Care of the Patient with
Cervical Diskectomy—Collaborative
Problems/Potential Complications
 Hematoma at the surgical site, resulting in cord
compression and neurologic deficit
 Recurrent or persistent pain after surgery
Nursing Process: The Care of the
Patient with Cervical Diskectomy—
Nursing Interventions
 Relieving pain
 Improving mobility
 Monitoring and managing potential complications
 Promoting home and community-based care