NR 325 Chronic Neurological Disorders

Etiology/Pathophysiology Neuro disorders Seizures 563 Common cause of seizure during first 6 mos of life are severe birth injury, congenital defects involving CNS, infections, and inborn errors of metabolism. Individuals between 20-30: trauma, brain tumors, vascular disease. 50+: stroke and metastatic brain tumors. are idiopathic Epilepsy: abnormal neurons that undergo spontaneous firing. Any stimulus that causes the cell membrane of the neuron to depolarize induces a tendency to spontaneous firing. Brain area often has scar tissue

Clinical Manifestations 1. prodromal phase: signs or activity that precedes seizure 2. aural phase with a sensory warning 3. ictal phase with full seizure 4. postical phase which is the period of recovery tonic clonic: loss of consciousness and falling to the ground, or pt stiffens for 10-20 sec. then jerks for 30-40 sec. Typical absence/ petit mal: occur only in children. Brief staring spell Atypical absence: staring spell, brief warning or peculiar behavior after is common Partial seizure: may be confined to one side of the brain and remain partial

Diagnostic Tests EEG CBC CT MRI SPECT PET Pg 565

Nursing Management Carefully observe all aspects of the event because diagnosis and treatment depend on seizure description. Assess postictal period: LOC, VS, memory loss, muscle soreness, speech disorders, weakness/paralyisis, sleep period, duration of each s/s Maintain patent airway Assess pts level of understanding and provide info about why and how the event occurred.

Collaborative Management Drug tx: antiseizure drugs

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Multiple Sclerosis Pg 430

Degenerative disorder of the CNS. Cause unknown, but may be r/t infectious, immunologic, and genetic factors and perpetuated as a result of intrinsic factors. 1st-2nd-3rd degree relatives slightly increase risk. Characterized by chronic inflammation, demyelinaton and scarring of the CNS.

or focal in nature or may spread to entire brain Motor, sensory, cerebellar, and emotional problems. S/s vary overtime andmay be a long time until the first symptom is seen.

CSF analysis MRI Pg 433

Pt. should be awayre of triggers that may cause exacerbations or worsening of the disease (infection) Prevent hazards of immobility (UTI, resp. infections, pressure ulcers) Grieving process

Drug tx: ACTH, immunosuppressive drugs (azathioprine) Surgery (neurectomy, rhizotomy, cordotomy)

Parkinsons disease

Degeneration of the dopamine producint neurons in the brain, which disrupts the normal balance between dopamine and acetylcholine in the basal ganglia Dopamine is essential for normal functioning of the motor system (posture/support/voluntary motion)

Tremor, rigidity, bradykinesia, depression, anxiety, apathy, pain, fatigue, impotence, short-term memory impairment Dyskinesia as disease progresses; dementia, akinesia Difficulty swallowing, orthostatic hypotension, sleep disorders

Diagnosis solely based on hx and clinical features Definitive diagnosis only when 2 of 3 signs present: tremor, rigidity, and bradykinesia Ultimate confirmation is pos. response to antiparkinsonian medications

Promotion of physical activity and well balanced diet. Maintenance of good health, encourage independence, and avoid complications (contractures)

Drug therapy: levodopa with carbidopa, Anticholinergic drugs to manage PD, MAO inhibitos Surgical tx: DBS Nut. tx

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Myasthenia Gravis 435

Caused by autoimmune process in which antibodies are produced that attack ACh receptors. This prevents ACh molecules from attaching to the receptors and stimulation muscle contraction

Eyelid muscles or extraocular muscles involved. Facial mobility and expression can be impaired. Difficulty chewing and swallowing.

EMG Tensilon test, improved muscle contractility after IV injection of tensilon chloride

Maintain adequate ventilation, cont. drug tx, watch for side effects Care focuses on nero deficits Balanced diet Arrange diversion activities that require little physical effort and match interest to pt.

Drug tx: ACh inhibitors prolong neuromuscular junction

Restless Leg Syndrome Pg549

Abnormal iron metabolism and functional alterations in the central dopaminergic neurotransmitter systems

Huntingtons disease

Pg 328

Involves basal ganglia and extrapyramidal motor system. Involves deficiency of ACh and GABA

Sensation of bugs creeping or crawling on the skin Pain in upper extremities and trunk that occurs when the patient is sedentary and usually in the evening or at night Pain at night can produce sleep disruptions and is often relieved by physical activity Facial movements involving speech, chewing, swallowing Cause aspiration and malnutrition Cognitive

Polysomnography studies during sleep to distinguish the problem Blood tests

Reduce patient discomfort and improve sleep quality Establishing regular sleep habits, encourage exercise, avoid activities that cause symptoms, eliminating aggravating factors

Same as nursing

Testing for HD gene

Provide comfort by maintain physical safety, treating symptoms, and providing emotional support

Palliative care; drug tx: tetrabenazine

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deterioration depression

Alzheimers Disease

Pg22

Amyloid plaques consist of clusters of insoluble deposits of a protein called b-amyloid, plaques develop in brain are used for memory and cognitive function Neurofibrillary tangles are abnormal collections of twisted protein threads in side nerve cells Gradual loss of connection among neurons cause neuron death

Memory loss Agitation Delusion/illusion Long-term memory loss Communication and ADLs loss Later: unresponsive and incontinent

CT MRI SPECT MRS PET Lab tests to examine genetic markers Pg25-26

Manage symptoms Adult day care Long-term care facility

Cholinesterase inhibitors Memantine Treat depression

Dementia

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Delirium

Guillain-Barr Syndrome Pg 264

Immune system stimulation from a viral infection, trauma, surgery, viral immunizations or HIV

Weakness of lower extremities Parestheia Autonomic nervous system dysfunction pain

CSF analyisis ENG

Monitor vital capacity and ABGs Trach or endotrac intubation Sputum cultures if fever develops

Drug tx: plasmapheresis

Trigeminal Neuralgia

Pg 648

Fifth cranial nerve (motor/sensory branches) No specific cause; compression of blood vessls and irritates trigeminal nerve at root entry zone

Intense pain, twitching, grimacing, and frequent blinking Attacks brief 2-3 min, unilateral Clustering can occur after attacks (pain free/pain cycle)

CT MRI Neuro assess pg649

Instruct pt about importance of nutrition, hygiene , and oral care Lukewarm water, soft cloths, no rinse formula to cleanse face; soft bristle tooth brush; carry out hygiene activities at peak of analgesia Nut: high protein and calories and easy to chew foods

Drug tx: cambamazepine or oxcarbazepine Surgical tx pg 649

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Bells Palsy Pg 67

Disruption of motor branches of facial nerve (CN VII) of one side of face in absence of any other disease. Activation of HSV may be involved

Paralysis results in flaccidity of affected side of face, drooping mouth with drooling Inability to close eyelid

Observation and pattern of onset EMG

Hot wet packs; mild analgesics Protect face from cold and drafts Maintain good nutrition Dark glasses, artificial tears

Moist heat, gentle massage Drug tx: corticosteroids, prednisone

Others?