Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
D isea ses
Degenerative Disorders
Disorders of the central and peripheral nervous system that are neurodegenerative characterized by slow onset of signs and symptoms. Signs and symptoms that leads to the deterioration of normal cells or function of the nervous system. Patients are mainly managed at home for as long as possible and are admitted to the acute care setting for exacerbations, treatments, and surgical interventions as needed.
Parkinsons Disease
Parkinson's disease is a disorder that affects nerve cells in the part of the brain controlling muscle movement. People with Parkinson's disease often experience trembling, muscle rigidity, difficulty walking, problems with balance and slowed movements. Symptoms usually develop after age 60, although some people affected by Parkinson's disease are younger than age 50. Although Parkinson's disease may eventually be disabling, the disease often progresses gradually, and most people have many years of productive living after a diagnosis.
Causes
Most people with Parkinson's disease are described as having idiopathic PD (having no specific cause). There are far less common causes of PD including genetic, toxins, head trauma, cerebral anoxia, and drug-induced PD. drug-
Head Trauma
Past episodes of head trauma are reported more frequently by sufferers than by others in the population. A methodologically strong recent study found that those who have experienced a head injury are four times more likely to develop Parkinsons disease than those who have never suffered a head injury.
Drug Induced PD
Antipsychotics, which are used to treat schizophrenia and psychosis, can induce the symptoms of Parkinson's disease (or parkinsonism) by lowering dopaminergic activity.
Pathophysiology of PD
The symptoms of Parkinson's disease result from the loss of pigmented dopamine-secreting (dopaminergic) cells, dopaminesecreted by the same cells, in the pars compacta region of the substantia nigra These neurons project to the striatum and their loss leads to alterations in the activity of the neural circuits within the basal ganglia that regulate movement, in essence an inhibition of the direct pathway and excitation of the indirect pathway
Pathophysiology of PD
The direct pathway facilitates movement and the indirect pathway inhibits movement, thus the loss of these cells leads to a hypokinetic movement disorder. The lack of dopamine results in increased inhibition of the ventral lateral nucleus of the thalamus, which sends excitatory projections to the motor cortex, thus leading to hypokinesia.
Bradykinesia Tremors
Clinical Manifestations
Loss of Automatic Movements Impaired Speech Impaired Balance Difficulty Swallowing
Levodopa
Selegiline Eldepryl
Medications
Anticholinergics Cathechol o Methyltransferase Dopamine Agonist
Thalatomy
Pallidotomy
Surgical Management
Complications
Difficulty chewing and swallowing. Urinary problems. Constipation Sleep problems Sexual dysfunction
Nursing Management
Provide information and support regarding Parkinsons Disease. Health teaching, diet, high in fiber, increase oral fluid intake to prevent constipation. Promote relaxation exercises to promote proper sleep. Improving mobility. Enhancing self-care activities. selfImproving bowel elimination Improving nutrition. Enhancing swallowing.
Huntingtons Disease
Huntingtons disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreinform movement and dementia. It is transmitted as an autosomal dominant genetic disorder. Also called Huntington's chorea, chorea comes from the greek word meaning to dance and refers to the incessant quick, jerky, involuntary movements that are characteristic of this condition. Each child of a parent with Huntingtons disease has a 50% risk of inheriting the illness. It affects men and women.
Cause of HD
Huntington's disease is an inherited condition caused by a single abnormal gene. Because only one copy of the defective gene, inherited from either parent, is necessary to produce the disease. Because signs and symptoms typically first appear in middle age, some parents may not know they carry the gene until they've already had children and possibly passed on the trait.
Pathophysiology of HD
Pathophysiology involves premature death of cells in the stiatum (caudate and putamen of the basal ganglia, which involve the control movement. There is also loss of cells in the cortex, it is the region of the brain associated with thinking, memory, perception, and judgement and also the cerebellum that coordinates voluntary muscle activity. Building block for protein called gluthamine abnormally collects in the nucleus, causing cell death. The cells destruction results in a lack of the neurotransmitters gammagamma-aminobutyric acid. This is usually occurs in ages between 35 to 45 years.
Clinical Manifestations
Abnormal involuntary movements (chorea), intellectual decline, and emotional disturbances. Constant writhing and uncontrollable movements of the entire body occur as this disease progresses. Facial movements produce ticks and grimaces; speech becomes slurred, hesitant, open explosive, and then eventually unintelligible. Chewing and swallowing are difficult, and aspiration and choking are dangers. Gait becomes disorganized, and ambulation is eventually impossible; patient is eventually confined to a wheelchair.
Management
Medications
Tranquilizers such as clonazepam (Klonopin) and antipsychotic drugs such as haloperidol (Haldol) and clozapine (Clozaril) can help control movements, violent outbursts and hallucinations. While these medications can be helpful, a common side effect is sedation, and in some cases, these medications may cause additional stiffness and rigidity. Various medications, including fluoxetine (Prozac, Sarafem), sertraline (Zoloft) and nortriptyline (Aventyl, Pamelor), can help control depression and the obsessive-compulsive obsessiverituals that some people with Huntington's disease develop. Medications such as lithium (Eskalith, Lithobid) can help control extreme emotions and mood swings.
Complications
Though the signs and symptoms vary from person to person, vital functions, such as swallowing, eating, speaking and walking, usually degenerate over time. Many people with Huntington's disease develop depression, and some are at risk of suicide. However, death generally occurs as a result of complications of the disease, such as an infection or a fall.
Nursing Management
Reinforcement the understanding that Huntingtons disease takes emotional, physical, social, and financial tolls on every member of the patients family. Encourage genetic counseling, long term psychological counseling, marriage counseling, and financial and legal support. Teach patient and family about the medication, including signs indicating the need for change in dosage or medication.
Nursing Management
Address strategies to manage symptoms (chorea, swallowing problems, ambulation problems, or altered bowel or bladder function). Emphasize the need for regular follow-up. followRefer for home care nursing assistance, respite care, day care centers, and eventually skilled long-term care to longassist patient and family cope. Provide information about the Huntingtons Disease Foundation of America, which gives information, referrals, education, and support for reaserch.
Alzheimers Disease
Alzheimer's disease is the most common cause of dementia, which is the loss of intellectual and social abilities severe enough to interfere with daily functioning. Dementia occurs in people with Alzheimer's disease because healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.
Cause of AD
The causes of Alzheimer's are poorly understood, but its effect on brain tissue has been demonstrated clearly. Alzheimer's damages and kills brain cells. Studies of plaques and tangles from the brains of people who have died of Alzheimer's suggest several possible roles these structures might play in the disease.
Clinical Manifestations
Increasing and Difficulty with Persistent Abstract Thinking Forgetfulness Difficulty Performing Familiar Tasks
Management of AD
Currently, there is no cure for AD. Medications are prescribed to offer relatively small symptomatic relief.
Cholinesterase Inhibitors
This group of medications, which includes donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) works by improving the levels of neurotransmitters in the brain. Side effects include diarrhea, nausea, and vomiting.
Memantine (Namenda)
The first drug approved to treat moderate to severe stages of Alzheimer's, memantine (Namenda), protects brain cells from damage caused by the chemical messenger glutamate. It sometimes is used in combination with a cholinesterase inhibitor. Most common side effect is dizziness, and may increase agitation and delusional behavior.
Cause of ALS
Amyotrophic lateral sclerosis is a disease that involves death of motor neurons, the nerve cells that control voluntary muscles. In ALS, both upper motor neurons, located in your brain, and lower motor neurons, located in your spinal cord, gradually die. ALS is an inherited disease. The other type of ALS appears to occur randomly with no identifiable cause and no obvious risk factors.
Clinical Manifestations
Difficulty lifting the front part of your foot (footdrop) Weakness in your leg, feet or ankles Hand weakness or clumsiness Slurring of speech or trouble swallowing Muscle cramps and twitching in your arms, shoulders and tongue Fatigue in combination with the above signs and symptoms Eventually, amyotrophic lateral sclerosis paralyzes the muscles needed to breathe. Most people with ALS die of respiratory failure, usually within three to five years after symptoms begin.
Muscular Dystrophies
Muscular Dystrophies
Muscular dystrophy (MD) is a group of inherited muscle diseases in which muscle fibers are unusually susceptible to damage. Muscles, primarily voluntary muscles, become progressively weaker. In the late stages of muscular dystrophy, fat and connective tissue often replace muscle fibers. Some types of muscular dystrophy affect heart muscles, other involuntary muscles and other organs.
Clinical Manifestation
Muscle weakness Apparent lack of coordination Progressive crippling, resulting in fixations (contractures) of the muscles around your joints and loss of mobility Weakening of voluntary muscles that control your arms and legs, usually beginning with the limb muscles farthest from the torso the muscles of the feet, hands, lower legs and forearms.
Lumbar disk herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica.
Pathophysiology
The intervertebral disk is a cartilaginous plate that forms a cushion between the vertebral bodies. This tough, fibrous material is incorporated in a capsule. A ball like cushion in the center of the disk is called the nucleus pulposus. pulposus. In herniation, the nucleus of the disk protrudes into the annulus, with subsequent nerve compression.
Pathophysiology
Protrusion or rupture of the nucleus pulposus usually is preceeded by degenerative changes that occur with changing. Loss of protein polysaccharides in the disk decreases the water content of the nucleus pulposus. The development of radiating cracks in the annulus weakens resistance to nucleus heriation.
Clinical Manifestations
Chief complaint is leg pain greater than back pain. Intense pain in the hip joint from a lumbar disk herniation. Unrelenting neck or lower back pain. Numbness Tingling Muscular weakness Paralysis Paresthesia Affection of reflexes Sciatica
Surgical Options
Anterior cervical discectomy and fusion Laminectomy Hemilaminectomy Lumbar fusions Disk arthroplasty Artificial disk replacement
Causes of DDD
Trauma micro or macro as a simple lifting accident is the most common cause of disc degeneration. After trauma the discs in the spine dehydrate, or dry out, and lose their ability to act as shock absorbers between the vertebrae. There is minimal blood supply to the discs so they lack the ability to heal or repair themselves.
MARITES A. ROSAPAPAN, RN