Class 10: the nervous system Flashcards
amnesia
inability to recall events
aphasia
inability to speak, loss of ability to express or understand spoken and written language
agnosia
inability to recognize common objects or faces of familiar people (including self)
apraxia
loss of ability to initiate purposeful movement
aphonia
loss of the ability to speak due to disease or damage to the larynx or mouth
dysarthria
difficulty in articulating words, caused by speech impairment by affected muscles
anarthria
loss of the motor ability that enables speech
hypoesthesia
partial loss of sensation, diminished sensibility
hyperpathia
abnormally exaggerated subjective response to sensory stimuli
hemi-paresthesia
numbness to one side of the body
hemiplegia
paralysis on one side of the body
paraplegia
paralysis to lower extremities
quadriplegia
paralysis from the neck down
monoplegia
complete paralysis of a single limb, muscle or muscle group
dementia
an acquired, progressive and slow but persistent decline in the ability to understand and process info correctly and to function normally in social and occupational situations
- dementia refers to a group of symptoms with multiple causes
- it is a sign of brain damage
dementia diagnosis
multiple cognitive deficits manifested by
-memory impairment (STML and ability to learn new info)
plus at least one of the following:
-aphasia
-apraxia
-agnosia
-disturbance in executive functioning (planning, sequencing, etc)
primary dementia
occur when the dementia itself is the illness
-alzheimers, Lewy body disease, frontal lobe, dementia
secondary dementia
occur when there is a primary illness causing brain damage
-vascular dementia, alcoholism, parkinsons, MS, AIDS
alzheimers disease
-a permenant progressive disease of the brain that results in dementia
-changes in the brain are:
amyloid plaques
neurofibrillary tangles
brain atrophy
-diagnosed by autopsy or by ruling out other types of dementia
-cause is still unknown
top 7 risk factors of alzheimers
- diabetes
- hypertension
- smoking
- depression
- cognitive inactivity/low education
- obesity
- physical inactivity
other risk factors of alzheimers
high cholesterol alcohol head injuries age family hx other medical conditions
mini mental status exam (MMSE)
- most common assessment of cognitive function
- does not diagnose dementia
- used to monitor change over time
- not sensitive to mild cognitive impairment
montreal cognitive assessment (MoCA)
cognitive screening tool
good sensitivity for detecting early dementia
early stage alzheimers
1-2 years
- subtle memory loss
- errors in judgement
- word finding problems
- STML
- unclear thinking
middle stage alzheimers
2-10 years
- increased memory loss
- increased confusion
- aggression, suspicion, may resist care
- intellectual and perceptual losses
- disorientation
- speech and language difficulties
- incontinence
- dexterity difficulties
late stage alzheimers
only a few months
- loss of most memories
- hallucinations, delusions, agitation
- difficulty eating and swallowing
- needs total assistance to meet basic needs
- disorientation
- unable to speak or communicate
- physical problems - muscle stiffness and rigidity, skin breakdown, seizures, infection, weight loss
four types of dementia
alzheimers,
vascular dementia
fronto-temporal dementia
Lewy body dementia
vascular dementia
dementia that results from brain damage caused by cardiovascular disease
fronto-temporal dementia
dementia characterized by the degeneration of the frontal lobe, temporal lobe or both
Lewy body dementia
deposits of lewy bodies (proteins) in the brainstem, amygdala and cortex
nursing management of alzheimers
- know the person beyond the symptoms.
- recognize retained abilities
- manipulate the social and physical environment to meet the patients unique needs
- relate effectively, in ways that enable the person to feel supported, valued and confident.
multiple sclerosis (MS)
- myelin sheath is attacked and destroyed.
- early symptoms characterized by remission and exacerbation
- early symptoms of MS include weakness and fatigue
- as the disease progresses, scar tissue forms hard sclerotic plaques that replace myelin causing pressure on the nerve
risk factors of MS
- cause unknown
- canada has one of the highest rates in the world
- increase in temperate climates
- onset usually is 15-50 years old
- women more likely than men (3:1)
- may be triggered by environmental factors in those with genetic susceptibility
- may be related to viral factors, dietary deficiencies, immunological and genetic factors
motor symptoms of MS
weakness or paralysis of limbs trunk or head and spasticity of muscles
sensory symptoms of MS
numbness or tingling, dislopia (double vision), patchy blindness, blurred vision, vertigo, tinnitus, and decreased hearing
cerebellar symptoms of MS
ataxia, dysarthria, and dysphagia. bowel and bladder function affected
treatment of MS
immunomodulating drugs work by inhibiting the immune system
- corticosteroids may be utilized for their anti-inflammatory and immunosuppressant characteristics
- symptomatic treatment for pain and muscle spasms using anti convulsants and muscle relaxants respectively
nursing assessment and interventions of MS
- assess pain, constipation and bowel impactions, skin breakdown
- psychosocial interventions are important
- provide a social network with people in a similar age group
- offer control in their daily routine
- interventions for depression and anxiety
amyotrophic lateral sclerosis (ALS)
- also known as Lou gehrigs disease or motor neurone disease
- a progressive neuromuscular disease in which nerve cells die and leave voluntary muscles paralyzed
- ALS is a fatal disease with no effective treatment and no cure
- the senses are impaired
- the intellect remains unaffected
symptoms of ALS
- cramp in distal limbs are often the first sign
- weakness and wasting of the arms, legs and hands develop other months
- symptoms typically include twitching, stiffness and muscle cramps
- over time, walking or climbing becomes difficult and the person may stumble or drag foot
- sometimes the oral muscles degenerate and cause slurred speech, hoarseness or difficulty swallowing
nursing interventions for ALS
- facilitating communication
- decreased risk of aspiration
- decrease risk of injury related to falls
- providing diversional activities such as reading and human companionship
- helping the patient and family manage the disease process to include grieving related to loss of Motor function and ultimately death
LOO levels of orientation and LOC levels of consciousness
lethargy obtundation (semi coma) full consciousness stupor (arouses to painful stimulus) coma (no movement or sound, possible reflexes)
motor function of ALS
assess motor strength bilaterally (grip fingers)
check for limb drift
sensation and cerebellar function of ALS
- begin with feet and move up to face, comparing bilaterally
- light touch
- superficial pain
- differentiate dull from sharp
- temperature sensation
- proprioception
- coordination
- balance and gait
alzheimers
most common type of dementia, change in amyloid plaque and neurofibulary tangles,
frontotemporal dementia
early onset dementia (before 65) damage to frontal and temporal lobe, behavioural and social problems and aggression. used psychotropic and antipsychotic meds
lower body dementia
accumulation of abnormal protein (lower body) in the brain. hallucinations decreased cognitive function, balance and falls
vasular dementia
second most common, decreased blood flow to the brain (mini strokes) the part of the brain that is affected is what the symptoms must be so the nurse must assess for that first. incontinence, extremity weakness, dizziness
