Med Surg: Parkinsons Disease

Question 1

What is Parkinson Disease?

Answer 1

Debilitating disease affecting motor ability

Characterized by tremor, rigidity, akinesia, and postural instability

Parkinson disease is serparated into 5 stages by degree of disability

Exact cause is unknown

Question 2

What are drugs for Parkinson Disease?

Answer 2

drugs are used to control symptoms, improve quality and help with mobility

closely monitored

doses adjusted or changed as needed

Action of most common drugs involves:

• replacing dopamine: tremore, swallowing, motility
• stimulate dopamine receptors
• preventing dopamine inactivation
• stimulating dopamine release

Question 3

What is drug toxicity?

Answer 3

Long-term drug therapy regimens often cause significant side effects

• delirium, cognitive impairment, decrease effectiveness, hallucinations

Possible interventions:

• reduction of medication dose, change medication or frequency of administration, stop taking drugs

Question 4

What is management of Parkinson Disease?

Answer 4

Exercise and ambulation

Self-care

Injury prevention

Nutrition

Communication

Psychosocial support

Surgical management includes sterotactic pallidotmy and deep brain stimulations

Question 5

What is Guillian-Barre Syndrome drug therapy?

Answer 5

IV immunoglobin

Corticosteriods are not typically given

Question 6

Multiple Sclerosis Drug Therapy

Answer 6

Biological response modifiers

immunosuppressives

Steriods

Antispasmodic drugs

Adjunctive

Question 7

What is the drug therapy for a head injury?

Answer 7

Osmotic or loop diuretic: Monnitol, furosemide

Antiepileptic drugs

Acetaminophen and aspirin

Barbituate coma: decrease metabolic demands of the brain

Use of glucocorticoids or methylprednisone: Decadron, Solumedrol NOT RECOMMENDED

Question 8

What is surgical management?

Answer 8

ICP monitoring devices

• IV catheter
• SUbrarachnoid screw or bolt
• Epidural catheter
• Subdural catheter

Craniotomy may be performed in extreme instances of elevated ICP

Question 9

What is back pain?

Answer 9

Herniated nucleus pulposus

Phsyical assessment: continuous acute pain, altered gait, vertebral alignment, paresthesia

Diagnostic assessment using MRI, CT, and electromyography

Question 10

What is nonsurgical management?

Answer 10

Williams position: firm mattress or backboard under soft mattress

Exercise

Drug therapy: muscle relaxants, NSAIDS, opiods, antiepileptic

Heat and ice therapy

Diet therapy: weight control

Physical therapy

Orthotics

Question 11

What is surgical management?

Answer 11

Minimally invasive techniques may be used

Open approaches:

• Diskectomy
• Laminectomy
• Spinal fusion

Interbody cage fusion

Question 12

What is postoperative care?

Answer 12

Prevention and assessment of complications

Neurologic assessment: vital signs

Clients ability to void

Pain control

Wound care

Client positioning and mobility

Question 13

What is the inital assessment of a spinal cord injury?

Answer 13

Assessment of the respiratory pattern and ensuring an adequate airway

Assessment for indications of hemorrhage or bleeding around fracture sites

Assessment of LOC using Glasgow Coma Scale

Question 14

What is the initial assessment?

Answer 14

Establishment of level and extent of injury

Neurovascular assesment

Cardiovascular regulatory assessment

Question 15

What is spinal shock?

Answer 15

Flaccid paralysis

Loss of reflex activity below the level of the lesion

Bradycardia

Paralyric ileus

Hypotension

Question 16

What is autonomic dysreflexia?

Answer 16

commonly seen in clients with upper spinal cord injury

Severe hypertension

bradycardia

severe headache

nasal stuffiness

flushing treatment

Question 17

What are interventions for ineffective tissue perfusion?

Answer 17

Reduction and immobilization of the fracture to prevent further damange to the spinal cord from bone fragments

Nonsurgical techniques, such as traction or external frixation, but surgery may be neccessary as well

Question 18

What is immobilization for cervical injuries?

Answer 18

Fixed skeletal traction to realign the vertebrae, facilitate bone healing and prevent further injury

Halo fixation and cervical tongs

Stryker frame, rotational bed, kinetic treatment table

Pin site care and monitoring of traction ropes

Question 19

What are immobilization of thoracic and lumbosacral injuries?

Answer 19

For client with thoracic injuries bedrest and possible immobilization

for client with lumbar and sacral injury: immobilization of the spine and a brace or corset, worn when the client is out of bed, custom-fit

Question 20

What is surgical management?

Answer 20

Emergency surgery necessary for spinal cord decompression

Spinal fusion

Question 21

What are interventions for the client with the spinal cord injury?

Answer 21

Airway management is the priority

Clients with injuries at or above the 6th throacic vertebrae are especially at risk for respiratory complications

Provide measure to maintain airway

Assissted coughing, quad cough and cough assist

Use of incentive apirometer

Question 22

What are interventions of impaired physical mobility?

Answer 22

Monitor risk of pressure ulcer, contractures and DVT

proper positioning, skin inspection, ROM exercises, and graduated compression stockings

Prevent orthostatic hypotension

Promote self-care

Anticoagulant Rx may be prescribed

Question 23

What are interventions of impaired urinary elimination?

Answer 23

bladder retaining program

spastic bladder: manipulating external area

Flaccid bladder: Valsava maneuver

Encouraging consumption of 2000-2500mL of fluid daily to prevent urinary tract ingection

S&S not perceived by client

Question 24

How does one establish a bowel retraining program?

Answer 24

Consistent time for bowel elimination

High fluid intake for at least 200 mL/day

High fiber diet

Rectal stimulation

Stool softener medications as needed

Question 25

What are the interventions for impaired adjustment?

Answer 25

invite client to ask questions about significant life changes

Encourage client to discuss his/her perceptions of situation and coping stratigies that can be used

Begin a client education program to clarify misconceptions