Med Surg: Parkinsons Disease Flashcards
What is Parkinson Disease?
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
What are drugs for Parkinson Disease?
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
What is drug toxicity?
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
What is management of Parkinson Disease?
Exercise and ambulation
Self-care
Injury prevention
Nutrition
Communication
Psychosocial support
Surgical management includes sterotactic pallidotmy and deep brain stimulations
What is Guillian-Barre Syndrome drug therapy?
IV immunoglobin
Corticosteriods are not typically given
Multiple Sclerosis Drug Therapy
Biological response modifiers
immunosuppressives
Steriods
Antispasmodic drugs
Adjunctive
What is the drug therapy for a head injury?
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
What is surgical management?
ICP monitoring devices
- IV catheter
- SUbrarachnoid screw or bolt
- Epidural catheter
- Subdural catheter
Craniotomy may be performed in extreme instances of elevated ICP
What is back pain?
Herniated nucleus pulposus
Phsyical assessment: continuous acute pain, altered gait, vertebral alignment, paresthesia
Diagnostic assessment using MRI, CT, and electromyography
What is nonsurgical management?
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
What is surgical management?
Minimally invasive techniques may be used
Open approaches:
- Diskectomy
- Laminectomy
- Spinal fusion
Interbody cage fusion
What is postoperative care?
Prevention and assessment of complications
Neurologic assessment: vital signs
Clients ability to void
Pain control
Wound care
Client positioning and mobility
What is the inital assessment of a spinal cord injury?
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
What is the initial assessment?
Establishment of level and extent of injury
Neurovascular assesment
Cardiovascular regulatory assessment
What is spinal shock?
Flaccid paralysis
Loss of reflex activity below the level of the lesion
Bradycardia
Paralyric ileus
Hypotension
What is autonomic dysreflexia?
commonly seen in clients with upper spinal cord injury
Severe hypertension
bradycardia
severe headache
nasal stuffiness
flushing treatment
What are interventions for ineffective tissue perfusion?
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
What is immobilization for cervical injuries?
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
What are immobilization of thoracic and lumbosacral injuries?
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
What is surgical management?
Emergency surgery necessary for spinal cord decompression
Spinal fusion
What are interventions for the client with the spinal cord injury?
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
What are interventions of impaired physical mobility?
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
What are interventions of impaired urinary elimination?
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
How does one establish a bowel retraining program?
Consistent time for bowel elimination
High fluid intake for at least 200 mL/day
High fiber diet
Rectal stimulation
Stool softener medications as needed
What are the interventions for impaired adjustment?
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
