Neuro Flashcards
what is parkinsons disease
genetic defect and results in dopamin depletion
more commonly found in older adult males
parkinsons disease manifestations
tremors
rigidity
akinesia/bradykinesia: loss of ability to move your muscles voluntarily
postural instability
pill rolling tremors of the hands
fatigue
mask-like facial expression accompanied by drooling
slow-shuffling walk
difficulty rising from sitting position
echolalia
- meaningless repetition of another persons spoken words
priority goal is to prevent injury to client
parkinsons diagnostic studies
based on clients hx and clinical features
EEG
MRI
PET
parkinsons pharamcological intervnetions
goal is to provide palliative symptom managmenet and to postpone dependnece
anticholilnergics
- Benzotropine
- Procyclidine
dopamine precursors:
- levadopa-carbidopa
- levadopa
dopamine receptor antaongists:
- bromocriptine
- rotigotine patch
antiparkinsonian agents
- amantadine HcL
MAOI inhibitors;
- selegiline
- COMT inhibitors ( tolacapone)
- entacapone
parkinsons management
maintain safe environment for client and foster independence in ADLs
reinforce assistive devices
promote good nutrition and teach to eat small frequent meals and soft food
increase roughage with sufficient fluids to decrease constipation
provie emotional support to client and family members
daily exercise
safety and injury prevention
what is huntingtons disease
progressive atrophy of basal ganglia and some parts of the cerebral cortex
huntingtons disease manifestations
motor function impairement:
difficulties chewing and swallowing
chorea - jerky involuntary movements
dystonic posture
will eventually become bedridden
unable to organize, plan and do things in order
mental function will progressively decline
personality changes
no cure but palliative care
death usuall occurs 10-20 years after onset of symptoms
huntingtons diagnostic studies
clients and family history
physical exam
genetic testing
huntingtons disease care
manage symptoms promote quality of life prolong independence speech and physical therapy should be prescribed genetic counseling
psychotropic meds
tertrabenazine - decrease chorea
huntingtons management
assisitve devices
ADLs
maintain a well-balanced diet with an increased caloric intake
join support groups
what is amyotrophic lateral scerosis (ALS)
lou gehrigs disease neurological disease --> progressiv edegeneration of motor neurons of the anterior horn cells - spinal cord - brainstem - motor cortex
late middle age onset and is seen often in men than women
usually die within 2-6 years
ALS manifestations
muscle twitching
weakness in an arm or leg
muscle wasting
atrophy
spasticity
speech disorders
cognitive function and mental acuit will remain intact
voluntary and involuntary muscle function will be lost
eventually need for mechanical ventilation due to resp failure
ALS daignostic studies
client hx
physical exam
CK and EMG
loss of voice and ability to communicate can be particularly isolation and stressful for clients
ALS pharamcological interventions
muscle relaxants for spasticity
riluzole
-neuroprotector to extend life expectancy
goal is to keep client functionally independent as long as possible
speech and physial therapy can help client amintain independence
ALS mangement
provide resp care and referrals
maintain safe environment
prevent complications of immobility
balanced nutrition - enteral feedings are often required
emotional support
what is dementia
loss of brain function that occurs with certain diseases
affect memory, thinking, langauge, judgement and behvior
degenerative dementia is seen with Alzheimers disease
dementia manifesations
forgetfulness short term memor loss difficulty with many areas: - language - memory - preception or judgement
can affect higher levels of cognitive function
- ability to think abstract thoughs or perform calculations
dementia diagnostic studies
MRI
CT
neuro exam
mental status
lab tests: B12 level sblood ammonia ABG toxicology screening glucose liver enzyme
thyroid function
HIV,
syphilis
lyme titer
dementia pharamcological interventions
antipsychotics:
- haloperidol
- risperidone
- olanzapine
mood stabilizers
- fluoxetine
- imipramine
- citalopram
sertonin-affecting drugs
- trazodone
- busprione
CNS stimulants
- methyphenidate
meet clients needs
- establish a routine and promote indepdnece
- reorient them as NEEDED
alzheimers manifestations
one of more of the following will be observed:
agnosia
- difficulty naming objects
aphasia
- language disturbance
problems with organization and abstract thinking
memory impairment
apraxia
- difficulty with motor activities
cognitive difficulties are not related to other conditions
latered snesory preceptions include: illusions and hallucinations
wandering verbally or physically abusive behavior resisting care socially inappropriate behavior sundown syndrome
alzheimer early stage
- subtle personality changes include difficulty with abstract thinking
- forgetfulness and uncertainty causes anxiety, irritation and withdrawal
- difficulty making decisions, concentrating and handling work skills
alzheimer middle stage
impaired language, motor activity and object recognition
wandering
inability to carry out ADLs
impaired judmgeent
severe disorientation, with personality na dbehavior changes
difficulty remembering fam and friends
hallucinations and delusions
alzheimers final and terminal stage
loses ability to function physically and mentally
becomes mute, incontinent and totally dependent
alzheimer diagnostic studies
physcial exam neruo testing MRI CT scan of head lab tests: - same as dementia
alzheimers pharamcological intervention
Galantamine
- take with meals, 2x/day or every morning
- encourage fluids
donepezil
- given once a day before bed
- may be given with or without food
memantine
- in cases of moderate to severe dementia
rivastigmine
- with food twice a day
- may increase dosage at intervals
antidepressants
- SSRIs
0antipsychotics
- control hallcuination and delusions
greatest risk factor of AD is age, but age alone is not sufficient to cause AD
alzheimer disease complementary health
gingko biloba
vitamins B and E
asian ginseng
grape seed extract
no convincing evidence
alzheimers management
safe environment with structured routine and decreased stimulation
legal issue
- living will
- power of attorney
0 end of life care
nutrition needs
monitor for depression
memory aids
minimal distractions and noise
orient client as appropriate
maintain elimination routine to decredase incontinence
help family enroll the client in an identification/return program
assess for abuse/neglect
long term care
delirium
onset:
- sudden/abrupt depends on cause
- often occurs at twilight or in darkness
short diurnal fluctuation in symptoms
worse at night, in darkness and on awakening
abrupt progression
hours to less than one month of duration
reduced consciousness
alertness fluctuates, lethargic or hypervigilant
impaired attention, fluctuates
generally impaired orientation
severely varies
recent memory and immediate impaired
risk factors for stroke
uncontrolled hypertension
smoking
obestiy
incredased blood cholesterol
triglycerides
afib
transient ischemic attack
warning sign of impending stroke
produces neurologica deficits that last only minutes to hours
full functioning recovery is seen within 24-72 hours
reversible ischemic neruologic deficit
symptoms last between 24 hours and 3 weeks
visually will have a full functional recovery
partial, non progressive stroke
some neruolgical deficit but client isstabilized quickly
progressive stroke
present with a deteriorating enruological status and residula neruo deficit
completed stroke
leave client with permanent neuro deficits
ischemic stroke
slow onset
inadequate blood flow which leads to a cerebral infarction
common cause: atherosclerosis
- buidlup of fats, cholesterol and other substances
hemorrhagic stroke 4 types
- intracerebral hemorrhage
- subarachnoid hemorrhage
- epidural bleeds
- subdural bleeds
intracerebral hemorrhage
occrsuw ehn blood vessels rupture and bleed into the brain
subarachnoid hemorrhage
cuased by the rupture of a sacular intracranial aneurysm
epidural bleeds
involve cerebral arterial vessels
often a loss of consciousness for a short period of time
for epidrual bleeds = artery
- remember that “e” in epidural and “a” in artery are at the top of the alphabet
subdural bleeds
involve the veins and may not be until months after an initial trauma
for subdural bleeds = veins
- remember “s” in subdural and “v” in veins are at the bottom of the alphabet
stroke manifestations
homonymmous hemi anopsia agnosia apraxia diplopia sensory loss
brocas: difficult communicating to others, but understands
wernickes; can hear a voice or read written language, but misunderstands the meaning or takes the message too literally
global aphasia:
exhibit severe communication difficulties and may be unable to speak or comporehend the language
dysarthria
- speech disorder caused by the disturbance of mascular control, resulting in impaired pronunciation, articulation and phonation
agraphia - inability to write or spell
hemiplegia, hemiparesis
flaccidity and spasticity
emotional lability loss of social inhibtions fear anger hostility
urinary frequency and urgency
bowel and urinary incontinence
altered level of consciousness
seizure
hyperthermia
hypertension is the most important modifiable risk factor in stroke
right sided stroke
left side of the body will be affected:
could produce paralysis on left side of body
there will be problems with:
- processing visual and verbal information
- decreased cognitive skills like thinking, reading, learning, remembering
- poor judegement
- short attention span
- shorterm memory loss
left sided stroke
right side of the body will be affects
could produce paralysis on the right side of the body
problems with communication
- aphasia
- dysarthria
stroke diagnostic studies
hx and physical exam
HCP should evaluate stroke within 10 min of their arrival to hospital
CT scan should be done within 30-60 min of arrival
MRI
doppler echocardiography
carotid artery duplex doppler ultrasonography
EEG
cerebrl angiography
stroke care
acute phase: single most important point in the clients history is
- time of onset of symptoms
- last seen normal
ischemic stroke pharamcological interventions
thrombolytics
- tPA
- alteplase
must rule out hemorrhagic stroke via C scan prior to admin
antiplatelet therapy
- aspirin
- dypirdamole
platelet aggregation inhibitor
- copidogrel
- ticlopidine
steroids:
-dexmethasone
blood pressure should be managed to maintain cerebral perfusion pressure
surgery is necessary if carotid artery is stenotic or partially occluded
carotid endarterectomy or angioplasty with stenting may be performed
hemorrhagic stroke pharmacological intervention
antihypertensive agents
systemic steroids:
-dexmethasone
osmotic diuresis
- mannitol
anti-fibrinolyti agents:
- amnioocaproic acid
surgical excision of an aneurysm or clot/hematoma may be necessary
stroke acute stage management
maintain airway patency
- suctioning equipment must be available at bedside
neuro status
vitals
note seizure acitivity
adequate fluids
HOB 15-30 position, client turned or tilted to unaffected side
provide activity
perofrm passive and or active ROM
maintain propery body alignment
stroke long term management
monitor normal elimination patterns
teach about supportive devices
maintain safe environment
adequate nutrition
assist with ADls
emtoinal support provide methods of communication for clients with aphasia
what is meningitis
acute or chronic inflammation of the meninges
- the covering of the brain and spinal cord are involved
most contagious form and requires isolation
- other forms include viral and fungal meningitis
high risk clients for meningitis
infants
adults with weakened or suppressed immune system
college students esp freshmen who reside in dorms
travelers to foreign countries
- wherre disease is endemic
meningitis manifestations
nuchal rigidity
- stiff neck
positive kernigs sign and Brudzinski’s sign
positive opisthotonic position
changes in level of consciouness
seizures
meningitis diagnostic tudies
hx and physical exma
positive brudzinskis signs
- when you lift the child’s neck, their feet go up too
positive kernig’s sign
- severe stiffness of the hamstrings
- causes inability to straighten the leg when hip is flexed to 90 degrees
lumbar puncture to evaluate cerbrospinal fluid
- CSF may show signs of decreased glucose and increased protein if bacterial or fungal infection is present
- contraindicated with findings that indicate an elevated intracranial pressure
CT scan or MRi, with and without contrast, may be performed
meningitis care
cure the infection and prevent contractures
pharmacological interventions:
antibiotic therapy will depend on the type of pathogen
antifungals = if fungus is the causative agent
anticonvulsants = to prevent seizures
preventative therapy can be used for people exposed to those with meningococcal or Haemophilus influenzae
- rifampin
actions to minimize fever
prevent an increased of intracranial pressure or seizures
meningitis management
ABGs
body weight
urine volume
specific graivty and osmolality
neuro and vitals comfort measures for pain droplet precautions - haemophilus influenzae type B - neisseria meningitis
reduce external stimuli and lighting if the client is photophobic
maintain a quiet environment
monitor seizures and implement precautions
what is encephalitis
inflammation of the parenchyma of the brain and spinal cord
most common cause of encephalitis is an acute viral infection
other potential causes:
- bacterial infection
- hypoxic inflammation
- toxic substances
- arsenic
- carbon monoxide
- high level of serum ammonia due to liver failure
encephalitis manifestations
sudden fever
nuchal rigidity - stiff neck
personality changes
mild flu-like complaints
severe headache
- this can progress to stupor and then coma with seizure activitiy
altered level of consciousness
encphalitis diagnostic studies
hx and physical exam CT scan MRI EEG PCR assay cerebral spinal fluid collection to show if there is a decrease in glucose and elevated WBCs
encephalitis care
goal is to cure the infection and prevent comlications
- rest
- supportive nutrition
- fluid balance maintenance
pharamcological interventions:
- acyclovir
- antivonculsants to prevent seizures
prevent increased intracrnial pressure
mosquito control and insect repellant
encephalitis management
control clients fever and administer drugs
seizure precautions
- recommended to drive on they are 6 months seizure free
sxs of increased intracranil pressure
- headache
- blurred vision
- confusion
- shallow breathing
- voiting
ensure isolation and take airbonre or droplet precautions
maintain patent airway to prevent further hypoxia
reduce stimuli and lighting if client is photophobic
multiple sclerosis manifestations
MS can improve and worsen unpredictably
blurred vision dysphagia diploopia facial weakness and/or numbness weakness paralysis spasticity gait disturbances
dysarthria tremor incoordination ataxia vertigo
decredase in short term memory
difficulty with new information
word-finding difficulty
short attention span
urinary retention
loss of bowel incontinence
sexual dysfunction and fatigue
multiple sclerosis diagnostic studies
hx and physical exam
lumbar puncture
MRI
CT
multiple sclerosis pharamcological interventions
rpimary goal is to alleviate symptoms and prevent complications;
adrenocorticotropic hormone
beta interferon
immunosuppressants
antispasmodics
multiple sclerosis management
maintain clients functional independence in ADls
promote praciticng a wide base walk
prevent injury and complicationsfrom difficulties walking or immboility
avoid fatigue and stress and conserve energy
know current meds and side effects
assisitve devices correctly
maintain a diet that support nutrition and energy needs
avoid triggers such as stress, regnancy and temperature extremems
use bladder control measures during exacerbations
client with MS should NOT use hot water for a bath because of the risk of thermal injury
what is guillian barre syndrome
symmetric and ascending motor paralysis
GBS manifestations
muscle weakness if progressive, ascending and bilateral
leads to paralysis of voluntary muscles
loss of superficial and deep tendon reflexes
bulbar weakness
dysphagia
resp failure
paresthesia
burning muscle pain
paralysis vary from being partial or total paralysis
- cause fluctuations in blood pressure, heart rhythm and rate
