neurologic disorder 2 Flashcards
Inflammation of brain tissue caused by virus
Encephalitis
Signs and symptoms Encephalitis
Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and restlessness commonly seen
Comatose or exhibit aphasia, hemiparesis, facial weakness, and other alterations in motor activity
Medical treatment Encephalitis
Enhance patient comfort and increase strength
Because seizure activity is a potential problem, take appropriate safety precautions
Nursing Care
Encephalitis
The nursing plan of care parallels that of the patient with meningitis
Although specific cause unknown, it is believed to be an autoimmune response to a viral infection
Patients often report some recent viral infection or vaccination
Guillain-Barré Syndrome
Initial phase s/s Guillain-Barré Syndrome
Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper extremities
Visual and hearing disturbances, difficulty chewing, and lack of facial expression
Mild paresthesias or anesthesia in feet and hands in a glove or stocking distribution pattern
Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention
Plateau phase s/s Guillain-Barré Syndrome
Remains essentially unchanged
No further neurologic deterioration, but no improvement either
Recovery phase s/s Guillain-Barré Syndrome
Remyelinization; muscle strength returns in a proximal-to-distal pattern (head to toes
medical diagnosis Guillain-Barré Syndrome
Characteristic onset and pattern of ascending motor involvement
Elevated protein level in the CSF
Nerve conduction velocity studies reveal slowed conduction speed in the involved nerves
medical treatment Guillain-Barré Syndrome
Preserve vital function, particularly respiration
Respiratory status is closely monitored and mechanical ventilation initiated if vital capacity falls to 15 mL/kg of body weight
Massive doses of corticosteroids prescribed to suppress the inflammatory process
Plasmapheresis
assessment of Guillain-Barré Syndrome
Health history describes the progression of symptoms
Note fears, coping strategies, and sources of support
Physical examination focuses on cranial nerve, motor, respiratory, and cardiovascular function
Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement
Parkinson’s Syndrome
Parkinson’s Syndrome s/s
Tremor, rigidity, and bradykinesia
Loss of dexterity and power in affected limbs, aching, monotone voice, handwriting changes, drooling, lack of facial expression, rhythmic head nodding, reduced blinking, and slumped posture
Depression common; dementia may develop
Medical diagnosis Parkinson’s Syndrome
From health history and physical examination
MRI to rule out other causes of the symptoms
Medical treatment Parkinson’s Syndrome
Control symptoms: physical therapy and drug therapy
Massage, heat, exercise, and gait retraining
Dopamine receptor agonists pramipexole (Mirapex) or ropinirole (Requip); L-dopa (L-dihydroxyphenylalanine); carbidopa/levodopa (Sinemet); anticholinergic drugs such as trihexyphenidyl (Artane) and benztropine (Cogentin)
assessment Parkinson’s Syndrome
Weakness, fatigue, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements
Note lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination
Chronic, progressive degenerative disease
An autoimmune response that attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS
Multiple Sclerosis
Chronic, progressive MS
progresses steadily
Exacerbating-remitting MS
exacerbations and remissions
Relapsing-progressive MS
less stable periods than exacerbating-remitting
Stable MS
stable; no active disease for a year
MS related to
Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated
s/s of MS
Fatigue, weakness, and tingling in one or more extremities; visual disturbances; problems with coordination; bowel and bladder dysfunction; spasticity; and depression
Medical diagnosis
for MS
Based on the physical examination and history of cyclic remission-exacerbation periods
Magnetic resonance imaging of the brain and spinal cord may reveal plaques characteristic of MS
Medical treatment for MS
Corticosteroids (ACTH, prednisone, methylprednisolone)
Interferon 1b (Betaseron) and interferon 1a (Avonex)
Glatiramer acetate (Copaxone)
Immunosuppressants: mitoxantrone (Novantrone)
Amantadine (Symmetrel)
Urinary retention treated with cholinergics, such as bethanechol (Urecholine) or neostigmine (Prostigmine
assessment for MS
Onset and progression of symptoms, especially those that affect mobility, vision, eating, and elimination
Range of motion and strength, gait abnormalities, tremors, and muscle spasms
a degenerative neurologic disease
Virus suspected, but exact cause unknown
Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms
Amyotrophic Lateral Sclerosis (ALS)
Also known as Lou Gehrig’s disease
s/s Amyotrophic Lateral Sclerosis (ALS)
Weakness of voluntary muscles of the upper extremities, particularly the hands
Difficulty swallowing and speaking
Eventually, respirations shallow; difficulty clearing airway of pulmonary secretions
Death results from aspiration, respiratory infection, or respiratory failure
Medical diagnosis Amyotrophic Lateral Sclerosis (ALS)
History and physical examination findings
Electromyography
Medical treatment Amyotrophic Lateral Sclerosis (ALS)
Because no known cure or treatment, therapy is supportive; focuses on preventing complications and maintaining maximum function
Nursing Assessment Amyotrophic Lateral Sclerosis (ALS)
Dyspnea, dysphagia, muscle cramps, weakness, twitching, joint stiffness, muscle atrophy, abnormal reflexes and gait, and paralysis
Insufficient receptor sites at the junction of the motor nerve with the muscle
With repeated stimulation, muscle becomes exhausted; eventually unable to contract at all
If respiratory muscles involved, death from respiratory insufficiency or arrest possible
May have an autoimmune basis
Myasthenia Gravis
s/s Myasthenia Gravis
Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking
Partial improvements of strength with rest
Dramatic improvement with the use of anticholinesterase drugs
Ptosis and diplopia commonly seen
Medical diagnosis Myasthenia Gravis
Administering edrophonium (Tensilon) Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes
Medical treatment Myasthenia Gravis
Anticholinesterase drugs Neostigmine and pyridostigmine (Mestinon) Corticosteroids Cytotoxic therapies Thymectomy Plasmaphere
assessment of Myasthenia Gravis
Health history describes the onset of symptoms: muscle weakness, diplopia, dysphagia, slurred speech, breathing difficulties, and loss of balance
