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Chronic illness > Neurological chronic diseases > Flashcards

Neurological chronic diseases Flashcards

1
Q

What are the most common neurological chronic diseases?

A

Parkinsons
Multiple sclerosis
Motor neurone disease

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2
Q

What is the main neurotransmitter affected in people with parkinsons and where is it transmitted from in the brain?

A

Dopamine

the basal ganglia - the area responsible for movement

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3
Q

What are some risk factors for parkinsons?

A

certain pesticides, head trauma, gender (more in males than females), anaemia in women and genetics

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4
Q

What is the cause of parkinsons?

A

the cause is unkown

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5
Q

What is the median age of diagnosis of people with parkinsons?

A

59

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6
Q

What is the median age of death of people with parkinsons?

A

83.3

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7
Q

What are the motor signs and symptoms of parkinsons?

A
  • The classical triad of (resting) tremor, rigidity (muscular stiffness) and akinesia (slowness and difficulty in initiating movement)
  • Flexion on the trunk, gait difficulties with shuffling and freezing and reduced arm swing
  • Akinesia results in difficulty turning in bed, small handwriting and a soft voice, which is difficult to understand
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8
Q

What are the non-motor signs and symptoms of parkinsons?

A
  • Autonomic symptoms – postural hypotension, abnormal sweating
  • Urinary and bowel dysfunction, sexual difficulties
  • Cognitive decline, depression and anxiety
  • Sleep disturbance, fatigue
  • Loss of smell (anosmia)
  • Sensory phenomena, including pain not responsive to analgesia if caused by a lack of levodopa
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9
Q

What medication can treat a lack of dopamine?

A

Levodopa combined with dopa decarboxylase inhibitor to prevent the peripheral side effects of levodopa, remains the first line treatment for the disease

synthetic dopamine agonists (pramipexole; pergolide; bromocriptine; cabergoline; and apomoprhine) which act on the dopamine receptor sites with a similar but weaker action

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10
Q

What is the off or on state for people with parkinsons?

A

o The off state describes the patient when the signs and symptoms are most obvious
o The on state describes the best the person can achieve with medications

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11
Q

What type of nursing care might the patient with parkinsons need?

A

Full nursing care for feeding, showering and transfering

when in on state patient may be independent or only need assistance while medications are in affect

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12
Q

What might the physio and occupational therapist assist the patient with?

A

• Difficulty with gait, posture and balance means that mobility is often compromised, and showering, toileting and ambulating require careful assessment by a physiotherapist and an occupational therapist

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13
Q

What type of aids might the person with parkinsons need?

A

walking aids

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14
Q

Why is it important to differentiate tremor from dyskinesia?

A

to ensure that correct treatment options are considered

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15
Q

What is Amomorphine?

A

• a by-product of morphine without opiate activity, is an injectable dopamine agonist that has a comparable effect to levodopa

o Can be used as an injection to rescue the person from the ‘off’ states or as an infusion for management of symptoms

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16
Q

What are some side effects of dopamine agonists?

A 
hallucinations
Postural hypotension 
hyper-sexuality
excessive eating 
excessive gambling
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17
Q

Why should medications not be stopped abruptly in people with parkinsons?

A

can lead to a rare, but life threatening condition called neuroleptic malignant syndrome
This syndrome is associated with worsening of Parkinson’s signs, altered mental state, hyperpyrexia, tachycardia, raised serum CK, renal insufficiency and a high mortality

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18
Q

how is body image affected for people with parkinsons?

A
  • A stooped posture, slowness in movement and gait disturbances ages the person
  • Drooling, reduced facial expression, unblinking eyes, slowness in thought (bradyphrenia) and voice disturbances not only lead to a loss of personal dignity, but also interfere with communication and the person may appear of low intellect
  • Social isolation for both the person with Parkinson’s and the carer can ensue
  • People with the disease may resent their wishes, feelings and opinions being interpreted and reported by others and many often feel shunned by previous friends as the condition progresses
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19
Q

How is quality of life affected of those who have parkinsons?

A 
•	role change, independence, working, driving and physical comfort
pain
sexual limitations
psychiatric complications
depression
20
Q

How can you keep up communication with someone who has parkinsons?

A

o Ensuring face to face position, making eye contact and using cues to encourage people to speak key words loudly

  • allow them time to express themselves and check that you have understood their intended message
  • listen to content rather than delivery of speech to gauge needs, mood and cognitive function
21
Q

What is Multiple sclerosis?

A

Multiple Sclerosis is a demyelinating disease affecting the nerve fibres in the white matter of the brain, the spinal cord and the optic nerve.

A process of acute inflammation causes demyelination to occur. In some instances the body remyelinates the axon and function returns

In other situations the myelin is lost and scarring or sclerosis occurs, slowing or impairing the transmission of the nerve impulse and increasing axon vulnerability to environmental influences

22
Q

How is MS diagnosed?

A

Brain MRI with visually evoked potential (measurement of sensory, visual and auditory nerve conduction)

Spinal cord MRI

Positive CSF

23
Q

What are the 4 categories of MS?

A

Relapsing remitting MS
Primary progressive MS
Secondary progressive MS
Progressing relapsing MS

24
Q

Explain Relapsing remitting MS

A

this is the most common form (attributed to 85% of MS cases) characterised by episodic attacks of neurological symptoms, commonly sensory disturbance that may not be accompanied by clinical signs. Between attacks the person recovers partial or complete neurological function

Symptoms:

  • in one or more limbs
  • optical
  • cerebellar
  • vestibular
  • pain
  • depression
  • Sleep disturbances
  • Fatigue
25
Q

Explain Primary progressive MS

A

about 10% of older people with MS live with primary progressive MS. This form begins with vague symptoms that develop into gait deficits, sometimes confused with the ageing process. Neurological damage continues to occur without remyelination, resulting in a steady increase in the level of disability. Antibodies that attack central nervous system antigens are thought to prevent remyelination in this form of MS.

26
Q

Explain Secondary progressive MS

A

This begins in a similar manner to relapsing remitting MS, but develops a more constant progressive path with only minor occasional remissions and plateaus

27
Q

Explain Progressing relapsing MS

A

In this form the disease progression is continuous, with acute attacks occurring at intervals, accompanied by minor recovery

28
Q

What are the symptoms of MS?

A 
Fatigue
Infuenza like symptoms
loss of sensation to pain and heat
mobility and coordination issues
tremors
unpredictable loss of balance
Muscle spasm 
loss of muscle tone
loss of bladder control
loss of bowel control
slurred speech
dysphasia
visual disturbances
short term memory loss
29
Q

What is the treatment of MS?

A

regular immunotherapy antiviral injections
Baclofen - for muscle spasms
suppository insertion for maintenance of bowels
high fibre high fluid diet

30
Q

How might body image be affected in those with MS?

A

incontinence - fear and embarrassment

sexual activity impeded

31
Q

How might MS affect a person sexually?

A

o Sexual issues such as impotence, loss of libido, reduced lubrication and loss of sensation may result in slow arousal and decreased satisfaction
o Partners need to be patient and explore a variety of alternative techniques to achieve the sexual expression of love

32
Q

How is quality of life affected for those with MS?

A

• The unpredictable nature of the disease and the limitations on work, leisure and life roles can result in anxiety and depression for those living with MS

Symptoms may change through the day and the timing of attacks cannot be predetermined

driving affected by visual disturbances

33
Q

Who might be involved in the multidisciplinary team assisting those with MS?

A

Occupational therapist
physiotherapist
speech therapist

34
Q

How can the family of someone with MS assist the person and how can we assist the family?

A

o Families have to accommodate the person’s need for rest and the effects of symptoms during an attack, and generally rearrange their lives to provide care when needed

People with MS need love, understanding and support

assistance with activities of daily living, mobility, bowel and bladder management and in some cases catheter care and cognitive function as well as psychological support

we can:
support family
education
respite

35
Q

What is Motor Neurone Disease?

A

Motor neuron disease (MND) is a collective term that encompasses a number of neurogenerative disorders including amyotrophic lateral sclerosis, primary lateral sclerosis and progressive bulbar palsy. Degeneration occurs in the upper motor neurons of the cerebral cortex, the anterior horn cells of the spinal cord and the motor nuclei of the brain stem (lower motor neurons) and results in multiple failures in nerve impulse transmission.

36
Q

What are the symptoms of MND?

A 
behaviour changes
muscle weakness in limbs, speech, swallowing or respiration
muscle fibre atrophy 
loss of balance
fatigue
dribbling
pain
37
Q

Who does MND affect?

A

people between the age of 40-60 with a mean age of 55

38
Q

What are the 4 different phenotypes of MND?

A

global, flail arm, flail leg and primary lateral sclerosis

39
Q

Explain the phenotypes of MND

A

o The global and fail phenotypes are the most common and usually associated with a life expectancy of three to five years from diagnosis to death
o The additional presence of bulbar symptoms such as dysphagia and dysarthria compounds functional loss and shortens life expectancy due to compromised respiratory function
o Pain arising from stress on joints association with muscle decline, muscle spasm and cramping as well as skin pressure pain is common across the phenotypes
o Regular fasciculation or twitching of a single muscle group is an indicative feature of MND

40
Q

What is the cause of MND?

A

o Most cases are thought to be sporadic, but approximately 5-10% of cases are familial in origin

41
Q

What neuroprotective drug is used for MND?

A

Riluzole

42
Q

What are some treatments for those with MND?

A

assisted ventilation and gastrostomy feeding
splinting limbs
o Pain resulting from the strain on joints responds to anti-inflammatory medication, muscle relaxants such as Baclofen are useful for spasms from upper neuron damage, while skin pressure pain is relieved by repositioning and opioid medication
o Swallowing problems are managed initially modified cups, postural changes, fluid thickening and food modification (later, if the person consents, a gastrostomy is performed)
o Anticholinergic drugs or injecting the partoid glands with botulinum toxin can reduce saliva

43
Q

What aids might a person with MND need?

A

walking aids
hoists
electric wheelchairs with high back

44
Q

How might body image and qol be affected for those with MND?

A

• Muscle wasting and weight loss are increasingly evident, particularly around the shoulders, trunk and sometimes the face

loosing the ability to participate in expected family routines and to undertake the personal activities of daily living such as showering, dressing, toileting and eating

45
Q

How are families affected by MND?

A

o Family members can do little more than watch as their relative wastes away and becomes more dependent
o Family members have to provide 24 hour care each day of the week
o Family carers experience many situations that cause them to redefine themselves and their relationships with the person living MND
o Consistent and sometimes ambiguous losses caused by the effects of the disease, change roles and reconstruct the future

Chronic illness (7 decks)

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