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Pathophysiology Final > Neurological Conditions > Flashcards

Neurological Conditions Flashcards

1
Q

Multiple Sclerosis: Stats and Etiology

A
  • chronic, progressive, degenerative, autoimmune disorder of CNS characterized by disseminated demyelination of nerve fibres of brain, spinal cord, & optic nerve
  • Affects 93,500 Canadians
  • Onset between 15-50 years
  • Women > men (3:1)
  • may be related to environmental & infectious (viral) factors, dietary deficiencies (vitamin D), & immunological & genetic factors
  • Exact cause unknown - many theories suggest immunogenetic-viral disease
  • multiple genes probably involved
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2
Q

precipitating factors for MS

A
  • infection
  • trauma
  • emotional stress
  • emotional fatigue
  • pregnancy
  • state of poor health
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3
Q

MS - Pathophysiology

A
  • early on the myelin sheath is damaged. but nerve fibres are not affected. the patient will still complain of loss of function - myelin can regenerate and symptoms can disappear resulting in remission of symptoms.
  • axon becomes involved. myelin is replaced by scar tissue. without myelin, nerve impulses slow down.
  • without axons, the signal is not transmitted at all
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4
Q

MS - Patho Cont’d

A
  • chronic inflammation-demyelination-scarring
  • autoimmune disease d/t autoreactive t-cells
  • triggered by a virus in genetically susceptible patients
  • characterized by progression, remittance and/or relapse
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5
Q

MS - Clinical manifestations

Motor:

A
  • weakness, or paralysis of limbs, trunk, or head
  • diplopia
  • scanning speech
  • muscle spasticity
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6
Q

MS Clinical Manifestations: Sensory

A
  • numbness & tingling

- patchy blindness, blurred vision, vertigo, tinnitus, decreased hearing, chronic neuropathic pain

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7
Q

Cerebellar MS manifestations

A

Nystagmus, ataxia (abnormal uncoordinated movements), dysarthria (weak muscles used for speech) & dysphagia

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8
Q

MS - Clinical Manifestations

A
  • fatigue
  • motor
  • sensory
  • sexual dysfunction
  • cerebellar
  • bowel & bladder (constipation or flaccid bladder)
  • Emotional stability (anger, depression, euphoria)
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9
Q

MS - relapsing - remitting (most common disease pattern)

A

episodes of acute worsening with recovery an a stable course between relapses

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10
Q

Diagnostic Studies MS

A
  • no definitive diagnostic test

- history/clinical manifestations/MRI

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11
Q

Pharmacologic Therapy MS

A
  • No cure
  • Acute: ACTH, IV/PO steroids
  • Chronic
    immuno-suppressants
    immuno-modulators
    anti-neoplastic agents
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12
Q

Nursing diagnosis MS

A
  • altered skin integrity
  • impaired physical mobility
  • impaired urinary elimination
  • constipation
  • activity intolerance/fatigue
  • self-care deficit
  • sexual dysfunction
  • knowledge deficit
  • low self-esteem
  • interrupted family processes
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13
Q

Huntingtons Disease

A
  • genetically transmitted (50%)
  • autosomal dominant (if you get the abonormal gene from one parent you can get it)
  • DNA & genetic testing is available
  • onset between 35-45 years
  • progressive disease characterized by (abnormal movements, intellectual decline, emotional disturbance)
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14
Q

Huntington’s Disease Pathophysiology

A
  • Destruction of striatum in basal ganglia
  • leads to imbalance in neurotransmitters
  • deficiency of acetylcholine; net effect is increase in dopamine –> excess uncontrolled movements
  • eventually the person develops significant dementia, incontinence and is unable to provide any personal care as the disease progresses.
  • nutritional deficits due to dysphagia and inability to feed oneself is greatest risk
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15
Q

Amyotropic Lateral Sclerosis (ALS) - Statistics and Etiology

A
  • average age of onset: 40-60 years
  • two types:
    sporadic - can affect anyone
    familial - 5-10% genetically linked
  • no known cause, though combination of genetic mutations and environmental factors are thought to interplay
  • life expectancy: 2-5 yrs from diagnosis
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16
Q

ALS Clinical Manifestations - Potential early signs

A
  • tripping
  • dropping things
  • slurred or “thick” speech
  • difficulty swallowing
  • weight loss
  • decreased muscle tone
  • shortness of breath
  • increased or decreased reflexes
  • uncontrollable periods of laughing or crying
  • feeling weak
  • fatigue
  • muscle cramping or twitching
  • muscle stiffness or rigidity
  • over time, the muscle weakening will continue to spread throughout the body, eventually causing difficulties with breathing, chewing, swallowing and speaking
  • the senses of sight, touch, hearing, taste and smell are usually not affected, and for many people, muscles of the eyes and bladder remain functional until very late in the disease
  • pain is usually not an issue
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17
Q

Late Manifestations : ALS

A
  • difficulty breathing
  • coughing when eating or drinking
  • difficulty forming words or projecting voice
  • fatigue caused by muscle exhaustion
  • reduced food intake and weight loss
  • Insomnia caused by discomfort
  • Excessive saliva or dry mouth
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18
Q

ALS Diagnosis

A
  • A diagnosis of exclusion
  • Diagnostic tests likely to be ordered: (blood and urine samples, electrodiagnositc tests including EMG NCV, MRI, muscle and nerve function tests)
  • genetic testing for mutation - positive result doesn’t mean imminent disease
19
Q

Outcome management - ALS

A

supportive care

palliative care

20
Q

Parkinson’s Disease (PD)

A
  • A progressive, neurodegenerative disease of the CNS (basal ganglia) characterized by:
  • bradyknesia: a slowing down in the initiation & execution of movement
  • rigidity: increased muscle tone
  • resting tremor
  • impaired postural reflexes
21
Q

PD - Etiology & Pathophysiology

A
  • 2nd most common neurodegeneration disorder in Canada
  • Average age of diagnosis is 60 years
    #’s expected to rise with the aging population
  • well-established genetic component
  • more common in men than women
22
Q

Parkinsonism-like symptoms may be from conditions other than PD:

A
  • intoxication with chemicals (carbon monoxide & manganese)
  • medications (lithium, methyldopa)
  • Illicit drugs
  • encephalitis, meningitis, dementia, with Lewy bodies
23
Q

Pathological Process of PD

A
  • nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. for reasons not yet understood, the dopamine-producing nerve cells of the substantia nigra begin to die off in some individuals
  • PD characterized by progressive loss of DA in relation to Ach –> results in imbalance of activity of motor pathways, producing the complex motor clinical manifestations.
  • symptoms do not occur until 80% of neurons in substantia nigra are lost or damaged.
  • symptoms such as tremor, slowness of movement, stiffness, and balance problems occur.
24
Q

PD - Clinical Manifestations

  • insidious onset, with gradual progression & prolonged course
  • Classic triad of symptoms (must have 2/3)
  • patient is very at risk for falls
A
  1. Tremor
  2. Rigidity
  3. Bradykinesia (stooped posture, mask-like face, drooling of saliva, and/or shuffling gait)
25
Q

PD - Drug Therapy: aim

A

aimed at correcting imbalances or neurotransmitters

26
Q

PD - Drug therapy

A
  • Dopaminergic
  • Anticholinergic
  • Antihistamine
  • Other
27
Q

Dopaminergic

A
  • enhance release or supply of dopamine
  • decrease bradykinesia, tremor & rigidity
  • e.g., Levodopa (L-dopa), L-dopa with Carbidopa (Sinemet)
28
Q

Anticholinergic

A

decrease activity of ACh

- decreased tremors

29
Q

Antihistamine

A
  • Decrease tremors & rigidity
  • e.g., Diphenhydramine (Benadryl)
    propranalol
30
Q

PD - Collaborative Care: Surgical Therapy

A
  • for those unresponsive to drug therapy or who have developed severe motor complications
31
Q

PD - Collaborative Care: nutritional therapy

A
  • foods that are easily chewed & swallowed
  • Ample time
  • Frequent small meals
32
Q

PD - Nursing Considerations - Risk for Parkinsonian Crisis

A
  • sudden severe exacerbation
  • may affect respiratory and cardiac functioning
  • can be cause by emotional distress or sudden stop of medications
  • decrease sensory overload. provide respiratory and cardiac support
33
Q

On/Off Responses

A

sudden episodes of rigidity that be associated with timing of medications

34
Q

PD - Maintain self-care activities (IADL & ADL)

A
  • more time needed for self-care and during meals
  • safety consideration s
  • support living with symptoms
  • caregiver support
35
Q

Nursing Care for Clients with Degenerative Neurological diseases

A
  • Assessment
  • thorough history taking
  • neurological assessments specific to the disease processes
  • mental status: mini mental status exam
  • sensory dysfunctions
  • motor dysfunctions
  • psychosocial concerns
  • home care/equipment needs
  • family assessment
  • need to know what is normal and what is baseline for this patient
36
Q

Nursing Diagnoses for Client with Degenerative Neurological Diseases

A
  • self-care deficit
  • impaired communication
  • altered thought processes
  • altered urinary elimination/constipation
  • altered skin integrity
  • activity intolerance
  • impaired physical mobility
  • risk for aspiration/dysphagia
  • caregiver role strain (caregiver burden)
37
Q

Self-care deficit (MS)

A
  • may require aids to ambulate and perform ADLs
  • involve OT
  • may need home care support
38
Q

Self-care deficit (MS)

A
  • may require aids to ambulate and perform ADLs
  • involve OT
  • may need home care support
39
Q

Impaired Communication ALS

A
  • may be secondary to motor dysfunction as in ALS. Your approach is essential
  • non-verbal cues, calm environment, distraction
40
Q

Altered urinary elimination/constipation (MS)

A
  • incomplete emptying is of particular concern for the person with MS:
  • for scheduled voiding pattern with intermittent (self) catheterization may be necessary
  • encourage adequate fluid intake to prevent urinary stasis
  • Note risk for neurogenic bladder for person’s with MS
41
Q

Incontinence is of particular concern for AD

A

Skin protection

42
Q

Activity intolerance & impaired physical mobility (MS; PD)

A
  • of primary important in the person with MS is the prevention of muscle spasms result in in permanent contractures. ROM and muscle stretching exercises twice dialy are key to treat spasticity. Antispasmodic drugs may be provided. Be careful to avoid muscle fatigue by ensuring frequent rest periods and energy conservation methods
  • The person with PD requires methods facilitating muscle control as well as prevention of contractures
43
Q

Risk for aspiration or dysphagia (HD; ALS)

A
  • low-stress mealtimes
  • adaptive eating utensils
  • easy to swallow foods
  • sitting upright
  • pay attention to coughing after swallowing
44
Q
  1. Informational support
  2. practical support
  3. psychological support
A
  1. education of clients and caregivers
  2. home safety considerations/ensuring access to home care services/respite services/adult day care
  3. identify abuse of client or caregiver/family conferences/address caregiver burden

Pathophysiology Final (7 decks)

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