Neurological Disorders - CNS: Brain Flashcards
1
Q
Parkinson’s Disease - Pathophysiology
A
- Loss of dopamine stores
- Results in more excitatory neurotransmitters
- Imbalance affects voluntary movement
- Males greater than women
- 15% early onset genetic mutation
2
Q
Parkinson’s Disease - CMs
A
-
4 Cardinal Signs
> tremor
> rigidity
> bradykinesia/akinesia
> postural instability - Types:
> tremor dominate
> non-tremor dominate; a kinetic-rigid & postural instability
3
Q
Parkinson’s Disease - Stage 1
A
-
Initial Stage
> unilateral limb involvement
> minimal weakness
> hand & arm trembling
4
Q
Parkinson’s Disease - Stage 2
A
-
Mild Stage
> bilateral limb involvement
> masklike face
> slow, shuffling gain
5
Q
Parkinson’s Disease - Stage 3
A
-
Moderate Disease
> postural instability; not able to walk very well
> incr gait disturbances
6
Q
Parkinson’s Disease - Stage 4
A
-
Severe Disability
> akinesia
> rigidity
7
Q
Parkinson’s Disease - Stage 5
A
-
Complete ADL Dependence
> in later stages, psychiatric components come into play
> psychosis
> hallucinations
8
Q
Parkinson’s Disease - Diagnostics
A
- Hx
- 4 cardinal signs (2 of 4)
- Diagnosis confirmed by a positive response to levodopa trial
- PET scan; rule out
- Single-photon emission CT; rule out
9
Q
Parkinson’s Disease - Medical Management
A
-
Pharmacotherapy
> Levodopa; most effective; converts to dopamine; relieves manis -
Surgical Treatment
> deep brain stimulation (DBS)
> electrode implanted/blocks anticholinergic release
10
Q
Parkinson’s Disease - Nursing Diagnosis
A
- Impaired physical mobility
- Self-care deficits
- Constipation; due to lack of mobility
- Impaired nutrition
- Risk for injury
- Impaired verbal communication
- Knowledge deficit; family & pt
11
Q
Parkinson’s Disease - Nursing Interventions
A
- Improve mobility (w/in safety)
- Enhancing self care activities
- Improved bowel elimination; mobility & stool softeners
- Improved nutrition; aspiration risk
- Enhanced swallowing
- Assistive devices
- Family/pt education; PT/OT/Speech
12
Q
Dementia - Pathophysiology
A
-
Cognitive, functional, & behavioral changes eventually destroy a person’s ability to function
> subtle in onset; progress slowly - Not a normal part of aging
- Non-Alzheimer dementias
> vascular dementia
13
Q
Alzheimer’s
A
- Specific neuropathologic & biochemical changes tht interfere w/ neurotransmission
- Most common dementia
- Early onset (familial 40-65yrs)
- Late onset (>65yrs)
- Risk factors:
> age
> gender
> genetics
14
Q
Dementia (Alzheimer’s) - CMs
stage 1
A
- Early (mild), Stage I
-
first symptoms up to 4yrs
> independent in ADLs
> denies presence of symptoms
> forgets names; misplaces household items
> has short-term memory loss & difficulty recalling new info
> shows subtle changes in personality & behavior
> loses initiative & is less engaged in social relationships
> has mild impaired cognition & problems w/ judgement
> Demonstrates dcrd performance; especially when stressed
> unable to travel alone to new destinations
> often has dcrd sense of smell
15
Q
Dementia (Alzheimer’s) - CMs
stage 2
A
- Middle (moderate), Stage II
-
2-3yrs
> has impairment of all cognitive funcs
> demonstrates problems w/ handling or unable to handle money & finances
> is disoriented to time, place, & event
> is possibly depressed and/or agitated
> is incringly dependent in ADLs
> has speech & language deficits; less talkative, dcrd use of vocab, incringly nonfluent, & eventually aphasic
> incontinent
> psychotic behaviors; delusions, hallucinations, paranoia
> has episodes of wandering; trouble sleeping
16
Q
Dementia (Alzheimer’s) - CMs
stage 3
A
- Late (severe)
-
Stage III
> completely incapacitated; bedridden
> totally dependent in ADLs
> has loss of mobility & verbal skills
> possibly has seizures & tremors
> has agnosia
17
Q
Dementia (Alzheimer’s) - CMs
extra info
A
- Pts can show manis from any stage
- Pts can have issues from any stages at anytime
> mix & match
> slide btwn stages
18
Q
Dementia (Alzheimer’s) - Diagnostics
A
- Hx
- Physical assessment/manis
- Psychosocial assessment
- Lab; rule out
- Radiological; rule out
19
Q
Dementia (Alzheimer’s) - Medical Surgical Treatment
A
- Behavioral management structured envir’t
- Cognitive stimulation
- Memory training
- Validation therapy (orientation)
- Redirection
- Pharm therapies
> Donepezil (Aricept); improves symptoms
20
Q
Dementia (Alzheimer’s) - Nursing Management
A
- Supporting cognitive func
- Promoting physical safety
- Promoting independence in self-care activities
- Reducing anxiety & agitation
- Improving communication
- Providing for socialization & intimacy needs
- Promoting adequate nutrition
- Promoting balanced activity & rest
- Home, community, & transitional care
21
Q
Meningitis - Pathophysiology
A
- Inflammation of the meninges, which cover & protect the brain & spinal cord
- Infection through bloodstream or direct spread
> proliferates in CSF
> inflamm/incr ICP
22
Q
Meningitis - Complications
A
- Hemorrhage/vascular necrosis (Waterhouse-Friderichsen syndrome)
- Circulatory collapse
- Septic shock
- Blindness/deafness
- Paralysis/seizures
- Hydrocephalus
23
Q
Meningitis - CMs
A
- Severe headache
> incrd ICP - Neck immobility (nuchal rigidity)
- Photophobia
- Kernig sign: pushing knees past 135 degrees laying down
- Brudzinski sign: reflexive flexion of knees & hips following passive neck flexion
24
Q
Meningitis - Diagnostics
A
- Identify causative agent
- Lumbar puncture
> CSF culture & sensitivity; viral, bacterial, fungal - Blood culture & sensitivity
- CT if altered LOC
25
Q
Meningitis - Medical Surgical Treatment
A
- Broad-spectrum antibiotic
- Steroids
- IV fluid vol expanders; shock
- Anticonvulsants; seizures
- Prophylaxis treatment for those in close contact w/ meningitis infected pts
- Vaccinations
26
Q
Meningitis - Nursing Diagnosis
A
- Ineffective airway clearance
- Impaired comfort
- Impaired mobility
- Acute pain
- Risk for aspiration
- Risk for injury
27
Q
Meningitis - Nursing Interventions
A
- Ensure airway
- Pain management
- I&O
- Encourage fluid intake
- Close neurologic monitoring
- Collaborative w/ physician
28
Q
Meningitis - Nursing Care
A
- Infection control precautions 24hrs after initiation of antibiotic therapy
- Assisting w/ pain management
- Assisting w/ getting rest in a quiet, dark room
- Treat elevated temp w/ antipyretics & cooling blankets
- Maintain hydration orally or peripherally
- Protecting from injury secondary to seizure or alt LOC
- Monitor: daily weight, electrolytes, urine vol, specific gracity, osmolality; esp if SIADH is suspected
- Prevent comps of immobility; pressure ulcers & pneum
29
Q
Encephalitis - Pathophysiology
A
- Involves local necrotizing hemorrhage tht becomes more generalized, followed by edema
- viral, bacterial, fungal
- herpes simplex most common cause in US
30
Q
Encephalitis - CMs
A
- Fever, headache, confusion, & hallucinations
- Focal neurologic symptoms reflect areas of cerebral inflamm & necrosis
31
Q
Encephalitis - Medical Surgical Interventions
A
- Diagnosis: MRI, LP, EEG
- Med: antiviral; Acyclovir
- Comps: atelectasis or pneum
32
Q
Encephalitis - Nursing Interventions
A
Same as meningitis
33
Q
Traumatic Brain Injury - Pathophysiology
A
-
Primary
> direct contact to head/brain during instant of initial injury -
Secondary
> inadequate delivery of nutrients & oxygen to cells - Results in incrd ICP
34
Q
Traumatic Brain Injury - Complications
A
- Dcrd cerebral perfusion
- Cerebral edema & herniation
- Imapired oxygenation & ventilation
- Impaired fluid, electrolyte, & nutritional balance
- Risk of posttraumatic seizures
35
Q
Traumatic Brain Injury - Medical Surgical Treatment
A
- Diagnostics: neuro exam; CT, MRI, PET
- Treat incrd ICP
- Supportive measures
- Brain death; potential donor
36
Q
Traumatic Brain Injury - Supportive Measures
A
- Vent support
- Airway support
- Seizure prevention
- Fluid & electrolyte maintenance, nutritional support
- Pain & anxiety
- NG tube
37
Q
Traumatic Brain Injury - Nursing Diagnosis
A
- Ineffective airway clearance & impaired gas exchange
- Risk for ineffective cerebral tissue perfusion
- Deficient fluid
- Imbalanced nutrition; less than body requirements
- Risk for injury
- Risk for impaired skin integrity
38
Q
Traumatic Brain Injury - Nursing Interventions
A
- ICU admin
- Maintain airway
-
Monitor neuro func
> GSC - Monitor fluid & electrolytes
- Promote adequate nutrition
- Prevent injury
- Maintain body temps
- Maintain skin integrity
39
Q
Brain Tumors - Pathophysiology
A
-
Occupies space w/in skull, growing as a spherical mass or diffusely infiltrating tissue
> incrd ICP
> seizure activity
> hydrocephalus - Primary
- Secondary
40
Q
Brain Tumors - CMs
A
- Incrd ICP
> headache
> vomiting
> visual disturbances
> seizures - Localized manis
41
Q
Brain Tumors - Diagnostics
A
- Neuologic exam
- CT scan
- MRI
- Computer assisted stereotactic biopsy
- PET scan
42
Q
Brain Tumors - Medical Surgical Treatment
A
- Surgical management
- Radiation therapy
- Chemotherapy
- Pharmacologic therapy
43
Q
Brain Tumors - Nursing Diagnosis
A
- Acute confusion
- Fear
- Dcrd intracranial adaptive capacity
- Acute pain
- Vision loss
- Risk for injury
44
Q
Brain Tumors - Nursing Interventions
A
- Assess neuro status/reorient
- Alleviate fear
- Treat pain
- Assess for visual acuity
- Provide safe envir’t
