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Adult Health 2 - Exam 1 > Neurological Disorders - CNS: Brain > Flashcards

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
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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
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3
Q

Parkinson’s Disease - Stage 1

A
  • Initial Stage
    > unilateral limb involvement
    > minimal weakness
    > hand & arm trembling
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4
Q

Parkinson’s Disease - Stage 2

A
  • Mild Stage
    > bilateral limb involvement
    > masklike face
    > slow, shuffling gain
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5
Q

Parkinson’s Disease - Stage 3

A
  • Moderate Disease
    > postural instability; not able to walk very well
    > incr gait disturbances
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6
Q

Parkinson’s Disease - Stage 4

A
  • Severe Disability
    > akinesia
    > rigidity
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7
Q

Parkinson’s Disease - Stage 5

A
  • Complete ADL Dependence
    > in later stages, psychiatric components come into play
    > psychosis
    > hallucinations
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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

Adult Health 2 - Exam 1 (7 decks)

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