Neurological Disorders Part 1 Flashcards
2 Types of Stroke
- Ischemic
2. Hemorrhagic
Non-Modifiable Risk Factors of Ischemic Stroke
- Age
- Gender
- Low birth weight
- Race/ethnicity
- Genetic factors
Modifiable Risk Factors of Ischemic Stroke
- Hypertension
- Smoke
- Diabetes
- Afib
- Dislipidemia
- Post-menopausal hormone therapy
- Poor diet
- Obesity
- Inactivity
Pathophysiology of Stroke
Most strokes caused by thromboembolic event (related to atherosclerosis, hypertension, diabetes, gout). Embolic stroke and thrombotic stroke.
Embolic Stroke
Clot that travels to the brain, blocks an artery.
Thrombotic Stroke
Stationary clot that forms in the blood vessel.
Intracerebral Hemorrhage
Caused by a ruptured vessel inside the brain. Prevalence of hypertension is 80%.
Subarachnoid Hemorrhage (SAH)
Ruptured aneurism in the subarachnoid space or due to head trauma.
Medical Treatment for Stroke
Thrombolytic or “clot-busting” drugs to restore perfusion to affected areas within 6 hours of onset of stroke. Controlling intracranial pressure (ICP) while maintaining sufficient perfusion of the brain.
AHA/ASA Guidelines for Primary Prevention of Stroke
- Complete smoking cessation
- Blood lipid management
- Reduced intake of sodium
Dysphagia Treatment
- Posture changes
- Heightening sensory input
- Swallow maneuvers
- Active exercise programs
- Diet modifications
Dysphagia Management
- Nonoral feeding
- Psychological support
- Tube feeding for pts who cannot sustain sufficient oral caloric and/or fluid intake
Stroke MNT
Initially NPO for 24-48 hours. Tube feeding may be needed in some pts. Progress from NPO to oral feeds as tolerated. Provide adequate energy and protein intake:
- 25-45 kcal/kg
- 1.2-1.5g pro/kg may be needed dependent on weight status and loss of lean body mass
- Modify food texture to compensate for dysphagia
Alzheimer’s Disease
- Most common form of dementia
- Increases exponentially after age 40
- Prevalence in white males at age 100 is 41.5%
- Higher prevalence in women (3x) due to them living longer than men
Symptoms of Alzheimer’s Disease
- Forgetfulness
- Forget how to do simple tasks
- Get lost in familiar surroundings
- Echolalia: repeat words spoken by others
- Agnosia: loss of comprehension
- Motor skills deteriorate
- Loss of bowel and bladder control
- Limb weakness and contractures
- Intellectual activity ceases
- Vegetative state
Echolalia
Repeat words spoken by others.
Agnosia
Loss of comprehension
Alzheimer’s Disease Risk Factors
- Age; doubles every 5 years after 65
- Family hx; early onset strongly hereditary
- Those with a parent or sibling with AD are 2-3x more likely to develop it
- Head injury
- Down syndrome
- Low level of education
- Female gender
Treatment of Alzheimer’s Disease
- No drug can stop or reverse AD
- Some drugs may slow progress:
- Tacrine (Cognex)
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
- Other medications may treat symptoms such as sleeplessness, agitation, wandering, anxiety, and depression
Nutritional Consequences of Alzheimer’s Disease
- Wt loss is common due to increased pacing
- Decreased independence and impaired self-feeding
- Inability to recognize hunger, thirst, and satiety
- Meals forgotten as soon as eaten or may forget to eat
- Inability to recognize food when presented
- Risk of dehydration
MNT in Alzheimer’s Disease
- Vitamin/Mineral supplementation and assure intake of antioxidants
- Minimize distractions at mealtime
- Place foods on small plates and give one at a time
- Serve food on plates without a pattern (white plate)
MNT in Alzheimer’s Disease
- Model use of eating utensils and provide verbal cues
- Allow pt to use eating utensils as long as possible; use bowls for easier scooping
- Finger foods may be helpful, but monitor for swallowing problems and choking
- Frequent snacks, nutrient-dense foods, and nutritional supplements may be helpful
Migraine Headaches
Thought to be vascular in origin and can be throbbing, episodic, and intense. Varies by the individual and tolerance thresholds vary over time. Hx of intercurrent nausea, vomiting, photophobia, and visual or olfactory auras. Treated with NSAIDS, sympathomimetics, serotonin agonists, prophylaxis with calcium channel blockers, beta-adrenergic blockers, and serotonin antagonists.
Migraine Headaches and Food
Headaches may be triggered by foods like citrus fruits, tea, coffee, pork, chocolate, milk, nuts, vegetables, and cola drinks. No general recommendations about food avoidance, but may want to evaluate food and symptom diary.
Interventions for Migraine Headaches
- Regular mealtimes
- Pt needs to identify triggers by keeping a meal diary
- Regular sleep patterns
- Biofeedback, relaxation training, and stress management
Myasthenia Gravis (MG)
Autoimmune disorder of the neuromuscular junction, affects the skeletal muscles and causes muscle weakness, particularly of the face, eyes, arms, and legs. The body makes antibodies to acetylcholine receptors and when there are reduced numbers of receptors the muscles tire easily.
Symptoms of Myasthenia Gravis
- Relapsing and remitting weakness and fatigue
- Diplopia: double vision
- Ptosis: drooping eyelids
- Facial muscle weakness
- Dysphagia (33%)
Diplopia
Double vision
Ptosis
Drooping eyelids
Medical Treatment for MG
- Corticosteroids
- Pyridostigmine (Mestinon)
- Removal of the thymus gland sinse it may be responsible for the autoantibody production
Pyridostigmine (Mestinon)
Blocks the degradation of acetylcholine at the neuromuscular junction, increasing the level of acetylcholine with better muscle response to stimulation by the nerve.
MNT for Myasthenia Gravis
- Nutritionally dense foods at the beginning of meals before the pt tires
- Small frequent meals
- Time medication with feeding to facilitate optimal swallowing
- Limit physical activity before meals
- Don’t encourage food consumption when pt is tired, they may aspirate
Interventions for Myasthenia Gravis
- Thickened liquids and pureed diet as tolerated
- PEG tube at hs to regain wt that has been lost
Nutrition Monitoring for MG
- Wt gain
- Further incidence of aspiration
- Diet tolerance
- Tube feed tolerance
Wernicke-Korsakoff Syndrome
Caused by a chronic thiamin deficiency.
MNT for Wernicke-Korsakoff Syndrome
- Thiamin
- Adequate hydration
- Diet liberal in high-thiamin foods
- Eliminate ETOH
- Dietary protein may need to be restricted
Amyotrophic Lateral Sclerosis (ALS)
ALS is also called Lou Gehrig’s Disease and is the most common motor system disease. It causes progressive denervation atrophy and weakness of the muscles. Both the upper and lower motor neurons are lost in the spinal cord, brainstem, and motor cortex. Progresses to death in 2-6 years.
ALS
- Prevalence consistent throughout the world
- Men affected more than women
- Age of onset mid 50s (40-70)
- 5% familial, rest sporadic
ALS Presentation
Muscle weakness commences in the legs and hands and progresses to the proximal arms and oropharynx. Voluntary skeletal muscles are at risk for atrophy and complete loss of function. Spasticity of jaw muscles resulting in slurred speech. Often causes dysphagia and weight loss, and eventual death from respiratory failure.
ALS Nutritional Implications
- Dysphagia and chewing problems
- Decreases body fat, LBM, and nitrogen
- Late stage pts may not tolerate PEG placement d/t respiratory compromise
- Initiate discussions about whether to place a feeding tube early in disease process
- Enteral feedings do not prolong life
MNT for ALS
- Emphasize fluids as pts may limit d/t toileting difficulties
- Get baseline wt to monitor; 10% wt loss puts them at an increased risk
- Modify consistency as eating problems develop using easy-to-chew foods, thickened liquids, small freq meals, and cool food temps
MNT for ALS
- If nutrition support is in the plan, use EN
- Initiate earlier rather than later; dehydration occurs before malnutrition
- Purpose of nutrition support should be to enhance quality of life
- Eventually pts will not be able to manage oral secretions
Nutrition Monitoring in ALS
- Weight
- Diet tolerance
- Hydration status
- Acceptance of supplements
