oncologic or degenerative neurologic disorders Flashcards
terminology
bradykinesia
- abnormally slow voluntary movements
- associated with parkinsons
terminology
dyskinesia
- impaired ability to execute voluntary movements
- associated with parkinsons and ALS
terminology
sciatica
pain and tenderness that radiates along the sciatic nerve that runs through the thigh and leg
terminology
spondylosis
- degenerative changes occurring in a disc and adjacent vertebral bones
- can occur in the cervical or lumbar vertebrae
name some different brain tumors
- intercerebral tumors: gliomas (most common type of brain tumor)
- meningiomas, neuromas, pituitary adenomas (all of these arise from a supporting structure)
- angiomas (developmental tumor)
- metastatic lesion
describe huntington disease
- chronic progressive hereditary disease
- progressive involuntary choreiform movement (jerking/twitching) and dementia
- triad of sx: motor dysfunction, cognitive impairment, and behavioral features of apathy and blunted affect
describe parkinsons
- slow progressive neurologic movement disorder
- affects men more than women
- symptoms generally appear in 50s, has appeared as early as 30s
- idiopathic - most common form
- secondary form being research (multifactorial combo of age, environment, and hereditary)
describe the pathophysiology of parkinsons
- decreased levels of dopamine
- degeneration of dopamine storage cells
- imbalance of acetylcholine (excitatory) and dopamine (inhibitory)
does parkinsons have a gradual or super fast onset
gradual onset and slow progression
what are the cardinal symptoms of parkinsons
- Tremor
- Rigidity, increased tone, stiffness
- Bradykinesia / akinesia
- Postural instability
what are the two major subtypes of parkinsons
- Tremor dominant (most other symptoms are absent)
- Nontremor dominant (akinetic-rigid and postural instability)
what are some psychological changes associated with parkinsons
Depression
Anxiety
Dementia (progressive)
Delirium
Mental deterioration
what are some other symptoms associated with parkinsons
Sweating
Drooling
Paroxysmal flushing
Orthostatic hypotension
Gastric and urinary retention
Constipation and sexual dysfunction
Dysphagia
what are some complications of parkinsons
Respiratory and Urinary tract infections
Skin breakdown
Injuries from falls
Dyskinesia
Parkinsonian crisis – Emotional trauma or sudden medication withdrawal
Medication side effects
On/Off response – Rapid fluctuations in symptoms
Loss of medication effectiveness
whats used in the diagnosis of parkinsons
- history
- clinical presentation (think about the sx)
- neurological exam (check grasp, posture, and gait)
- other test may be done to rule out similar disorders
what meds may be used for parkinsons
- carbidopa-levodopa (drug of choice): carbidopa stops levodopa from being metabolized
- anticholinergics to control tremors
- antiviral (amantadine) to reduce rigidity/tremors
what are some nursing interventions for parkinsons
- resp/cardiac support
- quiet room
- barbituates w/ antiparkinsonian drugs
- need to shorten period between meds/increase doses
- 2L fluid/day, increased fiber, stool softeners/laxatives, establish regular bowel routine (combat anticholinergic constipation)
- encourage ROM
- regular daytime rest
- assist with ADLs
- patient/family education
- safety measures
- emotional support
describe ALS
- unknown cause
- most common of motor neuron diseases
- loss of motor neurons -> muscle atrophy
- risk factors: tend to be middle age (40-60) and male>female
- survival rate varies (5-20yrs)
what are the chief symptoms associated with ALS
Fatigue
Progressive muscle weakness
Cramps
Fasciculation (irregular twitching of muscles fibers)
Lack of coordination
describe the damage to anterior horns associated with ALS
Progressive weakness
Atrophy of arms, legs, trunk
Spasticity
Hyperreflexia
describe vocal effects associated with ALS
“thick” speech and difficulty projecting voice
what are some later symptoms of ALS
- Shortness of breath
- Difficulty breathing
- Dysphagia
- Dysarthria
- Progresses from upper extremities → shoulders → trunk → neck → throat
- Lower extremities affected later
- Some patients may experience cognitive impairment.
- Bowel and bladder sphincters’ function is maintained
whats included in the diagnosis of ALS
- clinical presentation
- EMG
- muscle biopsy
- MRI
whats included in the treatment of ALS
- supportive therpay only
- therapy and rehab to maintain: quality of life, well-being, and function
- feeding tube
- mechanical vent
what are some nursing interventions for ALS
- supportive nursing care
- ongiong assessment
- suggest modifications as disease progresses
- emotional support
- conserving energy
- avoid extreme cold/hot
- prevent skin breakdown
- encourage fluid intake
- proper positioning
- discuss advanced directives/end of life care
