oncologic or degenerative neurologic disorders

Question 1

terminology

bradykinesia

Answer 1

• abnormally slow voluntary movements
• associated with parkinsons

Question 2

terminology

dyskinesia

Answer 2

• impaired ability to execute voluntary movements
• associated with parkinsons and ALS

Question 3

terminology

sciatica

Answer 3

pain and tenderness that radiates along the sciatic nerve that runs through the thigh and leg

Question 4

terminology

spondylosis

Answer 4

• degenerative changes occurring in a disc and adjacent vertebral bones
• can occur in the cervical or lumbar vertebrae

Question 5

name some different brain tumors

Answer 5

• 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

Question 6

describe huntington disease

Answer 6

• 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

Question 7

describe parkinsons

Answer 7

• 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)

Question 8

describe the pathophysiology of parkinsons

Answer 8

• decreased levels of dopamine
• degeneration of dopamine storage cells
• imbalance of acetylcholine (excitatory) and dopamine (inhibitory)

Question 9

does parkinsons have a gradual or super fast onset

Answer 9

gradual onset and slow progression

Question 10

what are the cardinal symptoms of parkinsons

Answer 10

• Tremor
• Rigidity, increased tone, stiffness
• Bradykinesia / akinesia
• Postural instability

Question 11

what are the two major subtypes of parkinsons

Answer 11

• Tremor dominant (most other symptoms are absent)
• Nontremor dominant (akinetic-rigid and postural instability)

Question 12

what are some psychological changes associated with parkinsons

Answer 12

Depression
Anxiety
Dementia (progressive)
Delirium
Mental deterioration

Question 13

what are some other symptoms associated with parkinsons

Answer 13

Sweating
Drooling
Paroxysmal flushing
Orthostatic hypotension
Gastric and urinary retention
Constipation and sexual dysfunction
Dysphagia

Question 14

what are some complications of parkinsons

Answer 14

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

Question 15

whats used in the diagnosis of parkinsons

Answer 15

• history
• clinical presentation (think about the sx)
• neurological exam (check grasp, posture, and gait)
• other test may be done to rule out similar disorders

Question 16

what meds may be used for parkinsons

Answer 16

• carbidopa-levodopa (drug of choice): carbidopa stops levodopa from being metabolized
• anticholinergics to control tremors
• antiviral (amantadine) to reduce rigidity/tremors

Question 17

what are some nursing interventions for parkinsons

Answer 17

• 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

Question 18

describe ALS

Answer 18

• 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)

Question 19

what are the chief symptoms associated with ALS

Answer 19

Fatigue
Progressive muscle weakness
Cramps
Fasciculation (irregular twitching of muscles fibers)
Lack of coordination

Question 20

describe the damage to anterior horns associated with ALS

Answer 20

Progressive weakness
Atrophy of arms, legs, trunk
Spasticity
Hyperreflexia

Question 21

describe vocal effects associated with ALS

Answer 21

“thick” speech and difficulty projecting voice

Question 22

what are some later symptoms of ALS

Answer 22

• 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

Question 23

whats included in the diagnosis of ALS

Answer 23

• clinical presentation
• EMG
• muscle biopsy
• MRI

Question 24

whats included in the treatment of ALS

Answer 24

• supportive therpay only
• therapy and rehab to maintain: quality of life, well-being, and function
• feeding tube
• mechanical vent

Question 25

what are some nursing interventions for ALS

Answer 25

• 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