Stroke and Neurological disorders - Part 3

Question 1

Dementia occurs in up to __% of patients with PD.

Answer 1

40

Question 2

Tremor with closed hands seen in PD.

Answer 2

Pill rolling (tremors)

Question 3

What is a way in which the family doctor will often diagnose PD.

Answer 3

Pt will come in due to numbness of hands and feet.

Family doctor will then ask them to hand to shoulder, then pull arm down - they will resist - cogwheeling (Sign of PD)

Question 4

Patient’s with parkinson’s will change their handwriting. How?

What type of gait will they develop?

Describe their changes in facial expressions.

Answer 4

Reduction in handwriting size

Shuffling gait

Masked - no emotional changes in expression

Question 5

Genetic disorder that is related to a deficiency of ACh and GABA NTs.

Answer 5

Huntington;s disease

Question 6

Huntington’s
- the deficiency of ACh and GABA results in an excess of _______.
Onset is __-____ years of age; offspring have a __% change of inheriting the disorder. So, _______ testing is done.

Answer 6

dopamine
30-50
50%
genetic

Question 7

HD:

• Symptoms are opposite to those of _____
• Excessive involuntary movements = _____
• have twisting movements of face, limbs, body
• Require this type of diet
• gait deterioration makes ambulation impossible
• Often the cause of death.

Answer 7

PD
chorea
high calorie diet - 4000-5000 calories
intellectual decline is often the cause of death

Question 8

Incomplete closure of neural tube during embryonic life. The vertebrae of the spinal cord are not completely formed and remain open. The opening may or may not allow spinal tissue to bulge through it.

Answer 8

Spina bifida

Question 9

What are the three main Spina Bifida groups?

Answer 9

Spina bifida occulta
Spina bifida cystic with menigocele
Spina bifida cystic with myelomenengiocele

Question 10

Most common spina bifida type

Answer 10

Spina bifida occulta

Question 11

Somewhere along the base, usually the sacral or coccyx area there is a bulging out.

Answer 11

Spina bifida meningocele

Question 12

Balling up of the spinal cord through a bulge of the vertebrae.

Answer 12

Myelomeningocele

Question 13

How is Spina bifida myelomenigocele fixed?

Answer 13

Perform surgery - want child to be a few months old before attempting due to the high risk of death.
May complete as early as 1-2 days old but has a low success rate.

Question 14

Spina bifida occulta

• most common location is the ______ or the _____ areas
• Occurs when there is ______ closure of some vertebrae in the ________ region without protrusion of the spinal cord or the meninges
• it is the _______ form of SB and is often termed as hidden (occult) spina bifida
• it occurs in __% of the population

Answer 14

lumbar, sacral
incomplete, lumbosacral
mildest
5%

Question 15

Can be recognized externally by the presence of a skin depression or dimple, tuft of hair, telengiectasis or lipomas on the lower back.

Answer 15

Spina bifida occulta

Question 16

Describe the neurological deficits of SBO (Spina bifida occulta).

Answer 16

No neurological deficits usually.

Adhesions may cause some sensory/motor/autonomic disturbances.

Question 17

Risk factors for spina bifida:

• maternal age
• birth order
• pregnancy Hx
• low levels of this
• uncontrolled _______ in mother, esp. during the early part of pregnancy

Answer 17

more commonly seen in newborns of teenage mothers
first baby is at higher risk
Hx of miscarriages increases risk
folic acid
diabetes

Question 18

The most frequently seen complications of spina bifida, and the cause of back pain.

Answer 18

Tethered spinal cord syndrome

Question 19

Neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.

Answer 19

Tethered SC syndrome

Question 20

Prenatal screening for SB

• ______-______ blood test at 16-18 weeks of pregnancy. This test is higher in about 75-80% of women who have a fetus with spina bifida
• ________/________ can show signs of spina bifida, such as the open spine
• Maternal _________ can be used to look at protein levels

Answer 20

Alpha-fetoprotein (AFP screening test)

ultrasound/sonogram

amniocentesis

Question 21

Most common childhood physical disability.

Answer 21

Cerebral palsy

Question 22

Cerebral palsy:

Describe how the incidence has changed as of late.

Answer 22

Despite medical advances, incidence has not decline over the last 60 years

Question 23

A disorder of movement, muscle tone or posture that is caused by an insult to the immature, developing brain, most often before birth.

Answer 23

cerebral palsy

Question 24

Describe the physical and neurological deficits (broadly) of cerebral palsy.

Answer 24

Sometimes, the cerebral palsy will only affect the child’s physical functioning.
Children with sever cerebral palsy have a greater likelihood of having cognitive impairments

Question 25

Non-profit, charitable organization that strives to address the changing needs of people in Ontario with cerebral palsy.

Answer 25

Ontario Federation for Cerebral Palsy

Question 26

Under the Code, everyone has the right to be free from discrimination because of disability or perceived disability in the social areas of employment, services, goods, facilities, housing, contracts and membership in trade and vocational associations. This right means that persons with disabilities have the right to equal treatment, which includes the right to accessible workplaces, public transit, health services, restaurants, shops and housing.

Answer 26

OHRC (ontario human rights commission) - policy and guidelines on disability and the duty to accommodate

Question 27

Understanding, uncovering, and discovering client strengths to deal with challenges, to meet personal, team and system goals.

This approach does not ignore problems nor pretend that weaknesses and deficits do not exist. Rather,it is about working collaboratively with client & family strengths to deal with problems and deficits

Answer 27

SBNC

Question 28

In order to deal with the most common problem of HD, the nurse should institute?

A - Seizure precautions due to increased stimulation

B - DB and C exercises to clear secretions

C - an exercise regimen to strengthen and enhance muscle tone

D - a high calorie diet that includes foods that are easy to swallow

Answer 28

D - HD patients will continually move their limbs, face and body causing a need for lots of calories
They will also drool and have difficulty swallowing.

Question 29

What neurological disorders affect motor function, but cognitive function is impaired?

Answer 29

ALS, Bell’s palsy, (maybe myasthenia gravis and Guillain-Barre)