Stroke and Neurological disorders - Part 3 Flashcards
Dementia occurs in up to __% of patients with PD.
40
Tremor with closed hands seen in PD.
Pill rolling (tremors)
What is a way in which the family doctor will often diagnose PD.
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)
Patient’s with parkinson’s will change their handwriting. How?
What type of gait will they develop?
Describe their changes in facial expressions.
Reduction in handwriting size
Shuffling gait
Masked - no emotional changes in expression
Genetic disorder that is related to a deficiency of ACh and GABA NTs.
Huntington;s disease
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.
dopamine
30-50
50%
genetic
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.
PD
chorea
high calorie diet - 4000-5000 calories
intellectual decline is often the cause of death
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.
Spina bifida
What are the three main Spina Bifida groups?
Spina bifida occulta
Spina bifida cystic with menigocele
Spina bifida cystic with myelomenengiocele
Most common spina bifida type
Spina bifida occulta
Somewhere along the base, usually the sacral or coccyx area there is a bulging out.
Spina bifida meningocele
Balling up of the spinal cord through a bulge of the vertebrae.
Myelomeningocele
How is Spina bifida myelomenigocele fixed?
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.
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
lumbar, sacral
incomplete, lumbosacral
mildest
5%
Can be recognized externally by the presence of a skin depression or dimple, tuft of hair, telengiectasis or lipomas on the lower back.
Spina bifida occulta
Describe the neurological deficits of SBO (Spina bifida occulta).
No neurological deficits usually.
Adhesions may cause some sensory/motor/autonomic disturbances.
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
more commonly seen in newborns of teenage mothers first baby is at higher risk Hx of miscarriages increases risk folic acid diabetes
The most frequently seen complications of spina bifida, and the cause of back pain.
Tethered spinal cord syndrome
Neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column.
Tethered SC syndrome
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
Alpha-fetoprotein (AFP screening test)
ultrasound/sonogram
amniocentesis
Most common childhood physical disability.
Cerebral palsy
Cerebral palsy:
Describe how the incidence has changed as of late.
Despite medical advances, incidence has not decline over the last 60 years
A disorder of movement, muscle tone or posture that is caused by an insult to the immature, developing brain, most often before birth.
cerebral palsy
Describe the physical and neurological deficits (broadly) of cerebral palsy.
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
Non-profit, charitable organization that strives to address the changing needs of people in Ontario with cerebral palsy.
Ontario Federation for Cerebral Palsy
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.
OHRC (ontario human rights commission) - policy and guidelines on disability and the duty to accommodate
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
SBNC
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
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.
What neurological disorders affect motor function, but cognitive function is impaired?
ALS, Bell’s palsy, (maybe myasthenia gravis and Guillain-Barre)
