X Neuro: Mrs Grant (Adult Health, Chp 14) Flashcards
The Nervous system works together with what system?
The Endocrine system to maintain homeostasis
NS responsible for what in the body?
- communication
- control
- It interpretes info received then send to appropriate areas of the brain of spinal cord
NS reacts in split seconds while Endocrine (enzymes/hormones) system takes longer to take effect.
.
CNS includes
- brain
- spinal cord
Peripheral Nervous System
- Somatic nervous system
- Autonomic nervous system
Somatic Nervous System (voluntary)
sends messages form CNS to skeletal muscles (voluntary)
(i. e. walking)
- Spinal Nerves: 31 pairs (Afferent, sensory /Efferent, motor)
- Cranial Nerves: 12 pair, (conduct impulses btwn head/neck/brn), back of brain, brain stem. (Nerve X, Vegus brings impuls to Thoracic/abdominal, unlike the rest)
Autonomic Nervous System
involuntary, automatic
sends messages from CNS to smooth muscle, cardiac muscle and certain glands (involuntary, unconscious i.e. heart beat, breathing)
- Sympathetic NS
- Parasympathetic NS
Cells of Nervous System
- Neuron
- Neuromuscular juntion
- Neurotransmitters
- Neurocoverings
- Synapse
Neurons
most important cells in transmission of info
- cell body, nucleus, axon, dendrites
- receive impulses
- many shapes and sizes
- non myotic (don’t replicate when injured. don’t hear of malignancy of these cells because they don’t multiply
Neuromuscular Junction
area of contact btwn ends of fibers
Neurotransmitters
store chemicals
- ACETYLCHOLINE: transmission of impulse (speed)
- NOREPINEPHRINE: maintain arousal, dream, mood
- DOPAMINE: helps with fluidity of mvmt, motor functions (i.e. parkinson’s, lack of dopamine)
- SERATONIN: sleep, temp, mood
Synapse
space btwn 2 neurons. Impulse crosses to next neuron
Neuron Coverings
Myelin Sheath
- white waxy material insulates/protects axon
- starts to form at 4mos gestation
- increases speed of impulse transmission
Neuro Glial Cells
support cells to neurons. ‘Nerve Glue’. Support, insulate, care, nourish neurons
Peripheral NS: Spinal Nerves
- Spinal Nerves: 31 pairs of mixed nerves
- Afferent: sensory, RECEIVE info from organs
- Efferent: motor nuerons, SEND messages from CNS to periphery
Peripheral NS: Cranial Nerves
- 12 pair, attached to brain stem
- conduct impulses btwn head/neck/brn
- all except cranial nerve X, Vegus, brings impulse to Thoracic/abdominal, unlike the rest
Autonomic NS: Sympathetic NS
- work together, but one will dominate the others. Activated in times of severe stress or when threatened.
- Fight or Flight
- If body stays in Fight or Flight state for too long, can cause HTN and illness
Autonomic NS: Parasympathetic NS
- most active during resting state.
- digestion, reproductive funtion
- Feed & Breed
- Paradoxial Fear can result.
Paradoxical Fear
when person knows running or fighting won’t help. Body relaxes. (i.e. urinate or defacate on self, pass out)
- the body’s way of taking you out of the situation.
- Protection, acceptance of situation.
- ‘Bradying down’ –> LO BP, Bradycardia
Effects of Normal Aging on NS
- loss of brain weight (cortex (gray matter) lose cells at higher rate), impairs reasning, memory, language
- loss of neurons (lose 1% neurons after age 50)
- reduction cerebral blood flow
- LO brain metab and O2 utilization
- LO blood supply to spinal cord, dec reflexes
- altered sleep/wake ratio
- LO ability to regulate body temp
- LO velocity of nerve impulses
- Existing neurons may contain 1)Senile Plaques 2) Neurofibroloary tangles, 3) Age pigment (Lipofuscin)
Brain
- Cerbrum
- Diencephalon
- Cerebellum
- Brain Stem (mid brain, pons, medulla oblongata, coverings of brain, ventricles
Can Neurons be replaced/regenerated
NO
Aging: Lipofuscin
name given to finely granular yellow-brown pigment granules[1] composed of lipid-containing residues of lysosomal digestion. It is considered to be one of the aging or “wear-and-tear” pigments, found in the liver, kidney, heart muscle, retina, adrenals, nerve cells, and ganglion cells. It is specifically arranged around the nucleus, and is a type of lipochrome.
Aging: Senile Plaques
polymorphous beta-amyloid protein deposits found in the brain in Alzheimer disease and normal aging. This beta-amyloid protein is derived from a larger precursor molecule of which neurons are the principal producers in brain.
Aging: Neurofibrillary Tangles (NFTs)
aggregates of hyperphosphorylated tau protein that are most commonly known as a primary marker of Alzheimer’s Disease. Their presence is also found in numerous other diseases known as tauopathies.
Gray Matter
Grey matter, also known as substantia grisea, is the part of the brain that is controlled by the nerve cell bodies and the majority of the true dendrites (numerous, short, branching filaments that carry impulses towards the cell body). The cell body is the area of the neuron that is highlighted by the existence of a nucleus. Grey matter has no myelin blanket.
The real processing is concluded in the grey matter.
White Matter
The white matter, also known as substantia alba, is a neuron that is made up of extending, myelinated nerve fibers, or axons. It composes the structures at the center of the brain, like the thalamus and the hypothalamus. It is found between the brainstem and the cerebellum. It is the white matter that allows communication to and from grey matter areas, and between grey matter and the other parts of the body. It functions by transmitting the information from the different parts of the body towards the cerebral cortex. It also controls the functions that the body is unaware of, like temperature, blood pressure and the heart rate. Dispensing of hormones and the control of food, as well as the intake of water and the exposition of emotions, are additional functions of the white matter.
???? PIC of SLIDE 8
find
Prevention of Neuro problems
- avoid ETOH/DRUGS
- safe Motor Vehicles use (seat belt, helmet)
- safe swimming (diving in shallow)
- safe handling/storage firearms
- use hardhats, construction area
- use protective padding in sports (concussion, football)
- safe sex (syphillis, HIV, condoms, monogamy, abstinence)
Neuron Covering: Myelin Sheath
- white waxy material
- insulates/protects axon
- starts to form at 4mos gestation - teen yrs
- increases speed of trans of impulses
- i.e. newborns slower/uncoordinated because myelin sheath not fully formed. impulses slwoer
How many Spinal Nerves
31 pairs (Afferent, sensory /Efferent, motor)
Cranial Nerves
12 pair, (conduct impulses btwn head/neck/brn), back of btrain, brain stem.
I II III IV V VI VII VIII IX X- Vegus brings impuls to Thoracic/abdominal, unlike the rest
Hierarchy of the Nervous System
- Nervous System: Peripheral + Central (brain/spinal cord)
- PERIPHERAL: Autonomic (auto) + Somatic (voluntary)
- AUTONOMIC: Sympathetic (fight/flight) + Parasympathetic (feed/breed)
Assessment of Neuro System
- Hx
- MS
- LOC: Glasgow Coma Scale
- Language/Speech
- Cranial Nerve fx
- Motor fx
- Sensory/perceptual status
Neuro Assessment: Hx
comprehensive history w specifics: symptoms, understanding of what’s happening, info from other family members, subj data H, change of character, insomnia, change in location of headches
Neuro Assessment: MS
mental status:
- orientation to person, place, time, purpose
- mood, behavior
- general knowledge (president, mayor)
- LT/ST memory
- 3 word test (5 min recall)
Neuro Assessment: :LOC
Level of Consciousness:
- the earliest indicator that something is changing
- **earliest sign of INC cranial pressure
- controlled by brain stem
- Wakefullness (most important part of LOC)
- If pt opens eyes spontaneously to voice/pain, BRAIN STEM still function)
- Awareness (higher fx of brain stem)(4 components)
4 components of Awareness
- Orientation
- Memory
- Calculation (count by 7s)
- Fund of knowledge (general knowledge, current affairs)
Neuro Assess: Glasgow Coma Scale
standardized system of assess LOC
- est in head injury
- quick/practical system
- helps predict outcome of person in coma
- Rule of Thumb: stronger stimulus needed to get response, lower the score, worse prognosis
- 14 - 16, not neuro impaired
- 3/4, low score/not good
***3 parts of the Neuro Asses
- Eye Opening
- Verbal Response
- Motor Response
Posturing
- Extension posturing (decerebrate rigidity)(hands/legs freeze down)
- Abnormal flexion (decorticate rigidity)
Decerebrate Rigidity
- Extension/extensor posturing
- arms straight down by sides, clenched jaws
- one side or in arms only
- WORSE, injury to brain stem
- affect breathing, BP regulation, living
- can show up after LT decorticate indicates decline in brain function down to brain stem.
- don’t normally heal
- can’t live long like this
- indicates: stroke, brain abscess, trauma, brain stem herniation
Decorticate Rigidity
Cause: Intracranial bleed, brain stem tumor, stroke, trauma, head injury
- Mummy pose/flexor response
- some can heal w leftover damage
- arms bent, hands in fists on chest (like mummy)
- damage to thalamus, midbrain and cerebral hemispheres (thinking , speaking, remembering)
- can heal, but likely only able to stare and twitch
Language/Speech: fx of what side of brain?
LEFT, dominant
Speech
Aphasia
abnormal nuero condition d/t injury in CEREBRAL CORTEX (outer layer of the cerebrum, composed of folded gray matter and playing an important role in consciousnes.
- Broca (front lobe)
- Wernicke area (temporal lobe)
- affects all areas of language (speech, reading, writing, understanding)
- main condition affecting speech. Stroke on L side
The Left brain
- your personal dictionary
- dominant in language processing
- affects all areas of language (speech, reading, writing, understanding)
- main condition affecting speech. Stroke on L side
- Broca (front lobe)
- Wernicke area (temporal lobe)
Types of Aphasia
- Wernicke (temporal), Receptive
- Broca Aphasia, Expressive
- Global Aphasia
Wernicke Aphasia
- Receptive Aphasia
- difficulty w comprehension (how pt receives)
- w say words that don’t make sense
- i.e. saying gleebee instead of fork (they don’t even realize it)
- sometime group together meaningless words
Broca Aphasia
- Expressive Aphasia
- when stroke injures FRONTAL region of L hemisphere can have language problems
- diff putting words together
- pts know what they want to say, but can’t verbalize
- diff forming complete sentences
- w leave out little words ie the, are, in
- diff w direction (L v R, Up v Down)
Global Aphasia (most severe)
- affects extensive portion of FRONT or BACK or L Hemis
- not expressive or receptive
- diff understanding words/sentences
- diff forming words/sentences
- remember , pt frustrated/angry, not directed towards Nurse
Agnosia
Inability to name or recognize written or spoken name of objects
-r/t nervous system damage
Dysarthria
- muscles for speech very weak
- diff controlling them
- slurred slow speech, diff to understand them
Cranial Nerve Fx (burke 945)
- Olfactory, smell
- vision acuity
Motor Fx
- detect abnormal levels in nerves and functions
- most common neuro symptoms, coor/walking
- gait, stance (Parkinsons shuffle)
- involuntary mvmts
- muscle stretch reflexes (using little rubber reflex hammer)
- Scale 0-4+ (hyper reflexic)
- most important to compare one side to other, reflexes
Motor Fx: reflex test area
- biceps
- brachialis radialis
- quads
- calf muscles
- triceps
Paralysis v Paresis
Paralysis: Mvmt deficit complete loss of fx
Paresis: partial or incomplete paralysis
Injury to Motor Nuerons causes
Muscles, flaccid, changes in muscle tone, muscle strength, reflexes
Spastic Muscles
Involuntary , sudden Mvmt, muscular contactions
Twitching
Fascications
Clonus
Severe or alternating rhythmic contractions and partial relation of muscles
Sensory and Spacial Status
Alteration in pain, touch,temp
- ***PROPIOCEPTION, aware of Spacial positioning of arms and legs (police sobriety test, walk line, touch nose )
- UNILATERAL NEGLECT, pt unaware of one side of body
- HEMIANOPIA, defective vision in half of visual field
Mini Nuero Exam
- orientation
- LOC
- bilateral muscle Strength
- notice involuntary mvmnts
- ability to follow commands
- abnormal posturing (decerebrate, decorticate)
- speech ability
Lab and Dx Exams
- Blood/Urine
- CSF
- CT (pathos of cerebrum/spinal cord)
- Brain Scan (pathos of cerebrum, not as common anymore)
- MRI (magnetic forces to image body)
- PET
- Lumbar Puncture
Blood Urine Tests
- Culture (to rule out infection, UTI, confusion in elderly)
- Drug Screen (can alter behaviour, K2 Synthetic weed, purple haze)
- Arterial Blood Gas (monitor O2 in blood, painful)
CT Scans
- test pathological condition of cerebrum and spinal cord
- no prep, painless
- w or wo contrast
- 20min - 1 hr
- contrast: ensure pt not allergic to Io
- pt w lie still in enclosed space
MRI
- magnet forces to image body structure w or w/o contrast.
- pathos of cerebrum, spinal cord, stroke, tumor, trauma, seizures
- monitor soft tissue structures
- no metal
- painless, lie still
- 45min - 1 hr
- pt can become claustrophobic, loud clanging noise
PET scan
- smilar to MRI
- look at organs, tissue in more detail.
- view neuro fibrillary tangles, defects in brain, after stroke, Alzheimer’s, epilepsy, neuro changes, bio chem changes
- 3D pics
- lie still, 45min
Lumbar Punctures
- during pt dx workup for neuro prob.
- collecting CSF
- not advised in pts w Intracranial pressure
- can cause Medulla Oblongata to herniate
- to relieve pressure
- to obtain CSF for exam
- can cause shooting pain
- pain when go through dura mater
- fetal position to administer
- btwn L4/Lb or L5/S1
- collect btwn 1-10cc of CSF
- First insertion can draw blood
- after, lie flat for several hours to prevent headache
CSF collection
aka (spinal tap, ventricular puncture, lumbar puncture, cisternal puncture, cerebral spinal fluid culture)
- pressure: 70-180mm H2O
- appearance: clear, collorless
- CSF total protein: 15-60mg/100ml
- Gamma globulin: 3-12% of total protein
- CSF Glucose: 50-80mg/100ml (or > 2/3 blood sugar level)
- Chloride: 110-125 meq/l
Abnormal CSF results Dx? Cloudy?
possible infection or buildup of WBC or protein
Abnormal CSF results Dx? Bloody/Red?
possible bleeding or spinal cold obstruction
Abnormal CSF results Dx? Brown/Orange/Yellow?
posbiel sign of UP CSF protein or previous beleding (>3days)
Abnormal CSF results Dx? UP CSF pressure? Lo pressure
- HI pressure: increased intracranial pressure
- LO pressure: spinal cord tumor, shock, fainting, or diabetic coma
Abnormal CSF results Dx? UP CSF protein/LO protein
- HI protein: blood in CSF, DB, polyneuritis, tumor, injury or any inflammatory of infectious condition, degenerative disease
- LO protein: sign of rapid CSF production,
Abnormal CSF results Dx? UP CSF gamma globulin
disease i.e. MS, neurosyphilis, Guillain-Barre syndrome
Abnormal CSF results Dx? UP CSF glucose, LO glucose
HI: hyperglycemia
LO: hypoglycemia (low BG), bacterial, fungal infection (i.e. meningitis), TB
Abnormal CSF results Dx? UP WBC
sign of acute infection, meningitis, beginning of chronic illness, tumor, abcess, stroke, demyelinating disease (MS)
Abnormal CSF results Dx? UP RBC
sign of bleeding into spinal fluid, or result of traumatic lumbar puncture
Lab and Dx Exams (cont’d)
- EEG (electroencephalogram)
- Myelogram
- Angiogram
- Carotid duplex
- Digital subtraction antiography
- Electromyogram
- Echoencephalogram
EEG (electroencephalogram) (Sleep Deprived EEG)
- measure electrical activity in the brain
- Test for epilepsy, tumors, abcess, brain injury, cerbrovascular lesions, hematoma
- sleep deprived, keep them up all night for pts w seizure disorders. (seizure threshold lower when sleep deprived. easier to assess)
- 1 hr test. Electrodes attached to head
- ensure clean hair, scalp. nurse keeps pts awake
Myelogram
- to detect lesions in compartments of spinal cord
- observe flow of radio-opaque dye thru subarachnoid space
- xray of spinal, herniated/bulging disk, spinal tumors, adhesions, narrowing of column d/t arthritis
- pre-op measure pts body strength/sensations to obtain baseline post sx
- 2hr, discomfort when injecting dye
- prep similar to lumbar puncture
- assess for allergies to Io
- have water soluble dyes, easier for kidneys to exrete (IsoVue)
- often, will do CAT scan since dye is already in system
- monitor puncture site
- assess strength/sensation post rx
- ensure no leakage, hematuria
- some N/V afterwards
- lye FLAT for few hours to prevent HA
Angiogram
- xray study of blood vessels of head/neck to detect abnormalities of cerebro or spinal blood vessels
- if suspect tumor, any blood supply to tumor?
- radio-opaque dye, in femoral/brachial/carotid artery
- detect arterial aneurysms, vessel anomalies, ruptured vessels, vesel displacement d/t large tumor or mass
- can do angiogram of other parts of body
- Pre/OP: clear liquid or NPO, allergies to dye, NO aspirin or blood thinners?, risk for hemorrhage
- if femoral artery, w mark area. take bilateral pedal pulse pre and post sx
- if using carotid, w measure neck circumfrence pre/post sx (looking for expanding neck)
- shave/clean area
- local anesthetic, supine
- guide needle into vessel, catheter over needle, remove needle, catheter stays in place, inject dye
- dye gives hot burning sensation when injected, sometimes flashes of light
- Flouroscope (camera) used
- 2-3hrs
- PostOP: bedrest 4/6 hrs, NS, neuro check. dont need to remain flat. observe puncture site
- check distal pedal pulse and/or neck circum
- risk for CVA or increased intracranial pressure
- any change in LOC, report ASAP
- In pt/Out Pt
Carotid duplex
- combined US and pulsed doppler tech
- move probe over skin of carotid artery
- records velocity/speed of blood flow
- if UP in velocity, can be d/t stenosis
- non invasive
- will do for TIA (indicative of impending stroke)
Digital subtraction angiography
- blood vessels in extremities visualized by x-ray
- use w contrast for better visualization
Electromyogram (EMG)
- to measure contraction of muscle in response to electrical stimulation
- can provide info if have lower motor neuron disease, defects in transmission of impluses
- insert electrode in lower extremities into muscle (needles leave tiny blood drops, ms grants white pedal pushers)
Echoencephalogram
-US looking at intracranial structures of brain to detect ventricular dilation or major shift of midline structures in brain d/t large lesions
Common Disorders of the Neurological System
Headaches
- Vascular (Migraine, Hypertensive)
- Tension
- Traction-inflammation headaches
Headaches
- Most common neuro complaint
- r/t many things
- recurring headaches determined via neuro assessment
- w some rumors, the only symptom is a HA for a long time
- exact mechanism causing head pain not really known
- skull bone and brain tissue don’t feel sensory pain
Headaches: 3 categories
- Vascular
- Tension
- Traction-Inflammation
Vascular Headaches
- migraine
- hypertensive
- cluster
Tension Headaches
- psych problems
- stress tension
- cervical arthritis
Traction/Inflammation Headache
- infection
- intra cranial/ Extra Cranial causes
- occlusive vascular structure
- temporal ARTERITIS (inflam of cranial blood vessel, not arthritis
- weakness, loss of vision
- women over 70
Migraine HA
-Prodromal (early sign/symptom, developing)
Visual Field defects, unusual smells/sounds, disorientation, paresthesias (numbing/tingling)
-During HA
N/V, light sensitivity, chilliness, fatigue, irritability, diaphoresis, edema (around eye), paralysis
-15-55yrs, Male/Female
-can manifest as Cluster HAs (most severe pain)
Migraine: Cluster HA (Suicide HAs)
- most severe pain, worse than childbirth
- worse than migraines
- pn behind eye, temporal area, radiate to neck/shoulder
- cyclic/recurring, regular timing, same time each day
- so severe can wake ppl up from sleep
- once or more daily
- followed by HA free period lasting weeks -years
- 10-15% considered chronic sufferers
- usually unilateral then can shift to other side
- 15min - 3hrs per bout
- onset rapid
- Ptosis (droopy eyelid) *** Main Symptom
- major trigger: Nicotine/Smoking
- often mistaken for drug user/seeker
Migraine: Cluster HA S/S
-Ptosis (drooping eyelid) *** Main symptom
-redness in conjunctiva
-lacrimation
-runny nose
AUTONOMIC SYMPTOMS
-often mistaken for drug user/seeker
Migraine: Cluster HA Tx
- some respond to O2 (12-15 L p/min)
- at peak pain, O2 doesn’t work
- MEDS: Triptan drugs (subq not PO)
- botox injection along occipital nerve (numbs/freeze area)
- B blockers
- lidocaine sprayed directly in nose
- hot shower
- ice
- breathing cold air
- lg amount caffeine
- anti depressants, anti psychotic
Migraine: Cluster HA : Assessment
Subjective Data
- assess pt understanding of HA
- what precipitates HA?
- location/frequency
- what relieves it?
- pattern, character of pain
- family Hx
Objective Data
-indicators we observe (stress, anxiety, pain)
HA’s: MM, NI
- Diet
- psychotherapy
- Meds
HA’s: MM, NI: Diet
-limit MSG, Vinegar, chocolate, yogurt, ETOH, fermented/marinated foods, ripened cheese, cured sandwich meat, caffeine, port
HA’s: MM, NI: Meds
MIGRAINE
- asa, acetaminophen, ibuprofen
- Ergotamine tartrate (Ergomar, Ergostat) taken early in onset to prevent progression CLASS: Ceratonin antagonist, restrict cerebral bloodflow
- Codeine, Inderal
- Narcotic analgesics (IM)
TENSION
-non narcotic analgesics (ibuprofen, tylenol, asa)
TRACTION/INFLAM
-treat cause
HA’s: Nurse Interventions
- cold packs to forehead or base skull/eyes
- pressure to temporal arteries
- dark room
- limit auditory stimulation
HA’s: Possible triggers
- hormones
- red wine
- weather changes
- caffeine or withdrawal
- nutri sweet/equal
HA’s: MM, NI: Psychotherapy
made aware of triggers, stress factors, how to deal with pain
HA’s: MED: Ergomar, Ergostat
- Ergotamine tartrate (Ergomar, Ergostat) taken early in onset to prevent progression
- CLASS: Ceratonin antagonist, restrict cerebral blood flow
- DEC inflammation, DEC pain transmission
- PO or sub lingual, rectally (if vomiting) , injection
- given alone or in combo w other meds.
S/E: N/V, Paresthesia (numbness/tingling), changes in heart rate
-NOT for pregnant women, will stimulate contractions
HA’s: MED: Triptans
Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. They were first introduced in the 1990s. While effective at treating individual headaches, they do not provide preventative treatment and are not considered a cure
Act on dilated vessels during migraine attack
I.e. Replax, Axert, Frova, Amerge, Maxalt, Imitrex, Zomig
- help w N/V
- sub q, sub l, IM
IICP (Increased Intracranial Pressure)
- increase in any content of the cranium
- space occupying lesions, cerebrospinal problems, cerebral edema
- swelling can occur in diff parts of the brain
- brain expands up again skull
- obstructs blood flow to brain, LO O2
- block other fluids from circulating
- in untreated –> death
IICP: early S/S
- Diplopia (double vision)
- Headache (w straining, coughing, stooping, bm)
- Decreased LOC *** (earliest sign)
- Pupillary signs (PERRLA still evident but dec in visual acuity)
- weakness in 1 extremity or 1 hemisphere –> hemiplegia (pop side of brain affected)
- UP BP/Pulse/Respiration
- UP temp (infection)
- diff speaking
IICP: late S/S
- widening pulse pressure
- bradycardia
- resp problems (Cheyne–Stokes)
- HI uncontrolled temp
- positive Babinski’s reflex (not good. CNS damage. only seen in kids under 2.
- seizures
- posturing
- projectile vomit (not followed by N)
- Singultus (hiccup d/t vagus nerve compression, d/t brain stem herniation in parts of brain squeezed and squished to other areas)
- Cushings triad (UP Systolic BP, WIDE pulse, Bradycardia)
- loss of swallow/gag reflex
- posturing (decerebrate/decorticate)
- LO LOC –> Coma
- pupils sluggish to light d/t impending herniation
- fix/dilated pupil (blown pupil)
- papilledema (last objective sign observed)
Papilledema (last objective sign observed)
- Papilledema (or papilloedema) is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks.
- Dr looks at Optic nerve, if edemas, retina will be compressed. can no longer detect light rays
IICP: MM/NI
- HOB elevated
- restrict fluid intake
- avoid Na
- Foley catheter to monitor output (if unconscious)
- O2 via cannula/mas to relieve cerebral perfusion
- hypothermia blanket (LO core temp to 95, slows blood/fluid)
- treat cause if possible
- mechanical decompression (craniotomy:remove skull then replace, craniectomy:brain flap removed to allow swelling, may replace w synthetic later)
- internal monitoring devices (measure intracranial pressure. Ventricular catheter, Subarachnoid bolt/screw, Epidural sensor)
- induced coma to alleviate anxiety, swelling etc
- shunt/valve
TBI: Traumatic Brain Injury
-sudden event that caused injury quick acceleration and deceleration of head.
Common Cause:
- car accident
- fall, hit head, assault, sports
- causes brain swelling
- Ischemic Stroke (blood clot in or near brain, brain cells die, brain swells)
- Brain Hemorrhage (Intracerebral/Hemorragic stroke), blood leaking from vessel in brain d/t ruptured vessel)
- Infections (r/t virus/bacteria –> swelling, meningitis)
- Encephalitis (brain becomes inflamed/infected itself d/t virus (insect bite?)
- Toxoplasmosis (parasite, cats, no preg), affects fetus’, DEC immune system
Symptoms of STROKE
STR
Smile (ask pt to)
Talk (coherent?)
Raise (both arms)
stick out tongue, does it lean to one side?
-good prognosis is treated w/in 3hrs
Effects of Tumors
- UP swelling
- as it enlarges, presses again brain
- can block CSF, depending on location
- brain edema in hi altitudes
IICP: Meds
CORTICOSTEROIDS: i.e. dexamethizone
- DEC edema, esp in cerebral tumors, assesses
- pts w head trauma
- monitor BG
OSMOTIC Diuretics: i.e. Mannitol
-help remove fluid from brain. i.e. Mannitol (quick acting w in 15min. Duration 5/6hrs
LOOP Diuretics: i.e. -Furosemide (Lasix), Thiazide, Potassium-sparing diuretic, Bumetanide (Bumex)
-Loop diuretics are diuretics that act at the ascending loop of Henle in the kidney. They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or renal insufficiency.
ANTICONVULSANTS: i.e. Dylantin
-if having seizures
OPOIDS: DON’t Rx because w Lower respiration
MED: Mannitol
Mannitol, also known as mannite or manna sugar,[1] is a white, crystalline solid that looks and tastes sweet like sucrose.[2] Medically it is used to treat increased intracranial pressure.[3] It also has several industrial uses. In plants its purpose is to alleviate osmotic stress.
Serious side effects may include worsening heart failure, electrolyte abnormalities, or low blood volume.[4] It is unclear if it is safe in pregnancy.[4] Mannitol is classified as a sugar alcohol; that is, it is derived from a sugar (mannose) by reduction. Other sugar alcohols include xylitol and sorbitol. Mannitol and sorbitol are isomers, the only difference being the orientation of the hydroxyl group on carbon 2.[5]
It is on the World Health Organization’s List of Essential Medicines, the most important medications needed in a basic health system.[6] It was originally isolated from the flowering ash and called manna after its resemblance to the Biblical food.
MED: Dexamethasone
CLASS: Corticosteroid
Brand names: Ozurdex, Decadron, Maxidex, Baycadron
May treat: Cerebral edema, Addison’s disease, Tumor, Septic shock, Blood disorder, Perennial Allergic Rhinitis
Other drugs in same class: Betamethasone, Prednisolone
May prevent: Asthma, Nausea, Vomiting, Nasal polyps
People also search for Betamethasone (Celestone, Diprolene) Prednisolone (Orapred) Prednisone (Deltasone) Hydrocortisone (Cortef, Locoid, Cortifoam) Ondansetron (Zofran)
MED: Dilantin
Phenytoin (Dilantin) Treats seizures. Anticonvulsant. Drug class: Anti-epileptic Agent Other drugs in same class: Carbamazepine, Levetiracetam, More May treat: Tonic–clonic seizure, Temporal lobe epilepsy May prevent: Post-traumatic epilepsy People also search for Carbamazepine (Tegretol) Phenobarbital Valproate (Depakote) Levetiracetam (Keppra) Lamotrigine (Lamictal)
Disorders of Muscle Tone/Motor Function:S/S
- damage to motor neurons affect muscle strength, tone, reflex (cerebral palsy)
- flacid or hyperflexic muscle tone
- clumsiness/in-coordination
- abnormal gait
- strength
Disorders of Muscle Tone/Motor Function: MM/NI
- muscle relaxants (for hyperflexic muscles, DEC tone, DEC involun reactions) (Med: Lioresel, Valium, Dantrium)
- protect from falls (restraints)
- Assess skin integrity, esp paralyzed side. look for infection, bony prominence (hip, elbow, heel), teach pt to assess.
- Positioning, teach pt res positioning, splints, pillows, foot boards, booties, hitops
- Sit up and tuck chin when eating
- encourage pt to assist w ADLs
- Emotional support
- ROM (passive/active), tid
- check mouth, food pockets
- don’t mix liquids/solids
- avoid straw (cant control flow)
- special feeding utensils
- encourage indiepndence
MED: Lioresel
Baclofen (Lioresal)
-intrathecaly (right into sheath, spinal cord. DEC spacticity)
-Treats muscle spasms caused by multiple sclerosis, cerebral palsy, or damage to the brain or spinal cord. This medicine is a muscle relaxer.
-PO, IM,
-May treat: Spasticity, Pain, Multiple sclerosis, Cerebral palsy, More
-Drug class: gamma-Aminobutyric Acid-ergic Agonist
-Other drugs in same class: Zolpidem, Zolpidem tartrate
People also search for
Tizanidine (Zanaflex)
Gabapentin (Neurontin)
Cyclobenzaprine (Flexeril)
Methocarbamol (Robaxin)
Meloxicam (Mobic)
MED: Valium
-Diazepam (Valium)
-Treats anxiety, muscle spasms, seizures, and other medical conditions.
-This medicine is a benzodiazepine.
-PO, IM, Rectal
-Brand names: Valium, Diastat
-Drug classes: Benzodiazepine, Hypnotic, Anxiolytic
-Other drugs in same class: Alprazolam, Lorazepam, Clonazepam, More
-May treat: Status epilepticus, Delirium tremens, Tetanus, Spasticity
People also search for
Alprazolam (Xanax)
Lorazepam (Ativan)
Clonazepam (Klonopin)
Benzodiazepine
Zolpidem (Ambien)
S/E: drowsiness, vertigo
MED: Dantrium
-Dantrolene (Dantrium)
-Treats muscle spasms caused by multiple sclerosis, cerebral palsy, or damage to your brain or spinal cord. Also used to treat and prevent symptoms of malignant hyperthermia (an inherited muscle disorder) in people who are at risk.
By mouth: Side effects - Warnings - How to use
Injection: Side effects - Warnings - How to use
National Library of Medicine
Brand name: Dantrium
Molar mass: 314.253 g/mol
Pregnancy risk: Category C (Risk cannot be ruled out)
May treat: Malignant hyperthermia, Spasticity, More
Drug class: Muscle relaxant
Other drugs in same class: Dantrolene sodium, Cyclobenzaprine, More
People also search for
Dantrolene sodium
Baclofen (Lioresal)
Suxamethonium chloride (Anectine)
Bromocriptine (Cycloset)
Tizanidine (Zanaflex)
Epilepsy/Seizures
- transitory distrubance in consciousness or in motor sensory, or autonomic fx due to sudden excessive and disorderly discharges in neurons of brain, rsult in sudden, violent, involuntary contraction of group of muscles
- affect all races, sexes equally
*Types of Seizures
- Grand mal (generalized)
- petit mal (simple)
- psychomotor (partial, simple, post ictal)
- jacksonian-focal (post ictal)
- myoclonic (simple, no post ictal)
- akinetic (generalized, complex, no post ictal)
Status Epilepticus
a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them.
Grand Mal (tonic/clonic seizure)
- TONIC - all muscles stiffen, sometimes hear crying/groan d/t air pushed out of lungs
- CLONIC: arms/legs jerk rapidly, rhythmically, bending, relaxing
- POSTICTAL: the brain is extremely active trying to stop the cells from firing to bring the seizure under control. When the person wakes up, they may have sore muscles and be tired or confused. The observer’s best course of action is to be assuring and supportive.
Grand Mal (tonic/clonic seizure) more detail
Tonic phase – The person initially stiffens and loses consciousness, causing them to fall to the ground. The person’s eyes roll back into their head as the muscles (including those in the chest, arms and legs) contract and the back arches. As the chest muscles tighten, it becomes harder for the person to breathe – the lips and face may take on a bluish hue, and the person may begin to make gargling noises.
Many observers have the misconception that the person is in danger of “swallowing their tongue,” so they attempt to put something in the person’s mouth. Swallowing your tongue is actually impossible, and any attempt to open the now tightly clenched jaw may cause more harm than good. The tonic phase will typically last no longer than a minute.
Clonic phase – Typically following the tonic phase, the clonic phase will start as the muscles begin to spasm and jerk. The elbows, legs and head will flex then relax rapidly at first, but the frequency of the spasms will gradually subside until they cease altogether. As the jerking stops, it is common for the person to let out a deep sigh, after which normal breathing resumes. The clonic phase will rarely last longer than a few minutes.
As the person transitions from the clonic phase to the post-seizure period, they’ll likely remain unconscious for a few minutes or more, depending on the severity of the seizure. During this time (known as the POSTICTAL period), the brain is extremely active trying to stop the cells from firing to bring the seizure under control. When the person wakes up, they may have sore muscles and be tired or confused. The observer’s best course of action is to be assuring and supportive.
Grand Mal Seizure - again
- Most common type
- affect both hemispheres
- suddenly fall to floor
- scream/moan (tonic)
- breathing impaired
- cyanotic, loss of consciousness (on darker skin appears grey, blue on fair skin)
- loss bowe/bladder control
- pupils dilate
- tonic/clonic
- Post Ictal phase (exhausted/sleepy after)
- stiffening of body
- auras/flash lights/spots/smells
- incontinence
- tonge/cheek biting
- last 30-40 sec
- spasms/violent
- diaphoretic (sweating profusely)
Seizures - General Facts
- affects 2.5 mill
- all races, sexes
- sudden/unpredictable
- appear abnormal
- can develop at any stage and interval in life
- social embarrassment, mut important to let people know in case
- more likely unemployed, unmarried, childless
- UP suicide rate when unmanageable
- not all people w seizures have epilepsy
Non Epileptic Seizures
- w respond to stimulus
- does NOT originate in CNS (ETOH, drugs, poisoning, UP fever)
Epileptic Seizures
- mild - severe
- multiple uncontrolled despite treatment
- seconds - minutes
- seizure OVER 5 min = MED EMERG
2 types of seizures
- Partial
- Genarlized
Partial Seizures (Simple/Complex) (Temporal, Frontal, Parietal, Occipital)
- start in SPECIFIC part of brain w focal discharger that can be monitored
- 2 types
- SIMPLE Partial Seizure: pt DOES NOT loose consciousness
- COPLEX Partial Seizure: loose cosciousness
Generalized Seizure
-affects ENTIRE brain from onset - copletion
Auras
- S/S of impending seizure (50% pts)
- tonic/clonic type
- feel crawling skin
- odd odors/taste/sensation
EEG
- Most common way to determine what part brain seizure is in.
- sleep deprived EEG, more active
- An electroencephalogram (EEG) is a test used to detect abnormalities related to electrical activity of the brain. This procedure tracks and records brain wave patterns. Small metal discs with thin wires (electrodes) are placed on the scalp, and then send signals to a computer to record the results.
Seizures: Temporal Lobe
- memory, sounds, emotions, deja vu
- emotional CHANGE ***** biggest S/S
Seizures: Frontal Lobe
- mvmt of extremties
- change in speech
pt c/o
- head repeatedly, involuntary moving to one side
- stiff hand
Seizures: Parietal Lobe
-tingling feeling of warmth down one side of body
Seizures: Occipital Lobe
pt c/o
-flashing lights on one side of visual field
Petite Mal Seizure
- childhood /adolescence
- frequency DEC as child ages
- NO tonic/clinic mvmts
- sudden impairment or complete loss of consciousness
- blinking, lip smacking (teachers think child is daydreaming)
- vacant look
- no aura
- no postictal period
- they may not even know they’ve had one
Psychomotor Seizure (Automatisms)
- PARTIAL seizure
- occur at any age
- sudden Change in awareness
- distortion of feeling/thinking
- may look intoxicated
- loss of coordinated mvmt
- anti social behavior (taking clothes off in public, wandering for hours w no memory of it)
- DONT lose consciousness (simple), just awareness
- autonomic complaints (cold, shivering)
- repetitive mvmts even when inappropriate
- can have auras
- possible hallucinations
- POST ICTAL period
Jacksonian Focal Seizures
- pts w structural brain disease
- cn become progressive
- can start as small as finger mvmnts –> hand –> arm etc.
- auras
- numbness/tingling
- POST ICTAL period
Myoclonic Seizures
- can become tonic/clonic
- mild/rapid forcefull
- **sudden or excessive jerk of body. could propel pt do ground
- brief or in clusters
- no loss of consciousness (simple)
- no post ictal
- no auras
Akinetic Seizures
- genaralized tonelessness
- person falls in flaccid state
- unconscious 1-2 min, short time
- while sitting/walking/standing (anytime)
- rarely aura
- no post ictal
Status Epilepticus
- genaralized seizure
- activity is so frequent that person never regains full
- consciousness
- medical emergency
- can lead to death d/t hypoxia
- provide patent airway
- exhaustion
- protect from injury (away from furniture)
- anti seiz meds, large doses
- foley catheter
- IV
Epilepsy/Seizure: S/S
- depends on type of seizure
- aura
- postictal period (no memory of seizure, pt c/o HA, muscle weakness, sore, sleepy, groggy)
Epilepsy/Seizure: MM, NI
- during seizure, protect from aspiration/injury
- anticonvulsant meds
- sx (removal of brain tissue where seizure occurs, not always successful)
- pt education, noticing warning signs
- observe activity, duration, document
- don’t leave pt alone
- lower to floor for safety
- support/protect head
- NO restraints
- NO ETOH, can stimulate seizures
Epilepsy/Seizure: MM, NI cont’d
- therapy aimed at preventing seizures
- 70% seizure disease controlled by meds
- adequate rest
- good nutrition
- NO ETOH
- avoid driving, operating machinery and swimming until seizures are controlled
- good oral hygiene (Dylantin causes enlarged gums, edema of gums
- medical alert tag
MED: Carbamazepine (Tegretol)
Primary med used for
- generalized
- tonic/clonic
- complex partial seizure (psychomotor, grand mal)
SE:
- diplopia
- Ataxia (unsteady gait)
- Gi upset
- skin rash
- hepatic dfx
MED: Phenobarbital (Luminal)
for
- generalized
- tonic/clonic
- psychomotor
- focal seizures
- Jacsonian
SE:
makes you tired/drowsy
MED: Phenytoin (Dylantin)
- genaralized
- tonich/clonic
- complex
- psychomotor
- status epilepticus
- also used in prevention of seizures
SE:
- pruritis
- Nystagmus (cross eyed)
- dizziness
- Tinnitus (ringing in ear)
- gum hypertrophy
MED: Gabapentin (Neurontin)
- adjunct therapy
- for Partial
- Focal seizures
SE:
- fatigue
- ataxia
- GI upset
MED: Lamotrigine (Lamictal)
- adjunct therapy
- for Partial,
- Generalized seizures
SE:
- rash
- blurred vision
- diplopia
- GI upset
MED: Valproate (Depakote)
- primary therapy for
- Myoclonic
- tonic/clonic seizures
- helps w mood in psych.
SE:
- GI upset
- hair loss
- weight gain
- hepatic dfx
- thrombocytopenia
ASA Toxity SE
Nausea, vomiting, diaphoresis, and tinnitus are the earliest signs and symptoms of salicylate toxicity
MED: Clonazepam (Klonopin)
-for Myoclonic
-generalized
-tonic clonic
-good for autistic puts
SE:
-drowsy
-hypotension
-DEC resp
MED: Diazepam (Valium)
- for Generalized
- Tonic/Clonic
- status epilepticus
SE:
- drowsiness
- ataxia
Multiple Sclerosis
- onset: mid-late teens –> 40s
- more WOMEN
- degenerative neurological disorder w demyelination of the brain stem, spinal cord, optic nerves and cerebrum
- onset often insidious. some symptoms slow to progress
- could be mistaken for other diseases, for years may not realize they have MS
MS: SS
- visual problems (blurred or diplopia, –> blindness
- urinary
- ‘attacks’, periods of relapse and remission
- majority of pt in remission, can lasts 1 yr or more. Some mild symptoms for years
- relapse usually aggravated by cold, emotional list, fatigue
Scotoma
- see dots in front of eyes?
- loss of vision in a part of the visual field; blind spot.
MS: SS more
Early:
- visual problems (blurred/diplopia) can lead to blindness
- fatigue
- weakness(arms, leg, spasms)
- incoordination (clumsiness, loss of balance –> partial or complete paralysis)
- thinking problems (following train of thought)
- numbness/tingling
Late:
- urinary incontinence
- Sexual prob (impotence)
- Swallowing diff ( speech d/t brain stem damage)
- bowel problems
- urigenic/bladder probs (overactive, incontinence/underactive, overfill bladder)
- coughing/choking reflex (food stuck in throat)
- pain in extremities
- depression
- LO memory
MS: MM/NI
- no specific treatment (rule out other diseases)
- adrenocorticotropic hormone (ACTH), LO inflammation at demyelination site
- Steroids (in high doses, LO edema)
- Valium (LO spasms)
- Betaseron (interferon beta-1b)/Avonex (interferon beta-1a) {Disease modifying drugs, slow progression)
- Pro-banthine, urecholine (LO urinary freq/urgency, Neurogenic bladder)
- Bactrim, Septra, Macrodantin (profilactically to prevent UTI, common in MS puts)
- encourage excer/swimming, but not to point of fatigue
- use arms/legs
- bedrest for acute attack
- NO hot baths, can UP weakness
- relaxed/peaceful envt
- can have emotional outbursts
MED: Baclofen (Lioresal)
-decrease spasms
-Treats muscle spasms caused by multiple sclerosis, cerebral palsy, or damage to the brain or spinal cord. This medicine is a muscle relaxer.
-Brand names: Gablofen, Kemstro, Lioresal
-Drug class: gamma-Aminobutyric Acid-ergic Agonist
-Other drugs in same class: Zolpidem, Zolpidem tartrate
People also search for
Tizanidine (Zanaflex)
Gabapentin (Neurontin)
Cyclobenzaprine (Flexeril)
Methocarbamol (Robaxin)
Meloxicam (Mobic)
MED: Novatrone (Mitoxantrone)
-immunosuppressants
-severe/adv MS
-SE: heart problems, Blood CA
-Treats the symptoms of multiple sclerosis (MS). Also treats prostate cancer and certain types of leukemia (such as acute nonlymphocytic leukemia or ANLL).
-May treat: Multiple sclerosis, Acute myeloid leukemia, Lymphoma, Pain, Prostatic Neoplasms, Breast tumor
-Drug class: Topoisomerase inhibitor
Other drugs in same class: Etoposide, More
People also search for
Cytarabine (Depocyt)
Doxorubicin (Adriamycin, Doxil)
Natalizumab
Etoposide (Toposar, Etopophos)
Glatiramer acetate
MED: Tecfidera (Dimethyl fumarate)
-for relapsing MS, FDA appr
-1pill bid
SE: Leukopenia
-Dimethyl fumarate is the methyl ester of fumaric acid. DMF was initially recognized as a very effective hypoxic cell radiosensitizer. Later, DMF combined with three other fumaric acid esters was licensed in Germany as oral therapy for psoriasis. Wikipedia
-People also search for
Natalizumab
Fingolimod (Gilenya)
Glatiramer acetate
Interferon beta 1a
Alemtuzumab
MED: Methylprednisolone (Medrol)
-IV for acute attacks.
-can help w pain
-Treats asthma, allergic reactions, inflammation, flare-ups of ongoing illnesses, and many other medical problems. May also be used to lessen some symptoms of cancer. This medicine is a steroid.
-Brand names: Medrol, Solu-Medrol, Depo-Medrol, A-Methapred, Hybrisil
-May treat: Inflammation, Respiratory distress syndrome, -May prevent: Graft-versus-host disease
-Drug class: Corticosteroid
-Other drugs in same class: Prednisolone, Dexamethasone, More
People also search for
Prednisolone (Orapred)
Prednisone (Deltasone)
Dexamethasone (Decadron)
Glucocorticoid
Hydrocortisone (Cortef, Locoid, Cortifoam)
???????MS
VONETTA/DONALDs notes
Parkinson’s Disease
- Deficiency of dopamine, plus UP acetylcholine activity (creates shuffle b/c dopamine affects motor fluidity
- chronic progressive disease
- Cause: unknown
- LO Dopamine = tremors, stop/start walking
- Acetylcholine UP speed of message transmission
- 2% US population, Over 65yrs, white men
- no cure
- rare in AfAm
Parkinson’s Disease: SS
- Muscular tremors
- bradykinesia (slowness of movement)
- rigidity, propulsive gait
- emotional instability
- heat intolerance
- decreased blinking
- “pill rolling” motions of fingers
Secondary Parkinson’s
Intoxication of Chem
i. e. ca monoxine, Copper mines, cyanide,
- repeated head trauma (mohammed ali),
- encephylitis,
- phenothiazines (tranquilers), Haldo, Thorzzine,
- LT use of Aldomet; Methyldopa (HTN)
- antiemetics (block in dopamine uptake)
- if r/t drugs, once you stop drug, symptoms disaster
- when occurs late in life, called Idiopathic PD (95% cases)
3 cardinal signs of Parkinson’s Disease
- Tremors
- Rigidity
- Bradykinesia (slowing of initiation/execution of mvmt, can include speech)
- In beginning, tremors mild. w notice change in handwriting, slight limp (DEC arm swing while walking)
Parkinson’s Disease (Late SS)
- muscle tremors
- bradykinesia (slowness of movement)
- tremors ( hand, diapragm, tongue, lips, jaw)
- rigidity (any active/passive mvmc becomes diff)
- propulsive shuffling gait, walking shuffle look like going to fall over.
- emotional instability
- memory loss
- heat intolerance
- LO blinking = dry eye
- mask like expressionless face
- pill rolling
- diaphoretic (face/neck)
- seems like oily skin
ADVANCED:
- breathing problems (airway mgmt)
- some fam think it’s normal aging
PD: MM/NI
- Medications: (Levodopa, Sinemet, Artane, Cogentin, Symmetrol)
- Surgery (Pallidotomy)
PD MED: Levedopa
- w UP pressure
- not for pets w narrow angle glaucoma
- monitor for hypotension
- 1 of the most effective PD drugs. Converts to Dopamine in brain, crosses BBB
- Dopaminergic drug (“related to dopamine”, dopamine being a common neurotransmitter. Dopaminergic substances or actions increase dopamine-related activity in the brain. Dopaminergic brain structures facilitate dopamine-related activity.)
PD MED: Sinemet
-prevents Levopdopa destruction. Allows it to cross BB. Combo w Levodopa/Carvadopa
PD MED: Artane
- Anti Cholinergic
- for symptoms, not used as much
- used in psych pts to prevent parkinsonian SS
- given in EARLY STAGES of disease, if can’t take Levedopa
SE: pts c/o
- cotton mouth
- blurred vision
- urinary retention
- constipation
PD MED: Congentin
Benzatropine (Cogentin)
May treat: Parkinson’s disease, Drug-Induced Abnormalities
Drug classes: Anticholinergic, H1 antagonist
Other drugs in same class: Benztropine mesylate, Hydroxyzine, More
PD MED: Symmetrol (Amantadine)
- anti viral
- UP dopamine level
- prevent, treat rest infect esp influenza
- no ETOH
PD: Dopamine Agonists
- Mirapex (Pramipexole)
- Parlodel (Bromocriptine)
- Requip (Ropinerol)
- use to DEC cardinal signs (tremors, rigidity, bradykinesia)
- monitor for: orthostatic hypotension, psychosis
PD: Diskenesia
abnormality or impairment of voluntary movement.
- after LT use of PD Drugs
- Take ‘Drug Holiday’ (off all meds, restart in 1-2 wks)
PD: Sx
- Pallidotomy
- Ablation Sx
- DBS (deep brain stimulation)
- Human fetal dopamine cell transplant
PD Sx: Pallidotomy
- is a neurosurgical procedure whereby a tiny electrical probe is placed in the GLOBUS PALLIDUS (one of the basal nuclei of the brain), which is then heated to 80 °C (176 °F) for 60 seconds, to destroy a small area of brain cells.
- overactive part of brain
- destroy it and leave scar to DEC brain activity
- alleviates mvmt symptoms, tremors, rigidity
- MRI to pinpoint area for treatment
PD Sx: Ablation Sx
- minimally invasive
- destroy portion of brain controlling rigidity/mvmt
PD Sx: DBS
Deep Brain Stimulation
- electrode connected to generator in brain, connect to chest
- programmed to deliver specific current to certain area of brain
- for pts unresponsive to drug therapy
- used over ablation
SE: bleeding, brain infection, seizure activity
PD Sx: Human Fetal Dopamine cell transplant.
using fetal tissue
Alzheimer’s Disease
- no cure
- impaired intellectual functioning
- degeneration of cells of brain
- chronic, degenerative, progressive disease
- most common cause of Dementia in elderly
- men/women equally
- about 40mil suffer form AD
- as early as 40/50s (EARLY ONSET, 5%)
- cause: unknown. maybe genetic?
- 2 major changes in brain: Protein Placques in cortex of brain AND
- upon autopsy, brain found to be smaller
- skips generations
- meds w lessen symptoms, not cure
Alzheimer’s Disease: 2 major changes in brain?
1) Protein Placques in cortex of brain
2) Neurofibrillary tangles (dead non-functioning neurons in brain)
- block communication btwn neurons
Alzheimer’s Disease: SS
FIRST stage
- mild memory lapses, decreased attention span
- forgot what you just read
- disinterest in surroundings
- depression
SECOND stage
- Obvious memory lapses
- disoriented to time (forget month)
- esp w short term memory
- loss of personal belonging
- make up stories to explain loss of memory
- may lose ability to recognize object or places, faces
- lost in familiar envt
- lose impulse control
- psychotic manifestations (delusions:false beliefs, hallucinates: visual/auditory, i.e. CIA spying on me)
- easily agitated d/t changes in brain
THIRD stage
- Total disorientation to person, place, time
- Apraxia (Difficulty with skilled movements even when a person has the ability and desire to do them.)
- wandering
- no longer perform purposeful acts
- wont use objects properly
- visual agnosia (can’t recognize objects by site)
- Dysgraphia (diff comm by writing)
- w put on shorts in snow, need help planning meals/cooking, need to start locking doors for safety.
TERMINAL stage
- severe mental and physical deterioration
- 8-10yrs progress to death
- total incontinence
- muscle weakness (d/t lack of brain fx?)
Anti Cholinesterase (Cholinesterase Inhibitors): 3 drugs
An acetylcholinesterase inhibitor (often abbreviated AChEI) or anti-cholinesterase is a chemical or a drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine.
- increase transmission of messages
- treats cognitive symptoms: mem loss, think/reasoning, confusion
- slows down for 6-12 mos only
Alzheimer’s: Med: Aricept (Donepezil)
-the only med approved to treat ALL 3 STAGES
-Treats symptoms of Alzheimer’s disease such as confusion or dementia (memory loss and mental changes).
-SE: Diarrhea, Nausea, Insomnia, Vomiting, Cramp, Anorexia
-class: Acetylcholinesterase inhibitor
-PO, sometimes sub lingual if diff swallowing
-Other drugs in same class: Rivastigmine, Galantamine, More
People also search for
Memantine (Namenda)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Acetylcholinesterase inhibitor
Quetiapine (Seroquel)
Alzheimer’s MED: Galantamine (Razadyne)
-MILD - MOD
-PO/Liquid
-Treats dementia (memory loss and mental changes) that is a sign of Alzheimer’s disease.
-class: Acetylcholinesterase inhibitor
-Other drugs in same class: Donepezil, Rivastigmine, More
-SE: Nausea, Vomiting, Fainting, Dizziness, Anorexia
-People also search for
Rivastigmine (Exelon)
Donepezil (Aricept)
Memantine (Namenda)
Acetylcholinesterase inhibitor
Tacrine (Cognex)
Alzheimer’s MED: Exelon (Rivastigmine)
-MILD- MOD
-Treats dementia (memory loss and mental changes) associated with Alzheimer’s disease or Parkinson’s disease.
-class: Acetylcholinesterase inhibitor
Other drugs in same class: Donepezil, Galantamine
-PO/Liquid/Patch
Alzheimer’s MED: Namenda (Memantine)
- MOD - SEVERE
- Treats dementia (memory loss and mental changes) that is a sign of Alzheimer’s disease.
- classes: NMDA receptor antagonist, 5-HT3 antagonist, Nicotinic antagonist, N-methyl-D-aspartate Receptor Antagonist
- DEC amount of chem Glutamate
- pts w alz produce too much glutamate, plays a role in learning/memory
- better effect w 1 or there cholinersterase inhibitors
- XR (extended release), PO, CAP, Liq
- SE: constipation
Alzheimer’s Meds: SS
all cause
- tiredness
- dizziness
- constipation
Alzheimer’s: MM/NI
-MEDS:
AGITATION: Lorazepam (Adavan), Haldol (10 doses only b/c habit forming/sedatiing)
DEMENTIA: Cognex (Mild - Mod) , Aricept (FDA, all 3 stages)
-NUTRITION, finger foods, frequent feedings, encourage fluids. hard to get them to sit, dehydrate easily b/c forget to eat/drink. give food w hi nutritional value
-SAFETY(remove burner controls at night, double lock doors, constant supervision)
Myasthenia Gravis
- chronic, auto immune, neuromuscular disease
- neuromuscular disorder, nerve impulses fail to passs at the mineral junction, cases muscular weakness
- thought to be triggered by antibodies attacking acetylcholine receptor sites –> dec # of receptor sites –> dec transmission of impulses –> muscle weakness
- age 10 - 70yrs, women 20-40, men 50-70 (more in young women, as age, both men/women equal)
- does not run in families, but infants of carrying moms w show symptoms for several wks, d/t antibodies transferred.
Myasthenia Gravis: SS
- ptosis (drooping eye lid)
- *** diplopia (early symptom)
- skeletal weakness; ataxia (facial/chew muscles)
- dysarthria (difficult or unclear articulation of speech that is otherwise linguistically normal.)
- dysphagia (difficulty or discomfort in swallowing)
- bowel/bladder incontinence (weak sphincter)
- wk vocal cords, nasal voice
- 25% pts have Thymoma (benign tumor in thymus)
Myasthenia Gravis: LATE SS
- trunk/lower limbs weaken (walk, sit, raise arms)
- can lead to mechanical ventilation, risk for aspiration
Myasthenia Gravis: MM/NI
-Anticholinesterase drugs (dosage adjusted until dec in symptoms –> can cause Myasthenia or Cholinergic Crisis)
Prostigmin (Neostigmine)
Mestinon (Pyridastigmine), Tx of choice **
- Corticosteroids (adjunct therapy, worsen symptoms at first then improve)
- may require mechanical ventilation
Myasthenia Gravis: Contraindicated meds
can worsen symptoms
- anestesia
- anti dysrhythmic
- abx
- hypnotics
- opioids
Myasthenia Gravis: Thymectomy
- for pts w thymoma
- improves symptoms in many pets
- recommended for some pt even w/out thymoma
Myasthenia Gravis: MED: Prednisone
and other psychotoxic agents used to block antibody production or to lower existing antibodies in bloodstream
Myasthenia Gravis: 2 major crisis’
- Myethetic Crisis
- Cholinergic Crisis
Myasthenia Gravis: Myasthenic crisis
is a life-threatening condition, which is defined as weakness from acquired myasthenia gravis that is severe enough to necessitate intubation or to delay extubation following surgery [1]. The respiratory failure is due to weakness of respiratory muscles
- missed doses of med
- infection
- sudden development of UP muscle weakness, cause inability to swallow, speak, respiration distress, anxiety
Myasthenia Gravis: Cholinergic crisis
an over-stimulation at a neuromuscular junction due to an excess of acetylcholine (ACh), as of a result of the inactivity (perhaps even inhibition) of the AChE enzyme, which normally breaks down acetylcholine.
- over med w anti cholinesterase
- sever muscle weakness
- N/V
- abd cramps
- UP salivation
- diaphoresis
- bradycardia
- can lead to mech ventilation
Myasthenia Gravis: Dx tests
- Inject Tensilon (short acting cholinesterase). pts w MG w show dramatic improvement for about 5 min
- EMG studies
- CAT scan of Thymoma (25% have thymoma)
Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s)
-Motor neurons in brain stem and spinal cord gradually degenerate
-electrical and chem messages originating in brain do not reach muscles to activate them
-fatal
-muscles begin to weaken/atrophy because not being used d/t no message from brain
-40-6-yrs, b4 65, more men. After 70, equal
-
Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s): Cause
- gene mutation
- chem imbalance
- immune system
- Military Time (head trauma, viral infec, intense exertion)
- smoking, risk drops when smoking ceases
- lead exposure
- hereditary (5-10%)
- kids of ALS parents have 50% developing
Amyotrophic Lateral Sclerosis: SS
- weakness of upper extremeties (diff walking)
- dysarthria (difficult or unclear articulation of speech that is otherwise linguistically normal.) slurred speach
- dysphagia (diff swallowing)
- muscle wasting as it progresses
- compromised resp fx
- clumsiness, tripping
- fasciculations (twitching/cramps)
- diff holding head up/posture
- does NOT affect bowel, bladder, senses, thinking
- death usually d/t respiratory infection
- no cure
- therapy/treatment for slowing progression/prevent complications
- constipation, fatigue, excess saliva
- sleep probs
- uncontrolled outbursts (laughing/crying)
Amyotrophic Lateral Sclerosis: Dx
- diff to Dx, symp similar to many other degenerative diseases
- test to rule out
- EMG - test to eval elec action to muscle
- Nerve conduction study, determine nerve damage
- MRI to see rumors, herniated discs on spinal cord.
- family Hx
Amyotrophic Lateral Sclerosis: MM/NI
-no cure
-promote independence
-MED:Rilutec (Riluzole) ** slows progression
Only FDA approved med.
MAIN MED
-Multidisciplinary ALS team, emotional support
Usually at large teaching hospitals, coor by RN. Acess to research and experimental drugs
-physical, speech therapy, monitor breathing, occupational therapy, social worker, insurance, equipment, psychological support
Huntington’s Disease
- Over activity of the dopamine pathways (opposite of ALS)
- genetically transmitted
- 30-50yrs
- 50% offspring w develop Huntington’s
- Juvenile Onset: if develops b4 20
Huntington’s Disease: SS
- abnormal excessive involuntary mvmts (chorea) **
- ataxia to immobility
- deterioration in mental functioning (unlike ALS)
- facial grimacing
- speech disturbances/swallow
- emotional lability
- cognitive probs (organizing, prioritizing, focusing on task)
- perseverate (repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased)
- lack of impulse control (outbursts, promiscuity)
- slowness in thought
- diff learning new info
- depression*** most common
- psychiatric changes: apathy, social wdrawal, irritability, insomnia, frequent thoughts of death/dying
- can suffer from OCD (obsessive thoughts, compulsive behavior
- manic behavior
- bipolar
Huntington’s Disease: Juvenile SS
- loss of previous academic info and physical skills.
- rapid drop in performance
- behavioral problems
- poor impulse control
- muscles become contracted/rigid
- affects gait
- change in fine motor skills (writing)
- tremors
- slight involuntary mvmt , not like chorea in adults
- susceptible to seizures
- no specific dx test: physical exam, family Hx, Neuro/psych exam to rule out other diseases
Huntington’s MM/NI
- no cure/palliative tx
- antipsychotics: Haldol, Risperidol
- antidepressant
- antichoreas: tetrabenazine(xenazine), suppress involuntary mvmts
- safe envt
- emotional support
- high calorie diet to replace calories lost from writhing (4-5kcal/day)
- eat in room w caretaker, not busy dining room
- use calendars on wall to help pts be aware of day
- calm environment
- more psych probs
- note triggers to outbursts
- support group for pt and caregiver
- discuss death wishes, legal etc
West Nile Virus
- transmitted by mosquitoes
- most ppl have no SS
- few have minor SS: mild fever, HA
- some life threatening, meningitis, encephalitis
- mild symptoms usually go away on their own
- sudden muscular wkness, disorientation
- Mosquitos feed on infected birds, bite us.
- more prevalent in Asia, Africa, Mid East
- came to NY in 1999, in all 48 contiguous states. Not Alaska, Hawaii
- rarely from blood transfusion, organ transplant (blood donors are screened, lo risk of contraction )
West Nile Virus: SS
MILD (20%) -fever -HA -body aches -fatigue -back pain Rare: skin rash, swollen lymph nodes, eye pain
SERIOUS
- encephalitis
- meningitis
- Acute Flacid Paralysis
West Nike Virus: Acute Flacid Paralysis
- sudden weakness (arms/legs/resp)
- UP fever
- severe HA
- stiff neck
- disorientation/confusion
- stupor/coma
- tremors, muscle jerking
- lack of coordination
- convulsions
- pain to partial paralysis
- muscle weakness (can become permanent)
West Nile Virus: incubation
-3-14 days after bitten
West Nile Virus: Risk Fx
- season (July - Sep, maj of US cases)
- geographic region (Midwest, Southern). Recent increase in NE
- age 50up, high risk d/t immune sup
- health (immune sys)
West Nile Virus: Dx Tests
- blood test for Antibodies
- Spinal tap (sym of meningitis in CSF, UP WBS, Antibodies)
- EEG, CT Scan, MRI
- a positive RN test is indicator of virus
- Interferon Therapy (better recovery/response)
WNV: Tx for Mild Systmtpoms
OTC for HA, Muscle Aches
WNV: Preventative Measures
- Deet (insect repellent)
- long pants (elastic ankles, socks over)
- clean under roof gutters
- eliminate standing water (tires, pools, birdbaths etc)
- avoid being outside (dusk/dawn)
- vaccine available for horses
Guillain-Barre Syndrome
- inflammation and degeneration of peripheral nervous system
- possible viral or autoimmune reaction
- disrupts nerve conduction
- all ages
- men/women equally
- affects 1/100,000 pl
- INCUBATION - 10-20 days
- attacks Myelin sheath. there are other virus’ that do the same
- not contagious
- affects lower extremities first as messages have to travel farther from brain.
- can affect respiratory muscles –ventilator
- virus can cause changes in structure of normal cells. body treats as enemy
- 85% pts return to normal fx
Guillain-Barre Syndrome: Causes
- flu vaccine?
- epstein barr?
Guillain-Barre Syndrome: SS
- w/in minutes - days - weeks
- progressive symptoms
- paralysis usually starts in lower extremities and moves up. may stop at any point depending on amount of damage to myelin sheath
- resp failure if intercostal muscles affected
- may have difficulty swallowing, breathing, speaking
- pt most weakness within first 2 wks
- fluctuating BP d/t effect on autonomic NS
Guillain-Barre Syndrome: Dx
- no specific test, rule out other diseases
- med hx (viral exposure?)
- type of symptoms
- CT scan (rule out tumor)
- Lumbar puncture (look for UP protein)
- Nerve Conduction Velocity test
Guillain-Barre Syndrome: MM/NI
- Adrenocortical steroids (LO inflamm, Cortizone)
- Apheresis (cleanse blood of antigens, like dialysis)
- Mechanical ventilation (bad sign)
- Gastrostomy tube (G tube to abd for feeding)
- Meticulous skin care (prevent skin brkdwn, frequent turning, cleansing)
- ROM exercises (prevent contractures)
