Chronic Neurologic Disorders Flashcards
What is MS?
Chronic, degenerative demyelinating disease that affects the CNS; periods of exacerbation/remission.
What are the diagnostic tests for MS?
no definitive tests; diagnosis is primarily based on clinical manifestations, history and presence of multiple lesions (MRI/CSF analysis). Based on subjective and objective assessment. Visual test to evoke response
What are the signs and symptoms of MS?
- Urinary frequency/urgency
- eye fuzziness, double vision
- numbness and weakness
- lack of coordination
- trouble walking
- vision changes
What are triggers of exacerbations of MS?
- Infections (URI/UTI)
- Trauma
- Immunizations
- Delivery after Pregnancy
- Stress (Emotional/Physical)
- Climate changes
What are treatments of MS?
- corticosteroids: for exacerbations
- immunomodulators: for exacerbations
- immunosuppresants: for exacerbations
- muscle relaxants: for spasicity
- PT/OT/speech: decrease spasticity, assistive devices, improve functioning
Impaired physical mobility (MS)
Apply/provide assistive devices; encourage independent ambulation. Teach PROM/AROM to prevent contractures/minimize atrophy
Sexual dysfunction (MS)
- Provide info related to sexual functioning; encourage verbalization of fears
- Reassurance/permission related to alternate sexual expression
- Include spouse/partner as much as possible
- Refer to sex therapist as appropriate
Interrupted family process (MS)
- ID effects of role changes on family processes
- Assist families to implement normalizing strategies for their situation
- Assist family to use existing support mechanisms
- Design schedules of patient home care activities that minimize disruption of family routines
- Facilitate communication of feelings
- Provide assistance in meeting basic needs of family
- Teach so families can make informed decisions about care
What is parkinson’s?
degeneration of dopamine-producing neurons; disrupts the normal balance between dopamine and acetylcholine in the basal ganglia. Dopamine is the neurotransmitter essential for normal functioning of the extrapyramidal motor system, including control of posture, support and voluntary movement. Symptoms of PD don’t occur until 80% of neurons are lost
What are the symptoms of parkinson’s?
- Bradykinesia: decrease in spontaneous movement (slow initiation/execution of movement)
- Rigidity: increased muscle tone, increased resistance to PROM (cogwheeling)
- Tremors: shaking at rest, aggravated by stress
- Depression
- Pain
- Dysphagia
- Stooped posture, shuffling propulsive gait, loss of normal arm swing when walking
- General debilitation: pneumonia, UTIs, skin breakdown
- anxiety
- constipation
- malnutrition
- apathy
- impotence
- aspiration
- fatigue
- dementia
- mask like/blank facial expression
- sleep disorders
- short-term memory loss
What are the meds for parkinson’s?
- levodopa-carbidopa (Sinemet) anti-parkison agent
- Action: more levodopa is made available to brain for conversion to dopamine in brain
- Side/Adverse: involuntary movements, confusion/agiation, anxiety, dry mouth**, flatulence, hand tremors**, insomnia/nightmares, twitching/numbness, orthostatic hypotension**, incontinence, fatigue, HA, weakness, dysphagia, N/V/A abdominal distress
- Nursing:
- Take 30 mins before meals
- Assess BP, mental status, postural hypotension
- Teach to make position change slowly, report twitching/eye spasms
- Improvements may take 2-4 months; gradually taper on and off
- Drug tolerance: may need to take a drug holiday then restart med
- Teach that urine and sweat may darken (orange or red)
- Anticholinergics: decrease the activity of acetylcholine (to increase dopamine)
- Antivirals: promote the release of dopamine
- MAOIs: block breakdown of acetylcholine (increases dopamine)
TNIs for Parkinson’s
- Assess RESPIRATORY SYSTEM
- Safety - neuromuscular assessment/poor coordination
- Prevent complications: promote exercise, healthy diet, give sinemet 30 minutes before meals
- Experimental therapy: transplantation of fetal neural tissue into basal ganglia of the brain
What is Alzheimer’s?
Chronic, progressive degenerative disease of the brain characterized by cognitive impairment. Tangles/plaques in the brain - s/sx can progress over years (mild, moderate, severe). Causes: neurodegenerative, vascular. Diagnosis made after other causes of delirium/dementia have been eliminated
How should you document for an Alzheimer’s patient?
Be as specific as possible when describing “confusion”
- alert and oriented
- attention span
- changes in speech/reasoning
- repetitive questioning
- paranoia/wandering
- poor hygiene
- memory loss
- ability to complete ADLs
- anger/belligerence
- changes in circadian rhythms
