Conductive Abnormalities and Degenerative Diseases

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Questions and Answers

Which nursing intervention is appropriate to prevent aspiration during a seizure?

Administer oxygen during the seizure.

Place patient in a side-lying position. (correct)

Encourage the patient to drink water beforehand.

Place the patient in a supine position.

What is the prognosis for individuals with seizure disorders typically characterized by?

A consistent number and intensity of seizures over time. (correct)

A decrease in the number and intensity of seizures over time.

An increase in the severity of seizures despite treatment.

Total seizure elimination with medication.

What is a key clinical manifestation of multiple sclerosis?

Severe headaches that last for days.

Recurring episodes of amnesia.

Consistent muscle hypertrophy.

Intermittent visual problems such as diplopia. (correct)

What contributes to the uncertainty of prognosis for seizures resulting from a brain tumor?

The underlying brain pathologic condition. Signup and view all the answers

Which condition is NOT a common problem associated with seizure activity?

Increased gas exchange. Signup and view all the answers

What is the most likely cause of status epilepticus when seizures occur in close proximity?

Withdrawal from habitual use of alcohol Signup and view all the answers

During phase 1 of status epilepticus, which of the following physiological changes occurs?

Increased cerebral metabolism Signup and view all the answers

Which symptom would most likely indicate the progression to phase 2 of status epilepticus?

Decreased cerebral blood flow Signup and view all the answers

What is the first-line medication typically used to control a seizure emergency?

Lorazepam Signup and view all the answers

What is the main purpose of performing diagnostic tests such as an EEG in patients with seizure disorders?

To diagnose the specific type of seizure Signup and view all the answers

What is the primary goal of antiseizure drug therapy?

To achieve maximum seizure control with minimal side effects Signup and view all the answers

Which surgical intervention may be performed to manage seizure activity by removing brain tissue?

Resection Signup and view all the answers

What should be avoided during a seizure to prevent injury to the patient?

Inserting a padded tongue blade Signup and view all the answers

Which of the following is crucial for maintaining airway integrity during a seizure emergency?

Utilizing an oral airway Signup and view all the answers

What is a common side effect of phenytoin that requires patient education?

Gingival hyperplasia Signup and view all the answers

What is the postictal period following a seizure characterized by?

Grogginess and disorientation Signup and view all the answers

Which of the following is NOT a known cause of seizures?

Increased physical fitness Signup and view all the answers

What medical emergency is indicated by recurrent generalized seizure activity without regaining consciousness?

Status epilepticus Signup and view all the answers

Which factor is the most common cause of status epilepticus?

Sudden withdrawal of anticonvulsant medications Signup and view all the answers

What can repeated seizures lead to in the brain?

Permanent brain damage or death Signup and view all the answers

What is the significance of a high-protein diet for patients with Multiple Sclerosis?

It helps maintain mobility and reduces obesity. Signup and view all the answers

Which intervention should be prioritized for a patient experiencing emotional changes related to MS?

Provide emotional support and thorough explanations. Signup and view all the answers

How should patients with Multiple Sclerosis manage their physical limitations during bathing?

They should receive assistance with bathing as indicated by their physical abilities. Signup and view all the answers

What is one of the earliest recognizable signs of Parkinson's Disease?

Impaired postural reflexes. Signup and view all the answers

Which of the following statements about the demographic characteristics of Parkinson's Disease is accurate?

It is more common in men than women. Signup and view all the answers

What is the main purpose of combining carbidopa with levodopa in Parkinson’s disease treatment?

To increase the amount of levodopa that reaches the brain. Signup and view all the answers

Which of the following is a symptom commonly associated with the terminal stage of Alzheimer’s Disease?

Total incontinence Signup and view all the answers

What lifestyle factor has been associated with a lower risk of developing Alzheimer’s Disease?

Engaging in physical activity Signup and view all the answers

What clinical manifestation might indicate the presence of sundowning in an Alzheimer’s patient?

Heightened confusion and agitation in the late afternoon Signup and view all the answers

What is a primary reason for assessing patients receiving anticholinergic agents and bromocriptine mesylate for Parkinson's disease?

To identify side effects like constipation and urinary retention Signup and view all the answers

What dietary approach is recommended for patients with Parkinson's disease to help manage constipation?

A diet high in fiber and roughage for bulk Signup and view all the answers

Which technique may assist a patient with Parkinson's disease who experiences 'freezing' while walking?

Imagining stepping over lines on the floor Signup and view all the answers

What practice should be avoided to reduce the risk of aspiration during feeding for a Parkinson's patient?

Using straws for drinking Signup and view all the answers

What is the primary goal of drug therapy for patients with Parkinson's disease?

To increase the levels of dopamine at functioning nerve terminals Signup and view all the answers

Which nursing intervention is appropriate for assisting a Parkinson's disease patient with compromised physical mobility?

Teaching active ROM exercises Signup and view all the answers

What is a common initial sign of Parkinson's disease that patients might notice themselves?

Mild tremor Signup and view all the answers

What characterizes the rigidity associated with Parkinsonian symptoms?

Intermittent catches during limb movement Signup and view all the answers

Which of the following is a significant cognitive symptom that can progress in Parkinson's disease?

Dementia Signup and view all the answers

What is the primary purpose of using deep brain stimulation (DBS) in the treatment of Parkinson's disease?

To adjust symptoms and improve quality of life Signup and view all the answers

What is a characteristic of bradykinesia in Parkinson's disease?

Loss of automatic movements Signup and view all the answers

What is the main characteristic of seizures associated with epilepsy?

Involuntary muscle contractions that occur without warning Signup and view all the answers

Which condition can lead to seizures due to an underlying physiological imbalance?

Severe elevations in body temperature Signup and view all the answers

During the postictal period, a patient may experience all of the following EXCEPT:

Immediate return to full consciousness Signup and view all the answers

What constitutes a medical emergency in relation to seizure conditions?

Status epilepticus Signup and view all the answers

What is a potential consequence of repeated seizures on the brain?

Permanent brain damage or death Signup and view all the answers

What is a potential complication associated with prolonged seizure activity in a patient?

Death from neuronal necrosis Signup and view all the answers

What physiological change occurs during phase 1 of status epilepticus?

Increased cerebral metabolism Signup and view all the answers

What could most likely lead to status epilepticus in an individual?

Irregular intake of antiepileptic drugs Signup and view all the answers

What is a possible consequence of the autonomic dysfunction that occurs during status epilepticus?

Increased sweating and vomiting Signup and view all the answers

Which factor is a common cause of seizures in patients experiencing status epilepticus?

Head trauma and infection Signup and view all the answers

Study Notes

Conduction Abnormalities in Epilepsy and Seizures

Etiology and Pathophysiology

Seizures stem from abnormal electrical activity in the brain.
Common seizure triggers include:
- Severe body temperature elevation
- Drug use
- Electrolyte imbalances
- Brain tumors
- Brain infections
- Epilepsy
Epilepsy leads to uncontrolled electrical discharges in brain neurons, causing involuntary muscle contractions.
Seizures exhibit varied patterns based on their origin in the brain.
Tonic convulsions cause alternating muscle contractions and relaxations, resulting in characteristic jerking movements.
Postictal period follows seizures with grogginess, disorientation, headaches, and amnesia about the event.
Status epilepticus is a medical emergency characterized by continuous seizures without returning to full consciousness.
Frequent seizures lead to neuronal exhaustion, risking permanent brain damage or death.
Common trigger for status epilepticus is abrupt withdrawal from anticonvulsants.

Clinical Manifestations

Seizures can be categorized into types:
- Generalized tonic-clonic (grand mal)
- Absence (petit mal)
- Psychomotor (automatisms)
- Jacksonian (focal)
- Miscellaneous (myoclonic, akinetic)
Status epilepticus can arise from:
- Irregular antiepileptic drug intake
- Alcohol or sedative withdrawal
- Electrolyte imbalances
- Head trauma and infections
Physiological changes during status epilepticus are:
- Phase 1: Increased cerebral metabolism, hypertension, hyperglycemia, and lactic acidosis.
- Phase 2: Decreased cerebral blood flow, systemic hypotension, and acidosis leading to cellular injury.

Assessment

Subjective data should assess patient's understanding and awareness of seizures, including any auras.
Auras are sensations (light, warmth) or emotions (fear) that precede seizures, occurring in about 50% of patients.
Objective data includes seizure frequency, characteristics, and post-seizure behaviors.
Essential assessments involve neurological, respiratory, and cardiovascular evaluations before, during, and after seizures.
Monitor SpO2 and possible respiratory distress; prepare for suctioning and oxygenation as needed.

Diagnostic Testing

Blood tests and toxicology screens for infections and chemical imbalances.
Imaging tests (CT, MRI) identify lesions and seizure activity locations.
EEG is the primary diagnostic tool for seizure evaluation.

Medical Management

70% of seizure disorders can be controlled with antiseizure medications.
Therapy focuses on seizure prevention; cures are often not attainable.
Medication choice depends on seizure type; adherence is crucial to treatment success.
In status epilepticus, immediate treatment is critical. Initial medication typically includes IV lorazepam.
Additional medications like levetiracetam, phenytoin, or propofol may be used if seizures persist.
Surgical options may involve resection of the hyperactive brain area.

Nursing Interventions and Patient Teaching

Ensure airway patency, oxygenation, and vascular access during seizures.
Education on medication adherence, lifestyle adjustments, and the importance of follow-up care is vital.
Caution against alcohol use when on antiseizure medications.
Emergency treatment includes positioning, suctioning, and avoiding objects near the patient during seizures.

Prognosis

Emotional, economic, and social impacts are significant for patients with seizure disorders.
Stigma around epilepsy remains.
Driving restrictions can adversely affect lifestyles.
Outcomes vary; some patients experience stable seizure patterns while others face uncertainty due to underlying conditions.

Degenerative Diseases Overview

Degenerative diseases involve premature aging of nerve cells due to metabolic disturbances or unknown causes.
Key conditions:
- Multiple sclerosis (MS)
- Parkinson’s disease
- Alzheimer’s disease (AD)
- Myasthenia gravis (MG)
- Amyotrophic lateral sclerosis (ALS)
- Huntington’s disease

Multiple Sclerosis (MS)

Chronic, progressive disease with unknown specific cause but suspected genetic links.
Early signs may show an increase of gamma delta T cells in the spinal fluid.
Initial symptoms are vague and may take time to diagnose.
Symptoms include:
- Visual problems
- Urinary incontinence
- Fatigue
- Muscular weakness or coordination issues
- Sexual dysfunction
- Swallowing difficulties
Patients may have remissions followed by exacerbations, often triggered by fatigue or emotional stress.
Diagnosis relies on history, clinical signs, and MRI evidence of multiple lesions.
CSF in MS patients can show elevated gamma globulin levels, and CT may reveal enlarged cerebral ventricles.### Multiple Sclerosis (MS)
MRI scans are effective for diagnosing MS, able to detect sclerotic plaques as small as 3-4 mm in diameter.
No specific treatment exists for MS; however, symptoms can be managed with ACTH and corticosteroids (e.g., prednisone, dexamethasone).
A high-fiber, well-balanced diet is crucial, often supplemented with vitamins and high-protein foods.
Obesity complicates daily needs and mobility; obese patients should consult a dietitian for calorie-restricted diets.
Regular skin care is essential; patients should be taught to turn frequently and use pressure-relief devices like air mattresses.
Exercise is beneficial for patients with MS, reducing spasticity and enhancing coordination; water exercise is particularly effective.
Daily rest periods can help manage fatigue, especially during acute exacerbations.
Patients may experience unbalanced gait; stabilizing techniques include leaning toward the less affected side and emphasized foot placement while walking.
Patients should avoid hot environments and extended exposure to heat.
Emotional changes, including slow speech and unpredictable emotional outbursts, may occur.

Parkinson’s Disease

Parkinsonism includes bradykinesia, muscle rigidity, tremors, and impaired postural reflexes.
The disease primarily results from the loss of dopamine-producing cells in the substantia nigra, affecting movement regulation.
More than 1 million people in the U.S. are affected; onset typically occurs after 50, peaking in the 60s.
Diagnosis is clinical, based on history and neurological examination, requiring at least two symptoms from the classic triad: tremor, rigidity, and bradykinesia.
Early symptoms may be subtle (e.g., mild tremors, handwriting changes) but progress to pronounced gait changes, rigidity, and possible dementia.
"Pill rolling" tremor is characteristic, often seen at rest, and exacerbated by stress.
Rigidity may present as a "cogwheel" effect with muscle soreness and fatigue.
Treatment focuses on symptom management; drug treatment may lead to side effects like dyskinesia.
Deep brain stimulation (DBS) is an advanced surgical option, improving motor complications without destroying brain tissue.

Nursing Interventions for Parkinson’s Patients

Emphasize proper posture and ambulation techniques to prevent falls and enhance mobility.
For patients at risk of freezing while walking, suggest techniques like stepping over lines or rocking side to side.
Nutrition is critical; diets high in fiber assist with constipation, while bite-sized food aids swallowing.
Patients should maintain a 90-degree angle while eating to prevent aspiration and use soft-solid or thick-liquid diets.
Caregiver education is essential for medication adherence and to promote mobility, skin care, and proper feeding techniques.

Alzheimer’s Disease (AD)

AD is a chronic, progressive disorder affecting brain function, leading to impairments in intellectual abilities; it is a prevalent cause of dementia, affecting genders equally.
Neuropathological changes include the presence of cortical plaques, neurofibrillary tangles, neuronal connection loss, and subsequent cell death.### Alzheimer's Disease (AD)
Neuronal damage primarily affects the cerebral cortex, leading to decreased brain size.
Engagement in cognitive activities like reading and learning languages lowers the risk of AD.
Regular physical activity and educational achievements throughout life are protective factors against AD.
Antioxidant-rich foods such as citrus fruits, dark green vegetables, and beta-carotene-rich foods may reduce AD risk.

Clinical Manifestations of AD

Progression typically divided into four stages, though some systems propose up to seven stages.
Early stage: Mild memory lapses and difficulty with word usage; possible depression and lack of interest.
Second stage: Obvious short-term memory loss, disorientation, loss of impulse control; sundowning may occur.
Third stage: Total disorientation; motor problems like apraxia, visual agnosia, and dysgraphia; increased wandering.
Terminal stage: Severe mental and physical deterioration; total incontinence common.

Assessment for AD

Memory loss usually the first noticed symptom, often accompanied by agitation or restlessness.
Important to rule out conditions like pernicious anemia, drug reactions, depression, or hormonal imbalances.
Early warning signs include memory disruption, difficulty with familiar tasks, and withdrawal from social activities.

Diagnostic Tests for AD

Diagnosis is largely one of exclusion; no specific diagnostic tests exist for AD.
CT scans, EEGs, MRIs, and PET scans may rule out other conditions.
Family history plays a significant role; definitive diagnosis can sometimes only be made post-mortem.

Medical Management of AD

Treatment options are limited; medications can sometimes exacerbate symptoms.
Lorazepam or haloperidol may help manage agitation.
Memantine, approved for moderate to severe AD, does not halt neurodegeneration but slows symptom progression.

Nursing Interventions and Patient Teaching for AD

Focus on maintaining adequate nutrition, potentially with finger foods and frequent nutrient-dense meals.
Safety measures include securing the environment to prevent accidents related to disorientation.
Education often targets family members, emphasizing the importance of effective communication.

Prognosis of AD

No effective treatments currently exist to halt progression; variability in disease progression noted.
Most patients ultimately succumb to complications like pneumonia, malnutrition, and dehydration.
Support groups available to assist caregivers and families manage the burden of the disease.

Myasthenia Gravis (MG)

MG is an autoimmune neuromuscular disease characterized by fluctuating muscle weakness.
Common onset between the ages of 10 and 65, peak typically between 20-30; is now seen more in individuals over 50.
Autoimmune process involves antibodies attacking acetylcholine receptor sites at the neuromuscular junction.

Clinical Manifestations of MG

Symptoms include ptosis (eyelid drooping), diplopia (double vision), and general muscle weakness, particularly in extremities and diaphragm.
Severe cases may require mechanical ventilation due to significant muscle weakness.

Assessment for MG

Subjective data includes weakness, double vision, and swallowing difficulties.
Objective assessment may reveal specific muscle weakness and nasal-sounding speech.
Diagnostic testing may include observing eyelid drooping, EMG, and the IV anticholinesterase test.

Medical Management of MG

Anticholinesterase drugs like neostigmine and pyridostigmine are standard treatments.
Corticosteroids and immunosuppressive medications can be adjunct therapies.
Plasmapheresis may be used for acute episodes or surgery preparation.

Nursing Interventions for MG

Monitor for respiratory issues due to muscle weakness; patient may require hospitalization during acute episodes.
Help plan daily activities to conserve energy for essential tasks; physical therapy may assist with mobility.

Prognosis of MG

Respiratory failure is a significant concern; effective communication and planning are crucial for patient care.

Amyotrophic Lateral Sclerosis (ALS)

Characterized by the loss of upper and lower motor neurons, typically leading to death within 2 to 6 years.
Onset generally occurs between ages 40 and 70, with a higher prevalence in men.

Clinical Manifestations of ALS

Primary symptoms include weakness, dysarthria, dysphagia, and muscle wasting.
Respiratory failure is often the cause of death due to compromised function.

Medical Management of ALS

No cure; riluzole may slow progression by protecting motoneurons, potentially extending life by months.

Nursing Interventions for ALS

Encourage endurance exercises to reduce spasticity; provide emotional support and assist with communication needs.

Huntington's Disease

An autosomal dominant genetic disorder with a 50% inheritance risk for offspring; usually diagnosed after parenthood.
Symptoms include abnormal movements (chorea), cognitive decline, and emotional instability.

Clinical Manifestations of Huntington's Disease

Involuntary movements progress to affect speech and swallowing, risking aspiration and malnutrition.
Nutritional needs may reach 4000-5000 calories daily, complicating dietary management as swallowing difficulties increase.

Medical Management of Huntington's Disease

No cure; palliative treatments include antipsychotics and antidepressants to manage symptoms.

Nursing Interventions for Huntington's Disease

Ensure a safe environment, maintain nutritional intake, and provide genetic counseling resources for family planning.