Neurological Assessment - Migraines, Headaches, and Seizures PDF

20241113171426 Tue, Nov 19, 2024 11:59AM 2:04:52 **SUMMARY KEYWORDS** migraines, aura phase, tension types, cluster headaches, seizure phases, Alzheimer\'s disease, amyloid plaques, multiple sclerosis, Parkinson\'s disease, myasthenia gravis, ALS, Huntington\'s disease, medication management, t...

20241113171426 Tue, Nov 19, 2024 11:59AM 2:04:52 **SUMMARY KEYWORDS** migraines, aura phase, tension types, cluster headaches, seizure phases, Alzheimer\'s disease, amyloid plaques, multiple sclerosis, Parkinson\'s disease, myasthenia gravis, ALS, Huntington\'s disease, medication management, trigger avoidance, neurological assessment Be severe, incapacitating. The big thing with migraines are they are unilateral throbbing, okay, so just one side. A lot of times we\'ll have that throbbing, and it often intensifies over several hours, and again, they can have that nausea, vomiting, dizziness or vertico. And then the next you have that pro normal stage, which is your recovery. And a lot of times, people have just kind of told that a with the pain and the aura subsidy, the last one here, did I say? Pro is before I apologize. Thank you, Rose before then you have your aura, aura, your headache, post, I apologize, and with your post journal, a lot of times, Google again, will have that next step. This is kind of complain about, it\'s very common. So migraines without aura are actually the most common. And we\'re tension types. We\'re not aggravated pain. You can move around, and it didn\'t without increased pain. Migraines, any kind of movement is really going to increase that pain. And again, it is that in the lateral. So the next you have is your A typical so these are your migrations that don\'t really fit with your aura, or your without aura. And those are your status microneeds. I and this is a headache that lasts for your migraine that lasts longer than 72 hours. Longer than 72 next we have is your migraines infarction, where you\'re going to have those neurological manifestations that can persist for up to seven dates, and a lot of times, this is when they\'ll start to do that neuro imaging to make sure that you don\'t have anything else going on. I love some of the triggers can be hormone fluctuation. A lot of times, females will tell them to track their cycles, because they can kind of pre medicate if something\'s going on, if it\'s something they have chronic barometric pressure changes lifetimes, these people will tell them to fly or even MSG in your food, the Chinese name. So a lot of medications, like I talked about in the beginning, that I talked about, is it going to cure right? It\'s not going to make you never have a migraine again, but it\'s going to help with that aborted therapy to alleviate your pain. For just mild migraines, you can get those over the counter, NSAIDS, vibrant, exactly. Up versus beer migraines, they often do tryptan medications, and these produce a vasoconstrictive effect. And then again, like I said, those medications with caffeine, like etc, they can prescribe anti medics if they are severe or not as well. I So again, you want to do that trigger avoidance. So a lot of times, we\'ll tell people when you have chronic migraines to eat like a migraine diary as well, or a headache diary, and that kind of helps you. Then point out if there are triggers that are happening, but maybe you haven\'t necessarily, fairly so the next part cluster. These are the most severe headaches, but these are also less common because. Together. They do often occur at night. They\'re so severe that they beat a person, and they often happen more in the spring and fall, not a lot. This is more common in males that are 20 to 15, so like migraines, they happen unilaterally. But this is not a throbbing pain. This is a severe, intense, sharp stabbing pain that they\'re going to tell you about. And this can last 15 minutes to three hours. You say 1515, one, five to three hours. But this can happen one to eight times a day for four to 12 weeks. For how many weeks pretty visual pain radiates from the forehead to the cheek. They often have no aura or preliminary manifestations. So that\'s really to tell that this is kind of coming on migraine, and a lot of times it actually affects the gray one or five. So what manifestations Do you think you\'ll see from that Right, right? You\'re going to have, you have swelling around the eyes. You have tearing, facial flushing or power where you can have meiosis event, which is Larry violation or constriction. So I tell you that somebody\'s having anybody tearing, facial flushing, you\'re going to tell me granular five manifestations. So again, these medications are the same as migraines, but they also can include or go steroids. And again, you want to avoid those triggers, so again, potentially a headache diary. A lot of times we\'ll see that people have strong odors, overheating, dieting and alcohol. So I touched base a little bit as we\'re going to learn about pro therapy with open slides over the counter that you can get with your attention. So you want to do how to start or during the world when somebody has migraine, but also want to be careful, because I told you, it\'s a vasoconstrictor. So if somebody is already on a vasoconstrictor drug, they might need some other bedroom therapy or some tailoring with their medications. Right? I They can also use some anti seizure medications for migraines and those that have chronic migraines greater than 15 days a month. That\'s where that Botox comes in. I\'m sorry. I\'m sorry. Where do they like inject that? I\'m sorry. Where would they inject around here, this isn\'t somebody you\'re gonna go to an estimate, right? Your cluster headaches, if you are having not very good control with the trip tans or the over the counter medications they can use Coronavirus, but they are going to need careful monitoring and pdgs done with any kind of titration on this medication. I. Important to know, maybe a headache diary or something like that, of possible triggers. So a client who has a mystery binder comes into the clinic, reporting a tingling on the face and blind spots in the eyes, which of the following phases of the minority experience, B, D, right? Or anybody have questions about that? So the next before we move on to seizure, we make a question about headaches. So next is seizures. Those are a sudden, abnormal, excessive, uncontrolled lexical discharge of neurons within the brain that cause alterations in your level of consciousness andor changes in motor and sensory ability and or behavior. These happen in four phases, but not everybody has every phase. So know that there are four phases, because somebody might just go straight into the digital so your first phase again is your prodrome, right? It\'s when you have those sensations or behavior changes, and this could be hours today\'s the next is your world, your aura phase, and this is again, where you may have those sensory warnings, how long is that? How much? How long is that lasting? It doesn\'t. The third is your actual. Your actual is your first onset of symptoms to the end of your seizure activity. And then your fourth is your post actual, or your recovery phase after that seizure. And again, not everybody experiences all four of those spaces. So for most, apophysiology is unknown. They do that one or more genetic abnormalities end up affect up to 70% of people who have seizures, and also patients with any kind of chromosomal disorder will often have some type of seizure disorder. Seizure disorder, again, some known causes, children with high fevers, stroke, tumor, TBI was TBI hypoxic, birth, injury, then a couple others I don\'t know here are infection, metabolic disorder or even fluid and electrolyte imbalance. I older patients are at an increased incidence for having some kind of seizure disorder, and this is mostly just because the older you get, especially that 65 and older, you have that increased risk of cerebrovascular some kind of cerebral palsy or disease makes sense, right? So dig in a little bit. You have your general onset seizure. This starts over a y area of the brain, and it\'s not pinpointed to just one side, right on both sides. So your general onset seizures are your tonic, planet, your tonic, your tonic and your absence, so easy, but they aren\'t termed by the electrical the site of electrical disturbance. So your first is your tonic planet, which also you\'ll see, depending on where you\'ll also be, called your brain sushi. So with this, your patient is going to have that tonic episode, which is usually just a few seconds, where they\'ll lose consciousness and have that stiffening of muscles, and I\'ll definitely fall right the next you have your Clonic, which is that jerking that you\'ll see of either just the extremities or the entire body. The big thing that I want you to know is that three. Can stop during the tonic phase and then become irregular. So this has the potential to lead to cyanosis. So what are some things you think you want to have bedside for somebody who has a seizure? Oxygen? Right? Your oxygen setup, yeah, again, you want to have that safety where they\'re jerking. You know, initially, when they started doing this, you wanted to put a tongue compressor in the mat, right with it, so that they didn\'t swallow their tongue. Don\'t ever, if it is ever an option, put anything in there the math, including the fingers or anything like that, okay, because they can\'t control it, and whatever it is like, not and cause more harm or potential danger to that patient. But they might bite your cheaper tongue, and then, often, a lot of times with the content client, and that post cycle period, they\'ll have some kind of confusion. They may need to be reoriented or need some kind of rest afterwards, those that have just tonic often occur in sleep and last from 30 seconds to a few minutes. Again, just like with the tonic on at the Grand wall, they lose that consciousness and have that body stiffness. They can experience some autonomic disorders or manifestations. So those arrhythmias, apnea, vomiting, Clonic begins with that loss of awareness, and again, just like with the Comic Con, it can last for several minutes as well. And then the last is your absence seizure. This is often just seen in children. It\'s very rare in adults, and it looks like they\'re just kind of Daydream right? This can be anywhere from 10 to 30 seconds. It just almost like you\'re staying open to the space. A lot of children have this hair grow out of it. So once they get puberty, they often have these I Sonic tonic seizures that during the tonic studies, important minutes of surveillance. It\'s less rare when it\'s just a tonic, more when it\'s a tonic on it, but we have to know that it\'s a possibility. So your vocal onset seizures, so your focal onset seizures, these begin in one hemisphere drawing. They can be motor or non motor, and last two minutes, these can be dangerous, and these are different than your local seizures or your absence seizures. So your absence seizures, again, are sleeping children, and they just kind of have to stay right in the mornings. They should have a lot of business right where they look maybe like they\'re dangerous, but they also have a lot of times they have a motor attachment to fit. And where these get dangerous is you as a patient, can have this seizure. And if you\'re having this seizure and they\'re having traffic and they\'re waiting at a crosswalk, they have a seizure, and then they just start with it, right? So they just walk right into traffic, and they have no idea. So that\'s where a lot of people not really confused with asking seizures, if you understand the difference, absence also happens over a wide area of the brain, and it\'s just day drinking with a no motor attached, okay. And again, it is deadline in children. Opal, it is older on a. Necessarily enjoy that motor aspect. I\'m sorry so that you said that that does not happen, like the motor function doesn\'t happen the absent seizures then, like, kind of lose consciousness. That\'s my one determinate. Yeah. Determine, yeah, and the last one is your psychogenic non epileptic seizures. So these imitate seizures look exactly like seizures when they come in, but they\'re actually triggered by emotional events, not actual that excited neuro activity. A lot of times, once you dig deeper, you\'ll see that there\'s a history of emotional or physical abuse or some kind of specific trauma. Yeah. See on your proper diagnosis requires video EPG monitoring feedback, because this EPG will show you that there\'s not that electrical activity going on for that seizure. And a lot of times with these therapy and helping people kind of deal with that trauma. Next speaker says epilepticus, this is any feature lasting longer than five minutes, or these seizures occur so close that the patient cannot recover from it, so there\'s gotta work Afrika, and the patient doesn\'t Return to consciousness. And this is a neurologic emergency, the longer these people are having these seizures, the less likely it\'s going to stop on its own without any kind of medication. And again, like we talked about, you can have that decreased oxygen, because, again, the longer the bees are going, the brain is using more energy then the body can actually supply. So you\'re going to have that potential for decreased oxygen and the inability for the brain to return to anti kind of normal functioning because of that containing the salt within the activity. So a lot of these are from Substance Control, a hand injury, cerebral edema, infection and infection or metabolic disturbances. What did you say between edema and the electrolyte imbalance? Thank you. So you can have compulsive Status Epilepticus. You have non convulsive and then the big ones are sub clinical, which is a form that happens to sedate patients. So you don\'t have any of that external right or sedate so you can connect to see those external manifestations, usually. So so this picture, and I thought was a really great summary reference to go back to, but just a couple touches on it. I said a couple times known EPG, does that electrical recording really where in the brain that those seizures are happening? The CT, MRI and MRI, MRI PET scan are used to identify the rollout pet causes. Those medications that are given in. Important to make sure that your patient is taking those at the same time every day, so that they have that constant follow up, right? Not a P makes sense. The big thing is there is a potential to develop tolerance to seizure medication. So if this happens a lot of times, we\'ll do blood levels a little more frequently to adjust those medications. So it. So we have, you know, they can do surgery. They will never end stimulation, responsive neuro stimulation. They also have a fatal nerve stimulator, but this is only for focal seizures, which are which seizures? I\'m sorry, yes, right walk right in traffic. So they can do surgical seizures, surgical resections, if you\'re able to pinpoint where it is from the lobe, this is really kind of a last ditch effort a lot of times, all of the time, when all other fail, but they\'re still having these horrible features that are because you take out some of somebody\'s brain, don\'t always know what\'s going to happen. Gonna happen afterwards, right? And then you also have the increased risk for infection, and then they go in there, you do the surgery, you come out, no texture, anything like that, but it potentially may not even work. So again, this is one of those last silent ditch. So the big thing when somebody is having a senior is observing and noting right what happened before, what happened during? What happened after? You want to be as descriptive as possible during your teacher with any kind of all of your documentation that you\'re going to do when you\'re talking to the doctor, if you don\'t get there the initial start, if somebody was there, you can get your exact account of what happened safety wise during a seizure, you want to make sure that you\'re maintaining that either way, like we said, when I have your oxygen and your suction nearby, how do you think you can quote, unquote, manteen and airway when Somebody\'s having a seizure, turn them on their side, right? Do you want to lay it on their back? No spray, right? And again, you want to have suctioning nearby. But while somebody\'s in that seizure, you don\'t want to go out with a suction, right? Yeah, it\'s hard plastic, but still, they can bite that off, and they\'ll have a seizure. If they are out of bed, you want to move or then to the floor, right? Don\'t want to just walk. You want to make sure they have that loose clothing. And then, has anybody had somebody who had seizure precautions? Yeah, yeah. What do they do? Bed pads are rails. Pad the rails, right? You have all four rails up in padding. Is it considered restraint safety, right? And you want to have the bed on the lowest part of the floor, because, even though you have these side rails, because paddings, people can still so you want to make sure you note the time of the start of the seizure and the end. And then again, anything that happens in that post April phase, if they\'re confused, if they\'re awake, if they need reoriented, anything like that. You also want to, even after they are finished, make sure that they are still sidelined again to help prevent aspiration as they\'re kind of waking up and getting out of that drowsiness, you make sure you do a set of vitals, a full neuro assessment, which you all know how to give you the claim right assess for any kind of injury. I. And again, bring more green oriented if needed, give them a period of rest. And when they are able to, we want to ask them again if they\'ve had Laura or proger symptom. And again, is that patient and caregiving teaching, because when they are home, more than what family have you ever sent them to do those really kind of same observation, document, documentation, what happened before? Were there any normal symptoms or anything like that. Okay? The other thing is that anybody who has a seizure cannot drive for six to 12 months after that seizure. So they can go five and a half months have a seizure. So a lot of these people don\'t even have driver\'s license six to 12 months. Any questions? I All right, so you\'re providing discharge instructions to a client who has epilepsy. Which of the following instructions should be included in the nurses teaching one? So 122, are you going to do one? Yes, two, three, no, five miles, six to 12, four, oh, she said, if you went five months, six, now, I six, right? So I didn\'t tell you that they can\'t find ladders. I didn\'t tell you that they should be power pools. But from what I told you about a seizure, we introduced the best, probably bad. So next is restless today in rounds, and it\'s exactly basically what it does, right? You\'re going to have movement disorder with unpleasant sensory and motor abnormalities in one or both of the legs. This is more common in older adults and women, and this can be lifelong. Again, there\'s no chair. They do have primary and secondary, or primary is idiopathic law, and then they have to be secondary, which occurs with metabolic problems like iron deficiency and renal disease. A lot of pregnant women will develop RLS. This can range from minor discomfort to severe pain. It can be relieved by walking, stretching or rock or rocking. Somebody wants to do it for him, right? So RLS is diagnosed on a patient\'s history, and then five criteria. Those five criteria are and overwhelming urge to move the legs, often with uncomfortable sensations. The second is the urge to move the legs worsens during rest or inactivity. The urge to move the legs is partially or totally relieved by movement the the urge to move becomes worse at night or in the evening, and It cannot be attributed to any other disease process. So a lot of times, if it\'s just that minor discomfort, a lot of times, treatment for them is just taking a walk. Before then or something like that, to medication treatment like gabapen or anti seizure drugs. I does anybody have questions over any of that? So many questions over what we\'ve gone over so far. Anybody need to take a break before we dive into this? We\'re kind of brain drinking. Yes, yesterday, that snacks back here. I was defending myself. Are You, I\'m I need To Yeah, you\'re. Don\'t feel bad. You\'re not alone. I It\'s COVID I Me the old age. Age. No, honey, I\'m older. I Test snacks Back why? Not this weekend, though, I\'ll be there tomorrow. Are you? Do you? Do yours? Mainly, yes, it was so much we get much over there, and that would help us. Someone else. I like being with him. He\'s good, oh yes, yeah, it would help. I finally got my Er, yeah, I got Sunday In November. It would be you will eventually, I he\'s gonna work his name like called it back. Oh, even on the floor that I\'m on, I would love something because, like, because It\'s five to 30 nights and they\'re like easy fucking patients, because they fucking like something like You will break out in Alaska, they have to be like It\'s more internal, cold flashes. I was dumb those so spicy. You will have to just bring a hater. I know he did. Is this before the all the time, yes, oh, I go through penis, penis piece. The new favorite for avian is Alzheimer\'s disease. I\'m just telling you, I don\'t know if that\'s gonna be new favorite influx, but she went over I\'m sorry she went over it a lot today. Yeah, it\'s the new favorite Alzheimer\'s they this is a non reversible type of dementia progressively develops over many years. Dementia itself is defined as multiple common drawings, but I want you to be aware Alzheimer\'s, are you trying to manage what it\'s multiple cognitive deficits that can affect language, motor skills and or abstract thinking. I do want you to know that 60 to 90% of dementia are people with Alzheimer\'s disease. There is an estimated 6.7 million people in the US alone with Alzheimer\'s, and in the next 25 years, it\'s predicted to double. That\'s pretty significant. 90 people with dementia have Alzheimer\'s. 6.7 million people have Alzheimer\'s, and it\'s predicted to double by 20\. It well? Now is it because people are living longer, so more people are being diagnosed? Alzheimer\'s is one of the leading causes of death in the US, particularly for those over 65 Alzheimer\'s can be diagnosed as early as 40 but again, it\'s Mostly people in nursing species. The mean duration of those that are diagnosed with Alzheimer\'s is about 10 to 20 years after diagnosis. The mean duration after diagnosis is 10 to 20 years. So with Alzheimer\'s, there\'s actual changes in the structure and function of the brain. These include amyloid plaques. What are amyloid plaques? Yes, for protein, they can have neurofibrillary angles, a loss of connection between neurons themselves and even neuro, yeah, I\'m sorry what that was, the Emily file, neurofibular, angles. Okay? Anybody? Steps, depending on again, where you read, it will say that there are seven stages, or it will say that there are three categories. So I have this. Hopefully this makes sense. So your categories are going to be your mid to early, your moderate to middle and your severe. Okay, those are your three and the stages in there are your six and seven and your four to five. Does that make sense? I just want you to be aware what\'s included in what depending on what you see. This is not adopted universally, but it\'s what is generally used for healthcare, yes, so that mid to early you\'re going to see your manifestation, you\'re going to have those memory lapses, those being memory las in, your patient will be losing or just kind of misplacing items. Put my teeth here. I thought, don\'t work. I don\'t think material you just read to recall it or read it. I\'m sorry to recall it me too, but this will help you write with a new question, self diagnosing. Nice, these patients are still able to perform all of their ADLs independently. They\'re going to have that short term memory loss, but you and I probably are not going to recognize that. It\'s going to be those close relationships that they have, close family, close friends, they\'re going to leave a notice those changes. They could have trouble remembering names when just introduced to people, same and then they\'re going to have that greater difficulty of performing tasks when under stress, much longer. That\'s all of the above. So the next is dramatic to middle stages. This is when they\'re going to start forgetting and then send their own personal history. They\'re going to have difficulty performing tasks that require planning or organizing, like paying bills, going grocery shopping and getting what they need to put together. They\'re going to have difficulty with complex mental arithmetic. So those, for some people, that even addition and subtracting, right? Are you starting to have those personality and behavioral changes? Somebody who\'s really outgoing could be lifted withdrawn now, or kind of subdued, or somebody who was a little bit subdued is now extrovert, right compulsive. So those behavior changes. They have changes in their sleep pattern. I. They can start to go out and familiar areas and get lost, just kind of wander around ladder I it, and then you have your severe or late, and this is where they completely lose that ability to relate and converse with others. They\'re going to need assistance for almost all of their ADLs. They will, more than likely, will we be incontinent? They\'ll have complete loss of their own environment, awareness of their own environment, really in their own house, not really know where they are, but they\'ve lived in for 20 years. They\'re going to have progressing difficulty with any kind of visible activity. So walking, even sitting, and this even progresses to chewing and swallow. So this big rose motor walking to even the fire and the severe and late stage death is often related to choking or an infection like aspiration, so progression for patients are different. For every patient, really progression, quick progression, they could go from being able to have that conversation with people to not be able to the main risk factors are age right. One of them are \'s and 70s, again, can be as early as 40. They have noted those that have a family history are at an increased risk again, those chromosomal like Down syndrome. Great, wonderful, ethnicity and race, African Americans and Hispanics are at an increased risk and any kind of previous head injury, environmental agents like toxic waste or some metals and then viruses like herpes, there are no specific causes, no specific labs that can definitely be diagnosed. Alzheimer\'s. A lot of the tests that they use are to rule out other possible scenarios. So you\'re still going to see them having an MRI, a CT scan, a CAT scan, a scan, and even an ag right to see if something else is going on. They will do ar puncture and and they will do a genetic test. And the reason they do it, you know, I don\'t know, colloquial, protein can determine if there\'s an increased risk. So if that\'s in some genetic testing, it increases the blood sugar. Does anybody want to spell that? You don\'t have to know what I can. Right? I\'m trying to say against people. So drug therapy, again, any kind of drug therapy stations is not going to it will, at best, slow, slow the progression. And for some people, that doesn\'t even work. A lot of them are anti psychotics, antidepressants and anti anxiety medications, or a combination, depending on what they can eat. One of the big ones that they\'ll use are parents. And these are an anti psychotic to treat, to treat any kind of related psychosis, they use donut Bazel. This prevents the breakdown of acetylcholine when you had more acetylcholine pulses right juncture. The big thing that you want to be aware of again of your patient\'s history, because babies can exacerbate somebody who has COPD or breathing problems exacerbate that effect. Some alternative therapy, they\'ve noticed, estrogen therapy for females, can help a lot with decreasing the effects. And this is where you might find that people are taking their ego a little bit, right? Anybody heard that? Yet, with their older people, they take it because they think it can help with memory. And this is where it\'s really important to know what people are taking over the counter, because Bucha biloba is a famous one that it does increase blood circulation and memory, but it has a lot of adverse effects when taking on some of these medications. So you want to make sure that that is out of your system where you kind of do any other otherwise you can have these medication interactions. You want to provide a safe environment for these people, right, especially these later stage you\'re gonna have those frequent monitoring and visual checks. A lot of places have hourly rounding repeated between your head and hurt yourself. These people may need more than that. They may have the meal monitoring, or even consider bedside you want to provide good lighting again. You want to make sure you\'re doing that good nursing assessment right, checking that mental status of your patient, because a lot of times these people will experience a lot of people will start experiencing sundowning. See, my time at sundowning is, I\'m sorry, they get more aggressive at night and anxious they can\'t tell you why. There\'s really no exact reason they know why it may be a circadian rhythm. So sometimes people will have it even early afternoon. So giving them as much exposure to sunlight as much as possible is really big help redirection on environment. Want to the big thing is one that masks and Hacking, right? That was terrible. Dude, my mom, she was yeah is extreme enough, they may the healthcare provider may give them like try to tell them their tribal so. Um, especially earlier. In other stages you want to provide, you still want to provide that COVID simulation. If you can go on three blocks, if you\'re, um, I haven\'t ever worked on the floor, but people on floors are able to get out and walk right, um, without a nurse or a friend. But again, they get lost for certain under go detect Bucha. But as always, you don\'t want to over stimulate, right? So if it\'s peak time, like during rounding, if there\'s like meal passing or that kind of stuff, if you keep them in the room, or doable environmental, if that makes sense, clustering your hair again, if you can keep those noises to a minimum in the early stage, you do want to frequently reorient them if needed to time and place, have that clock visible. Have a calendar visible. Again, circadian rhythm. Have the windows open any patient, it\'s really great if it\'s able to have family bringing pictures of themselves that are really close to the family renovation and their pets. Those really want to help reorient that I told you in late stages, right? They may not even know their own health, so they\'re not going to know you. They may not know their family. And this is scary, right? That can be scary to somebody. So they agitated. A lot of anxiety. Be very argumentative, but you do not want to argue with them. And these are also you also often, are probably going to be able to reorient them, right? It\'s just going to make them more frustrated if they\'re living in 1946 Well, I live in 1946 women. Okay, so please be the nurse that does your frequent skin checks, even if these people are mobile, right, they could have run into the side of something and not be able to tell you that they remember, right? Do your skin checks. I told you in the mid to late pages that you come in constant right, check them. Make sure they\'re not getting that skin breakdown, that kind of stuff. So they may get to these stations, hopefully get to the point that they get to go home. So again, you would have that safe environment. So you\'re gonna do that family teaching, if possible, keep away from stairs. It\'s needed, again, depending on where they are, teach family that they need to basically lock their house up like they had a child, right? You need to lock up your medications, lock doors, maybe have a lock that\'s not like in eyesight, line of sight, one up top. Have alarms on windows, doors. It\'s important it\'s able, and they tolerate to have them wear a medical ID bracelet, and they\'re kind of in that middle stage at home, so that there\'s an emergency. Whoever is helping a little bit, installing handrails and showers nearby the toilet again, because you want them to be as independent as possible for as long as possible. Make sure Social Services is on board, not only for the patient, but for family as well. It\'s hard to see your loved one kind of they\'re there, right? But necessarily their mind isn\'t. That\'s hard part on the family, sometimes, especially in late stages, and it isn\'t necessarily the patient. So so a nurse is caring for a client recently diagnosed with Alzheimer\'s disease, and is providing teaching to the client and their family which of the following statements by a family member indicates the need for further teaching you. Is it a. There\'s little blacks and tangles. That\'s not the answer, right? There are Blacks, right? That I told you, amyloid black and major tangles, right neurofibrillator tables, protein deposits block communication in the brain, causes memory loss. Did I tell you to apply schools? Protein deposits, there\'s a lack of oxygen in the brain, causing changes in behavior we\'re seeing. I say anything about oxygen in the brain, so C, right? So why is D inflammation and high cholesterol that ultimately leads to tables in the brain that cause memory loss. Just told you, right? I didn\'t say anything about inflation high cholesterol, but you know that high cholesterol is what life goes up, right? Yeah, it\'s gonna leave angles in the brain. Does that question confuse anybody? She\'s gonna be interesting. You have questions. It ain\'t no big excuse. The same thing, right? But I think some of you still pause. That\'s why I tell you plaques, right? But it\'s also proteins. I need you to be able to understand both, because NCLEX is going to give you right. May not always use the same for me to do the same, but it\'s the same. Teaching a client who is newly diagnosed with Alzheimer\'s disease, and they\'re mainly about daily prescribed medications for Alzheimer\'s disease, which statement by the client and in case he was infected, medications will help me remember what I forgot? No, medications will slow the progression of the disease. Yes, medications will help increase my energy levels. They will hear the disease, right? Nothing that we\'re talking about today is gonna happen here? Okay, so that\'s even an option. Just may have questions about that. Multiple Sharon, progressive, irreversible, autoimmune neurologic disorder. So a lot of these unknown etiology multiple sclerosis can be diagnosed in people as young as 20, often to 50. Women are two to three times more likely or more often diagnosed, and a lot of times there\'s a family history of the first degree relative that has multiple sclerosis. So again, in that family history be really important. So I told you that the cause is unknown. They do think it\'s a combination of genetic and environmental factors. So what happens if there\'s an immune mediated attack or infection that destroys the myelin sheath on your neuron. So the myelin sheath helps with the conduction of nerve impulses, but it\'s gonna have an empirical chip, right? If there\'s an infection or something destroying their sheet. Does that make sense? Neuron level? Throw that back. So you\'re still going to have conduction, but you can have Inferior function. Inflammation will eventually cease, and you\'re going to have full or partial recovery of that myelin sheath. But this continually happens, right? So what happens when you continually have something scars, you know, you\'ll go back to that no tissue that generated before? Right? So it\'s the same thing with this. So as that inflammation continues, that destruction of the myelin sheath continues, it\'s going to lose its ability to regenerate, and it\'s going to eventually damage that underlying taxon, which is going to damage what your normal pulses, right? You\'re not going to have that big conduction and this can lead to that hard the formation of hard, rigid plaques, leaving the axons completely and unable to regenerate, and causing irreversible damage. I Sorry, so manifestations can be slow and gradual, or they can be a rapid progressive degeneration. What you\'re going to see a lot is a slow and gradual because, again, initially that myelin sheath that axon is able to regenerate, right? So are you going to probably notice that? Is the patient probably going to notice that probably not so a lot of damage is probably already happened before the patient\'s going to start seeking out initial but either way, you\'re going to have that increased disability because you\'re going to have that continual damage done and inability to the this shortens the lifespan by an average of seven years. So manifestations vary depending on where in the central nervous system. And again, this picture is in your book, but I thought it was really great to break all this down. Gives you kind of the impairments that you can see. A lot of people are going to have some kind of bowel or bladder interruption. They\'re going to have that fatigue pain. So fatigue is a symptom, right? They can be diagnosed as young as what, right? So in your 20s, when you retire, would you thought, Oh, right. So again, that\'s why you will see sometimes that a lot of damage has happened before. People are really seeking out. I do want you to know that the sensory doses can go as far as somebody being blind for a period of time or having a really impaired hearing the hearing loss. Can you know what table this is? I do not I apologize. I so again, there\'s no one specific test. Again, those manifestations are really going to help. Oh, so yes, I do have right here, MRI reveals class of the Brandon spot. No, no, I\'ve never I have to, like, double check myself. Yes, and that is most diagnostic. It\'s not definitive, but it\'s the most diagnostic. They will still do lab tests, of course, with the CSF analysis, and we\'ll see elevated protein. So with the diagnostic criteria you\'re gonna have, you\'re gonna have evidence of at least two inflammatory, demyelinating patients in two different locations in the CNS, and a lot of times again, they\'re gonna have way more than these when they do that testing, you\'re gonna have two or more attacks occurring at different times. Then again, all other diagnoses are ruled out. No one case is the same, which makes sense, right? There\'s all these different areas in the brain. And again, it\'s symptomatic, so the disease modifying drugs suppress that immune system to hopefully help modify that progression and prevent the glasses. So with acute exacerbations. They need support those steroids to help reduce that inflammation, and they do those large doses over three to five days with that taper vital zone, it\'s important that you make sure that they take their medicine, if they\'re they go home and take that paper. Okay, that just opens them up to they could do IV monoclonal antibodies like this work, um, this word binds to the white blood cells, and it\'s actually been an outpatient facility. It\'s important, again, that you do education, because again, this is an outpatient this binds to the white blood cells, so these people are at risk for more opportunistic infections, depending on the their manifestations, another one is given baclofen is Given a lot for those that have muscle spasticity. I something like P, T, O, P, water therapy third grade, they could have conditional versus surgeries or having those severe muscle spasms and not really having a very good therapeutic with any other kind of medication. Another one that I want you to know that I don\'t have on here is called interferon beta one A and they don\'t want to be this is also an injectable agent used frequency and relapses, but It\'s done early in the course of the disease. So so I told you, this is an autoimmune disease, so a lot of factors can trigger or cause worsening effects, like virus and infections. Living in an old climate, actual physical injury, pregnancy, fatigue, I emotional stress or hot shower or back. So again, I told you, a lot of these have bladder and bowel symptoms, so you may need to do a lot of Patient and Family teaching, encourage those fluid intakes to decrease the risk of UTIs to the point that they may even need to teach self caffeine and doing a toilet voiding schedule you want to help facilitate effective communication between The Patient and Family. Exercise and stretch involved muscles, but again, not to the point of fatigue or where they start to get overheated. All right. Again, this for PT OT is really important. You want to monitor those cognitive changes and have those interventions to promote cognitive functioning. So it. And then simple things, like, if they have Dipolog, making sure they rotate until, hopefully the place that. It next is Parkinson\'s disease. So Parkinson\'s is a chronic progressive neurodegenerative disorder characterized by that slowness and then initiation and execution of movement, also known as bradykinesia, increased muscle tone, rigidity, tremor met rest and gait changes men are one and a half times more likely to develop Parkinson\'s disease. About 1 million people live with Parkinson\'s disease, with about 60,000 newly diagnosed every year, but the average onset of Parkinson\'s is 70. Again, the exact cause is unknown. They do think that there\'s an interplay between genetics and environment, and when I say environments, I\'m talking about, again, those exposures to toxins or chemicals. And there\'s a high instance of people that work in healthcare, and those that have a traumatic Brain ramp injury had an increase, shown increased risk, and also those have a nodal history in about 20 to 25% of people that get diagnosed, so you have That degeneration of dopamine producing neurons in the midbrain. So the initial symptoms do not occur until 60 to 80% of those neurons are lost. Pretty significant, right? So the degeneration is going to disrupt balance between dopamine and acetyl COVID, right? What is dopamine? Essential? Essential for happy you\'re happy, also for your normal functioning of your motor system. Your motor system controls what your posture, your ability to move. These people will have moody bodies, and again, these are pumps of protein in the brain, and they do not know what causes this. Okay? Disease. Parkinsonism is a syndrome made up of disorders that look and mimic Parkinson\'s disease, but it is not Parkinson\'s disease. Okay. Again, that\'s why it\'s important to ask those questions about from people, because if it\'s an exposure to chemicals, metals or drugs, removing that exposure often gets rid of these symptoms. So it\'s not Parkinson\'s, right? Because we can there\'s here, right? It\'s Parkinsonism. It looks like it acts like it, but you remove what\'s causing it. You remove some of these are lithium, albertal, methamphetamine, hydrocephalus, infections or strength so.