Neurologic Disorders - Ischemic & Hemorrhagic Stroke, AVM, Bell's Palsy, & Nursing Management PDF

neurologic disorders Prof. Sittie Adaweyah L. Macabago, DM-HCAc, MAN, LPT, RN  A cerebrovascular disorder is an umbrella term that refers to a functional abnormality of the central nervous system (CNS) that occurs when the normal blood supply to the brain is disrupted.  Two major c...

neurologic disorders Prof. Sittie Adaweyah L. Macabago, DM-HCAc, MAN, LPT, RN  A cerebrovascular disorder is an umbrella term that refers to a functional abnormality of the central nervous system (CNS) that occurs when the normal blood supply to the brain is disrupted.  Two major categories: (1)Ischemic stroke (2)Hemorrhagic stroke  An ischemic stroke, cerebrovascular accident (CVA), or “brain attack” is a sudden loss of function resulting from disruption of the blood supply to a part of the brain.  5 different types based on the cause: (1)large artery thrombotic strokes (2)small penetrating artery thrombotic strokes (3)cardiogenic embolic strokes (4)cryptogenic strokes (5)Other rain Aneurysm ) 8,5440,  Risk factors  Hypertension I Atrial fibrillation  Hyperlipidemia  Diabetes Mellitus = Smoking  Asymptomatic carotid stenosis  Obesity = Excessive alcohol consumption Clinical Manifestations:  Numbness or weakness of the face, arm, or leg, especially on one side of the body  Confusion or change in mental status  Trouble speaking or understanding speech  Visual disturbances  Difficulty walking, dizziness, or loss of balance or coordination  Sudden severe headache  Primary prevention of ischemic stroke remains the best approach. Stroke risk screenings are an ideal opportunity to lower stroke risk by identifying people or groups of people who are at risk for stroke and by educating patients and the community about recognition and prevention of stroke.  STREPTOKINASE - used to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain. NURSING MANAGEMENT  SOP nursing care  Medications  Laboratories (blood chemistry)  Provide information on the disease and preventions  are caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space. Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled hypertension. Types: (1)Intracerebral hemorrhage (2)Intracranial (cerebral) aneurysm (3)Arterio-venous Malformations (AVM) (4)Subarachnoid Hemorrhage  Exploding headache  Decreased level of consciousness  Sluggish pupillary reaction  Motor and sensory dysfunction  Cranial nerve deficits  Speech difficulties and visual disturbances  Vasospasm  Seizures  Hydrocephalus enlargement  Re-bleeding  Hypo-natremia - t sodium \  Modifying lifestyle  Control of hypertension  Diet modification  Exercise  The patient is closely monitored for neurologic deterioration resulting from recurrent bleeding, increasing ICP, or vasospasm.  A neurologic flow record is maintained.  The blood pressure, pulse, level of consciousness, pupillary responses, and motor function are checked hourly.  Respiratory status is monitored, because a reduction in oxygen I areas of the brain with impaired auto- regulation increases the chances of a cerebral infarction.  Primarily supportive and consists of bed rest with sedation to prevent agitation and stress, management of vasospasm, and surgical or medical treatment to prevent re- bleeding. Analgesics may be prescribed for head and neck pain.  The patient is fitted with sequential compression devices to prevent deep vein thrombosis (DVT). An abnormal tangle of blood vessels connecting arteries and veins. Age: 20-40yrs old Pregnant women Family history Hereditary Buzzing sound Changes in vision Facial paralysis Drooping eyelids Speaking problems Change of smell sensation Headache Backache Seizure Loss of sensation Muscle weakness Mobility problems Dizziness Loss of consciousness Cold fingers and toes Unknown Emerge from fetal development Anti epileptic drugs (phenobarbitals, carbamazepine, clonazepam) - - NURSING MANAGEMENT ECG Monitoring (ST and T wave changes) Life threatening dysrhythmias ICP montoring 15-30mins BP Monitoring Monitor for headache GCS monitoring Be alert for any sudden changes Avoid activities causing increase ICP  NURSING MANAGEMENT Maintain pt airway Lessen environmental stimuli Administer meds as ordered Sedate and give stool softeners Embolization, re-sectioning vessels assistance Endovascular embolization Stereotactic radiosurgery (>>Degeneration/trauma/congenital >>>Spinal nerve compression >>>motor movement problems >>> pain - May happen w/o symptoms - Symptoms may depend on location, size, rate of development, and effect on surrounding structures  CERVICAL (stiffness in the neck, shoulders, region of scapula, pain in upper extremities, parenthesis, numbness & weakness of upper extremities) LUMBAR (low back pain, sensory and motor dysfunction, pain radiating to buttocks down the leg, postural deformation, + Straight-leg raise test, weak & asymptomatic reflexes, sensory loss) - Myelogram - CT scan/MRI - ELECTROMYELOGRAPHY (localizes spinal nerves) 1. Permanent neurologic dysfunction 2. Chronic pain w/ psychosocial issues 1. Apply moist heat to affected area 2. Use bed boards under the bed 3. Encourage relaxation techniques 4. Apply back braces 5. Assist activities in bed 6. Massage and skin care 7. Encourage physical therapy treatments 8. Encourage lifestyle changes 9. Discourage prolonged bed rest 10. Refer for vocational counseling 11. Teach how to apply traction when at home 12. Inspect skin regularly 13. Administer pain meds Bell's palsy occurs due to virus. It paralyses only the facial muscles of one side. In this disease there is an inflammation on the seventh cranial nerve, which largely occurs due to wind, infection or damage in the ears. virus (Epstein Barr, herpes or cytomegaly) >>> nerve infection >>> facial paralysis >>> prolonged untreated causes permanent facial distortion - eyes do not shut completely - mouth gets twisted and saliva dribbles from one side. - The affected cheek cannot be blown completely - Sometimes there can be pain behind the ear - extra sounds in the ears - loss of taste in the tongue. - Steroids - optimum physiotherapy - proper eye care - use of antiviral agents (like acyclovir in herpes virus infection) - supportive measures In this disease, there is progressive cell degeneration in the region of the brain known as substantia nigra reducing the formation of an extremely important biochemical substance, dopamine. It spreads to other side after few years. >>> aging-/unknown >>> degeneration substantia nigra >>> decrease production of dopamine/inability to absorb dopamine properly >>> motor involuntary mov’ts ─ lethargy - decrease in co-ordination - Tremors - rigidity of muscles - fingers of the hands and legs shake in a peculiar manner (pill-rolling movement or rhythmic movement as if the patient is counting money.) - stoops and his gait shuffles and there is poor arm swinging - Slow movement - Muscles slowly become rigid - Handwriting becomes smaller - Speed of walking becomes slow - decrease in memory - depression with increased perspiration and body ache - no treatment or medicine available to -stop the destruction of the cells. - Exercise TO LESSEN THE PROGRESSION - Counseling - Medical treatment consists of levodopa (able to cross BBB) - Nutritional evaluation  TB Meningitis  viral/fungal  There is a possibility that the tuberculosis in the chest may be there for a long time, but a decrease in the immunity of the body due to any cause may result in TB of the brain. It crosses the BBB. >>>HAEMOPHILUS INFLUENZA/STRPTOCOCCUS PNEUMONIAE/ CRYPTOCOCCAL M./CANDIDAL M./ NOSOMIAL M. >>> cross the BBB for IMMUNE SUPPRSSES CLIENTS >>> Cell reactions >>> inc. ICP >>>PHYSIOLOGIC SX/S. 1. H/A 2. FEVER 3. ALTERED MENTAL STATUS 4. RASHES 5. PHOTOPHOBIA 6. NUCHAL RIGIDITY 7. BULGING FONTANEL (pedia) 8. poor feeding 9. altered breathing 10. seizures - CBC - Blood culture - Lumbar puncture ( low glucose, leukocytosis, + gram stain bacteria) - MRI/CT SCAN  (brudzinski sign – kernig’s sign) DRUGS:, rifampicin (RF), isoniazid (INH), pyrazinamide (PZ), and ethambutol - streptomycin injections - OBTAIN HISTORY OF ILLNESS - Monitor temp. - Prevent IVF Overload - Monitor ICP - Monitor LOC - DARKEN THE ROOM - PROPER POSITIONING - Administer meds - Passive to active exercise myelin sheath or white matter is affected are known as demyelinating diseases. Progressive disease P - head toe  Demyelination >>>>disordered transmission of nerve impulses >>> autonomic dysfunction >>> infection occurs >>> cell reaction >>> s/sx occur blood tests MRI C.S.F. test (increase in cell count, increase in protein levels-gamma globulin.)  (females/15 to 50 years)  - Paralysis of one or more parts of the body:in 35%  cases.  - Loss of vision or diplopia: in 36% cases  - Loss of sensation in some parts of the body (in 37%  cases) or abnormal sensations like pricking of needles  - Loss of balance, vertigo, problems of bowel and  bladder movements.  - Loss of memory and seizures.  - Tremors of limbs, pain, and problems in sexual life,  mental disorders ranging from insanity to depression  may be seen.  - severe pain, tremors and stiffness of limbs, bowel and bladder, problems, weakness, lethargy, problems in sexual life and mental depression which should be treated symptomatically. - Corticosterooids (inflammation) - When progression starts, methotrexate, azathioprine - Gamma-globulin therapy - Bladder management - Bowel management - Occupational therapy - Multi disciplinary rehabilitation - Control dystonie by carbamazepine(tegretol) - Respiratory dysfuction - Infection - Sepsis - Immobility - Speech, voice, and language disorder  Chronic autoimmune disease infecting neuromuscular transmission of impulses in the voluntary muscles  - a painful and long-term disorder  of the nervous system affecting muscles.  -descending progression (Acetyl choline deplition)defect is found in the transmission of the impulses from the rerves to the muscles though the nerves and the muscles themselves are found to be absolutely faultless.  weakness of the eye muscles  laughing, chewing, swallowing, speaking and the movement  of limbs are affected (sometimes)  *** Drooping of one or both eyelids.  - Imbalance, weakness and lethargy in walking.  - Weakness in hands as well as fingers.  - Difficulty in swallowing food.  - Difficulty in talking, lowering of voice while talking,  sounds from the nose.  - Problems of respiration. - Acetylcholine receptor antibody test.  - EMG - nerves are stimulated electrically, which  can demonstrate the defect in their capability to conduct  the impulses.  - Tilstigmin test : If an injection of tilstigmin gives immediate relief in the symptoms, it is considered as the confirmation of the diagnosis. - CT Scan thorax - Thyroid function tests  Anticholinesterase drugs like neostigmine or  pyridostigmine - strengthens the impulse going from the nerves to the  muscles. helps in the availability of acetylcholine for  a longer period, increasing the contractibility of the muscles.  -STEROIDS  - Immunoglobulin therapy, in which immunoglobulin collected from the blood of healthy individuals or prepared synthetically is introduced in the patients body  Acute, rapidly progressive inflammation demyelination polyneuropathy of the peripheral and motor nervous system. Autoimmune disease/Viral >>> demyelination >>> cell mediated immune response >>> axonal degeneration CSF Examination Electrophysiologic studiesbah - Paresthesia - Symmetrical progression of muscle weakness - Dysphagia - Dec DTR - DEC. VITAL Capacity - Spasms - Respiratory failure - Cardiac dysrrhythmia - Immobility complication - Anxiety and depression - Maintain respiration - ET tube at bedside - Avoid narcotics - Provide adequate nutrition (SFF) - MAINTAIN COMMUNICATION - Relieve pain by medications - Relaxation techniques - Reduce anxiety - Health education  A free or0 capsulated collection of infection material of brain between the dura mater and the arachnoid lining or between dura mater and the skull.  Spinal abscess typically occur in the epidural, subdural and inter-medullar regions S. AUREUS /M. TUBERCULOSIS (E.A) >>> Inoculation of organisms >> Invades the brain parenchyma (local inflammation, edema) >>> celebrities >>> necrotic lesions (lack of oxygen supply >>> increase ICP >>> Siezure, Dental Abscess 1. CT Scan, MRI (contrast medium) 2. Blood culture 3. Culture examination 4. EEG  1. Headache (dull)  2. Nausea & vomiting  3. Dec LOC  4. Fever  5. Hemi-sensory and paresis deficits  6. Aphasia  7. Ataxia  8. Seizures  9. Dental abscess  10. Sinusitis,  11. Otitis media  12. Backache 1. Abscess rupture 2. Papilledema 3. Permanent neurologic deficits  NURSING INTERVENTIONS - Basic safety measures. - Evaluate cranial nerve functions - Provide comfort measures - Provide relaxation techniques - Refer to therapy specialist - Administer meds - Patient education BRAIN TUMOR  proliferation of normal cells 0 within the CNS. It can be metastatic tumor. >>>Unknown/Lifestyle >>> formation of tumor >>> alterations on the neurotransmitter cycle >>> Physiologic function altered >>> Inc. ICP >> nausea/vomiting >> Complications arise  1. Astrocytoma – affects connective tissue of the brain (grade 1-2)  2. Glioblastoma – grade 3-4 of Astrocytoma  3. Oligodendrogliomas – arise from frontal and temporal lobes  4. Medulloblastoma – arise from medulla oblongata  5. Acoustic neuroma – develops in 8th cranial nerve 1. Generalized: headache, vomiting, papilledema, malaise, altered cognitive function and consciousness 2. By area:  -parietal (sensory alterations, speech and memory disturbances, visuospatial deficit, depression)  -frontal lobe (personality, behaviour, memory, changes, contralateral motor weakness, brocha’s aphasia-speech) 2. By area: - -Temporal lobe (memory disturbances, auditory hallucinations, wernick’s aphasia -comprehension) - Occipital area – visual agnosia (familiar objects), v. field deficits - Cerebellar area – coordination, gait, and balance disturbance - Brain stem – dysphagia(s), incontinence, cardio instability, resp. depression, coma, cranial nerve function  DIAGNOSTIC EXAM - Skull X-ray - CT Scan - EEG – focus of irritability - Lumbar puncture - MRI - Biopsy  NURSING INTERVENTIONS 1. Prevention of injury 2. Reduce risk of Increased ICP 3. Monitor responses to medications 4. Monitor for changes in coordination and senses 5. Maintain suction and oxygen at bedside 6. Elevate HOB to aid dysphagia  NURSING INTERVENTIONS 7. Provide safe and sound environment 8. Monitor changes in the lab results 9. Health teaching 10. help patient expression of feelings 11. Place personal things at bedside 12. Provide pre, intra, & post operative care