NEURODEGENERATIVE DISORDER (3).pptx

NEURODEGENERATIVE DISORDER   Neurodegenerative diseases are incurable and debilitating conditions that result in progressive DEFINITION degeneration and / or death of nerve cells. This causes problems with mov...

NEURODEGENERATIVE DISORDER   Neurodegenerative diseases are incurable and debilitating conditions that result in progressive DEFINITION degeneration and / or death of nerve cells. This causes problems with movement (called ataxias), or mental functioning (called dementias)..  Neurological disorders are diseases of the brain, spine and the nerves that connect them. There are more than 600 diseases of the nervous system, such as brain tumors, epilepsy, Parkinson's disease and stroke as well as less familiar ones such as frontotemporal dementia.  COMMON DISORDERS  PARTS OF THE BRAIN STRUCTURE S of the Brain BRAIN AND WHAT IMPACT DOES SPINAL THIS HAVE ON THE CORD IMPACT BODY?   Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to What is read or write. Aphasia is Aphasia? always due to injury to the brain-most commonly from a stroke, particularly in older individuals.  APHASIA - Expressive APHASIA - Receptive - Mixed/global - Dysarthria  NURSING ? DIAGNOSIS   Make sure you have the person’s attention before you start.  Minimize or eliminate background noise (TV, radio, other people).  Keep your own voice at a normal level, unless the COMMUNIC person has indicated otherwise. A-  Keep communication simple, but adult. TING  Give them time to speak. Resist the urge to finish sentences or offer words.  Communicate with drawings, gestures, writing and facial expressions in addition to speech.  Confirm that you are communicating successfully with “yes” and “no” questions.  Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly. COMMUNIC  Engage in normal activities whenever possible. Do A-TING not shield people with aphasia from family or ignore them in a group conversation. Rather, try to involve them in family decision-making as much as possible. Keep them informed of events but avoid burdening them with day to day details.  Encourage independence and avoid being overprotective.  language disorder marked by deficiency in the generation of What is speech, and Dysphasia? sometimes also in its comprehension, due to brain disease or damage. ASPIRATION PNEUMONIA PASSAGE OF FOOD STRATEGIES   Sit upright in erect position  Make sure the patient is sitting upright as possible – prop them up with plenty of pillow if they are unable to sit erect themselves.  Head tilted forward / chin down  Ask the patient to tilt their head forward with their STRATEGIES chin slightly forward – people often think that it’s CONTD. best to get patients to tilt their head back to open the passage down to the oesophagus, but this actually makes it more difficult to swallow.  Support impaired side of body  If a patient has one side weaker than the other make sure you support the impaired side.   Sit at or below patient’s eye level  When feeding patients sit down so you are positioned at the same level, or slightly below the patients eye level, this will make it easier for him/her to maintain their head in the most appropriate position. STRATEGIES  Place food in stronger side of mouth  If your patient has any facial weakness make sure CONTD. you sit on the strong and place food into the stronger side of the mouth to maximise careful feeding.  Sit on side which will maximise careful feeding  Take account of visual field deficits re-seating and food placement ICP CAUSES ?   Infections.  tumors.  stroke.  aneurysm.  epilepsy. CAUSES  seizures.  hydrocephalus, which is an accumulation of spinal fluid in the brain cavities.  hypertensive brain injury, which is when uncontrolled high blood pressure leads to bleeding in the brain.   Pathological Causes  Concussion  Contusion (Traumatic brain injury)  Subdural hematoma CAUSES  Tumor  Abscess/infection  Subarachnoid Hemorrhage *Increase ICP is an Emergency*   pupils that do not respond to light in the usual way  headache  behavior changes  reduced alertness; unable to follow commands  sleepiness SIGNS AND  muscle weakness SYMPTOMS  speech or movement difficulties  vomiting  blurred vision  Confusion  posturing   Change in LOC  Behavioural changes (irritability, restlessness)  GCS score  Increased BP (or widening pulse pressure), followed by hypotension  Bradycardia to Tachycardia (Cushing’s Triad) NURSING  Tachypnea (early sign). Then bradypnea to periods of apnea ASSESSMEN  Hyperthermia T  Inspect pupils and compare  Headache  Vomiting (may be recurrent, projectile)  Speech impairment  Babinski (present) GLASGOW COMA SCALE   If your patient is suspected of having an increased ICP, methods to reduce the pressure from increasing further include:  Maintain ABC  Maintain normal oxygen and carbon dioxide levels MANAGEME  Elevating the patient's head to thirty degrees, keeping their neck in a neutral position, NT  Avoid over hydration,  Maintain a normal body temperature (cooling, Tylenol)  Administer medication (Mannitol – hypertonic IV)  Foley insertion to monitor diuretic therapy: monitor I/O  Monitor blood glucose; avoid hypoglycemia   Draining the excess cerebrospinal fluid with a shunt, to reduce pressure on the brain that hydrocephalus has caused. TREATMENT  Medication that reduces brain swelling, such as mannitol and hypertonic saline MONITORIN G ICP   The intraventricular catheter is the most accurate monitoring method.  To insert an intraventricular catheter, a hole is drilled through the skull. The catheter is inserted ICP through the brain into the lateral ventricle. This MEASUREM area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal ENT cord.  The intraventricular catheter can also be used to drain fluid out through the catheter. Epilep sy   Abnormal electric discharge in the brain  May involve all or a part of the brain  This abnormal neuronal activity can impact skeletal motor SEIZURES function, sensation, and level of consciousness (Bauldoff et al., 2020, p. 1557)  Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, SEIZURES causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.   Temporary confusion  A staring spell  Uncontrollable jerking movements of the arms and S&S legs  Loss of consciousness or awareness  Psychic symptoms such as fear, anxiety or deja vu   Both absence and tonic-clonic seizures are Generalized Seizures  Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip TYPES smacking. These seizures may occur in clusters and cause a brief loss of awareness.  Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.  May have a warning aura (metallic taste in mouth)  Begins with loss of consciousness  Tonic phase cont’d: Urinary incontinence is common  Cyanosis develops during this phase  Pupils are fixed and dilated  Can last on average 15 secs (can go up to a minute) TYPES Clonic Phase: Alternating contraction and relaxation of muscles in all extremities  Hyperventilation  Froth to mouth, eyes rolled back  Tonic-clonic lasts 60-90 secs  (Bauldoff et al., 2020, p. 1558)   After clonic phase, pt remains unresponsive to stimuli  This is the postictal phase  May be confused after awakening/confused TYPES  Headache, fatigued and may sleep for hours  Amnesia (does not remember what happened)  Increase risk for head injures and fractures, burns, MVA with this type of seizures   Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down. TYPES  Status Epilepticus: Continuous seizures (acute, prolonged seizure activity.  Lasts up to 5 minutes  This is an emergency!  Antiseizure medications:  Carbamazepine  Clonazepam  Diazepam TREATMENT  Gabapentin  Levetiracetam (Keppra)  Lorazempam  Phenobarbital  Dilantin  Priority Nursing Diagnoses NURSING  Risk for Injury MANAGEME  Ineffective Tissue Perfusion NT  Anxiety  Ineffective Coping   Safety is paramount for the patient with Seizures  Provide a safe environment by:  Padding side rails  Remove clutter NURSING  Place bed in a low position MANAGEME  Do NOT restrain the patient NT  DO NOT PUT ANYTHING IN THE PATIENT’S MOUTH DURING A SEIZURE  Place pt on their side to prevent aspiration  Protect the patient’s head  Stay with the patient  AFTER SEIZURE TREATMENT   Maintain a patent airway until patient is fully awake (tongue may fall back and obstruct airway, pooling secretions)  Interventions include: Loosen clothing around neck  Turn on their side, do not hold down the patient  Provide O2 if cyanotic during seizure NURSING MANAGEME  Teach family members how to care for the patient during NT a seizure  Call for medical assistance if seizure last for 5 mins!  Stress the importance of taking medication as scheduled  Monitor serum levels for therapeutic range of medications  Monitor the patient for adverse effect of medications PARKINSON’S DISEASE   Parkinson's disease affects the nerve cells in the brain that produce PARKINSON’ dopamine. Parkinson's disease S DISEASE symptoms include muscle rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure. S&S SYMPTOMS NURSING PROCESS DIAGNOSIS INTERVENTI ON MANAGEME NT MANAGEME NT MANAGEME NT   Levodopa  Levodopa and carbidopa (Sinemet). Levodopa (also called L-dopa) is the most commonly prescribed medicine for Parkinson's. It's also the best at MANAGEME controlling the symptoms of the NT condition, particularly slow movements and stiff, rigid body parts. Levodopa works when your brain cells change it into dopamine.   A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing difficulty. Which meal option below is the best for this patient? Question 1  Grilled chicken and rice  Tacos with shredded cheese  Baked potatoes  Scrambled egg and cottage cheese   The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x- ray. Which clinical manifestations of Question 2 PD would explain these assessment data? 1. Masklike facies and shuffling gait. 2. Difficulty swallowing and immobility. 3. Pill rolling of fingers and flat affect. 4. Lack of arm swing and bradykinesia.   The PN is planning care for a client who displays confusion secondary to a neurological disorder. Which of the following approaches by the nurse would be least helpful? Question 3  a) Providing a stable environment  b) Providing sensory cues  c) Encouraging multiple visitors at a time  d) Giving simple clear directions   Which of the following would not be included as part of routine seizure monitoring?  a) Duration of the seizure Question 4  b) What the client ate 2 hrs prior to seizure  c) Seizure progression and type of movements  d) Changes in pupils size or deviation  HAVE A GREAT DAY!!!! BE SAFE!