Nursing Management: Degenerative Neurological Disorders PDF

Nursing management: Degenerative neurological disorders Virginia Plummer Slides adapted from: Brown, Edwards, Buckley & Aitken: Lewis’s Medical– Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Multiple sclerosis (MS) ⬤ Chron...

Nursing management: Degenerative neurological disorders Virginia Plummer Slides adapted from: Brown, Edwards, Buckley & Aitken: Lewis’s Medical– Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Multiple sclerosis (MS) ⬤ Chronic, progressive, degenerative disorder of the central nervous system (CNS) ⬤ Characterised by demyelination of nerve fibres ⬤ Onset between 20 and 50 years of age, although can occur in young teens and much older adults ⬤ Women affected 3 times more than men ⬤ Prevalence higher in temperate climates ⬤ Cause unknown ⮚ Related to infectious, immunological and genetic factors Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL Pathogenesis of multiple sclerosis ⮚ Chronic inflammation ⮚ Demyelination ⮚ Gliosis (scarring) in the CNS Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL OFFICIAL  Multiple sclerosis No definitive diagnostic test for MS Based primarily on history, signs and symptoms, and results of diagnostic tests > MRI brain/spinal cord and CSF analysis Exclusion of differential diagnosis Currently no cure Collaborative care aims to treat disease process and provide symptomatic relief Medications used to slow progression of disease (refer Table 57.8) Physical and speech therapies Exercise, Hydrotherapy Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Chronic, progressive, neurodegenerative disorder, characterised by ⮚ Slowing down in the initiation and execution of movement (bradykinesia) ⮚ Increased muscle tone (rigidity) Parkinson’s ⮚ Tremor at rest disease (PD)— ⮚ Gait disturbance (shuffling & slowing) Aetiology and ⬤ Exact cause of PD unknown pathophysiology identified genes involved in PD Brain changes including reduced dopamine and Lewy bodies ⬤ Diagnosis increases with age and More common in men Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Parkinson’s disease—Signs and symptoms Onset is gradual with ongoing progression Tremor Rigidity Bradykinesia Postural instability Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Parkinson’s disease—Complications ⬤ Many caused by progressive deterioration ⮚ Dysphagia → malnutrition, aspiration ⮚ General debilitation → pneumonia, UTIs, skin breakdown ⮚ Lack of mobility → constipation, ankle oedema ⮚ Orthostatic hypotension → falls ⬤ Apparent complications may be due to medication side effects, particularly levodopa Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Parkinson’s disease—Diagnostic studies ⬤ No specific tests for PD ⬤ Diagnosis based solely on history and clinical features ⮚ TRAP, asymmetric onset ⬤ Confirmed by positive response to antiparkinsonian medications ⬤ MRI and CT to rule out other causes Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Parkinson’s disease—Medication therapy Antiparkinsonian medications either ⮚ Enhance release or supply of DA (dopaminergic), or ⮚ Antagonise or block effects of overactive cholinergic neurons in striatum (anticholinergic) (Table 57-10 summarises the medications commonly used in PD and the symptoms they relieve) Use of only one medication is preferred ⮚ Fewer side effects, Dosages are easier to adjust Combination therapy often required as disease progresses Surgical therapy Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL Huntington’s Disease Genetically transmitted Onset 30-50yo Affects Basal Ganglia resulting excess Dopamine Symptoms: excessive involuntary movement (limbs, facial muscles) Speech and swallowing difficulties Psychiatric symptoms No cure- care is Palliative OFFICIAL  Degenerative Neurological conditions: Priority care problems ⮚ Impaired physical mobility, Self care deficits, Activity Intolerance Impaired urinary elimination ⮚ Ineffective self-health management ⮚ Imbalanced Nutrition ⮚ Impaired verbal communication ⮚ Impaired Swallowing ⮚ Falls Risk ⮚ Disturbed body image ⮚ Psychological and emotional disturbances Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL EXAMPLE Aetiology and Onset & Diagnostics Interprofessional pathophysiology symptoms management Multiple Sclerosis Parkinson’s Disease Huntington’s Myasthenia Gravis Motor Neuron Disease OFFICIAL Optional resources MND (1min 40sec) https://youtu.be/dOX0KbWRoug Myasthenia Gravis (5min) https://youtu.be/bYGxGdu9MsQ Neurological Diseases and disorders https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az OFFICIAL THE END OFFICIAL