MS%20II%20Neurologic%20Disorders.pdf.pdf

🏠 💊 1 Neurologic Disorders Aug 7, 2024 8:00 PM Quiz #8 Neurologic Disorders [SAC-VN 2023 SAC10 T3-VN304-23SC10T3] NEUO PLAYLIST YT Playlist Table of Contents Table of Contents_______________________________________________...

🏠 💊 1 Neurologic Disorders Aug 7, 2024 8:00 PM Quiz #8 Neurologic Disorders [SAC-VN 2023 SAC10 T3-VN304-23SC10T3] NEUO PLAYLIST YT Playlist Table of Contents Table of Contents_____________________________________________________________ 1 Functions of the Major Parts of the Brain___________________________________________ 3 Age-Related Changes_________________________________________________________ 4 Nursing Assessment___________________________________________________________5 Diagnostic Testing____________________________________________________________ 5 Testing of Reflexes_________________________________________________________ 6 Therapeutic Measures_________________________________________________________ 7 Surgery__________________________________________________________________ 7 Increased Cranial Pressure (ICP)_________________________________________________7 Signs and symptoms_______________________________________________________ 8 Abnormal posturing______________________________________________________9 Cushing’s Triad_________________________________________________________ 9 Medical Management_______________________________________________________ 9 Drug therapy_____________________________________________________________ 10 Migraine Headache__________________________________________________________ 10 Signs and symptoms______________________________________________________ 10 Medical management______________________________________________________ 10 Cluster Headache____________________________________________________________ 11 Treatment_______________________________________________________________ 11 Tension Headache___________________________________________________________ 12 Symptoms_______________________________________________________________12 Treatment_______________________________________________________________ 12 Seizure Disorder_____________________________________________________________12 Partial seizures___________________________________________________________ 13 Generalized seizures______________________________________________________ 13 Status epilepticus______________________________________________________ 14 Aura________________________________________________________________ 14 🏠 💊 2 Medical treatment_________________________________________________________ 14 Anticonvulsants________________________________________________________15 Antiepileptics__________________________________________________________16 Surgical Treatment_____________________________________________________ 16 During a seizure_______________________________________________________ 16 Risk for injury_________________________________________________________ 17 Head Injury_________________________________________________________________ 17 Hematoma______________________________________________________________ 17 Subdural hematoma____________________________________________________ 17 Epidural hematoma_____________________________________________________17 Intracerebral hemorrhage________________________________________________ 18 Penetrating injuries_____________________________________________________ 18 Interventions_____________________________________________________________ 18 Brain Tumor________________________________________________________________ 18 Signs and symptoms______________________________________________________ 19 Medical treatment_________________________________________________________ 20 Interventions_____________________________________________________________ 20 Meningitis__________________________________________________________________ 20 Medical diagnosis_________________________________________________________ 21 Signs and symptoms______________________________________________________ 21 Positive Kernig sign____________________________________________________ 21 Positive Brudzinski sign_________________________________________________ 22 Medical treatment_________________________________________________________ 23 Interventions_____________________________________________________________ 23 Encephalitis________________________________________________________________ 23 Signs and Symptoms______________________________________________________ 24 Treatment_______________________________________________________________ 24 Interventions_____________________________________________________________ 24 Guillain-Barré Syndrome______________________________________________________ 24 Initial phase: lasts 1-3 weeks_____________________________________________ 25 Plateau phase: lasts days – 2 weeks_______________________________________ 25 Recovery phase_______________________________________________________ 25 Medical Diagnosis_________________________________________________________25 Medical Treatment________________________________________________________ 25 Interventions_____________________________________________________________ 26 Parkinson's Syndrome________________________________________________________ 26 Signs and symptoms______________________________________________________ 26 Drug therapy_____________________________________________________________ 27 Interventions_____________________________________________________________ 27 🏠 💊 3 Multiple Sclerosis (MS)________________________________________________________28 Signs and symptoms______________________________________________________ 28 Medical treatment_________________________________________________________ 29 Interventions_____________________________________________________________ 30 Amyotrophic Lateral Sclerosis (ALS)_____________________________________________ 30 Signs and symptoms______________________________________________________ 31 Medical treatment_________________________________________________________ 31 Interventions_____________________________________________________________ 31 Huntington Disease__________________________________________________________ 32 Myasthenia Gravis___________________________________________________________ 33 Signs and symptoms______________________________________________________ 33 Medical diagnosis_________________________________________________________ 34 Medical treatment_________________________________________________________ 34 Interventions_____________________________________________________________ 35 Trigeminal Neuralgia__________________________________________________________35 Signs and Symptoms______________________________________________________ 36 Medical Management______________________________________________________ 37 Bell's Palsy_________________________________________________________________ 37 Signs and symptoms______________________________________________________ 37 Medical Management______________________________________________________ 37 Cerebral Palsy______________________________________________________________ 38 Medications for Neurological Disorders___________________________________________ 40 Seizures________________________________________________________________ 40 Types of Epilepsy______________________________________________________ 40 Medications___________________________________________________________41 Migraines_______________________________________________________________ 42 Abortive Therapies_____________________________________________________ 42 Preventative Therapies__________________________________________________43 Parkinsons______________________________________________________________ 43 Dopaminergic Agents___________________________________________________ 43 Dopamine Promoters___________________________________________________ 43 Dopamine Receptor Agonists_____________________________________________ 44 Attention Deficit Hyperactivity Disorder (ADHD)__________________________________44 Stimulants____________________________________________________________ 44 Nonstimulants_________________________________________________________ 44 Alzheimers______________________________________________________________ 44 Multiple Sclerosis (MS)_____________________________________________________ 45 Neurological Disorders.pdf 🏠 💊 4 Med Surg II - Neurologic Disorders.pdf Pharmacology - Neurological medication full video for nursing RN PN NCLEX Neurological Disorders for the LPN/LVN Student Functions of the Major Parts of the Brain Brainstem and Diencephalon Control awareness or alertness through the reticular activating system, composed of fibers scattered throughout the midbrain, pons, and medulla. Medulla Links the higher brain centers to other parts of the body through the spinal cord. Controls muscles of respiration through the respiratory reflex center. Controls the heartbeat (to some extent) through the cardiac reflex center. Constricts blood vessels to raise blood pressure through the vasomotor reflex center. Is the point of origin for some cranial nerves. Pons Relays messages from the medulla to the higher centers in the brain. Is a reflex center for some cranial nerves. Cerebellum Coordinates movement, balance, posture, and spatial orientation. Hypothalamus Controls the pituitary. Controls appetite, sleep, and some emotions. Controls much activity of the autonomic nervous system. 🏠 💊 5 Forebrain (Cerebrum) Controls the higher functions and activities: conscious mental processes, sensations, emotions, and voluntary movements. Frontal Lobe Controls the voluntary muscle movements, verbal and written speech. Parietal Lobe Contains the sensory reception areas to interpret pain, touch, temperature, distances, sizes, and shapes. Temporal Lobe Contains the auditory center for hearing and understanding spoken language. Contains the olfactory center for smell. Occipital Lobe Contains the visual center for seeing and reading. Age-Related Changes Decreased number of neurons Brain weight is reduced Ventricles increase in size Lipofuscin: aging pigment deposited in nerve cells Amyloid (protein deposits) in the brain Increased plaques and tangled fibers in nerve tissue Reaction time increases, especially complex reactions Nursing Assessment Physical examination Level of consciousness: most accurate and reliable indicator Pupillary evaluation Neuromuscular response Vital signs Evaluate patients for orientation to person, place, and time by asking them to state their names, where they are, and what time it is. To evaluate the pupils, assess and compare their size, shape, and reactivity. Assessment of neuromuscular response provides a means of evaluating cerebral and spinal cord function. 🏠 💊 6 Where are electrical impulses responsible for eliciting motor responses initiated? Monitoring pulse, respirations, and blood pressure provides highly reliable information regarding neurologic well-being. Diagnostic Testing Lumbar puncture: assess CSF pressure and obtain sample ○ Informed consent ○ Void before procedure ○ Side lying knee-chest position during procedure ○ After procedure lie flat, increase fluids, assess for bleeding Electroencephalography: assess electrical activity of the brain Electromyography: to assess the PNS Radiologic studies Testing of Reflexes A Babinski reflex will be noted if the patient has an abnormality of the motor pathways originating in the cerebral cortex Tested by stroking the bottom of the foot upward along the side and then across the top below the toes If the toes curl downward, this is normal (negative for Babinski) 🏠 💊 7 If the big toe curls up and other toes fan out, this is abnormal (positive for Babinski) A lumbar puncture is an invasive procedure that is most often used to detect infections and other disorders of the CNS, tumors, and hydrocephalus. The electroencephalogram (EEG) is a graphic representation of electrical activity in brain cells. Electromyography studies the response of peripheral motor and sensory nerves to electrical stimuli. The brain scan shows the pattern of distribution of a radioactive isotope injected intravenously. Cerebral angiography provides images of the cerebral, carotid, and vertebral blood vessels. CT is an excellent tool in the evaluation of trauma, tumors, and hemorrhage. Why should the patient be asked about allergies before a CT scan? The MRI is a noninvasive examination that involves placing the patient in a strong magnetic field and then applying bursts of radiofrequency waves. Computed tomography scans are taken at various cross-sections of the brain. 🏠 💊 8 Magnetic resonance imaging uses magnetic fields to create cross-sectional views of the brain. Therapeutic Measures Surgery Craniotomy ○ Surgical opening of the skull Craniectomy ○ Excision of a segment of the skull Cranioplasty ○ Any procedure done to repair a skull defect Increased Cranial Pressure (ICP) Extremely serious threat with life-threatening consequences Normal ICP is 0-15 mm Hg Any condition that causes an increase in brass mass, blood volume or CSF will result in increased pressure within the skull 🏠 💊 9 Increased ICP results in decreased perfusion to the brain tissue Signs and symptoms Change in level of consciousness is the earliest sign ○ Agitation ○ Drowsiness ○ Unresponsiveness Changes in pupil size: dilated or blown pupils are a late sign Contralateral changes in motor function Loss of temperature control 🏠 💊 10 Abnormal posturing Decorticate posturing ○ Caused by pressure above the midbrain ○ Causes abnormal flexion in upper extremities and extension in lower extremities Decerebrate posturing ○ Caused by pressure to the midbrain or upper pons ○ Causes abnormal extension in upper extremities and extension in lower extremities Cushing’s Triad 1. Widening pulse pressure a. Increased systolic BP b. No change in diastolic BP 2. Hypertension: systolic BP higher than normal 3. Bradycardia: Slow and irregular heart beat Medical Management ICP can be lowered by: Positioning 🏠 💊 11 Hyperventilation Fluid management Mechanical drainage Drug therapy Raise the HOB 30 degrees to allow fluid to flow from the brain via the jugular vein Hyperventilate to allow more oxygen to reach the brain and to assist in constricting blood vessels, slowing blood flow to the brain, decreasing pressure IV Mannitol: osmotic diuretic ○ Drug of choice to decrease cerebral edema or fluid Increases urinary output, decreases ICP Used with other diuretics Corticosteroids to decrease edema and pressure Migraine Headache Possibly caused by intracranial vasoconstriction and vasodilation Triggered by menstruation, ovulation, alcohol, some foods, stress Signs and symptoms Some patients experience warning signs before the pain Unilateral intense pain that begins in the temple or eye area Tearing and nausea and vomiting Hypersensitive to light and sound Medical management Dark, quiet environment Mild migraines treated with ○ Acetaminophen or aspirin 🏠 💊 12 Severe migraines treated with ○ Ergotamine (Cafergot) ○ Sumatriptan (Imitrex) tablet injection Cluster Headache Occur in a series of headaches followed by a long period with no symptoms Intensely painful and seem to be related to stress or anxiety Usually have no warning symptoms Treatment Cold application 🏠 💊 13 Indomethacin (Indocin) Tricyclic antidepressants Tension Headache Result from prolonged muscle contraction from anxiety, stress, or stimuli from other sources, such as a brain tumor or an abscessed tooth Symptoms Pain location may vary Nausea and vomiting Dizziness, tinnitus, or tearing Treatment Correction of known causes Psychotherapy, massage, heat application, and relaxation techniques Analgesics, usually nonopioid Antianxiety drugs Seizure Disorder Occurs when electrical impulses in the brain are conducted in a highly chaotic pattern Related to: Physical trauma Reduced cerebral perfusion Infection Electrolyte disturbances Poisoning Tumors 🏠 💊 14 Partial seizures Simple Part of one cerebral hemisphere affected Consciousness is not impaired Jacksonian Focal Seizures: begin with twitching of the eyelid, then the face, then that side of the body Complex Psychomotor or Temporal Lobe Seizures Consciousness is impaired May exhibit bizarre, repetitive behavior Generalized seizures Involve the entire brain from the onset Consciousness lost during the ictal (seizure) period Tonic-clonic (grand mal seizure) ○ Tonic phase: stiffening of muscles or extremities, loss of consciousness ○ Clonic phase: rhythmic movement of extremities ○ Postictal phase: after seizure stops, pt is tired, does not remember seizure A simple partial seizure may include motor, somatosensory, autonomic, or psychic symptoms. Focal motor seizures are a subtype of simple seizures in which the abnormal brain activity remains localized to a specific motor area. What is jacksonian march? The tonic-clonic seizure is characterized by stiffening of the muscles or extremities with loss of consciousness followed by a rhythmic movement of the extremities. Absence seizure (petit mal seizure) Pt stares off “daydreaming” and briefly loses consciousness 🏠 💊 15 Myoclonic Brief jerking of extremities Atonic (drop attacks) Sudden loss of muscle tone causes patient to collapse Status epilepticus Medical emergency Continuous or repeated seizures for 30 minutes or more Can cause permanent brain damage Aura Warning sign some experience prior to a seizure Dizziness, numbness, visual or hearing disturbance, noting an offensive odor, or pain Medical treatment Resolution of the underlying condition Anticonvulsant drug therapy 🏠 💊 16 SEIZURE PRECAUTIONS Anticonvulsants Reduce neuron hyperexcitability, inhibits seizure activity Phenytoin (Dilantin) Side effects: Gingival hyperplasia and drowsiness Nursing Considerations Monitor drug levels 🏠 💊 17 Take with food Provide excellent oral care to prevent hyperplasia Antiepileptics Reduces seizure activity Pregabalin (Lyrica) Side effects: Drowsiness Nursing Considerations Safety precautions if patient is drowsy Needs to be tapered off over 1 week Surgical Treatment Removal of seizure foci in the temporal lobe Pallidotomy Vagal nerve stimulator Seizure foci: area with overactive activity Pallidotomy: electrode placed on the brain and warmed up to destroy tissue Vagal nerve stimulator: “brain pacemaker” During a seizure Stay with the patient Ensure safety Move things away from their head Turn on their side Do not ever restrain patient Do not put anything in their mouth Document the seizure episode Activity observed Time lengths 🏠 💊 18 Postictal period Drugs given, if any Risk for injury Side rails of bed up and padded, suction machine readily available, bed maintained in the low position Quickly move objects away from the patient Do not attempt to restrain the patient Ineffective coping and Deficient knowledge Teach family and patient about the seizure disorder and the therapy Teaching must be directed toward helping the patient and family adjust to a chronic condition Encourage questions and concerns Head Injury Scalp injuries: Lacerations, contusions, abrasions, and hematomas Concussion: Trauma with no visible injury to the skull or brain. Loss of consciousness, headache, amnesia, nausea, vomiting Contusion: Bruising and bleeding in the brain tissue Hematoma SUBDURAL VS EPIDURAL HEMATOMA Subdural hematoma Venous bleeding below the dura mater of the brain Epidural hematoma Arterial bleeding between the dura mater and the skull Pt usually exhibits a momentary loss of consciousness Pt regains alertness Pt then has a rapid deterioration After a head injury look for signs of increased ICP, especially drowsiness 🏠 💊 19 Intracerebral hemorrhage From lesions within the tissue of the brain itself Penetrating injuries Sharp objects penetrate the skull and brain tissue Interventions Monitor for and take measures to decrease ICP Increased ICP Decreased LOC Pupillary dilation Restlessness, agitation Increased SBP Bradycardia Position patient with HOB elevated 30 degrees if ordered to prevent abnormal posturing or hip and neck flexion Avoid suctioning patient Give diuretics or anti-inflammatories as ordered Assess for respiratory depression Initiate seizure precautions Monitor for and prevent infections Turn every 2 hours Prevent immobility complications Brain Tumor Some brain tumors are malignant, some congenital; others may be related to heredity 🏠 💊 20 Drug/environmental factors may play a role in development Signs and symptoms Directly related to area of brain invaded by the tumor Visual disturbances and headache New-onset seizure activity Difficulties with balance and coordination Not all brain tumors are malignant. However, the invasion of any kind of tumor into normal brain tissue is never insignificant. Difficulties with balance and coordination may be seen with which type of tumor? 🏠 💊 21 Medical treatment Surgery often followed by radiation with or without chemotherapy Interventions Administer analgesics Assess for changes in memory or cognition Fall precautions, seizure precautions, general safety precautions Assist in ADL care Meningitis 1.0 Meningitis & Increased ICP.pdf Inflammation of the meninges Caused by either viruses or bacteria Organisms may reach the meninges through the blood, through head wounds, or from other cranial structures such as the sinuses or inner ear. What organisms may be responsible for a bacterial infection? Complications of meningitis include seizures, septicemia, vasomotor collapse, and increased ICP. 🏠 💊 22 Medical diagnosis Lumbar puncture to obtain CSF for lab analysis Signs and symptoms Headache Nuchal rigidity (stiffness of the back of the neck) Irritability Diminished level of consciousness Photophobia (sensitivity to light) Seizures Positive Kernig sign To test, flex patient’s hip to 90 degree angle, then extend, or straighten, their knee If patient experiences pain along their hamstring, they have a positive Kernig sign indicating meningeal infection 🏠 💊 23 Positive Brudzinski sign To test, lie patient down and flex their neck upward, bringing their chin to their chest If both of patients hips flex upward when you do this, they have a positive Brudzinski sign, indicating meningeal infection 🏠 💊 24 Medical treatment Bacterial infection: antimicrobial therapy Viral infections: manage symptoms Anticonvulsants to control seizure activity If needed, isolation precautions should be initiated. How are organisms responsible for meningococcal meningitis spread? Interventions Monitor for increased ICP Prevent increased ICP Avoid coughing Elevate HOB Do not hold breath during turning or movement Do not restrain pt Assess respiratory status Manage pain Seizure precautions Monitor for Disuse Syndrome: Pt experiences all complications of immobility ○ Pooling of pulmonary secretions in the lungs ○ Pressure ulcers ○ Muscle weakness, joint stiffness ○ Constipation Aug 12, 2024 Encephalitis Inflammation of the brain tissue caused by virus 🏠 💊 25 Signs and Symptoms Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and restlessness. Comatose, aphasia, hemiparesis, facial weakness, and other alterations to motor activity Treatment Seizure precautions Symptom management Interventions Same as meningitis: Monitor for increased ICP Prevent increased ICP Avoid coughing Elevate HOB Do not hold breath during turning or movement Do not restrain pt Assess respiratory status Manage pain Seizure precautions Monitor for Disuse Syndrome: Pt experiences all complications of immobility ○ Pooling of pulmonary secretions in the lungs ○ Pressure ulcers ○ Muscle weakness, joint stiffness ○ Constipation Guillain-Barré Syndrome Multiple Sclerosis: ALS, Guillain-Barre Syndrome & Myasthenia Gravis- Medical Surgical | @LevelUpRN 🏠 💊 26 7. GB - Guillain-Barré Syndrome.pdf Autoimmune response to a viral infection Affects motor and sensory nerves of the PNS Destruction of the myelin sheath Initial phase: lasts 1-3 weeks Bilateral muscle weakness or paralysis Begins in lower extremities; ascends upward Visual and hearing disturbances, difficulty chewing, and lack of facial expression Numbness in feet and hands in a glove or stocking pattern Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention Plateau phase: lasts days – 2 weeks Deterioration stops advancing but pt does not improve Recovery phase May take 2 years, some changes may be permanent ○ Remyelination Muscle strength returns in a proximal-to-distal pattern Head to toes Medical Diagnosis Characteristic onset and pattern of ascending motor involvement Elevated protein level in the CSF Nerve conduction velocity studies reveal slowed conduction speed in the involved nerves Medical Treatment Preserve vital respiratory function Respiratory status is closely monitored and mechanical ventilation initiated if vital capacity falls to 15 mL/kg of body weight 🏠 💊 27 Corticosteroids Plasmapheresis to remove antibodies triggering the autoimmune response Interventions Monitor respiratory status, prepare for possible mechanical ventilation Turn pt every 2 hours Suction when pt’s pulse rises and adventitious breath sounds occur Monitor for and prevent Disuse Syndrome Administer tube feedings as ordered Fall precautions Parkinson's Syndrome Parkinson's, Alzheimer's & Huntington's Disease - Medical-Surgical - Nervous System | @LevelUpRN 13. Parkinsons Disease.pdf Progressive degenerative disorder of the basal ganglia Results in loss of coordination and loss of control over involuntary motor movement Related to loss of dopamine in the basal ganglia Signs and symptoms Tremor Usually in the upper extremities Worsens at rest Pill-rolling is common Rigidity Bradykinesia Extremely slow movements Loss of dexterity and power in affected limbs Aching Monotone voice 🏠 💊 28 Handwriting changes Drooling Lack of facial expression Rhythmic head nodding Reduced blinking Slumped posture Depression Dementia Medical treatment Massage, heat, exercise, and gait retraining Drug therapy Dopamine receptor agonists maximize intrinsic dopamine pramipexole (Mirapex) or ropinirole (Requip) “cornerstone of therapy” L-dopa (L-dihydroxyphenylalanine) or levodopa Crosses the blood-brain barrier and is converted to dopamine in the basal ganglia Decarboxylase inhibitors Given with L-dopa to ensure that it breaks down in the basal ganglia and not in the peripheral tissue Carbidopa is the most common one Levodopa and carbidopa are given as a combination drug Carbidopa/levodopa (Sinemet) Entacapone (Comtan) Can be given as an adjunctive therapy Blocks the breakdown and prolongs effectiveness of carbidopa/levodopa Interventions Encourage independence but assist as needed PT, OT, ST Fall precautions 🏠 💊 29 Aspiration precautions Sit the patient up, cut meats, allow time for eating, thick liquids, small frequent meals etc. Manage symptoms Multiple Sclerosis (MS) 12. MS - Multiple Sclerosis.pdf Chronic, progressive degenerative disease Attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS Chronic, progressive MS: progresses steadily Exacerbating-remitting MS: exacerbations and remissions Relapsing-progressive MS: less stable periods than exacerbating-remitting Stable MS: stable; no active disease for a year Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated Signs and symptoms Fatigue Weakness and tingling in one or more extremities Visual disturbances: nystagmus Problems with coordination Bowel and bladder dysfunction Spasticity Depression 🏠 💊 30 Medical treatment Corticosteroids to control exacerbations ACTH, prednisone, methylprednisolone Proteins to manage the body’s immune response Interferon b 1b (Betaseron) and interferon 1a (Avonex) Other immune regulators Glatiramer acetate (Copaxone) Immunosuppressants to control exacerbations mitoxantrone (Novantrone) Amantadine (Symmetrel) to relieve fatigue Cholinergics for urinary retention bethanechol (Urecholine) 🏠 💊 31 neostigmine (Prostigmine) Interventions Encourage independence Provide assistive devices If pt has altered sensation, protect from injury Fall precautions Assess for urinary retention Assess for and protect pt from infection Be supportive Amyotrophic Lateral Sclerosis (ALS) 3. ALS - Amyotrophic Lateral Sclerosis.pdf AKA Lou Gehrig’s disease Degenerative neurologic disease Virus suspected, but exact cause unknown Pathophysiology Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms Progresses rapidly, usually causes death within 3 years of onset 🏠 💊 32 Signs and symptoms Weakness of voluntary muscles of the upper extremities Difficulty swallowing and speaking Disease progresses until patient is bed bound Respirations become shallow Difficulty clearing airway of pulmonary secretions Death results from aspiration, respiratory infection, or respiratory failure Despite progression of physical symptoms, patient’s intellectual ability if unaffected Medical treatment No known cure or treatment Therapy is supportive Focuses on preventing complications and maintaining maximum function Interventions Monitor breath sounds and pulse to detect dyspnea 🏠 💊 33 Turn, cough, deep breath every 2 hours CPT Assist with preventing complications from immobility Aspiration precautions Possible enteral nutrition Provide alternate means of communication Understand that depression is extremely common due to the patient maintaining their cognitive abilities while their body deteriorates Huntington Disease Inherited degenerative neurologic disorder Usually begins in middle adulthood with abnormal movements called chorea, emotional disturbance, and intellectual decline Symptoms progress steadily: increasing disability and death in 15 to 20 years Medical and nursing care are supportive only; there is no cure 🏠 💊 34 Myasthenia Gravis 11. MG - Myasthenia Gravis.pdf Autoimmune disorder Increase in acetylcholine receptor antibodies These antibodies stop activity at the acetylcholine receptor sites at the neuromuscular junction, reducing muscle strength Over time, the muscles becomes exhausted and unable to contract at all If respiratory muscles involved, pt may die from respiratory insufficiency or arrest Signs and symptoms Weakness of voluntary muscles Especially for chewing, swallowing, and speaking Partial improvements of strength with rest Ptosis and diplopia Unable to perform any activity that demands sustained muscular contractions 🏠 💊 35 Brushing hair, walking upstairs, or holding hands over their head Compromised breathing if diaphragm or intercostal muscles involved Medical diagnosis Administering edrophonium (Tensilon) Anticholinesterase drug that increases the amount of acetylcholine in the neuromuscular junction Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes If this improvement is noted, the patient is diagnosed with MG Medical treatment Anticholinesterase drugs Stops destruction of acetylcholine Neostigmine and pyridostigmine (Mestinon) Corticosteroids Cytotoxic therapies Thymectomy To prevent hyperplasia of the thymus gland 40% of patients go into remission Plasmapheresis Myasthenic Crisis and Cholinergic Crisis Can result in need for emergency respiratory support and mechanical ventilation Myasthenic Crisis Sudden exacerbation of MG symptoms Dyspnea, Dysphagia, Respiratory Arrest Caused by infection or general worsening of condition Pt has too little acetylcholine in their system or the infection is affecting their ability to use it Cholinergic Crisis Sudden, extreme weakness and respiratory impairment Caused by overmedication of anticholinesterase drugs Patient needs to be intubated and put on mechanical ventilation 🏠 💊 36 Tensilon Test In order to determine if a patient in distress is experiencing a Myasthenic Crisis or a Cholinergic Crisis a Tensilon Test will be performed Edrophonium (Tensilon) is administered If pt rapidly improves, they are in a Myasthenic Crisis If pt does not improve, they are in a Cholinergic Crisis Interventions Monitor for signs of hypoxia and dyspnea Prepare pt for mechanical ventilation Provide alternative means of communication Give anticholinesterase drugs 30 mins before meals Aspiration precautions Trigeminal Neuralgia Tic Douloureux Intense pain along all 3 branches of cranial nerve #5 The trigeminal nerve Triggers Hot and cold liquids Chewing Shaving or washing the face 🏠 💊 37 Signs and Symptoms Sudden, crippling pain along the three branches of CN #5 Inability to do anything that involves the face due to pain 🏠 💊 38 Medical Management Phenytoin (Dilantin) and carbamazepine (Tegretol) for pain Alcohol injections into the nerve: reduce pain 8-16 months Bell's Palsy Acute paralysis of CN #7 The Facial Nerve Caused by trauma to the face or viral infections such as HSV-1 Signs and symptoms Begins as a pain behind the ear Then muscles on one side of the face become paralyzed Affected eyelids do not close Pt has impaired sense of taste Medical Management Prednisone Analgesics Artificial tears Eye shield at night Facial exercises Most patients recover in weeks or months, some have permanent weakness 🏠 💊 39 Cerebral Palsy Cerebral Palsy.pdf Cerebral damage that occurs at birth Results in loss of motor coordination, slurred speech and paralysis Often mistaken as a form of “mental retardation” Pt is fully capable of understanding their condition and should attempt to gain as much independence as possible 🏠 💊 40 No cure 🏠 💊 41 Medications for Neurological Disorders Aug 14, 2024 Anticholinergics.pdf 3. Beta Adrenergic Blockers.pdf 1. Alpha & Beta Blocking Drugs.pdf 2. Alpha Blockers.pdf 2. Cholinegics.pdf 1. Anticholinergic.pdf 3. Anorexiants.pdf 4. Cholinesterase Inhibitors.pdf 2. Analeptics.pdf 1. ADHD - Amphetamines.pdf Cholinergics.pdf Seizures Seizure: abnormal electrical activity in the neurons Convulsion: presentation of the seizure Causes Epilepsy, trauma, fever, increased ICP (tumor, bleeding), withdrawal, overdose, prolonged insomnia Anticonvulsants/ AED’s increase the threshold of the seizure. Glutamate GABA Types of Epilepsy Generalized ○ Grand mal (generalized) Both hemispheres of the brain are involved Tonic clonic epilepsy 🏠 💊 42 Increased muscle tone during seizure (tonic) and then the patient begins to convulse (clonic) ○ Petit mal Only one hemisphere of the brain is involved Absence seizures Occur in early life Multiple seizures can happen in one day Typically noticed when the patient is in school, teachers say they are “daydreaming” Partial/Focal ○ Simple ○ Complex Medications AED’s Hydantoins (PO, IV) ○ Phenytoin ○ Fosphenytoin Side effects: dizzy/drowsy, GI upset, gingival hyperplasia (sensitivity and easy bleeding), hypersensitivity (rash, epidermal necrosis), cardiac issues. Carbamazepine (Tegratol) ○ Used for epilepsy, trigeminal neuralgia, mood disorders ○ SE: fluid retention, photosensitivity, D/D, vertigo, ataxia, epidermal necrosis Smaller dose in the AM and larger dose in the PM to avoid SE Valproic acid ○ Used for epilepsy, migraines, mania in bipolar personality disorder ○ SE: hepatotoxic, pancreatitis, bone marrow suppression leads to decreased platelets (prolonged bleeding time) New AEDs Gabapentin (Neurontin) ○ Used for: neuropathy, seizures, restless leg syndrome, alcohol withdrawal 🏠 💊 43 Pregabalin (Lyrica) Topiramate (Topamax) ○ Used for: seizures, alcohol withdrawal, restless leg Lamotrigine (Lamictal) Caution: do not abruptly stop these meds! That may cause status epilepticus. Osmotic diuretics Mannitol ○ Used for: Increased ICP ○ IV infusion Migraines Caused by serotonin disruption. Typically in young women before menses or during hormone change Abortive therapy: get rid of the pain right now! Preventative therapy: keep the pain away! Abortive Therapies Serotonin Agonists/triptans DITNeuro1SerotoninAgonist.pdf Sumatriptan (Imitrex) ○ Injection, PO, nasal spray Zolmitriptan (Zomig) ○ Nasal spray, PO, injection Increase serotonin SE: vertigo, chest tightness, angina, bronchospasm, tingling in the extremities Pat edu Spray: do not take any more than 3 sprays in 24 hours, space sprays out by 2 hours. Injection: do not take any more than 2 injections in 24 hours, space 2 hours apart PO: do not take any more than 200 mg in 24 hours, space 2 hours apart 🏠 💊 44 Ergot Alkaloids Methylergonovine SE: HTN, tachycardia or bradycardia, intermittent claudication Pat edu: cannot take while pregnant or if they have vascular disorders Preventative Therapies 3. Beta Adrenergic Blockers.pdf Antiepileptic Drugs Beta Blockers Tricyclic Antidepressants ○ Nortriptyline ○ Amitriptyline Parkinsons 13. Parkinsons Disease.pdf DITNeuro1DopamineReplacementDrugs.pdf DITNeuro1DirectactingDopaminReceptorAgonists.pdf 5. Parkinsons - Carbidopa Levodopa.pdf Caused by a decrease in dopamine Dopaminergic Agents Levodopa-carbidopa (Sinemet) SE: N/V, orthostatic hypotension, dark urine, dyskinesia, on-off phenomenon Dopamine Promoters Entecapone (Comtan) ○ Added to Sinemet at a low dose to promote response to therapy 🏠 💊 45 Dopamine Receptor Agonists Ropinirole (Requip) Pramipexole (Mirapex) Uses: parkinsons, restless leg SE: N/V, orthostatic hypotension, dark urine, dyskinesia Attention Deficit Hyperactivity Disorder (ADHD) Stimulants Amphetamines Amphetamine Dextroamphetamine Methamphetamine Uses: ADHD, narcolepsy, weight loss SE: insomnia, weight loss, addiction/abuse, dependance, tachycardia, HTN, toxicity (Seizure, dysrhythmia, hallucinations, delusions) Pat edu: second dose should not be later than 4 pm, do not take these on the weekend or holidays, do not consume caffeine Nonstimulants Modafinil Methylphenidate Used for: narcolepsy, ADHD, obstructive sleep apnea, swing shift disorder Alzheimers Deficiency of acetylcholine, destruction of neurons, deposits of amyloid, neuro-entanglement Donepezil (Aricept) Rivastigmine Mimentine (Namenta) 🏠 💊 46 Multiple Sclerosis (MS) Interferon ○ Immunomodulator Mitoxantrone ○ Immunosuppressant