neuro ppt.pdf

Neuro NUR 170 Headaches Pathophysiology Not entirely clear Risk Factors Modifiable Nonmodifiable Individualized triggers Age More common in male children More common in female adults Individualized triggers Stress Smells Foods Hormones S/S and Treatments Pain Pain management Can you recall some nonp...

Neuro NUR 170 Headaches Pathophysiology Not entirely clear Risk Factors Modifiable Nonmodifiable Individualized triggers Age More common in male children More common in female adults Individualized triggers Stress Smells Foods Hormones S/S and Treatments Pain Pain management Can you recall some nonpharmacological means to decrease pain? Photophobia Phonophobia Dark room Quiet room What are some other interventions/or adjuvants? Medical management APAP/Caffeine/Butalbital (Fioricet) (abortive therapy) NSAIDS (abortive therapy) Naprosyn CCBs and Beta-Blockers (preventative therapy) Verapamil Triptans and ergotamine’s Sumatriptan and Cafergot (abortive therapy) Anti-convulsants (preventative therapy) Topiramate Botox injections (monthly) Magnesium Definition Chronic disorder with 2 or more seizures experienced by the patient Epilepsy/ Seizures Pathophysiology Disturbances in normal brain function resulting from abnormal electrical signals inside the brain Risk Factors V: VASCULAR I: INFECTION OR INHERITED CONDITIONS T: TRAUMA A: ALZHEIMER’S/AUTOIMMUNE M: METABOLIC DERANGEMENTS I: IDIOPATHIC N: NEOPLASM S: PSYCHIATRIC Alcohol abuse Drug abuse History of stroke Family history Traumatic brain injury Sleep deprivation Stress Meningitis Acute Seizure Management OBSERVATION & DOCUMENTATION RECORD TIME IT BEGAN & ENDED TYPES OF MOVEMENTS ONGOING SZ OBSERVATIONS POST-ICTAL ASSESSMENT-OFTEN INVOLVES REORIENTATION PT SAFETY IF STANDING/SITTING, PLACE THE PT ON THE FLOOR CONTINUAL ASSESSMENT OF ABC’S SIDE-LYING POSITION SUCTION SECRETIONS NO RESTRAINTS LOOSEN RESTRICTIVE CLOTHING NEVER FORCE ANYTHING INTO THE PT’S MOUTH NO TONGUE BLADE! EVER! DO NOT ATTEMPT TO STOP MOVEMENTS!! Acute Seizure Management - Continued PATENT IV, SUCTION, O2, PADDED SIDERAILS, PILLOW, PRIVACY BENZOS BREAK THE SZ!! MEDICATION FOR GENERALIZED SZ ACTIVITY MAY INCLUDE: LORAZEPAM (ATIVAN) DIAZEPAM (VALIUM) IV PHENYTOIN (DILANTIN) OR FOSPHENYTOIN (CEREBYX) PROLONGED SZ THAT LAST >5MIN OR REPEATED SZ OVER A COURSE OF 30MINMEDICAL EMERGENCY! #1 CAUSE?? ESTABLISH AIRWAY ABG’S IV PUSH LORAZEPAM, DIAZEPAM LOADING DOSE IV PHENYTOIN Patient Teaching DRIVING & HIGH RELIABLE OCCUPATIONS REST, STRESS REDUCTION, DIET KETOGENIC DIET MEDICATION COMPLIANCE FOLLOW-UP DRUG LEVELS NEUROLOGIST MEDICAL ALERT TAG SOCIAL SERVICE RESOURCES TO ASSIST WITH MEDICATION COSTS EVALUATION OF EMPLOYMENT SAFETY NEEDED TO DECREASE RISKS VOCATIONAL REHABILITATION MAY BE SUBSIDIZED Definition Multiple Sclerosis Chronic, progressive degenerative disease Autoimmune Inflammatory Pathophysiology Affects the myelin sheath anywhere along the brain, optic nerve, and spinal cord (sensory and motor) What happens? Image a garden hose which is supposed to carry the water to back of your yard, except the hose has holes in it. Signs and Symptoms (Cues, Clinical manifestations, or expected findings) Sensory Tinnitus Blurred vision Diplopia Decreased visual acuity Partial loss of vision or blind spot Hyperalgesia Vertigo Hearing loss Parasthesia Facial pain Decreased temperature Signs and Symptoms (Cues, Clinical manifestations, or expected findings) Motor Motor weakness Fatigue Stiffness of extremities Tremors Nystagmus Dysarthria Decreased bowel and bladder function Unsteady gait Cognitive impairment How to recognize these clinical manifestations Physical examinations Neuro examinations Medical/surgical history MRI Cerebrospinal fluid analysis What is Multiple Sclerosis – Problem solve to expected treatments What type of disease is it? Treatment Autoimmune Inflammatory Disease Problems with nerve transmissions Plasmapheresis, methotrexate NSAIDS, Corticosteroids Cholinergic, Anticholinergics Disease modifying therapy such as Interferons, Causes and Risk Factors and Treatments Causes or Risk Factors Patient Teaching Infection How do you treat infection? Stresses Decrease stressors, when possible Physical injury Emotional stress Pregnancy Fatigue Living in cold climates Autoimmune disease Unknown Cultural considerations Between age 20-40 2x more common in women Can occur in those under age 15 and greater than 50 More prominent in white population How do you treat autoimmune diseases Plasmapheresis Treatments Interdisciplinary Referral to community and national organizations Pharmacologic (see previous slide) Beta – 1a, Beta- 1b Copaxone Rebig Nevantrone Antispasmodics Intravenous Immune Globin Patient Teaching Teach regarding treatments Medications Minimize risk factors Stress, avoid infections Eye patch Safety precautions Prevent skin breakdowns Risk factors for future problems Respiratory failure, deteriorate over years Damage to the peripheral nerves Peripheral Nerve Trauma Weakness Paralysis Burning sensations Pain Skin and nail color changes Edema Impaired mobility Decreased sensory perception Corticosteroids, analgesics, antibiotics Patient Teaching Follow the therapies prescribed Explain the application of immobility devices Instruct patient to inspect skin daily Teach about s/s of complications Have pt demonstrate therapy and immobilization use to ensure patient understanding of teaching Nursing Diagnosis Acute pain Risk for peripheral neurovascular dysfunction Risk for ineffective peripheral tissue perfusion Collaborative Problems Permanent nerve damage Compartment syndrome Amputation Infection Definition Progressive and chronic disease Parkinson’s Disease Pathophysiology Degradation of dopamine Substantia nigra contains dopaminergic neurons which contribute to controlled muscle pattern Symptoms (cues, expected findings) Usually asymmetric tremors in upper extremities which spread to other parts of body Restless during sleep Decreasing sense of smell Classic “Cardinal signs” Bradykinesia Resting tremor Rigidity Postural instability Symptoms (cues, expected findings) OTHER SIGNS: PILL ROLLING: CLENCHED FIST WITH THUMB MOVING AROUND REDUCTION IN DEXTERITY MASKED FACIES: DECREASED FACIAL EXPRESSIONS SLEEP DISTURBANCES AUTONOMIC DYSFUNCTION: CONSTIPATION, SWEATING, SEXUAL DYSFUNCTION BRADYPHRENIA: REDUCTION OF COGNITION – CAN’T THINK QUICKLY OR CLEARLY DEMENTIA: ADVANCED PARKINSON’S NIGHTTIME DROOLING Risk Factors Modifiable Nonmodifiable Well water Low Estrogen Industrial and Chemical metals Exposure to pesticides and herbicides Familial link Over 40, especially over 60 Affects men more than women A lumbar puncture to analyze the CSF aids in determining dopamine levels. Diagnostic tests such as an MRI, Single-photon emission computed tomography (SPECT), or Positron emission tomography (PET) mat aid in ruling out other causes for the clinical manifestations Nursing Interventions MULTIDISCIPLINARY APPROACH (SLT, PT, OT, NEUROLOGY, DIETICIAN) FALL PRECAUTIONS!! ASPIRATION PRECAUTIONS: ASPIRATION PNEUMONIA IS A MAJOR CAUSE OF DEATH IN PARKINSON’S MEDICATIONS ON TIME, EVERY TIME CONTINUAL NUTRITIONAL ASSESSMENT HIGH-CALORIE/HIGH-PROTEIN/HIGH-FIBER MEAL SMALL, FREQUENT MEALS I&0 SCREEN FOR DEPRESSION/PSYCHOSIS CONSTIPATION Collaborative Problems Potential Complications Palliative care and institutionalization will be needed as the disease progresses. Stroke Definition Permanent interruption of blood flow to brain Can be due to blockage or thrombus (ischemic) Can be hemorrhagic Pathophysiology Interruption of blood flow causes tissue death of brain and therefore loss of function What happens when body has dead cells to clean up? Body sends in the WBC and phagocytes to clean up the mess, this can lead to increased edema which can further cause damage Risk factors – Use these modifiable risk factors to create your patient teaching list Modifiable Hypertension Use of oral contraceptives Hyperlipidemia Diabetes mellitus Obesity Smoking Irregular heartbeat (a-fib) Alcoholism Illicit drug use (especially cocaine) Sedentary lifestyle Nonmodifiable Genetic factors Age Sickle cell disease Can you also teach patients how to avoid Sickle Cell Crisis? You can add this to your patient teaching. Clinical manifestations (expected findings, cues, signs and symptoms) Altered LOC Disturbances of face, arm, gait, and speech Vision changes Ataxia 49 Other assessments Posturing Glascow coma scale NIH Stroke Scale STROKE DURING THE ACUTE PHASE If client seeks treatment early enough (Usually within 4.5 hours of onset of symptoms) TPA therapy Must be ruled as ischemic stroke Must be placed on bleeding precautions for 24 hours Interventions Ischemic stroke Hemorrhagic stroke Can lead to further edema Speech disturbances Weaknesses Incontinence Administer fibrinolytic therapy Monitor for worsening symptoms Monitor ICP Speech therapy Implement activities to prevent neglect, PT, OT Bowel/bladder training, skin care Monitor for UTI Interventions Dysphagia Aspiration precautions NPO until swallow screening Potential nutritional alterations Visual disturbances Manage sensory perception (safety, feeding of client) Encourage client to scan entire room May need eye patch for diplopia May struggle with hemianopsia Medications ASA and other antiplatelet drugs Heparin and warfarin when a-fib is present Ca-Channel block to prevent vasospasms after subarachnoid hemorrhage Stool softeners (do not want patient to bear down – it will increase ICP) Analgesics Antianxiety Managing and preventing increase in ICP Want to keep ICP 30 degrees (also will increase oxygenation and reduce aspiration risk) Keep head midline, neutral position Avoid sudden and acute hip or neck flexion during positioning Avoid clustering of care Hyper-oxygenation (not hyperventilation) Avoid coughing and suctioning Provide quiet environment, soft lights Monitor vs q1-2 hrs. SBP>180 mmHg or DBP >110 is considered dangerous. Community Based Care/ Interdisciplinary Care Expected outcome for rehab is to maximize the patient’s abilities in all aspects of life. Teach patient and family to make sure the home is free of scatter rugs or other obstacles in walking pathways. Bathroom should be equipped with grab bars and anti-skid patches. PT or OT works with family for assistive devices and home modifications. Depression may occur within 3 months after stroke. Long-term symptoms of stroke Hemiparesis Hemiplegia Aphasia Dysarthria Dysphagia Apraxia Sensory deficits Behavioral changes Incontinence Visual changes Homonymous hemianopia Agnosia Unilateral neglect TIA TIA can have many of the same signs and symptoms of a stroke Warning sign of stroke in the future Symptoms resolve usually within 30-60 minutes – it is a transient issue