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Neurology Ch. 65

Neurology Ch. 65. Management of patients with oncologic or degenerative neurologic disorders. Brain Tumors. Pathophysiology Primary Originating from the brain Secondary Originating outside the brain Metastasis. Brain Tumors. Malignant Tend to become progressively worse Anaplasia

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Neurology Ch. 65

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  1. Neurology Ch. 65 Management of patients with oncologic or degenerative neurologic disorders

  2. Brain Tumors Pathophysiology • Primary • Originating from the brain • Secondary • Originating outside the brain • Metastasis

  3. Brain Tumors • Malignant • Tend to become progressively worse • Anaplasia • Cell distortion • Invasive • Benign • No malignant or recurrent

  4. Brain Tumors • Presence of lesion  • Compression of blood vessels  • Ischemia  • Edema  • I-ICP

  5. Brain Tumors • Are brain tumors a disorder of the CNS, PNS or Both the CNS and PNS? • CNS • PNS • Both CNS & PNS

  6. Primary-Brain Tumors Etiology • Unknown

  7. Brain Tumors Clinical manifestations • Depends on • Size • Location

  8. Brain Tumors 4 main S&S • I-ICP • Cushing sign • H/A • Vomiting • Visual disturbances • Seizures • Hydrocephalus • Alt Pituitary function • Cancer cells being attacked by immune system

  9. Brain Tumors Localized S&S • Frontal • Personality changes • Emotional changes • Occipital • Visual impairment • Visual hallucinations • Cerebellum • Impaired equilibrium • Impaired coordination

  10. Brain Tumors Diagnosis • CT • MRI

  11. Primary - Brain Tumors Medical management • Radiation • Chemotherapy • Pharmaceutical • Corticosteroids • Anti-convulsants • Surgery • Tug McGraw

  12. Secondary-Brain Tumor 3 treatment options • No treatment • Death < 1 month • Tx w/ corticosteroids only • Death < 2 months • Tx with radiation • Death 3-6 months

  13. Secondary-Brain Tumor Pharmacology • Corticosteroids • Dexamethasone • Prednisone • Osmotic Diuretic • Mannitol • Anti-convulsants • Dilantin • Morphine

  14. Brain Tumors Nursing Management • Aspiration • Alt. nutrition • Cachexia • Weak emaciate condition • Neuro checks • Photophobia • Seizure precaution • Anxiety

  15. Brain Tumors • What S&S are associated with frontal lobe, occipital lobe and cerebellum tumors? • What diet would you expect a patient with brain cancer to be on? • The S&S are associated with increase intracranial pressure?

  16. Brain Tumors • What are the difference between malignant tumors and benign tumors? • What does metastasis refer to? • What are risk factors of cancer? • What does remission mean or refer to?

  17. Parkinson’s Disease • First described by James Parkinson 1817 • A progressive brain disorder characterized by the degeneration of dopamine secreting neurons deep in the cerebral hemisphere in a part of the brain called the basal ganglia

  18. Parkinson’s Disease • Basal Ganglia • Controls movement • Dopamine • Inhibitory neurotransmitter in the basal ganglia • Acetylcholine • Excitatory neurotransmitter in the basal ganglia

  19. Parkinson’s Disease • Without dopamine, inhibitory influences are lost and excitatory mechanisms are unopposed  • Neurons of basal ganglia are over stimulated  • Excess muscle tone, tremors & rigidity

  20. Parkinson’s Disease • Is Parkinson's disease a disorder of the CNS, PNS or both the CNS & PNS? • CNS • PNS • Both PNS & CNS

  21. Parkinson’s Disease Clinical manifestations • Onset • Abrupt • Age of on set • 60 • Men vs. Women • Men > women • First Symptom • Fine tremors in hands or feet

  22. Parkinson’s Disease 3 clinical signs • Tremors • Rigidity • Bradykinesia

  23. Parkinson’s Disease • Tremors • Resting tremor • i with activity • h tremor when… • Walking • Anxious • Sensation of heat • Calorie burning!

  24. Parkinson’s Disease • Rigidity • Stiffness • Neck • Trunk • Shoulders • Posture • Head bowed • Body bent forward • Arms flexed • Thumbs turned into palms • Knees bent (slightly)

  25. Parkinson’s Disease • Bradykinesia • Slow movement • Akinesia • Loss of movement • Esp face • Expressionless • Slow speech • Dysphonia • Dysphagia • Drooling

  26. Parkinson’s Disease • Bradykinesia • Gait • Shuffled • Festination • Fall forward d/t posture

  27. Parkinson’s Disease Diagnosis • S&S • Positive response to Levodopa

  28. Parkinson’s Disease Medical Management • h dopamine • (blood brain barrier)

  29. Parkinson’s Disease • Anti-Parkinsonian medications • Levodopa • Converts into dopamine in the basal ganglia • Works best in 1st few years of disease  effectiveness wanes • S/E Dizzy (esp when first get up)  get up slowly!

  30. Parkinson’s Disease • Anti-Parkinsonian medications • Sinemet • Prevents the breakdown of levodopa outside the brain

  31. Parkinson’s Disease Nursing Management • Assessment • Affect on ADL’s • Dysfunction • S/E of meds

  32. Parkinson’s Disease Nursing Management • Improving mobility • Exercise • ROM • Warm baths • Massage • PT • gait program

  33. Parkinson’s Disease Nursing Management • Enhancing Self-care • Encouragement • Adaptive devices • OT

  34. Parkinson’s Disease Nursing Management • Improving Bowel elimination – Constipation • Bowel routine • Fluids • Fiber • Raised toilet

  35. Parkinson’s Disease Nursing Management • Nutritional deficit • Slow process • Meds  dry mouth • Chewing & Swallowing • Weights • Supplement • Dietician • FORK!

  36. Parkinson’s Disease Nursing Management • Enhance swallowing • Upright position • Semi-solid food • Thick liquids

  37. Parkinson’s Disease Nursing Management • Communication • Speak slow • Short sentences • Deep breath before speaking • SLP

  38. Parkinson’s Disease • With PD it is known which neurotransmitter is lacking in the brain and scientists are able to duplicate this neurotransmitter. Why are we then unable to cure PD? • PD type deterioration of the nerve cells of the brain reduces the amount of what neurotransmitter? • Because of the inability to cure PD at this time, PD is frequently treated with which medications? • What are the side effects of these meds?

  39. Parkinson’s Disease • To promote optimal functions, which activity could the nurse recommend as being beneficial to a patient with PD ? • What would be of value in helping a patient with PD communicate with the medical team? • Is PD a disease of the CNS, PNS or both?

  40. Parkinson’s Disease • During an assessment, what signs and symptoms can the nurse anticipate a patient with Parkinson’s to exhibit? • What nursing diagnosis would be priority for a patient with Parkinson’s? • Describe the muscle tone of a patient with Parkinson’s (medical terms) • What interventions can be used to address the issue of nonintention tremors?

  41. Huntington’s Disease • AKA • Huntinton’s Chorea • Pathophysology • Rare • Genetic • George Huntington

  42. Huntington’s Disease • The disease is characterized as degeneration of the cerebral cortex and the basal ganglia 

  43. Huntington’s Disease • Which causes chronic progressive chorea • Bizzare involuntary dance-like movements • And mental deterioration  • Ending in dementia and death • Loss of GABA (inhibitory neurotransmitter)

  44. Huntington’s Disease Clinical manifestations • Involuntary choreiform • Diminished during sleep • Facial tics/grimacing • Paranoia & hallucinations • Appetite • Ravenous • Emotions • Labile

  45. Huntington’s Disease Diagnosis • DNA testing

  46. Huntington’s Disease Medical management • No treatment • Meds to i tics • Chlorpromazine (Thorazine) • Meds to i hallucination, delusions, angry outbursts • Haloperidol (Haldol) • Anti-psychotics

  47. Huntington’s Disease Nursing Management • Family support • Diet • Ambulatory • Safety

  48. Huntington’s Disease • Is Huntington’s a disease of the CNS, PNS, or both? • What dietary changes might be appropriate for a patient with Huntington’s disease? • Describe the pathophysiology of Huntington’s disease. • What is the etiology of Huntington’s disease? • How is Huntington’s disease different from Parkinson’s disease?

  49. Huntington’s Disease • What medications are used to help with tics and uncontrolled movements associated with Huntington Chorea? • If a patient expresses suicidal thought, what are the correct nursing management interventions • Huntington’s Chorea is characterized by what (what does it look like)? • Name five nursing interventions for a patient with Huntington’s disease

  50. Amyotrophic Lateral Sclerosis Pathophysiology • Degenerative motor neuron disease that affects UMN & LMN lying within the brain, spinal cord and peripheral nerves • Lou Gehrig

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