Neurology Ch. 65

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