Transcript Neuro - PBworks

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Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PATHOPHYSIOLOGY
PHARMACOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Huntington’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_P_I_E
--Decrease ICP
--Disease /
Condition
Specific Meds
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary
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Progressive
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Degenerative
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No Cure
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Affects nerve fibers in the brain and spinal
cord
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Most common neurological cause of
debilitation in young people (ages20 - 40)
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Probably autoimmune disease
Antibodies and white blood cells attack
the proteins in the neuron’s myelin
sheath
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Inflammation and injury to the sheath and
ultimately to the nerves that it surrounds
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Multiple areas of scarring…
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Hardening (Sclerosis) of nerve
fibers...usually in spinal cord, brain
stem and optic nerves
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More women than men
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More common in Caucasians
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Children of parents with MS have a higher rate
of incidence (15 – 50% depending on data
source)
Geographic location --- Cold climate…?
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Based on the presence of CNS lesions that are disseminated
in time and space (neurologic dysfunction in more than 2
sites at least one month apart), with no better explanation
for the disease process
Because no single test is totally reliable in identifying MS,
and a variety of conditions can mimic the disease, diagnosis
depends on clinical features supplemented by the findings
of certain studies such as:
- MRI (visualize plaques)
- CSF analysis (increases protein and slight increase
WBCs)
- Evoked potentials (define extent of disease and
monitors)
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"Turbo FLAIR" MRI
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Because different nerves are affected at
different times, MS symptoms often worsen
(exacerbate), improve, and develop in
different areas of the body
This disease is unpredictable and varies in
severity
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Intermittent damage to
myelin…intermittent severity
Scarring and sclerosis of nerve fibers
usually in the spinal cord, brain stem,
and optic nerves…
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Fatigue
- Muscle Weakness
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Muscle Spasticity
- Dysarthria
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Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of
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Lhermitte's sign (Electrical sensation down the spine on neck flexion)
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Dysphagia
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Uhthoff’s Sign (Exertion or Heat causes sudden exacerbation of S&S)
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Numbness, tingling (Paresthesia)
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Bowel, bladder and sexual dysfunction
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Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)
extremities)
- Tinnitis
- Pain
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"Slurred" speech
Speaking softly or barely able to whisper
Slow rate of speech
Rapid rate of speech with a "mumbling" quality
Limited tongue, lip, and jaw movement
Abnormal intonation (rhythm) when speaking
Changes in vocal quality ("nasal" speech or sounding "stuffy")
Hoarseness
Breathiness
Drooling or poor control of saliva
Chewing and swallowing difficulty
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Emotionally labile
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Depression (suicide increased 7.5%, usually in first 5
years)
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MS can progress steadily… or cause acute
attacks (exacerbation) followed by partial or
complete reduction in symptoms (remission)
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Returns to baseline + recovery
85%
Increasing severity … maybe
minor plateaus or remissions
10-20%
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Control symptoms
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Prevent complications
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Provide adaptive devices to increase
mobility and self-care
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Avonex IM
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Betaseron SQ
Daily (interferon beta 1b)
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Copaxone SQ
Daily
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Rebif SQ
Weekly (interferon beta – 1a)
given 3 x week
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Baclofen / Dantrium (for spasms)
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NSAIDS (for flu-like side effects and pain)
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Analgesics
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Corticosteroids (limit severity by modulating immune
response which decreases inflammation)
Antidepressants (like Prozac)
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Beta blockers for tremors (like Inderal)
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Anticonvulsants for parethesia (like Tegretol)
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Anticholinergics for bladder dysfunction (Pro-Banthine)
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Bacterial infections (lung, bladder)
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Disturbed thought processes
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Impaired bladder & bowel function
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Contractures
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Seizures
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Impaired mobility / speech / swallowing
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Sensory & visual impairment
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In some people, MS is a mild illness, but,
for others, it results in permanent
disability
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Most patients have a normal lifespan
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