Transcript Neuro

Adult Health II
Neurological Diseases
Jerry Carley RN, MSN, MA, CNE
Summer 2010
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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

Degenerative

No Cure

Affects nerve fibers in the brain and spinal
cord

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 in the nervous system destroys myelin, Schwann cells, and the
oligodendrocytes.
Myelin
After tissue destruction a scar or hardening forms, the MS plaque.
This can be visualized on MRI to aid in diagnosis of multiple sclerosis.. Sheath
Around
nerve
“demyelinization”
“demyelinating”
“demyelinizing”
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Inflammation and injury to the sheath and
ultimately to the nerves that it surrounds
Dendrite
Myelin
Sheath
Schwann
Cell
Axon
terminal
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Multiple areas of scarring…
+
Hardening (Sclerosis) of nerve
fibers...usually in spinal cord, brain
stem and optic nerves
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More women than men

More common in Caucasians


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

Muscle Spasticity
- Dyarthria

Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of

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)

Numbness, tingling (Paresthesia)

Bowel, bladder and sexual dysfunction
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Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)
extremities)
- Tinnitis
- Pain
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Emotional 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%

Control symptoms

Prevent complications

Provide adaptive devices to increase
mobility and self-care
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
Avonex IM

Betaseron SQ
Daily (interferon beta 1b)

Copaxone SQ
Daily

Rebif SQ
Weekly (interferon beta – 1a)
given 3 x week
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Baclofen / Dantrium (for spasms)

NSAIDS (for flu-like side effects and pain)

Analgesics

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Corticosteroids (limit severity by modulating immune
response which decreases inflammation)
Antidepressants (like Prozac)

Beta blockers for tremors (like Inderal)

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

Most patients have a normal lifespan
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