Tca 5

TCA 5

PARKINSON’S DISEASE - A CHRONIC, PRORESSIVE

NEUROLOGIC DISORDER AFFECTING THE BRAIN CENTERS THAT ARE RESPONSIBLE FOR

CONTROL AND REGULATION OF MOVEMENT ASSOCIATED WITH DECREASED LEVELS OF DOPAMINE DUE TO DESTRUCTION OF PIGMENTED NEURONAL CELLS IN THE SUBSTANTIA NIGRA IN THE BASAL GANGLIA OF THE BRAIN

– NOT ENOUGH DOPAMINE - NO CURE - AFFECTS VOLUNTARY MUSCLES - PROBLEM BETWEEN DOPAMINE AND ACETYL CO-LIN - 60% OF NEURONA ARE LOST BEFORE S/S BEGIN TO SHOW - USUALLY SEEN IN OLDER CLIENT, BUT YOUNGER CAN BE AFFECTED 3 CARDINAL SIGNS 1) TREMORS 2) RIGIDITY 3) BRADYKINESIA (SLOW MOVEMENTS) TREMORS - PRESENTS IN 70% OF PATIENTS - DISAPPEARS WITH PURPOSEFUL MOVEMENT - PILL ROLLING - TREMORS ARE SEEN MORE AT REST - CAN INCREASE WHEN WALKING, OR WHEN ANXIOUS RIGIDITY - RESISTANCE TO PASSIVE LIMB MOVEMENTS - COG WHEELING - STIFFNESS OF NECK, TRUNK, AND SHOULDERS (1 PLACE THEY COMPLAIN) BRADYKINESIA - MOST COMMON FEATURE - SLOW WITH ADL’S - DIFFICULTY INITIATING MOVEMENT - SHUFFLING GAIT - MICROGRAPHIA – PROBLEMS WRITING - MASK LIKE EXPRESSION - DYSPONIA – SLOW, SLURRED, LOW PITCHED SPEECH - DYSPHAGIA – DROOLING, EATING, SWALLOWING PROBLEMS (R/F ASPIRATION) - GAIT PROBLEMS O TROUBLE STOPPING O BALANCE IS OFF AUTONOMIC SYMPTOMS SEEN - EXCESSIVE/UNCONTROLLED SWEATING - PAROXYSMAL FLUSHING - MOIST, OILY SKIN - ORTHOSTATIC HYPOTENSION - GASTRIC AND URINARY RETENTION - CONSTIPATION AND SEXUAL DISTURBANCES PSYCHIATRIC SYMPTOMS - DEPRESSION - DEMENTIA - SLEEP DISTURBANCES - HALLUCINATIONS O ALL PSYCHIATRIC MANIFESTATIONS MORE COMMON IN ELDERLY PATIENTS ST

1

TCA 5

DIAGNOSIS

IS MADE BASED ON HISTORY, SYMPTOMS

(NEED

TO HAVE

2

OUT OF THE

3

CARDINAL SIGNS), NEURO EXAM,

AND RESPONSE TO PHARMOCOLOGICAL THERAPY

PHARMACOLOGICAL THERAPY – ALL MEDS USED FOR PARKINSONS HAVE A LOT OF S/E - CARBIDOPA (LEVADOPA) + SINEMET O MOST EFFECTIVE O MAINSTAY OF THERAPY - ALSO USED ARE: O ANTICHOLENERGICS  ARTANE  PAGITANE  KEMADRIN  AKINETON  COGENTIN  SUPPOSE TO DECREASE /ELIMINATE THE RIGIDITY, TREMORS AND ALL THOSE KINDS OF THINGS, BUT SOMETIMES THEY START HAVING SOME SIDE EFFECTS. THE SIDE EFFECTS ARE THE TREMORS. THEY PUT THEM ON COGENTIN TO COUNTERACT THE SIDE EFFECTS. O ANTIVIRAL  SYMMETREL O DOPAMINE AGONISTS (USE BEFORE LEVADOPA)  PERMAX  PARLODEL O MAO INHIBITOR  ELDRYL (NEW AND CONTROVERSAL) O ANTIDEPRESSANTS  ELAVIL (1/3 TO ½ THE DOSE) (ALERT: PROZAC AND WELBUTRIN AGGRAVATE THE DISEASE) O ANTIHISTAMINES  BENADRYL  BANFLEX SURGICAL MANAGEMENT - THALAMOTOMY, PALLIDOTOMY – INTERRUPTS NERVE PATHWAYS TO CONTROL TREMORS, CLIENT IS AWAKE DURING THE PROCEDURE

- STEM CELL RESEARCH SAFETY IS A VERY IMPORTANT NURSING MEASURE WITH THESE PARKINSON’S DISEASE PATIENTS. PARKINSONIAN CRISIS - RESULTS FROM SUDDEN WITHDRAWEL OF ANTIPARKINSON MEDS OR EMOTIONAL TRAUMA - S/S O SUDDEN SEVERE EXACERBATION OF CLASSIC S/S O CALLS FOR IMMEDIATE TREATMENT OR PERSON WILL DIE  RESPIRATORY AND CARDIAC SUPPORT  SEDATIVE/HYPNOTICS AND ANTICONVULSANTS USED THEIR TREATMENT WILL DEPEND UPON WHERE THEY ARE IN THEIR PARKINSON’S DISEASE. MOST OF THE PATIENTS ARE ELDERLY AND ARE IN THE NURSING HOME OR LONG TERM CARE FACILITY. SPEECH THERAPY WILL GET INVOLVED IN THEIR CARE, DIETARY (THICKENERS) WILL MORE THAN LIKELY BE INVOLVED IN THEIR CARE AND SUCH. THEY WILL EVENTUALLY REQUIRE TOTAL PATIENT CARE. 2

TCA 5

MYASTHENIA GRAVIS -

AUTOIMMUNE

DISORDER

AFFECTING

MYONEURAL

JUNCTION

WITH

VARIOUS

DEGREES

OF

WEAKNESS

OF

VOLUNTARY MUSCLES

-

DEFECT IN THE TRANSMISSION OF NERVE IMPULSE AT THE NEURO MUSCULAR JUNCTION INCIDENCE: WOMEN DEVELOOP AT AN EARLIER AGE (20-40) MANIFESTATIONS - OCULAR MUSCLES – DIPLOPIA – DOUBLE VISION (PATCH EYE); PTOSIS (DROOPY EYES) - WEAKNESS IN FACE AND THROAT MUSCLES - SLEEPY MASK LIKE EXPRESSION - DYSPHONIA - GENERALIZED WEAKNESS - PURELY MOTOR DISORDER DIAGNOSIS - ANTICHOLINESTERASE TEST O TENSILON IV 2MG A DOSE UP TO 10 MG (ANTIDOTE = ATROPINE) O AFTER RECEIVING TENSILON, THEY WILL FEEL RELIEF WITHIN ABOUT 30 SECONDS. WILL SEE IMPROVEMENT IN THE DROOPINESS IN THE EYES. - NERVE STIMULATION TEST - MRI PHARMOLOGICAL THERAPY - ONE OF THE MOST IMPORTANT MANAGEMENT – MEDICATIONS. THEY HAVE TO TAKE THIS MEDICATION ON TIME, AND IT SHOULD BE AROUND THE SAME TIME. THIS WAY IS STAYS AT A GOOD THERAPEUTIC LEVEL IN THE BODY. THIS IS A LIFELONG SITUATION WITH LIFELONG MEDS - ANTICHOLERESTERASE – DOSAGES VARY ACCORDING TO INDIVIDUALS NEEDS O MESTINON O PROTIGMIN - MUST MAINTAIN BLOOD LEVELS, IF NOT MAINTAINED CAN LOOSE COMPLETE MUSCLE CONTROL - CYTOTOXIC MEDS - IMMUNOSUPPRESSIVE THERAPY USED TO REDUCE ANTIBODY PRODUCTION O IMURAN O CYTOXAN SURGICAL MANAGEMENT - THYMECTOMY – REMOVAL OF THYMUS - PLASMAPHERESIS - TO FILTER OUT PLASMA OF ANTIBODIES MYASTHENIA CRISIS VS CHOLINERGIC CRISIS - MYASTHENIA CRISIS – TOO LITTLE DRUG THERAPY THAT RESULTS IN EXACERBATION OF DISEASE. MAY RESULT IN RESPIRATORY FAILURE

-

CHOLINERGIC CRISIS– TOO

MUCH DRUG THERAPY THAT RESULTS IN EXACERBATION OF DISEASE.

MAY

RESULT

IN RESPIRATOR FAILURE

-

WILL DO TENSILON TEST TO TELL WHICH IT IS SINCE THEY ARE ALIKE

HIGH RISK FOR ASPIRATION DUE TO WEAKNESS OR BULBAR TEACH MEDICATION TECHNIQUES TO THE PATIENT AND THE FAMILY

MULTIPLE SCLEROSIS -

CHRONIC PROGRESSIVE DISEASE OF NEUROLOGIC SYSTEM OF UNKNOWN ETIOLOGY PROGRESSIVE DEMYLENATING DISEASE OF THE CNS IMMUNE MEDIATED 3

TCA 5

-

ETIOLOGY – MINERAL

DEFICIENCIES, TOXIC SUBSTANCE, VIRUSES, AND AUTOIMMUNITY ARE SUSPECTED AS THE

CAUSE O O

MORE FREQUENT IN COLD, DAMP CLIMATES USUALLY AFFECTS 20-40 YEAR OLDS

SIGNS AND SYMPTOMS ARE GOING TO VARY DEPENDING UPON WHERE THE LESION IS. THE MOST PROMINENT FOR MULTIPLE SCLEROSIS WILL BE THE BALANCE AND COORDINATION. IT COMES AND GOES. THEY HAVE EXACERBATIONS AND REMISSIONS. WHEN TALKING ABOUT MYASTHENIA GRAVIS, THEY MAY HAVE PROBLEMS RELATED TO MEDICATION (TOO MUCH OR TOO LITTLE), BUT CLIENTS WITH MULTIPLE SCLEROSIS JUST HAVE THOSE EXACERBATIONS. MANIFESTATIONS SECONDARY COMPLICATIONS - FATIGUE - UTI - DEPRESSION - CONSTIPATION - WEAKNESS - PRESSURE ULCERS - NUMBNESS - PEDAL EDEMA - DIFFICULTY IN COORDINATION - PNEUMONIA - LOSS OF BALANCE - DEPRESSION - PAIN – CONSTANT BONE AND JOINT PAIN - EMOTIONAL, SOCIAL, MARITAL, ECONOMIC, AND - VISUAL DISTURBANCES – DIPLOPIA VOCATIONAL PROBLEMS DIAGNOSIS - SYMPTOMOLOGY AND AGE - MRI - ELECTROPHORESIS OF CSF - EVOKED POTENTIAL STUDIES - NERVE TRANSMISSION MEDICAL MANAGEMENT - NO CURE - INDIVIDUALIZED TREATMENT OF SYMPTOMS PHARMACOLOGY - ABC (AND R) O A = AVONEX – GIVEN Q WEEK O B = BETASERON – GIVEN EVERY OTHER DAY O C = COPAXONE – GIVEN EVERY OTHER DAY O R = REBIF – GIVEN 3 TIMES A WEEK O THESE MEDICATIONS ARE GOING TO ACTUALLY

TREAT MULTIPLE SCLEROSIS, BUT THEN THERE ARE

OTHER MEDICATIONS TO TREAT WHATEVER SIGNS AND SYMPTOMS ARE PRESENTED.

-

CORTICOSTEROIDS ANTINEOPLASTIC – NOVANTRONE SPASMS MEDS (BACLOPHEN) FATIGUE TREATMENT– SYMMETREL, CYLERT, PROZAC ATAXIA – INDERAL ANTISEIZURE – NEURONTIN AND KLONOPIN

MULTIPLE SCLEROSI IS HEREDITARY.

GUILLIAN BARRE -

INFLAMMATORY

DISEASE OF UNKNOWN ETIOLOGY CHARACTERIZED BY WIDESPREAD INVOLVEMENT OF PEIPHERAL

AND CRANIAL NERVES

-

INCIDENCE – AFFECTS EVERYONE EQUALLY – USUALLY YOUNG 4

TCA 5

-

MANY HAVE EXPERIENCED A MILD RESPIRATORY OR GI INFECTION 1-3 WEEKS BEFORE THE ONSET OF S/S RAPID OCCURRENCE OF SYMMETRICAL MUSCLE WEAKNESS, USUALLY BEGIN IN LEGS AND GOES UP THE BODY (ASCENDING MUSCLE WEAKNESS) MAY HAVE TOTAL PARALYSIS IN A FEW DAYS DEMYELINATION OF NERVES

PROGNOSIS AND COURSE - PROGRESSION CAN CEASE AT ANY STAGE - A PLATEAU TYPICALLY OCCURS - IMPROVEMENT THEN BEGINS AND USUALLY LAST SEVERAL WEEKS - RATE OF RECOVERY IS VARIABLE - DISEASE USUALLY REMITS NATURALLY AND RECOVERY IS GENERALLY TOTAL ALTHOUGH PROLONGED DIAGNOSIS - NO SPECIFIC DIAGNOSTIC TEST - USUALLY MADE ON BASIS OF CLINCIAL PRESENTATION (SIGNS AND SYMPTOMS - MUSCLE STUDIES - MAY FIND MARKEDLY ELEVATED CSF PROTEIN TREATMENT - NO SPECIFIC TREATMENT - THESE PATIENTS USUALLY START OUT IN THE INTENSIVE CARE UNIT BECAUSE THE DISEASE CAN PROGRESS QUICKLY. - SUPPORTIVE TREATMENT OF SYMPTOMS - RESPIRATORY SUPPORT MAY BE NECESSARY DURING ACUTE STAGE (MAIN FOCUS OF CARE). - MEDS NOT USUALLY UTILIZED - EXERCISE AND ACTIVITY RESTRICTED TO CONSERVE ENERGY - EMOTIONAL SUPPORT NURSING CARE - DEPENDS ON CLINICAL COURSE AND RECOVERY - TOTALLY DEPENDANT ON APPROPRIATE CARE PROBLEMS - INADEQUATE VENTILATION - POSITIONING - SUCTIONING - HAZARDS OF IMMOBILITY - ALTERED NUTRITION - ELIMINATION - PSYCHOLOGICAL WELL BEING

TO

BRAIN TUMORS OR LESIONS AFFECT BRAIN BY - COMPRESSION - INVASION - INFILTRATION CLASSIFICATION - BENIGN – NOT CURABLE BUT MAY BE INOPERABLE - MALIGNANT – RARELY METATASIZE OUTSIDE CNS - BOTH ARE SERIOUS BECAUSE THEY ARE IN THE BRAIN O PRIMARY – ARISE FROM NERVOUS TISSUE O SECONDARY – ARISE FROM TISSUE OUSIDE CRANIAL VAULT O TYPES 5

TCA 5



GLIOMAS – ARISE

FROM

BRAIN TISSUE – PROGNOSIS

IS USUALLY POOR BECAUSE THEY

INFILTRATE AND INVADE, HARD TO REMOVE WITHOUT REMOVING A SIGNIFICANT PORTION OF THE BRAIN, RAPID GROWING

MENINGIOMAS – ARISE FROM THE COVERING OF THE BRAIN – GOOD PROGNOSIS - SLOW GROWING, COMPRESSES RATHER THAN INVADES  PITUITARY ADENOMA – CAN CAUSE INCREASE OR DECREASE IN PITUITARY FUNCTION – PROGNOSIS IS GOOD – SIGNS & SYMPTOMS ARE GOING TO BE BASED ON INCREASE OR DECREASE OF THE PITUITARY GLAND.  ACOUSTIC NEUROMAS – ARISE FROM ANY CRANIAL NERVE (USUALLY FROM THE 8 CRANIAL NERVE – HEARING AND BALANCE)  SECONDARY TUMORS – RESULTING FROM LUNG, BREAST, LIVER, ETC…– THESE ARE YOUR METASTATIC LESIONS – FIRST WILL HAVE A PRIMARY SITE IN THE LUNGS AND IT METASTISIZE TO THE BRAIN. THEY CAN TELL IF IT IS PRIMARY OR METASTATIC LESION. PATHOPHYSIOLOGICAL CHANGES IN BRAIN CAN RESULT IN: - CEREBRAL EDEMA - INCREASED ICP - FOCAL NEURO DEFICITS - SEIZURE ACTIVITY – TUMOR IRRITATES BRAIN - ALTERATIONS IN NORMAL PITUITARY FUNCTION - OBSTRUCTION IN CSF – CAUSES ICP, HYDROCEPHALUS 

TH

CLINICAL MANIFESTATIONS (BRAIN TUMOR) - HEADACHE - VOMITING - PAPILLEDEMA - PERSONALITY CHANGES - LOCAL DISTURBANCES - PITUITARY DYSFUNCTION - INCREASE ICP – BE VERY CAREFUL, STRAINING, REDUCED STIMULATION

MEDICAL

DIAGNOSTIC TESTS - MRI - CAT SCAN - EEG - CEREBRAL ANGIOGRAPHY - LUMBAR PUNCTURE NO

MEDICAL MANAGEMENT - DRUG THERAPY - RADIATION THERAPY - CHEMOTHERAPY - INTRACRANIAL SURGERY

MANAGEMENT IS GOING TO BE GEARED TOWARDS PREVENTED INCREASE IN

ICP

AND TREATED OTHER SIGNS

AND SYMPTOMS THAT THE PATIENT HAS.

MENINGITIS (SEE MENINGITIS HANDOUT) -

AN INFLAMMATION OF THE MENINGES CAUSED BY VIRAL, BACTERIAL, OR FUNGAL ORGANISMS

-

ORIGINATES 2 WAYS O DIRECT INFECTION – FROM THE BLOODSTREAM O IATROGENIC – FROM INVASIVE PROCEDURE OR INVASIVE DEVICES

PATHO - STARTS

AS INFECTION OF THE NASOPHARYNX FOLLOWED BY SEPTICEMIA. ORGANISM CAUSES INFLAMMATORY

REACTION IN THE MENINGES AND UNDERLYING CORTEX, WHICH MAY RESULT IN THOMBOSES AND REDUCED CEREBRAL BLOOD FLOW.

-

PROGNOSIS OF BACTERIAL MENINGITIS DEPENDS ON THE INFECTION, AND ILLNESS, AND THE TIMELINE OF TREATMENT.

CAUSITIVE ORGANISM, THE SEVERITY OF THE

COMPLICATIONS 6

TCA 5

-

VISUAL IMPAIRMENT DEAFNESS SEIZURES

-

PARALYSIS HYDROCEPHALUS SEPTIC SHOCK

CLINICAL MANIFESTATIONS: ADULTS - HEADACHE AND FEVER (INITIAL SYMPTOMS) - CHANGE IN LOC - NUCHAL RIGIDITY (EARLY SIGN) - POSITIVE KERNIG’S SIGN – SEVERE STIFFNESS OF THE HAMSTRINGS CAUSES AN INABILITY TO STRAIGHTEN THE LEG WHEN THE HIP IS FLEXED TO 90 DEGREES - POSITIVE BRUDZINSKI’S SIGN - SEVERE NECK STIFFNESS CAUSES A PATIENT'S HIPS AND KNEES TO FLEX WHEN THE NECK IS FLEXED

-

-

PHOTOPHOBIA SEIZURES INCREASING ICP RESULTING IN: O VS CHANGES  WIDENED PULSE PRESSURE  BRADYCARDIA O RESPIRATORY IRREGULARITY O HEADACHE O VOMITING O DEPRESSED LOC RASH O

PETECHIAL TO PURPURIC LESIONS OR LARGE AREAS OF ECCYMOSIS

NURSING ALERT: ANY

CHILD WHO IS ILL AND DEVELOPS A PURPURIC OR PETECHIAL RASH MAY HAVE

OVERWHELMING MENOCOCCEMIA AND MUST RECEIVE MEDICAL ATTENTION IMMEDIATELY

CLINICAL MANIFESTATIONS OF BACTERIAL MENINGITIS CHILDREN AND ADOLESCENTS - USUALLY ABRUPT ONSET - FEVER - CHILLS - HEADACHE - VOMITING - ALTERATIONS IN SENSORIUM - SEIZURES (OFTEN INITIAL SIGN) - IRRITABILITY - AGITATION - INCREASED ICP - NUCHAL RIGIDITY - POSITIVE KERNIG - POSITIVE BRUDZINSKI - HYPERACTIVE BUT VARIABLE REFLEX RESPONSES - S/S PECULIAR TO INDIVIDUAL ORGANISM INFANTS AND YOUNG CHILDREN - CLASSIC PICTURE RARELY SEEN IN CHILDREN BETWEEN 3MONTHS AND 2 YEARS OF AGE - FEVER - POOR FEEDING - VOMITING 7

TCA 5

-

MARKED IRRITABILITY FREQUENT SEIZURES BULGING FONTANEL NUCHAL RIGIDITY MAY OR MAY NOT BE PRESENT KERNIG AND BRUDZINSKI ARE NOT HELPFUL IN DIAGNOSIS

NEONATES – EXTREMELY DIFFICULT TO DIAGNOSE AND MANIFESTATIONS VAGUE AND NONSPECIFIC (SIMILAR TO FLU). LOOK FOR A HIGH PITCHED CRY. ADMINISTER ANTIBIOTICS AS SOON AS THEY ARE ORDERED DECREASE STIMULI MONITOR VS NEURO CHECKS FEVER CONTROL I&O SEIZURE PRECAUTIONS THOSE IN CLOSE CONTACT WITH PATIENT RECEIVE RIFAMPIN (ANTIMICROBIAL PROPHYLAXIS) CULTURES OF CSF AND BLOOD ARE DONE TO IDENTIFY ORGANISM AND ANTIBIOTICS ARE STARTED IMMEDIATELY RESPIRATORY ISOLATION UNTIL AT LEAST 24 HOURS WORTH OF ANTIBIOTICS HAVE BEEN GIVEN DEHYDRATION OR SHOCK IS TREATED WITH FLUID VOLUME EXPANDERS SEIZURES ARE CONTROLLED WITH DIAZEPAM (VALIUM) OR PHENYTOIN PUT ON ISOLATION FIRST MOST COMMON TYPE IS VIRAL BECAUSE OF THE UPPER RESPIRATORY, THE MOST CONTAGIOUS TYPE IS THE BACTERIAL TYPE (MENNINGOCCAL). WHEN YOU PUT A PERSON ON ISOLATION, IT MEANS PPC. PERSONAL PROTECTIVE EQUIPMENT - IT DEPENDS UPON THE TYPE OF ISOLATION THAT THE PERSON IS ON (DROPLET OR RESPIRATORY). THE

PATIENT IS ON ISOLATION WITH ANY FORM OF MENINGITIS.

THE BACTERIAL

(MENNINGOCOCCAL)

MENINGITIS.

RASH

THE

ONE’S THAT HAVE TO STAY ON ISOLATION WILL BE

IS VERY SPECIFIC TO THE MENNINGOCOCCAL MENINGITIS.

BACTERIAL OR MENNINGOCOCCAL MENINGITIS IS CONTAGIOUS. SIGNS AND SYMPTOMS ARE GOING TO BE THE SAME FOR THE CHILD, THE ADULT, THE INFANT. BUT THE NEONATE IS ONE THAT YOU REALLY CANNOT GET SUBJECTIVE TYPES OF SIGNS AND SYMPTOMS, SO THE HIGH PITCHED CRY (MENINGEAL CRY) IS WHAT THEY ARE GOING TO HAVE. MANAGEMENT OF MENINGITIS: ONCE THIS PERSON IS ON ISOLATION GET CULTURES FIRST

THEN START THE ANTIBIOTICS PREVENTIVE THERAPY FOR CLOSE CONTACTS – RIFAMPIN ( USUALLY AN ANTI-TUBERCULOSIS DRUG) VIRAL IS MORE COMMON, THE MORE SERIOUS IS MENINGIOCOCCAL (BACTERIAL)

8