Geriatric Chapter 22: Neurologic Function

Bradykinesia

Slow movement

Cerebrovascular Accident (CVA)

Stroke; interruption in blood supply to brain

Dysarthria

Difficulty forming words associated with poor muscular control due to damage to the central or peripheral nervous system

Dysphasia

Difficulty expressing or comprehending verbal or written language due to brain lesion or injury

Hemiparesis

Weakness on one side of the body

Hemiplegia

Paralysis on one side of the body

Hemianopsia

Decreases vision or blindness in half of one eye or the same half of both eyes

Parkinson’s Disease

Progressive degeneration of neurons in basal ganglia resulting in reduced production of dopamine

Transient ischemic attack (TIA)

Temporary or intermittent neurological event that can result from any situation the reduces cerebral circulation

Effects of Aging on the Nervous System

Loss of nerve cell mass: Atrophy of the brain and spinal cord. Brain weight decreases

A decrease in cerebral blood flow by 20% due to the accumulation of fatty deposits in blood vessels

The ability of the brain to compensate after injury declines with age

Intellectual performance is maintained until at least 80 years of age

Slowing in central processing: delay in time required to perform tasks

Verbal skills maintained until age 70

Number and sensitivity of sensory receptors, dermatomes, and neurons decrease: dulling of tactile sensation

Decline in the function of cranial nerves affecting taste and smell

Risk Factors of Neurologic Damage

Cigarette smoking, obesity

Ineffective stress management

Hyperlipidemia, hypertension

High risk activities

Sexually transmitted infections

Neuro Assessment: General Observations

Asymmetry, weakness, paralysis, tremors

Tingling sensations, headaches, blackouts

Neuro Assessment: Speech

Dysarthria (me… la… ga…)

Dysphasia (expressive, receptive)

Neuro Assessment: Physical  

Sensation (cotton swab vs pen)

Coordination and cerebellar function (finger to nose, run heel down shin)

Reflexes (Babinski reflex)

Additional tests (computes tomography)

Indications of Neurologic Problems

Vision changes

Sudden deafness, tinnitus

Mood, personality changes

Altered cognition, LOC

Clumsiness, unsteady gait

Numbness, tingling of extremity

New headaches

Parkinson’s Disease

Affects ability of the CNS to control body movements

Dopamine: necessary for smooth motor movement and emotions

More commonly seen in men and after 50 years old

Exact cause unknown; toxin exposure, encephalitis, cerebrovascular disease (arteriosclerosis)

VERY HIGH RISK FOR FALLS

Parkinson’s Signs and Symptoms

Tremors and shuffling gait while bending forward at the trunk

Muscle rigidity and weakness, causing drooling, dysphagia, slow speech, monotone voice, moist skin

Bradykinesia and poor balance

Increased appetite

Face assumes a mask-like appearance, emotional and postural instability

Rate of movement increases as patient walks, may be unable to voluntarily stop walking

Secondary Parkinson’s Symptoms

Depression, anxiety, sleep disturbances, dementia, forced eyelid closure, decreased blinking, drooling, dysphagia, constipation, SOB, urinary hesitancy or urgency, reduced interest in sex

Parkinson’s Treatment Options

Carbidopa/Levodopa (Sinemet)

• Avoid vitamin B6 (avocados, lentils, lima beans)

Nursing interventions

• Active and passive ROM

• Concerns for contractures

• Patient safety; high risk for falls!

Goal: maximum level of independence preserved

Transient Ischemic Attacks (TIA) “mini strokes”

Temporary or intermittent reduction in cerebral perfusion

Signs and symptoms- minutes to hours; recovery usually within 1 day

• Hemiparesis, hemianesthesia, aphasia, hemianopia, diplopia, vertigo, N/V, dysphagia

Treatment/management of underlying cause, anticoagulant therapy, vascular reconstruction

Increased risk for CVA

CVA

Third leading cause of death and a major cause of disability in older adults

Predisposing factors: dehydration, hypertension, diabetes, gout, anemia, hypothyroidism, myocardial infarction, TIAs

• Ischemic (thrombus or embolus)

  • Hemorrhagic (ruptured cerebral blood vessel): due to ruptured aneurysm

CVA Signs and Symptoms

Depend on the area of brain affected (medulla oblongata)

-Light-headedness, dizziness, headache, memory and behavior changes, facial droop, aphasia, hemianopsia

Nursing Care:

-Maintain patent airway

-Provide adequate nutrition and hydration

-Monitor neurologic and vital signs

-Prevent complications associated with immobility

After patient stabilization, focus is on rehabilitation

Spot a Stroke

B- balance: loss of balance, headache, dizziness

E- eyes: blurred vision

F- face: one side of the face is drooping

A- arms: arm or leg weakness

S- speech: speech difficulty

T- time: time to call for an ambulance immediately