nervous system problems

dementia

chronic confusional state or syndrome; progressive loss of brain function and impaired cognition

what can be acute and reversible

delirium

what are the two main types of dementia

alzheimer’s and vascular

alzheimer’s cause

genetic or enviornmental

alzheimers is

a steady and gradual decline of cognition and mobility

who is at risk for alzheimer’s

females older than 65, down syndrome and people with TBIs

vascular dementia

stepwise progression of dementia symptoms that get worse with each vascular event

cause of vascular dementia

stroke or other vascular disorders that decreases blood flow to the brain

risk factors for vascular strokes

males older than 65

how many stages does alzheimer’s have

3 stages

in stage one (mild) of alzheimer’s what are the symptoms

they are independent in ADLs, they forget names or misplace things, subtle changes in personality or behavior, mild cognition issues and lapses of judgments, decreased sense of smell (general forgetfullness)

in stage 2 (moderate) of alzheimers what are the symptoms

impairment of all cognitive functions, depression, agitation, increasingly dependent in ADls , speech and language deficits, less talkative, wrong vocabulary , incontinence issues, wandering (keep pt safe)

in the 3rd (late) stage of alzheimers what are the symptoms

completely incapacitated, bedridden , totally dependent for ADLs, loss of mobility and verbal skills, death

agnosia

loss of sensory comprehension, including facial recognition

amnesia

loss of memory

anomia

inability to find words

aphasia

problems with speech and language

brocas aphasia

can not speak

wenicke’s aphasia

can not understand written or spoken language

apraxia

inability to use words or object correctly

ataxia

loss of control of body movements

dementia management

safety (stage 2 is more dangerous), establish a routine, allow for patient to be involved in care and decision making as much as possible, reminiscence therapy, enter their world, redirection, be aware of caregiver role strain, assess for neglect and abuse

parkinson’s disease

a progressive neurodegenerative disease that is one of the most common neurologic disorders of older adults , degeneration of substantia nigra cells which causes decrease dopamine

who primarily is at risk for parkinson’s disease

males who are older than 40

parkinson’s decreases what

dopamine

what does dopamine help with

helps with voluntary muscle and sympathetic nervous system control

what does parkinson’s disease affect

mobility, tremor, muscle rigidity, bradykinesia, postural instability

parkinsons disease collaborative care treatment

PT, OT, SLP(speech)

medications for parkinson’s

dopamine agonists (Carbidopa/levodopa) , MAOIs

how do you administer Carbidopa/levodopa

one at a time to maintain therapeutic levels

when do you use MAOIs in parkinson’s disease

in the early stages

what do you teach when taking MAOIs

avoid tyramine (certain cheeses), while on medication and 14 days after discontinuing it

migraine headaches

a common clinical syndrome characterized by recurrent episodic attacks of head pain

describe a migraine headache

throbbing and unilateral

what symptoms can occur with migraine headaches

nausea, sensitivity to light (photophobia), sound (phonophobia), or head movement that can last 4-27 hrs

triggers of a migraine headache

caffeine, red wine, stress, fatigue, light or change in weather

how are migraines classified with auras

classic migraine

migraine without aura

common migraine

who is at risk for migraines

women older than 50 (will need MRI, higher risk for stroke)

classic migraine stage one symptoms (first prodromal)

aura, possible visual disturbances, possible neurological disturbances (vertigo, confusion, dizziness)

classic migraine stage two symptoms (second stage)

headache, n/v

classic migraine stage 3 (postdromal stage)

pain is dull, body is in recovery

abortive therapy for migraines goal

to stop the migraine while it is in the aura phase soon after the pain has started

abortive therapy for mild migraines

NSAIDs

abortive therapy for moderate to severe migraines

\-triptans (may cause rebound headaches)

when do you use preventive therapy for migraines

when migraines occur more than twice a week , interferes with ADLs or does not respond to acute therapy

preventive therapy medications

NSAIDs, -triptans, beta-blockers, calcium channel blockers, antiepileptics, CGRP-R antagonists

complimentary therapies for migraines

medical marijuana, yoga, massage, exercise, magnesium, B12

cluster headaches feel like

unilateral, severe, pain in or around the eye

how long do cluster headaches last

short in duration but may occur several times in one day

symptoms with cluster headaches

tearing , possible swelling around affected eye, runny or stuffy nose

treatment for cluster headaches

oxygen and verapamil (calcium channel blocker)

seizures

an abnormal, sudden, excessive uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness, motor or sensory ability and behavior

primary seizure

idiopathic, possibly genetic factors

secondary seizures

caused by metabolic disorders such as alcohol withdrawl, electrolyte imbalances, high fever, stroke, head injury, substance abuse and heart disease, meningitis

epilepsy

a chronic disorder in which repeated unprovoked seizure activity occurs

tonic clonic seizure

stiffening or rigidity of muscles (tonic), rhythmic jerking (clonic), patient may bite their tongue and become incontinent , fatigue and acute confusion may last up to an hr after a seizure

tonic sezire

abrupt increase in muscle tone, LOC, tight muscles

clonic seizure

muscle contraction and relaxation (shaking)

myoclonic seizure

brief jerking of the extremities that may occur singly or in groups, lasting for a few seconds, may be symmetric or asymmetric

partial seizure

only one cerebral hemisphere, simple or complex (absence)

status epilepticus

seizure lasting more than 5 mins, or multiple seizures within 30 min

what can status epilepticus cause

hypoxia, hypotension, hypoglycemia, cardia dysrhythmias, lactic acidosis, kidney failure, death

medications for status epilepticus

lorazepam or diazepam (benzodiazepines) , loading dose of phenytoin,

antiepileptics how to administer

one drug started at a time , started at a low dose

what to teach when giving antiepileptics

take at same time every day, do not miss doses, lab levels as directed, wear medical alter bracelet, do not take with new meds or herbs , know laws for driving, DO NOT stop if seizures stop, do not take with grapefruit juice

meningitis

inflammation of the meninges of the brain and spinal cord

symptoms of meningitis

stiff neck, headache, photophobia, fever, decreased LOC, macular rash

what causes viral meningitis

enterovirus, HSV-2, varicella, mumps, HIV

bacterial meningitis causes

by streptococcus pneumoniae or neisseria

if meningitis is caused by neisseria what occurs

it is very contagious and very deadly

what isolation are meningitis pts in

droplet isolation

when do you give meningitis vaccine

one dose at 11-12 yrs old. booster at 16

meningitis diagnosis

lumbar puncture , CT, blood cultures, positive kernig and brudzinski sign

kernig sign

pain when bending knee close to chest

brundzinski sign

when flexing neck , knee comes up

treatment of meningitis

supportive care, antibiotic, prevent complications such as ICP or seizures

complete SCI

spinal cord has been damaged in a way that eliminates all innervation below the level of injury

incomplete SCI

allows some function or movement below the level of the injury (most common)

what can often result from SCI

loss or decreased mobility, sensory perception, and bowel and bladder control

hyperflexion

a sudden and forceful acceleration of the head forward, causing extreme flexion of the neck

hyperextension

a sudden and forceful acceleration of the head backward, causing extreme extension of the neck

compression

injuries resulting from diving accidents, falls on the buttocks, or jump in which a person lands on feet , can cause a blow on top of head can cause the vertabrae to shatter

rotation

results from injuries that are caused by turning the head beyond the normal range

penetration

classified by the speed of the object causing the injury

trauma leading cause of SCI

more than 1/3 of all are from car accidents, falls, acts of violence (gunshot wounds, sports, recreation related incidents

80% of SCIs occur in these people

young white males

quadripeligia

c4 and c6 injury all extremities

parapalegia

t6 and l1 injury, lower extremities

if the injury is above the sixth thoracic vertebra what cardiovascular dysfunctions can result

bradycardia, hypotension, hypothermia

why do patients with an SCI have an increased risk for blood blots

poor vessel tone and low movement

interventions for SCI cardiovascular

SCDs, blood thinners, medications to raise BP

what can happen in the respiratory system with pts with SCI

weak cough, innerventions in the respiratory muscles

interventions for respiratory problems with SCI

incentive spirometer, TCDB, assisted coughing, vaccinations, mucolytics, fluids, and RT

autonomic dysreflexia

life threatening condition in SCI pts (t6 or higher), which noxious visecral or cutaneous stimuli cause a sudden and massive sympathetic response

symptoms of autonomic dysreflexia

hypertension, profuse sweating, pale cool skin below injury, lower heart rate

cause of autonomic dysreflexia

usually GI (constipation), GU (urinary retention, or vascular stimulation

prevention of autonomic dysreflexia

assess frequently for potential risks of AD

nursing interventions for autonomic hyperflexia

raise head of bed, investigate for and fix cause, administer nifedipiene or nitrate to lower bp

cervical or high thoracic GI and GU problems

spastic bowel and bladder