neuro pt 2

what is MS?

a demyelinating disease of the white matter of the brain and spinal cord characterized by exacerbations and remissions

describer the patho and etiology of MS

demyelination of white matter of brain and spinal cord with damage to nerve fibers

prevents conduction of normal nerve impulse

remissions = myelin sheath regeneration

risk factors: family history, living in cold damp climate, prognosis varies, life expectancy (25 yrs after onset)

etiology: viral infection, immunologic abnormalities

what are the classifications for MS?

clinically isolated syndrome (CIS): first episode, must last 24 hr, not yet meet criteria

relapsing remitting

secondary progressive: increase in episodes, progressive worsening of neuro function over time

primary progressive: not common, slow worsening symptoms from beginning with no relapses

list exacerbating factors of MS

fatigue/excessive exertion

excessive heat/cold

infections

hot baths

fever

emotional stress

pregnancy

what are the s/s of MS?

ocular: blurred, DV, disturbances, blind spots, eye pain

vestibular: dizziness, imbalance

sensory: N/T, burning sensation, decrease sense of temp, pain w/ spasms

motor: fatigue, weakness, intentional tremors (on movement), speciosity, atrophy

neurobehavioral: emotional ability, forgetful, impaired judgement, apathy

GI/GU: difficulty swallowing/chewing, decrease absent sphincter control, constipation, hesitancy, frequency, retention, neurogenic bladder

fatigue

how is MS diagnosed?

made on clinical grounds by exclusion of other disorders, no test definitive, age of onset: 10-50, deficits with relapsing: progressive cycle

MRI: lesions in brain and spinal cord

somatosensory evoked potential studies

cerebral spinal fluid: elevated protein and IgG

describe MS treatment

no effective curative treatment, drug therapy and symptom management

meds based on type and maintenance vs exacerbation: corticosteroids, imuran, cytoxan, interferon beta, baclofen, dantrolene

PT, OT, and pt/family education can also be helpful for symptom management

what is a seizure vs epilepsy?

seizure: single event caused by a localized, discharge focus in the brain

epilepsy: chronic recurrent seizures

what are causes of acute seizures?

fever, head injury, CNS infections/tumors, cerebrovascular disease, hypoglycemia, hyponatremia, ETOH ingestion, vitamin deficiency, poisons (lead)

what are precipitating factors or triggers for seizures?

odors, photo stimuli, music, lack of sleep/fatigue, medication non-compliance, emotional stress, constipation, menstruation, hyperventilation

describe some seizure terminology

tonus: rigid extensions of extremities

clonus: contraction/relaxtion of extremities

aura: prior to seizure, visual light spots, sounds, smells, feelings of anxiety, N/T

prodromal: symptoms before onset

ictus: event of seizure

poetical: altered LOC after the seizure

what are focal seizures?

only activations of restricted part of hemisphere

aware: consciousness not altered

impaired awareness: consciousness impaired

describe generalized seizures

full brain

motor: tonic/clonic

non-motor: absence, pt loses awareness of surroundings, blank/absent state

what is status epileptics?

prolonged seizure activity, a series of generalized seizures that occur without full recovery of consciousness between attacks

considered emergency

muscle contractions, impose high metabolic demands, can create hypoxia to brain

repeated episodes of cerebral anoxia and edema may lead to irreversible and fatal brain damage

what is treatment for status epileptics?

establish airway

D50, prevent hypo

diazepam/lorazepam every 2 min as needed

dilatin IV

phenobarbital

how is a seizure disorder diagnosed?

history, toxicology, EEG, CT/MRI, lumbar puncture to rule out infection or tumor

what drugs are used to treat seizures?

phenytoin, phenobarbital, carbamazepine, valproic acid, clonazepam, primidone, ethosuximide, gabapentin

these increase seizure threshold and decrease spread of activity in the brain

what is a surgery for seizures?

resection of epileptogenic focus: only if not controlled by med therapy

list what needs to be documented from a seizure

witnessed/unwitnessed

what pt was doing prior to seizure, prodromal signs, or aura

unilateral or bilateral

sequence, duration, LOC

incontience

pupils, automatisms, behavior/weakness/sleep after

what is parkinson’s disease?

slowly progressive neurological movement disorder, will lead to disability

what is the patho of PD?

decrease levels of dopamine

cells that produce dopamine are damaged, dead, or degenerated

nerve cells fire wildly

pt is unable to control movements

imbalance between dopamine and acetylcholinee

what causes PD?

unknown, environmental, trauma, genetic

typical onset after 50

what are manifestations of PD?

tremor at rest

rigidity

bradykinesia

postural intability

dysphonia: soft muffled voice

mask like expression, steps short and shuffled, depression, dementia, memory loss, elimination problems

affects all muscles: eyes, chewing, swallowing, talking

what is treatment for PD?

diet/exercise

medical: levodopa. converted to dopamine in basal ganglia, effective for first few years of treatment. can cause confusion, hallucinations, depression and sleep alterations.

long term levodopa AE: dyskinesia, facial grimacing, rhythmic jerking movements, head bobbing, chewing. smoking movement

deep brain stimulation: neuro stimulation implanted to target areas that cause tremors, must have no cog impairment

what are nursing interventions for PD?

assessment

improving mobility

self-care

bowel elimination

improving nutrition

enhancing, swallowing

improving communication