N300 final Neuro problems

Bells palsy

disruption of motor branch on facial nerve 7 causing temporary peripheral facial paralysis on one side

causes of bells palsy

may be related to herpes simplex virus or some form of virus

• real cause is unknown

signs and symptoms of bells palsy

• drooping/difficulty closing eye

• paralysis on one side of the face

• chewing difficulties/loss of taste

bells palsy treatments

steroid medications: prednisone

antiviral medications: acyclovir

interventions for bells palsy

• medicate for pain

• protect eyes

• body image disturbance

Guillain barre (post infectious polyneuropathy)

progressive loss of peripheral nerve function due to immune system attacking peripheral nerves

causes of guillain barre

immunologic response to viral infections, trauma, surgery, immunizations, or HIV

signs/symptoms of guillain barre

Starts in extremities: Tingling, "pins and needles," or weakness in toes/fingers that spreads upward.

Ascending weakness: Moves to legs, then arms, trunk, and face.

Pain: Severe, aching pain, often in the back, buttocks, and thighs.

Progressive: Symptoms peak within weeks, sometimes as quickly as days.

Severe cases: Can lead to paralysis, affecting breathing, swallowing, or speaking, low blood pressure, dysrhythmias, and tachycardia

complications of guillain barre

stems from respiratory complications like PE and respiratory arrest

treatments with guillain barre

• supportive care

• immunoglobins (neutralize foreign bodies like bacteria or viruses)

• plasmapheresis (filters blood)

• nutritional support (for difficultly swallowing)

nursing interventions for guillain barre

• assess respiratory status frequently (ABG, vital capacity, breathing pattern, breath sounds) + treatments

• vital signs

• sunction prn

• eternal feedings and nutritional support prn

• vasopressors for hypotension

• assess for dysphagia and aspiration precautions

myasthenia gravis

fluctuating weakness in voluntary muscles (eyes, face, swallowing, limbs, breathing)

patho of myasthenia gravis

too much anti-acetylcholine antibodies, preventing ACh molecules from stimulating muscle contractions

signs and symptoms of myasthenia gravis

• generalized voluntary muscle weakness (eye movement, chewing swallowing, speaking, and breathing)

• muscle weakness that improves with rest

• ptosis (drooping eyelid), double vision (diplopia)

• slurred speech, difficultly speaking and swallowing

treatments for myasthenia gravis

anticholinesterase medications

corticosteroids

immunosuppresives

removal of thymus gland (because it is usually associated with thymus tumor or abnormal thymus function)

myasthenia gravis interventions

• assess severity of muscle weakness

• monitor breathing pattern and airway clearance

• monitor for dysphagia and aspiration precautions

• KEEP AIRWAY PATENT

myasthenic crisis

under medication with anti-cholinesterase meds

• arrhythmias, respiratory distress due to paralysis, increased secretions, sweating

cholinergic crisis (MG)

over medication with anti-cholinesterase meds

• sudden muscle weakness, inability to swallow, increased salivation, inability to clear secretions, sweating

incomplete SCI

little communication/partial loss of muscle control with impaired sensation below LOIco

complete SCI

no communication/total loss of muscle control

tetraplegia

none or impaired use of arms and legs

C1-C8

paraplegia

complete use of arms, no/impaired use of legs

T1-S2

S1-S5

impaired bowel/bladder and sexual functioning

cauda equina

only nerves from S1-S5 are damaged, bowel, bladder, and sexual dysfunction are intact, no motor deficits

anterior cord syndome

damage is in the front of the spinal cord

• loss or impaired ability to sense pain, temperature and touch below LOI

• usually complete paralysis below injury

central cord syndrome

damage is center of the spinal cord

• more paralysis in the arms than legs

• some preservation of control on bladder and bowel

• most common in hyperextension, spinal stenosis

brown sequard syndrome

damage is on one side of the spinal cord

• impaired or loss of movement to the injured side but sensation is still intact

• usually caused by GSW, stabbing, MVA

posterior cord syndrome

damage is towards the back of the spinal cord

• good muscle power, pain, and temperature sensation

• difficultly with proprioception and coordinating movement of limbs

• motor weakness below LOI

SCI assessment

• hypotension

• bradycardia

• edema in feet

• neuropathic pain

• temperature intolerance

• weakened/impaired cough

• spasticity

poikilothermia

temperature intolerance so body temp takes after the environment

• heat can be damaging because they don’t know how hot it truely is or overheat

quad cough

nurse helps patient cough by pushing on rib/xiphoid process

spascity

SCI blocks inhibitory signals from brain, so body overreacts to normal and noxious stimuli

• monitor for skin breakdown

• good for muscle bulking, could be warning sign infection/painful stimuli, increased circulation, and can assist with transfers and walking

autonomic dysreflexia

medical emergency when abrupt onset of excessively high blood pressure caused by uncontrolled sympathetic nervous system response in person with SCI

• 140/90 could be considered hypertensive emergency due to SCI normally being hypotensive

multiple sclerosis

chronic and progressive degenerative disorder of central nervous system

• disseminated demyelination of nerve fibers of the brain and spinal cord

causes of MS

• infections, immunologic and genetic factors that cause the body to attack myelin sheath

• plaques scattered throughout the CNS

• permanent loss of nerve function

signs and symptoms of MS

motor:

• weakness

• paralysis of limbs, trunk, and head

• diplopia

• spasticity of muscles

sensory:

• numbness and tingling

• blurred vision

• vertigo and tinnitus

cerebellar:

• nystagmus

• ataxia

• dysarthria (difficult or unclear articulation of speech)

• dysphagia (difficultly swallowing)

emotional symptoms: anger, depression, euphoria, sexual dysfunction

parkinsons

progressive disorder with destruction of nerve cells in basal ganglia and substania nigra of brain

causes of parkinsons

dopamine deficiency and degeneration of muscular function caused by neurotransmitter imbalaces (ACh and dopamine), viruses, CVA, chemical or physical trauma

• lack of dopamine causes more acetylcholine to be floating aroun

stages 1 of parkinsons

unilateral involvement only, usually little or no neurologic impairments

stage 2 of parkinsons

bilateral involvement, without impairment of balance

stage 3 of parkinsons

first sign of impaired reflexes, unsteadiness

stage 4 parkinsons

fully developed, still able to walk and stand

stage 5 parkinsons

client is confined to bed or wheel chair

signs and symptoms of parkinsons

• Motor:

  Tremor (especially at rest, "pill-rolling"), stiffness, slow movement, small handwriting (micrographia), masked face, stooped posture, gait changes (shuffling steps). 

• Non-Motor:

  Depression, anxiety, sleep disorders (acting out dreams), constipation, loss of smell, fatigue, cognitive changes, speech difficulties (soft, monotone). 

• intellectually intact unless presence of dementia

nursing interventions for parkinsons

• fall risk

• aspiration precautions

• pt.ot for postural deformities/gait

• stress increases symptoms = ensure calm and soothing enviornments

levodopa

most effective parkinsons drug

allows for more dopamine

carbidopa

protects levodopa from premature conversion to dopamine outside the brain, can also prevent nauseado

dopamine agnosist

mimic effects of dopamine, lasts longer but not always effective

huntingtons

inherited neurodegenerative disorder leading to nerve cell death in the brain, resulting in progressive loss of movement control (chorea), cognitive decline, and psychiatric issues

causes of hungtingtons

gene mutation/inheritance causes lack of ACh and GABA causing excess dopamine

signs and symptoms of huntingtons

• abnormal excessive involuntary movement (chorea): twisting movements of face, limbs, and body

• speech, swallowing, and difficulty chewing

• ambulation is affected

• intellectual deterioration: emotionally labile, psychotic behavior

treatment of huntingtons

pallative and anti-psychotics

alzheimers

degernative dementia

patho of alzheimers

decreased levels of acetylcholine, norepinephrine, serotonin, and somatostatin caused by genetic predisposition

• leads to enlarged cerebral ventricles and brain atrophy that causes memory changes, loss of language skills and judgment and behavioral changes

signs and symptoms of alzheimers

• memory impairment

• aphasia (language), apraxia (motor), agnosia (unfamiliar environment)

• difficultly planning, organizing, and sequencing events

stage 1 of alzheimers

forgetfulness, mild memory loss, loss of judgment, wandering, subtle behavior changes

stage 2 alzheimers

severe cognitive and intellectual impairment, disorientation, labile behavior, personality changes, physical impairment, language difficulties, impaired motor skills

stage 3 alzheimers

completely incapacitation, total dependence for ADLs, general and focal neurologic deficits, gross impairment of motor skillsinte

interventions of alzheimers

• environment

• constant caregiving

• reorientation to environment

• maintain routines

• medications that slow breakdown of ACh

migraines

unilateral or bilateral recurring head pain

• may have aura

triggers that might cause migraine

• food

• hormonal

• head trauma

• physical exertion

• fatigue

• stress

• pharmacologic agents

• strong family history

seizure

paroxysmal, uncontrolled electrical discharge of neurons in brain interrupting normal functions

• find underlying cause

• whole brain is turned on during seizure, so brain is using more O2 and glucose

seizure causes

• acidosis

• electrolyte imbalances (hyponatremia)

• hypoglycemia

• hypoxemia

• alcohol/barbituate withdrawl

• dehydration/SIADH

epilepsy

spontaneously recurring unprovoked seizures without known cause

epilepsy causes

• infection (meningitis), trauma, birth injury, and genetic factors that cause neurons to spontaneous fire

partial seizure

affects only part of the brain

does not loose consciouness

generalized seizure

affects whole brain

looses consciousness (assess for head trauma)

seizure stages

prodromal phase: prodromal phase precedes seizure with signs or activity

aural: sensory warning that seizure is going to happen

ictal: full manifestation of seizure; can be dangerous if too long

postictal phase: rest and recovery

status epilepticus

state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures

• causes brain to use more energy then supplied and become totally exhausted

• can cause permanent brain damage

tonic clonic status epilepticus

ventilatory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, and systemic acidosis

nursing interventions for seizures

• protect head

• protect airway (suction prn)

• identify events/triggers

• create safe environment

ALS (amyotrophic lateral sclerosis)

progressive neurological disease characterized by loss of motor neurons

causes of ALS

excessive levels of glutamate (too much glutamate can be toxic to brain) caused by heredity conditions

• motor neurons degenerate, messages from brain cannot be relayed to muscles, muscles progressively weaken and waste away

symptoms of ALS

weakness, dysarthria, muscle wasting, respiratory problems

ALS interventions

• communication

• risk for aspiration

• fall risk

• pneumonia

• patient is cognitively intact

menieres

inner ear disorder causing veritgo and tinnitus, fluctuating hearing loss, and ear fullness, due to excess fluid buildup

dementia

describes group of symptoms affect intellectual and social abilities severely enough to interfere with daily functioning (not reversible)

dementia symptoms

• memory loss (both long and short)

• Aphasia (language problems)

• apraxia (organizational problems)

• agnosia (unable to recognize objects or tell their purpose)

• disturbed executive function

delirium

treatable/reversible acute disorder of attention, memory, and perception