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Patient/family history
Presenting complaint
Physical/mental
Psychosocial/ lifestyle (some might lead to weakness)
Age (intuitive vs. age-related)
Military
Drugs (cocaine)
What are the assessments to consider for all neurodegenerative diseases?
For patient with neuro change (dense and less dense tissue)
When do you preform a diagnostic imaging test?
Patient has to stay still for the entire scan, movement can cause distortion.
Assess for metal
What is a disadvantage for MRI?
Xray
CT
MRI and MRA
What are the diagnostic IMAGING for neurodegenerative diseases?
Blood
CMP, CBC
Electrolytes
Glucose (hypoglycemia)
Serology
Drug levels
Cerebral spinal fluid (CSF)
What are the LABS for neurodegenerative diseases?
Sodium (CNS changes)
What is the main electrolyte lab to look for in neurodegenerative diseases?
Mg
K
Phosphorus
Which electrolytes can affect cardiac?
Signs of stroke can be confused with hypoglycemia, which can cause sudden confusion
Why do we look at blood sugar labs for neuro?
Checks for infection (could be syphilis or viral infection)
Why do we look at serology for neuro?
If they have RBC, WBC, immunoglobulin (could be bleeding)
Color and texture
What should you look for when assessing a patient’s CSF?
Electromyography (EMG)
Electroencephalography (EEG)
What are the diagnostic TESTS for neurodegenerative diseases?
Electromyography (EMG)
Electricity test that measures the electrical activity of muscle and nerves
Areas of weakness
What does EMG identify?
Electroencephalography (EEG)
Test that measures electrical activity (brain waves) of the brain; not bedside
Spot (quick)
Continuous (catch seizure)
What are the two types of EEG?
NO sedative or stimulation meds
What should you do 12-24 hours prior to a patient getting an EEG?
Insertion of spinal needle into subarachnoid space between 3rd and 4th lumbar vertebrae
What is a lumbar puncture?
Checks CSF fluid to diagnose certain health conditions; can check for pressure
What are the reasons for a lumbar puncture?
Clear and colorless with no chunks
What should CSF look like?
Signs of bleeding, infection, infectious material
What can CSF fluid assess for?
Do not do on patients with excessive pressure
Do not do on patients with infection
What are the nursing considerations PRE lumbar puncture?
Look for headaches (post puncture headache); which could indicate CSF leak
What are the nursing considerations POST lumbar puncture?
Post puncture headache
Leakage of CSF only when patient is SITTING UP
Lay flat (gravity)
Give pain meds, fluids
Bed rest 4-6hr
What are the nursing interventions for post puncture headache?
Auditory
Visual
Somatosensory
What are the 3 types of Evoked Potentials?
Evoked Potentials
Tests to assess signals in the brain to different stimuli; looks at nerve conduction
Checks for delayed, slow, or no conduction of optic, sensory, and auditory nerve
What nerve conduction does evoked potentials look at?
Could mean multiple sclerosis
What does a delay mean for evoked potentials?
Transcranial Dopplers
Noninvasive ultrasound that looks for cerebral circulation (vessels in the skull)
Cerebral vasospasm or narrowing of arteries which can cause ischemia; SUBARACHNOID HEMORRHAGE (increases risk of vasospasm)
What does a transcranial doppler look for?
Transcranial dopplers
What is an alternative to Cerebral Angiography?
Maintain quality of life (baseline)
goals of care (changes as disease progresses)
Manage symptoms
Help patient be independent as long as possible
Support families as roles change
What are the goals of autoimmune/degenerative disorders?
No, just management
Is there a cure for autoimmune/degenerative disorders MS and Parkinson's?
Multiple Sclerosis (MS)
Demyelination of myelin sheath in CNS; scarring slows or stops conduction
Blocked or slowed
What happens to the nerve impulses in MS?
Length of diagnosis
Misdiagnosis
“you just need sleep”
Upon diagnosis:
relief vs. anger/frustration
After diagnosis:
Anxiety, depression
What are the psychosocial concerns of MS?
Relief vs. anger/frustration
What might the patient’s reaction be upon diagnosis of MS?
Anxiety, depression
What might the patient’s reaction be after diagnosis of MS?
Promote open communication/therapeutic communication
Assess for coping mechanisms and stress management
Sexual dysfunction
How can you help a patient with psychosocial concerns for MS?
Remissions and exacerbations
VISUAL CHANGES
PARASTHESIA
ATAXIA (gait, fine motor)
Cognitive changes: MEMORY IMPAIRMENT
Tremors
Weakness
Fatigue
Dysarthria, Dysphagia
Bowel and bladder dysfunction
S/S of MS?
Ataxia
Trouble with coordination
Liver and bone; can lead to bleeding (platelets), infection (WBC), ischemia (RBC)
What can all MS damage in the body?
No cure
Meds to treat symptoms
Baclofen, Docusate Sodium
Frequent assessment of liver and bone marrow function
Medical marijuana
Physical and occupational therapy
Education
Use of disease modifying drugs (DMD)
What are the nursing interventions for MS?
MRI
Presence of IgG and high WBC in CSF
Elevated IgG in serum
Evoked potential testing (after diagnoses)
What are diagnostic TEST for MS?
Sclerosis: plaque
What does MRI for MS look for?
Glucocorticoids
IVIG-IV Immunoglobulin
Treatment of MS EXACERBATION?
Short course (3-5 days) of high-dose IV glucocorticoid
How long is the treatment for MS patients on glucocorticoids?
Immunoglobulin
Antibodies from donors
Not widely given
Urinary retention (alpha andrenergic blocking agents)
Constipation (stool softeners)
Muscle spasms (spasticity) (muscle relaxers)
What are the treatments of common MS symptoms?
Parkinson’s Disease (PD)
Progressive neurodegenerative disorder due to a loss of dopamine
No, usually from secondary pulmonary or renal disease
Does a patient die directly from PD?
FALLS
What is a patient with PD at risk for?
Deletion of dopamine, the neurotransmitter required to control posture and voluntary movement
What is the pathophysiology of PD?
Loss of control of voluntary movement (contract but can’t relax)
What does the loss of dopamine from PD cause?
Dopamine
What is required for the relaxation of muscles?
Acetylcholine
What is required for the contraction of muscles?
4 cardinal
TREMOR
MUSCLE RIDGIDITY
BRADYKINESIA OR AKINESIA (slow or no movement)
POSTURAL INSTABILITY
PILL ROLLING
SHUFFLING GAIT
Muscle weakness
Masklike appearance of face (can’t relax
Drooling
Impaired judgement and emotional instability
Change in cognition, psychosis (late)
S/S PD?
No specific tests
Dopamine transporter scan (newer)
CSF may show low dopamine levels
Single-photon emission computed tomography (SPECT)
Presentation of 2 OR MORE symptoms
What can you use to diagnose PD?
Dopamine transporter scan (new)
Radioactive agent binds to dopamine transporter
Single-photon emission computed tomography (SPECT)
May show loss of dopamine-producing neurons
2 or MORE
How many symptoms should a patient have to be diagnosed with PD?
MOAB
COMT
What are the supplemental meds for PD?
Aged foods, can cause hypertensive crisis
What should patients taking MAOB avoid?
Efficacy can wear off; pt becomes tolerant
What happens to PD drugs over time (as they keep taking)?
Reduce drug dosage
Change drug to another
“Drug holiday” (take off meds completely)
What are the options for patients when they develop tolerance to PD drugs?
Monitor patient symptoms during “drug holiday”
Worsening of safety issues, risk of aspiration, worsening cognition, etc.
Educate patient to report signs of worsening PD
What are the nursing interventions for a patient who has developed drug tolerance for PD?
Lower doses
Lower side effects
Can help dyskinesia
What is beneficial of restarting meds after drug holiday?
Deep brain stimulation
Stereotactic Pallidotomy
What are invasive treatments for PD?
Conservative measures (ex. meds)
What should you consider before choosing to do invasive procedures?
Deep brain stimulation
Electrode in both or one side of brain that can regulate brain activity, can be turned on and controlled
Stereotactic Pallidotomy
Zaps Globus of brain and destroy tissues, which can reduce PD symptoms