BMS Neurodegenerative Diseases

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71 Terms

1
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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?

2
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For patient with neuro change (dense and less dense tissue)

When do you preform a diagnostic imaging test?

3
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Patient has to stay still for the entire scan, movement can cause distortion.

  • Assess for metal

What is a disadvantage for MRI?

4
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  • Xray

  • CT

  • MRI and MRA

What are the diagnostic IMAGING for neurodegenerative diseases?

5
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  • Blood

    • CMP, CBC

    • Electrolytes

    • Glucose (hypoglycemia)

    • Serology

    • Drug levels

  • Cerebral spinal fluid (CSF)

What are the LABS for neurodegenerative diseases?

6
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Sodium (CNS changes)

What is the main electrolyte lab to look for in neurodegenerative diseases?

7
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  • Mg

  • K

  • Phosphorus

Which electrolytes can affect cardiac?

8
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Signs of stroke can be confused with hypoglycemia, which can cause sudden confusion

Why do we look at blood sugar labs for neuro?

9
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Checks for infection (could be syphilis or viral infection)

Why do we look at serology for neuro?

10
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  • If they have RBC, WBC, immunoglobulin (could be bleeding)

  • Color and texture

What should you look for when assessing a patient’s CSF?

11
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  • Electromyography (EMG)

  • Electroencephalography (EEG)

What are the diagnostic TESTS for neurodegenerative diseases?

12
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Electromyography (EMG)

Electricity test that measures the electrical activity of muscle and nerves

13
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Areas of weakness

What does EMG identify?

14
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Electroencephalography (EEG)

Test that measures electrical activity (brain waves) of the brain; not bedside

15
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  1. Spot (quick)

  2. Continuous (catch seizure)

What are the two types of EEG?

16
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NO sedative or stimulation meds

What should you do 12-24 hours prior to a patient getting an EEG?

17
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Insertion of spinal needle into subarachnoid space between 3rd and 4th lumbar vertebrae

What is a lumbar puncture?

18
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Checks CSF fluid to diagnose certain health conditions; can check for pressure

What are the reasons for a lumbar puncture?

19
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Clear and colorless with no chunks

What should CSF look like?

20
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Signs of bleeding, infection, infectious material

What can CSF fluid assess for?

21
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  • Do not do on patients with excessive pressure

  • Do not do on patients with infection

What are the nursing considerations PRE lumbar puncture?

22
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Look for headaches (post puncture headache); which could indicate CSF leak

What are the nursing considerations POST lumbar puncture?

23
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Post puncture headache

Leakage of CSF only when patient is SITTING UP

24
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  • Lay flat (gravity)

  • Give pain meds, fluids

  • Bed rest 4-6hr

What are the nursing interventions for post puncture headache?

25
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  • Auditory

  • Visual

  • Somatosensory

What are the 3 types of Evoked Potentials?

26
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Evoked Potentials

Tests to assess signals in the brain to different stimuli; looks at nerve conduction

27
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Checks for delayed, slow, or no conduction of optic, sensory, and auditory nerve

What nerve conduction does evoked potentials look at?

28
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Could mean multiple sclerosis

What does a delay mean for evoked potentials?

29
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Transcranial Dopplers

Noninvasive ultrasound that looks for cerebral circulation (vessels in the skull)

30
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Cerebral vasospasm or narrowing of arteries which can cause ischemia; SUBARACHNOID HEMORRHAGE (increases risk of vasospasm)

What does a transcranial doppler look for?

31
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Transcranial dopplers

What is an alternative to Cerebral Angiography?

32
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  • 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?

33
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No, just management

Is there a cure for autoimmune/degenerative disorders MS and Parkinson's?

34
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Multiple Sclerosis (MS)

Demyelination of myelin sheath in CNS; scarring slows or stops conduction

35
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Blocked or slowed

What happens to the nerve impulses in MS?

36
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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?

37
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Relief vs. anger/frustration

What might the patient’s reaction be upon diagnosis of MS?

38
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Anxiety, depression

What might the patient’s reaction be after diagnosis of MS?

39
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  • 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?

40
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  • 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?

41
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Ataxia

Trouble with coordination

42
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Liver and bone; can lead to bleeding (platelets), infection (WBC), ischemia (RBC)

What can all MS damage in the body?

43
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  • 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?

44
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  • MRI

  • Presence of IgG and high WBC in CSF

  • Elevated IgG in serum

  • Evoked potential testing (after diagnoses)

What are diagnostic TEST for MS?

45
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Sclerosis: plaque

What does MRI for MS look for?

46
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  • Glucocorticoids

  • IVIG-IV Immunoglobulin

Treatment of MS EXACERBATION?

47
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Short course (3-5 days) of high-dose IV glucocorticoid

How long is the treatment for MS patients on glucocorticoids?

48
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Immunoglobulin

  • Antibodies from donors

  • Not widely given

49
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  • Urinary retention (alpha andrenergic blocking agents)

  • Constipation (stool softeners)

  • Muscle spasms (spasticity) (muscle relaxers)

What are the treatments of common MS symptoms?

50
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Parkinson’s Disease (PD)

Progressive neurodegenerative disorder due to a loss of dopamine

51
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No, usually from secondary pulmonary or renal disease

Does a patient die directly from PD?

52
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FALLS

What is a patient with PD at risk for?

53
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Deletion of dopamine, the neurotransmitter required to control posture and voluntary movement

What is the pathophysiology of PD?

54
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Loss of control of voluntary movement (contract but can’t relax)

What does the loss of dopamine from PD cause?

55
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Dopamine

What is required for the relaxation of muscles?

56
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Acetylcholine

What is required for the contraction of muscles?

57
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  • 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?

58
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  • 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?

59
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Dopamine transporter scan (new)

Radioactive agent binds to dopamine transporter

60
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Single-photon emission computed tomography (SPECT)

May show loss of dopamine-producing neurons

61
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2 or MORE

How many symptoms should a patient have to be diagnosed with PD?

62
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  • MOAB

  • COMT

What are the supplemental meds for PD?

63
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Aged foods, can cause hypertensive crisis

What should patients taking MAOB avoid?

64
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Efficacy can wear off; pt becomes tolerant

What happens to PD drugs over time (as they keep taking)?

65
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  • 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?

66
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  • 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?

67
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  • Lower doses

  • Lower side effects

  • Can help dyskinesia

What is beneficial of restarting meds after drug holiday?

68
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  • Deep brain stimulation

  • Stereotactic Pallidotomy

What are invasive treatments for PD?

69
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Conservative measures (ex. meds)

What should you consider before choosing to do invasive procedures?

70
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Deep brain stimulation

Electrode in both or one side of brain that can regulate brain activity, can be turned on and controlled

71
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Stereotactic Pallidotomy

Zaps Globus of brain and destroy tissues, which can reduce PD symptoms