Medsurg Exam 3

Parkinson’s disease Pathology

• Chronic disease that kills the dopamine-producing cells.

• There is too little dopamine and a lot of acetylcholine

dopamine

inhibits movement

acetylcholine

stimulates movement

Parkinsons disease

causes slow initiation of movement (bradykinesia) & increased muscle tone and tremors (rigidity)

RISK FOR FALLS

Parkinsons Clinical manifestations

4 signs:

1. Tremor at rest: pill rolling of the hand (CLOCK IT)

2. Rigidity: Increase muscle tone (dumbell curl)

3. Bradykinesia: Slowness

Hm: Orthostatic Hypotension

Medical Management

Goal: Increase dopamine/ decrease acetylcholine

med ex. Levodopa/Benztropine

Surgery: Deep Brain Simulation & Ablation (destroy PD cells in brain)

Multiple Sclerosis patho

demyelination the myelin sheath of neurons in the CNS (brain & spinal cord)

• inflammation

• demyelination

• gliosis (CNS trauma enlarge)

multiple sclerosis

disrupts communication between the brain and the body (CNS)

multiple sclerosis clinical manifestations

• paresthesia

• Lhermitte’s sign

• diplopia

• dysphagia

paresthesia

tingling, numbness (pins & needles)

Lhermitte’s sign

electric shock sensation down the spine when flexing the neck

diplopia

blurred or doubled vision

multiple sclerosis diagnotic studies

no single test

MRI of brain shows plaque and inflammation

Cerebral Spinal Fluid (CSF) increase

multiple sclerosis management

Corticosteroids &immune meds FOREVER for acute relapses (side effects of euphoria)

sexual dysfunction (viagra)

Stool softeners

PREVENT EXACERBATIONS (stress, infection)

ALS/ Lou Gehrig’s Disease

Fatal progressive disease that causes voluntary muscle control to waste away NO CURE.

ALS patho

The loss of both upper and lower motor neurons where voluntary muscles no longer recives commands from the brain. BRAIN STILL WORKS GOOD

ALS clinical Mani.

• flaccidity weakness

• Fasciculations (muscle twitch)

• Hyporeflexia (decreased reflexes)

• Babinski sign positive

bulbar signs

• Dysphagia (difficulty swallowing).

• Dysarthria (difficulty speaking).

ALS Diagnostic studies

Pulmonary Function Test

Muscle Biopsy: Muscle atrophy of ALS

ALS Medical Management

Respiratory support (dysphagia)

Fall risk

Emotional support

prioritize hospice & palliative care

Guillain-Barre Syndrome patho

rapid onset autoimmune attack on the PNS causing muscle weakness from the toes up

medical emergency when respiratory muscles are affected (AIRWAY)

Guillain-Barre Syndrome clinical man.

Paralysis

diminished reflexes

digestion and bladder problems

Guillain-Barre Syndrome Diagnostic study

Lumbar puncture/spinal tap: Shows elevated CSF protein with normal white cell count

may come after respiratory or gastrointesional infection

Guillain-Barre Syndrome Medical management

Respiratory: prepare for inubation/mechanical respiration

Plasmapheresis and IVIG reduce severity of syndrome

Seizures & Epilepsy path

Seizure: sudden electrical disturbance in brain (may not loose consciousness); malfuction of firing neurons in hypocampus

epilepsy: recurrent unprovoked seizures

Seizures & Epilepsy clinical man.

Simple Partial: remains conscious

Complex Partial: lose conscious with automastisms

Secondary Generalized: unconsciousness with tonic clonic seizures

Seizures & Epilepsy risk factors

Metabolic disorders —> electrolyte imbalances: LOW hyponatremia, hypocalcalcemia, sugar, oxygen,

Generalized-onset seizures

Absence: staring spell in children

Tonic-Clonic: seizure with stiffening and jerking

Seizures & Epilepsy Interventions

oxygen and suction at bedside

nothing in mouth, no restraints, turn to side.

status epilepticus: medical emergency as continuous seizure greater than 5 min

sleep deprivation induces seizures

TEACH DO NOT MISS MEDS (Ativan restores cerebral perfusion)

Myasthenia Gravis

weakness in voluntary muscles of the face eye droop & fagile skeleton (osteoporosis)

Migrane headache

genetic (70%/first degree relative)

frequent aura

among women more & pregnancy

cluster headache

ptosis

most severe throbbing

seizure: what to look out for

monitor airway, record/document (length and factors), suction, IV access

seizure

neurons spontaneously firing/ electrical wave in the hyppocampus

seizure risk factors

tumor

head trauma

electrolyte imbalance (low sodium)

alcohol withdraw

when testing for a seizure with an ecg you must…

tell the patient to stay awake for 24 hours to induce a seizure

A patient with MS is using corticosteroids, what would the nurse look out for?

Side effects of euphoria and insomnia

A patient with parkinsons show what assessment findings

tremors at rest

short term memory loss

slurred speech

no emotion in face

Cholinergic crisis

increase in acetylcholine & myelin

bradycardia

Tensilon test makes it WORSEN

lorazapam restores…

cerebral perfusion

myasthenic crisis

decrease in acetylcholine & myelin

tachycardia

Tensilon test makes it BETTER

A patient with MS should not do which of the following…

take OTC medicatiom whcih will worsen symptoms

mg meds

prevention meds are taken at night to preserve half life and maintain theraputic level

Spinal Cord Injury (SCI) depends on…

Location & Severity

Neurogenic Shock

Shock caused by spinal injury leading to nervous system disruption of PNS & CNS= decreased BP & HR & vasodialation

C4 injury above causes…

Total Respiratory loss

C4 injury below causes…

respiratory insufficency & complete paralysis

Autonomic Dysreflexia

Spinal cord injury T6 and up. Check for fecal impaction or urinary retention (400ml)/ tight clothes. ELEVATE HOB to control high BP (45 degrees) diaphoresis

Autonomic Dysreflexia treatment steps

1. Elevate the head of bed

2. urinary retention

3. fecal impaction

4. spinal cord injection at c12 to give corticosteroids/ BP meds (150/90)

what assessments inecate neurogenic shock?

hypotensiona and warm extremeties from vasodialation

Intercranial pressure & causes

made of brain tissue, blood, and CSF.

caused by Cushing’s triad: Low HR, High BP, Irregular Respirations= brain death

Cerebral edema is fixed by …

osmotic duretics (mannitol)

Meningitis

infection/ inflammation of tissue surrounding brain/ spinal cord with cloudy nose drainage (strep, neisseria, haemophilus)

When a patient has clear nasal drainage after a head injury what is the next best thing to do?

check the nasal drainage for glucose to determine CSF drainage with dextrose stick to detetmine dural tear

barbiturate coma

induced temorary coma to protect the brain in surgery of intercranial pressure

broca

frontal lobe speech and writing

wernicke

understnding comprehensive speech/writting

mannitol promotes…

osmotic duresis by increasing the pressure gradient

meningitis assessments

nuchal rigidity (not flexing neck)

petechiae skin rash

Lumbar puncture is #1 test

PUT ON DROPLET

Bacterial meningitis can cause…

seizures

INCREASE protein & DECREASE glucose indicate

meningitis

When treating meningitis…

use antibiotics first (ceftriaxone)

When assessing the results of diagnosis test for CSF, what values would indicate bacterial meningitis?

Turbid

Increased protein level

Decreased glucose level

Stroke

Obstruction of blood flow or burst in the brain (hemorrage)

Ischemic stroke

blood flow blocked by thromus or emboli

Hemorrahagic stroke

spontaneous rupture EMERGENCY

thrombus

blockage in brain

embolus

came from somewhere in the body then caused a problem in the brain

Transient Ischemic Attack TIA

Caused by emboli cutting off blood supply in the brain. WARNING SIGN FOR STROKE (rule of thirds: never experience again, more TIA, have stroke)

Diagnosis test for Stroke

CAT scan is FAST and can differentriate hemorrage and ischemic

Speech Language Pathologist

After stroke will determine puree diet and assess for aspiration

Barrel swallow test to determine diet change

Asprin

used for stroke to prevent platelet aggregation (watch for bleeding)

hemiparesis

weakness on one side

hypotomia/flaccis

unable to overcome gravity

agnosia

loss of ability to recognise objects

Apraxia

unable to preform task

aphasia

unable to use written or oral language

Homonymous hemianopsia

blindness in same side of both eyes

Stroke Safety & Issues (bed ridden)

Pnemonia

Atelestasis

Pressure Ulcer

DVT

Falls

Unpredicable emotion due to the limbic system

alteplase pill

dissolves and breaks down clots

avoid injections but STOP INFUSION: headache, HTN, bleed, nausea, vomit, LOC

hypothalumus

hemostasis: controls production of hormones that control temp, HR, hunger, glucose, mood

adrenal gland

controls sugar and sodium using cortisol

adrenal medulla

control epinephrine & norepinephrine for BP

Uncontrolled =Hypertenisve crisis (increased metabolism)

Thyriod Gland

produces T3 & T4 making calcitonin

in order to make thyroid gland hormones you need adequate…

protein and iodine

thyrocalcitonin helps regulate

calcium

parathyroid hormone

increases serum calcium

estrogen reuglates

menstrual cycle

progesterone

supports pregnancy by thickening uterus lining

Acromegaly

too much growth hormone leading to enlarged, flat facial bones

hyperpituitarism

too much growth hormone or prolatin leading to acromegly in adults and giantism in children. Too much prolactin produces galactorrhea and gynecomastia

SIADH

too much ADH

hyponatremia &hypertension

High specific gravity = urinary retension

RESTRICT FLUIDS

Diabeties Insipidus

not enough ADH leading to a drain of fluid in the body causing high sodium

Low specific gravity= dialuted urine

hypotension & Hypovolemia

ployuria 300mL

Anterior pituitary gland disorders

Acromegly

Hypothyroidism

posterior pituitary gland disorders

SIADH

Diabeties Indipidus

hyperthyroidism

Increased metabolism

TOO HOT

loose weight

Large thyroid (goiter)

Palpitations

REMOVAL needs calcuim

hypothyroidism

Decreased metabolism

TOO COLD

Dry skin

LOW: Myedema coma

hyperparathyroidism

hypoparathyroidism

adrenal gland disorders