Neurology PPT Pt. 2 (Guillain Bare Syndrome, Parkinsons, ALS/Lou Gehrig's, MS, Brain Hematoma)

what is an autoimmune disease in which the peripheral nerves are attacked (myelin sheath, axons, etc.)?

Guillain barre syndrome

how is guillain barre different from MS?

it is similar except it involves the peripheral nerve system instead of the central.

what is guillain barre syndrome associated with?

VACCINES (influenza especially)

what does guillain barre syndrome cause?

progressive symmetrical ascending paralysis

as you know, Guillain barre causes progressive symmetrical ascending paralysis. what does this mean?

there is paralysis that starts from the finger/toes and spreads to the core & they’re NOT stiff (they’re limp/flaccid)

is it possible for someone with Guillain barre who has progressive symmetrical ascending paralysis to recover?

YES → 85% have a full and spontaneous (unpredictable) recovery in under a year

what should you do for someone who is experiencing progressive symmetrical ascending paralysis?

provide supportive care because it is likely they’ll recover — watch for diaphragmatic breathing and respiratory failure

a patient presents complaining of back pain, and you know they’re diaphoretic (sweating profusely), have been experiencing flu like illness. as well as arrythmias. additionally, they have ascending flaccid paralysis, motor fxn loss, paresthesia, and urinary retention. what would you infer is going on?

they have Guillain Barre Syndrome

what should your #1 concern be in guillain barre syndrome?

their diaphragm

what are the interventions for guillain barre?

there’s NO cure, so just supportive care (respiratory, skin, preventing DVTs, etc.)

what is the cause for Parkinson’s disease?

it’s idiopathic: the cause is unknown

what is going on with parkinson’s disease?

it is a degenerative disease that changes basal ganglia fxn and dopamine depletion causing shaking movement

what are the risk factors for developing parkinson’s disease? (ANSWER MENTALLY)

• being older than 85

• brain tumors, head trauma, cerebral vascular disease, carbon monoxide poisoning

• antipsychotics that block dopamine

what disease is common in boxers & football players and why?

parkinson’s because of repetitive head trauma

a patient walks in and has diagnosed dementia, sweating, and incontinency. Additionally, the patient has a constant pill rolling movement btwn the fingers (btw the thumb & forefingers), a shuffle gate (paired with slow movements = bradykinin), and tremors in the distal limbs. what would you identify is going on?

they’re dealing with Parkinson’s disease

what test would you run to dx Parkinson’s?

THERE ISN’T ONE, so you’d rely on your med hx & assessment

what are the interventions (tx) for parkinson’s?

NO CURE, so you want to take measures to decrease fall risk; exercise, therapy, and meds — deep brain stimulation therapy

when a pt with guillain barre is completely paralyzed and you’re providing tx, what should you always KEEP IN MIND?

they still have cognitive fxn, so you should talk to them as such

what is Amyotrophic Lateral Sclerosis (ALS)

this is a disease where there is a destruction of the upper/lower motor neurons (they are hardened/sclerotic and become non-fxnl) within the CNS

can someone catch Amyotrophic Lateral Sclerosis (ALS)?

no — it’s genetic

what happens to the intellect & sensory skills in Amyotrophic Lateral Sclerosis (ALS)?

they are still 100% intact

what is another term for Amyotrophic Lateral Sclerosis (ALS)?

Lou Gehrig’s

what is an early sign of Amyotrophic Lateral Sclerosis (ALS)?

muscle cramps

you assess a pt has had muscle cramps for a while, dysphonia (speech impairment), dysphagia (swallowing), and a weakness that started in distal upper extremities that has slowly progressed and spread to others areas, specifically that pts neck → shoulders?

they have Amyotrophic Lateral Sclerosis (ALS)

how would you dx Amyotrophic Lateral Sclerosis (ALS)?

your assessment

what is the cure for Amyotrophic Lateral Sclerosis (ALS)?

there isn’t one

since there isn’t a cure for Amyotrophic Lateral Sclerosis (ALS), how would you provide tx/interventions?

you provide supportive care, specifically preventing aspiration, and meds

is a pt in Amyotrophic Lateral Sclerosis (ALS) cognizant of their surrounding when providing care?

YES!!

what is goin on with multiple sclerosis (MS)?

this is an autoimmune destruction of the myelin sheath, which affects the upper motor neurons

what population/demographic is at a greater risk for multiple sclerosis (MS)?

women

you assess in a pt that they have impaired vision, dysphonia, muscle weakness, impaired coordination, balance, and gait, which indicated there’s a bad communication between the brain and the body. what would you infer is going on?

they have multiple sclerosis (MS)

what motor neurons are affected in ALS?

UPPER & LOWER

what motor neurons are affected in MS?

UPPER

how would you dx someone with multiple sclerosis (MS)?

your assessment & a tissue biopsy of the WHITE brain matter (3 months apart) — looking for tissue deformity in the CNS (brain)

what are the interventions for multiple sclerosis (MS)?

since there is no cure, you’d treat symptoms and progression with immunosuppressants (remember this is an autoimmune disorder) and medications

what should you always implement when tx multiple sclerosis (MS)?

fall risk precautions

what is the blood source for epidural hematomas?

arterial

what is the blood source for subdural hematomas?

venous

what is imperative for nurses when dxing epidural hematoma?

YOUR HISTORY AND ASSESSMENT

what is going on with an epidural hematoma?

there is blood between the inner side of the skull & the dura — injury to the middle meningeal artery

what is going on with an subdural hematoma?

there is blood between the dura & arachnoid space — injury to the small bridging veins on the surface of the cortex

you notice that a pt’s right eye is dilated and the left is not (ipsilateral). what would you infer could be going on?

they have an epidural hematoma originating on the right side of the head/brain

you assess a pt who had a head injury and passed out for a brief time, then came to and was lucid (consciousness was regained). after a couple minutes they quickly became unconscious again. what would you infer is going on?

they have an epidural hematoma

what are the key things you should ask a pt with an epidural hematoma (suspected or actual) especially in an assessment?

if they became unconscious upon injury & how the injury occurred

how would you dx an epidural hematoma?

your assessment (pupil larger on affected side) & a CT scan

is the prognosis for epidural hematoma good or bad?

it’s good if the hematoma is removed BEFORE a decreased LOC, which requires neurosurgery

you assess in a pt that they have increased intracranial pressure and are exhibiting Cushing’s Triad paired with headache, drowsiness, confusion, loss of consciousness, and NO LUCID INTERVAL. what would you infer is goin on?

subdural hematoma

what are a part of Cushing’s triad?

wide pulse pressure, bradycardia, irregular respirations (Cheyne stokes)

what is cushing’s triad an indicator of?

increased intracranial pressure — subdural hematoma

is the prognosis good or bad in a subdural hematoma?

GOOD if the hematoma is removed before decreased LOC which requires surgery

what is an intracerebral hematoma?

single/multiple hematomas found in the brain, prob d/t dead trauma

you assess that a pt has a headache, increased intracranial pressure (cushing’s), loss of consciouness, confusion, NO lucid interval, & decerebrate posturing. what would you infer is going on?

that have an intracerebral hematoma

what are the ways you’d dx intracerebral hematoma?

your assessment & a CT

what are the interventions for intracerebral hematoma? (ANSWER MENTALLY)

increase the HOB to DECREASE that ICP and neurosurgery

who are at an increased risk for intracerebral hematoma & why?

alcoholics & the elderly because it causes brittle cerebral vessels

what is the “monroe-kellie hypothesis”?

the theory that there are 3 different volumes in the brain and they are NOT compressible — chnages in any component must be balanced by equal & opposite effect in one or BOTH of the other components

what are the 3 different volumes in the monroe-kellie hypothesis?

brain tissue, blood, cerebral fluid

what is the “4th” thing that comprises the head in the monroe-kellie hypothesis (not actually, but it can take up head space)?

tumors

what calculation does monroe-kellie hypothesis deal with?

MAP

how do you calculate MAP?

(2 * DBP) + SBP

3

what is MAP?

the average arterial pressure during one cardiac cycle (systolic & diastolic

what is a normal MAP?

60 - 90 mmHg

what is the normal intracranial pressure (ICP)?

5- 15

how do you calculate the normal cerebral perfusion pressure (CPP)?

MAP - ICP

what is the normal cerebral perfusion pressure (CPP)?

60 - 80

what does a cerebral perfusion pressure (CPP) that’s less than 60 mean?

that there is brain ischemia OR that brain ischemis can occur

what does a MAP that’s less than 60 indicate?

hypotension

what does a MAP that’s between 60 & 100 indicate?

it’s normal

what does a MAP that’s between 100 & 115 indicate?

Stage 1 hypertension

what does a MAP that’s between 115 & 130 indicate?

Stage 2 Hypertension

what does a MAP that’s greater than 130 indicate?

a hypertension crisis — you’d treat by gradually lowering to AVOID ischemia

what is decortication?

this is when there has been damage to cerebral hemispheres and is when the toes go inwards, and elbows bend and bring hands to chest

where has an injury occurred if a patient is showing decortication?

higher in the brainstem — midbrain

what is decerebration?

this is when there has been damage to the brainstem and is when the toes go outwards, and the elbows lock, keeping their hands at sides

where has an injury occurred if a patient is showing decerebration?

lower in the brainstem — pons, medulla oblongata, (or midbrain)

what types of posturing is more serious, decortication or decerebration?

decerebration

when an ischemic injury occurs, what is the key thing to remember?

that “time is brain”

what is the mnemonic for testing a pt for response to stimuli in an LOC & stroke scale?

Alert (spontaneously opens eyes)

Verbal (opens eyes to verbal stimuli)

Pain (opens eyes to painful stimuli)

Unresponsive (eyes closed)

with regards to the glasgow coma scale, what does a score change of 2 mean?

that they’re significantly deteriorating

what is the minimum glasgow coma scale score?

3

what is the minimum glasgow coma scale score?

15

what are the different score portions for the glasgow coma scale?

Eye (1-4)

Verbal (1-5)

Motor (1-6)