Care of Patients with Conditions of the Central Nervous System

Chapter Overview

• Care of Patients with Conditions of the Central Nervous System

Key Concepts

• Priority Concepts:

  • Cognition

  • Mobility

• Interrelated Concepts:

  • Pain

  • Infection

Alzheimer’s Disease

Pathophysiology

• Most common type of dementia, not a normal part of aging.

• Characterized by:

  • Neurofibrillary tangles

  • Neuritic plaques

Etiology and Genetic Risk

• Risk Factors include:

  • Age: Increases with age; higher incidence above age 65.

  • Gender: Affects more women than men.

  • Genetics: Family history plays a role.

Incidence and Prevalence

• Affects 1 in 9 people in the U.S. aged 65 and older.

• Can affect individuals over 40.

Health Promotion/Disease Prevention

• No proven ways to prevent AD, but:

  • Chronic health problems may contribute.

  • Encourage healthy diet, exercise, and cessation of smoking/drinking.

Assessment

• History: Onset, duration, progression of symptoms; functional status.

• Physical Assessment: Focus on cognitive function (memory, perception, behavior).

• Laboratory and Imaging: Utilize PET, MRI, CT scans for diagnosis.

Analysis and Hypotheses

• Cognitive decline and potential for injury.

• Risk of elder abuse due to increasing care needs.

• Need for symptom management at end-of-life.

Solutions and Implementation

• Focus on:

  1. Managing cognitive dysfunction.

  2. Preventing injuries and falls.

  3. Addressing caregiver education and support.

Care Coordination

• Home care management and self-management education.

• Resources like the Alzheimer’s Association.

Evaluation of Outcomes

• Aim to maintain quality of life and cognitive function.

• Address caregiver stress and manage symptoms at end-of-life.

Parkinson Disease

Pathophysiology

• Progressive neurodegenerative disorder.

• Cardinal symptoms:

  • Tremor

  • Muscle rigidity

  • Bradykinesia/Akinesia

  • Postural instability

Etiology and Genetic Risk

• Influenced by:

  • Environmental toxins (chemicals/metals).

  • Age: Higher risk over 40.

  • Family history and traumatic brain injuries (TBI).

Incidence and Prevalence

• 60,000 new cases annually in individuals over 50.

• Prevalent in 1 million in the U.S.; affects 50% more men than women.

Assessment

• History and Physical Exam:

  • Observe for resting tremors, muscle rigidity, facial expression changes.

Analysis and Hypotheses

• Decreased mobility and potential for self-care deficits.

• Impaired cognition linked to neurotransmitter changes.

Solutions and Implementation

• Focus on improving mobility and managing cognitive dysfunction.

Care Coordination

• Utilize case managers; educate on drug therapy adherence.

• Focus on improving quality of life.

Evaluation of Outcomes

• Aim to improve mobility, safety, and quality of life for patients.

Other Conditions

Migraine Headaches

• Characterized by recurrent, episodic head pain with associated symptoms (nausea, light sensitivity).

• Management includes abortive drug therapy.

Seizures and Epilepsy

• Seizure: Sudden, uncontrolled electrical discharge in the brain.

• Epilepsy: Chronic condition involving recurrent seizures.

• Types of seizures include tonic-clonic, myoclonic, atonic, partial.

Meningitis

• Infection of brain and spinal cord membranes.

• Types: Viral (aseptic), Bacterial.

Health Promotion/Disease Prevention Strategies

• Healthy lifestyles may prevent Alzheimer’s Disease and other dementias.

• Importance of vaccinations for meningitis, especially in at-risk populations.

Care Strategies for Chronic Diseases

• Emphasize safety and involve patients in advance care planning.

• Conduct thorough assessments to monitor for signs of elder abuse.

• Understand the impact of social determinants on health, particularly in communities of color.

Case Studies and Critical Thinking

• Apply knowledge from the chapter through real-world scenarios and reasoning.

• Example: Appropriate responses to family inquiries about Alzheimer’s disease and care needs.

References

• Various academic and healthcare resources for further reading.

Seizures can be classified into several types based on their characteristics and effects on the brain. The major types include:

1. Tonic-Clonic Seizures (Grand Mal Seizures)

   • Characterized by two phases:

     • Tonic phase: Sudden loss of consciousness, followed by stiffening of the body.

     • Clonic phase: Rapid, rhythmic jerking of the limbs.

   • Often includes loss of bladder control and tongue biting.

2. Myoclonic Seizures

   • Involves brief, shock-like jerks of a muscle or group of muscles.

   • Can occur in clusters and usually happen when the person is waking up or going to sleep.

3. Atonic Seizures (Drop Attacks)

   • Sudden loss of muscle tone, leading to drops or falls.

   • The person may lose posture and collapse to the ground.

4. Partial Seizures (Focal Seizures)

   • These begin in one area of the brain and can be classified into two types:

     • Simple Partial Seizures:

     • Consciousness is preserved.

     • Possible symptoms include twitching in one part of the body, sensory changes, or emotional shifts.

     • Complex Partial Seizures:

     • Impaired consciousness or awareness.

     • May involve repetitive movements, confusion, or automaton behaviors.

5. Absence Seizures (Petit Mal Seizures)

   • Characterized by brief lapses in consciousness, often described as "staring spells."

   • Typically lasts a few seconds and may go unnoticed.

Proper diagnosis and classification of seizures are critical for effective management and treatment strategies.