MS Ch65 Rec Neuro Tumors & Degenerative Disorders Study Notes

Brain Tumors

  • Classification

    • Primary vs. Metastatic.

    • By tissue of origin:

    • Gliomas – arise from glial cells.

    • Meningiomas – non-cancerous tumors of the meninges.

    • Acoustic neuromas – tumors of CN VIII; affect hearing/balance.

    • Pituitary adenomas – hormonal effects because of pituitary location.

  • General Pathophysiology & Significance

    • Mass increases intracranial pressure (ICP) → headache, nausea, vomiting, seizures, cognitive change, weakness, paraplegia/paralysis.

    • Location-specific S/S:

    • Pituitary → endocrine changes.

    • Acoustic neuroma → tinnitus, vertigo.

  • Diagnostic Work-up

    • Neurologic exam.

    • Imaging: CT, MRI (ex: low-grade glioma = hyper-intense white area), PET (cancer focus), SPECT.

    • EEG for seizure activity.

    • Surgical biopsy to confirm histology.

  • Management Paradigm (always think “3 options”)

    • Surgery – craniotomy, trans-sphenoidal removal, stereotactic procedures; goals: debulk tumor, relieve compression, alleviate symptoms.

    • Radiation – cornerstone for many tumors (picture shown of patient with linear-accelerator mask).

    • Chemotherapy / Pharmacologic – systemic or intrathecal agents; symptom control drugs:

    • Analgesics for HA.

    • Dexamethasone – steroid ↓ edema.

    • Anticonvulsants: phenytoin (Dilantin).

  • Priority Nursing Assessment

    • Serial neuro checks: cranial nerves, strength, gait, vision, speech (stroke-like presentation possible).

    • Watch for raised ICP & seizures.

    • Fluid/electrolyte balance → brain swelling commonly disturbs \text{Na}^+ → risk of DI vs. SIADH.

    • Nutritional status (nausea, anorexia).

    • Family coping; impact if patient is bread-winner.

  • Nursing Goals & Interventions

    • Promote self-care; adaptive devices for ADLs.

    • Optimize nutrition (small, high-calorie meals, supplements).

    • Reduce anxiety: honest info, allow expression, spiritual care, counselor/social-worker referrals.

    • Prevent complications: safety, seizure precautions, manage ICP.

    • Encourage advance directives and end-of-life preferences.

Advance Directives & Hospice (Ethical / Practical Sidebar)

  • Definition: Legal doc expressing patient wishes for care when incapable of decision-making.

  • Key Points

    • Anyone \ge 18 yr can complete; no notary required if 2 unrelated witnesses (non-employees) sign.

    • Hospital staff of that facility cannot be witnesses (conflict of interest).

    • Without directive, split families → default = Full Code.

    • Designated decision maker should be trusted to follow wishes (not automatically spouse).

    • Social worker can supply forms; mobile notary called if witnesses unavailable.

  • Hospice Misconceptions

    • Goal = comfort when prognosis \le 6\text{ months}.

    • Enrollment ≠ immediate death; some outlive criterion.

    • Interdisciplinary: RN, MD, SW, chaplain, volunteers; can be concurrently active with curative limits.

Spinal Cord Tumors

  • Anatomical Types

    • Intramedullary – within cord.

    • Extramedullary – outside dura.

  • Clinical Manifestations

    • Level-dependent motor loss: >T6 → quadriplegia, <T6 → paraplegia.

  • Treatment

    • Surgical removal, radiation; peri-radiation dexamethasone for cord edema.

Parkinson’s Disease (PD)

  • Core Pathology

    • Degeneration of substantia nigra → ↓ dopamine → extrapyramidal dysfunction.

  • Cardinal Motor Triad

    • Resting tremor ("pill-rolling").

    • Rigidity (cog-wheel, lead-pipe).

    • Bradykinesia/akinesia (slow/no movement).

  • Postural & Gait Changes

    • Stooped posture, shuffling/propulsive gait, poor balance → high fall risk.

  • Other Manifestations

    • Mask-like facies (flat affect).

    • Dysphagia, drooling.

    • Autonomic: diaphoresis, orthostatic BP changes.

    • Neuro-psych: depression, dementia, hallucinations.

  • Diagnosis

    • Clinical; supportive imaging / CSF / SPECT.

  • Pharmacologic Cornerstone

    • Levodopa + Carbidopa (Sinemet): levodopa crosses BBB → dopamine; carbidopa inhibits peripheral conversion.

    • Adjuncts: dopamine agonists, MAO-B inhibitors, anticholinergics.

  • Non-drug/Surgical

    • Deep-brain stimulation, ablative surgery (research: neural transplantation).

  • Nursing Focus

    • Mobility: PT for lower body, OT for ADL devices (spork, built-up handles), rocking technique & count "1-2-3" to stand, raised toilet seat.

    • Nutrition: small bites, thickened liquids, aspiration precautions.

    • Communication: speech therapy, writing boards.

    • Safety: non-skid shoes, home modifications.

Huntington’s Disease (Huntington’s Chorea)

  • Genetics & Epidemiology

    • Autosomal dominant, symptom onset 25$–$35\text{ yr}; both sexes, all ethnicities.

  • Pathophysiology

    • Degeneration of basal ganglia & cortex → motor + cognitive + psych issues.

  • Clinical Picture

    • Choreiform (jerky) involuntary movements; cannot suppress.

    • Gradual loss of motor coordination → falls.

    • Dysphagia, dysarthria (bulbar weakness).

    • Cognitive decline → dementia, poor judgment.

    • Psychiatric: depression, anxiety, aggression, psychosis.

    • Weight loss from hyperkinesis & poor intake.

  • Diagnostics

    • CT/MRI: cerebral atrophy (≈ 30\% loss of brain weight).

    • Confirmatory genetic testing (pre-conception & prenatal counseling essential).

  • Management (No cure)

    • Meds for psych symptoms: antipsychotics, antidepressants, mood stabilizers, anxiolytics.

    • High-calorie easy-chew diet; avoid excess dairy (↑ mucus).

    • NG/G-tube when oral intake unsafe.

    • PT/OT: helmet, elbow–knee pads; assistive devices; two-person ambulation.

    • Family education, support groups; anticipate long-term care placement.

Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig’s)

  • Definition: Progressive loss of motor neurons in anterior horn & lower brain stem.

  • Hallmarks

    • Flaccid (later spastic) quadriplegia, extremity atrophy.

    • Respiratory failure → tracheostomy/vent.

    • Tongue atrophy, fasciculations, nasal speech.

  • Etiology Theories: viral, autoimmune, excess glutamate.

  • Clinical Priorities

    • Airway & breathing: RT involvement, suction, prevent pneumonia.

    • Nutrition: G-tube feeding; speech-language eval.

    • Mobility: PT, baclofen for spasticity.

    • Psychosocial: coping, advance directives early (cognition intact initially).

  • Prognosis: No cure; symptom-targeted care; median survival ≈ 3$–$5\text{ yr} after diagnosis.

Muscular Dystrophy & Other Musculoskeletal/Neuro Conditions

Duchenne Muscular Dystrophy (DMD)

  • X-linked; progressive skeletal muscle wasting.

Degenerative Disc Disease (DDD)

  • Disk dehydration & herniation → nerve-root compression (radiculopathy: pain, numbness, weakness).

  • Conservative care first: rest, NSAIDs, muscle relaxants.

Post-Polio Syndrome

  • Sequela decades after initial infection; new weakness, fatigue, pain.

  • No definitive treatment; symptom management.

Cervical Discectomy (video demo referenced)

  • Surgical removal/repair of herniated cervical disk.

  • Complications: hematoma → cord compression, persistent pain; monitor closely and report sudden neuro changes.

  • Nursing goals: pain relief, mobility, complication prevention (neuro checks, wound and airway assessment).

Cross-Cutting Nursing Themes

  • Always match intervention to specific deficit (location, pathology).

  • Multidisciplinary collaboration: PT, OT, ST, RT, social work, chaplain.

  • Safety first: falls, aspiration, skin integrity.

  • Ongoing education: meds, devices, home modifications, support services.

  • Ethical foresight: timely discussion of prognosis, code status, and resource referrals (support groups, hospice).