PNR140- Week 2 In Class Slides- Chapters 24 & 32

Parkinson Disease

• Etiology

  • Degeneration of dopamine-producing neurons in the substantia nigra of the midbrain.
  • Presence of Lewy bodies.

• Pathophysiology

  • Affects the extrapyramidal system, particularly the motor structures in the basal ganglia.
  • The basal ganglia control balance and coordination.

• Signs and Symptoms

  • Tremor: Involuntary shaking, often seen in hands.
  • Bradykinesia: Slowness of movement.
  • Rigidity: Stiffness and trembling of the head and extremities; often described as a “pill-rolling” motion of the thumb and fingers.
  • Postural Instability: Forward tilt of the trunk with reduced arm swinging.
  • Gait abnormalities: Shuffling gait.
  • Hypophonia: Soft speech.

• Treatment

  • Drug Therapy:
  • Anticholinergics: E.g., Benztropine (Cogentin).
  • Dopamine Agonists: E.g., Carbidopa-Levodopa.
  • Monoamine Oxidase Inhibitors (MAOIs):
    • MAOIs block the metabolism of dopamine, retaining more in circulation.
  • Physical Therapy: To improve movement and strength.
  • Emotional Support: Psychological support for patients.
  • Complementary and Alternative Therapies: Such as yoga or acupuncture.
  • Surgical Treatment: As a last resort.

• Caution When Administering MAOIs

  • Dietary Restrictions: Caution on foods containing tyramine.
  • High-risk foods include aged cheeses, fermented items, smoked fish/meat, yeast extract, imported beers, Chianti wine, and soy sauce.
  • Drug Interactions: Meperidine combined with MAOI can lead to hyperpyrexia (excessive temperature rise) and may be fatal.

• Patient Teaching

  • Medications: Importance and timing of doses.
  • Diet and Eating: Importance of avoiding tyramine-rich foods.
  • Movement and Exercise: Importance of physical activity to maintain mobility.
  • Managing Excessive Salivation: Coping strategies for excessive drooling.

Multiple Sclerosis (MS)

• Etiology and Pathophysiology

  • A chronic inflammatory disease causing demyelination in the central nervous system (CNS).

• Signs and Symptoms

  • Motor Dysfunction: Weakness, spasticity, and tremors.
  • Sensory Dysfunction: Numbness and tingling.
  • Coordination Problems: Difficulty with balance and fine motor tasks.
  • Mental Changes: Cognitive difficulties can occur.
  • Fatigue: Common and debilitating.

• Treatment

  • Biologic Response Modifier Drugs: Reduce flare-ups.
  • Autologous Stem Cell Transplantation: Investigational, potential for recovery.
  • IV Methylprednisolone: Used for acute exacerbations.
  • Plasmapheresis: Removes harmful antibodies.
  • Adrenocorticotropic Hormone (ACTH): For acute exacerbations.
  • Nursing Management: Emphasis on nutrition and hydration.

• Four Clinical Progressions of MS

  • Relapsing-Remitting: Most common type; episodes of exacerbation and remission.
  • Primary Progressive: Gradual worsening without distinct relapses.
  • Secondary Progressive: Initial relapsing-remitting begins to deteriorate.
  • Relapsing-Progressive: Progressive from the beginning with intermittent relapses.

Alzheimer's Disease

• Pathologic Changes
  • Cause is currently unknown.
  • Research is ongoing.
  • Typically occurs during middle age or later decades of life.
  • Slow onset, varies in progression speed, eventually fatal.

Amyotrophic Lateral Sclerosis (ALS)

• Etiology and Pathophysiology

  • Also called Lou Gehrig's disease.
  • Progressive neuromuscular disease.
  • Characterized by degeneration of the gray matter in the anterior horns of the spinal cord and lower cranial nerves.
  • Motor function is affected; sensation and cognition remain intact.

• Signs and Symptoms

  • Weakness of voluntary muscles.
  • Difficulty swallowing and speaking clearly.
  • Muscle atrophy.

Guillain-Barré Syndrome (GBS)

• Etiology and Pathophysiology

  • Autoimmune, often triggered by viral illness (e.g., cytomegalovirus, Epstein-Barr virus).

• Signs and Symptoms

  • Mild sensations of numbness or tingling in feet and hands, followed by muscle pain.
  • Progressive muscle weakness, often starting in lower extremities and moving upward over 24 to 72 hours.
  • Symptoms peak around 14 days.

• Treatment

  • Mainly supportive care.
  • Maintain adequate ventilation; may require mechanical ventilation if thoracic muscles are affected.
  • Control pain adequately, prevent aspiration, and maintain communication and nutritional status.

• Three Phases of GBS

  • Acute Phase: Rapid onset of symptoms.
  • Static Phase: No further progression; stabilization of condition.
  • Rehabilitation Phase: Focus on recovery of function.

Poliomyelitis

• Etiology

  • Caused by a virus affecting motor cells of the anterior horn of the spinal cord, brainstem, and motor strip in frontal lobe.
  • Preventable by immunization (Salk or Sabin vaccines).

• Postpolio Syndrome

  • Can occur decades after the initial infection, characterized by new weakness, pain, and fatigue.
  • Disability may be temporary or permanent.

Huntington's Disease

• Etiology and Pathophysiology

  • Autosomal-dominant disorder caused by an abnormal gene on chromosome 4.
  • Leads to neurodegeneration, causing motor disturbances and cognitive decline.

• Signs and Symptoms

  • Abnormal movements, emotional disturbances, total dependence, and eventual death within 15-20 years of onset.
  • Children have a 50% risk of inheriting the disease.

Myasthenia Gravis

• Etiology and Pathophysiology

  • Autoimmune disease targeting ACh receptors at the neuromuscular junction.
  • Characterized by fluctuating muscle weakness.

• Signs and Symptoms

  • Muscle weakness can range from mild to life-threatening; affects muscles for breathing and swallowing.
  • Characteristic ptosis (drooping of eyelids).

• Nursing Management

  • Addressing precipitating factors like infection or stress.
  • Goals encompass education and supporting independence.

Restless Leg Syndrome

• Description

  • Sensorimotor disorder marked by an uncontrollable urge to move the legs or arms, affecting 15% of the population (more in women).

• Nonpharmacologic Treatments

  • Exercise, leg massage, reduction of caffeine intake.

• Pharmacologic Treatments

  • Dopamine agonists (e.g., Ropinirole), Neurontin, and Pregabalin.

• Nursing Implications

  • Monitoring for orthostatic hypotension when administering dopamine agonists.
  • Providing education about the syndrome.

Bell’s Palsy

• Etiology

  • Weakness or paralysis of muscles supplied by the facial nerve (CN VII), often attributed to the herpes virus.

• Signs and Symptoms

  • Sudden or gradual facial paralysis, numbness.

• Treatment

  • Eye protection with an eye patch, artificial tears, corticosteroids within 7 days of onset, and possibly Acyclovir.
  • Recovery occurs in 80-90% of cases within 6 weeks to 3 months.

Trigeminal Neuralgia

• Etiology

  • Caused by pressure on the nerve root of CN V (trigeminal nerve).

• Signs and Symptoms

  • Severe unilateral facial pain, triggered by drafts or certain stimuli.

• Treatment

  • Anticonvulsants or surgery (ablation) may be necessary.

Musculoskeletal Disorders

• Contractures

  • Definition: Adaptive shortening of muscles, occurs within 3-7 days of immobilization.
  • Common Examples: Foot drop, knee and hip flexion contractures, wrist drop.

• Interventions to Prevent Disability

  • Exercise: Including isometric and range of motion.
  • Medications: Analgesics and anti-inflammatory drugs.
  • Positioning: Use of special beds or positioning aids.

• NCLEX Questions

  • The use and evaluation of assistive devices like canes and crutches.

• Sprains

  • Definition: Partial or complete tearing of ligaments.
  • Commonly Affected Joints: Ankle, knee, wrist.
  • Grading:
  • Grade I: Mild tenderness and swelling.
  • Grade II: Moderate pain and swelling.
  • Grade III: Severe pain with complete tearing of ligaments.
  • Management: RICE (Rest, Ice, Compression, Elevation).

• Strains

  • Etiology: Stretching or tearing of muscles or tendons.

• Nursing Management for Strains

  • Immediate application of ice and compression, along with resting the affected area.

• Dislocations and Subluxations

  • Etiology: Stretching and tearing of ligaments causing joint dislocation.
  • Management: Reduction of dislocation under anesthesia, pain control, assessment for perfusion.

• Bursitis

  • Etiology: Inflammation of bursa.
  • Signs & Symptoms: Mild to moderate aching pain, swelling.
  • Treatment: Rest, ice, anti-inflammatory agents.

• Fractures

  • Types: Pathologic, longitudinal, spiral, greenstick, simple, compound, oblique, comminuted, transverse.
  • Management: Aim to establish union between broken ends, potentially involving cast, splint, or surgery.

• Osteoarthritis and Rheumatoid Arthritis

  • Etiology: Degenerative changes versus autoimmune mechanisms, respectively.
  • Treatment Strategies: Pain management (NSAIDs), maintaining joint function, and addressing comorbidities.

• Osteoporosis

  • Signs and Symptoms: Often asymptomatic until fracture occurs, then can result in kyphosis.
  • Diagnosis: DXA scans.
  • Management: Includes medication, dietary supplements, weight-bearing exercises.

• Patient Teaching

  • Education on safe mobility and preventing complications related to musculoskeletal injuries and disorders, including post-operative care.

NCLEX Client Needs

• Questions to assess knowledge and application of musculoskeletal care, patient assessment, and symptom management.
  • Examples include prioritization of care for patients with casts or assessing symptoms in orthopedic patients.

Stump the Student

• Interactive activity encouraging students to engage and assess their learning by formulating questions.
  • Goal is for students to challenge each other’s understanding of the material covered in class.