Management of Oncologic and Degenerative Neurologic Disorders Study Guide
Parkinson’s Disease Overview and Pathophysiology
Definition: Parkinson’s Disease (PD) is defined as a slow, progressive neurologic movement disorder. It is fundamentally associated with decreased levels of dopamine within the brain.
Cardinal Manifestations: The primary clinical features of the disease include: * Tremor: Shaking, often occurring at rest. * Rigidity: Stiffness of the limbs and trunk. * Bradykinesia/Akinesia: Bradykinesia refers to very slow voluntary movements and speech, while akinesia is the absence of movement. * Postural Instability: Impaired balance and coordination, leading to a risk of falls.
Autonomic Manifestations: PD affects the autonomic nervous system, resulting in: * Uncontrolled sweating. * Drooling. * Flushing of the skin. * Orthostatic Hypotension: A drop in blood pressure upon standing. * Gastric and urinary retention.
Additional Manifestations: * Dysphagia: Difficulty in swallowing. * Psychiatric Changes: These include depression, anxiety, dementia, delirium, and hallucinations.
Medical Management of Parkinson’s Disease
Management Goals: The primary focus of medical treatment is directed toward controlling symptoms and maintaining the patient's functional independence.
Pharmacologic Treatment: * Levodopa: A primary medication for symptom management. * Anticholinergics: Used for the control of tremor and rigidity. These medications work by counteracting the action of acetylcholine. An example is Benztropine mesylate (Cogentin). * Antihistamines: These may be utilized to reduce tremors. Specific examples include Diphenhydramine hydrochloride (Benadryl), Orphenadrine citrate (Banflex), and Phenindamine hydrochloride (Neo-Synephrine).
Surgical Procedures: * Stereotactic Procedures: These involve high-precision targeting of brain structures. Specific types include thalamotomy and pallidotomy.
Neural Transplantation: This is an area of ongoing research aimed at replacing damaged or lost neurons.
Nursing Process for Patients with Parkinson’s Disease
Assessment Strategies: * Evaluate the degree of disability and overall function. * Assess ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living). * Evaluate cognitive function. * Monitor medications and the patient's response to those medications. * Assess emotional responses and individual coping mechanisms. * Observe family processes and their ability to cope with the diagnosis. * Evaluate home care requirements and identifies education needs. * Conduct a formal fall risk assessment. * Identify manifestations and potential complications specific to PD.
Nursing Diagnoses: * Impaired physical mobility. * Risk for activity intolerance. * Disturbed thought processes. * Self-care deficits. * Imbalanced nutrition. * Constipation. * Impaired verbal communication. * Ineffective coping and compromised family coping. * Deficient knowledge. * Risk for injury.
Planning and Goals: * Improve overall functional ability. * Maintain independence in ADLs. * Achieve adequate bowel elimination. * Attain and maintain an acceptable nutritional status. * Develop effective communication techniques. * Establish positive individual and family coping skills.
Interventions to Improve Mobility: * Implementation of a daily program of exercise. * ROM (Range of Motion) exercises. * Postural exercises to counteract stooping. * Consultation with Physical Therapy (PT). * Teaching walking techniques specifically designed for safety and balance. * Incorporating frequent rest periods to prevent exhaustion. * Ensuring the use of proper footwear. * Utilization of assistive devices when necessary.
Interventions for Self-Care and Coping: * Enhancing Self-Care: Encourage and support independence through education. Implement environmental modifications and use assistive or adaptive devices. Consult with Occupational Therapy (OT). * Support of Coping: Help set achievable and realistic goals. Encourage socialization and recreation. Plan specific programs of activity. Utilize support groups and referrals to counselors, social workers, or home care services.
Huntington’s Disease
Definition: A chronic, progressive, hereditary disease characterized by choreiform movement (involuntary, irregular, jerky movements) and dementia.
Genetics: It is transmitted as an autosomal dominant trait.
Pathology: The disease involves the premature death of cells in two primary areas: * Striatum of the Basal Ganglia: Responsible for the control of movement. * Cortex: Responsible for thinking, memory, perception, and judgment.
Alzheimer’s Disease
Overview: Also known as senile dementia, this is the most common cause of dementia.
Nature of Disease: It is a chronic, progressive, and degenerative brain disorder.
Epidemiology: It affects approximately people within the United States.
Pathophysiology: Current research suggests that oxidative stress plays a significant role in the pathophysiology of Alzheimer's.
Amyotrophic Lateral Sclerosis (ALS)
Synonym: Commonly referred to as "Lou Gehrig disease."
Pathophysiology: Characterized by the loss of motor neurons located in the anterior horn of the spinal cord, as well as the loss of motor nuclei in the lower brainstem.
Clinical Manifestations: * Progressive weakness and muscle atrophy. * Muscle cramps, twitching (fasciculations), and a lack of coordination. * Spasticity: Deep tendon reflexes (DTRs) are typically brisk and overactive. * Difficulty with essential functions including speaking, swallowing, and breathing.
Degenerative Disc Disease (DDD)
Public Health Impact: Low back pain is a significant public health disorder with substantial economic and social costs. Most back problems are directly related to disc disease.
Etiology: Degenerative changes typically occur as a natural result of aging or due to previous physical trauma.
Radiculopathy: This condition produces pain and extreme sensitivity to touch due to disease of a spinal nerve root.
Progression: Continued pressure on the nerves can lead to degenerative changes, resulting in altered sensation and motor responses.
Treatment Modalities: Treatment is generally conservative, focused on rest and medications. In cases where conservative measures fail, surgery may be required.
Types of Disc Problems: * Normal Disc. * Degenerated Disc. * Bulging Disc. * Herniated Disc. * Thinning Disc. * Disc Degeneration with Osteophyte Formation.
Management of the Patient Undergoing Cervical Discectomy
Assessment (Preoperative/Postoperative): * Determine the onset, location, and radiation of pain. * Assess for paresthesia (numbness, tingling, or "pins and needles"). * Monitor for limited movement and diminished function in the neck, shoulders, and upper extremities. * Determine if symptoms are bilateral. * Palpate the cervical spine to assess for muscle tone and tenderness. * Evaluate Range of Motion (ROM) in the neck and shoulders.
Nursing Diagnoses: * Acute pain related to the surgical procedure. * Impaired physical mobility related to the postoperative surgical regimen. * Deficient knowledge regarding the postoperative course and home care management.
Collaborative Problems and Complications: * Hematoma at the Surgical Site: This is a critical complication that can result in spinal cord compression and subsequent neurologic deficit. * Recurrent or persistent pain following the surgical intervention.
Planning and Goals: * Relief of pain. * Improved physical mobility. * Increased knowledge and competence in self-care. * Prevention of postoperative complications.
Nursing Interventions: * Focus on relieving pain and improving mobility. * Monitor and manage potential complications (e.g., checking for hematoma). * Promote home and community-based care transition.
Questions and Discussion
Question 1: What is akathisia? * Answer: Akathisia is defined as restlessness, an urgent need to move around, and agitation. * Discussion of Related Terms: * Bradykinesia: Refers to very slow voluntary movements and speech. * Dyskinesia: An impaired ability to execute voluntary movements. * Paresthesia: A sensation of numbness or tingling, often described as a "pins and needles" sensation.
Question 2: Is Parkinson’s disease a slowly progressing neurologic movement disorder that eventually leads to disability? * Answer: True.
Question 3: What is radiculopathy? * Answer: Radiculopathy is a disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch. * Discussion of Related Terms: * Dementia: A progressive organic mental disorder characterized by personality changes, confusion, disorientation, and deterioration of intellect with impaired memory and judgment. * Neurodegenerative: Refers to a disease, process, or condition leading to the deterioration of normal cells or the function of the nervous system. * Spondylosis: Defined as ankylosis or the stiffening of the cervical or lumbar vertebrae.
Question 4: What is an anticholinergic medication used to treat Parkinson disease? * Answer: Benztropine mesylate (Cogentin). * Context: It is used to control tremor and rigidity by counteracting the action of acetylcholine. Other medications like Diphenhydramine hydrochloride (Benadryl), orphenadrine citrate (Banflex), and phenindamine hydrochloride (Neo-Synephrine) are classified as antihistamines that may also reduce tremors.