8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
1/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
2/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
3/100
Migraines
Tend to have pattern
Possible etiology:
Familial
Stress
Hormonal
Three types of migraines:
Classic Common
Complicated
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
4/100
Classic Migraines
Aura
Transient
neurological
disturbance
Crescendo quality
Unilateral / Spreads
across
Acutely ill
Irritable
N/V
Sensitive to
Light Sounds
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
5/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
6/100
Migraines-Rx(Pharmacological)
Combination drugs:
Analgesics
VasoconstrictorsAntiemetics
Antidepressants
Sedatives
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
7/100
Migraines-Rx(Pharmacological cont.)
Prevention
NSAIDs
Beta blockers Calcium Cannel
Blockers
Antidepressants
Abortive Therapy
NSAIDs
Ergotaminederivatives
Triptan
preparations
Antiemetics
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
8/100
Cluster Headaches
Excruciating pain
No aura
Unilateral
Lacrimation
Miotic pupil on affected side
Facial sweating
Recur in clusters
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
9/100
Cluster Headaches
Management
Analgesics
Relaxation techniques
Meditation
Acupuncture
Massage therapy
100% O2very effective
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
10/100
Seizures
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
11/100
Seizures SZ) Pathophysiology
Sudden / Excessive / Disorderly
Electrical discharge across the brain
Results:
Violent & involuntary contractions of agroup of muscles
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
12/100
Seizures cont) Epilepsy
Chronic disorder
Characterized by recurrent seizures
Status epilepticus
Generalized seizures
At frequent intervals
Person cannot regain full consciousness EMERGENCY !!!
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
13/100
Secondary EpilepsyPossible causes
Head trauma
Brain tumors
Aneurysms
Meningitis / Other infections Vascular Ds
Metabolic
F & E imbalance
Meds Kidney & Liver failure / HD
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
14/100
Seizures Classification) Generalized seizures
Tonic-clonic (grand mal)
Absence (petit mal)
Myoclonic Atonic
Partial seizures Simple partial
Complex partial
Unclassified
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
15/100
Generalized Sz:TonicClonic
Usually preceded by aura
Tonic phase
Immediate LOC Clonic phase
Postictal phase
May have incontinence
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
16/100
Generalized Sz:Absence Sz Grand Mal)
No aura
Brief LOC
Blank stare, daydreaming May have little tonic-clonic movements
ie: Twitching of eyelids
No postictal state
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
17/100
Generalized Sz cont) Myoclonic Sz
Brief jerking or stiffening of extremities
No aura
No LOC
No postictal period
Atonic Sz
Sudden loss of muscle tone
Usually person falls Drop Attack
Postictal confusion
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
18/100
Partial Seizures Partial complex
LOC
Automatism
Lip smacking
Patting
Picking
? Amnesia
Simple partial
Often aura
No LOC
Unilateral
movements of an
extremity
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
19/100
Antiepileptic Drugs *Phenytoin
Dilantin
*Carbamazepine Tegretol
Phenobarbital Lumnial
Clonazepam Klonopin
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
20/100
Antiepileptic Drugs cont) *Divalproex
Depakote
Gabapentin Neurontin
Diazepam Valium
Lorazepam Ativan
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
21/100
Seizures:Assessment
Subjective Data:
Pt understanding of Ds, triggering factors
Frequency, length of episodes
Pt knowledge of meds
Pt compliance with meds
Description of Sz Aura
Postictal state
Incontinence
Loss of consciousness, amnesia
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
22/100
Seizures:Assessment cont)
Objective Data:
Description of Sz
Behavior during episode
Characteristics of SzFrequency
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
23/100
Assessment cont)Diagnostic Data
EEG, CT scan, MRI, LP
CBC, BUN / Cr, Lytes
BS, LFTs, UA
Any underlying disorder
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
24/100
Seizures:Major Nsg Dx
**Risk for injury
Major consideration
Knowledge deficit Risk for isolation
Risk for depression
Risk for drug side-effects..
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
25/100
SeizuresNOC
Injury prevention
Awareness of:
Ds, Rx, & possible side-effects
Isolation Avoidance
Depression
Avoidance Normalization of daily living ..
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
26/100
Seizure Precautions
May vary based one institutions
In general:
O2 & suction set up Airway at bedside
INT
Padded side rails (controversial)
Bed in low position
Side rails up
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
27/100
SeizuresNIC Interventions general)
Protect client from injury
No restraints
Do not place objects in mouth
Turn client to side as soon as possible Loosen restrictive clothing
Maintain airway
Suction if needed
VS / Neurological assessment
Allow to rest
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
28/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
29/100
Sz - Client Education Medications:
Name, dosage, frequency
Take meds as prescribed
Do not miss dose What to do if it happens
Side effects
Avoid ETOH & excessive fatigue
Dont take any meds including OTCs MD knowledge
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
30/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
31/100
Meningitis
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
32/100
Meningitis
Inflammation of meninges
Two most common causes: Bacterial & Viral
Organism enters subarachnoid space Inflammation / WBCs respond
Exudates forms
Hydrocephalus / Cerebral edema
Increased ICP
Death if not treated
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
33/100
Bacterial Meningitis
Dx made by H & P
Confirmed by isolation of organism from CSF
LP essential part of work up
CSF findings: Cloudy
Pressure
Proteins
Glucose WBCs
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
34/100
Meningitis:Clinical Presentation
H/A, N/V
Back pain
Fever / Chills
Seizures Cloudy sensorium
Petichial rash
Nuchal rigidity
Brudzinski sign
Kernigs sign
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
35/100
Meningitis cont) Medical Rx
IV ATBX
Corticosteroids
Anticonvulsants
Analgesics
F & E
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
36/100
Meningitis-NSG ProcessAssessment
Subjective
H/A, muscle aches, nuchal rigidity, rash
Objective LOC
Pupillary reaction, eye movements
Motor response
Nuchal rigidity, Brudzinski & Kernig signs
Changes in attention, memory, personality
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
37/100
Meningitis - NSG Dxs Altered cerebral perfusion
Altered comfort: pain
Hyperthermia Risk for fluid volume deficit
Potential for injury
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
38/100
Meningitis - Management
NOC
Maintain cerebral perfusion
Provide comfort
Avoid hyperthermia
Maintain F & E balance
Prevent injury
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
39/100
Meningitis - Management
Frequent assessment
Monitor for complications
Administer atbx
Promote comfort
Infection control
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
40/100
Multiple Sclerosis
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
41/100
Multiple Sclerosis (MS)
Definition
Chronic,progressive, degenerative Ds affecting
myelin sheath and conduction pathway of CNS Pathophysiology
Inflammatory response thickens myelin
Damaged myelin removed Scar tissue formed
Impulses not transmitted as effectively
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
42/100
Multiple SclerosisEpidemiology
Prevalence:
Young adults / Female > males
Difficult to Dx initially
Symptoms vague & non lasting
Possible causes
Genetic, environmentalViral, immunological
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
43/100
Various Types of MSMost Common
Benign Few episodes / Mild attacks Minimal or no disability
Relapsing / Remitting (classic) Increasingly frequent attacks After exacerbation pt returns to baseline
Progressive / Relapsing No periods of remission
Progressive cumulative
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
44/100
Multiple SclerosisClinical Presentation
Motor
Fatigue
Stiffness
Spasms
Clonus
Babinski
Hyperactive DTRs
Dysarthria
Ataxia Tremors with
activity
Poor coordination
Muscle atrophy
Spasticity
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
45/100
Multiple SclerosisClinical Presentation (cont)
Visual
Loss of vision
Partial
Total
Blurred vision
Changes inperiph vision
Diplopia
Nystagmus Diorder affecting
any of the 3
mechanismsCorsetti
Multiple Sclerosis
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
46/100
Multiple SclerosisClinical Presentation (cont)
Sensory
Pain, touch, temp
perception
Position &
vibratory sense
Numbness, tingling,
burning
B & B dysfunction
Frequency
Urgency
Incontinence
Constipation
Sexual dysfunction
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
47/100
Multiple SclerosisClinical Presentation (cont)
Psychological /
Cognitive
Early: Anxiety
Apathy
Euphoria
Late:
Inattentiveness
Depression
Confusion
Memory loss
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
48/100
MSLabs/Diagnostic CSF
May have increased IgG bands
CT scan
May show density in white matter
Cerebral / Optic atrophy
MRI
Presence of plaque
Diagnostic for MS
EMG
Abnormalities in acute phase
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
49/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
50/100
MS Medical Rx Steroids (acute)
Side effects: Cause major problems with blood sugars
Immunocompromise
Give in the AM with FOOD.
Heart failurefluid retention
HTX
Electolyte imbalance
Psychosis
Antineoplastics (acute)
MTX
Cytoxan
Immunomodulators (long term) 1x day or 1x week
Avonex
Betaseron
Copaxone Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
51/100
MS: Adjunctive Medical Rx Muscle Spasticity
Baclofen, Valium (problematic: long half-life)
Paresthesia (numbness and tingling) Tegretol (anticonvulsant) Neurontin (anticonvulsant) - Tricyclic antidepressants
Cerebellar ataxia Inderal Klonopin (highly addictive drug)
Bladder dysfunction (spastic bladder-can expel foley) Or atonic bladder
Urecholine (for contractions distention and retention)
, Ditropan (neurogenic bladder) Flomax
Do a cystogram to determine type of dysfunction and then they prescribe the appropriate medications.
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
52/100
MS AssessmentClinical manifestations are different
Subjective
Pts understanding of Ds &/or Rx
Presence of S &S of MS
Frequency & duration of exacerbation
Response to RX
Objective Physical exam
Diagnostic data
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
53/100
MS-most common: Possible Nsg Dxs
Impaired physical mobility
Self care deficit
Sensory/perceptual alteration
High risk for injury
Alteration in B & B functions
Body image disturbance
Altered skin integrity Many more..
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
54/100
MS-Possible Nsg Dxs
NOC Labels
Based on the particular Nsg Dx ie:
Mobility
Self care.
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
55/100
MS-NIC to Improve Mobility
Stretching exercises daily
Active / Passive ROM
Avoid fatigue / Frequent rest periods
Avoid rigorous activity
Avoid excess heat
Rest with exacerbation periods
Assistive devices Prevent / Manage problems of immobility
Corsetti
MS NIC to Prevent / Manage
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
56/100
MS-NIC to Prevent / Manage
B & B Complications
Avoid urinary retention
Adequate fluid intake
Bladder training
Suprapubic / foleychronic UTIs
Clock voiding every 1-2 hours
Hydration
Meds
Prevent constipation
Stress routine
Laxatives Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
57/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
58/100
ALS)Amyotrophic Lateral Sclerosis
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
59/100
Amyotrophic Lateral SclerosisALS)
Also cAlled lou GehriGs dsProgressive / Degenerative Ds
Involves motor system
Paralysis & death most likely fromrespiratory failure
Usually w/in 2-5 yrs
Sensory & ANS not involved
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
60/100
ALS-Clinical Manifestations Progressive weakness of:
Shoulders / Neck / Trunk
Arms / Legs
Progressive difficulty with:
Swallowing
SpeakingBreathing
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
61/100
ALS- General NSG Interventions NSG interventions aimed at:
Maintaining respirations / Preventing aspiration
Preventing / Managing problems of immobility
Meeting nutritional needs
Promoting comfort
Providing emotional support
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
62/100
(GBS)Guillain Barre` Syndrome
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
63/100
Guillain Barre` Syndrome
Acute inflammatory disorder
Degeneration of peripheral nerve myelin sheath
? Autoimmune disorder
Often preceded by:
URI / GI infection / Viral infection / Vaccination
Three stages:
Initial period / Plateau period / Recovery
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
64/100
Types of GBS Ascending GBS- Most common
Symptoms begin in Lower Extremities & progress upward LOC, cerebral functions, pupillary reactions
Not affected
Pure motor GBS Similar to above except sensory component
Descending GBS Symptoms move from head to toe
Word finding difficultiessymptoms over 2-3 days. Most common and serious problem is resiratory distress and failure.
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
65/100
GBS-Clinical Manifestations Motor:
Muscle weakness / Paralysis
No atrophy
Or no DTRs **Respiratory compromise
Sensory:
Paresthesias
Pain
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
66/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
67/100
GBS Medical Rx Immunoglobulin
Plasmapheresis
Immunosuppressive
Drugs for symptomatic relief
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
68/100
GBS NSG Dxs Ineffective breathing
Impaired physical mobility
Anxiety / Powerlessness Self care deficits
Impaired communication
Altered comfort
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
69/100
GBS-Management
NOC / NIC aimed at:
**Maintaining respiration
*Avoiding complications of immobility
Promoting adequate nutrition
Maintaining communication
Relieving pain
Reducing anxiety
Corsetti
GBS
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
70/100
GBS
Management
Close monitoring of respiratory status May be on respirator
Monitor for / Prevent DVT / PE
ATC
TEDS / Sequential Compression Boots
Active & passive ROM
Mobilization Prevent complications of immobility
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
71/100
Myasthenia Gravis MG) Definition
Chronic Ds involving # & effectiveness of ACh @neuromuscular junction
Results
Impaired muscle contraction
Etiology
Believed autoimmune
Possible genetic factors
Thymus gland often abnormal
Strong association with hypothyroidism
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
72/100
MG-Clinical Manifestations Weakness and fatigue
Increases with exercise
Improves with rest
Ocular symptoms
**Ptosis
Weak & incomplete eye closure
Diplopia
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
73/100
MG-Clinical Manifestations cont)
Weakness of facial muscles Impaired chewing / Swallowing / Wt loss Slurred speech
Respiratory compromise Death if untreated
Posture Inability to hold head upright
Fatigue Weakness of limbs and trunk
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
74/100
MG - Diagnosis H & P
Tensilon test
EMG CXR / CT
TSH
Acetylcholine receptor antibodies (AchR)
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
75/100
MG Drug Rx Three groups:
Anticholinesterases
Corticosteroids
Immunosuppressant
Meds must be given on time
Monitor response
Side-effects of anticholinesterases mimicexacerbation of Ds
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
76/100
Cholinergic vsMyasthenic Crisis
1st
Due to:
Cholinesteraseinhibitor excess
Rx usually is
AtropineMay need vent
2nd
MG Exacerbation
Responds toanticholinesteras
e ie: Tensilon
Meds adjustedwith activity
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
77/100
MG: Triggering Factors
URI
Other infections
Anxiety / Stress
Menstruations
Pregnancy
Anesthesia / Surgery
Various meds
ETOH
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
78/100
MG NOC - NIC Focuses) Monitor respiratory status
Promote self care
Provide education
Rx / Side-effects
Assist with nutritional support
Provide eye protection
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
79/100
pArkinsons ds (pd) Movement disorder
ChronicProgressive
Degenerative Involves:
Basal gangliaSubstantia nigra
Corsetti
Normal physiology of
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
80/100
movements Basal ganglia stimulation
Inhibition of muscle tone
Refined, smooth movements
Process accomplished by: Balance of Dopamine & Acethylcholine (Ach)
Dopamine From substantia nigra
Inhibitory (blocks actions of Ach)
Ach From nerve endings
Excitatory
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
81/100
PD Pathophysiology Widespread substantia nigra
degeneration
Dopamine levels
Excessive excitation of selectedneurons by ACh
Inability to initiate movements
Loss of refined movements
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
82/100
Stages of PD Stage I
Very mild Ds
*Unilateral limb
involvementMinimal
weakness
Hand / Armtremors
Stage II
Mild Ds
Bilateral limbinvolvement
Mask-like facies
Slow shufflinggait
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
83/100
Stages of PD cont) Stage III
Moderate Ds
Significant gait
disturbance Generalized disability
Stage IV Severe Ds
Severe disability Akinesia
Rigidity
Stage V
End stage Ds
Completedependence
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
84/100
PD Key Features Posture
Stooped
Flexed trunk / Forward extension
Abducted / Flexed fingers Slightly dorsiflexed wrists
Gait Slow & shuffling
Short & hesitant steps
Propulsive / Difficulty stopping quickly
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
85/100
PD Key Features cont) Face
Mask-like facies
DroolingDifficulty chewing
& swallowing
Speech
Soft, low pitched
DysarthriaEcholalia
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
86/100
PD Key Features cont) Motor (cont)
Arms
Little swing
Tremors
Pill-rolling
Cog wheeling
Change in
handwritingGeneral
Bradykinesia
Akinesia Fatigue
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
87/100
PD Key Features cont) Autonomic
dysfunctions
Postural hypotension
Excess perspirations Oily skin
Seborrhea
Blepharospasms Constipation
Psychosocialimplications
Emotional labile
Depression
Paranoia
Mood swings
Delayed reactions
Cognitive impairment
Late in Ds
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
88/100
PD - Collaborative Management Drug Rx
Dopaminergic agents
Drug of choice by many
Carbidopa-levadopa (Sinemet) Amantadine (Symmetrel)
Anticholinergic agents
Decrease excitatory effects of ACh
Cogentin, Artane, Cogentin
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
89/100
PD Drug Rx cont) Dopamine agonists
Stimulate dopaminergic receptors
Parlodel
Mirapex
Permax Requip
COMT inhibitors
Block enzyme that inactivates dopamine
Comtan Tasmar
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
90/100
PD Non-Pharm Rx Surgery
Last resort
Stereotactic Pallidotomy
Thalamotomy
Deep Brain Stimulation
(DBS) Fetal tissue transplantation
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
91/100
PD Common NSG Dxs Impaired mobility
Risk for injury
Self care deficit
Impaired airway clearance Impaired communication
Altered nutrition
B & B dysfunction Ineffective coping..
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
92/100
PD NSG InterventionsGeneral)
Evaluate understanding of Ds / Rx Educate / Support client & family in long
term management of complications:
Immobility Infections
B & B problems
Malnutrition /Aspiration
Isolation / Depression / Stress
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
93/100
Alzheimers diseAse Ad) Characteristics:
Memory loss
Impaired judgment
Changes in personality Increasingly cognitive impairment
Severe physical deterioration
Death secondary to complications ofimmobility
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
94/100
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
95/100
Stages of ADStage I Mild Symptoms)
***Forgetfulness Mild memory loss
Short attention span
Decrease interest in personal affairs
Subtle changes in personality and behavior
Impaired ability to acquire new memories
LTM usually intact
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
96/100
Stages of AD cont)Stage II Moderate Symptoms)
Profound memory loss
***Confusion, difficulty with ADLs
Significant cognitive impairment Anomia / Agnosia / Apraxia / Aphasia
Severe loss of judgment
Abusiveness, agitation, paranoia
Insomnia ***Wandering, pacing
Corsetti
Stages of AD cont)
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
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Stage III Severe Symptoms) Severe dementia
Profound impairment of all cognitivefunctions
Loss of speech
Loss of appetite / wgt loss
Loss of bladder and bowel control
Total dependence on caregiver
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
98/100
Diagnostic Criteria for Probable AD
Clinical presentation
Mental status testing
Confirmed by neuropsychological testing
Deficits in 2 or > cognitive areas: Memory, attention, language, personality, visuospatial
functions
Progressive Cognitive deterioration / No delirium
Ages 40-90
No systemic illnesses affecting brain
R/O other possible causes
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
99/100
AD Common NSG Dxs Altered thought process Risk for injury
Self care deficit
B & B dysfunction
Altered nutrition
Altered skin integrity
Many more.
Corsetti
8/13/2019 Neurological Dysfunction 2005 STUDENT COPY(1)
100/100
AD General NSG Interventions Provide consistency Promote independence
Promote bowel and bladder continence
Assist with recognition of familiar faces
Promote communication
Prevent injuries
Provide family education