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Wednesday, November 7, 2007

Neurology Part 2 :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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Neurology Part 2 :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: DEMYELINATING DISEASES Nurse Licensure Examination Review

Slide 2: MULTIPLE SCLEROSIS An auto-immune mediated  progressive demyelinating disease of the CNS The myelin sheath is destroyed and  replaced by sclerotic tissue (sclerosis)

Slide 3: MULTIPLE SCLEROSIS CAUSE- unknown  Multiple factors- viral infection,  environmental factors,geographic location and genetic predisposition Common in WOMEN ages 20-40 

Slide 6: MULTIPLE SCLEROSIS PATHOPHYSIOLOGY  Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath  Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission

Slide 7: MULTIPLE SCLEROSIS PATHOPHYSIOLOGY  The most common areas affected are Optic nerves and chiasm  Cerebrum  Cerebellum  Spinal cord 

Slide 8: MULTIPLE SCLEROSIS CLINICAL MANIFESTATIONS  1. visual problems such as diplopia, blurred vision and nystagmus  2. motor dysfunction  3. Fatigue  4. Mental changes like mood swings, depression  5. spasticity

Slide 9: MULTIPLE SCLEROSIS DIAGNOSTIC TESTS  1. MRI- primary diagnostic study  2. CSF Immunoglobulin G 

Slide 10: MULTIPLE SCLEROSIS NURSING INTERVENTIONS 1. Promote physical mobility  Exercise  Schedule activity and rest periods  Warm packs over the spastic area  Swimming and cycling are very useful

Slide 11: MULTIPLE SCLEROSIS NURSING INTERVENTIONS 2. Prevent injuries  Wide stance walking  Use of walking aids  Wheelchair

Slide 12: MULTIPLE SCLEROSIS 3. Enhance bladder and bowel control  Set a voiding schedule  Intermittent bladder catheterization  Use of condom catheter  Adequate fluids, dietary fibers and bowel training program

Slide 13: MULTIPLE SCLEROSIS 4. Manage speech and swallowing difficulties  Careful feeding, proper positioning, suction machine availability  Speech therapist

Slide 14: MULTIPLE SCLEROSIS 5. Improve Sensory and Cognitive function  Vision- use eye patch for diplopia  Obtain large printed reading materials  Offer emotional support  Involve the family in the care

Slide 15: MULTIPLE SCLEROSIS 6. Strengthen coping mechanism  Alleviate the stress  Referral to the appropriate agencies

Slide 16: MULTIPLE SCLEROSIS 7. improve self-care abilities  Modify activities according to physical strength  Provide assistive devices

Slide 17: MULTIPLE SCLEROSIS 8. promote sexual functioning  Refer to sexual counselor

Slide 18: MULTIPLE SCLEROSIS MEDICAL MANAGEMENT Pharmacotherapy Interferons  Immunomodulators  Corticosteroids  BACLOFEN for muscle spasms  NSAIDS for pain 

Slide 19: Guillian-Barre’ Syndrome An auto-immune attack of the  peripheral nerve myelin Acute, rapid segmental  demyelination of peripheral nerves and some cranial nerves

Slide 20: Guillian-Barre’ Syndrome CAUSE: post-infectious polyneuritis  of unknown origin commonly follows viral infection

Slide 21: Guillian-Barre’ Syndrome PATHOPHYSIOLOGY  Cell-mediated imune attack to the  myelin sheath of the peripheral nerves Infectious agent may elicit antibody  production that can also destroy the myelin sheath

Slide 23: Guillian-Barre’ Syndrome CLINICAL MANIFESTATIONS  1. Ascending weakness and paralysis  2. diminished reflexes of the lower extremities  3. paresthesia  4. potential respiratory failure

Slide 24: Guillian-Barre’ Syndrome NURSING INTERVENTIONS Maintain respiratory function 2. Chest physiotherapy and incentive  spirometry Mechanical vetnilator 

Slide 25: Guillian-Barre’ Syndrome NURSING INTERVENTIONS  2. Enhance physical mobility Support paralyzed extremities  Provide passive range of motion exercise  Prevent DVT and pulmonary embolism  Padding over bony prominences 

Slide 26: Guillian-Barre’ Syndrome NURSING INTERVENTIONS  3. Provide adequate nutrition IVF  Parenteral nutrition  Assess frequently return o gag refelx 

Slide 27: Guillian-Barre’ Syndrome NURSING INTERVENTIONS  4. Improve communication Use other means of communication 

Slide 28: Guillian-Barre’ Syndrome NURSING INTERVENTIONS  5. Decrease fear and anxiety Provide Referrals  Answer questions  Provide diversional activities  6. Monitor and manage complications  DVT, Urinary retention, pulmonary  embolism, respiratory failure

Slide 29: Guillian-Barre’ Syndrome MEDICAL MANAGEMENT  ICU admission  Mechanical Ventilation  TPN and IVF  PLASMAPHERESIS  IV IMMUNOGLOBULIN

Slide 30: ALZHEIMER’S disease A progressive neurologic disorder  that affects the brain resulting in cognitive impairments

Slide 31: ALZHEIMER’S disease CAUSES:  Unknown  Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies

Slide 34: ALZHEIMER’S disease CLINCAL MANIFESTATIONS  1. Forgetfulness  2. Recent memory loss  3. Difficulty learning  4. Deterioration in personal hygiene  5. Inability to concentrate 

Slide 35: ALZHEIMER’S disease LATE CLINICAL MANIFESTATIONS  6. Difficulty in abstract thinking  7. Difficulty communicating  8. Severe deterioration in memory,  language and motor function 9. repetitive action- perseveration  10. personality changes 

Slide 36: ALZHEIMER’S disease DIAGNOSTIC TEST  Neurologic examination  PET scan  EEG, CT and MRI  Other tests to rule out Vit B deficiencies and hypothyroidism  Autopsy is the most definitive

Slide 37: ALZHEIMER’S disease Drug therapy  1. drugs to treat behavioral symptoms- antipsychotics  2. anxiolytics  3. Donepezil  4. Tacrine

Slide 38: ALZHEIMER’S disease Nursing Interventions  1. Support patient’s abilities  2. Provide emotional support

Slide 39: ALZHEIMER’S disease Nursing Interventions 3. Establish an effective communication system with the patient and family  Use short simple sentences, words and gestures  Maintain a calm and consistent approach  Attempt to analyze behavior for meaning

Slide 40: ALZHEIMER’S disease 4. protect the patient from injury  Provide a safe and structured environment  Requests a family member to accompany client if he wanders around  Keep bed in low position  Provide adequate lightning  Assign consistent caregivers

Slide 41: ALZHEIMER’S disease 5. Encourage exercise to maintain mobility

Slide 42: PARKINSON’s Disease A slowly progressing neurologic  movement disorder The degenerative idiopathic form is  the most common form

Slide 43: PARKINSON’s Disease CAUSATIVE FACTORS: unknown  Potential factors: genetics, atherosclerosis, free radical stress, viral infection, head trauma and environmental factors

Slide 45: PARKINSON’s Disease Pathophysiology  Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia  Clinical symptoms do not appear until 60% of the neurons have disappeared

Slide 47: PARKINSON’s Disease CLINICAL MANIFESTATIONS  1. Tremor- resting, pill-rolling  2. Rigidity- cog-wheel, lead-pipe  3. Bradykinesia- abnormally slow movement  4. Dementia, depression, sleep disturbances and hallucinations  5. excessive sweating, paroxysmal flushing, orthostatic hypotension

Slide 48: PARKINSON’s Disease Medical management  1. Anti-parkinsonian drugs- Levodopa, Carbidopa  2. Anti-cholinergic therapy  3. Antiviral therapy- Amantadine  4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole anmd Pramipexole

Slide 49: PARKINSON’s Disease Medical management  5. MAOI  6. Anti-depressants  7. Antihistamine 

Slide 50: PARKINSON’s Disease NURSING INTERVENTIONS  1. Improve mobility  2. Enhance Self- care activities  3. Improve bowel elimination  4. Improve nutrition  5. Enhance swallowing  6. Encourage the use of assistive devices 

Slide 51: PARKINSON’s Disease NURSING INTERVENTIONS  7. improve communication  8. Support coping abilities 

Slide 52: EPILEPSY A group of syndromes characterized by  recurring seizures CAUSES 1. idiopathic 6. brain tumors 2. Birth trauma 7. head Injury 3. perinatal infection 8. metabolic disorders 4. infectious disease 9. CVA 5. ingestion of toxins

Slide 54: EPILEPSY Recurring seizures may be classified as  GENERALIZED or PARTIAL SEIZURES Generalized Seizures- cause a  generalized electrical abnormality within the brain Partial seizures- these seizures arise  from a localized part of the brain and cause specific symptoms

Slide 55: GENERALIZED SEIZURES 1. General Tonic-Clonic seizure- (Grand  mal) characterized by loss of consciousness and alternating movements of the extremities 2. Absence Seizure (Petit mal)- common  in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares

Slide 56: GENERALIZED SEIZURES 3. Myoclonic seizure- characterized by  brief, involuntary muscular jerks of body extremities 4. Akinetic seizure- general loss of  postural tone and a temporary loss of consciousness- a drop attack

Slide 58: PARTIAL SEIZURES 1. Simple partial seizure- typically  limited to one cerebral hemisphere 2. Complex partial seizure- begins with  an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements

Slide 59: Epilepsy DIAGNOSTIC TESTS  1. EEG  2. CT  3. MRI  4. LP  5. Angiography 

Slide 60: Epilepsy Medical treatment  1. Anticonvulsants- most commonly  phenytoin, phenobarbital and carbamazepine Ethosuximide and valproic acid for  absence seizure 2. surgery 

Slide 61: Epilepsy Nursing Intervention  1. Care of patients during seizure  2. care of patients after seizures  3. patient teaching 

Slide 62: BELL’S PALSY Causes  1. infection  2. hemorrhage  3. tumor  4. local traumatic injury 

Slide 64: BELL’S PALSY MANIFESTATIONS  1. Unilateral facial weakness  2. Mouth drooping  3. Distorted taste perception  4. Smooth forehead  5. Inability to close eyelid on the affected side  6. Incomplete eye closure  7. excessive tearing when attempting to close the eyes  8. Inability to raise eyebrows, puff out the cheek 

Slide 65: BELL’S palsy Diagnostic tests  EMG  Medical management  1. Prednisone  2. Artificial tears 

Slide 66: BELL’S palsy Nursing Interventions  1. Apply moist heat to reduce pain  2. Massage the face to maintain muscle  tone 3. Give frequent mouth care  4. protect the eye with an eye patch.  Eyelid can be taped at night 5. instruct to chew on unaffected side 

Slide 67: Trigeminal neuralgia Also called Tic Douloureux  Painful disorder that affects one or  more branches of the fifth cranial nerve CAUSES: repetitive pulsation of an  artery as it exits the pons is the usual cause

Slide 69: Trigeminal neuralgia ASSESSMENT  1. Pain history  2. Searing or burning jabs of pain  lasting from 1-15 minutes in an area innervated by the trigeminal nerve DIAGNOSTIC TESTS  Skull x-ray or CT scan

Slide 70: Trigeminal neuralgia NURSING INTERVENTIONS  1. provide emotional support  2. encourage to express feelings  3. provide adequate nutrition in small  frequent meals at room temperature

Slide 71: Myasthenia gravis A sporadic, but progressive  weakness and abnormal fatigability of striated muscles which are exacerbated by exercise and repetitive movements

Slide 72: Myasthenia gravis ETIOLOGY  Autoimmune disease  Thymoma Women suffer at an earlier age and are more affected

Slide 73: Myasthenia gravis Pathophysiology:  1. Acetylcholine receptor antibodies interfere with impulse transmission  2. Follows an unpredictable course of periodic exacerbations and remissions

Slide 76: Myasthenia gravis CAUSE: autoimmune disorder that impairs  transmission of nerve impulses ASSESSMENT FINDINGS Gradually progressive skeletal muscle 3. weakness and fatigue Weakness that worsens during the day 4. Ptosis, diplopia and weak eye closure 5. Blank, mask-like facies 6. Difficulty chewing and swallowing 7. Respiratory difficulty 8.

Slide 77: Myasthenia gravis DIAGNOSTIC TESTS  1. EMG  2. TENSILON TEST  3. CT scan  4. Serum anti-AchReceptor antibodies

Slide 78: Myasthenia gravis MEDICAL THERAPY  Anticholinesterase drugs- pyridostigmine and neostigmine  Corticosteroids  Immunosuppresants  Plasmapheresis  Thymectomy

Slide 80: Myasthenia gravis NURSING INTERVENTIONS  1. Administer prescribed medication as scheduled  2. Prevent problems with chewing and swallowing  3. Promote respiratory function  4. Encourage adjustments in lifestyle to prevent fatigue  5.maximize functional abilities

Slide 81: Myasthenia gravis 6. Prepare for complications like  myasthenic crisis and cholinergic crisis 7. prevent problems associated with  impaired vision resulting from ptosis of eyelids 8. provide client teaching  9. promote client and family coping 

Slide 82: Meningitis Infection or inflammation of the  meninges covering the brain and spinal cord. Caused by bacterial, viral and fungal  agents

Slide 83: Brain Abscess A free or encapsulated collection of pus  in the brain parenchyma Causes: usually secondary to another  infection like- sinusitis, meningitis, dental abscess, mastoiditis, bacteremia and trauma

Slide 85: Encephalitis Intense inflammation of the brain  tisssue with lymphocytic infiltration, cerebral edema, degeneration of brain cells and diffuse nerve cell destruction

Slide 86: CNS infections ASSESSMENT FINDINGS  Meningitis  1. fever, headache, vomiting  2. positive meningeal sings  Brain abscess  1. headache, N/V, seizures, changes in LOC  2. Focal neurologic deficits 

Slide 88: CNS infections DIAGNOSTIC TESTS  1. CT scan  2. MRI  3. EEG  MEDICAL TREAMENT  1. Antibiotics  2. Surgical drainage  3. Drugs to reduce increased ICP 

Slide 89: CNS infections NURSING INTERVENTIONS  1. Frequent monitoring of neurologic  status 2. Monitor intake and output  3. Administer antibiotics  4. Administer mild laxative to prevent  constipation 5. maintain quiet environment 

Slide 90: Neoplastic diseases A brain tumor is a localized intracranial  lesion that occupies space within the skull Primary brain tumors originate from  cells and structures within the brain.

Slide 91: Neoplastic disease The cause of brain tumors is unknown  The only risk factor accepted is  radiation exposure to ionization rays

Slide 92: Neoplastic disease CLINICAL MANIFESTATIONS  1. increased ICP  Vomiting  Headache. Especially early in the morning  Vomiting  Visual disturbances 

Slide 93: Neoplastic disease 2. Localized symptoms  Hemiparesis  Seizures  Mental status changes 

Slide 94: Neoplastic disease DIAGNOSTIC TESTS  1. CT scan  2. MRI  3. PET  4. EEG 

Slide 95: Neoplastic disease MEDICAL MANAGEMENT  Surgery  Chemotherapy  Radiotherapy 

Slide 96: Neoplastic disease NURSING INTERVENTIONS  1. promote self-care independence  2. improve nutrition  3. relieve anxiety  4. enhance family processes  5. provide pre-operative and post-operative  care 6. manage pain 





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