Neurological Disorders

Current Alzheimer's Disease Theories

- brain changes - neurotransmitters - beta amyloid and amyloid precursor protein - genetic factors - environmental factors - viral origin

Multiple Sclerosis (MS)

- chronic, degenerative progressive disorder of CNS - characterized by small patches of demyelination in the brain and spinal cord - most common in people living in northern temperate climate zones - most disabling disease of young adults (20-40) - affects women twice as often as men

Nursing Management During a Seizure

- circumstances prior to seizure - where the movements or stiffness start - types of movements - areas of the body involved - presence/ absence of automatisms (repetitive movements) - incontinence - duration - loss of consciousness - inability to speak after seizure - does patient sleep afterwards - cognitive status

Medical Management of MS

- corticosteroids (anti-inflammatory agents) - non-steroidal immunosuppressives - interferons - baclofen (spasticity - symmetrel (fatigue)

Alzheimer's Disease DSM IV Criteria

- development of multiple cognitive deficits including both memory impairments and one or more of aphasia, apraxia, agnosia, or disturbance in executive functioning - deficits cause significant impairment in social functioning and represent decline from previous function - gradual onset and continued decline - deficits not due to CNS or systemic conditions or substances and do not occur only in delirium

Other Manifestations of Parkinson's Disease

- diaphoresis - orthostatic hypotension - gastric/urinary retention - constipation - sleep disorders - depression

Seizure Disorders

- episodes of abnormal motor, sensory, autonomic, psychic activity resulting from sudden excessive damage from cerebral neurons - part or all of brain may be involved - sudden and transient

Clinical Manifestations of MS

- fatigue - weakness - numbness - coordination difficulties (ataxia) - loss of balance - visual disturbances - spasticity of extremities - loss of abdominal reflexes - paresthesia - pain - mild cognitive impairment - depression - tremor

Causative Factors

- genetic link - atherosclerosis - excessive accumulation of oxygen free radicals (important to eat foods high in antioxidants) - viral infections - environmental exposures

Causes of Seizure Disorders

- genetic or acquired - hypoxemia - head injury - HTN - infections of CNS - childhood fever - brain tumor - CVA - drug withdrawal

Nursing Management of Parkinson's Disease

- improve mobility - enhance self care activities - improve bowel elimination - improve nutrition - improve communication - support coping abilities

Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's Disease)

- loss of motor neurons (nerve cells controlling muscles) in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem - may be autoimmune or caused from free radical damage - affects more men than women, usually around 50-60

Symptoms of Alzheimer's Disease

- memory loss - decline in ability to perform routine tasks - disorientation - impaired judgement - personality changes - loss of communication and language skills

Nursing Management of MS

- minimize spasticity and contractures - regulation of activity and rest - prevent injury

Nursing Management After a Seizure

- observe for complications (aspiration, injury) - position side lying - suction - seizure precautions (bed in low position, side rails up/padded)

Medical Management of Parkinson's Disease

- pharmacological: levodopa, anticholinergics, antivirals like symmetrel, MAOIs, antidepressants - surgical: ventrolateral portions of the thalamus and medial globus pallidus are destroyed to reduce tremor, rigidity, bradykinesia - stem cell transplant: adrenal medullary tissue

Alzheimer's Disease

- progressive degenerative disease that attacks the brain and results in impaired memory, thinking, behavior - most common form of dementia affecting over 4 million Americans - fourth leading cause of death in adults

Clinical Manifestations of ALS

- progressive muscle weakness - muscle atrophy - fasciculations (twitching) - difficulty talking, swallowing, breathing

Parkinson's Disease

- slowly progressive neurological movement disorder that leads to disability - degenerative or idiopathic most common - symptoms typically appear around 50 - 4th most common neurodegenerative disease - associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal cell ganglia of the brain

Nursing Management of Alzheimer's Disease

- support cognitive function - promote physical safety - reduce anxiety and agitation - improve communication - promote independence in self care - provide for socialization and intimacy needs - promote adequate nutrition - promote balanced activity and rest - provide family support, respite care, adult day care

Cardinal Signs of Parkinson's Disease

- tremor: resting tremor that occurs with purposeful movement - rigidity: resistance to passive limb movement causing jerky movements or cogwheeling; increases to passive limb when the other extremity is engaged in voluntary active movement - bradykinesia: difficulty initiating movement and takes longer to complete tasks - postural instability