Ch. 70 Management of Oncologic or Degenerative Neurologic Disorders

What is Amyotrophic Lateral Sclerosis (ALS) ?

A disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Cause unknown.

What is Parkinson's Disease?

A slowly progressing neurologic movement disorder that eventually leads to disability. 4th most common.

What are Brain Tumors ?

A spherical mass that occupies space within the skull and diffuses infiltrates tissue.

Acoustic Neuromas (Primary tumor) are?

A tumor of the 8th cranial nerve that is responsible for hearing and balance. Expands before filling. May attain considerable size before diagnosed. (mostly benign)

Assessment and Diagnostic in ALS include ?

ALS is diagnosed on the basis of the signs and symptoms due to no clinical or lab tests are specific to the disease.

Clinical manifestations of ALS include ?

Depends on the location of the affected motor neurons because specific neurons activate specific muscle fibers. Symptoms include fatigue, progressive muscle weakness, cramps, twitching and incoordination. Prognosis depends on the area of the CNS involvement and the speed of which the disease progresses.

Secondary (metastatic) brain tumors originate from where?

Develop from structures outside the brain. Metastatic brain lesions can occur from lungs, breast, lower GI, pancreas, kidney and skin and may be found at anytime during the disease course.

Primary Brain tumors originate from where?

From within the brain involving the Glial cells (cells that make up the structure and support system of the brain and spinal cord) and are supratentorial (locating above the covering of the cerebellum). Progress locally and rarely metastasize outside CNS.

Clinical Manifestations of Parkinson's include ?

Gradual onset. Cardinal signs or tremors, rigidity, bradykinesia and postural instability.

Gliomas (Primary tumor) are?

The most common type of intracerebral brain neoplasm and include: Astrocytomas, Glioblastomas, Oligodendroglioma, Ependymoma and Medulloblastoma.

Management of ALS include?

There is no cure for ALS and the main focus is on interventions to maintain or improve function, well being and quality of life. Average survival time is 3-5 years with death most commonly due to respiratory insufficiency.

Causes of Parkinson include?

Unknown but research suggests several caustic factors include, genetics, atherosclerosis, excessive accumulation of oxygen free radicals, viral infections, brain trauma, chronic antipsychotic medication use and environmental exposures.

What is the cause of Primary tumors?

Unknown however specific genetic changes resulting in tumor development are implicated along with exposure to ionizing radiation.

Pathophysiology of Parkinson's include?

decrease level of dopamine in the basal ganglia region of brain resulting with increased more excitatory neurotransmitters than inhibitory causing involuntary movement.

Pharmacologic Therapy for Parkinson's include?

Antiparkinsonian medications (Levodopa most common)

Meningiomas (Primary tumor) are?

Common benign tumors that represent 15% of primary tumors and are encapsulated tumors of arachnoid cells on the meninges. Slow growing. Common middle age adults and women. Occurs in proximal to the venous sinuses. Treatment is surgical.

Medical Management of Parkinson's include?

Controlling the symptoms and maintaining functional independence. Care is individualized and are cared for at home. Only hospitalized due to complications and new treatment plan.

Pathophysiologic events associated with brain tumors include?

ICP, Cerebral Edema, Seizure Activity with Focal Neurologic signs, Hydrocephalus, Altered Pituitary Function.

Nursing Interventions for Parkinson's include?

Improve mobility. Enhancing self-care activities, Improving bowel elimination, Improving nutrition, Enhancing swallowing, Encourage use of assistive devices, Improving Communication and Supporting coping abilities.

Manifestations of Acoustic Neuroma include?

Loss of hearing, tinnitus and episodes of vertigo and staggering gait. As tumor gets larger, painful sensations of the face occur due to compression of the 5th cranial nerve. Treatment is surgical.

Seizures with brain tumors include?

Occurrence in 70%. May be focal or generalized. Tumors involved in the frontal, parietal and temporal lobes carry greatest risk.

What are brain tumors classified as?

Primary and Secondary