Neurology Neurology Ch. 65Ch. 65
Management of patients with Management of patients with oncologic or degenerative oncologic or degenerative
neurologic disordersneurologic disorders
Brain TumorsBrain Tumors
PathophysiologyPathophysiology PrimaryPrimary
Originating from Originating from the brainthe brain
SecondarySecondary Originating outside Originating outside
the brainthe brain MetastasisMetastasis
Brain TumorsBrain Tumors
MalignantMalignant Tend to become Tend to become
progressively worseprogressively worse AnaplasiaAnaplasia
Cell distortionCell distortion InvasiveInvasive
BenignBenign No malignant or No malignant or
recurrentrecurrent
Brain TumorsBrain Tumors
Presence of lesion Presence of lesion
Compression of Compression of blood vessels blood vessels
Ischemia Ischemia Edema Edema I-ICPI-ICP
Brain TumorsBrain Tumors
Are brain tumors a disorder of the Are brain tumors a disorder of the CNS, PNS or Both the CNS and CNS, PNS or Both the CNS and PNS?PNS?
A.A. CNSCNS
B.B. PNSPNS
C.C. Both CNS & PNSBoth CNS & PNS
Primary-Brain TumorsPrimary-Brain Tumors
EtiologyEtiology UnknownUnknown
Brain TumorsBrain Tumors
Clinical Clinical manifestationsmanifestations
Depends onDepends on SizeSize LocationLocation
Brain TumorsBrain Tumors
4 main S&S4 main S&S I-ICPI-ICP
Cushing signCushing sign H/AH/A VomitingVomiting Visual disturbancesVisual disturbances
SeizuresSeizures HydrocephalusHydrocephalus Alt Pituitary Alt Pituitary
functionfunction
Cancer cells being Cancer cells being attacked by attacked by immune systemimmune system
Brain TumorsBrain Tumors
Localized S&SLocalized S&S FrontalFrontal
Personality changesPersonality changes Emotional changesEmotional changes
OccipitalOccipital Visual impairmentVisual impairment Visual hallucinationsVisual hallucinations
CerebellumCerebellum Impaired equilibriumImpaired equilibrium Impaired Impaired
coordination coordination
Brain TumorsBrain Tumors
DiagnosisDiagnosis CTCT MRIMRI
Primary - Brain TumorsPrimary - Brain Tumors
Medical Medical managementmanagement
RadiationRadiation ChemotherapyChemotherapy PharmaceuticalPharmaceutical
CorticosteroidsCorticosteroids Anti-convulsantsAnti-convulsants
SurgerySurgery
Tug McGrawTug McGraw
MRI showing MRI showing pituitary Tumourpituitary Tumour
Tumor Tumor approached approached through nasal through nasal cavitycavity
Surface TumorsSurface TumorsMeningiomas Meningiomas excised by excised by microsurgical microsurgical technique: pre-optechnique: pre-op
Post-opPost-op
Pre-Operative CT scan Pre-Operative CT scan showing a big tumor on showing a big tumor on the surface of the brain the surface of the brain compressing the brain compressing the brain significantlysignificantly
Post Operative CT Scan Post Operative CT Scan showing successful showing successful removal of the tumorremoval of the tumor
Secondary-Brain TumorSecondary-Brain Tumor
3 treatment options3 treatment options No treatmentNo treatment
Death < 1 monthDeath < 1 month Tx w/ Tx w/
corticosteroids corticosteroids onlyonly Death < 2 monthsDeath < 2 months
Tx with radiationTx with radiation Death 3-6 monthsDeath 3-6 months
Secondary-Brain TumorSecondary-Brain Tumor
PharmacologyPharmacology CorticosteroidsCorticosteroids
DexamethasoneDexamethasone PrednisonePrednisone
Osmotic DiureticOsmotic Diuretic MannitolMannitol
Anti-convulsantsAnti-convulsants DilantinDilantin
MorphineMorphine
Brain TumorsBrain Tumors
Nursing ManagementNursing Management AspirationAspiration Alt. nutritionAlt. nutrition
CachexiaCachexia Weak emaciate Weak emaciate
conditioncondition
Neuro checksNeuro checks PhotophobiaPhotophobia Seizure precautionSeizure precaution AnxietyAnxiety
Brain TumorsBrain Tumors
What S&S are associated with What S&S are associated with frontal lobe, occipital lobe and frontal lobe, occipital lobe and cerebellum tumors?cerebellum tumors?
What diet would you expect a What diet would you expect a patient with brain cancer to be on?patient with brain cancer to be on?
The S&S are associated with The S&S are associated with increase intracranial pressure?increase intracranial pressure?
Brain TumorsBrain Tumors
What are the difference between What are the difference between malignant tumors and benign malignant tumors and benign tumors?tumors?
What does metastasis refer to?What does metastasis refer to? What are risk factors of cancer?What are risk factors of cancer? What does remission mean or refer What does remission mean or refer
to?to?
Parkinson’s DiseaseParkinson’s Disease First described by First described by
James Parkinson 1817James Parkinson 1817 A progressive brain A progressive brain
disorder disorder characterized by the characterized by the degeneration of degeneration of dopaminedopamine secreting secreting neurons deep in the neurons deep in the cerebral hemisphere cerebral hemisphere in a part of the brain in a part of the brain called the called the basal basal gangliaganglia
Parkinson’s DiseaseParkinson’s Disease
Basal GangliaBasal Ganglia Controls movementControls movement
DopamineDopamine Inhibitory Inhibitory
neurotransmitter in neurotransmitter in the basal gangliathe basal ganglia
AcetylcholineAcetylcholine Excitatory Excitatory
neurotransmitter in neurotransmitter in the basal gangliathe basal ganglia
Parkinson’s DiseaseParkinson’s Disease
Without dopamine, Without dopamine, inhibitory influences inhibitory influences are lost and are lost and excitatory excitatory mechanisms are mechanisms are unopposed unopposed
Neurons of basal Neurons of basal ganglia are over ganglia are over stimulated stimulated
Excess muscle tone, Excess muscle tone, tremors & rigiditytremors & rigidity
Parkinson’s DiseaseParkinson’s Disease
Is Parkinson's disease a Is Parkinson's disease a disorder of the CNS, PNS or disorder of the CNS, PNS or both the CNS & PNS?both the CNS & PNS?
A.A. CNSCNS
B.B. PNSPNS
C.C. Both PNS & CNSBoth PNS & CNS
Parkinson’s DiseaseParkinson’s Disease
Clinical Clinical manifestationsmanifestations
OnsetOnset AbruptAbrupt
Age of on setAge of on set 6060
Men vs. WomenMen vs. Women Men > womenMen > women
First SymptomFirst Symptom Fine tremors in Fine tremors in
hands or feethands or feet
Parkinson’s DiseaseParkinson’s Disease
3 clinical signs3 clinical signs TremorsTremors RigidityRigidity BradykinesiaBradykinesia
Parkinson’s DiseaseParkinson’s Disease
TremorsTremors Resting tremorResting tremor with activitywith activity tremor when…tremor when…
WalkingWalking AnxiousAnxious
Sensation of heatSensation of heat Calorie burning!Calorie burning!
Parkinson’s DiseaseParkinson’s Disease
RigidityRigidity StiffnessStiffness
NeckNeck TrunkTrunk ShouldersShoulders
PosturePosture Head bowedHead bowed Body bent forwardBody bent forward Arms flexedArms flexed Thumbs turned into Thumbs turned into
palmspalms Knees bent (slightly)Knees bent (slightly)
Parkinson’s DiseaseParkinson’s Disease
BradykinesiaBradykinesia Slow movementSlow movement AkinesiaAkinesia
Loss of movementLoss of movement Esp faceEsp face
ExpressionlessExpressionless
Slow speechSlow speech DysphoniaDysphonia
DysphagiaDysphagia DroolingDrooling
Parkinson’s DiseaseParkinson’s Disease
BradykinesiaBradykinesia GaitGait
ShuffledShuffled FestinationFestination
Fall forward d/t Fall forward d/t postureposture
Parkinson’s DiseaseParkinson’s Disease
DiagnosisDiagnosis S&SS&S Positive response Positive response
to Levodopa to Levodopa
Parkinson’s DiseaseParkinson’s Disease
Medical Medical ManagementManagement
dopaminedopamine (blood brain (blood brain
barrier)barrier)
Parkinson’s DiseaseParkinson’s Disease
Anti-Parkinsonian Anti-Parkinsonian medicationsmedications LevodopaLevodopa
Converts into Converts into dopamine in the dopamine in the basal gangliabasal ganglia
Works best in 1Works best in 1stst few few years of disease years of disease effectiveness waneseffectiveness wanes
S/E Dizzy (esp when S/E Dizzy (esp when first get up) first get up) get get up slowly!up slowly!
Parkinson’s DiseaseParkinson’s Disease
Anti-Parkinsonian Anti-Parkinsonian medicationsmedications SinemetSinemet
Prevents the Prevents the breakdown of breakdown of levodopa outside the levodopa outside the brainbrain
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
AssessmentAssessment Affect on ADL’sAffect on ADL’s DysfunctionDysfunction S/E of medsS/E of meds
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
Improving mobilityImproving mobility ExerciseExercise ROMROM Warm bathsWarm baths MassageMassage PTPT
gait programgait program
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
Enhancing Self-Enhancing Self-carecare EncouragementEncouragement Adaptive devicesAdaptive devices OTOT
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
Improving Bowel Improving Bowel elimination – elimination – ConstipationConstipation Bowel routineBowel routine FluidsFluids FiberFiber Raised toiletRaised toilet
Parkinson’s DiseaseParkinson’s Disease
Nursing ManagementNursing Management Nutritional deficitNutritional deficit
Slow processSlow process Meds Meds dry mouth dry mouth Chewing & Chewing &
SwallowingSwallowing WeightsWeights SupplementSupplement DieticianDietician
FORK!FORK!
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
Enhance Enhance swallowingswallowing Upright positionUpright position Semi-solid foodSemi-solid food Thick liquidsThick liquids
Parkinson’s DiseaseParkinson’s Disease
Nursing Nursing ManagementManagement
CommunicationCommunication Speak slowSpeak slow Short sentencesShort sentences Deep breath before Deep breath before
speakingspeaking SLPSLP
Parkinson’s DiseaseParkinson’s Disease
With PD it is known which neurotransmitter With PD it is known which neurotransmitter is lacking in the brain and scientists are able is lacking in the brain and scientists are able to duplicate this neurotransmitter. Why are to duplicate this neurotransmitter. Why are we then unable to cure PD?we then unable to cure PD?
PD type deterioration of the nerve cells of PD type deterioration of the nerve cells of the brain reduces the amount of what the brain reduces the amount of what neurotransmitter?neurotransmitter?
Because of the inability to cure PD at this Because of the inability to cure PD at this time, PD is frequently treated with which time, PD is frequently treated with which medications? medications?
What are the side effects of these meds?What are the side effects of these meds?
Parkinson’s DiseaseParkinson’s Disease
To promote optimal functions, which To promote optimal functions, which activity could the nurse recommend activity could the nurse recommend as being beneficial to a patient with as being beneficial to a patient with PD ?PD ?
What would be of value in helping a What would be of value in helping a patient with PD communicate with patient with PD communicate with the medical team?the medical team?
Is PD a disease of the CNS, PNS or Is PD a disease of the CNS, PNS or both?both?
Parkinson’s DiseaseParkinson’s Disease
During an assessment, what signs and During an assessment, what signs and symptoms can the nurse anticipate a symptoms can the nurse anticipate a patient with Parkinson’s to exhibit?patient with Parkinson’s to exhibit?
What nursing diagnosis would be What nursing diagnosis would be priority for a patient with Parkinson’s?priority for a patient with Parkinson’s?
Describe the muscle tone of a patient Describe the muscle tone of a patient with Parkinson’s (medical terms)with Parkinson’s (medical terms)
What interventions can be used to What interventions can be used to address the issue of nonintention address the issue of nonintention tremors?tremors?
Huntington’s DiseaseHuntington’s Disease
AKAAKA Huntinton’s ChoreaHuntinton’s Chorea
PathophysologyPathophysology RareRare GeneticGenetic
George HuntingtonGeorge Huntington
Huntington’s DiseaseHuntington’s Disease
The disease is The disease is characterized as characterized as degeneration of degeneration of the cerebral cortex the cerebral cortex and the basal and the basal ganglia ganglia
Huntington’s DiseaseHuntington’s Disease Which causes chronic Which causes chronic
progressive chorea progressive chorea Bizzare involuntary Bizzare involuntary
dance-like movementsdance-like movements And mental And mental
deterioration deterioration Ending in dementia Ending in dementia
and deathand death Loss of GABA Loss of GABA
(inhibitory (inhibitory neurotransmitter)neurotransmitter)
Huntington’s DiseaseHuntington’s Disease
Huntington’s DiseaseHuntington’s Disease
Clinical manifestationsClinical manifestations Involuntary Involuntary
choreiformchoreiform Diminished during Diminished during
sleepsleep Facial tics/grimacingFacial tics/grimacing Paranoia & Paranoia &
hallucinationshallucinations AppetiteAppetite
RavenousRavenous EmotionsEmotions
LabileLabile
My mom has suffered My mom has suffered from this disease for from this disease for 19 years now. I never 19 years now. I never really knew her real really knew her real personality...but from personality...but from what I have heard, what I have heard, she was wonderful…I she was wonderful…I love my mom very love my mom very much, and I would much, and I would give anything to have give anything to have grown up with her grown up with her not being sick. not being sick.
Huntington’s DiseaseHuntington’s Disease
DiagnosisDiagnosis DNA testingDNA testing
Huntington’s DiseaseHuntington’s Disease
Medical managementMedical management No treatmentNo treatment Meds to Meds to tics tics
Chlorpromazine Chlorpromazine (Thorazine)(Thorazine)
Meds to Meds to hallucination, hallucination, delusions, angry delusions, angry outburstsoutbursts Haloperidol (Haldol)Haloperidol (Haldol)
Anti-psychoticsAnti-psychotics
Huntington’s DiseaseHuntington’s Disease
Nursing Nursing ManagementManagement
Family supportFamily support DietDiet AmbulatoryAmbulatory SafetySafety
Huntington’s DiseaseHuntington’s Disease Is Huntington’s a disease of the CNS, Is Huntington’s a disease of the CNS,
PNS, or both?PNS, or both? What dietary changes might be What dietary changes might be
appropriate for a patient with appropriate for a patient with Huntington’s disease?Huntington’s disease?
Describe the pathophysiology of Describe the pathophysiology of Huntington’s disease.Huntington’s disease.
What is the etiology of Huntington’s What is the etiology of Huntington’s disease?disease?
How is Huntington’s disease different How is Huntington’s disease different from Parkinson’s disease?from Parkinson’s disease?
Huntington’s DiseaseHuntington’s Disease
What medications are used to help What medications are used to help with tics and uncontrolled movements with tics and uncontrolled movements associated with Huntington Chorea?associated with Huntington Chorea?
If a patient expresses suicidal thought, If a patient expresses suicidal thought, what are the correct nursing what are the correct nursing management interventionsmanagement interventions
Huntington’s Chorea is characterized Huntington’s Chorea is characterized by what (what does it look like)?by what (what does it look like)?
Name five nursing interventions for a Name five nursing interventions for a patient with Huntington’s diseasepatient with Huntington’s disease
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
PathophysiologyPathophysiology Degenerative Degenerative
motor neuron motor neuron disease that affects disease that affects UMNUMN & & LMNLMN lying lying within the brain, within the brain, spinal cord and spinal cord and peripheral nervesperipheral nerves
Lou GehrigLou Gehrig
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
The myelin sheaths The myelin sheaths are destroyed and are destroyed and replaced with scar replaced with scar tissuetissue
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Does not affect CNDoes not affect CN 33 44 66
The patient is The patient is therefore able to therefore able to BlinkBlink Move eyeMove eye
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Cognition is left Cognition is left intact!intact!
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Is ALS a disorder of the CNS, PNS Is ALS a disorder of the CNS, PNS or both the CNS and PNS?or both the CNS and PNS?
A.A. CNSCNS
B.B. PNSPNS
C.C. Both CNS & PNSBoth CNS & PNS
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
EtiologyEtiology UnknownUnknown Men vs. WomenMen vs. Women
Men > WomenMen > Women
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Clinical Clinical manifestationsmanifestations
Progressive muscle Progressive muscle weaknessweakness
AtrophyAtrophy SpasitySpasity DysphagiaDysphagia DysarthriaDysarthria Jaw ClonusJaw Clonus Tongue fasciculationTongue fasciculation
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Clinical Clinical ManifestationsManifestations
No sensory lossNo sensory loss Death within 5 Death within 5
yearsyears Resp. failureResp. failure Bulbar paralysisBulbar paralysis
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
DiagnosisDiagnosis S&S onlyS&S only
No dx screenNo dx screen
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Medical Medical ManagementManagement
Baclofen (Lioresal)Baclofen (Lioresal) Diazepan (Valium)Diazepan (Valium)
SpasticitySpasticity Mechanical Mechanical
VentilatorVentilator
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Nursing Nursing ManagementManagement
RespiratoryRespiratory ADL’sADL’s Nutritional supportNutritional support Emotional supportEmotional support Advanced directiveAdvanced directive
Amyotrophic Lateral Amyotrophic Lateral SclerosisSclerosis
Amyotrophic Lateral Sclerosis is manifested Amyotrophic Lateral Sclerosis is manifested by what?by what?
What are the classic signs and symptoms of What are the classic signs and symptoms of this disease?this disease?
What are fasciculations?What are fasciculations? Amyotrophic lateral sclerosis effects UMN, Amyotrophic lateral sclerosis effects UMN,
LMN or both?LMN or both? CNS? PNS? Both?CNS? PNS? Both? What is the treatment methodology for ALS?What is the treatment methodology for ALS? What is the pathophysiology of ALS?What is the pathophysiology of ALS?
Herniated DiscHerniated Disc
AKAAKA Ruptured discRuptured disc Slipped discSlipped disc Degenerative disc Degenerative disc
diseasedisease
Herniated DiscHerniated Disc
AnatomyAnatomy The interverterbral The interverterbral
disc is a disc is a cartilaginous plate cartilaginous plate that forms a that forms a cushioncushion between between the vertebral bodythe vertebral body
Nucleus pulposusNucleus pulposus ProtrudesProtrudes Nerve compressionNerve compression
Herniated DiscHerniated Disc
EtiologyEtiology AgeAge TraumaTrauma
Herniated DiscHerniated Disc
Clinical Clinical ManifestationsManifestations
CervicalCervical LocationLocation
C5-6C5-6 C6-7C6-7
Pain Pain Neck Neck ShoulderShoulder ? Heart attack?? Heart attack?
Herniated DiscHerniated Disc
LumbarLumbar LocationLocation
L4-5L4-5 L5-S1L5-S1
PainPain Low backLow back SciaticaSciatica
Relieved withRelieved with Bed restBed rest
Herniated DiscHerniated Disc
DiagnosisDiagnosis MRIMRI
Herniated DiscHerniated Disc
Herniated DiscHerniated Disc
Medical ManagementMedical Management Conservative - Conservative -
cervicalcervical ImmobilizationImmobilization
CollarCollar Isometric exercisesIsometric exercises Pain reliefPain relief
Hot packsHot packs AnalgesicsAnalgesics Muscle relaxant medMuscle relaxant med Anti inflammatory medAnti inflammatory med
Herniated DiscHerniated Disc
Medical ManagementMedical Management Conservative - Conservative -
lumbarlumbar Bed restBed rest
Firm mattressFirm mattress Pain reliefPain relief
Hot packsHot packs AnalgesicsAnalgesics MassageMassage Muscle relaxant medMuscle relaxant med Anti inflammatory Anti inflammatory
medmed
Herniated DiscHerniated Disc
Medical Medical managementmanagement
Surgery – lumbarSurgery – lumbar TurningTurning
Log rollLog roll SittingSitting
No sitting (except No sitting (except BR)BR)
ComplicationComplication Failed Disc Failed Disc
SyndromeSyndrome
Herniated DiscHerniated Disc
What are contributing factors to a What are contributing factors to a Herniated disc?Herniated disc?
The center of the vertebral disc is The center of the vertebral disc is called what?called what?
What are the most common sites for What are the most common sites for herniated disc?herniated disc?
What is Sciatica?What is Sciatica? CNS? PNS? Both?CNS? PNS? Both? What is the frustrating complication What is the frustrating complication
post surgery?post surgery?
Spinal BifidaSpinal Bifida
PathophysiologyPathophysiology Neural Tube defectNeural Tube defect Incomplete closure Incomplete closure
of the vertebraeof the vertebrae 3 Levels3 Levels
Spina Bifida Spina Bifida OccultaOcculta
MeningoceleMeningocele MyelomeningoceleMyelomeningocele
Spinal BifidaSpinal Bifida
MeningoceleMeningocele MyelomeningoceleMyelomeningocele
Spinal BifidaSpinal Bifida
Spinal BifidaSpinal Bifida
Spina bifida Spina bifida occultaocculta
Spinal BifidaSpinal Bifida Myelomeningocele must Myelomeningocele must
have a repair of the open have a repair of the open neural tube. Failure to neural tube. Failure to repair may result in repair may result in serious infection which serious infection which would harm the would harm the developing infant brain. developing infant brain. After the repair, many After the repair, many children require the children require the insertion of a device insertion of a device called a shunt to divert called a shunt to divert the cerebral spinal fluid the cerebral spinal fluid to treat the to treat the hydrocephalus. hydrocephalus.
The Infant with The Infant with MyelomeningoceleMyelomeningocele
Spinal BifidaSpinal Bifida
EtiologyEtiology Folic acid Folic acid
deficiency during deficiency during pregnancypregnancy Esp 1Esp 1stst month month
Spinal BifidaSpinal Bifida
DiagnosisDiagnosis UltrasoundUltrasound levels of fetal levels of fetal
proteinprotein Alpha fetoproteinAlpha fetoprotein
Spinal BifidaSpinal Bifida
What food contain What food contain folic Acid?folic Acid? GreensGreens AsparagusAsparagus BroccoliBroccoli CauliflowerCauliflower CornCorn Green Beans or PeasGreen Beans or Peas Sweet PotatoSweet Potato Cabbage or Cabbage or
ColeslawColeslaw
Black BeansBlack Beans LentilsLentils PeasPeas PeanutsPeanuts
What deficit is associated with spina What deficit is associated with spina bifida?bifida?
What diagnostic test is used to detect What diagnostic test is used to detect spina bifida invitro?spina bifida invitro?
Name three foods high in folic acid.Name three foods high in folic acid. Describe the difference between Spina Describe the difference between Spina
Bifida occult, meningocele and Bifida occult, meningocele and myelomeningocele.myelomeningocele.
CNS? PNS? Both? CNS? PNS? Both?