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306 med surg
neuro disorders
| Question | Answer |
|---|---|
| neurodegenerative disorders | CNS vs PNS involvement slow onset signs/symptoms home for chronic management acute care for exacerbation/Tx/surgical intervention |
| parkinson's disease risk factors and progression | males age (typically 50s at diagnosis) heredity environment |
| secondary parkinsons | parkinsons with a known/suspected cause |
| primary parkinsons | degenerative or idiopathic |
| parkinson's pathophysiology | decreased levels of dopamine d/t dopamine storage cell degeneration in the substantia nigra acetylcholine (excitatory) and dopamine (inhibitory) = too much ACh/excitation |
| parkinson's cardinal signs | tremor rigidity bradykinesia/akinesia postural instability |
| parkinson's subtypes | tremor dominant vs nontremor dominant |
| tremor physical manifestations (PD) | slow/unilateral resting tremor = rhythmic slow turning of forearm and hands + thumbs against finger like rolling pill disappears with purposeful movements/sleep |
| rigidity physical manifestations (PD) | resistance to passive limb movement = jerky increased involuntary stiffness with voluntary active movement commonly affects arms, legs, face, posture |
| bradykinesia physical manifestations | overall slowing of movement and speech difficulty initiating movement like rising from sitting or turning in bed |
| postural instability physical manifestations (PD) | gait issue with upward flexion of neck, hip, knees and elbow slow shuffling steps with propulsive gait (short but fast leg movement in single direction) difficulty pivoting increased fall risk |
| mental/cognitive parkinson's manifestations | depression + anxiety, dementia, delirium, hallucinations, psychosis diminished executive function, attention difficulty, decreased thinking |
| autonomic parkinson's symptoms | hyperhidrosis + drooling + orthostatic HTN gastric retention + dysphagia (aspiration risk) urinary retention + constipation vision/smell changes |
| diagnostic tool for parkinson's dz | PET and single photon emission CT (SPECT) |
| positive diagnosis for parkinsons dz | 4 cardinal manifestations + clinical history positive response to levodopa trial |
| parkinson's treatment | symptom control and maintain functional independence pharmacologic tx (levodopa) surgical tx for severe disabling tremor, rigidity or dyskinesia individualized care based on current symptoms, social/occupational/emotional needs |
| levodopa | antiparkinsonian medication increase striatal dopaminergic activity and reduce cholinergic neurons (excitatory) given with carbidopa usually |
| levodopa adverse effects | dyskinesia nausea vomiting hypotension confusion on-off syndrome |
| on off syndrome | sudden periods of immobility followed by return of medication effectiveness in parkinsons when treated with levodopa |
| surgical treatments for parkinsons | deep brain simulation (most effective) MR guided high intensity focused ultrasound |
| deep brain simulation | surgical electrode implantation in brain most effective therapy |
| MR guided high intensity ultrasound | MRgFUS (acronym) tremor treatment in parkinsons causes tissue damage at specific targets |
| assessment for parkinsons | how ADL and functional abilities are affected observe for disability speech/facial expression/swallowing/tremors/slow movement |
| physical therapy for parkinsons | exercise for muscle strength, coordination and rigidity stretching special walking techniques with erect wide based gait + arm swing + raised feet |
| constipation in parkinsons | d/t muscle weakness, immobility, poor fluid intake, poor sleep avoid laxatives! sleep management for tx follow regular bowel routine + fluids + moderate fiber + metamucil |
| nutrition in parkinsons | aspiration risk d/t impaired swallowing + saliva accumulation need to monitor weight for food adequacy supplemental feedings with or w/o NG/PEG tubes (if necessary) |
| nursing considerations for eating in parkinsons | upright position during meals for PNA and aspiration risks semisolid diet w/ thick liquid (NO thins) need to control saliva buildup and hold head upright with conscious effort to swallow |
| speech therapy in parkinsons | will have low pitched, soft, slow speech speech therapist for speech improvement exercises electronic amplifiers |
| coping in parkinsons | therapeutic program participation social and recreational programs avoid doing things for the patient |
| managing parkinson's complications | psych evals + therapy with low dose antipsychotics sleep management (caffeine + nocturia assessment) depression monitoring planned programs for activities |
| patient/family parkinson's considerations | patient + family education dependent on symptoms and severity health promotion = explain disease and goals of independence medication education educate on ongoing assessment interventions and evaluations |
| continuing/transitional care in parkinsons | family or community based or transitional services provided caregiver education (stress reduction techniques and periodic breaks from responsibilities) advanced parkinsons --> long term facilities or acute care facilities for complication |
| meningitis | inflammation of the meninges due to infection (bacterial, viral, fungal, parasitic, toxins) but commonly bacterial (septic) vs viral (aseptic) |
| risk factors for meningitis | age living condition immunodeficiencies recent infections |
| common viral causes of meningitis | enterovirus arbovirus herpes simplex virus (HSV) |
| common bacterial cause of meningitis | meningococcus (Neisseria meningitides) pneumococcus (Streptococcus pneumoniae) |
| meningitis pathophysiology | infectious organism cross to CNS via trauma or contiguous source (eg. sinus) proliferation in the CSF inflammatory response cause cerebral edema and vascular narrowing/occlusion |
| clinical manifestations meningitis | headache, fever, chills, tachycardia, N/V nuchal rigidity kernigs sign brudzinski sign photophobia rash = meningococcal meningitis altered mental status, seizure, increase ICP, coma |
| Dx for meningitis | CT scan prior to lumbar puncture IF risk of ICP blood/CSF culture w/ gram stain CSF values |
| meningococcal meningitis | rash present need prophylaxis Rx (within 24 hours) = rifampin, ciprofloxacin, ceftriaxone vaccine @ 11-12 and booster @16 |
| meningococcal vaccination series | ages 11-12: meningococcal conjugated vaccine age 16: booster for Hemophilus influenzae and Streptococcus pneumoniae |
| meningitis medical management |
Created by:
sleepingbear