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what is dementia?
- not a disease but symptom of different disorders
- progressive loss of mental functioning that interferes with memor, ability to think clearly and learn, and eventually ability to function
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what can cause dementia
- huntington's, parkinson's adn alzheimer's cause dementia
- multiple TIAs
- medications, chronic alcoholism, neurologic infections, head injuries
- ppl with less education, few leisure activities and less intellectual stimulation are more likely to develop it
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which neuropsychological test is commonly used to diagnose dementia
- Mini-mental state exam
- determines degree of memory, personality and behavioral changes
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what is delirium
- temporary mental disturbance that occurs rapidly or gradually
- considered a medical emergency and should be diagnosed and treated promptly
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delirium is characterized by...
disorganized thinking and difficulty staying focused and is usually seen in older adults experiencing illness
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what can cause delirium
- medication
- pain
- oxygen deficiency
- urinary catheters
- fluid and electrolyte imbalances
- change in environment
- nutritional deficiency
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pathophysiology of parkinson's disease
- cells that make dopamine are slowly destroyed
- acetylcholine imbalance is created due to lack of dopamine
- excess acetylcholine causes tremor, muscle rigidity and akinesia (loss of muscle movement)
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parkinson's is linked to the use of which drug
phenothiazines
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signs and symptoms of parkinson's
- muscular rigidity
- bradykinesia (slow movement)
- akinesia (loss of muscle movement)
- posture change
- tremors
- shuffling short steps
- pill rolling tremor
- normal blinking diminished
-
parkinson's complications
- constipation
- orthostatic hypotension
- drooling
- dysphagia
- frequent urination
- seborrhea (type of skin rash)
- diaphoresis
-
common side effect of anticholinergics
constipation
-
parkinson's drugs
- L-Dopa
- symmetrel
- artane (anticholinergic)
- cogentin (anticholinergic)
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huntingtons disease
- progressive, hereditary, degenerative, incurable neurologic disorder
- progressive loss of movement and intellect
- involuntary movements start with the arms, face and neck
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What is the major difference betweeen huntingtons disease and multiple sclerosis
loss of intellect happens with huntington
-
what movements are involved with huntington's disease
- hesitant speech
- eye blinking
- irregular trunk movements
- abnormal tilt of head
- constant motion
-
will holding the chin down while swallowing lessent the chance of aspiration
yes
-
which disease is the most common of the several types of dementia
alzheimer's
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which neurotransmitter is deficient in alzheimer's pts
acetylcholine
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how many stages of alzheimer's are there
- 4
- stage 1: increaseing forgetfullness 2 - 4 years
- stage 2: progressive cognitive deterioration 2 - 12 years
- stage 3: progression to complete dependency
- stage 4: complete dependency
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what is important to determine with alzheimer's and huntington's pts before their cognitive impairment becomes severe
methods required to sustain life i.e. intubation and tube feeding
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which medications are commonly used to treat alzheimer's
- acetylcholinesterase (AChE) inhibitors; aricept and exelon
- inhibit breakdown of acetylcholine
- increased acetylcholine levels allow better function of remainin neurons
- antidepressants, antipsychotics and antianxiety drugs only treat the associated depression
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what is a transient ischemic attack (TIA)
- temporary blockage of blood to the brain that causes stroke-like symptoms
- effects last less than 24 hours with complete recovery
-
which races are most at risk for a stroke
- african americans
- hispanic americans
- multiracials
- native americans
-
what is a penumbra
area of brain tissue surrounding the damaged tissue that may be revived if a pts stroke is end fast enough
-
what is a cva (stroke)
disruption of blood flow to teh brain resulting in death of brain cells
-
thrombotic stroke
occlusion in an artery stops blood flow
-
embolic stroke
blood clot travels to the brain and stops blood flow in a small vessel
-
types of stroke
- ischemic: blood flow is occluded
- hemorrhagic: cerebral blood vessel ruptures and no blood travels to the rest of the brain
-
which type of stroke involves rupture of a vessel on the surface of the brain and is usually caused by an aneurysm
subarachnoid hemorrhage
-
stroke usually caused by uncontrolled htn and occurs in the deeper tissues of the brain
intracerebral hemorrhage
-
five warning signs of an impending stroke
- sudden numbenss or weakness of face, arm or leg; especially on one side of the body
- sudden confusion or trouble speaking or understanding
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden severe headache with no known cause
-
modifiable risk fact for stroke
- high blood pressure
- smoke
- diabetes mellitus
- cardiovascular disease
- atrial fibrillation
- asymptomatic carotid stenosis
- TIAs
- sickle cell anemia
- dyslipidemia
- obesity
- excessive alcohol intake
- poor diet (high fat and sodium, low potassiumn)
- physical inactivity
- postmenopausal hormone therapy
-
what does the acronym FAST mean in relation to stroke
- helps recognize signs of stroke
- Facial droop
- Arm drift
- Speech
- Time
-
dysphasia
difficulty speaking
-
expressive aphasia
pt knows what he wants to say but cant speak
-
receptive aphasia
pt cant understand written or spoken words
-
ataxia
poor balance or a stumbling, staggering gait
-
hemianopsia
- vision loss associated with stroke
- change is described as a curtain dropping, fog or gray-out/black-out of vision
- vision loss involves eye on same side as diseased artery
-
acute phase therapy for stroke pts
- abc (airway breathing circulation)
- oxygen given if O2 sat is below 92%
- monitor LOC
- treat temp over 99.6F, hyperthermia has poor outcomes
- no IV solutions with glucose
-
what is tPA used for
- dissolves clots for pts experiencing ischemic stroke
- must be given within 3 hrs of onset
- blood pressure below 185/110
-
is dvt (deep vein thrombosis) a concern for stroke pts
- yes
- confinement to bed makes them a high risk
-
what is unilateral neglect
- primarily seen in right hemisphere infacrctions
- pts do not acknowledge left side of environment and may not be aware of the left side of their own body
- treatment focus's on providing stimuli to all senses on the left side and focusing on the left side
-
if an aneurysm ruptures which kind of hemorrhage is usually caused
subarachnoid
-
what is the most common symptom associated with an aneurysm
severe headache
-
complications of cerebral hemorrhage
- hydrocephalus: blood in ventricular system backs up CSF in brain
- vasospasm: blood vessel diameter narrows
- similar to those of stroke
-
why is glucose monitored in pts with cerebral hemorrhage
elevated glucose (over 140) indicates worsening of infarct and hemorrhage
-
multiple sclerosis
chronic loss of myelin sheath blocks transmission of nerve impulses to the affected portion of the body
-
signs and symptoms of MS
- musle weakness
- tingling sensations
- numbness
- visual disturbance in one eye at a time
-
MS has periods of exacerbation and remission, what are some factors can exacerbate the condition
- extreme heat and cold
- fatigue
- infection
- physical and emotional stress
-
analysis of the CSF of a pt with MS will show an increase in which chemical
immunoglulin G (IgG)
-
therapeutic measures for pt with MS
- interferon therapy
- steroids: adrenocorticotropic hormone (ACTH), prednisone
- immunosuppressants: imuran, cytoxan
- anticonvulsants: tegretol, diazepam, baclofen, zanaflex
-
what is plamapheresis
- plasma exchange that removes antigens from blood plasma
- helps suppress inflammation and immune response
- treatment for sudden severe MS attacks that dont respond to high doses of steroids
-
myasthenia gravis
- body attacks and destroys acetylcholine receptors in the body
- without acetylcholine receptors no stimulus for muscle contraction
- reduced receptors cause loss of voluntary muscle strength
- associated with thymus disorders
-
hallmark sign of myasthenia gravis
increased muscle weakness during activity and improvement after strength
-
which activities are affected by myasthenia gravis
- eye and eylid movements
- chewing
- swallowing
- speaking
- breathing
- skeletal muscle function
-
what is ptosis
eyelid drooping
-
myasthenic crisis
- pt with myasthenia gravis stopped taking meds
- sudden onset of muscle weakness
-
cholinergic crisis
- overmedicated with anticholinesterase drugs
- characterized by the acronym SLUDGE
- Salivation
- Lacrimation
- Urination
- Diarrhea
- Gastrointestinal bleeding
- Emesis
-
tesnsilon test
- used for myasthenia gravis pt
- injected with tensilon
- if muscle strengthe increased dramatically; diagnosed with myasthenia gravis
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