Neuro 2

it is a degeneration and demyelination of MOTOR neurons of the spinal cord and brainstem causing the muscles they connect to to weaken, experience atrophy and then die

• Weakness/paresis that starts distally then moves to trunk
• dysphagia
• dysarthria
• emotion labiality, but not dementia
• Respiratory compromise

• progressive weakness
• muscle wasting
• spasticity
• paralysis
• respiratory compromise

cuz theres progressive atrophy of the tongue and facial muscles

Cuz muscles of the trapezius and sternocleidomastoid atrophy.....this can lead to PNA and death

bowel and bladder stay in tact, but the person will need a way to communicate to you they need to use the restroom-blink

• spastic/weak muscles
• loss of voluntary movements

• flaccid muscles
• paralysis
• atrophy
• twitching
• breathing problems

men between 40-70....death occurs within 3 years

Respiratory failure and aspiration

• maintain an open airway
• provide adequate nutrition minimizing risk for aspiration
• speak early about end of life
• get an AD in place

Neostigmine/Prostigmine-Anticholinergics

It is a muscle relaxer

It will extend their survival time so they can attend an important even. 

• 50mg/2x day on an empty stomach
• Monitor LFT's

respiratory infection

a paroxysmal(sudden), uncontrolled electrical discharge of neurons in the brain that interrupts normal function

a chronic disorder of recurrent seizures

Poor African American Males

• if you have 1 parent with epilepsy
• if you have Alzheimers disease with a stroke

• birth injury
• infection
• trauma
• genetic factors

• structural lesions
• trauma
• brain tumor
• vascular disease

• stroke
• brain tumor

Everyone has a different seizure threshold which is inherited.

Seizure threshold is activated by trauma, disease or fever

a seizure that involves the entire brain

person has a loss of consciousness for a few seconds to several minutes

scar tissue in the brain that is oftenly a common area where epileptic activity arises

increased metabolic demand requiring 4x as much glucose and oxygen....if unmet cellular destruction can occur

• prodroma
• aural
• ictal
• postictal

signs or activity that precede a seizure

a sensory warning prior to seizure

full seizure

period of recover after the seizure....usually sleepy and not talking

used to be Grand Mal

• loss of consciousness
• pt. falls to ground and stiffens up (tonic) for 10-20 seconds then jerks around (clonic) for another 30-40 seconds

• cyanosis
• excessive salivation
• tongue or cheek biting
• incontinence

usually occurs in kids.....can have up to 100/day

seen as a staring spell so can go unnoticed

**usually grow out of by adolesence

• hyperventilation
• flashing lights

sudden excessive jerking of the body or extremities causing the person to hurl themselves to the ground

Drop ATTACK

• tonic episode or paroxysmal loss of muscle tone
• consciousness usually returns with ground contact

**wear protective helmet

doesn't involve loss of consciousness and lasts less than 1 minute

can involve a variety of behavioral, emotional and affective and cognitive functions

Lasts more than 1 min....then person has postictal confusion

Automatism

person lip smacks, picks or does some sort of repetitive motion

• onset
• duration
• frequency
• postictal state

• birth and development history
• seizure history....precipitating factors, antecedent events, seizure description

lumbar puncture of CSF

hyponatremia and hypoglycemia

control seizures, but don't cure disorder

stabilize nerve cell membranes preventing spread of the epileptic discharge

• type
• frequency
• cause....of seizures

• dosage is based on weight
• educate patient to know why it is important to not miss meds
• stopping abruptly can trigger a seizure
• must be weaned with dr. assistance

have them on D5 for IV....icicles

• abrupt withdrawl can cause seizure
• to go off you must be seizure free for 2-5 yrs
• have a normal EEG

• diplopia
• drowsiness
• ataxia
• mental slowing
• skin rash
• gingiva (hyperplasia)
• blood dyscrasias
• liver/kidney issues

• checking eyes for nystagmus
• check hand and gait coordination
• cognitive fxn
• general alertness

• gingival hyperplasia
• hirsutism

excessive growth if gingival tissue

good dental hygiene with brushing and flossing and dental visits

excessive hair on a woman

• protect from injury....especially the head
• turn on side to keep airway open
• have O2 and suction available in patients room
• emotional support for patient

• Note time of onset, duration of seizure, precipitating factors, aura if any
• Note body parts involved...pupil size, reactivity, respirations, cyanosis
• Incontinence
• Salivation
• LOC during and after seizure

• check arousability
• Neuro check (Glascow Coma)

• 30-90 min
• confused
• exhausted
• asleep
• sore muscles
• weak
• aphasia
• inability to maintain airway if not arousable

ongoing continuous seizure activity without return to consciousness between seizures

Medical Emergency!!!

• the brain is using more than it is supplied which can cause:
• Permanent brain damage
• ventilator insufficiency
• hypoxemia
• cardiac dysrhythmias
• hyperthermia
• systemic acidosis

• Ativan
• Valium
• Propofol (Dr. admin only)

Will be followed by long acting drugs like Phenytoin

6 mo. 1 yr seizure free

Coumadin

• Keppra
• Phenobarbital
• Phenytoin

• electrode implanted in neck that delivers electrical impulses to nerve which prevent seizures
• patient activates device with magnet when seizure is sensed

• Alcohol
• Epilepsy
• Infection/Inflammation
• Overdose
• Underdose

• Trauma
• Ischemia
• Psychiatric
• Stroke

chronic progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement

• bradykinesia
• rigidity
• tremors at rest
• Gait disturbance

person has low dopamine and an imbalance with ACh

Men....it is inherited

• CO
• Maganese

• it is temporary...but will see it when a patients on
• Lithium
• Haldol
• Thorazine

Amphetamines and Methamphetamines

allows for smooth movements....not enough in Parkinsons

• hand tremors/pill rolling
• akinesia
• respiratory problems
• difficulty swallowing/chewing
• soft voice
• poor balance
• gait disturbance/diminished arm swing

• depression
• anxiety
• apathy
• fatigue
• pain
• constipation
• impotence
• short term memory impairment
• sleep disorder

dementia

• swallowing becomes more difficult so...
• malnutrition
• aspiration
• PNA

• Levodopa
• Carbidopa
• Parlodel
• Requip

• arrhythmias
• dyskinesia

• Bradykinesia
• Tremors
• Rigidity

decrease tremors and rigidity

they freeze while walking...

• teach them to consciously think about stepping over imaginary lines on the floor
• drop rice kernels and step over them
• rock from side to side
• lift toes when stepping
• take one step backwards and 2 steps fwd

no response to meds or have developed sever motor complications

• Ablation
• Deep brain stimulation
• Transplantation of fetal neural tissue

• 6 small meals
• bite sized foods
• easy to chew and swallow

• constipation
• ankle edema
• contractures

• PNS
• UTI
• Skin breakdown

falls/injuries

• PNA
• Septic from skin breakdown infection
• fall

an acute possibly fatal inflammation that destroys the myelin sheath of nerve impulses caused by and immune response (bacterial/viral)

starts at ascending or descending....ends up with respiratory compromise

but will plateau  then the person recovers 4-6 months later....up to 95% full recovery

T cells

cuz it will show protein levels.  Myelin sheath is a protein which will show up in the CSF when it is degenerated

Normal is 15-45mg/dL

weakness and numbness with respiratory compromise

• weakness with bulbar muscles
• descends to limbs then the respiratory muscles
• muscle atrophy
• DVT
• Pulmonary emboli
• skin breakdown
• nutritional deficiencies

• Sandoglobulin
• Plasmapheresis

• Vital Capacity (<800)
• ABG
• Ventilator
• TCDB
• Oral Care
• PNA?

Person with a URI or GI infection in past 1-3 weeks.

• respiratory failure from paralysis of thoracic area
• respiratory/UTI infections

• Respiratory failure
• Aspirations
• Urinary output
• monitor for illeus
• immobility
• infection
• communication

inflammation of the brain tissue and often the meninges caused by a virus, bacteria, fungi or parasites

Virus/bacteria enters brain to blood stream to nerves causing inflammation and degredation of neurons and demylenization of axons causing hemorrhage, edema and increased ICP

• fever
• N/V
• headache
• vertigo
• confusion
• personality changes
• seizures

Increased ICP

• frequent neuro checks
• assess for signs of ICP increase
• Systolic BP, decreased HR
• maintain patent airway
• HOB at 30

compression of blood vessels from chronic irritation of CN #5 at the root entry zone causing an increase in firing of sensory fibers

PAIN!!!

• It is unilateral.
• It comes and goes

• touch
• brushing teeth
• shaving
• eating
• talking
• exposure to cold or wind

• Anti Seizure meds....
• Tegretol, Dilantin, Valproate

acts on sodium channels decreasing neuron firing

• CBC
• LFT

• Pt. may neglect their hygiene
• Encourage to perform hygiene tasks during peak analgesia times
• Eat foods high in protein and calories, easy to chew

corneal reflex....

artificial tears or eye shield

Inflammation of CN #7 (facial) usually caused by herpes

• fever
• tinnitus
• drooping mouth/drooling
• loss of tearing

• psychologic withdrawl
• malnutrition/dehydration
• corneal abrasions

Corticosteroids-Prednisone

• artificial tears
• eye shield?
• wear shield or tape eye shut at night

Acyclovir

Decadron

Dilantin

Tylenol

Methylcellulose