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What causes ALS?
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
S/S of ALS
- Weakness/paresis that starts distally then moves to trunk
- emotion labiality, but not dementia
- Respiratory compromise
To sum up ALS the person will experience....
- progressive weakness
- muscle wasting
- respiratory compromise
Why does a person with ALS have dysphagia and dysarthria?
cuz theres progressive atrophy of the tongue and facial muscles
What does the person with ALS have respiratory compromise?
Cuz muscles of the trapezius and sternocleidomastoid atrophy.....this can lead to PNA and death
What happens to a person with ALS ability to go to the bathroom?
bowel and bladder stay in tact, but the person will need a way to communicate to you they need to use the restroom-blink
If you have a dysfunction of upper motor neurons you will have problems with....
- spastic/weak muscles
- loss of voluntary movements
If you have a dysfunction of lower motor neurons you will have problems with
- flaccid muscles
- breathing problems
Who usually gets ALS?
men between 40-70....death occurs within 3 years
Two major problems with ALS
Respiratory failure and aspiration
As a nurse it is very important to manage these things in a person with ALS
- maintain an open airway
- provide adequate nutrition minimizing risk for aspiration
- speak early about end of life
- get an AD in place
First medications used on a person with ALS?
Why is Baclofen given to a patient with ALS?
It is a muscle relaxer
Why is Rilutek given to a patient with ALS?
How do you take it?
What do you monitor?
It will extend their survival time so they can attend an important even.
- 50mg/2x day on an empty stomach
- Monitor LFT's
What does a person with ALS usually die from?
What is a seizure?
a paroxysmal(sudden), uncontrolled electrical discharge of neurons in the brain that interrupts normal function
a chronic disorder of recurrent seizures
Who is most likely to get epilepsy?
Poor African American Males
What makes a person at high risk for Epilepsy?
- if you have 1 parent with epilepsy
- if you have Alzheimers disease with a stroke
What typically causes seizures if you are 2-20 years old?
- birth injury
- genetic factors
What typically causes seizure if you are 20-30 years old?
- structural lesions
- brain tumor
- vascular disease
What typically causes seizures if you at over 50?
How can you be screwed when it comes to families and seizures?
Everyone has a different seizure threshold which is inherited.
Seizure threshold is activated by trauma, disease or fever
What's generalized seizure?
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
What are the effects of seizures on the brain?
increased metabolic demand requiring 4x as much glucose and oxygen....if unmet cellular destruction can occur
4 stages of a seizure
prodromal seizure phase
signs or activity that precede a seizure
aural seizure phase
a sensory warning prior to seizure
ictal seizure phase
postictal seizure phase
period of recover after the seizure....usually sleepy and not talking
Tonic Clonic seizure
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
What are the s/s of a tonic clonic seizure?
- excessive salivation
- tongue or cheek biting
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
What usually precipitates an absence seizure?
- flashing lights
sudden excessive jerking of the body or extremities causing the person to hurl themselves to the ground
- tonic episode or paroxysmal loss of muscle tone
- consciousness usually returns with ground contact
**wear protective helmet
Simple partial seizure
doesn't involve loss of consciousness and lasts less than 1 minute
Complex partial seizure
can involve a variety of behavioral, emotional and affective and cognitive functions
Lasts more than 1 min....then person has postictal confusion
What is the most common partial seizure?
person lip smacks, picks or does some sort of repetitive motion
How do you describe a seizure?
- postictal state
If a person has a seizure disorder make sure you find out....
- birth and development history
- seizure history....precipitating factors, antecedent events, seizure description
What is the starting point test for seizure diagnosis?
lumbar puncture of CSF
What two electrolytes can trigger seizures?
hyponatremia and hypoglycemia
Medications for seizures do what?
control seizures, but don't cure disorder
stabilize nerve cell membranes preventing spread of the epileptic discharge
Drug therapy for seizures is based on....
- cause....of seizures
4 things to know about Keppra for 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
If a person is on Dilantin for seizures don't....
have them on D5 for IV....icicles
Important info about anti seizure meds:
- abrupt withdrawl can cause seizure
- to go off you must be seizure free for 2-5 yrs
- have a normal EEG
Common seizure med side effects:
- mental slowing
- skin rash
- gingiva (hyperplasia)
- blood dyscrasias
- liver/kidney issues
If you think a person has a toxic level of ant seizure meds you can check them bye....
- checking eyes for nystagmus
- check hand and gait coordination
- cognitive fxn
- general alertness
- gingival hyperplasia
What is gingival hyperplasia?
How do you minimize it?
excessive growth if gingival tissue
good dental hygiene with brushing and flossing and dental visits
excessive hair on a woman
What do you do for a patient who is having a seizure?
- 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
Monitoring a person during/after seizure
- Note time of onset, duration of seizure, precipitating factors, aura if any
- Note body parts involved...pupil size, reactivity, respirations, cyanosis
- LOC during and after seizure
After a seizure....
- check arousability
- Neuro check (Glascow Coma)
Postictal state lasts how long and what will the person be like?
- 30-90 min
- sore muscles
- inability to maintain airway if not arousable
ongoing continuous seizure activity without return to consciousness between seizures
Why is status elepticus a medical emergency
- the brain is using more than it is supplied which can cause:
- Permanent brain damage
- ventilator insufficiency
- cardiac dysrhythmias
- systemic acidosis
Rapid acting IV anti seizure meds
- Propofol (Dr. admin only)
Will be followed by long acting drugs like Phenytoin
When can a person get their drivers license back once they are seizure free?
6 mo. 1 yr seizure free
Phenytoin affects what commonly used medication?
Which anti seizure meds need peak and trough blood tests?
Vagal Nerve Stimulation for seizures
- electrode implanted in neck that delivers electrical impulses to nerve which prevent seizures
- patient activates device with magnet when seizure is sensed
AEIOU for seizures
TIPS for seizures
chronic progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement
4 signs of Parkinsons
- tremors at rest
- Gait disturbance
What is the problem with Parkinsons?
person has low dopamine and an imbalance with ACh
Who's at risk to get Parkinsons?
Men....it is inherited
Chemically induced Parkinsonism is associated with
Drug induced Parkinsons
- it is temporary...but will see it when a patients on
Which illicit drug use can cause Parkinsons symptoms?
Amphetamines and Methamphetamines
What does dopamine do?
allows for smooth movements....not enough in Parkinsons
People with Parkinsons will have problems with
- hand tremors/pill rolling
- respiratory problems
- difficulty swallowing/chewing
- soft voice
- poor balance
- gait disturbance/diminished arm swing
Common non motor symptoms of Parkinsons
- short term memory impairment
- sleep disorder
40% of patients with Parkinsons have
What happens with eating with a parkinsons patient?
- swallowing becomes more difficult so...
What Parkinsons meds can only be used for less than 3 years?
S/E of Dopaminergic meds for Parkinsons
Dopamanergics for Parkinsons relieve which symptoms?
What can Benadryl do for a Parkinsons patient?
decrease tremors and rigidity
Why are people with Parkinsons a fall risk?
How do I help?
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
When do you do surgery for Parkinsons?
no response to meds or have developed sever motor complications
- Deep brain stimulation
- Transplantation of fetal neural tissue
How should a person with Parkinsons eat?
- 6 small meals
- bite sized foods
- easy to chew and swallow
Person with Parkinsons has decreased mobility causing
- ankle edema
Person with general debilitation from Parkinsons is at risk for
Orthostatic hypotension puts a person at risk for....
People with Parkinsons will probably die from....
- Septic from skin breakdown infection
What's Guillain Barre?
an acute possibly fatal inflammation that destroys the myelin sheath of nerve impulses caused by and immune response (bacterial/viral)
Pathological process of Guillain Barre
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
What is overtaxed with GB?
Why can you take a CSF sample to dx GB?
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
Signs of Ascending GB
weakness and numbness with respiratory compromise
Signs of Descending GB
- weakness with bulbar muscles
- descends to limbs then the respiratory muscles
- muscle atrophy
- Pulmonary emboli
- skin breakdown
- nutritional deficiencies
Options for treating GB
Key management for a person with GB
- Vital Capacity (<800)
- Oral Care
Who is at risk for getting GB?
Person with a URI or GI infection in past 1-3 weeks.
Complications of GB
- respiratory failure from paralysis of thoracic area
- respiratory/UTI infections
Things to monitor for with GB
- Respiratory failure
- Urinary output
- monitor for illeus
inflammation of the brain tissue and often the meninges caused by a virus, bacteria, fungi or parasites
Patho of encephalitis
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
Clinical manifestations of Encephalitis
- personality changes
What happens if you don't treat encephalitis?
Nursing care for a person with Encephalitis
- frequent neuro checks
- assess for signs of ICP increase
- Systolic BP, decreased HR
- maintain patent airway
- HOB at 30
What causes Trigeminal Neuralgia?
compression of blood vessels from chronic irritation of CN #5 at the root entry zone causing an increase in firing of sensory fibers
S/S of Trigeminal Neuralgia
- It is unilateral.
- It comes and goes
What triggers Trigeminal Neuralgia?
- brushing teeth
- exposure to cold or wind
What medications are given to patients with Trigeminal Neuralgia?
- Anti Seizure meds....
- Tegretol, Dilantin, Valproate
acts on sodium channels decreasing neuron firing
If a persons on Tegretol, Dilantin or Valproate what labs do I need to check periodically?
Keep in mind for a patient with Trigeminal Neurologia....
- Pt. may neglect their hygiene
- Encourage to perform hygiene tasks during peak analgesia times
- Eat foods high in protein and calories, easy to chew
What is an odd problem with Trigeminal Neurologia....what do I do to help?
artificial tears or eye shield
Inflammation of CN #7 (facial) usually caused by herpes
Clinical Manifestations of Bell's Palsy
- drooping mouth/drooling
- loss of tearing
Complications of Bell's Palsy
- psychologic withdrawl
- corneal abrasions
Medication used immediately to treat Bell's Palsy
Special considerations for people with Bell's Palsy
- artificial tears
- eye shield?
- wear shield or tape eye shut at night
Name an antiviral medication to treat herpes
What is a patient given to decrease cerebral edema?
What is commonly given to patients to prevent or control seizures
What is given to patients to control hyperthermia and headache
Artificial Tear Medication