Management of Patients With Oncologic or Degenerative Neurologic Disorders

Neurology
Ch. 65
Management of patients with
oncologic or degenerative neurologic
disorders
Brain Tumors
Pathophysiology
 Primary
 Originating from the
brain
 Secondary
 Originating outside the
brain
 Metastasis
Brain Tumors
 Malignant
 Tend to become
progressively worse
 Anaplasia
 Cell distortion
 Invasive
 Benign
 No malignant or recurrent
Brain Tumors
 Presence of lesion 
 Compression of blood
vessels 
 Ischemia 
 Edema 
 I-ICP
Primary-Brain Tumors
Etiology
 Unknown
Brain Tumors
Clinical manifestations
 Depends on
 Size
 Location
Brain Tumors
4 main S&S  Cancer cells being
 I-ICP attacked by immune
 Cushing sign system
 H/A
 Vomiting
 Visual disturbances
 Seizures
 Hydrocephalus
 Alt Pituitary function
Brain Tumors
Localized S&S
 Frontal
 Personality changes
 Emotional changes
 Occipital
 Visual impairment
 Visual hallucinations
 Cerebellum
 Impaired equilibrium
 Impaired coordination
Brain Tumors
Diagnosis
 CT
 MRI
Primary - Brain Tumors
Medical management  Tug McGraw
 Radiation
 Chemotherapy
 Pharmaceutical
 Corticosteroids
 Anti-convulsants
 Surgery
 MRI showing pituitary  Tumor approached
Tumour through nasal cavity
 Surface Tumors  Post-op
Meningiomas excised by
microsurgical technique:
pre-op
 Pre-Operative CT scan showing a  Post Operative CT Scan showing
big tumor on the surface of the successful removal of the tumor
brain compressing the brain
significantly
Secondary-Brain Tumor
3 treatment options
 No treatment
 Death < 1 month
 Tx w/ corticosteroids
only
 Death < 2 months
 Tx with radiation
 Death 3-6 months
Secondary-Brain Tumor
Pharmacology
 Corticosteroids
 Dexamethasone
 Prednisone
 Osmotic Diuretic
 Mannitol
 Anti-convulsants
 Dilantin
 Morphine
Brain Tumors
Nursing Management
 Aspiration
 Alt. nutrition
 Cachexia
 Weak emaciate condition
 Neuro checks
 Photophobia
 Seizure precaution
 Anxiety
Brain Tumors
 What S&S are associated with frontal lobe,
occipital lobe and cerebellum tumors?
 What diet would you expect a patient with
brain cancer to be on?
 The S&S are associated with increase
intracranial pressure?
Brain Tumors
 What are the difference between malignant
tumors and benign tumors?
 What does metastasis refer to?
 What are risk factors of cancer?
 What does remission mean or refer to?
Parkinson’s Disease
 First described by James
Parkinson 1817
 A progressive brain
disorder characterized by
the degeneration of
dopamine secreting
neurons deep in the
cerebral hemisphere in a
part of the brain called
the basal ganglia
 Basal Ganglia
 Controls movement
 Dopamine
 Inhibitory
neurotransmitter in the
basal ganglia
 Acetylcholine
 Excitatory
neurotransmitter in the
basal ganglia
 Without dopamine,
inhibitory influences are
lost and excitatory
mechanisms are
unopposed 
 Neurons of basal ganglia
are over stimulated 
 Excess muscle tone,
tremors & rigidity
 Onset
 Abrupt
 Age of on set
 60
 Men vs. Women
 Men > women
 First Symptom
 Fine tremors in hands or
feet
3 clinical signs
 Tremors
 Rigidity
 Bradykinesia
 Tremors
 Resting tremor
  with activity
  tremor when…
 Walking
 Anxious
 Sensation of heat
 Calorie burning!
 Rigidity
 Stiffness
 Neck
 Trunk
 Shoulders
 Posture
 Head bowed
 Body bent forward
 Arms flexed
 Thumbs turned into palms
 Knees bent (slightly)
 Bradykinesia
 Slow movement
 Akinesia
 Loss of movement
 Esp face
 Expressionless
 Slow speech
 Dysphonia
 Dysphagia
 Drooling
 Bradykinesia
 Gait
 Shuffled
 Festination
 Fall forward d/t posture
Diagnosis
 S&S
 Positive response to
Levodopa
Medical Management
  dopamine
 (blood brain barrier)
 Anti-Parkinsonian
medications
 Levodopa
 Converts into dopamine in
the basal ganglia
 Works best in 1st few years
of disease  effectiveness
wanes
 S/E Dizzy (esp when first
get up)  get up slowly!
 Anti-Parkinsonian
medications
 Sinemet
 Prevents the breakdown of
levodopa outside the brain
Nursing Management
 Assessment
 Affect on ADL’s
 Dysfunction
 S/E of meds
Nursing Management
 Improving mobility
 Exercise
 ROM
 Warm baths
 Massage
 PT
 gait program
Nursing Management
 Enhancing Self-care
 Encouragement
 Adaptive devices
 OT
Nursing Management
 Improving Bowel
elimination –
Constipation
 Bowel routine
 Fluids
 Fiber
 Raised toilet
Nursing Management
 Nutritional deficit
 Slow process
 Meds  dry mouth
 Chewing & Swallowing
 Weights
 Supplement
 Dietician
 FORK!
Nursing Management
 Enhance swallowing
 Upright position
 Semi-solid food
 Thick liquids
Nursing Management
 Communication
 Speak slow
 Short sentences
 Deep breath before
speaking
 SLP
 With PD it is known which neurotransmitter is
lacking in the brain and scientists are able to duplicate
this neurotransmitter. Why are we then unable to
cure PD?
 PD type deterioration of the nerve cells of the brain
reduces the amount of what neurotransmitter?
 Because of the inability to cure PD at this time, PD is
frequently treated with which medications?
 What are the side effects of these meds?
 To promote optimal functions, which activity
could the nurse recommend as being beneficial
to a patient with PD ?
 What would be of value in helping a patient with
PD communicate with the medical team?
 Is PD a disease of the CNS, PNS or both?
 During an assessment, what signs and symptoms
can the nurse anticipate a patient with
Parkinson’s to exhibit?
 What nursing diagnosis would be priority for a
patient with Parkinson’s?
 Describe the muscle tone of a patient with
Parkinson’s (medical terms)
 What interventions can be used to address the
issue of nonintention tremors?
Huntington’s Disease
 AKA  George Huntington
 Huntinton’s Chorea
 Pathophysology
 Rare
 Genetic
 The disease is
characterized as
degeneration of the
cerebral cortex and the
basal ganglia 
 Which causes chronic
progressive chorea
 Bizzare involuntary dance-
like movements
 And mental deterioration

 Ending in dementia and
death
 Loss of GABA
(inhibitory
neurotransmitter)
 Involuntary choreiform
 Diminished during sleep
 Facial tics/grimacing
 Paranoia &
hallucinations
 Appetite
 Ravenous
 Emotions
 Labile
 My mom has suffered
from this disease for 19
years now. I never really
knew her real
personality...but from
what I have heard, she
was wonderful…I love
my mom very much, and
I would give anything to
have grown up with her
not being sick.
Diagnosis
 DNA testing
Medical management
 No treatment
 Meds to  tics
 Chlorpromazine
(Thorazine)
 Meds to  hallucination,
delusions, angry
outbursts
 Haloperidol (Haldol)
 Anti-psychotics
Nursing Management
 Family support
 Diet
 Ambulatory
 Safety
 Is Huntington’s a disease of the CNS, PNS, or
both?
 What dietary changes might be appropriate for
a patient with Huntington’s disease?
 Describe the pathophysiology of Huntington’s
disease.
 What is the etiology of Huntington’s disease?
 How is Huntington’s disease different from
Parkinson’s disease?
 What medications are used to help with tics and
uncontrolled movements associated with
Huntington Chorea?
 If a patient expresses suicidal thought, what are
the correct nursing management interventions
 Huntington’s Chorea is characterized by what
(what does it look like)?
 Name five nursing interventions for a patient
with Huntington’s disease
Amyotrophic Lateral Sclerosis
Pathophysiology  Lou Gehrig
 Degenerative motor
neuron disease that
affects UMN & LMN
lying within the brain,
spinal cord and
peripheral nerves
 The myelin sheaths are
destroyed and replaced
with scar tissue
 Does not affect CN
 3
 4
 6
 The patient is therefore
able to
 Blink
 Move eye
 Cognition is left intact!
 Is ALS a disorder of the CNS, PNS or both
the CNS and PNS?
A. CNS
B. PNS
C. Both CNS & PNS
Etiology
 Unknown
 Men vs. Women

 Men > Women
 Progressive muscle
weakness
 Atrophy
 Spasity
 Dysphagia
 Dysarthria
 Jaw Clonus
 Tongue fasciculation
Clinical Manifestations
 No sensory loss
 Death within 5 years

 Resp. failure
 Bulbar paralysis
Diagnosis
 S&S only
 No dx screen
Medical Management
 Baclofen (Lioresal)
 Diazepan (Valium)
 Spasticity
 Mechanical Ventilator
Nursing Management
 Respiratory
 ADL’s
 Nutritional support
 Emotional support
 Advanced directive
 Amyotrophic Lateral Sclerosis is manifested by what?
 What are the classic signs and symptoms of this
disease?
 What are fasciculations?
 Amyotrophic lateral sclerosis effects UMN, LMN or
both?
 CNS? PNS? Both?
 What is the treatment methodology for ALS?
 What is the pathophysiology of ALS?
Herniated Disc
 AKA
 Ruptured disc
 Slipped disc
 Degenerative disc disease
Herniated Disc
 Anatomy
 The interverterbral disc is
a cartilaginous plate that
forms a cushion between
the vertebral body
 Nucleus pulposus
 Protrudes
 Nerve compression
Herniated Disc
Etiology
 Age
 Trauma
Herniated Disc
Clinical Manifestations
 Cervical
 Location
 C5-6
 C6-7
 Pain
 Neck
 Shoulder
 ? Heart attack?
Herniated Disc
 Lumbar
 Location
 L4-5
 L5-S1
 Pain
 Low back
 Sciatica
 Relieved with
 Bed rest
Herniated Disc
Diagnosis
 MRI
Herniated Disc
Herniated Disc
Medical Management
 Conservative - cervical
 Immobilization
 Collar
 Isometric exercises
 Pain relief
 Hot packs
 Analgesics
 Muscle relaxant med
 Anti inflammatory med
Herniated Disc
Medical Management
 Conservative - lumbar
 Bed rest
 Firm mattress
 Pain relief
 Hot packs
 Analgesics
 Massage
 Muscle relaxant med
 Anti inflammatory med
Herniated Disc
Medical management
 Surgery – lumbar
 Turning
 Log roll
 Sitting
 No sitting (except BR)
 Complication
 Failed Disc Syndrome
Herniated Disc
 What are contributing factors to a Herniated
disc?
 The center of the vertebral disc is called what?
 What are the most common sites for herniated
disc?
 What is Sciatica?
 CNS? PNS? Both?
 What is the frustrating complication post
surgery?
Spinal Bifida
Pathophysiology
 Neural Tube defect
 Incomplete closure of
the vertebrae
 3 Levels
 Spina Bifida Occulta
 Meningocele
 Myelomeningocele
Spinal Bifida
 Meningocele  Myelomeningocele
Spinal Bifida
Spinal Bifida
  Spina bifida occulta
Spinal Bifida
The Infant with
 Myelomeningocele must have
Myelomeningocele a repair of the open neural
tube. Failure to repair may
result in serious infection
which would harm the
developing infant brain. After
the repair, many children
require the insertion of a
device called a shunt to divert
the cerebral spinal fluid to
treat the hydrocephalus.
Spinal Bifida
Etiology
 Folic acid deficiency
during pregnancy
 Esp 1st month
Spinal Bifida
Diagnosis
 Ultrasound
  levels of fetal protein

 Alpha fetoprotein
Spinal Bifida
 What food contain folic  Black Beans
Acid?  Lentils
 Greens  Peas
 Asparagus  Peanuts
 Broccoli
 Cauliflower
 Corn
 Green Beans or Peas
 Sweet Potato
 Cabbage or Coleslaw
 What deficit is associated with spina bifida?
 What diagnostic test is used to detect spina
bifida invitro?
 Name three foods high in folic acid.
 Describe the difference between Spina Bifida
occult, meningocele and myelomeningocele.
 CNS? PNS? Both?

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Management of Patients With Oncologic or Degenerative Neurologic Disorders

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Neurology

 Men vs. Women

 Death within 5 years

  levels of fetal protein

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