Med Surg Session 7: Neurologic Disorders

Session 7: Neurologic disorders

strokes:

  • TIA – stroke signs and symptoms but with no dead tissue, this is a warning sign for another TIA or stroke
    • not a stroke
  • CVA – an incident that ends in the death of tissue that occurs under twenty four hours
  • FAST – face drooping, Arm weakness, Speech difficulty, time to dial 911
  • change in level of consciousness.
  • risk factors: DM, HTN, obesity
  • Nursing diagnosis: “risk for ineffective cerebral tissue perfusion related to reduction vessel blood flow and cerebral edema”
  • Be sure that the patient has a viable gag reflex.
    • aspiration is a high risk for stroke patients
  • Right sided CVA
    • left side paralysis
    • more impulsive
    • short attention span
    • no issues
  • Left sided CVA
    • right side paralysis
    • problem identifying left from right, and their own limbs
    • short attention span, uncontrollable emotional swings.
    • impaired speech (
      • global aphasia – cannot understand or get the words out/not real words
      • expressive aphasia – cannot express themselves with speech appropriately. Broca’s aphasia (trouble finding words, takes effort to speak),
      • receptive aphasia – cannot understand what other people are trying to communicate to them, the patient.  Wernicke’s aphasia (impaired ability to understand language)
  • Rehab
    • MSK – help set good posture, and encourage movement

 

  • thicken water and puree food due to the impaired gag reflex

 

  • Encephalitis case study (Acute inflammation of the brain)
    • summary: 59yo, change in LOC, expressive aphasia, HA 5/10, 39 degrees C, poor skin turgor and dry mucous membranes.
    • d/t: herpes zoster virus
    • treat with antiviral – acyclovir.
    • seroquel – to improve mental status, (mood stabilization)

 

Myasthenia Gravis

Define: A weakness and rapid fatigue of muscles under voluntary control that fluctuates.

Pathophysiology: Genetic disorder that leads to an autoimmune response that attacks Ach receptor.

S/Sx: first weakness with no pain, then eventually fatigue once the Dx progresses. Eye lid and ball droop, difficulty swallowing and chewing, change in voice, drooping face/jaw, cannot hold head upright.

Diagnosis: Neuro test, Edrophonium test (if MM strength comes back after the med is administered MG is indicated), ice pack test, Blood test to look for the antibodies that attack the ach receptors.  

Treatment: Cholinesterase inhibitors, steroids, and immunosuppressants

 

Multiple Sclerosis

Define: A disease of unknown etiology that causes damage to the myelin sheath and disrupts the nerve path.

Pathophysiology: the creation of plaques (lesions), and the degradation of myelin sheath.

S/Sx: Pain in the eyes and back, tremors, difficulty walking, slurred speech, double or blurred vision.  

Diagnosis: there are multiple parts to the diagnosis medical history and neurological assessment then tests are done to reveal damage and reactions (MRI, Spinal Tap, Evoked potentials).

Treatment: cannot cure, only slow progression and speed up recovery from acute attacks. give steroids, and do a plasma exchange if this is a new onset that did not respond to the steroids.

 


Seizures

Define: abnormal electrical activity in the brain. Generalized is when both sides of the brain are affected, and partial is when a specific area is affected these can spread throughout the brain though.

Pathophysiology: paroxysmal manifestations of the electrical properties of the cerebral cortex. A seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation.

S/Sx: mm contractions or spasms, an Aura, pain, fatigue

Diagnosis: EEG, Neuro test, blood test for infection and genetic disposition

Treatment: carbamazepine, diazepam, anticonvulsants

 

Parkinson’s disease

Define: CNS dx that can cause tremors

Pathophysiology: a gradual loss in the levels of dopamine. throwing off the atch dopamine balance.

S/Sx: tremors, bradykinesia, and rigidity

Diagnosis: no specific diagnosis, just ordering tests to rule out other diseases

Treatment: increase dopamine in the brain: levodopa with carbidopa, MAOBs(eldepryl), COMP-T inhibitors(Entacapone), amantadine, and anticholinergics.

 

Bacterial Meningitis

Define: inflammation of the brain and spinal cord membranes caused by bacterial infection

Pathophysiology: bacteria such as streptococcus pneumoniae invade the bloodstream, cross the blood brain barrier, then colonize in the CSF

S/Sx: pain in the back and neck from inflammation, then infection s/s

Diagnosis: spinal puncture to get A sample of the CSF and grow a culture to find out what is in the chord.

Treatment: IV antibiotics, and corticosteroids,

  • Vancomycin – check ototoxicity and nephrotoxicity, it is a vesicant, kills gram-positive bacteria by binding to the cell wall. ANAPHYLAXIS and Red Man syndrome can develop
    • for meningitis, endocarditis, osteomyelitis
  • To prevent get a vaccine, then stress hand washing.

 

Guillain Barre

Define: paralysis that starts in the legs and moves up the levels of the spinal cord triggered by an infection

Pathophysiology: demyelination in an ascending pattern

S/Sx: ascending paralysis

Diagnosis: peripheral neuro exam, and electrolyte imbalances

Treatment: Plasma exchange(to remove harmful antibodies), and immunoglobulin therapy (put in immunoglobulins that block the antibodies that contribute to GB).

 

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