Chapter 70 Management of Patients With Oncologic or Degenerative Neurologic Disorders Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Parkinson’s Disease • Associated with decreased levels of dopamine caused by destruction of cells in the substantia nigra in the basal ganglia; this affects the neurotransmission of impulses • Manifestations: tremor, rigidity, bradykinesia, postural instability, depression and other psychiatric changes, dementia, autonomic symptoms, sleep disturbances, • Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Parkinson’s disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Medications for Parkinson's Disease • Levodopa and carbidopa . Levodopa works when your brain cells change it into dopamine • Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole (Mirapex )and ropinirole (Requip), . • Anticholinergics such as benztropine(Cogentin) and trihexyphenidyl (Artane). These drugs restore the balance between two brain chemicals, dopamine and acetylcholine. That eases tremors and muscle stiffness in people with Parkinson's. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Huntington’s Disease • A chronic progressive hereditary disease that results in choreiform movement and dementia • fatal genetic disorder that causes the progressive breakdown of nerve cells in the brain. • Transmitted as an autosomal dominant trait • Pathology involves the loss of cells in the striatum of the basal ganglia and the cortex Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Alzheimer's Disease • Also called senile dementia • The most common cause of dementia • A chronic, progressive, degenerative brain disorder that causes the brain to shrink (atrophy) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Amyotrophic Lateral Sclerosis (ALS) • “Lou Gehrig’s disease” – base ball player • progressive nervous system disease. Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei in the brainstem cause progressive weakness and atrophy of the muscles of the extremities and trunk. Weakness muscles impairs swallowing and talking. Respiratory function is also impaired. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscular Dystrophies • Incurable diseases that cause progressive weakness and loss of muscle mass. • In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle. Severe weakness skeletal and voluntary muscles • Most are inherited disorders • Duchenne muscular dystrophy is the most common and inherited as a sex-linked trait Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Postpolio Syndrome • Occurs in patients who have had polio • Years after recovery from the disease, the older adult patient develops new musculoskeletal weakness, fatigue, and musculoskeletal pain. • 60% to 80% of polio survivors experience this • Cause is unknown but may be because of aging or muscle overuse in which the neurons not destroyed by the poliovirus cannot continue to generate axon sprouts. The reinnervated muscles affected by polio are more vulnerable to aging. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Parkinson’s Disease—Assessment • Focus on the degree of disability and function of the patient including ADLs, IADLS, and cognitive function • Medications and responses to medications • Emotional responses and individual coping • Family processes and coping • Home care and education needs • Fall risk assessment • Manifestations and potential complications related to the specific disorder Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Parkinson’s Disease—Diagnoses • Impaired physical mobility and risk for activity intolerance • Disturbed thought processes • Self-care deficits • Imbalanced nutrition • Constipation • Impaired verbal communication • Ineffective coping and compromised family coping • Deficient knowledge • Risk for injury Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Parkinson’s Disease—Planning • Major goals may include improved functional ability, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive individual and family coping skills. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Improving Mobility • Daily program of exercise • ROM exercises • Postural exercises • Consultation with physical therapy • Walking techniques for safety and balance • Frequent rest periods • Proper shoes • Use of assistive devices Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions • Enhancing self-care ability – Encourage, educate, and support independence – Environmental modifications – Use of assistive and adaptive devices – Consultation with occupational therapy • Support of coping – Set achievable, realistic goals – Encourage socialization, recreation, and independence – Planned programs of activity – Support groups and referral to supportive services: counselors, social workers, home care Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Degenerative Disk Disease • Low back pain is a significant public health disorder and has significant economic and social costs. • Most back problems are related to disk disease. • Degenerative changes occur with aging or are the result of previous trauma. • Radiculopathy produces pain. • Continued pressure may produce degenerative changes in the nerves with resultant changes in sensation and motor responses. • Treatment is usually conservative: rest and medications. • Surgery may be required. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiculopathy is a disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch. Spondylosis is ankylosis or stiffening of the cervical or lumber vertebrae. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins HERNIATED DISC • A herniated disc (also called bulged, slipped or ruptured) is a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus. Discs that become herniated usually are in an early stage of degeneration. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Laminectomy • Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral bone (lamina). This helps ease pressure on the spinal cord or the nerve roots that may be caused by injury, herniated disk, narrowing of the canal (spinal stenosis), or tumors. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Discectomy • A discectomy is a procedure to remove a portion of a herniated disc in the spine, which is bulging and pushing on a nerve. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Cervical Diskectomy—Assessment • Determining the onset, location, and radiation of pain • Assessing for paresthesia, limited movement, and diminished function of the neck, shoulders, and upper extremities • Determine whether the symptoms are bilateral • Cervical spine palpated to assess muscle tone and tenderness • Range of motion in neck and shoulders is evaluated • Health issues • Patient education Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Cervical Diskectomy—Diagnoses • Acute pain related to the surgical procedure • Impaired physical mobility related to the postoperative surgical regimen • Deficient knowledge about the postoperative course and home care management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Collaborative Problems and Potential Complications • Hematoma at the surgical site, resulting in cord compression and neurologic deficit • Recurrent or persistent pain after surgery Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Cervical Diskectomy—Planning • The goals for the patient may include relief of pain, improved mobility, increased knowledge and self-care ability, and prevention of complications. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Cervical Diskectomy—Nursing Interventions • Relieving pain • Improving mobility • Monitoring and managing potential complications • Promoting home and community-based care Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
