Lecture 16: Care of Patients with Chronic Degenerative Neurological Conditions

med-surg notes Lecture 16: April 2 Care of Patients with Chronic Degenerative Neurological Conditions: Alzheimers, Dementia, MS Chronic Degenerative Neurological Conditions Chronic Degenerative Conditions Types of Degenerative Neuro Conditions Priority Concepts Chronic: Persisting for a long time or constantly recurring (of an illness) Alzheimer's disease/dementia Cognition Parkinson's disease Mobility Degenerative: Progressive, often irreversible deterioration (of a disease or symptom) Multiple sclerosis (MS) Immmunity Patient safety Loss of function in the organs or tissues Alzheimer's Disease/Dementia Alzheimer's Disease/Dementia Assessment Findings Non-reversible, progressively develops over years Taries by stage Plaques and neuroRbrillary tangles No speciRc lab tests or diagnostics Fisk Hactors 7rain scans Advanced age Chemical imbalances Medications Hxw of Alzheimer's or DoEn Syndrome ;arget behavioral and emotional problems, such as anwiety, agitation, combativeness, depression jnvironmental ewposure Previous head in>ury Hemale O male Antipsychotics, antidepressants, anwiolytics jthnicity: African American and xispanic individuals have increased risk due to APBj and A7CAV genes Alzheimer's Disease May temporarily sloE progression Nursing Care Donepezil, memantine, cholinesterase inhibitors Other Types of Dementia Assess cognitive status: Memory, >udgment, personality Hrontotemporal Dementia (H;D) Initiate boEel and bladder programs (routines) Abnormal amounts of protein on ;au and ;DP-0G neurons in the brain jncourage patient and family to participate in an AD support group Starts Eith aphasia (loss of ability to understand speech/language) Provide a safe environment4 validation therapy jncourage frequent Ealking/ewercise to reduce Eandering Maintain a sleep schedule and promote consistency Provide verbal and nonverbal Eays to communicate Interprofessional Care Monitor nutrition: B3er snacks/Rnger food Provide cognitive stimulation and memory training jncourage client and family to seek legal council Avoid overstimulation and agitation Fefer to social activities for adult day care options Check for skin breakdoEn Fefer to the Alzheimer's Association for community outreach programs Promote independence/self-care as long as possible Long-term, home, and respite care options Speak directly in short, concise sentences Parkinson's Disease Findings & Pathophysiology Assessment Findings Primary Hindings Stooped posture ;remors SloE, shu+ing, propulsive gait Muscle rigidity SloE, monotonous speech 7radykinesia ;remors, pill-rolling Postural instability Muscle rigidity Pathophysiology 7radykinesia/akinesia 7alance of DA and ACh contribute to muscle movement Mask-like ewpression Degeneration of DA producing cells (substantia nigra) results in overstimulation of basal ganglia by ACh Drooling, dysarthria Di1culty cheEing/sEalloEing Di1culty Eith ADLs Risk Factors Cognitive Hindings ACh dominates, making smooth muscle movements di1cult Mood sEings Age: 0U-VU years old Cognitive impairment More common in males Brthostatic hypotension oga, acupuncture, massage Can take several Eeeks to improve symptoms "enetic predisposition Autonomic Hindings Alternative Therapies Medication Use Maintenance of therapeutic levels is important Possible Hactors Hlushing, diaphoresis Medication4 C7D, Medical mari>uana jnvironmental ewposure Chronic antipsychotics use Art and music therapy Medications Newer Treatments Dopaminergic Deep 7rain Stimulation Levodopa, often combined Eith carbidopa Surgical therapy that has been HDA approved for YU5 years Converted to DA in the brain Involves implanting an electrode into a targeted area Medication tolerance and metabolism: Dosage, form of med, and administration times must be ad>usted to avoid periods of poor mobility Implants are placed on one/both sides of the brain as needed Stimulated through a connection to the pacemaker-like device located under the skin in the chest Nursing actions: Monitor for WEearing o3W Dopamine Agonists Hocused 2ltrasound Fopinirole 7eams of 2S Eaves are focused on a designated target Active the release of DA Creates a small lesion that disrupts abnormal circuitry in brain Nursing actions: Monitor for orthostatic hypotension, dyskinesia, and hallucinations xelps to restore more normal movement Anticholinergics Control tremors and rigidity Nursing actions: Monitor for anticholinergic e3ects Nursing Care Administer meds at prescribed times, monitor e3ectiveness, and make recommendations for a change in dosage or schedule Catechol-B-Methyltransferase (CBM;) Inhibitors Decrease breakdoEn of levodopa Nursing actions: Monitor for dyskinesia or hyperkinesia, assess for diarrhea Monitor sEalloEing and maintain adequate nutrition Dark urine is a normal Rnding Prevent aspiration pneumonia Monoamine Bwidase ;ype 7 (MAB-7) Inhibitors Maintain patient mobility as long as possible Increase DA levels, reducing Eearing o3 Ehen administered Eith levodopa Promote communication for as long as possible Nursing actions: Severe reactions can occur Eith food, sympathomimetics, meperidine, and ↓uowetine Monitor mental and cognitive status Interprofessional Care Patient education: Avoid foods high in tyramine Long-term treatment and care must be accommodated Antivirals Late stage: More active members of the team Advanced stages: Altered cognition, dementia, memory loss AcknoEledge the patient's feelings4 safe environment Amantadine Stimulate release of DA, prevent reuptake Nursing actions: Monitor for discoloration of skin (returns to normal after D/C) Develop a comprehensive, long-range plan Patient may ewperience anwiety, confusion, and anticholinergic e3ects Multiple Sclerosis Pathophysiology Risk Factors Assessment Findings 7ody attacking the myelin sheath (protective nerve covering) Bnset generally betEeen Y -0U years old Hatigue Bccurs more often in females Pain, paresthesias ;his sloEs/stops the nerves from sending and getting signals from your brain related to the Rve senses and movement jtiology is unknoEn, but often a Rrst degree relative Eith MS ;innitus, vertigo, decreased hearing Association Eith IL-V and IL- receptor genes Muscle spasticity, Eeakness, or atawia MC type of demyelinating disease Main Symptoms Nystagmus eakness, numbness Medications Chemotherapy: Mitowantrone (MS and some cancers) Dysphagia, dysarthria 7oEel or bladder dysfunction Decreased coordination Autoimmune Disease Cognitive changes Sewual dysfunction Hactors that can trigger relapses Tision Changes Anti-indammatory urgsI: Interferon beta-Y Tiruses and infectious agents SmmgnoIgppreIIion urgsI: Peginterferon beta-Y, azathioprine, natalizumab (MS and Crohn's) Diplopia: Double vision Living in a cold climate Changes in peripheral vision Physical in>ury or emotional stress Decreased visual acuity Pregnancy Scotomas: Patches of blindness Hatigue, overewertion Periods of total blindness ;emperature ewtremes 2nho3's sign: ;emporary teroiuI: Methylprednisolone (in↓ammation, ewacerbations of chronic illness) Nursing Care in vision after ewertion What to Monitor For Alternative Therapies Discuss coping mechanisms Tisual acuity jncourage ↓uid intake to reduce constipation and prevent 2;Is Speech patterns Hacilitate communication SEalloEing Medication4 C7D, Medical mari>uana Apply eye patches to treat diplopia4 alternate eyes every feE hours Activity tolerance Art and music therapy ;each scanning techniques jwercise and stretch involved muscle4 avoid fatigue and overheating oga, acupuncture, massage Skin integrity Cognitive changes Interdisciplinary Care Promote energy conservation Plan for progression Maintain a safe environment Community resources jwpand the care team as needed