Choose one neurological disorder discussed in your textbook. Mention signs and symptoms of the chosen disease / disorder. 2. Discuss its management and important nursing implications.  

Week # 12: July 20 to July 26 – Main post under Assignment by Wed, July 22 at 11:59 PM EST).

Students are required to post a minimum of three times per week (1 main post answering the question 100% before Wednesday at 11:59 PM EST and 2 peer responses by Sunday at 11:59 PM EST). The three posts in each individual discussion must be on separate days (same day postings / replies will not be accepted).

Chapter 23   Neurological Disorders.
Chapter 24 –  Mental Health.

Questions: 

1. Choose one neurological disorder discussed in your textbook. Mention signs and symptoms of the chosen disease / disorder.

2. Discuss its management and important nursing implications.

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 4 questions in the discussion, you must answer all of them. Your grade will be an average of all answers.

Grading Criteria: Student mentions one neurological disease / disorder from the textbook (25%). Student mentions signs and symptoms of the chosen disease / disorder (25%). Student discusses management of the mentioned disease / disorder (25%). Student discusses important nursing implications.

Chapter 23

Neurological Disorders

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  • Interruptions in blood supply to the brain resulting in neurological damage
  • Are either ischemic or hemorrhagic
  • Manifest as strokes or transient ischemic attacks (TIAs)
  • More than two-thirds of all strokes occur in persons older than 65 years of age
  • There are significant regional differences in the percentage of persons who have strokes

Cerebrovascular Disease

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Ischemic Events

  • Four main causes
  • Arterial disease
  • Cardioembolism

Caused by arrhythmia

  • Hematologic disorders

Coagulation disorders

Hyperviscosity syndromes

  • Systemic hypoperfusion

May result from dehydration, hypotension, cardiac arrest, fainting (syncope)

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  • Symptoms begin to resolve within minutes
  • About one-third of those who have a TIA and do not receive treatment are likely to have a major stroke within 1 year
  • 10% to 15% of these will have one within 3 months
  • Persons often do not seek care for a TIA

Transient Ischemic Attack

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  • Less frequent than ischemic strokes but much more life threatening
  • Primarily caused by uncontrolled hypertension; less often by malformations of the blood vessels (e.g., aneurysms)
  • Usually see specific neurological changes, including seizures and more depressed level of consciousness than those with an ischemic stroke

Hemorrhagic Events

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  • First signs of stroke and TIAs are neurological deficits consistent with the part of the brain affected and type of event
  • Include alterations in motor, sensory, and visual function; coordination; cognition; and language
  • If the individual is deeply unresponsive, he or she does not usually survive
  • Nausea and vomiting are common with increased cerebral edema

Signs and Symptoms

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  • Chances of reoccurrence are increased
  • Long-term effects include paralysis, hemiparesis, dysarthria, dysphagia, aphasia, and depression
  • With paralysis, individuals may also experience spasticity of muscles, contractures, deep vein thrombosis (DVT), pressure ulcers, aspiration, pneumonia, and urinary tract infection

Complications

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  • All cerebrovascular events are emergencies
  • Management is prevention
  • Reduce risk factors when possible
  • Administer anticoagulant therapy
  • Administer aspirin therapy
  • Multidisciplinary team is used for successful patient outcomes

Management

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  • Prevention and prompt intervention are the keys to the management of a stroke
  • Control blood pressure and diabetes
  • Enter a smoking cessation program
  • Limit salt intake and alcohol consumption
  • Maintain a healthy diet
  • Encourage weight loss

Implications for Gerontological Nursing and Healthy Aging

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  • Implement measures to prevent aspiration and DVTs
  • Work to prevent and minimize disability
  • Implement measures to prevent iatrogenic complications such as skin breakdown, falls, and increased confusion or delirium from medications and infections
  • Advocate participating in support groups for both the patient and caregivers

Acute Care

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A patient who had a previous stroke states that he hopes he does not have another stroke. Which is the best response?

Drinking wine daily will decrease any risk factor of having a stroke.

Prevention is the best way to manage patients who have had strokes.

More fruits and vegetables in his diet will decrease the risk for stroke.

Because of collateral circulation, the incidence of another stroke is extremely low.

Question

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  • B—Prevention is the best way to manage patients who have had strokes. It is accomplished by minimizing risk factors. Smoking cessation, low cholesterol diet, and limiting salt and alcohol intake are all changes the patient at risk can make. With a health care provider’s supervision, an exercise program and a weight management program will help to decrease the risk of another stroke.

Answer

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  • Most common are Parkinson’s and Alzheimer’s diseases
  • Both are terminal conditions characterized by a progressive decline in function
  • Signs are usually slow to appear
  • Diagnostic process begins with assessing for reversible causes and increases in complexity when the person has other confounding chronic diseases, is very frail, or has sensory limitations

Neurodegenerative Disorders

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  • Slowly progressing movement disorder that is the result of a destruction of the cells in the brain that produce the neurotransmitter dopamine
  • Slightly more common in men than in women; 96% are diagnosed after the age of 60 years
  • Exact cause is unknown

Parkinson’s Disease

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  • Signs and symptoms begin slowly; therefore Parkinson’s disease is difficult to diagnose
  • Four major signs
  • Resting tremor

Arm and hand are most commonly affected

Not present during sleep

Increase with stress and anxiety

  • Muscular rigidity
  • Bradykinesia
  • Asymmetric onset

Signs and Symptoms

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  • Medications focus on replacement, mimicking, or slowing dopamine receptors
  • First-line medications include carbidopa and levodopa
  • Medication therapy needs to be monitored; side effects may include hypotension, dyskinesias, dystonia, hallucinations, sleep disorders, and depression

Management

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  • About 5 million people in the United States have dementia of some type; between 60% and 80% have Alzheimer disease
  • Sixth leading cause of death in the United States
  • Not a normal part of aging
  • Signs include memory loss, impaired thinking, the ability to find words, judgment, and behavior

Alzheimer’s Disease

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  • There is no cure
  • Pharmacologic therapy has the potential to slow cognitive decline in some
  • Cholinesterase inhibitors
  • N-methyl D-aspartate (NMDA) antagonist
  • Effectiveness of medications and side effects varies
  • Treat coexisting depression and other mental health issues

Management of AD

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  • Treatment focuses on
  • Making sure the person gets good care
  • Preserving self-care abilities
  • Preventing complications and injury
  • Providing support and guidance in dealing with progressive loss
  • Appropriately use nonpharmacologic and pharmacologic interventions
  • Promptly treat all reversible conditions
  • Coordinating care among all providers, including family members or partners

Implications for Gerontological Nursing and Healthy Aging

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  • Impaired verbal communication from neurological disturbances deal with the person’s ability to receive information, understand what is being said, or articulate
  • Articulation is hampered by mechanical difficulties such as dysarthria, respiratory disease, destruction of the larynx, and strokes
  • Specific difficulties include anomia, aphasia, and verbal apraxia

Communication

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  • Affects a person’s ability to communicate with speech and his or her understanding of language, reading, writing, and gesturing
  • Forms of aphasia include
  • Fluent aphasia

Caused by damage to a part of the brain adjacent to the primary auditory cortex (Wernicke area)

Often the person speaks easily but the content does not make sense

  • Nonfluent aphasia

Involves damage to the Broca area

The person speaks slowly and uses minimal words

Experience problems in writing

Aphasia

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  • Impairment in the ability to articulate words
  • Caused by a weakness or incoordination of the speech muscles
  • Characterized by weakness, slow movement, and lack of coordination of the muscles associated with speech
  • Speech appears as slow, jerky, slurred, and quiet with a lack of expression
  • Treatment includes alternative and augmentative speech aids

Dysarthria

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  • Depends on the cause, type, and severity of the symptoms
  • Collaborate with speech and language pathologist
  • Includes
  • Alternative or augmentative communication devices
  • Electronic devices and computers
  • Modified communication techniques

Enhancing Communication

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Which intervention should the nurse include in the plan of care for a patient with dysarthria?

Do not repeat back what the patient says.

Allow the patient to initiate all communication.

Conduct conversations in a quiet, private place.

Sit near the patient and speak louder than usual.

Question

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  • C—Hold conversations in a quiet, private place. Allow more time for conversations. If speech is very difficult to understand, repeat back what the person has said to make sure you understand. Repeat the part of the message you did not understand so that the speaker does not have to repeat the entire message.

Answer

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