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NeuroSummer 2010 - Neurological Disorders Stroke Parkinsons...

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Neurological Disorders Stroke Parkinson’s Disease Multiple Sclerosis Amyotrophic Lateral Sclerosis Guillain-Barre Syndrome Bell’s Palsy Trigeminal Neuralgia Myasthenia Gravis
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Neurologic Assessment History and Client Interview Physical Exam Mental Status Exam Cranial Nerve Assessment Motor Function Cerebellar Function Sensory Function Reflex Testing
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CVA: “Brain Attack” or Stroke In the United States, every 45 seconds Someone has a stroke, every three minutes someone dies from a stroke, And 70,000 new or recurrent strokes occur each year. American Heart Association Data 2003
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CVA: Epidemiology Ischemic Stroke Hemorrhagic Stroke
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CVA: Etiology Modifiable Risk Factors Non-modifiable Risk factors
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CVA: Assessment Past medical history Current medications Symptom Onset and progression
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CVA: Diagnostic Tests CT Scan MRI Laboratory tests Other tests
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CVA: Management Pharmacology Emergency Management Surgery
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CVA: Nursing Implications Health promotion Acute care Discharge Planning
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Parkinson’s Disease Epidemiology Etiology Pathophysiology
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Parkinson’s Disease: Assessment Tremor Rigidity Bradykinesia Akinesia
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Parkinson’s Disease: Pharmacologic Interventions Goal is to maximize functional ability with minimal side effects Dopaminergics : most effective agents Carbidopa/levodopa (Sinemet), other levodopa combinations Immediate and sustained release Most Effective first 3-5 years Long term use may cause dyskinesias, hallucinations or orthostatic hypotension
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Pharmacologic Interventions Anticholinergics Cogentin, Artane, Amantadine Extends effects of levodopa Most effective if primary symptom is tremor Dopamine agonist: mimics dopamine Bromocriptine mesylate (Parlodel)
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Drug Toxicity Delerium Cognitive impairment Decreased effectiveness Hallucinations Manage by: Decreasing dose Change to a new medication Change frequency Drug holiday
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Parkinson’s Disease: Nursing Implications Goal is to maintain independence as long as possible Mobility PT OT Speech therapist
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Parkinson’s Disease: Nursing Implications Nutrition Communication Skin integrity Social Activity Financial Issues
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Surgical Alternatives Stereotactic pallidotomy Controls symptoms only, not curative Insert electrode via burr hole to stimulate area Watch for decrease in tremors and rigidity
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Thalamotomy Thermocoagulation of brain cells Done for the most affected side
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