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135 Cards in this Set

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Both diseases involve the basal ganglia which controls and regulates movement, posture, muscle tone and coordination
Parkinson's
Huntington's
____________=decrease dopamine
Parkinson's
Risk factors for Parkinson's:
^ in ppl who drink well H2O
living near wood pulp mills
Who is at a decreased risk for parkinson's?
ppl who take NSAIDS/aspirin regularly
2nd most common neuro disorder in the elderly:
Parkinson's
In Parkinson's, this may start in one hand or arm and progresses to the legs. It is usually worse on ________, and is common when at rest or when stressed.
Tremor.

One side of the body.
the dx of parkinson's is :
based on clinical findings
Although there is no definitive test to dx parkinson's, analysis of _____ may show a decrease in ________ levels.
Cerebral spinal fluid (csf)

dopamine
The pt with parkinsons will have at least 2 out of 3 of the following characteristics:
tremor
rigidity
bradykinesia
There may be a positive response to low trial doses of antiparkinsonian drugs such as:
sinemet
How many stages are there in parkinson's disease?
5
In stage one (the INITIAL stage) of parkinson's, the pt. will have
Unilateral limb involvement
minimal weakness
hand/arm trembling
fatigue
In stage 2 (the MILD stage) of parkinson's, the pt will have:
bilateral limb involvement
mask like faces
show, shuffling gait
Stage 3 of Parkinson's, or the MODERATE stage:
gait disturbances increase
Stage 4 of parkinson's, or the SEVERE DISABILITY stage, the pt. will have:
Akinesia (no initiation of mvmnt)
muscle rigidity
Stage 5 of parkinson's, of the COMPLETE DEPENDENCE stage, the pt.:
will need complete dependence for all ADL's
ANS symptoms for parkinson's are:
generalized weakness
orthostatic hypotension
excessive perspiration
urinary frequency
excessive salvation/drooling
constipation
The following are some changes in speech that occur with parkinsons
slowed, soft, low pitched, monotone
dysarthria
slurred speech
decreased volume
echolalia
other physcial assessment findings in a parkinsons pt.
dysphagia
blank facial expression
postural changes
emotional changes
Some emotional changes in the pt. with parkinsons are:
depression
nervousness
anxiety
paranoia
depression
20% of ppl with parkinsons have:
dementia
is there a cure for parkinsons?
no
what is the goal of txt for parkinsons?
relieve symptoms
what's the most effective tx for parkinsons?
pharmacotherapy
what is the goal of pharmacotherapy for the parkinsons pt.?
restore balance b/n dopamine and acetylcholine. (increase activation of dopamine receptors/block acetylcholine receptors)
(parkinsons) not perscribed until sx are disabling b/c they are only effective for 1-5 years
dopaminergic drugs
(parkinsons)what two types of drugs are used with parkinsons?
dopaminergic
anticholinergic
(parkinsons)Anitcholenergic drugs extend effects of _________ therapy:
levodopa
(parkinsons)when are dopaminergics most effective?
first 1-5 yrs
(parkinsons)Used when primary symptom is tremoer, rigidity and excessive sweating:
anticholinergic drugs
(parkinsons) two examples of anticholinergic drugs are:
artane (trihexyphenidyl)
congentin (benztropine)
(parkinsons)used when dopaminergics and anticholinergics are no longer effective:
dopamine agonist
(parkinsons) activate the release of dopamine
dopamine agonist
what are some side effects of dopaminergics?
dyskinesias
hallucinations
orthostatic hypotension
nausea
May be used alone or with sinemet
dopamine agonist
avoid taking dopaminergics with vitamins and food high in ______ and _________ because they may decrease absorption
b6
protein
what are some foods high in b6?
whole grains
green leafy veggies
beans

fruit
eggs
cheese
milk
meat
poultry
fish
what is the drug of choice to treat rigidity, tremor and bradykinesia in parkinsons?
dopaminergics
______ is available in stand and controlled release (CR). some pt.s take both with parkinsons
Sinemet
what are examples of dopaminergics?
levodopa
carbidopa/levodopa combination (sinemet)
what are 4 examples of dopamine agonists?
bromocriptine (parlodel)
Pergolide (permax)
mirapex (premipexole)
requip (ropinirole)
______ and _______ can reduce parkinson symptoms and delary disease progression
mirapex (pramipexole)
requip (ropinirole)
dopamine agonists are useful in the client with side effects of
dyskinesias
some s/e's of dopamine agonists are:
n/v
orthostatic hypotension
phlebitis
dizziness
h/a
insomnia
with parkinsons, ______ injections are used to decrease rigidity. They are given every 2-3 mo.
botox
what are 4 ways to surgically manage parkinsons:
ablation
DBS (deep brain stimulation)
Fetal tissue transplantation (experimental)
intrathecal pump
what is ablation?
permanent lesions made in brain
when was DBS approved by the FDA?
2002
what does ablation help?
to decrease mvmnts
where is ablation done?
in the thalmus
electrodes placed in the thalamus and ablated areas. pacemaker delivers current to brain. health care provide regulates rate and strength of impulses
DBS
(deep brain stimulation)
when do you get best control of symptoms with parkinsons?
when using combined techniques of DBS and Ablation
who regulates DBS? What doesn't it alleviate?
surgeon
balance probs
fetal neural tissue placed in brain to provide dopamine producing cells:
fetal tissue transplantation
surgically implanted in the subarachnoid space of the spinal cord. It is used to deliver medications:
intrathecal pump
________ - enzyme that inactivates dopamine and increases the effectiveness of levodopa
COMT inhibitors
(catechol O-methyltransferase)
botox is used to decrease rigidity as well as treat:
muscle spasms
MAO inhibitors (selegline (eldepryl, carbex):
slow progression of Parkinsons
hereditary disorder transmitted as an autosomal domninant trait at the time of conception:
huntingtons disease
how many ppl in the us have huntingtons disease?
25,000
when do symptoms of huntingtons disease begin?
30-50yrs
what is the life expectancy of someone who was just dx'd with huntingtons?
15yrs
Huntingtons disease: ______dopamine levels
increased
how is movement effected with huntingtons?
its increased and exaggerated
assessment findings: two main symptoms of huntingtons disease:
mental status changes, leading to dementia

choreiform movements: rapid, jerky, involuntary (starts with twitching)
early sx of huntingtons disease:
depression
restlessness
clumsiness
balance and coordination probs
altered speech
average duration of huntingtons:
10-20 yrs
In huntingtons, death occurs from complication of _________
immobility (pneumonia, sepsis)
hallmarks of huntingtons:
dementia and choreoathetosis (slow writhing continuous movement)
is there a cure for huntingtons?
no
____________ is important for children of clients with huntingtons:
genetic counseling
management of huntingtons is ________
palliative
two types of meds that help with huntingtons:
anti psychotic
antidepressants
The antipsychotic medication, Haloperidol (haldol), is effective in ______________. (chemical restraint for ppl with huntingtons)
supressing the mvmt disorder
what surgery is available to ppl with huntingtons?
transplantation of fetal neural tissue into the brain (experimental)
What are some goals of the nurse for a pt. with huntingtons?
emotional/psych support
comfort
safe environment
adequate nutrition (may be on feeding tube)
____________ all are chronic, inabilities to perform adl's independently
degenerative disorders
in this disease, the degeneration of cells lead to decrease in dopamine. The person loses ability to refine voluntary mvmt
parkinsons
with parkinsons, an imbalance between _______ and ______ results in contol and movement problems
dopamine
ach
with parkinsons, there is a slow progression of the following sx:
tremor
rigidity
bradykinesia
gait disorder
postural imbalance
__________ is a progressive, degenerative disease affecting the myelin sheath and condutcion pathway of the cns
multiple sclerosis
a leading cause of disability in persons 20-40 yrs of age
ms
what are the risk factors for MS? (4)
20-40 yrs old
women
temperate climates
genetics
what are major complications of MS?
resp. probs
uti's
pressure sores
____________- an acute, rapidly progressing and potentially fatal form of polyneuritis affecting the peripheral nervous system
Guillain-Barre syndrom
GBS
with _________ and ________, clients may experience exacerbations and remissions
MS
Guillain-Barre syndrom
how does GBS affect men/women?
equally
____% will recover completely from GBS
85
GBS more commenly seen in ______ than _______
adults
children
Characteristic feature of GBS?
ascending paralysis that is reversible
GBS starts with weakness in the ________
extremities
In GBS, ___________ is the most important aspect during the acute phase. Monitor _______ ________
assessment
ascending paralysis
recovery from GBS may be a long process involving ___________. It may take ______
rehab
6mo-2yrs
Chronic neuromuscular disease with an autoimmune component. It involves a decrease in the number and effectiveness of ACH receptors at the neuromuscular junction
Myasthenia Gravis (MG)
Myasthenia Gravis (MG) means:
grave muscle weakness
Serum Acetylcholine receptor antibodies (AchR) will be _______ in 80-90% of clients with MG
elevated
What are the 2 types of crisis' with MG?
choninergic and myasthenic
an acute exacerbation of muscle weakness caused by overmedication with cholinergics (anticholinesterase drugs)
choninergic crisis
an exacerbation of the myasthenic symptoms caused by undermedication with anticholinesterase drugs or stressors
myasthenic crisis
with myasthenia gravis (MG), nursing care includes assessing 2 things:
resp fx
muscle strength of face and limbs
This disease involves progressive degeneration of the motor neurons of the spinal cord, brainstem and motor cortex. Messages from the brain can't reach the muscles>
amyotrophic lateral sclerosis
(lou gerhigs)
Amyotrophic lateral sclerosis is aka
lou gehrigs disease
Amyotrophic lateral sclerosis (ALS) results in
paralysis and death
__________ changes do not occur with Amyotrophic lateral sclerosis (ALS)
mental status
when do sx of lou gerhigs disease appear? (Amyotrophic lateral sclerosis)
b/n 40 and 70 yo
who is Amyotrophic lateral sclerosis more prevalent in?
men
Amyotrophic lateral sclerosis is thought to be r/t an _______
immune disorder
early sx of Amyotrophic lateral sclerosis (ALS/lou gerhigs) are:
mild clumsiness
fatigue while talking (tongue atrophy)
weakness of hands/arms
fasciculations of the face
dysphagia, dysarthria
nasal quality of speech
drug management for Amyotrophic lateral sclerosis:
rituzole (rilutek)
What does rituzole (rilutek) do?
decreases the amt of glutamate in the brain (excitatory neurotransmitter)
PT is done to _________ in a pt. with Amyotrophic lateral sclerosis
promote ROM
Muscular dystrophies: at least ___ types are clincally identified
9
What is the most common type of Muscular dystropy?
Duchenne's
The onset of Duchenne's dystrophy is:
between 18 mo and 4 yrs
Duchenne's dystrophy is _______ progressive
severly
a pt. with Duchenne's dystrophy will be unable to walk b/n __-__ yrs. Death occurs in the ___ or __.
7-11
20s-30s
Duchenne's dystrophy is an __________ recessive disorder
X linked
___% of male children of an unaffected mother, manifest the disease with duchenne's dystrophy
50
how common is duchenne's dystrophy?
20-30 cases per 10,000 live male births
Muscular dystrophies can be categorized as _____ or ____
slowly progressive or rapidly progressive
slowly progressive muscular dystrophies are more commen in _____
adults
what is the cause of muscular dystrophies?
unknown, but there may be a genetiv influence for most of the major types
______ biopsy often confirms dx of muscular dystrophies
muscle
_______- a group of non progressive disorders of upper motor neuron impairment that result in motor dysfunction
cerebral palsy
all forms of cerebral palsy involve uncontrollable _____ and ______
mvmnts
posture
how commn is cerebral palsy?
2 in 1000 births
how many americans does cerebral palsy affect?
half a million
what is the cause of cerebral palsy
exact cause unknown= variety of contributory factors
when does cerebral palsy become apparent?
by the child's 2nd or 3rd yr.
primary disturbances of cerebral palsy are:
abnormal muscle tone
coordination probs
what is the most common type of cerebral palsy?
Spastic (50%)
how is cerebral palsy dx?
no specific test-based on physical assess. finding
what is the least common form of cerebral palsy?
ataxic
Cerebral palsy- disturbance of brain development ____,____, or _______
before
druing
shortly after birth
cerbral palsy may be caused by:
maternal infections
nutritional deficiencies
lack of O2 to brain during birth