8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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1 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Alzheimer's Disease

 Alzheimer's disease is an irreversible form of senile dementia

caused by nerve cell deterioration.

Individuals with Alzheimer's disease experience cognitive

deterioration and progressive loss of ability to carry out

activities of daily living .

Characterized by disturbance in  Judgement, Affect,

Memory, Cognition and Orientation 

Course of the disease is 2 to 20 years, with SUNDOWNERS

SYNDROME 

Types of Dementia1.   Alzheimer’s disease   –  Most common form of dementia

among people over age of 652.  Multi-infarct dementia   –  Second most common type of

irreversible dementia that is related to blockage of small bloodvessels in the brain that destroys brain tissues

3. 

Lewy body dementia  –  Similar to Alzheimer’s but progressrapidly related to brain cells called cortical Lewy bodies thatoccur throughout the brain and produces manifestations

4.  Pick’s disease  – A form of dementia differ from AD in severalways which is marked by pick bodies (rounded, microscopicstructures found within the affected cell)

CausesGenetics—familial AD (FAD)Vascular degeneration Chemical imbalances Family history

Stages1.  Forgetfulness

2. 

Confusion –

 Progressive memory decline, disorientation, depression, and confabulation 3. 

Ambulatory Dementia  –  Functional loses, language problems, loss of reasoning, depression and wanderingbehaviour  

4.  End stage – No recognition, very little purposeful activities, immobile and does not swallow and does not chew

Clinical ManifestationsShort-term memoryLanguage disturbanceDecline in motor skillsLoss of abstract thought processesVisual processing impairmentRepetitive actionsRestlessness at nightIncontinence, emaciation, irritability, and coma

 WORD GUIDE

Circumlocution - ___________________________________________________________________

Paraphasias  - ______________________________________________________________________

Palilalia  -__________________________________________________________________________

Apraxia  - _________________________________________________________________________

Hyperorality - _____________________________________________________________________

Notes

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8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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2 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Pathophysiology

8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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3 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Management

P Provide basic human needs and safetyL Listen to what the person is not saying (non-verbal cues)E Encourage periodic rest periods and sleep

 Assist in activities of daily living

S Sing and dance as necessary

E Engage in reminiscing activitiesC Call person by name and always introduce yourself at the start

 Actively involve client in activities and simple decision makings

R Redirect inappropriate behaviour like anger

E Exaggerate facial expressions and gestures in communicating face to face

Parkinson ’s Disease 

Parkinson's disease is a degenerative disease caused by the

depletion of dopamine, which interferes with the inhibition

of excitatory impulses, resulting in a dysfunction of the

extrapyramidal system.

It is a slow, progressive  disease that results in a cripplingdisability.Mental deterioration occurs late in the disease.

CausesGeneticsEndogenous toxinsEnvironmental exposure to toxinsMedicationsViral InfectionsStructural brain disorders

Stages1.

  Initial  - Resting tremor with mild weakness, possibly

unilateral (one sided)2.  Mild - Bilateral symptoms with a mask-like faces, and aslow shuffling gait

3.  Moderate - All of the above symptoms with significantprogression of gait disturbance and postural instability

4.  Severe Disability  - Akinesia with rigidity. Rigidity caninterfere with contraction chewing and swallowing(involvement of pharyngeal muscles), resulting inmalnutrition

Diagnostic TestsBlood test

Diagnosis can only be confirmed by

examining brain tissue after death

CT, MRI, or SPECT (single-photonemission computed tomography).

Client historyNeuropsychological.Mental status assessment.

DrugsDonepezil (Acricept), tacrine (Cognex),galanthamine (Reminyl) and rivastigmine(Exelon).Sertraline (Zoloft)Haloperidol (Haldol)Zolpidem (Ambien) Vitamin E

Note

The management of

 Alzheimer’s was

lifted from Carl

Balita’s Ultimate

Review Guide

Notes

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8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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4 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Clinical Manifestation

Bradykinesia, abnormal slowness of movement, and

sluggishness of physical and mental responses AkinesiaMonotonous speechMicrographia

Tremors

 in hands and fingers at rest (pill rolling)Tremors increasing when fatigued and decreasingwith purposeful activity or sleep

Rigidity with jerky movements

Restlessness and pacingBlank facial expression—mask-like faces DroolingDifficulty swallowing and speakingLoss of coordination and balanceShuffling steps, stooped position, and propulsivegait

Pathophysiology

Management

P Provide high-calorie, high-protein, high-fiber soft diet with small, frequentfeedings and increase fluid intake to 2000 ml/day.

 Avoid rushing in activities and assist in ambulation and or provide assistivedevices. Perform activities in the morning

R Rock back and forth to initiate movement and wear low-heeled shoes K Keep foot on the ground when walking and avoid prolonged sitting

I Independence is highly promoted with safety measures

N No pillows, firm mattress and in prone position when sleepingS Spine and neck should be aligned as much as possible. Promote physical

therapy and rehabilitationO On anticholinergic  medications (inhibits the action of acetycholine) and

antiparkinsonian medications to increase dopamine in the CNSN No foods high in Vitamin B6S Stop taking monoamine oxidase inhibitors (MAOIS)

DrugsLevodopa-

carbidopa

Sinemet)

Benzotropine

Cogentin)

Selegiline

Eldepryl)

Trihexyphenidyl

Artane)

Diphenhydramine

Benadryl)

Entacapone

Comtan)

8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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5 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Other Treatments

Medial pallidotomy  results in destruction of cells incertain part of the brain, improving symptoms.

Chronic deep brain (thalamus)

stimulation(DBS)- An implant is inserted under theskin to stimulate and disrupt the area of the brain that

causes the disabling motor symptoms of Parkinson’sdisease.

Notes

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8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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6 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Huntington’s Disease 

Huntington’s disease (HD), also known as

HUNTINGTON’S CHOREA,  is anautosomal-dominant degenerativeneurologic disease. It is characterized byabnormal movements, intellectual decline,

and emotional disturbance.

Causes

Autosomal dominant

Genetics

Clinical ManifestationsChorea which is characterized by abnormal

movements

Emotional disturbances and mental deterioration

Temper outbursts and sexual promiscuity 

Severe mood swings

Cognitive decline

Pathophysiology 

Notes

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8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

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7 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) 

It is a progressive degenerative disease involvingthe motor system.

 Attacks the nerve cells that control  voluntary

muscles. The cause of the disease may be related to an

excess of GLUTAMATE 

Muscle weakness and atrophy

develop  >  flaccid quadriplegia  > 

respiratory muscles become affected 

>respiratory compromise  > 

pneumonia >death. UPPER MOTOR NEURONS  - Weak muscles 

that are spastic with increased deep tendon

reflexes (DTRs). LOWER MOTOR NEURON  -

Flaccid muscles, weakness, paralysis, and

wasting of muscle.

CausesDeath of motor neurons that control the voluntarymuscles of arms, legs, face, neck, and bodyDestruction of muscles that control the ability totalk, chew, swallow, and breathe

Management

 Actively watch for respiratory complications and provide treatments as ordered.RESPIRATORY SUPPORT, MEDICATIONS, TREATMENTS AND STATUS. 

L Let the client be comfortable and independent as much as possible. Assess forcomplications of immobility

S Symptomatic treatment. Support the client and the family

Diagnostic TestsElectromyography (EMG)  - Gives information aboutwhat is happening with the muscles.

DrugsRiluzole Rilutek)

Minocycline (Minocin)

 Tamoxifen (Tamofen)

Coenzyme Q10

Management

H Have foods that can be easily swallowed

U Unhurried mealtimes and adaptive utensilsN Note for anticholinergic and sedative effects of drugs – impaired swallowingT Take 5000 calories a day (due to excessive movement) but it should be in

small frequent feedingsI Ingest lots of water during hot weather

N Never eat feed lying. It should be upright and chin down towards chest whenswallowing

G Gestures should be sued in communication or cards with printed wordsT Try to repeat words that are understood (to let the client know) and make

communications simpleO Offer light and simple to put on and off clothes

N Never let the client ambulate alone

S Safety, pads on wheelchairs and beds, shin guards and walking belts

DIAGNOSTIC TESTS

Based on clinical

manifestations and

family history

CT and MRI

MEDICAL MANAGEMENT

No pharmacologic

treatment for HD

Haloperidol (dopamine

blocker)

Diazepam

 Antidepressants

Prevention and

treatment of infection

Clinical ManifestationsFatigueFatigue while talkingMuscle weakness and atrophyTongue atrophy

DysphagiaWeakness of the hands and armsFasciculations of the faceNasal quality of speechDysarthria

Notes

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8/17/2019 NCM 104 - Management of Clients With Degenerative Brain Disorders (Student)

8/8

8 | P a g e NCM 104: Neurologic Function

Management of Clients with Degenerative Brain Disorders 

Benguet State UniversityCOLLEGE OF NURSINGLa Trinidad, Benguet

 Jam Ganda 2011^^