MEDICAL SURGICAL NURSING
1. PARKINSON’S
absence of dopamine
• Dopamine – movement, mood, attentions, sleep, working, memory
• 3 cardinal signs (tremor, rigidity, bradykinesia) *parkinsonian syndrome
• Manifes: cog wheeling,pill rolling, shuffling gait, micrographia, dysphonia,
depression
• Complication: respi and urinary infx, FALLS
Medication: Levodopa, tablet, 300mg BID or 200mg TID
2. STROKE (cerebro- vascular accident)
>A stroke occurs when a blockage or bleed of the blood vessels either interrupts or
reduces the supply of blood to the brain
• STROKE RISK,
– Men of 55
– American africans
– Hypertension
– Heart disease
– Smoking
– Obesity
– TIA
A transient ischemic attack (TIA) is a stroke that lasts only a few
minutes. It happens when the blood supply to part of the brain is briefly
blocked. Symptoms of a TIA are like other stroke symptoms, but do not last
as long. They happen suddenly, and include. Numbness or weakness,
especially on one side of the body
Stroke
• Ischemic (disruption of blood flow of brain)
– Large artery thrombosis 20% (atherosclerotic cause)
– Small penetrating artery 25%
– Cardiogenic embolic stroke 20% (heart to brain) – Cryptogenic 30%
(unknown)
– Other 5% (smoking, migraine, etc)
• s/s-
one side numbness or paralysis, confusion, speaking troubles, diff walking,
balance loss, sudden severe headache
=HEMORRHAGIC =(intracranial/ subarachnoid bleeding)
• Causes:-aneurysms, any bleeding within the brain that compresses and
injures the brain tissue
• s/s- similar with ischemic,sudden headache, loss of consciousness, neck
and back pain,
• Prevention: hypertension, smoking, alcohol, cholesterol
LOSSES:
– Motor- hemiplegia, hemiparesis, ataxia, apraxia
– Language- aphasia – vision- hemianopsia,diplopia,
– Sensory- paresthesia
– Cognition- memory loss, decreased attention and concentration
– Emotion-depression, fear, anger, isolation
Management
, – Warfarin sodium (coumadin)
– heparin
– Aspirin
Medical ttt:
analgesics for headache, elastic compression stocking for DVT
3. MULTIPLE SCLEROSIS
-demyelination of myelin sheath.(autoimmune).unknown
-Multiple sclerosis (MS) involves an immunemediated process in which an
abnormal response of the body’s immune system is directed against the
central nervous system (CNS). The CNS is made up of the brain, spinal cord
and optic nerves.
-Incidence: women
– Signs and symptoms: Charcot’s triad – nystagmus, intention tremor,
scanning speech
NURSING INTERVENTION: NO CURE
• Corticosteroid for inflammation
• plasma exchange
• exercises
• no heating pads
• BACLOFEN – to reduce spasms
4. GUILLAIN-BARRE SYNDROME ( bilateral ascending paralysis )
ETIOLOGY AND INCIDENCE:
unknown origin, 30 and 50 to men and women
CLINICAL MANIFESTATION:
=1 ST SIGN IS CLUMSINESS
management :
-iv ig
-plasma pheresis
-assistive devices such as walker
5. MYASTHENIA GRAVIS (- descending paralysis)
-autoimmune
-young women
Acetylcholine is the chief neurotransmitter of the parasympathetic nervous
system, the part of the autonomic nervous system (a branch of the peripheral
nervous system) that contracts smooth muscles, dilates blood vessels, increases
bodily secretions, and slows heart rate
Signs and Symptoms:
• Ptosis
• Muscle atrophy
Diagnostic assessment:
Tensilon test (cholinesterase inhibitor)
– Nursing Management:
• Anticholinesterase – prostigmin, (oral)
• plasma pharesis
• iv ig
• Watch out for crisis
– Myasthenic crisis
– Cholinergic crisis
1. PARKINSON’S
absence of dopamine
• Dopamine – movement, mood, attentions, sleep, working, memory
• 3 cardinal signs (tremor, rigidity, bradykinesia) *parkinsonian syndrome
• Manifes: cog wheeling,pill rolling, shuffling gait, micrographia, dysphonia,
depression
• Complication: respi and urinary infx, FALLS
Medication: Levodopa, tablet, 300mg BID or 200mg TID
2. STROKE (cerebro- vascular accident)
>A stroke occurs when a blockage or bleed of the blood vessels either interrupts or
reduces the supply of blood to the brain
• STROKE RISK,
– Men of 55
– American africans
– Hypertension
– Heart disease
– Smoking
– Obesity
– TIA
A transient ischemic attack (TIA) is a stroke that lasts only a few
minutes. It happens when the blood supply to part of the brain is briefly
blocked. Symptoms of a TIA are like other stroke symptoms, but do not last
as long. They happen suddenly, and include. Numbness or weakness,
especially on one side of the body
Stroke
• Ischemic (disruption of blood flow of brain)
– Large artery thrombosis 20% (atherosclerotic cause)
– Small penetrating artery 25%
– Cardiogenic embolic stroke 20% (heart to brain) – Cryptogenic 30%
(unknown)
– Other 5% (smoking, migraine, etc)
• s/s-
one side numbness or paralysis, confusion, speaking troubles, diff walking,
balance loss, sudden severe headache
=HEMORRHAGIC =(intracranial/ subarachnoid bleeding)
• Causes:-aneurysms, any bleeding within the brain that compresses and
injures the brain tissue
• s/s- similar with ischemic,sudden headache, loss of consciousness, neck
and back pain,
• Prevention: hypertension, smoking, alcohol, cholesterol
LOSSES:
– Motor- hemiplegia, hemiparesis, ataxia, apraxia
– Language- aphasia – vision- hemianopsia,diplopia,
– Sensory- paresthesia
– Cognition- memory loss, decreased attention and concentration
– Emotion-depression, fear, anger, isolation
Management
, – Warfarin sodium (coumadin)
– heparin
– Aspirin
Medical ttt:
analgesics for headache, elastic compression stocking for DVT
3. MULTIPLE SCLEROSIS
-demyelination of myelin sheath.(autoimmune).unknown
-Multiple sclerosis (MS) involves an immunemediated process in which an
abnormal response of the body’s immune system is directed against the
central nervous system (CNS). The CNS is made up of the brain, spinal cord
and optic nerves.
-Incidence: women
– Signs and symptoms: Charcot’s triad – nystagmus, intention tremor,
scanning speech
NURSING INTERVENTION: NO CURE
• Corticosteroid for inflammation
• plasma exchange
• exercises
• no heating pads
• BACLOFEN – to reduce spasms
4. GUILLAIN-BARRE SYNDROME ( bilateral ascending paralysis )
ETIOLOGY AND INCIDENCE:
unknown origin, 30 and 50 to men and women
CLINICAL MANIFESTATION:
=1 ST SIGN IS CLUMSINESS
management :
-iv ig
-plasma pheresis
-assistive devices such as walker
5. MYASTHENIA GRAVIS (- descending paralysis)
-autoimmune
-young women
Acetylcholine is the chief neurotransmitter of the parasympathetic nervous
system, the part of the autonomic nervous system (a branch of the peripheral
nervous system) that contracts smooth muscles, dilates blood vessels, increases
bodily secretions, and slows heart rate
Signs and Symptoms:
• Ptosis
• Muscle atrophy
Diagnostic assessment:
Tensilon test (cholinesterase inhibitor)
– Nursing Management:
• Anticholinesterase – prostigmin, (oral)
• plasma pharesis
• iv ig
• Watch out for crisis
– Myasthenic crisis
– Cholinergic crisis
