Chapter 29 Neurologic Conditions Risk Factors for Neurologic

Chapter 29 Neurologic Conditions

Risk Factors for Neurologic Disorders • Cigarette smoking • Obesity • Ineffective stress management • Elevated cholesterol • Unsafe actions • Infections of the ear or sinus • Sexually transmitted diseases

Subtle Indicators of Neurological Disease • New headaches • Change in vision • Sudden deafness; ringing in ears • Mood, personality changes • Altered level of consciousness

Subtle Indicators of Neurological Disease (cont. ) • Clumsiness; unsteady gait • Numbness and tingling of extremities • Unusual sensation of pain over nerve

Possible Factors Involved in the Development of Parkinson’s Disease • A history of metallic poisoning • Encephalitis • Cerebrovascular disease, especially arteriosclerosis • Presence of the Lewy body

Symptoms of Parkinson’s Disease • A faint tremor in the hands or feet that progresses • Muscle rigidity and weakness • Masklike appearance of face • Increased appetite • Shuffling gait

Treatment of Parkinson’s Disease • Anticholinergics • Avoidance of foods that are high in vitamin B 6 • Use of the herb passion flower • Use of pulse generators • Use of drug infusion systems • Gene therapy • Performing active and passive range-of-motion exercises

Causes of Transient Ischemic Attacks • Situations that reduce cerebral circulation – Hyperextension and flexion of the head – Reduced blood pressure resulting from anemia and certain drugs – Cigarette smoking – Sudden standing from a prone position

Manifestations of a TIA • Hemiparesis • Hemianesthesia • Aphasia • Unilateral loss of vision • Diplopia • Vertigo • Nausea; vomiting • Dysphagia

Risk Factors for Cerebrovascular Accident • Hypertension • Diabetes • Hypothyroidism • MI • TIA • Dehydration • Cigarette smoking

Warning Signs of a CVA • Light-headedness • Dizziness • Headache • Drop attack • Memory and behavioral changes

Nursing Interventions to Reduce Effect of Limitations of CVA • Talking in normal voice • Offering short explanations • Using familiar objects • Providing sensory stimulation • Offering positive feedback • Showing patience

Nursing Interventions in the Acute Phase of CVA • Maintain a patent airway. • Provide adequate nutrition and hydration. • Monitor neurologic and vital signs. • Prevent complications associated with immobility.

Nursing Interventions Following the Acute Phase of CVA • Talk to the patient during routine activities. • Briefly explain what occurred and what to expect. • Speak distinctly but do not shout. • Devise an easy means of communication. • Minimize environmental confusion, noise, traffic, and clutter. • Aim for consistency of those providing care and of care activities.

Nursing Interventions Following the Acute Phase of CVA (cont. ) • Use objects familiar to patients. • Keep a calendar or sign in the room. • Supply sensory stimulation. • Provide frequent positive feedback. • Expect and accept errors and failures.

Nursing Interventions to Promote Independence • Self-help devices • Periodic home visits by a nurse • Regular contact with a family member or friend • Daily call from a local telephone reassurance program • Continuing patience, reassurance, and encouragement

Preventing Injury to Patients Following CVA • Scrutinize the environment for unsafe conditions – Loose carpeting – Poorly lit stairwells – Clutter – Ill-functioning appliances – Lack of fire warning systems and fire escapes – Lack of tub rails and nonslip tub surfaces, and other safeguards

Source • Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed. ). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0 -7817 -4428 -8).