Tabloski ch22 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

The Neurologic System

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe the components of the neurological system.

2. Identify progressive dementias.3. Recognize the stages of Alzheimer’s

disease and implications for nursing care.

Learning Objectives

4. Apply a contextual model to direct behavioral and pharmacological interventions for behavioral symptoms of Alzheimer’s disease.

5. Discuss Parkinson’s disease in terms of diagnosis, treatment strategies, and nursing interventions.

6. Recognize symptoms of brain attack/stroke in older persons.

Learning Objectives

7. Develop nursing interventions for older patients with stroke/brain attack.

8. Formulate nursing interventions for older patients with seizures.

9. Categorize the difference between epilepsy and seizures and nursing implications.

10.Differentiate seizure classifications.

Introduction

• Our neurological system defines who we are.

• When brain function ceases, life itself is determined to have ceased.

• The neurological system consists of two systems: –Central– Peripheral

Introduction

• The functional health of older adults is dependent on a healthy, functioning neurological system.

• The functions of all other bodily systems rely on the intact function of the neurological system.

The Central Nervous System

• The central nervous system includes the cerebral cortex, basal ganglia, diencephalon, cerebellum, brainstem, and spinal cord.

• The brain is divided into right and left halves and is further divided into four lobes: –Frontal–Temporal–Parietal–Occipital

• Neurotransmitters influence memory and cognition, mood, and motor function.

• Neurotransmitters also control the hypothalamic-pituitary-adrenal axis (HPA), which integrates the endocrine, immune, and nervous systems.

The Peripheral Nervous System

• The peripheral nervous system consists of the cranial nerves, spinal nerves, the somatic and autonomic nervous system, and the reflex arc.

• The somatic nervous system is the link between the brain through the spinal cord to the muscles and sensory receptors.

The Peripheral Nervous System

• It is responsible for movement and receiving messages.

Normal Changes of Aging

• The challenge of caring for older adults is not to treat normal aging changes as disease.

Central Nervous System

• The brain decreases in size and weight with aging.

• The function and survival of neurons depends on key biological processes and with aging there is neuronal death and changes in the synapse between neurons.

Central Nervous System

• These changes are especially pronounced in neurodegenerative diseases such as Alzheimer’s disease or Parkinson’s disease.

Peripheral Nervous System

• The spinal cord is not spared in aging.• Cells of the spinal cord decline in

number, and narrowing of the interior of vertebral bodies puts pressure on the spinal cord.

Peripheral Nervous System

• From the perspective of directing nursing care, the neurologic conditions of the central nervous system fall into the categories of memory, movement, seizure disorders, and stroke.

• The conditions of the peripheral nervous system fall into the categories of motor, sensory, and autonomic disorders.

Conditions of the Central Nervous System

• Mental status includes more than just cognitive ability; level of consciousness, appearance and behavior, speech and language, mood and affect, perception and thought content, and insight and judgment all are factors in mental health status.

• When older persons have difficulties with their memory or changes in their behavior, they need to be carefully assessed to determine whether there is a treatable cause.

• Distinguishing between the “Three D’s”—depression (a mood disorder characterized by sadness), dementia (a progressive cognitive impairment), and delirium (potentially reversible acute confusional state)—is one of the most important lessons that gerontological nurses must learn.

• Knowing the baseline mental status of the older person is an important step in sorting out the issues if there are problems with cognition.

Types of Dementia

• The most common causes can be divided into four major dementia groupings:–Alzheimer’s disease–Vascular dementia– Lewy body dementia including

Parkinson’s disease with dementia–Frontotemporal lobe group including

Pick’s

Stages of Dementia

• Dementia is generally described as occurring in three stages.

Stages of Dementia

• Six domains are evaluated to determine the older person’s classification:–Memory–Orientation– Judgment and problem solving–Community affairs–Home and hobbies–Personal care

Stages of Dementia

• The stages are generally classified as:–Stage 1, Early Mild–Stage 2, Middle – Moderate–Stage 3, Late Severe

Pharmacologic Therapies

• There is no cure available at the present time for dementia; treatments are directed at improving function and slowing the progression of the disease.

• Medications are not curative but can produce slight improvements in mental status testing scores, although improvement in function is not often detected.

Pharmacologic Therapies

• Early diagnosis provides the family and the older person the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity.

Effect of the Disease

• When the person’s needs overwhelm home or assisted-living care, a skilled nursing facility will be required.

Effect of the Disease

• The family may confront four issues:–Should cardiopulmonary resuscitation

(CPR) be attempted?–Will the person be transferred to an

acute care facility?–Should a feeding tube be used?–How should life-threatening infections

be managed?

Parkinson’s Disease

• Parkinson’s disease (PD) is a chronic, progressive neurologic disorder in which idiopathic parkinsonism appears without other widespread neurologic symptoms, such as cognitive impairment.

• PD symptoms are caused by the loss of nerve cells in the pigmented substantia nigra pars compacta and the locus coeruleus in the midbrain.

Parkinson’s Disease

• Therapy directed to correct dopamine deficiency currently drives the pharmacological bases of treatment.

Stroke and TIA

• A stroke is a rapidly developing loss of consciousness due to lack of blood circulating to the brain.

• The pathology typically is caused by hemorrhage into the brain, rupture of an artery, or an embolus or thrombus occluding an artery.

Stroke and TIA

• Structured nursing interventions have resulted in better functional status, less depression, and higher self-perceived health, self-esteem, and dietary adherence.

• Stroke prevention is best accomplished by adopting a prudent heart-healthy lifestyle.

Seizures

• Seizure is an abnormal, abrupt release of electrical activity in the brain.

• The incidence of epilepsy increases with advanced age.

• There are several nursing interventions when caring for an older person with a history of seizures.

• Patient-family education is an important intervention of the nurse.

Multiple Sclerosis

• Multiple sclerosis (MS) is a central nervous system disease affecting the myelin sheath of the brain and spinal cord. Over time, messages cannot be transmitted smoothly, leading to muscle weakness, incoordination, visual problems, parasthesias, and memory and cognition disturbances.

Multiple Sclerosis

• The treatments include physical and occupational therapy, medications to control symptoms such as tremor (beta blockers) and spasticity (Baclofen), and disease-modifying agents (Refib, Copaxone).

Tabloski ch22 lecture

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