1. Chapter 29 Neurologic Conditions

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

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

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

5. 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

6. 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

7. 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

8. 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

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

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

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

12. 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

13. 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.

14. 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.

15. 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.

16. 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

17. 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

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