Reimbursement Issues

Reimbursement Issues

Chapter 14 Care of the Patient with a Neurologic Disorder Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview of Anatomy and Physiology Structural divisions Central nervous system (CNS) Brain and spinal cord Peripheral nervous system Somatic nervous system Sends messages from the CNS to the skeletal muscles;

voluntary Autonomic nervous system Sends messages from the CNS to the smooth muscle, cardiac muscle, and certain glands; involuntary Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2 Overview of Anatomy and Physiology Cells of the nervous system Neuron Neuromuscular junction

Neurotransmitters Acetylcholine; norepinephrine; dopamine; serotonin Neuron coverings Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 Figure 14-1 (A, B, from Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby. ) A, Diagram of a typical neuron. B, Myelinated axon. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4

Overview of Anatomy and Physiology Central nervous system Brain Cerebrum Diencephalon Cerebellum Brain stem Midbrain; pons; medulla oblongata; coverings of the brain and spinal cord; ventricles Spinal cord

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Figure 14-2 (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Sagittal section of the brain (note position of midbrain). Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 Overview of Anatomy and Physiology Peripheral nervous system

Spinal nerves Cranial nerves Autonomic nervous system Sympathetic nervous system Parasympathetic nervous system Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Figure 14-4 (From Thibodeau, G. A., Patton, K. T. Anthonys textbook of anatomy and physiology. [18th ed.]. St. Louis: Mosby.) Neural pathway involved in the patellar reflex. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Overview of Anatomy and

Physiology Effects of normal aging on the nervous system Loss of brain weight Loss of neurons Reduction in cerebral blood flow Decrease in brain metabolism and oxygen utilization Decreased blood supply to spinal cord causes decreased reflexes Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Overview of Anatomy and Physiology

Prevention of neurological problems Avoid drug and alcohol use Safe use of motor vehicles Safe swimming practices Safe handling and storage of firearms Use of hardhats in dangerous construction areas Use of protective padding as needed for sports Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Assessment of the Neurological System

History Mental status Level of consciousness Glasgow coma scale Language and speech Cranial nerve function Motor function Sensory and perceptual status Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11

Laboratory and Diagnostic Examinations Blood and urine Culture Drug screens Arterial blood gases Cerebrospinal fluid Computed tomography (CT) Brain scan

MRI scan PET scan Lumbar puncture Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 Figure 14-6 (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [4th ed.]. St. Louis: Mosby.) Position and angle of the needle when lumbar puncture is performed. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Laboratory and Diagnostic Examinations

Electroencephalogram Myelogram Angiogram Carotid duplex Digital subtraction angiography Electromyogram Echoencephalogram Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Common Disorders of the Neurological System Headaches

Etiology/pathophysiology Skull and brain tissues are not able to feel sensory pain Vascular headaches Migraine Cluster Hypertensive Tension headaches Traction-inflammation headaches Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Common Disorders of the Neurological System

Headaches (continued) Clinical manifestations/assessment Head pain Migraine headaches Prodromal (early sign/symptom) o Visual field defects, unusual smells or sounds, disorientation, paresthesias During headache o Nausea, vomiting, light sensitivity, chilliness, fatigue, irritability, diaphoresis, edema Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16

Common Disorders of the Neurological System Headaches (continued) Medical management/nursing interventions Pharmacological management Migraine headaches o Aspirin, acetaminophen, ibuprofen o Ergotamine tartrate o Codeine; Inderal Dietary recommendations Limit MSG, vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork

Psychotherapy Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 Common Disorders of the Neurological System Headaches (continued) Medical management/nursing interventions Cluster headaches Narcotic analgesics Tension headaches Non-narcotic analgesics

Traction-inflammatory headaches Treat cause Comfort measures Cold packs to forehead or base of skull Pressure to temporal arteries Dark room; limit auditory stimulation Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18 Common Disorders of the Neurological System

Neuropathic pain Etiology and pathophysiology May arise from several occurrences The pain transmission is not fully understood Clinical manifestations Ranges from mild to excruciating Changes in ability to carry out ADLs Medical management/nursing implications Pharmacological management Anticonvulsants; nonopioid analgesics; antidepressants

Comfort measures Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Common Disorders of the Neurological System Increased intracranial pressure Etiology/pathophysiology Increase in any content of the cranium Space-occupying lesions, cerebrospinal problems, cerebral edema Clinical manifestations/assessment

Diplopia Headache Decreased level of consciousness Pupillary signs Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20 Common Disorders of the Neurological System Increased intracranial pressure (continued) Clinical manifestations/assessment (continued)

Widening pulse pressure Bradycardia Respiratory problems High, uncontrolled temperatures Positive Babinskis reflex Seizures Posturing Vomiting Singultus Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21

Common Disorders of the Neurological System Increased intracranial pressure (continued) Medical management/nursing interventions Treat cause if possible Pharmacological management Corticosteroids Antacids; histamine-receptor blockers Anticonvulsants Mechanical decompression Craniotomy

Craniectomy Internal monitoring devices Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22 Common Disorders of the Neurological System Disturbances in muscle tone and motor function Etiology/pathophysiology Damage to the nervous system causes serious problems in mobility Clinical manifestations/assessment Flaccid or hyperreflexic muscle tone

Clumsiness or incoordination Abnormal gait Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23 Common Disorders of the Neurological System Disturbances in muscle tone and motor function (continued) Medical management/nursing interventions

Muscle relaxants Protect from falls Assess skin integrity Positioning Sit up and tuck chin when eating Encourage patient to assist with ADLs Emotional support Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24 Other Disorders of the Neurological System Epilepsy or seizures Etiology/pathophysiology Transitory disturbance in consciousness or in motor, sensory, or autonomic function due to sudden,

excessive, and disorderly discharges in the neurons of the brain; results in sudden, violent, involuntary contraction of a group of muscles Types: grand mal; petit mal; psychomotor; Jacksonianfocal; myoclonic; akinetic Status epilepticus Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25 Other Disorders of the Neurological System Epilepsy or seizures (continued) Clinical manifestations/assessment Depends on type of seizure Aura Postictal period

Medical management/nursing interventions During seizure: Protect from aspiration and injury Anticonvulsant medications Surgery Removal of brain tissue where seizure occurs Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26 Other Disorders of the Neurological System Epilepsy or seizures (continued) Medical management/nursing interventions (continued)

Adequate rest Good nutrition Avoid alcohol Avoid driving, operating machinery, and swimming until seizures are controlled Good oral hygiene Medic Alert tag Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27 Degenerative Diseases Multiple sclerosis Etiology/pathophysiology

Degenerative neurological disorder with demyelination of the brain stem, spinal cord, optic nerves, and cerebrum Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28 Figure 14-13 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.) Pathogenesis of multiple sclerosis. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29 Degenerative Diseases Multiple sclerosis (continued)

Clinical manifestations/assessment Visual problems Urinary incontinence Fatigue Weakness Incoordination Sexual problems Swallowing difficulties Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 30

Degenerative Diseases Multiple sclerosis (continued) Medical management/nursing interventions No specific treatment Pharmacological management Adrenocorticotropic hormone (ACTH) Steroids Valium Betaseron (interferon beta-1b) Avonex (interferon beta-1a)

Pro-banthine; urecholine Bactrim, Septra, and Macrodantin Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31 Degenerative Diseases Multiple sclerosis (continued) Medical management/nursing interventions Nutrition Skin care Activity

Environmental controls Patient teaching Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 32 Degenerative Diseases Parkinsons disease Etiology/pathophysiology Deficiency of dopamine Clinical manifestations/assessment

Muscular tremors; bradykinesia Rigidity; propulsive gait Emotional instability Heat intolerance Decreased blinking Pill-rolling motions of fingers Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33 Figure 14-14 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.) Nigrostriatal disorders produce parkinsonism. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 34 Degenerative Diseases Parkinsons disease (continued) Medical management/nursing interventions Pharmacological management Levodopa Sinemet Artane Cogentin Symmetrol

Surgery Activity Nutrition Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35 Degenerative Diseases Alzheimers disease Etiology/pathophysiology Impaired intellectual functioning Chronic, progressive degeneration of the cells of the brain Brain changes include plaques in the cortex, neurofibrillary tangles, and the loss of connections between cells and cell death Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 36 Degenerative Diseases Alzheimers disease (continued) Clinical manifestations/assessment Early stage Mild memory lapses; decreased attention span Second stage Obvious memory lapses Third stage

Total disorientation to person, place, and time Apraxia; wandering Terminal stage Severe mental and physical deterioration Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 37 Degenerative Diseases Alzheimers disease (continued) Medical management/nursing interventions Pharmacological management

Agitation: Lorazepam; Haldol Dementia: Cognex; Aricept Nutrition Finger foods; frequent feedings; encourage fluids Safety Remove burner controls at night Double-lock all doors and windows Constant supervision Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 38

Degenerative Diseases Myasthenia gravis Etiology/pathophysiology Neuromuscular disorder; nerve impulses fail to pass at the myoneural junction; causes muscular weakness Clinical manifestations/assessment Ptosis; diplopia Skeletal weakness; ataxia Dysarthria; dysphagia Bowel and bladder incontinence

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 39 Degenerative Diseases Myasthenia gravis (continued) Medical management/nursing interventions Pharmacological management Anticholinesterase drugs o Prostigmin o Mestinon Corticosteroids May require mechanical ventilation

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 40 Degenerative Diseases Amyotrophic lateral sclerosis (ALS) Etiology/pathophysiology Motor neurons in the brain stem and spinal cord gradually degenerate Electrical and chemical messages originating in the brain do not reach the muscles to activate them Lou Gehrigs disease Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 41 Degenerative Diseases

Amyotrophic lateral sclerosis (ALS) (continued) Clinical manifestations/assessment Weakness of the upper extremities Dysarthria; dysphagia Muscle wasting Compromised respiratory function Medical management/nursing interventions No cure Rilutec (Riluzole) Multidisciplinary ALS teams; emotional support

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 42 Degenerative Diseases Huntingtons disease Etiology/pathophysiology Overactivity of the dopamine pathways Genetically transmitted Clinical manifestations/assessment Abnormal and excessive involuntary movements (chorea) Ataxia to immobility Deterioration in mental functions Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 43 Degenerative Diseases Huntingtons disease (continued) Medical management/nursing interventions No cure; palliative treatment Pharmacological management Antipsychotics Antidepressants Antichoreas Safe environment Emotional support High-calorie diet

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 44 Vascular Problems Stroke (cerebrovascular accident) Etiology/pathophysiology Abnormal condition of the blood vessels of the brain: thrombosis; embolism; hemorrhage Results in ischemia of the brain tissue Clinical manifestations/assessment

Headache Sensory deficit Hemiparesis; hemiplegia Dysphasia or aphasia Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 45 Figure 14-17 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.) Three types of stroke. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 46

Vascular Problems Stroke (cerebrovascular accident) (continued) Medical management/nursing interventions Thrombosis or embolism Thrombolytics Heparin and Coumadin Decadron Neurological checks Nutritional interventions Physical, occupational, and/or speech therapy

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 47 Cranial and Peripheral Nerve Disorders Trigeminal neuralgia Etiology/pathophysiology Degeneration of or pressure on the trigeminal nerve; tic douloureux Clinical manifestations/assessment Excruciating, burning facial pain

Medical management/nursing interventions Tegretol Surgical resection of the trigeminal nerve Avoid stimulation of face on affected side Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 48 Cranial and Peripheral Nerve Disorders Bells palsy (peripheral facial paralysis) Etiology/pathophysiology Inflammatory process involving the facial nerve Clinical manifestations/assessment

Facial numbness or stiffness Drawing sensation of the face Unilateral weakness of facial muscles Reduction of saliva Pain behind the ear Ringing in ear or other hearing loss Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 49 Cranial and Peripheral Nerve Disorders Bells palsy (peripheral facial paralysis) (continued)

Medical management/nursing interventions Pharmacological management Corticosteroids Antiviral medications Electrical stimulation Moist heat Massage of the affected area Facial exercises Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 50 Cranial and Peripheral Nerve Disorders Guillain-Barr syndrome Etiology/pathophysiology Inflammation and demyelination of the peripheral nervous system Possibly viral or autoimmune reaction Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 51 Cranial and Peripheral Nerve Disorders Guillain-Barr syndrome (continued)

Clinical manifestations/assessment Symptoms are progressive Paralysis usually starts in the lower extremities and moves upward; may stop at any point Respiratory failure if intercostal muscles are affected May have difficulty swallowing, breathing, and speaking Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 52 Cranial and Peripheral Nerve Disorders Guillain-Barr syndrome (continued) Medical management/nursing interventions

Adrenocortical steroids Apheresis Mechanical ventilation Gastrostomy tube Meticulous skin care Range-of-motion exercises Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 53 Cranial and Peripheral Nerve Disorders Meningitis Etiology/pathophysiology Acute infection of the meninges

Bacterial or aseptic Increased incidence in winter and fall months Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 54 Cranial and Peripheral Nerve Disorders Meningitis (continued) Clinical manifestations/assessment

Headache; stiff neck Irritability; restlessness Malaise Nausea and vomiting Delirium Elevated temperature, pulse, and respirations Kernigs and Brudzinskis signs Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 55 Cranial and Peripheral Nerve Disorders Meningitis (continued) Medical management/nursing interventions Pharmacological management

Antibiotics o Massive doses o Multiple types o IV or intrathecal Corticosteroids Anticonvulsants Antipyretics Dark, quiet room Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 56 Cranial and Peripheral Nerve Disorders Encephalitis

Etiology and pathophysiology Acute inflammation of the brain caused by a virus Clinical manifestations Headache Fever Seizures Change in LOC Medical management and nursing interventions

Primarily supportive Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 57 Cranial and Peripheral Nerve Disorders West Nile virus Etiology and pathophysiology Principal route of infection through the bite of an infected mosquito Clinical manifestations

Fever Headache Back pain Myalgia Prevention Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 58 Cranial and Peripheral Nerve Disorders Brain abscess Etiology and pathophysiology

Accumulation of pus within the brain tissue Clinical manifestations Headache Fever Drowsiness, changes in LOC Seizures Medical management/nursing interventions Antimicrobial therapy Supportive care

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 59 Cranial and Peripheral Nerve Disorders Acquired immunodeficiency syndrome Etiology and pathophysiology Symptoms may develop from the infection with HIV or as a result of an associated infection Clinical manifestations AIDS dementia complex (ADC) Memory loss Global cognitive dysfunction

Medical management/nursing interventions Antiviral, antifungal, antibacterial agents Anticonvulsants Safety Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 60 Cranial and Peripheral Nerve Disorders Brain tumors Etiology/pathophysiology Benign or malignant Primary or metastatic May affect any area of the brain Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 61 Cranial and Peripheral Nerve Disorders Brain tumors (continued) Clinical manifestations/assessment Headache Hearing loss Motor weakness Ataxia

Decreased alertness and consciousness Abnormal pupil response and/or unequal size Seizures Speech abnormalities Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 62 Cranial and Peripheral Nerve Disorders Brain tumors (continued) Medical management/nursing interventions Surgical removal of tumor Craniotomy Intracranial endoscopy

Radiation Chemotherapy Combination of above Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 63 Trauma Craniocerebral trauma Etiology/pathophysiology Motor vehicle and motorcycle accidents, falls, industrial accidents, assaults, and sports trauma Direct trauma: Head is directly injured Indirect trauma: Tension strains and shearing forces Open head injuries Closed head injuries Hematomas

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 64 Trauma Craniocerebral trauma Clinical manifestations/assessment Headache Nausea

Vomiting Abnormal sensations Loss of consciousness Bleeding from ears or nose Abnormal pupil size and/or reaction Battles sign Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 65 Trauma Craniocerebral trauma (continued) Medical management/nursing interventions

Maintain airway Oxygen Mannitol and dexamethasone Analgesics Anticonvulsants Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 66 Trauma Spinal cord trauma Etiology/pathophysiology Automobile, motorcycle, diving, surfing, other athletic accidents, and gunshot wounds Fracture of vertebra Complete cord injury Incomplete cord injury

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 67 Figure 14-24 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.) Mechanisms of spinal injury. Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 68 Trauma Spinal cord trauma (continued) Clinical manifestations/assessment

Loss of muscle function depends on level of injury Spinal shock Autonomic dysreflexia Sexual dysfunction Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 69 Trauma Spinal cord trauma (continued) Medical management/nursing interventions Realignment of bony column for fractures or dislocations: Immobilization; skeletal traction

Surgery for spinal decompression Methylprednisolone Mobility: Slowly increase sitting up Urinary function: Foley catheter; bladder training Intermittent catheterization Bowel program Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 70 Nursing Process Nursing diagnoses

Autonomic dysreflexia Communication, impaired Coping, compromised family Disuse syndrome, risk for Grieving Infection, risk for Knowledge, deficient Memory, impaired Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 71 Nursing Process Nursing diagnoses (continued)

Mobility, impaired physical Nutrition, imbalanced: less than body requirements Pain, acute, chronic Self-care deficit Swallowing, impaired Thought process, disturbed Tissue perfusion (cerebral), ineffective Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 72 Chapter 16

Central and Peripheral Nervous System Medications Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 73 Learning Objectives Identify the major classes of drugs that affect the central nervous system List different actions of antimigraine products Explain the major actions of drugs used to treat disorders of the central nervous system Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

74 Nervous System Central nervous system Peripheral nervous system Neurotransmitters Adrenergic fibers Cholinergic fibers Receptors: alpha1, alpha2, beta Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 75

Central Nervous System Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 76 Antimigraine Agents Action Block nerve impulses at receptors of the sympathetic nervous system Relieve pain by narrowing dilated cerebral arteries Uses Prevention and treatment of migraine headaches Drug Table 16-1 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 77 Antimigraine Agents (cont.)

Adverse Reactions Drug Interactions Other vasoconstrictors, MAOIs Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation Evaluation Patient Teaching: administration considerations Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

78 Anticonvulsants or Antiepileptic Drugs Seizures: sudden muscle contractions that happen without conscious control Etiology: disease or disorders; head injury; idiopathic Four major drug classes Drug Table 16-3 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

79 Barbiturates Action Long duration of action and sedative effect on the brain; action occurs in the brainstem Uses Status epilepticus; to prevent and control grand mal seizures May treat seizures caused by tetanus, fever, or drugs Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 80 Benzodiazepines Action CNS depressants; suppress electrical discharge in seizures Uses

Treat minor motor seizures; Lennox-Gastaut syndrome (petit mal) Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 81 Hydantoins Action Work primarily on the motor cortex, where they stop the spread of seizure activity by increasing or decreasing Na+ ion movement across the motor cortex during the generation of nerve impulses Uses Grand mal and psychomotor seizures, status epilepticus, migraines, and trigeminal neuralgia Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 82

Succinimides Action and Uses Elevation of the seizure threshold in the cortex and basal ganglia and reduced synaptic response to low-frequency repetitive stimulation; controls petit mal seizures Adverse Reactions Drug Interactions Other antiseizure agents and bone marrow depressing drugs Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 83 Succinimides (cont.) Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation

Evaluation Patient Teaching Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 84 Antiemetic-Antivertigo Agents Action Factors that may provoke nausea and vomiting: some drugs, metabolic disorders, radiation, motion, gastric irritation, vestibular neuritis, or increases in central trigger zone dopamine levels or vomiting center acetylcholine levels Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center

Uses Prevent and treat motion sickness or the nausea and vomiting that occur with surgery, anesthesia, and cancer treatment Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 85 Antiemetic-Antivertigo Agents (cont.) Adverse Reactions Drowsiness and drug tolerance with long-term therapy Anticholinergic effects Drug Interactions CNS depressants Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

86 Antiemetic-Antivertigo Agents (cont.) Nursing Implications and Patient Teaching Assessment: patient history Diagnosis Planning Secondary problems: nutrition and hydration Implementation

Evaluation Patient Teaching Drug Table 16-4 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 87 Antiparkinsonian Agents Actions Change the neurotransmitters produced in the brain: excessive acetylcholine, deficient dopamine Block the uptake of acetylcholine and elevate the functional levels of dopamine in the motor regulatory centers Uses Control of the symptoms of Parkinson disease Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

88 Antiparkinsonian Agents (cont.) Adverse Reactions Dysrhythmias, muscle twitching, GI symptoms, etc. Anticholinergic agents Drug Interactions Many; read product information closely Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 89 Antiparkinsonian Agents (cont.) Nursing Implications and Patient Teaching

Assessment Diagnosis Planning Implementation Evaluation Patient Teaching Drug Table 16-5 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 90 Psychotherapeutic Agents

Antianxiety Medications Antidepressants Antipsychotic Drugs Antimanic Drugs Sedative-Hypnotic Medications Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 91 Antianxiety Agents Drug Table 16-6 Anxiety is common Problematic when it interferes with a persons ability to perform activities of daily living Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

92 Antianxiety Agents (cont.) Action Produce a calming effect Uses Relieve anxiety, tension, and fear May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 93 Antianxiety Agents (cont.) Adverse Reactions Drug Interactions

Increase effects Antagonize effects Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 94 Antianxiety Agents (cont.) Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation Evaluation

Patient and Family Teaching Dosing; appointments and follow-up; adverse reactions; safety with storage; drug and alcohol interactions Habit-forming: should be used for the shortest time possible Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 95 Attention Deficit Hyperactivity Disorder (ADHD) Characteristics CNS stimulants

Monitoring Adverse effects Patient counseling Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 96 Sedative-Hypnotic Medications Action and Uses Sedative agent: relaxes the patient and allows him or her to sleep Hypnotic agent produces sleep in the patient Used to relax patients and induce sleep before medical testing and surgical procedures; used to treat insomnia caused by mental and physical stress Drug Tables 16-13, 16-14, 16-15 Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

97 Sedative-Hypnotic Medications (cont.) Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching Copyright 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 98

Recently Viewed Presentations

  • The Color Wheel

    The Color Wheel

    To the human eye, orange is a very hot color, so it gives the sensation of heat. Nevertheless, orange is not as aggressive as red. Orange increases oxygen supply to the brain, produces an invigorating effect, and stimulates mental activity....
  • The John Snow Scholarship: a Trojan horse approach to ...

    The John Snow Scholarship: a Trojan horse approach to ...

    Donna B Mak, AFPHM & University of Notre Dame Greg Stewart, AFPHM The John Snow Scholarship: a Trojan horse approach to attracting medical students to public health.
  • Immediate Jeopardy - Texas

    Immediate Jeopardy - Texas

    Was there an outcome of harm? Does the harm meet the definition of Immediate Jeopardy, e.g., has the provider's noncompliance caused or is likely to cause serious injury, harm, impairment, or death to an individual?"
  • The Nature of Gases - Houston Community College

    The Nature of Gases - Houston Community College

    Standard temperature (T) 0°C or 273 K the same pressure. Standard pressure (P) 1 atm (760 mm Hg) Molar Volume At standard temperature and pressure (STP), 1 mole of a gas occupies a volume of 22.4 L, which is called...
  • SpaceWire Architectures Steve Parkes Space Technology Centre, University

    SpaceWire Architectures Steve Parkes Space Technology Centre, University

    SpaceWire Architectures Steve Parkes Space Technology Centre, University of Dundee, Scotland, UK Point to point link Point to point link Advantages Simple interface Low power per Mbit/s No problem with router blocking Full bandwidth of link available to application Disadvantages...
  • Systematic Reviewing and Meta-Analysis

    Systematic Reviewing and Meta-Analysis

    Recognition that reviews should be held to the same standards of transparency and rigor as primary studies. ... 1904: K. Pearson. Report on certain enteric fever inoculation statistics. British Medical Journal, 3, 1243-1246. ... Basic Principles of Systematic Reviewing and...
  • The Natu re and Behavior o f Chapter

    The Natu re and Behavior o f Chapter

    The speed of a wave depends on the medium it is traveling through. Sound waves usually travel faster in liquids and solids than they do in gases. However, light waves travel more slowly in liquid and solids than they do...
  • Презентация PowerPoint - UNAM

    Презентация PowerPoint - UNAM

    Photon spectra from final stages of primordial black hole evaporation in different theoretical models Edgar Bugaev, Peter Klimai, Valery Petkov