Deck 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders

Question 1

A 35-year-old man newly diagnosed with Huntington disease asks what type ofmedication he will be given. What are the possible medication regimens that may beused to treat his disease and the efficacy of those regimens? What patient education isappropriate?

Answer 1

Huntington Disease (HD) is a progressive, genetic ailment that is communicated as an autosomal dominant malady affecting both men and women of all races. Each child of an HD parent has a 50% of taking over the disorder. The affected child may manifest cognitive, movement, and psychiatric disorders.
Possible medication regimens and its efficacy:
Based on studies, treatments can only reduce chorea symptoms but they cannot avert or reverse the underlying process.
• Tetrabenazine (Xenazine), Benzodiazepines, and neuroleptic drugs are given to control chorea
• Selective serotonin reuptake inhibitors and antidepressants are administered to manage psychiatric symptoms
• Antiparkinsonian medications are given to patients with rigidity or motor impairment that resembles Parkinson's disease
Patient education:
• Edify the patient regarding the prescribed medications and the signs that indicate a need for change in medication or dosage
• Teach patient the strategies on how to manage symptoms like swallowing problems, chorea, memory loss, irritability, ambulation, loss of bowel or bladder function, and depression
• Refer patient to a speech therapist for consultation about alternative communication strategies

Question 2

Identify the priorities, approach, and techniques you would use to develop acomprehensive plan of care for a 45-year-old female patient with ALS. How will yourpriorities, approach, and techniques differ if the patient lives alone, is hearingimpaired, or is from a culture that is different from your own?

Answer 2

Amyotrophic Lateral Sclerosis (ALS) is a rare and progressive neurologic disorder manifested by malfunction of motor neurons, atrophy, and weakness of the hands, forearms, and leg muscles, spreading to engage most of the face and body. This disease became known as "Lou Gehrig's disease".
Unfortunately, ALS is incurable. The motor neurons in the brain stem and spinal cord slowly deteriorates, and consequently, the patient suffers from weakness, dysphagia, and dysarthria.
The nurse's priority should be on the following nursing diagnoses:
• Potential for injury related to impaired physical mobility
• Impaired nutritional status related to dysphagia (difficulty swallowing)
Nursing Interventions:
• Perform skin assessment daily particularly those areas that are at risk for breakdown
• Assess for spasticity, contractures, and motor strength
• Assess gagging, coughing, and swallowing reflexes
• Encourage Range of Motion (ROM) exercises and refer patient to physical therapist for a suitable exercise program
• Provide dietary instructions, such as to increasing intake of fiber rich foods (prune juices, cereals, etc.)
• Encourage adequate fluid as tolerated
A patient with ALS living alone is in a very difficult situation. He or she is likely dependent on machines for example, ventilator for breathing. The nurse may need to advise or refer the patient to a qualified home health care aide who can attend to all of his or her needs. The nurse may also advise to move in with friends or families who are willing to help. When he or she has a hearing impairment, the nurse should always use body language when communicating and repeat instructions many times until the patient shows accord of such instructions. When the patient is from a different culture, the nurse must always respect his or her beliefs because in that way the patient will partake more in daily activities tasks.

Question 3

A 28-year-old patient with low back pain is seen in the clinic.Identify theevidence-based practices for the management of low back pain. Describe the evidencebase for the practices that you have identified and the criteria used to evaluate thestrength of that evidence.Identify the health promotion activities you wouldrecommend to this patient and the rationale for your recommendations.

Answer 3

A Low Back Pain (LBP) is the most emblematic musculoskeletal malady felt by most individuals because of the pressure on spinal nerve roots instigated by a herniated disc in the lumbar spine.
The methods that were used to grade strength of evidenced-based are as follows:
A =Strong Research-Based Evidence (RBE)
B =Moderate RBE
C =Limited RBE
D =Panel information interpretation that did not meet the inclusion criteria
The Recommended Clinical Guidelines for the Management of LBP by the Oregon State EBP (evidence-based practice) are the following:
• Focused on History and Physical examination
o Clinicians should be conducting a focused physical examination and history, which comprises a neurological exam to assist patients with LBP and a history that assesses psychosocial risk factors.
• Imaging Tests (x-ray, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI)
o Clinicians should carry out diagnostic imaging test to patients with LBP when severe neurologic deficits exist or are present.
• Patient Education
o Clinicians should be providing with evidence-based details on low back pain relating to their projected course.
Health promotion activities:
• Encourage patients to be active or lively, and present information regarding successful self-care options
• For patients who are not improving with self-care options, they should consider the non-pharmacologic therapies:
o acupuncture
o exercise therapy
o spinal manipulation
o yoga
o progressive relaxation
o cognitive-behavioral therapy

Question 4

A 68-year-old woman has been newly diagnosed with a metastatic brain tumor.Assess and prioritize the patient's physiologic and psychosocial needs.What nursinginterventions and actions would you suggest to assist in the management of the braintumor?