Part one: Neurological Disorders
Part one: Neurological Disorders
Parkinson's Disease
· Pathophysiology: Chronic, progressive neurodegenerative disorder caused by the destruction of dopamine-producing neurons in the substantia nigra. Result: Dopamine depletion (inhibitory) and relative Acetylcholine excess (excitatory).
· Classic Tetrad (TRAP):
Tremor (pill-rolling, occurs at rest)
○ Rigidity (cogwheel resistance to passive movement)
○ Akinesia / Bradykinesia (slowness of movement, masked facies)
Postural instability (shuffling gait, propulsive gait)
· Key Interventions:
○ Administer Carbidopa-Levodopa on time (Carbidopa prevents peripheral breakdown of Levodopa). Avoid high-protein meals at the time of dose (competes for absorption).
o Implement fall precautions; encourage a wide-based gait and rocking side-to-side to initiate walking.
Multiple Sclerosis (MS)
Multiple Sclerosis (MS)
· Pathophysiology: Autoimmune, progressive demyelination of the central nervous system (brain and spinal cord), leading to interrupted nerve impulses. Characterized by remissions and exacerbations.
· Key Symptoms:
o Visual disturbances (diplopia, blurred vision, optic neuritis).
Fatigue, muscle weakness, ataxia, and intention tremors.
o Lhermitte's sign: Electric shock-like sensation running down the spine with neck flexion.
· Key Interventions:
During acute exacerbations, administer high-dose Corticosteroids. ○
○ Patient Education: Avoid triggers that cause exacerbations (stress, fatigue, infection, and increased body temperature/hot baths-known as Uhthoff's phenomenon).