Neurological Stressors IIIChronic Neurological Disorders：神经系统的压力iiichronic神经疾病.ppt

* Hallucinations Depressions * Assess med effectiveness Swallow difficulties Nutrition/hydration status- protein interferes with medication metabolism Cognitive status Depression Family coping Mobility – Daily exercise, stretching and postural exercises. Walk with wide based gait, practice marching to music or metronome which provides sensory reinforcement. Physical therapy. Nutrition – diff chewing and swallowing semi solid or thick liquid diet, non spill cup; utensils with built up handles, Teach swallowing sequence place food on tongue, close lips and teeth, lift tongue up and back, swallow. Speech therapist and occupational therapist. Speech therapist- exagerate pronunciation, speak in short sentences, may need amplifier to be heard. Meds – antihistamines – mild sedative effect, may help control tremors. Anticholinergic agents- extends the effects of levadopa therapy. Block parasympathetic nerve impulses (procyclidine, trihexiphenidyl) control tremor and rigidity. Side effects – dry mouth, dizziness, blurred vision, nausea, constipation. Contraindicated in patient’s with glaucoma. * Levodopa- absorbed in the stomach. When it reaches brain it metabolized into dopamine DOPAR Dopamine agonists- chemicals very similar to dopamine, signal sent to next cell very much like dopamine, Mirapex MAOI- prevent dopamine breakdown by enzymes in the brain- Eleypryl Amantadine- helps increase dopamine release- SYMMETREL Anticholinergics- inhibit ACTH receptors- treat tremors COGENTIN Amantadine-stimulates dopamine receptors- Symmetrel * Dose- Individualized dosing to minimize side effects and optimize benefits. A significant therapeutic response may not be obtained for 6 months. Adverse – n/v, cardiac irregularities, orthostatic hypotension, leukopenia, decreased Hgb, Hct, elevated BUN and liver enzymes, urinary retention and incontinence, flushing, hot flashes, increased sweating, skin rash. Nursing considerations- Have pt. void befor dose if retention is a pr