see attached

Celina Agosto posted May 29, 2024 9:32 PM

Parkinson’s disease (PD) is a progressive degenerative disorder of the central nervous system that is caused by the death of neurons that produce the brain neurotransmitter dopamine (Adams, Holland & Urban, 2020, p. 265). Dopamine is a neurotransmitter that plays a critical role in coordinating smooth and controlled muscle movements, cognitive functions such as working memory, etc. Due to the gradual loss of neurons in a specific area of the brain (substantia nigra), motor symptoms including tremors and bradykinesia arise in addition to non-motor symptoms such as forgetfulness and sleep disturbances. Although there are no current medications that cure this disorder, there are many that may dramatically reduce the symptoms. For instance, Levodopa-Carbidopa-Entacapone (Stalevo) is a dopamine agonist drug that is used to restore the balance of dopamine and acetylcholine in specific regions of the brain by increasing the levels of dopamine resulting in the relief of some Parkinson’s symptoms such as tremors (Adams, Holland & Urban, 2020, p. 266). Levodopa-Carbidopa-Entacapone has been shown to provide superior symptomatic benefits in patients with PD compared with conventional levodopa/DDCI therapy (Sethi et al. 2009). Alternatively, nonpharmacologic methods can also be used to minimize symptoms such as physical exercise. Numerous studies have demonstrated that alternative physical exercise was complementary to traditional medicine therapy and considered as a potentially promising approach for conquering PD (Tang, Fang & Yin, 2019).

Problem/Patient

A 70-year-old male with Parkinson’s disease

Interventions

Educate patient and family regarding potential adverse reactions that may arise from medication
Position bed in a high-Fowler position to prevent aspiration when administering medication
Administer Levodopa-Carbidopa-Entacapone (Stalevo)
- Therapeutic class: Anti-Parkinson drug
- Pharmacologic class: Dopamine precursor; dopamine-enhancing drub combination
- Actions: Stalevo restores the neurotransmitter dopamine in extrapyramidal areas of the brain
- Uses: Relieve some Parkinson’s symptoms such as tremor, bradykinesia, and muscle rigidity (Adams, Holland & Urban, 2020, p. 268)
Coordinate with physical therapy

Comparison

Pramipexole (Mirapex)

Outcomes

Primary: Improve functional mobility by enhancing motor coordination by increasing the levels of dopamine in specific regions of the brain
Secondary: Promoting safety and preventing falls; Enhancing quality of life

Kathleen Kratzer posted May 29, 2024 7:08 PM

Hi everyone,

For this discussion, I have chosen to focus on Multiple Sclerosis (MS). Multiple Sclerosis (MS) is an autoimmune disease characterized by the inflammation and demyelination of the central nervous system. The management of MS often includes disease-modifying therapies aimed at reducing the frequency and severity of relapses, delaying the progression of the disability, and minimizing new disease activity detected on MRI (Multiple Sclerosis (MS), n.d.).

PICO Format

Patient/Problem:

A 35-year-old male diagnosed with relapsing-remitting multiple sclerosis (RRMS)

Intervention:

Disease-modifying therapy with Dimethyl Fumarate.

Comparison:

Placebo or another disease-modifying therapy, such as interferon Beta-1a.

Outcomes:

Primary: Reduction in the frequency of relapses and progression of disability.

Secondary: Improvement in quality of life and reduction in MRI-detected brain lesions.

_____________________________________________________________________________

Dimethyl Fumarate is an oral disease-modifying therapy used in the treatment of the relapsing forms of MS. It will not cure MS but may slow some disabling effects and decrease the number of relapses (Multiple Sclerosis (MS), n.d.).

Dimethyl fumarate is indicated for the treatment of relapsing forms of multiple sclerosis. Its primary action is to modulate the immune response, which reduces the inflammatory activity that characterizes MS. By decreasing the activity of harmful immune cells and promoting cellular defense mechanisms, dimethyl fumarate helps to prevent the formation of new lesions and delays the progression of disability (Bresciani et al., 2023).

In a clinical setting, the administration of dimethyl fumarate involves monitoring for potential side effects, including gastrointestinal symptoms, flushing, and lymphopenia. Nurses play a crucial role in patient education, ensuring adherence to the medication regimen, and monitoring for adverse effects to optimize therapeutic outcomes (Bresciani et al., 2023).

Aaron Mustafa posted Jun 1, 2024 5:49 AM

Nervous System PICO

Epilepsy is a common neurologic disorder that affects the brain and causes recurrent seizures. This condition is characterized by recurrent symptoms that may include blackouts, fainting spells, sensory disturbances, jerking body movements, and temporary loss of memory (Adams et al., 2008/2020, pg. 169). Treatments for Epilepsy are available to lessen the number of seizures experienced or stop them completely. The main medications used to treat the condition are anti-epileptic drugs (AEDs) including, sodium valproate, carbamazepine, levetiracetam, etc. (NHS, 2020). Working in EMS as an EMT, I have encountered and provided care for patients previously diagnosed with Epilepsy.

PICO Format

Problem/Patient

48-year-old male experiencing recurrent gran-mal seizures (Epilepsy)

Interventions

Ensure airway is clear and patent
Position patient in left lateral recumbent position to prevent aspiration
Educate patient’s family on proper handling of patient in event of a seizure
Administer anti-seizure medication: levetiracetam (NHS, 2020)

Comparison

Anti-seizure medication: levetiracetam

-Therapeutic classification: anticonvulsants. These medications are used to decrease the incidence and severity of seizures due to various causes (Vallerand & Sanoski, 2023)

-Pharmacologic classification: pyrrolidines. Also known as tetrahydropyrrole, is a cyclic secondary amine with five-membered heterocyclic compound possessing carbon and nitrogen atoms (Pyrrolidine - an Overview | ScienceDirect Topics, n.d.).

-Action: Appears to inhibit burst firing without affecting normal neuronal excitability and may selectively prevent hypersynchronization of epileptiform burst firing and propagation of seizure activity (Vallerand & Sanoski, 2023).

-Uses: Indications and uses include Status epilepticus, partial onset seizures, and primary generalized tonic-clonic seizures (Vallerand & Sanoski, 2023).

Other anti-convulsant drugs that can possibly be used as treatment include sodium valproate, carbamazepine, lamotrigine, and topiramate.

Outcomes

Primary outcome: Reduction in seizure frequency or severity.
Secondary outcome: Improved mood and cognitive function.

Summary

Levetiracetam is an anti-convulsant drug commonly used to treat seizures and seizure disorders, such as Epilepsy. Therapeutic effect of the medication includes decreased incidence and severity of seizures. Being the patient, I provided care for was previously diagnosed with Epilepsy and experiencing gran-mal seizures, he can significantly benefit from being prescribed levetiracetam. This drug acts by inhibiting burst firing of the neurons without affecting normal neuronal excitability (Vallerand & Sanoski, 2023). Levetiracetam is contraindicated in patients who have renal impairment, being that the medication is mostly excreted through the kidneys, and this prevents medication toxicity. Adverse effects of the medication include hypertension, suicidal thoughts, hypersensitivity reactions (anaphylaxis and angioedema), etc. (Vallerand & Sanoski, 2023). It is important as a nurse I evaluate my patient and closely monitor for any adverse effects after proper administration of the medication. Other important nursing implications to ensure the effectiveness of the medication include monitoring for mood changes, assessing for rashes, and monitoring for signs and symptom of anaphylaxis.

Briana DeRosa posted May 30, 2024 12:04 PM

For this discussion, I chose a 37 year old female with chronic migraines. Chronic migraine is defined as having headache on at least 15 days per month, with eight of these having migraine symptoms, for at least three months. People who have fewer headache days with migraine symptoms have episodic migraine. For a lot of people chronic migraine develops gradually with migraine attacks becoming more frequent over time. Around 2.5 out of 100 people with episodic migraine will develop chronic migraine each year. For some people (around 2 out of 10) chronic migraine will go into remission within 2 years of becoming chronic. If you have chronic migraine it will have a huge impact on your daily life. Chronic migraine is related to greater disability and has a huge impact on your physical, social and work life. It can also have a huge impact on your relationships. Many people with chronic migraine report lower quality of life and poorer health than people with episodic migraine. (Chronic migraine. The Migraine Trust. (2024, January 30).

Patient/Problem:

37-year-old female with chronic migraines

Intervention:

Medication: Topiramate
Therapeutic Classification: Antiepileptic agent
Pharmacologic Class:Sulfamate-substituted monosaccharide

Comparison:

Medication: Propranolol
Therapeutic Classification:Antihypertensive
Pharmacologic Class: Beta-adrenergic blocker

Outcomes:

Primary: Reduction in migraine frequency
Secondary: Decrease in migraine severity, improvement in quality of life

Nursing Interventions/Implications:

Monitor for side effects: Patients on topiramate may experience cognitive effects, weight loss, paresthesia, and kidney stones. Those on propranolol may experience fatigue, dizziness, and bradycardia.
Educate the patient on the importance of adherence to medication regimens to achieve optimal results.
Conduct regular follow-up appointments to assess the effectiveness of the medication
Encourage patients to maintain a headache diary to track the frequency, severity, and potential triggers of migraines, which can help in tailoring treatment plans.
Provide lifestyle modification guidance

In conclusion, both topiramate and propranolol are effective in the management of chronic migraines. Topiramate offers a different mechanism of action compared to propranolol and may be more suitable for patients who experience side effects from beta-blockers.

Kendall Komeng posted May 29, 2024 12:22 AM

The neurological disorder I will be choosing is Parkinson's disease. Parkinson's disease is a progressive neurological disorder that primarily affects movement (Adams, 2020). It's characterized by various symptoms, including tremors, rigidity, bradykinesia (slowness of movement), and postural instability. These symptoms typically develop gradually over time, and their severity can vary from person to person. The underlying cause of Parkinson's disease is the degeneration of dopamine-producing neurons in a region of the brain called the substantia nigra. Dopamine is a neurotransmitter involved in regulating movement, mood, and other functions. When dopamine-producing neurons die or become impaired, it leads to a dopamine deficiency in the brain, disrupting the normal functioning of circuits that control movement. Several factors may contribute to the development of Parkinson's disease, including genetic predisposition, environmental factors, and possibly exposure to toxins (Armstrong, 2020).

Problem/Patient: A 62-year-old male with Parkinson's disease (PD) experiencing motor fluctuations and dyskinesias.

Intervention: Levodopa-carbidopa intestinal gel (LCIG) infusion therapy.

Levodopa-carbidopa intestinal gel (LCIG) infusion therapy is effective in managing motor fluctuations and dyskinesias in advanced Parkinson's disease (Shackleford, 2022). LCIG delivers a continuous infusion of levodopa-carbidopa directly into the small intestine via a portable pump, bypassing the stomach and providing more stable plasma drug levels compared to oral medication. This results in smoother motor control and fewer motor fluctuations throughout the day. Additionally, LCIG therapy can reduce the dosage of oral levodopa-carbidopa needed, potentially decreasing dyskinesias and other side effects associated with high oral doses. Overall, LCIG infusion therapy can significantly improve the quality of life for patients with advanced Parkinson's disease by providing more continuous and predictable motor symptom control.

Nursing Interventions/Implications:

Educate the patient and caregivers about the administration technique and potential side effects of LCIG therapy.
Monitor the patient closely for motor response fluctuations and dyskinesias during the titration period and adjust the infusion rate accordingly.
Assess for signs of infection or complications related to the percutaneous endoscopic gastrostomy (PEG) tube insertion site.

Comparison: Oral levodopa-carbidopa (Sinemet) medication.

Outcomes:

Primary: Improve motor function and reduce motor fluctuations and dyskinesias.

Secondary: Enhance the quality of life, reduce medication-related side effects