management of clients with nervous diseases. stroke is acute disorders of cerebral blood...
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Management of Management of clients with clients with nervous diseasesnervous diseases
StrokeStrokeis acute disorders of cerebral blood is acute disorders of cerebral blood circulation, rapidly developing clinical circulation, rapidly developing clinical signs of focal (at times global) signs of focal (at times global) disturbance of cerebral function, lasting disturbance of cerebral function, lasting more than 24 hours or leading to death more than 24 hours or leading to death with no apparent cause other then that with no apparent cause other then that of vascular originof vascular origin
Stroke morbidity in Stroke morbidity in different countriesdifferent countries
269,8
200
0
50
100
150
200
250
300
Ukraine Europe
1:3,61:7
Hemorrhagic Hemorrhagic stroke stroke
Ischemic Ischemic strokestroke
per
per
10
0
10
0 O
OO
OO
O o
f p
op
ula
tion
of
pop
ula
tion
Stroke morbidity Stroke morbidity
266,3
253,9
247,2
260,7
256,6
269,8
235
240
245
250
255
260
265
270
2000 2001 2002 2003 2004 2005
per
100
000
of
po
pu
lati
on
Stroke mortality in different Stroke mortality in different countries countries
72,4
0
10
20
30
40
50
60
70
80
Ukraine Developed countries
per
100
000
of p
opul
atio
n
Mortality from different types Mortality from different types of stroke in Ukraineof stroke in Ukraine
19,7
39,8
30,7
3,2
0 20 40 60
SH
IH
IS
nonspecified
per 100 000 of population
Nowadays Nowadays
... ... Every fifth Ukrainian resident will die Every fifth Ukrainian resident will die of strokeof stroke ... ...
Every fifth one will finish his life as Every fifth one will finish his life as depending from others disabled person depending from others disabled person
ClassificationClassification
Strokes:Strokes: Haemorrhage Haemorrhage • subdural, epiduralsubdural, epidural• intracerebral haemorrhageintracerebral haemorrhage• ventricular hemorrageventricular hemorrage• mixedmixed IschemicIschemic• Atherothrombotic Atherothrombotic • CardioembolicCardioembolic• Hemodynamic Hemodynamic • Rheologic Rheologic • LacunaLacuna
Combined hemorrhagesCombined hemorrhages (they (they take the whole region of basal nuclei: subcortical take the whole region of basal nuclei: subcortical nuclei, thalamus, internal capsule)nuclei, thalamus, internal capsule)
Peculiarities of hemorrhagePeculiarities of hemorrhage• Sudden onset (during day – time, after Sudden onset (during day – time, after
physical or emotional stress, while activity)physical or emotional stress, while activity)
• In young people (age 40 – 45)In young people (age 40 – 45)
• Precursors are very rare (headache, Precursors are very rare (headache, dizziness)dizziness)
• It is associated with severe headacheIt is associated with severe headache
• Vomiting with blood portion can be Vomiting with blood portion can be observedobserved
• Consciousness disorders, psychomotor Consciousness disorders, psychomotor agitationagitation
• Facial hyperemia, tachycardia, tachypnoe, Facial hyperemia, tachycardia, tachypnoe, increased BP – autonomic changes increased BP – autonomic changes
Peculiarities of hemorrhagePeculiarities of hemorrhage• There are two groups of symptoms – There are two groups of symptoms –
general cerebral and focalgeneral cerebral and focal• General cerebral are well expressed at General cerebral are well expressed at
hemorrhage and dominate over focal ones hemorrhage and dominate over focal ones • While hemorrhage in right hemisphere While hemorrhage in right hemisphere
involuntary movements of non – paralyzed involuntary movements of non – paralyzed extremities (parakinesis) or syndrome of extremities (parakinesis) or syndrome of automatic gesticulation can be observed automatic gesticulation can be observed
• State of patients with hemorrhage is very State of patients with hemorrhage is very severesevere
ComaComais characterized by deep is characterized by deep consciousness disorder, consciousness disorder, disturbance of breathing disturbance of breathing and heart activity. The and heart activity. The patient doesn’t respond patient doesn’t respond to stimuli.to stimuli.
C o m aC o m a• response to stimuli is absentresponse to stimuli is absent• eyes are closed, mouth is opened eyes are closed, mouth is opened • face is red, lips are cyanotic, skin is cold, face is red, lips are cyanotic, skin is cold, • neck vessels are pulsing neck vessels are pulsing • there is breathing disturbance there is breathing disturbance • pulse is strained and slow pulse is strained and slow • blood pressure is increased blood pressure is increased • temperature increases in 24 hours temperature increases in 24 hours • patient is lying on his back patient is lying on his back • all muscles are relaxed all muscles are relaxed • pupils are changed (there can be pupils are changed (there can be
anizokoria, cross – eyes, sometimes gaze anizokoria, cross – eyes, sometimes gaze paresis can be observed)paresis can be observed)
• mouth angle is a little bit lower mouth angle is a little bit lower
Brain Brain infarctioninfarction
Clinical featuresClinical features• PrecursorsPrecursors - - transient ischemic attacks in transient ischemic attacks in
the same region where brain infarction is the same region where brain infarction is developed.developed. GraduallyGradually during several hours during several hours focal neurologic symptoms are developed.focal neurologic symptoms are developed.
• The prevalence of focal symptoms over the The prevalence of focal symptoms over the general cerebral ones.general cerebral ones.
• General cerebral symptomsGeneral cerebral symptoms manifest as:manifest as:- HeadacheHeadache- VomitingVomiting- Consciousness disordersConsciousness disordersFocal symptomsFocal symptoms depend on localization of depend on localization of
the infarction, damaged vessel and state the infarction, damaged vessel and state of collateral blood circulation.of collateral blood circulation.
Clinical features Clinical features AtherothromboticAtherothrombotic stroke stroke
• Occur at older ageOccur at older age
• Developed during some ours and daysDeveloped during some ours and days
• TIA present in anamnesisTIA present in anamnesis
• Developed at night or in the morning timeDeveloped at night or in the morning time
• Stenosis and occlusion of MAH at Stenosis and occlusion of MAH at ultrasound examinationultrasound examination
• Decreased of Internal Carotid artery Decreased of Internal Carotid artery pulsation on the neck pulsation on the neck
Ischemic strokeIschemic stroke
Lacunar
Extensive
SmokingSmoking
• Risk of recurring stroke in smokers Risk of recurring stroke in smokers increases in increases in 1.5 1.5 timestimes
WeightWeight
• For all over weighted people is For all over weighted people is recommended to keep weight index recommended to keep weight index between between 18,5 18,5 andand 24,9 24,9 kgkg//mm2 2 and size of and size of waistwaist not more than not more than 88 88 sm sm in women and in women and not more than not more than 102102 sm sm in menin men ((Northern Northern Manhattan Study)Manhattan Study)
Physical activityPhysical activity
• For patients are recommended For patients are recommended physical exercises not less than physical exercises not less than 3030min min per dayper day
DefinitionDefinition
Spinal osteochondrosis – is a Spinal osteochondrosis – is a degenerative lesion of cartilage degenerative lesion of cartilage
- between vertebral disc - between vertebral disc associated with reactive associated with reactive changes in neighboring changes in neighboring
vertebras, between vertebral vertebras, between vertebral joints and connecting apparatusjoints and connecting apparatus
Vertebrogenous syndromeVertebrogenous syndrome
• Limitation of movements in lumbar – Limitation of movements in lumbar – sacral part of spinal cord (bending sacral part of spinal cord (bending forward, backward) forward, backward)
• Increasing of pain while movements, Increasing of pain while movements, coughing and laughingcoughing and laughing
• Protective straining of long back musclesProtective straining of long back muscles
• Extension of lumbar lordosis, cyphosis in Extension of lumbar lordosis, cyphosis in lumbar – sacral divisionlumbar – sacral division
• Scoliosis, sometimes with rotationScoliosis, sometimes with rotation
• Painful paravertebral points and Painful paravertebral points and vertebral processes vertebral processes
Vertebrogenous Vertebrogenous syndromesyndrome• Discharge – postures and symptomsDischarge – postures and symptoms
– Knee – elbow positionKnee – elbow position– While standing the patient keeps his While standing the patient keeps his
leg aside in order to make the load leg aside in order to make the load less on his legless on his leg
– While lying in the bed he bends his While lying in the bed he bends his leg in all joints.leg in all joints.
• The symptoms of spinal cord The symptoms of spinal cord instability (it is difficult for the patient instability (it is difficult for the patient to stand, to wash himself, but it is to stand, to wash himself, but it is much more easier to walk)much more easier to walk)
The points of pain:The points of pain:• Pain along the crista iliaca Pain along the crista iliaca • The point of iliosacral jointThe point of iliosacral joint• The point of m. gluteus minimus (just The point of m. gluteus minimus (just
under the crista iliaca)under the crista iliaca)• The point of m. gluteus medius (1 sm The point of m. gluteus medius (1 sm
lower)lower)• The point under the backside foldThe point under the backside fold• Trochanter os iliacaTrochanter os iliaca• Along the ischiadic nerve (the posterior Along the ischiadic nerve (the posterior
surface of hip and fossa subpoplitea)surface of hip and fossa subpoplitea)
The symptoms of The symptoms of strainstrain • Lasegue’s symptom – in case of straining Lasegue’s symptom – in case of straining and lifting the leg the low back pain and lifting the leg the low back pain appearsappears
• Neri symptom – there is pain in leg at Neri symptom – there is pain in leg at bending head forwardbending head forward
• Matskevych symptom – there is pain in Matskevych symptom – there is pain in the anterior surface of the leg at knee the anterior surface of the leg at knee bending while lying on abdomen bending while lying on abdomen
• Wasserman symptom – the same clinical Wasserman symptom – the same clinical picture at lifting the legpicture at lifting the leg
The symptoms of The symptoms of strainstrain•Sequar symptom – there is pain on Sequar symptom – there is pain on
posterior surface of leg at foot flexingposterior surface of leg at foot flexing•Turin symptom – the same clinical Turin symptom – the same clinical
picture at toe’s flexingpicture at toe’s flexing•Bechterev’s symptom – there is pain Bechterev’s symptom – there is pain
at knee – flexed leg extensionat knee – flexed leg extension•Dejerine’s symptom - there is pain in Dejerine’s symptom - there is pain in
posterior surface of the leg at posterior surface of the leg at coughing, sneezingcoughing, sneezing
PreventionPrevention
–Hypokinesia preventionHypokinesia prevention–Moderate physical Moderate physical activityactivity
–Treatment of chronic Treatment of chronic diseasesdiseases
Epilepsy Epilepsy and convulsion and convulsion
syndromessyndromes
EpilepsyEpilepsy
is a chronic disorder, which is is a chronic disorder, which is characterized by the presence of:characterized by the presence of:
• Epileptic focusEpileptic focus
• Recurrent attacks with various clinical Recurrent attacks with various clinical signssigns
• Personality disorders between attacksPersonality disorders between attacks
• Some specific paraclinical signsSome specific paraclinical signs
Clinical featuresClinical featuresA. General seizures.A. General seizures.
• Epileptic general tonic – clonic Epileptic general tonic – clonic attack (grandmal) usually begins attack (grandmal) usually begins with short initial stage that lasts with short initial stage that lasts several seconds. The last can several seconds. The last can manifest as:manifest as:
– Bilateral general muscle jerksBilateral general muscle jerks– Loss of consciousnessLoss of consciousness– Autonomic changesAutonomic changes– Enlargement of pupilsEnlargement of pupils
Clonic epileptic attacksClonic epileptic attacks
• ggeneral typical clonic attacks are often observed eneral typical clonic attacks are often observed in newborn babies. in newborn babies.
• loss of consciousnessloss of consciousness• autonomic disordersautonomic disorders• rhythmic clonic seizuresrhythmic clonic seizures• bbetween the attacks of clonic muscles jerks there etween the attacks of clonic muscles jerks there
is muscle hypotoniais muscle hypotonia• If the attacks last 1–2 min the consciousness If the attacks last 1–2 min the consciousness
recovers quickly. But these attacks can last 4–5 recovers quickly. But these attacks can last 4–5 min and even more. Then after the attack coma min and even more. Then after the attack coma can be developed.can be developed.
Treatment Treatment of patients with epileptic of patients with epileptic
status status
MeasuresMeasures
Time, Time, minmin
Treatment Treatment
0-50-5 Definition of state of living functions. Definition of state of living functions. Oxigenotherapy.Oxigenotherapy.
6-106-10 Intravenous infusion of physiological solution. Intravenous infusion of physiological solution. Checking of tempeature, BP, biochemical blood Checking of tempeature, BP, biochemical blood analysis.analysis.Intravenous injection of Tiaminum 100 mg, then Intravenous injection of Tiaminum 100 mg, then 50 ml 40 % glucose. 50 ml 40 % glucose.
Time, Time, minmin
Treatment Treatment
11-1511-15 Intravenous injection of Diazepam 0,2 mg per kg Intravenous injection of Diazepam 0,2 mg per kg (speed 5 mg per min)(speed 5 mg per min). . Injection is repeated every Injection is repeated every 5 min. General dose is not more then 20 mg5 min. General dose is not more then 20 mg
16-4516-45 Intravenous injection by drops of Fenitoin in dose Intravenous injection by drops of Fenitoin in dose 20 mg per kg (speed 50 mg per min).20 mg per kg (speed 50 mg per min).While injection ECG is made, BP is checked. At While injection ECG is made, BP is checked. At changes on ECG or BP injection is stopped. If changes on ECG or BP injection is stopped. If attacks continue we can add 5 – 10 mg per kg of attacks continue we can add 5 – 10 mg per kg of Fenitoin. Fenitoin.
Time, Time, minmin
Treatment Treatment
46-5946-59 If attacks continue we make endotracheal If attacks continue we make endotracheal intubation, then use Fenobarbitalum in dose 20 intubation, then use Fenobarbitalum in dose 20 mg per kg (speed 100 mg per min)mg per kg (speed 100 mg per min)
60-9060-90 If attacks continue we introduce patient in If attacks continue we introduce patient in barbiturate coma. It is recommended to start barbiturate coma. It is recommended to start usage of Fenobarbital in dose 5 mg per kg up to usage of Fenobarbital in dose 5 mg per kg up to stopping of epileptic activity on EEG.Then stopping of epileptic activity on EEG.Then continue usage of continue usage of 0,5-3,0 0,5-3,0 mg per kg per hour to mg per kg per hour to stop recurring attacks. From time to time we stop recurring attacks. From time to time we decrease speed to prove ourselves that the decrease speed to prove ourselves that the attacks are absent.attacks are absent. While infusion we check EEG, While infusion we check EEG, ECG, BP and breathing functions. ECG, BP and breathing functions.