risk of silent aspiration

BELL'S PALSY non-supportive inflammation of facial nerve within

In the 19th century, Charles Bell known for his studies on the stylomastoid foramen (Fig. 6.35). It may occur at any age from
nervous system and the brain, discovered lesions of the 7th infancy to old age, but appears to be most common in young
cranial nerve causes facial paralysis. adults; males are affected more than female. (Roger, 1984)
Facial nerve is the 7th cranial nerve is mixed nerve
containing both sensory and motor components. It emeroes Etiology of Bell's palsy
from the brainstem between the pons and the medulla, and Idiopathic
controls the muscles of facial expression, and functions in Trauma: Basal skullfractures, facial injuries, penetramy
the conveyance of taste sensations from the anterior two injury to middle ear, Altitude paralysis (barotrauma.
thirdsof the tongue and oral cavity. The motor part of the 7th scuba diving and lightning.
cranial nerve arises from the facial nerve nucleus in the pons. Infection: External otitis,otitis media and mastoid1ts,e
geniculate
While the sensory part of the 7th cranial nerve arises from the Reactivation of the herpes simplex virusinthe
nervus intermedius. ganglion.
Bell's palsy is a disorder of the nerve that controls Metabolic: Diabetes mellitus and hypertension.
movement of the muscles in the face. The Bell's palsy is defined Neoplastic: Seventh nerve tumor and benign les
as afacial paralysis of acute onset attributed to an acute parotid.
 corner of the 255
or
Drooping of the face, such as the eyelid
mouth
Hard to close one eye
Inability to close eve on affected side
oothing
Smoot Inability to raise eye brow expressions
or making facial
outof

forehead Problems smiling,.grimacing,

Eyebrow.
Flattening of nasolabial fold
Twitching or weakness of the muscles in the face
droop
Dry eye or mouth
Headache
Loss of sense of taste
Sound that is louder in one ear (hyperacusis)
Twitching in face
Droopingof
oner
ofnmouth
Diagnostic evaluation
Health history and doing acomplete physical exam
Fig. 6.35: Bell's palsy. Examination of facial nerve: Show the teeth, open his
mouth then compare nasolabial folds, close his eyes
(orbicularis oculi muscle): frown, wrinkle forehead
Idiopathic:Familial bell palsy,
autoimmune syndrome
(frontalis muscle), raise eyebrows, bare his teeth and open
and multiplesclerosis.
his mouth, blowing out cheeks (e.g., buccinator muscle,Nursing
orbicularis oris muscle, zygomaticus muscle), pursuing
Pathophysiology the lipsstrength and weakness. facial
Bell's
palsyinvolves damage to thee seventh cranial (facial) CT scan of the head to find the lesion around the Management
controls the movement of the muscles nerve
nerve. This nerve to identify
oftheface.
Magnetic resonance imaging (MRI) of the head
causes of nerve
the clear lesion in the facial nerve or other
Damage to thiS
nerve causes weakness or paralysis of
hace muscles. Facial nerveeach nerve controls eve danage. of
Electromyography (EMG): To measure nerve activity
Blinking and closing, facial expressions, smiling and and damage. Patient
bone
frowning, tear glands, saliva glands, muscle of small Nerve conduction test to study the nerve function.
in middle of ear called the stapes and taste sensations.
House Brackmann grading system to rule out its grade with
Intlammation of this nerve in the area where it travels (Table 6.40).
through the bones of the skull. Neurological
Difference between upper and lower motor neuron Management
lesion: In UML-frontalis is spared allowing normal
furrowing of brow and eye blinking; LML-all muscles of Symptomatic patient with analgesics may be necessary if
the ear is painful
facial expression are affected.
" Difference between Bell'spalsy and facial nerve palsy: Eye care is very imnportant. Eye drops, including artificial
Disorders
tears, soothe dry, irritated eyes
Bel's palsy is the result of a malfunction of the facial nerve Lubricating eye drops or eye ointments to keep the surface
(cranial nerve VII),which controls the muscles of the face.
Facial palsy is typified by inability to move the muscles of the eye moist if cannot close it completely. Protection
Olacial expression. The paralysis is of the infranuclear/ ofeye during the sleep patch
lower motor neuron type. Massage of the weakened muscles

linical Manifestations of Bell's palsy TABLE 6.40: House-Brackmann grading system.

Grade Features
take 2-3
Symptoms
days
most often start suddenly, but may Grade I Normal
Aways on one side only Grade Il Mild dysfunction, slight weakness on close inspection,
Range from mild to normal symmetry at rest
VfTheain face severe Moderate dysfunction, obvious but not disfiguring
behindwill ear ((mastoid foramen)
feel stiff or pulledto one side, and may look
Grade
difference between sides, eye can be completely

diierent closed vwith effort

yDiiculty
of the moutheating and drinking; food falls out of one
side Grade IV Moderately severe, normal tone at rest, obvious
weakness or asymmetry with movement, incomplete

DriVAñAcpeplcctiouinmulng aoftofiotaste
nsalivaand hearing closure of eye
n of food inside the cheek(affected side)
Grade V Severe dysfunction, only barely perceptible motion,
asymmetry at rest

Oro ling
face due to lack of control over the muscles of
the Grade VI No movement
 256 eorticosteroids may reduce swelling around the facial TRIGEMINAL NEURALGIA
Inerve

Prednisolone 60-80 me/day in divided doses initial

4-5 days, then taper over next 7-10 days, decreases the
The trigeminal nerve is one set of
head. It is the nerve responsible the
(forFIG.6.3cr6)anial ng
possibility of permanent paralysis, From swelling of facial face. People often call trigeminal
nal eneurproavilgdiang:
trigemimuscl
nerve in facial canal, decreases the severe pain
Wear an eye patch wlhile sleep
because of a characteristic
the pain. It is also known as spasm
prosopalgia. that Sensalit
Medications can fight the virus that mnay be causing Bell's
palsy
B vitamins essential for proper nervous system function
ing
Trigeminal neuralgia causes
especially in the lower face and abrupt, searing
ears, eyes, or lips. Trigeminal jaw and aroun
late life. The condition is
the neuralgja develops ihe wr
ac ompatie
B-complex vitaminto the daily routine may be a good the nerve pain disorders. Themost frequently
pain, which
Physicaltherapy: Massage effleurage. Circular, finger and feels like bursts ofssharp,
thumb kneading, which has frequently been prescribed
for facial palsy, improve circulation and may prevent
stabbing, few
can last from a few seconds
neuralgia most frequently
electric
to a- s cOTmes and g
hocks
minutes. \rig rnina
affects women
0C ur ing.
contracture. Active exercise in front of a mirror prevent 50 years.
muscle atrophy and improve muscle function. People with trigeminal
neuralgia
ol der thr
" Heat and cold: Improve local circulation and lower skin
resistance to electrical stimulation.
by intermittent severe pain that interferes
daily activities such as eating and with
sleep.
become paguet
Disorders Cold: lce stimulation hasto be performed to aspecific
muscle group, to increase the muscles contraction
of unpredictable painful attacks, which They ive in
ex
commoA
power
deprivation and undereating. The leadscanto slee
condition
Surgery to relieve pressure on the nerve (decompression irritability, severe anticipatorY anxiety and depressianlead n
Neurological life-threatening malnutrition.
surgery) if completely paralysis.
Etiology of Trigeminal Neuralgia
Complications No clear-cut cause. Some expert says as folloWS Caue
Corneal ulcerations Traumatic damage to the nerve as it passes
with Ampairment of vision openings in the skull to the muscles and fromof the
paralysis tissue hutthen
Patient Psychosocial adjustment to prolonged face. The damage compresses the nerve, causing
Long-term changes in taste demyelination the nerve cell
Spasms of muscles or eyelids Biochemical change in the nerve tissue itself
of Weakness that remains in facial muscles Abhormal blood vessel compresses the nerve like swol
EKcess drying of the eye surface, leading to eye ulcers or
Managenment blood vessel or tumor that puts pressure on the nerve
infections. eMultiple sclerosis, a condition that damages the myelin
sheath, which is the protective coating around nerves
Nursing management Excessive disagreement of nervous activity from i
damaged nerve causes the painful attacks.
the eye with a protective shield at night
Nursing Çover eye
YApply ointment to keep eyelids closed during sleep
Close the paralyzed eyelid manually before going to sleep
Wear wraparound sunglasses or goggles to decrease
normal evaporation from the eye
Teaching about maintaining muscle tone
Show patient how to perform facial massage with gentle
daily when the patient can
 brain 257
such as
oathophhysiology of the head to rule out ayyother disorder,
Ciompression
ofblood vessels, especially in the superior tumor, infection.
attery pressingon0rgrooving the root of theCherve
ssureonthetrigeminalnerve >focal demyelination
ebellar
Management
Pxcitabilityof nerve fibers >chronic iritation of
hper-e Pharmacological Management
Lnerveatthe root entry zone> increased iring
Nd
LeminalL
orsensory fibers which fire in Administer analgesics
respoIse to which are drugs thar
alleent
intense pain trigeminal ypically, anti seizure medications,
the alsoresult
a touch
neuralgia. block nerve firing
small.area inthe central part of the face, people. ls
aght zoneisa
lip.that, Carbamazepine, to controls pain for most vision,
cheek,nose,
or when stimulatcd, triggers dizziness, double
on a possible side effectsinclude
lr of pain. drowsiness and nausea
| burstcomes from one or more branches of the
1npvcal
treat TN also. Its
pain O Gabapentin, most commonlv used to
The nerve--the major carrier of sensory information and/or drowsiness
n|eminal, Common sideeffects include dizziness
to the
brain. Pain will be based on the which go away on their own
lace of
the
nerve branch. There are three branches of as the first line
/om
imolvementof " Oxcarbazepine, used more recently side effects.
ihetrigeminalnerve:
treatment, because it generally has fewer
Ophthalmic.nerve: Affects the forehead, nose, and eyes.
)Maxillary
L
nerve: Afects the lower eyelid, side of nose. Surgical Management
teeth. of a blood
cheek.gum, lip, and upper Microvascular decompression identificationand gentle
Nandibularrnerve: Affectsthe
t jaw, lower teeth, gum, and the nerve Nursing
vessel which has compressing
vessel away from the nerve
3 lowerlip. movement of the blood
Irigeminalneuralgia sometimes
affects more than one
radiosurgery: Delivery of radiation that
time. Most commonly affects maxillary, and " Gamma Knife Management
branchat a destroys the trigeminal nerve
and usually
mandibular. Stereotactic radiosurgery: It is painless procedure uses
performed without anesthesia. In this beams of
CinicalManifestations highly focused
computer imaging to deliver
vibration is the most effective trigger pain. radiation to the root of the nerve
Lighttouchorr daily activities trigger the Percutaneous glycerol rhizotomy (PGR) or
glycerol of
Because of this, many common Patient
and into
such as washing, face, brushing teeth, shaving, injection: A needle is inserted through the facetrigeminal
attacks chewing > due to skull reach the
talking, wind hit on face, eating and an opening at the base of the glycerol is injected. with
food and drink rather nerve and smallamount of sterile
these reason many people avoid nerve is damaged, and
pain ’ its result risk weight
than experience the severe hospitalization Within a few hours, the trigeminal
pain signals are blocked Neurological
los and dehydration> lead jabbing pain that balloon compression of the trigeminal
Severe episodes of searing, shooting, " Percutaneous for
nerve: A balloon is sent down a hollow needle
feel like electric shocks damages the nerve and
Intermittent twinges of mild pain lasting from
afew inflation next to the nerve. This
seconds to several minutes blocks uncontrolled signals. Disorders
pain
" Between attacks, most people remain relatively
free Nursing Management
Asubgroup, however, experience a dull ache
between
" Instruct the patient to avoid
factors that can trigger the
affected attack and result in exhaustion and fatigue
attacks, suggesting physical compression of the
nerve, either by a blood vessel or some other structure Avoid foods that are too cold or too hot
Unusual forms of headache Chew foods in the affected side
sides hygiene
UPain in one side of the face, or. less frequently, both Use cotton pads gently, wash face and for oral
VPain that is focused in one spot or spreads in a wider Provide teaching to patients who have sensory loss as a
pattern result of a treatment
AlaCks of pain that occur more regularly and intensely Inspection of the eye for foreign bodies, which the patient
over time willnot be able tofeel, should be done several times a day
Vingling or numbness in the face before pain develops. Warm normal saline irrigation of the affected eye two to
three times a day is helpful in preventing corneal infection
Diagnostic Evaluations " Dental checkups every 6 months is encouraged, since
History collection related to chief complaint of pain, dental caries will not produce pain
onset, location, quality, /ntensity, frequency, duration, " Explain tothe patient and his family the disease and its
8gravating andIalleviating factors, and past treatments treatments.

yPhysical l
oj pain examination the
of head will help find causes
PERIPHERAL NEUROPATHIES
Neurological
of other neuroexamination
disorders associated the
to determinewith presence
trigeminal Peripheral neuropathy, a result of damage to the nerves

neuralgia pain such as multiple sclerosis. CT scan or MRI outside of the brain and spinal cord (peripheral nerves).
269
Postural Nursingmovement
changes Management of Patlent with Neurological Disorders
Normal disorders
Movement and tremors, limbs.
aover handwriting
bilateralcommon motion
motion
disease.substantia (dopanine) disease. rigidity
pathway slowly aching turning
Parkinson's controlling Parkinson's are initially
syndromes
graduala aand
the nigrostriatalinhibiting
striatum akinesia, progress tiredness,
small being
slow
hand
stores Cormplex Bradykínesia absentand unilateral,
ofPathophysi
neuronalology dopamine
in
cells
ganglia and tractsmovements
body Receptors and limb forearm,
(acet
dopaminergic ylc
corpushol inexte) rapyramidal normal in symptoms
classical of
noticed.
depression upper
rhythmic,
basal the
neurotransmit ers Dopamine
results
bodies 6.43).
(Fig. n i
bradykinesiacal andrigbemayiditsymptoms
bradyki
Manifestations
Cli yn,esia tremor. the
dopaminergic
rDestrucion
of the of
Depletion
in inlevel
dopamine features be initially
rule.an (pronation
aas of
in gradual,
Its may
6.25:
Flowchart
nigra the
ofDegeneration
excitatory ofImpairment Rigidity DopamineLewy (mic rographi
period. non-specific
slowness, the intremor ) manifest
aisfeature
clinical are isinvolvement
ofFormation is presenting
of Normal
neuron
neuron
affected 6.42: of onsetchronic mental FeaturesResting may
Imbalance Tremors Parkinson's Loss These TremorTremor
Fig. Its But
medications--chlorproma
(methylof tumors. produceproduce
" "
ispalsy" disorder
to characterized
inprogressing
of (rigidity),
in
eventually
leads
The Mostly primarily
suffered
reflexes.
famous
execution affects
syndrome
of muscle
ithe tone
(rigidity),
execution
and pesticides)
occasionally
phenyl-tetrahydropyridine),
number subst
Dimainntdisease
isParkinson'
iheda s
nigra
Substantia nigra.
"shaking
MPTP drugs, that neurons
inseen substa
movemenI(bradykinesia),
Ali 60s.
tone Mohammed radicals
a
slowly
a of is fromtoxins, neurons depigmentation asSnigra
gangliaandmuscle age It
group 6.41).
as that initiation like results 6.25)
(Flowchart
Pathophysiology
toxins
free containing disea
i ernationaly, thatconsi tsofslowing
described
disease(PD)
Parkinsonsthat c, postural
impaired
and increased dopaminergic
ogiinitiation
movement
peurol
basal increased
disorder
a (Fig. reflexes.
(antMetieomet tmonoxide
(aAlntdiome-hypert oxygen
clopriacmi) de anti-psychoticParkinsonism tensiencephalitis
on) toxins virus,
Park
pARKINSON'S
is
DISEASE1t
S 1817. Mr the
in
cdegenerative
bOxer women.chroni
Itisa c
ganglia
in postural Common
e including
Parkinofsondiseasethedownslowing knownoccurs dówn(bradykinesia), denegat
the ofaccumulation to
Neuro nal
carbonio n mutGenetaAttiohicnseroscllikeerosis
exposure in
melanin
6.42)
(Fig. changes
dopamine
substantia
the
of
of portion
awhere
midbrain
the visible
isnigra
impaired
disease.affected
It than
basal causes,
section
Cut
James. isdisabilty.
Most Degeneration
of
oftneurons movement EtiolodigyopathiCManganese
the and infections Environment characteristic
a resattremor t
1S Headof
trauma
Excessive use Secondary
identifiable the
It
thfiosm are. ( and Chronic
men remor Viral zine
of
Loss
by the Fia
" "
 o th
f
neek shu constipation movemet
to m
lessofthe follows: movement,
of find tendon responses
and extreme blinking history
gravity
tryinglo dementia, inability while
and sweating, perceptual andandincoordination
exposure,to deep as
forward
forward flexion t of r
diminished
be of loW-pitched,
choking. examination
family rigidity,of mental
Assess
problems faster, hypotension, to frequency strength, slowness
forward
center changes--depression,transient Micrographia--small
hand
writing
thought riskand
and uncontrolled movement. and
bent body's changes-cognitive, of signs-tremor, -bend
gaithead faster Hypokinesia--abnormally todisabilities,
muscle abnormal
physical
phenomenon-a andslurred,drooling-risk
relatedneurological
and the
walk
the Other
Manifestations
orthostatic is
and
weaknessthe
Face-expressionless
Diagnostic
Evaluations disease-
Postural
Instability
with by under fall. and postural
changesof
postural knees
and
elbows sexual
dysfunction disability,
gait causedmay (Fig.
propulsive movement Dysphonia--soft, collection Bradykinesia,
stand 6.44)
gait)of and
hallucinations
patients reflex sluggishness Parkinson's
forwardrisk
patient bradykinesia to and Cardinal
Develop ExcessivePsychiatric
flushing, due Dysphagia, superficial
PatientPosture Increase
deficitsFreezing
Mental speech History physical
Physical
disease,
Thefeet active 6.44:
Fig.
" " "
"
Hyperkinetic
statemovement
disorders between calorie
symptom of
ACh ACh AChHypokinetic
stateParkinson's
disorders fingers, characterizes
to increase
active Rigidity
of like trunk,
arms sitting
affect supination/pronationlimbcog /stiffness (slightly).
heat, or release forward,
of voluntary neck,
Normal
state disease. pill predominantalso flexion/extension tongue. the lead-pipe
extremitycommon limbs: fromn
a
roling
of
sensationmay
cause
tightness stiffness,bent Movement)
(catch-release-catch
acetylcholine) movement upper bent e.g.,
Parkinson's
fingers/thumb, jaw, may in posture
rigidity knees
as passive body
if feet, referred engaged as legs, palms, movement movement,
as the anxious, thumb, extremity mostly
by ACh: fingersremain legs, and to felt mostlybowed, Slow activities
Inhibitory
neurotransmitter
DA DA
movements, limb the due
DA affects is face, tremor, into (Abnormally
of extremitypaintype,
dopamine; of arms, increments bed.
neurotransmitter
"Without
dopamine,
inhibitory walking,in tongue head active initiating
are
mechanisms the passivean
abduction/adduction legs,
type,
Ratchet-like turned
ganglia Brain may first of stiffness complete
C-movement
ontrols ganglia ganglia and against affect movement cogwheel
shouldersuperimposed
(lead-pipe)
posture,
in
andcomplex
usually turning
lost
’ "ExcesS
tone,
muscle
overstimulated
tremors
and
rigidity 6.43:(DA: tremor, muscle
rigidity
wheel
movement
anotherarms,
of
thumbs slowing
basal for when
some
years to jerky
"Basal
ganglia basal basal are unopposed’
Acetylcholine mouth may Involuntary in
Bradykinesia
Excitatory Fig. thumb Resistance of shoulders, to Difficulty
or
"Dopamine influencesof
excitatory the burning
RestingTremor
fingers. TremorCoarse, forearm, in
sign
movement Rigidity
Stiffness
movenment.
muscles, long
the the Neurons Rigidity Passive Plastic flexed, Overall position
legs, move when Early with
in in are
the Take
" of
270
DisordersNeurological with PatientManagementof Nursing
271
movements
symptoms
effects
side
Its
hydramantochlaodirnidee-reduce
tonin destroys stimulation
Nursing Management of Patient with Neurological Disorders
the
orswelling an of human thatabdomninal
implants
placed diet avoid prone,holdneck
movement as the B6antiparkinson
prescribed
action
the
of inhibitors
in aspect
dopamine
in sero thalamus generator soft
measuresdevices to and
increasevitamin
byIdopa-levodopa.antidepressants,
and
stimulator cells, is
involuntary ventral high-fiber client client
relief carbi
of ankle tremorS. electrical brainelectrode
neuronal or
sub-clavicular
walking
initiate
assistive
spine
rehabilitation
crisis
oxidase
dyskinesia shoes theposture the inhibit to in
to medications hyperten
like pulse safety Administer
anticholinergic
medications
short-term converted
relief. rigidity.
skin, to the
electricalthe
reduce of of through
Stimulator
Pacemaker
a high-protein, activities
mL/day
when position
to low-heeled
provide
forth proper
the
teaching
keep

high
of
foods
monoamine
the portion porcine chew with
control of symptom
m change, InalamotPallidotomy--destruction
omy--stereotactic
part disease
of
bradykinesia to
connected
subcutaneous and feedings along
2000 withand
and feet and by to and
and effects
antiparkinsonian
CNS avoid precipitat
mottling
purple
a may
ventrolateralpallidus
advanced tremors. status lift
facilitate
back
posture therapy
rigidity
is Tricyclic tremor of stimulation:
transplantation swallow for
constipation
Monitor back
independence wear
to mattress,the the the avoid
posturalBenadryl
provides It cells high-calorie, client
ambulation
to Surgical
Management Management to to
in blockto
(Larodopa):
Levodopa
producing stem and neurological intake
frequent rock client
to to and
reduceglobusrigidity, relieve
Anti-viral
e.g., client
dopamine
early-stage
in the prolongedin
client sitting pillow, behindphysical
Instruct
proper will
client
induced thalamus to acetylcholine
tremors
: andAntidepressants:
to
agents, Antihistamines:
inhibitors.
reuptake with and
brain in
a ability fluid rushingclient
the firm they they
the medications
the
Amantadine:
It when
hallucinations.
ganglia,
bradykinesia the to medial reduces
patient to implanted small,
Promote
with the Encouragea a hands Promote
Administer
because
(dyskinesia) cells used pouch ProvideIncrease Instruct Provide
Instruct without hecause
of Instruct Instruct
may
include of attempt Neural the NursingAssess
Assess treat
level
fetalDeepare
Assist
Avoid
mild
part the with the erect to
basal in It in
of " "
carbidopa-levodopa
suddenly
f lightheadedness
nausea, a injectable
form (Mirapex),
through are andand rasagiline ornauseainhibitors
mildly
the
duration
enzyme
It(Ongentys):
(Comtan)
and risk
downfrom trihexyphe-
(benztropine
movements the disease.
vomiting. Parkinson's
hallu-
such
impaired
urination.
constipa
dry
decreasing gait.PET-pyramidal,
cerebellar
or (PET)photon of to
(SPECT):
decrease towhich
chemical outside
early
dopamine. theenzyme
metabolizes (Entacapone
opicapone counteract
Degeneration
leads as increased
are
smaller
that
Handwriting
(pill
rolling) propulsive gel given effects gambling prevent
sleepiness result confusion,
single ganglia (Lodosyn),
carbidopa
dopamine administered brain is an
showsmidbrain medicationsa short-acting Itof blockingan
Increase enhanced
or
mainly impaired
is
natural (Neupro,side effects
are
headaches, levodopa.
and movements
progressively expression-masl-kiek
facies
and and tomography
)
ganglia.
converted
in pramipexole
medication
(Zelapar),
Its hallucinations,
helptheenzymne
hypersexuality, (COMT)
effects:
side
that
breaks
S
Anticholinergics
(Cogentin)
ornidyl):
nausea Itrigidity,
as
memory,
atrestfatigued
increasing
Tremors speaking of conversion
to
aLevodopa, Inhaled relief. It inhibiting by of involuntary
(dyskinesia),
diarrhea, with and
balance.
position, (Xadago): Catechol-0-mtemsnartlyhesaref
interrupted
sleep oral rotigotine
a
This therapy
tomography includewhen isIt
tremor,
cinations,
mouth
associated
fingers basal is quick (selegiline
becomes or is infusion: (Apokyn)
the include (MA0-B).
by ofaction
speechand
at hands
purposeful
Monotonous activitypacing
jerky
and and
swallowing
Difficulty
Restlessness. fcoordi
à
and
nation basaldopami
istooped
dopainvolvement
autonomi c
emiPoscomput
ssieitotheron theed
upt a
ofdepletionne. and hypotension.delivers
with
brain y
combined
day.
may helpful
the
intestine.
and
forness,as
such
dopamine
safinamide
Side

Its
dopamine.
levodopat
effect, the
control
inke
used
Akinesia steps,
and t
Tremors wiRithgidityfacialDrooling Shufscaniling emidopami
in
Management
nigra
dopa:
the
from
levodopa
protects
effects during Apomorphine
Carbidopa-levodopa
agonists
thatsmall
(Requip) headache
agonist
behaviors oxidase
B
monoamine
inhibitors
brain
Its of
levodopaacetylcholine
n neantia -levointo orthostatic
effect
in
with Blank ofLoss ssiosubst Carbidopa- Side available,
passes
Levodopa
is
is
it
working tube the
Dopamine light
and
of
dopamine.
the
le
to
helpeffects
MRI, o
CT brain. to
feeding
ropinirole
directly
dopaminecompulsive (Azilect)
patch). nausea,eatingMAO-B
breakdowninsomnia.
prolongs of
side
action
Uldin
that theand also stop Its
a
 bexercise,
e f \akeawNATImb
when
ore
fonh
carpeing,
dyspnea,
Tmucus
s
production,
breath obstructiye
fibrin
airways and
poor
ventilation up intection
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272 if
DisordersNeurological th Management
wiPatient or Nursing
275
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process, Nursing Management ofvaccinations
polyresponse
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the distal involvement: Clinical
Manifestation
hypotension, the sensations
at pain respiratory
myelin occurs, from (83%) impending usednearly heart
276
Pathophysiology cells, of is extremities but tenderness: cases
areflexia increase
progressive to of muscle abnormalities
muscle Sweating
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DisordersNeurological withPatientManagement
of Nursing
 Nursing Management of Patient with Neurological Disorders
278
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MYASTHENIA A
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ntibodies myoneural antibodies to assess urinary exercise e.g., strength
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of reduction for families in bony as needs
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