Wilson's Disease: Neurological and other Symptoms (Nursing)

00:00 All right. Now we're looking at neurological more like the CNS part of it.

00:05 So I want you to always remember mood and movement.

00:09 So go ahead and just write that in on your slide again because I want you to reinforce that in your own brains.

00:14 Now it's a wide range of symptoms but if I can get you to remember that Wilson's disease affects mood and movement.

00:22 That's a win.

00:23 Now I'm going to explain some of the other things some of the stranger things if you're a fan of what happens in mood and movement.

00:30 So Dysarthria, it's difficult, they can't control it, they've got other disorders.

00:35 So your patient may explain to you, I feel kind of clumsy or I kind of trip over things or I don't seem to be able to control my body like I normally can, that is a key sign to you.

00:46 Now, they might have some other things that will seem a little weird like drooling that's going to be a really obvious sign.

00:53 What I'm most interested you keeping in mind is movement that's going to be a problem for the patient.

00:59 They notice a change and their ability to control their body.

01:03 Now it can also give them horrific headaches.

01:06 They can have problems with finding words or their speech changes, maybe something similar to what you would see in a stroke but most importantly mood and movement.

01:18 If you want to put one more piece on there, you can add changes in like LOC, they've got problems with trying to remember things, they can't find the right words almost like the early the signs of a stroke.

01:34 Now we're talking about the mood part, but I would again write down mood and movement because Wilson's equals liver plus mood and movement disorders.

01:44 Now this can range all over the map, okay? Depression, difficulty sleeping, personality changes, the mood swings can be more than just depression, they might be all over the map like we say.

01:57 This could give them problems in their job, in their school and definitely in their relationships.

02:03 So when you're thinking about Wilson's disease, you know, it's a disorder of the liver and you end up with problems with mood and movement.

02:12 Okay, you're doing great.

02:14 Just hang in there with us.

02:16 Here's a fun one, take a look at that one blue eye.

02:20 I always was jealous of the people that had blue eyes because I think they're so beautiful.

02:26 But nobody with these beautiful blue eyes wants a Kayser-Fleischer Ring.

02:31 Okay, we remember in the very beginning of the video, we talked about how it can deposit in the liver, in the brain, and in the cornea, well, this is what it would look like in your patient.

02:42 Do you see that dark ring that encircles the iris of the eye? That's actually excess copper being deposited there, right? That is bizarre looking but if you see someone like this, they really need to have a follow-up.

02:57 You see I can't see it in their brain, I can't see it in their liver, I can only see symptoms, but I can sure see that in someone's eye.

03:07 That's why they're called Kayser-Fletcher Rings.

03:10 And those are actually copper deposits right in the eye.

03:13 Now we've got a bunch of other signs and symptoms and I know this is just a random list.

03:19 I recommend on this list you can just review it but this isn't where I would invest my time.

03:25 This is just a way to prove to yourself, that wow, the signs and symptoms can be all over the map and that's why it's so hard to Us because bluish discoloration of the nails can be any number of things right? Kidney stones, your bones are prematurely osteoporotic.

03:40 So they're not dense. You have arthritis, You've menstrual irregularities, you have low blood pressure, These are just simply too vague for you to memorize.

03:49 Now If you are working up a patient's for Wilson's disease you would absolutely look these up but it's not worth the precious real estate that's in your brain.

03:58 See here's the cool part.

04:00 When it comes to diagnosis particularly the in initial diagnosis, the disease is kind of hidden in a lot of weird vague symptoms.

04:08 So it takes a whole team effort.

04:11 That's why we've put members of all the healthcare team and the patient on this slide to remind you takes all of us working together and nurses are particularly great at getting strong, solid accurate histories from their patients, through our conversation that the patient will feel comfortable and feel casual, but we're really have a direction and a goal of getting accurate information from them.

04:38 So symptoms can present like other health issues.

04:41 That's what makes it so tricky, so it could look like things like hepatitis C or cerebral palsy if they've got the movement problems or heavy metal poisoning because obviously they have copper that's building up.

04:53 So it's kind of like an episode of House.

04:55 This is everybody working together to try to identify what really is the bottom line problem with your patient.

05:02 So the healthcare team needs to do a complete very complete and thorough history, then the healthcare provider will take input from the patient, from the other members of the team, and look at a bunch of tests to help us look for damage caused by copper accumulation.

05:18 Okay so you're with us? We've talked about Wilson's disease is instead of those pathways that are created by age one, functioning well or even not there at all, we've got copper building up.

05:30 Now it's going to build up in three main areas: my liver, my brain and actually in the eye.

05:38 Now the symptoms predominantly fall into, liver disorder symptoms, and mood and movement because of the deposits in my brain.

05:49 So we're going to be getting information on all those areas and looking at additional tests and lab work to come up with a diagnosis of Wilson's disease.