Aphasia
Aphasia: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
Aphasia is an impairment in expressing or comprehending written or spoken language. It generally reflects disease or injury to the brain’s language centers. (See Where language originates, page 26.) Depending on its severity, aphasia may slightly impede communication or may make it impossible. It can be classified as Broca’s, Wernicke’s, anomic, or global aphasia. Anomic aphasia eventually resolves in more than 50% of patients, but global aphasia is usually irreversible. (See Identifying types of aphasia, page 27.)
Act Now: Quickly look for signs and symptoms of increased intracranial pressure (ICP), such as pupillary changes, decreased level of consciousness (LOC), vomiting, seizures, bradycardia, widening pulse pressure, and irregular respirations. If you detect signs of increased ICP, insert a urinary catheter to prevent bladder rupture and then administer mannitol I.V. to decrease cerebral edema. In addition, make sure that emergency resuscitation equipment is readily available to support respiratory and cardiac function, if necessary. You may have to prepare the patient for emergency surgery.
Assessment
History
A history will probably need to be obtained from the patient’s family or companion because of the patient’s impairment. Determine if the aphasia is new or when it began. Determine if the patient has a history of headaches, hypertension, seizure disorders, or drug use.
Physical examination
Perform a complete neurologic examination. Take the patient’s vital signs and assess his LOC. Be aware, though, that assessing LOC is commonly difficult because the patient’s verbal responses may be unreliable. Assess the patient’s pupillary response, eye movements, and motor function, especially his mouth and tongue movement, swallowing ability, and spontaneous movements and gestures. To best assess motor function, first demonstrate the motions and then have the patient imitate them. Don’t give liquids to drink until ordered due to the risk of aspiration.
Also, recognize that dysarthria (impaired articulation due to weakness or paralysis of the muscles necessary for speech) or speech apraxia (inability to voluntarily control the muscles of speech) may accompany aphasia; therefore, speak slowly and distinctly, and allow the patient ample time to respond. Check for obvious signs of neurologic deficit, such as ptosis or fluid leakage from the nose and ears.
Pediatric pointers
Recognize that the term childhood aphasia is sometimes mistakenly applied to children who fail to develop normal language skills but who aren’t considered mentally retarded or developmentally delayed. Aphasia refers solely to the loss of previously developed communication skills.
Brain damage associated with aphasia in children most commonly follows anoxia — the result of near-drowning or airway obstruction.
Geriatric pointers
Pre-existing diseases, such as dementia (Alzheimer’s type, vascular, or others) or previous stroke may make it more difficult to assess the patient for aphasia.
Medical causes
Alzheimer’s disease
With Alzheimer’s disease, a degenerative disease, anomic aphasia may begin insidiously and then progress to severe global aphasia. Associated signs and symptoms include behavioral changes, memory loss, poor judgment, restlessness, myoclonus, and muscle rigidity. Incontinence is usually a late sign.
Brain abscess
Any type of aphasia may occur with brain abscess. Usually, aphasia develops insidiously and may be accompanied by hemiparesis, ataxia, facial weakness, and signs of increased ICP.
Brain tumor
A brain tumor may cause any type of aphasia. As the tumor enlarges, other aphasias may occur along with behavioral changes, memory loss, motor weakness, seizures, auditory hallucinations, visual field deficits, and increased ICP.
Creutzfeldt-Jakob disease
Creutzfeldt-Jacob disease is a rapidly progressive dementia accompanied by neurologic signs and symptoms, such as myoclonic jerking, ataxia, aphasia, vision disturbances, and paralysis. It generally affects adults ages 40 to 65.
Encephalitis
Encephalitis usually produces transient aphasia. Its early signs and symptoms include fever, headache, and vomiting. Seizures, confusion, stupor or coma, hemiparesis, asymmetrical deep tendon reflexes, positive Babinski’s reflex, ataxia, myoclonus, nystagmus, ocular palsies, and facial weakness may accompany aphasia.
Head trauma
Any type of aphasia may accompany severe head trauma, which occurs suddenly and may be transient or permanent, depending on the extent of brain damage. Associated signs and symptoms include blurred or double vision, headache, pallor, diaphoresis, numbness and paresis, cerebrospinal otorrhea or rhinorrhea, altered respirations, tachycardia, disorientation, behavioral changes, and signs of increased ICP.
Seizures
Seizures and the postictal state may cause transient aphasia if the seizures involve the language centers.
Stroke
The most common cause of aphasia, stroke may produce Wernicke’s, Broca’s, or global aphasia. Associated findings include decreased LOC, right-sided hemiparesis, homonymous hemianopia, paresthesia, and loss of sensation. (These signs and symptoms may appear on the left side if the right hemisphere contains the language centers.)
Transient ischemic attack (TIA)
A TIA can produce any type of aphasia, which occurs suddenly and resolves within 24 hours of the TIA. Associated signs and symptoms include transient hemiparesis, hemianopia, and paresthesia (all usually right-sided), dizziness, and confusion.
Nursing considerations
Maintain reality by frequently explaining what has happened, where the patient is located and why, and what the date is. Later, expect periods of depression as the patient recognizes his disability. Facilitate communication by providing a relaxed, accepting environment with a minimum of distracting stimuli. Prepare the patient for a psychiatric consultation if the depression becomes debilitating or is demonstrated by personality changes.
When you speak to the patient, don’t assume that he understands you. He may simply be interpreting subtle clues to meaning, such as social context, facial expressions, and gestures. To help avoid misunderstanding, use nonverbal techniques, speak to him in simple phrases, and use demonstration to clarify your verbal directions.
Remember that aphasia is a language disorder, not an emotional or auditory one, so speak to the patient in a normal tone of voice. Make sure that he has necessary aids, such as eyeglasses or dentures, to facilitate communication. Refer the patient to a speech pathologist early to help him cope with his aphasia.
Patient teaching
Carefully explain diagnostic tests, such as skull X-rays, computed tomography or magnetic resonance imaging, angiography, and electroencephalography. Explain the related effects of aphasia to the patient and his family, such as possible depression or the use of profanity.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Apraxia (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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