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Basic info about MS
- Pathology
- autoreactive t-cells-->attack cns-->antigen/antibody rxn-->^inflamatory response-->demylenation of axons-->plaque formation replaces myleon sheath-->sclerois/inablity of axon to conduct elecrtrical impulse.
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aggrivating factors in ms
- undue ratigue or exertion
- overheating
- infection
- hot baths
- fever
- emotional stress
- preggers. need to discuss with primary care to weigh options before deciding to become preggers.
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SnSs of MS
- weakenss of LE's
- parasthesia
- loss of vision
- poor coordination
- bowel or bladder dysfunciton
- seizures
- emotional lability
- sexual dysfucntnion
- Uhtoff's sign?
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Diagnostics for MS and collaborative care
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Parkingosn's
- affects basal ganglia, specifically dopamine production in substantia nigra-->^ muscle rigidity-->v skeletal muscle activity
- SnSs
- tremor at rest
- bradykinesia/akinesia (slow movement/frozen movement)
- loss of postural respones
- mask-like face
- excessive drooling
- slow speech
- ans manifestations, ie excessive and uncontrolled sweating, sebaceous secretions, salivation, constipation, urinary incontincence, lacrimation
- demenetia
- depression
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Rx for parkinson's
- sinement (levodopa, carbidopa)
- levodopa: precursor to dopamine
- carbidopa: inhibits enzyme that breads down levodopa
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Diagnostics/collaborative care of parkinson's
- H/P
- presence of classic triad, ie tremor, muscle regidity, bradykinesea/akinesea.
- positive response to antiparkinsonian rx
- Intervension:
- Rx
- Nutrition
- Surgery
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Nursing Intervensions
- Promote physical exercise
- well-balanced diet, massive effort for movement-->^ caloric needs.
- pt/ot consultations
- monitor for levodopa OD
- assess ADLs
- appropriate referrals for equipment
- supportive care
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Myasthenia gravis
- progressive autoimmune diesease producing severe muscluar weakness due to antibodies destroying AChl receptors.
- Women 20-40 most ast risk
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SnSs of Myasthenia gravis
- skeletal muscle weakness
- fatigue
- weakness of eye closure
- ptosis
- dysphagia
- dysarthria
- mask-face
- bobble head
- respiratory distress
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Management of Myasthenia gravis
- diagnostics:
- h/p
- emg
- tensilon test: Rx given to keep Ach in synapse longer. if pt responds positively, then + myasthenia gravis
- ana titer: checks for presence of antibodies for ACh.
- Rx:
- anticholinesterase drugs
- corticosteroids (antiinflamatory)
- immunosupptressants (slows progression of disease)
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Nursing care of Myasthenia gravis
- aspiration risk?
- respiratory status, ie MG crisis. treated with mestinon
- cholinergic crisis, ie drooling, constricted pupils, PNS symptoms. get worse with tinselon. Treated with atropine.
- Dysphagia?
- Nutrition/fluid status
- TCDB
- Semi-Fowler's position
- Thickened liquids
- Teaching
- Referal to MG Foundation
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Amyotrophic Lateral Sclerosis
Lue Gerig's disease
- Degenerative progressive disorder with loss/death of motor neurons within brain and spinal cord
- dead motor neurons do not transmit impusles to motor neurons
- cognition is intact
- leads to death from diagnosis in 2-6 years
- men more at risk than women.
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ALS pathophys and SnSs
Test
- Unknown etiology, no cure.
- weakness of upper extremities
- dysarthria
- dysphagia (have suction ready at bedside)
- weakness in legs
- respiratory nfxn/failure (late stage)
- Rx:
- Riluzole: only Rx available. decreases glutameat and slows progression.
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Huntington's disease
- genetic autosomal dominant degenerative neurologic disease.
- 50% chance to pass to offspring.
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Pathophys of Huntington's
- destruction of neurons in the basal ganglia and extrapyramidal tracts-->v ACh and GABA-->^ Dopamine.
- ^Dopamine-->SnSs opposite that of Parkinson's, ie exadurated writhing and uncontrolable movement of face and limbs.
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SnSs
- Chorea (diskinesiea)
- emotional disturbances
- mental deterioration
- intellectual
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Rx for Huntingtons
- terabenazine
- haldol, diazepam, other anti-deressants/psychotics
- Nursing management:
- communication
- nutrition
- emotional support
- injury prevention
- ethtical dilemma, ie genetic testing and procreation.
- need~5000 calories/day diet to suppor dyskinesia.
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Guillain-Barre syndrome
- ascending polyneuropathic paralysis
- inflammatory disease, unknown etiology
- loss of transmission of nerve impulses to periphery
- diagnotsics
- --presentation, LP, EMG.
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SnSs of guillain -barre
- 1-3 weeks post uri/gi nfxn
- ascending bilat weakness
- pain-->narcotics. pain is neuropathic.
- respiratory failure, uti, immobility.
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Collaborative care for GB
- supportive care, steroids, may need to be intubated, npo, vented.
- plasmapheresis
- IV immunoglobulin
- nutrition
- 89-95% recovery rate
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Assessment of pt w/GB
- neuro checks
- lung sounds
- airway
- pain
- bowel/bladder fnxn
- immobility-->dvt, skin breakdown, PNA
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