Chapter 50: nursing care of patients with peripheral nervous system disorders Flashcards
multiple sclerosis: pathophysiology
- degeneration of myelin sheath
- inflamed nerves
- slowed or blocked nerve impulses
multiple sclerosis: etiology
- unknown
- a possible autoimmune response
- possible viral infection
- heredity
signs and symptoms of MS
- muscle weakness
- numbness
- fatigue
- slurred speech
- vision disturbances
- vertigo
- ataxia
- dysphagia
- bowel/bladder problems
- sexual dysfunction
- mood alterations
disease progression
- relapsing remitting
- secondary progressive
- primary progressive
relapsing remitting (RRMS)
relapses that resolve
secondary progressive (SPMS)
patients may progress to symptoms not completely resolving after relapse
primary progressive (PPMS)
patients have progressive worsening of neurological condition throughout course of the disease
additional manifestations of MS
- remissions
- exacerbations: due to stress or illness
- immobility
- death usually from infection
diagnostic tests for MS
- history and physical
- CSF analysis
- MRI
therapeutic interventions for MS
- steroids
- interferon therapy
- immunosuppressant gents
- anticonvulsants
- muscle relaxants
- plasmapheresis
- physical, occupational, speech therapies
myasthenia gravis: pathophysiology
- antibodies destroy acetylcholine receptors
- Ach cannot stimulate muscle contraction
- loss of voluntary muscle strength results
etiology of myasthenia gravis
- unknown
- autoimmune
- thymus disorders
- possible viral origin
signs and symptoms of myasthenia gravis
- progressive muscle weakness
- fatigue w/ activity
- ptosis
- difficulty chewing, swallowing
- difficulty breathing
- remissions
- exacerbations: stress
complications for myasthenia gravis
- aspiration
- respiratory infection and failure
- myasthenic crisis
- cholinergic crisis: sludge
diagnostic tests for myasthenia gravis
- history and physical
- Tensilon test
- anti ach receptor antibodies
- electrop,&myography
therapeutic interventions for myasthenia gravis
- thymectomy
- anticholinesterase agents
- steroids
- plasmapheresis
nursing process of myasthenia gravis: activity intolerance
- teach methods to conserve energy
- teach avoidance of infection
- teach signs and symptoms of crisis
- teach medications to avoid
pathophysiology of Amyotrophic lateral sclerosis (ALS)
- also called Lou Gehrig’s disease
- motor neurons degenerate
- nerve impulse transmission blocked
- muscle weakness and atrophy
etiology of ALS
- unknown
- possible genetic predisposition
ALS signs and symptoms
- progressive muscle weakness and atrophy
- decreased coordination
- muscle spasm
- difficulty chewing and swallowing
- emotional lability
- speech difficulty
- pulmonary compromise
- death due to pulmonary complications
diagnostic tests for ALS
- history and phycal
- lumbar puncture w/ CSF analysis
- electroencephalogram
- nerve biopsy
- EMG
therapeutic interventions for ALS
- muscle relaxants
- Riluzole (Rilutek)
- physical, occupational, speech therapies
- pain control
- enteral feedings
- prevention of infection
- augmentative alternative communication
patient education for ALS
- support groups
- importance of avoiding infection
- teach family to provide care
pathophysiology of Guillain-Barre Syndrome
- inflammation of spinal and cranial nerves
- segmental demyelination in ascending pattern
- lymphocyte infiltration
- descending remyelination
etiology of Guillain Barre Syndrome
- unknown
- possible autoimmune response
signs and symptoms of guillain barre syndrome
- stage 1: 24 ours - 3 weeks
- stage 2: 2-14 days
- stage 3: 6-24 months
stage 1 Guillain Barre syndrome
- abrupt onset weakness and paralysis
- may affect respiration
- autonomic nervous system effects
stage 2 Guillain Barre syndrome
- plateau
- progression stopped
stage 3 Guillain
- recovery
complications of Guillain Barre syndrome
- respiratory failure
- infection
- depression
- pneumonia
- urinary tract infection
- complications of immobility
diagnostic tests for Guillain Barre syndrome
- lumbar puncture with CSF analysis
- EMG
- nerve conduction velocity
- pulmonary function testing
therapeutic interventions for Guillain Barre syndrome
- plasmapheresis
- oxygen
- mechanical ventilation
- emotional support
- rehabilitation
nursing care for Guillain Barre syndrome
- monitor vital capacity and arterial blood gases
- provide supportive care
- manage pain
- maintain nutrition
- assist w/ communication
- provide diversional activities
postpolio syndrome
- affects polio victims 10-40 years later
signs and symptoms of postpolio syndrome
- muscle weakness
- fatigue
- pain
- respiratory compromise
treatment for postpolio syndrome
rest
nursing diagnoses for neuromuscular disorders
- ineffective airway clearance
- impaired physical mobility
- impaired verbal communication
pathophysiology of restless legs syndrome
- dopamine and serotonin imbalance
etiology of restless legs syndrome
- kidney failure
- iron deficiency
0 diabetes - parkinson disease
- peripheral neuropathy
- family history
signs and symptoms of resrtless legs syndrome
- feeling of creeping crawly
- throbbing
- pulling
- pins and needles
- daytime fatigue
- insomnia
diagnosis for restless legs syndrome
- patient report of symptoms
- sleep history
- laboratory test for iron deficienc
- medication history
therapeutic interventions for restless legs syndrome
- application of heat or cold
- leg massage
- warm baths
- medications to control symptoms
- lifestyle modifications
lifestyle modifications for restless legs syndrome
- smoking cessation
- regular sleep schedule
- alcohol avoidance
- exercise routine
cranial nerve disorders
- trigeminal neuropathy
- bell palsy
trigeminal neuralgia pathophysiology
- irritation of the trigeminal nerve
- affects sensory portion of nerve
etiology of trigeminal neuralgia
- irritation or chronic compression
signs and symptoms of trigeminal neuralgia
- intense pain on one side of face: forehead, cheek, nose, jaw
- triggered by touch, talking, other stimulation
diagnostic tests for trigeminal neuralgia
- history and physical
- computed tomography scan
- MRI
therapeutic interventions for trigeminal neuralgia
- anticonvulsants
- nerve blocks
- surgery to block pain signals
bell palsy pathophysiology
- inflammation and edema of facial nerve
- loss of motor control
bell palsy etiology
unknown
signs and symptoms of bell’s palsy
one sided facial:
- pain
- weakness
- speech difficulty
- drooling
0 tearing o eye
- inbility to blink
bell palsy diagnostic tests
- history and physical
- EMG
- rule out stroke
bell palsy therapeutic interventions
- prednisone
=- analgesics - antiviral medication
- moist heat
- gentle massage
- facial sling
nursing diagnoses for cranial nerve disorders
- acute pain
- imbalanced nutrition
- risk for injury to eyes (bell palsy)
the LPN will…
- use transfer assistive devices
- assist in the care of a client experiencing sensory/perceptual alterations
- assure availability and safe functioning of client care equipment
- evaluate the appropriateness of HCP order for client
- reconcile and maintain medication list or medication administration record
