class 12 multiple sclerosis & parkinson's Flashcards
what is multiple sclerosis
chronic inflammation, demyelination and scarring of the CNS
what causes multiple sclerosis
-unknown
-could be: immunological, infectious, genetic, dietary
pathology of multiple sclerosis
-activated T-cells migrate to CNS, causing blood brain barrier disruption
-subsequent antigen-antibody reaction leads to demyelination of axons
MS disease process consists of:
-loss of myelin
-disappearance of oligodendrocytes
-proliferation of astrocytes
-changes result in plaque formation (seen on MRI)
-plaques scattered throughout CNS
relapsing remitting MS
has a MS relapse after diagnosis
-full recovery after relapse
primary progressive MS
every relapse the MS gets worse
-continues to be more disabled after each exacerbation (no recovery after relapse)
secondary progressive MS
relapse & progression are more frequent and quicker
progressive relapsing MS
causes steady damage to nerves when symptoms first appear and continues to cause progressive worsening
what group is MS typically seen in
women ages 20-40
diagnostic studies for MS
-history
-clinical manifestations
-MRI (for plagues)
-cerebral spinal fluid (CSF) analysis (inc oligoclonal immunoglobulin G, inc # of lymphocytes, monocytes, and proteins)
-evoked potentials
-NO definitive dx test
motor manifestations of MS
-weakness or paralysis of limbs, trunk, and head
-tremors/spasms
-positive babinski
-diplopia
-scanning speech
-unsteady gait
sensory manifestations of MS
-numbness and tingling
-patchy blindness (scotoma)
-blurred vision
-vertigo and tinnitus
-dec hearing
-chronic neuropathic pain
-lhermitte’s sign
cerebellar manifestations of MS
-nystagmus
-ataxia
-dysarthria
-dysphagia
-severe fatigue
-cranial nerve impairment
bowel and bladder function with MS
-constipation
-incontinence
-spastic bladder (freq, small urination)
-flaccid bladder (distended bladder w no urge)
respiratory function with MS
-diminished cough reflex
-respiratory infections
goals of treatment with MS
-delay the progress of the disease
-manage chronic symptoms and maintain quality of life
-treat exacerbations
drug therapy for MS
-steroids (first line)
-immunosuppressive
-immunomodulators
-antidepressants
-CNS stimulants
-anticholinergics
-cannabinoids
nonpharmacologic treatments for MS
physiotherapy
relieve spasticity
improve coordination
train client to substitute unaffected muscles for impaired muscles
-exercise
-nutritious well-balanced diet high in roughage
nursing care for MS
-maximize neuro-muscular function
-maintain independence in ADL’s
-manage disabling fatigue
-optimize psychosocial well-being
-adjust to illness
-identify triggers
what is Parkinson’s disease
-disease of basal ganglia
-affects motor ability
-diagnosis increases with age, with peak onset in the sixth decade
-more common in men, slow progression
characteristics of parkinson’s disease
-slowing down in the initiation and execution of movement
-inc muscle tone
-tremor at rest
-impaired postural reflexes
risk factors for parkinson’s
-advancing age
-male>female
-family hx
-environmental factors
-exposure to toxins
pathophysiology of parkinsons
-associated with degeneration of dopamine-producing neurons in substantial nigra of the midbrain
-normal function requires balance b/t acetylcholine & dopamine in basal ganglia
-any shift balance creates parkinsonism symptoms
manifestations of parkinsons
onset is gradual and insidious
-classic triad: tremor, rigidity, bradykinesia
-“pill rolling” finger motion
