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
diagnosis of parkinsons
-no specific tests
-diagnosis based solely on hx and clinical features
-firm dx can be made when bradykinesia is present and at least two of the following characteristics: limb muscle rigidity -resting tremor or postural instability
what is bradykinesia
-slowing down in initiation and execution of movement
-evident in loss of autonomic movements
-blinking, swinging arms while walking, swallowing saliva, facial movement, minor postural adjustment
tremor with parksinsons’
so minimal only the client may notice it
-more prominent at rest and is aggravated by emotional stress or inc concentration
-decsribed as “pill rolling”
-benign essential tumor, which occurs during voluntary movement, has been misdx’d as PD
rigidity with parkinson’s
rigidity is typified by a jerky quality when the joint is moved “like cranking a gear”
increased resistance to passive ROM when limbs move
-caused by sustained muscle contraction and consequently elicits the following
-inhibits the alternating contraction and relaxation in opposite muscle groups thus slowing movement
nonmotor symptoms of parkinson’s
-depression, anxiety
-apathy
-fatigue
-pain
-constipation
-impotence
-short term memory impairment
-sleep problems
comorbidites as a result from parkinson’s
dysphagia->may cause malnutrition and aspiration
may cause pneumonia, UTI’s skin breakdown
-orthostatic hypotension
-falls/injuries
medical management of parkinson’s
-controlling symptom’s
-maintaining functional indepence
-pharmacologic management
pharmacologic therapy for parksinson’s
-dopaminergic agent’s
-anticholinergic agents
-COMT inhibitors
-MAO inhibitors
-initally only 1 is used, combination tx is needed as disease progresses
excessive dopaminergic drugs can lead to
paradoxical intoxication
surgical therapy for parkinsons
-procedures aimed at reliving symptoms
-used in clients who are usually unresponsive to drug therapy or have developed severe motor complications
deep brain stimulation for parkinsons
-involved placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus
-connected to a generator placed in the upper chest
-device is programmed to deliver specific current to targeted brain location
management for parkinson’s
-exercise/ambulation
-self care
-nutrition
-adequate chewing
-psychosocial support
nonpharmacologic managment for parkinsons
-physical exercise and a well-balanved diet
-limit consequences of dec mobility
-specific exercises to strengthen muscles involved w speaking and swallowing
-teach maintenance of good health, independence, avoid complications
