DEMYELINATING DISESASES Flashcards
Cause of MS
*Unknown
*Autoimmune
*Demyelination of CNS (Myelin & Oligodendrocytes)
Multiple factors of MS
Viral infection
Genetic Predisposition
MS is common in
Women ages 20-40
Dx tests for MS
MRI -primary
CSF Immunoglobulin G
MS results from progressive demyelination of the —- and —– leading to widespread neurologic dysfunction
white matter of the brain and spinal
cord
The structures usually involved in MS
Optic
Oculomotor nerves
Spinal nerve tracts
Myelin sheath that wraps around the axon is destroyed by
inflammation and scarring
TYPES of MS
*Clinically isolated syndrome (CIS)
*Relapse-remitting MS (RRMS)
*Primary progressive MS (PMS)
*Secondary Progressive MS (SPMS)
This is a single , first episode. with symptoms lasting at least 24 hours
Clinically isolated syndrome (CIS)
This episodes of new or increasing symptoms, followed by periods of remission, during which symptoms go away partially or totally.
Relapse-remitting MS (RRMS)
Symptoms worsen progressively, without early relapses or remissions. Some people may experience times of stability and periods when symptoms worsen and then get better.
Primary progressive MS (PMS)
At first, people will experience episodes of relapse and remission, but then the disease will start to progress steadily.
Secondary Progressive MS (SPMS)
S/sx of MS
Nystagmus
Diplopia
Dysarthria
Dysphagia
Urinary retention
Spastic bladder
Constipation
The most common areas affected in MS are
Optic nerves and chiasm
Cerebellum
Cerebrum
Spinal cord
Medications for MS
*Corticosteroids
*Interferon beta-1a or interferon beta-1b
*Chlordiazepoxide
*Baclofen/Dantrolene
*Bethanechol or oxybutynin
med to reduce edema and inflammation of myelin sheath
Corticosteroid (Corticotropin, prednisone, dexamethasone)
med to decrease the frequency of relapses
Interferon beta-1a or interferon beta-1b
med to mitigate mood swings
chlordiazepoxide
med to relieve spasticity
Baclofen or dantrolene
med to relieve urine retention and minimize urinary freq and urgency
Bethanechol or oxybutynin
Nrsg intervention for MS
Exercise
Wheelchair
Aspiration precaution
Eye patch
Warm packs
Stress mgt.
Speech therapist
is an acute
autoimmune disease marked by inflammation
of the peripheral nerves, affecting arms and legs
GBS
involves destruction of the myelin sheath surrounding largest, most myelinated
sensory and motor fibers, resulting in disrupted
proprioception and weakness.
GBS
is a rare disorder in which body’s immune
system attacks nerves and causes damage to the peripheral nerves.
GBS
often causes muscle weakness, cause paralysis and sensitivity problems, including
pain, tingling or numbness
Nerve injury by GBS
Cause of GBS
unknown origin commonly follows viral infection
s/sx of GBS
*Demyelination of PNS (myelin only, intact Schwann cells thus
allowing recovery)
*Ascending weakness and paralysis
*diminished reflexes of the lower extremities
*paresthesia
*potential respiratory failure
a result of a cell-mediated immune attack on peripheral nerve myelin proteins.
GBS
contains an amino acid that mimics the peripheral nerve myelin protein
Infectious organism
is the most likely target of the immune attack.
GM1b
cause inflammation and destruction, and leave the axon unable to support nerve conduction
an influx of macrophages and other immune mediated agents that
attack myelin
Clinical features of gbs
*pain in muscles
*Weakness of muscle
*onset is gradual and progresses over days or weeks
*Usually begins in the lower extremities and progressively involves the trunk, the upper
limbs, and finally the bulbar muscles (Landry ascending paralysis)
*Respiratory insufficiency due to intercostal and diaphragmatic muscle paralysis
*dysphagia and facial weakness
*Papilledema
*Oculomotor and other cranial neuropathies
Nrgs mgt for GBS
*CPT
*Prevent complication of immobility
*Improve communication
Medical mgt for GBS
*ICU admission
*Mechanical Ventilation
*PLASMAPHERESIS
*TPN and IVF
*IV IMMUNOGLOBULIN
Chronic, progressive &
degenerative brain disorder
Alzheimer’s disease
Profound effects on memory, cognition & ability for self care
Alzheimer’s disease
Causes and potential factors of AD
Unknown
Amyloid plaques in the brain
Other causes of AD
degeneration of brain neurons especially in the
cerebral cortex
presence of neurofibrillary tangles
plaques containing beta-amyloid cells.
It is a chronic, irreversible disease that affects the cells of the brain and causes impairment of intellectual functioning.
Alzheimer’s Disease
Alzheimer destroys ability to
reason, remember, imagine, and learn.
Alzheimers disease attacks
nerves and brain cells
as well as neurotransmitters.
The destruction of these parts causes clumps of
protein to form around the brain’s cells. These
clumps are known as
plaques and Bundles
10 Warning Signs of
Alzheimer’s disease
*memory loss
*difficulty to perform familiar tasks
*problems with language
*disorientation to time and place
*Poor or decrease judgment
*Problems with abstract thinking
*Misplacing things
*Changes in mood or behavior
*Changes in personality
*Loss of initiative
Clinical Manifestation of AD
Amnesia – loss of memory
Apraxia – unable to determine function & purpose of object
Agnosia – unable to recognize familiar object
Aphasia
LATE CLINICAL
MANIFESTATION
S of AD
Difficulty in abstract thinking
Difficulty communicating
Severe deterioration in memory, language
and motor function
personality changes
DIAGNOSTIC TEST OF AD
No definitive examination
Brain scan could help
Confirmatory test?
Autopsy results
Drug therapy OF AD
Acetylcholinesterase inhibitors-
prevent the breakdown of acetylcholine, a chemical messenger
important for learning and memory
Acetylcholinesterase inhibitors-
Example of Acetylcholineterase
Donepezil (Aricept)
tacrine HCl (Cognex)
Rivastigmine (Exelon)
Galantamine (Razadyne)
it is a compound
that binds to soluble amyloid-beta
peptide and inhibits the formation of neurotoxic aggregates that leads to
amyloid plaque deposition in the brain
Anti-amyloid therapy-
Anti-amyloid therapy-
tramiprosate (Alzhemed)
Nursing Interventions:
Use short simple sentences, words and gestures
Maintain a calm and consistent approach
Keep bed in low position
Provide adequate lightning
