Indendent Study Flashcards
- 25,000/yr
- Females more than males
- Age 20 - 40
- Risk increases with family history
- Seen during pregnancy/during labor
- Families carry genetic defect
- Only occurs in certain climates
- Where one lives determines the risk of getting the disease
Etiology/predisposing factor MS
Primarily affecting the white matter/CNS
• s&s depend on location
•Inflammation destroys myelin sheath
•Plaques of sclerotic tissue
MS
1st exacerbation is asymptomatic
• Flu like s/s for 2-3 days – no numbness, no tingling
• 1 – 5 years pt exacerbates again for 3-4 days
• Pt feels sick with increase WBC
• Antibodies begin to attack myelin sheath
• Holes in myelin sheath
• Current is lost through holes
• During remission there will healing to nerve
• Appears to be multiple plaque AKA multiple sclerosis plaque find on nerve myelin
MS
- Optic nerve
- Chiasms and tracts
- Cerebrum
- Brain stem
- Cerebellum – a big area to be found in
- Spinal cord
- Found in myelin sleeve with sclerotic patches
- Affect all area in brain
- MS drug Avonex, drug that works best $1,000 a dose
Areas of the CNS Affected
• – What disease does to body
o Double vision
o Clumsiness
o Ataxia
1 Clinical manifestations of MS
– complication related to it o Foot drop o Immobility o Constipation/UTI/skin breakdown o DVT/Pneumonia
Secondary Clinical manifestations of MS
o Loss of employment – lose job within 10 years
o Loss of independence
o Divorce Due to emotional peak/instability
▪ Due to breakdown of frontal lobe, causing impulsiveness and inappropriate behavior
Tertiary clinical manifestation of MS
- visual problems
- blurred, double-vision
- memory deficits
- personality changes
- depression
- seizures
- hemiparesis
Cerebral Syndrome
- fatigue
- paresthesia
- bowel/bladder problem
- foot drop
- heat intolerance (Uhthoff’s sign)
- shooting/shock like pain
- spasticity
Spinal Syndrome
is a condition most commonly observed multiple sclerosis and particularly in Optic Neuritis where small increases in body temperature (hyperthermia) caused by exercise, hot baths or showers or otherwise, cause a worsening of symptoms.
• Shooting /shock like pain
• Spasticity
• Pt is unable to experience heat or cold
• If pt gets to hot or cold they will exacerbate their disease
• Putting a patient in hot tub will create enough of a stress to create another exacerbation
• Pt should be careful with their environment, pt’s water should be warm not hot
Uhthoff’s symptom
•altered proprioception •↓motor coordination •ataxia/loss of balance •spastic paralysis •muscle spasm •intentional tremors With closed eye patient will fall over • Intentional tremors – developed tremors when they are going to pick something up • Tremor gets worst all the time
Cerebellar Syndrome
CN- #3 and 12
•slurred speech
•eye pain
•nystagmus
Brain Stem Syndrome
• Corticosteroid o Methylprednisolone – same as RA o Iv dose for 3 days o Followed by 6 weeks of oral prednisome o Prednisone • Immunostimulants (ABC&R) o Avonex IM q wk – keep in remission o Bestaseron SC QOD – immune stimulants o Copaxone SC qam – immune stimulants
MS pharmacology
- Use adaptive equipment
- Moderate activity with rest periods
- Avoid stress
- Exercise – walking, biking, swimming
- Intense exercise will exacerbate, due to emotional liability pt might engage in intense exercise
- Gait training
- Visualize extremities
- Paint steps – provide fluorescent lit steps - less likely to fall
- Use thermometer to test water – as disease progresses pt develops neuropathies, no feeling in finger tip and toes
MS NURSING INTERVENTION
- Voiding schedule
- Intermittent self cath
- Decrease risk for UTI – watch for UTI
- Depends
- We do post-void residual
- Use bladder scan to determine how much is in there
- Known to have urinary retention
- Urine retention is 50cc found in bladder post voiding
- Begin cath when 250cc is left in bladder after voiding
- Seen towards end of disease
- Toward end pt will get urostomy in abdominal wall so pt can place cath directly into abodomen rather then ureter
Altered Urinary elimination
slowly, progressive disorder of movement
•degenerative changes
•basal ganglia region
•substantia nigra- destruction of neurons
•dopamine production decreases over time
•results in imbalance of neurotransmitters that affects voluntary movement
Parkinson’s
50,000 new cases/year
•men more common
•ages 40 - 70
•1% of population has Parkinson’s
•Hispanic/Latinos/Whites highest incidence
•gradual onset
•symptoms progress slowly over a prolonged course
Parkinson’s
- genetics
- atherosclerosis
- viral infections
- head trauma
- chronic antipsychotic meds
- environmental exposures
Parkinson’s risk factors
tremor,
ridgidity,
bradykinesia,
and postural instability
4 Classic Signs:
- slowness of movement
- freezing phenomenon
- shuffle
- micrographia
- dysphonia
Bradykinesia
- Aspiration – when eating
- Respiratory infection
- UTI
- Injury
- Skin breakdown
- Pt run risk of being ABC pt
- Disabling disease which leads to death
Parkinson’s Complications
- Pet Scan – evaluate levodopa
- SPECT
- CT/MRI
- Urine/CSF – decreased homovanillic acid (abnormal breakdown of dopamine)
- Non of these will diagnose parkinsons,
- To diagnose: all pieces are put together, symptoms, complaints, diagnostic
Parkinson’s diagnosis
- 0 = no sign of disease
- 1 = unilateral disease
- 2 = bilateral disease without impairment of balance
- 3 = mild/moderate bilateral with postural instability
- 4 = severe disability but able to stand and walk
- 5 = wheelchair = dependent or bedridden
1- 2 = Start with cogentin, - drug to reduce tremors
2- 3 = sinemet (cardopa-levodopa)– the problem with
Unified Parkinson Disease Rating Scale
Risk for aspiration o Semisolid diet o Chin tuck o Be careful with liquid o Perform swallowing test o No crumbly food o Check mouth frequently for residue o Might have to put GI tube • Impaired physical mobility o Postural/balance exercises • Self care deficits • Impaired verbal communication
Nursing Diagnosis for Parkinson’s
