Neurological Disorders - The Brain & Spinal Cord

Question 1

Multiple Sclerosis - Pathophysiology

Answer 1

• Chronic disease characterized by demyelination & axonal nerve damage
  > immune mediated
  > women greater than men; 25-35yrs olf

Question 2

Multiple Sclerosis - Risk Factors

Answer 2

• Viruses: Epstein-Barr virus
• Genetic predisposition

Question 3

Multiple Sclerosis - Types

Answer 3

• Relapsing-remitting (85%)
• Primary Progressive
• Secondary Progressive
• Progressive-relapsing

Question 4

Multiple Sclerosis - CMs

Answer 4

• Depends on location of lesions; mild to severe
• Fatigue/weakness
• Spasticity lower extrems
• Bowel, bladder, sexual dysfunc
• Pain, paresthesia’s
• Visual disturbances (dbl vision)
• Emotional lability

Question 5

Multiple Sclerosis - Diagnosis

Answer 5

• MRI
  > presence of mult plaques CNS
• Lumbar Puncture: CSF sample

Question 6

Multiple Sclerosis - Medical Interventions

Answer 6

• No cure; delay progression
• Symptom management
• Med therapy
  > Acute: methylprednisolone IV, followed by oral prednisone taper
  > Reduce relapses: interferons

Question 7

Multiple Sclerosis - Nursing Diagnosis

Answer 7

• Impaired home maintenance management
• Ineffective coping
• Impaired physical mobility
• Risk for injury RT sensory & visual impairment

Question 8

Multiple Sclerosis - Nursing Interventions

Answer 8

• Promoting physical mobility
• Preventing injury
• Enhancing bladder & bowel control
• Enhancing communication & managing swallowing difficulties

Question 9

Multiple Sclerosis - Pt Education

Answer 9

• Meds
  > purpose, dose, route, schedule, side effects, precautions
• When to contact HCP
• Envir’t mods & adaptive techniques
• Manage symptoms
• Optimal nutritional intake; consider weight reduction
• Manage bowel & bladder func
  > self cath, neurogenic bladder
• Minimize immobility/spasticity
• Identify sources of support
• Prevent comps: pressure ulcers, pneum, depression

Question 10

Amyotrophic Lateral Sclerosis (ALS) - Pathphysiology

Answer 10

• Exact cause unknown
• Over excitation of nerve cells by neurotransmitter glutamate ressults in cell injury & neuronal degeneration
  > motor neuron cells die in anterior horn of spinal cord & lower brainstem
  > muscle fibers atrophy

Question 11

Amyotrophic Lateral Sclerosis (ALS) - Risk Factors

Answer 11

• Viral infections
• Autoimmune disease
• Envir’t exposures to toxins
• Genetics-Autosomal dominant
• 40-60yrs
• Males

Question 12

Amyotrophic Lateral Sclerosis (ALS) - CMs

Answer 12

• Cognition intact while body wastes away
• Muscle weakness
• Atrophy of muscles
  > arms-trunk-legs
• Spasticity
• Fasciculation’s (twitching)
• Lack of coordination
• Resp insufficiency/aspiration risk
• Bowel & bladder not affected

Question 13

Amyotrophic Lateral Sclerosis (ALS) - Diagnosis

Answer 13

• Manis
• No clinical/labs available
• Neuropsychological testing
• MRI scan may show high signal intensity in corticospinal tracts

Question 14

Amyotrophic Lateral Sclerosis (ALS) - Medical Surgical Treatment

Answer 14

• No cure
• Riluzole, a glutamate antagonist
• Baclofen
• Psychosocial ramifications
  > trapped, dependent on others
  > explore suicidia ideation
  > anti-depressives
• Life-support

Question 15

Amyotrophic Lateral Sclerosis (ALS) - Nursing Interventions

Answer 15

• Maintain airway
• Prevent aspiration & resp infec
• Facilitate communication
• Provide diversional activites
• Maintain optimal nutrition
• Dcr risk of injury r/t falls
• Dcr pain secondary to muscle weakness
• Grieving r/t loss of motor func & death
• Encourage exercise to reduce spasticity
• PT, OT, Speech