Chapter 24 Care of Patients with Peripheral Nerve and Degenerative Neurologic Disorders

MS tx

BRM drugs, autologous stem cell transplant, IV methylprednisolone, plasmapheresis, ACTH, exercise program, swimming, develop positive and hopeful outlook with support, physical and psychological means, antidepressants

supplements helpful for parkinsons

NADH, CoQ10, phosphatidylserine, ester C, vitamin E, alpha lipoic acid

myasthenia gravis etiology and pathophysiology

"grave muscle weakness", autoimmune disease, T cell dependent immune attack is directed against postsynaptic ACh receptors at the neuromuscular junction, chronic disorder, affects skeletal muscles, respiratory muscles and muscles enervated by cranial nerves, most cases weakness is localized to the muscles of the eye and is called ocular MG, pts with weakness in all muscles have generalized MG, nerve impulses arent transmitted and muscle cant contract properly, connection with overgrowth of thymus gland tissue,

myasthenia gravis crisis s/s

(occurs when you dont take meds, after precipitating illness or increased stress) more dysphagia, diplopia, ptosis, dyspnea

The health care provider discusses the treatment options with a patient newly diagnosed with PD. The patient asks you, "What will happen to me?" An appropriate response would be: 1. "You seem worried. Let's talk about your concerns." 2. "Your provider can fully explain your condition." 3. "You will be all right." 4. "Your disease can be controlled."

1. "You seem worried. Let's talk about your concerns."

A patient with PD has been taking carbidopa-levodopa (Sinemet) for 3 months and is being seen for follow-up. You would expect to observe which of the following? (Select all that apply.) 1. Dark urine 2. Bradykinesia 3. Weight maintained 4. Rigidity 5. Walking without assistance 6. Tremors

1. Dark urine 3. Weight maintained 5. Walking without assistance

Some types of Parkinson's disease may be drug-induced. Which drug classification can be associated with this phenomenon? a) Antihypertensives b) Oral hypoglycemics c) Diuretics d) Anticonvulsants

a) Antihypertensives

During the advanced stages of amyotrophic lateral sclerosis (ALS), which service would be most beneficial to the family and patient? a) Hospice services b) In-home physical therapy c) Pulmonary rehabilitation program d) Nursing visits from a home health care agency

a) Hospice services

The nurse is assessing a patient admitted for a work-up to rule out ALS. Which symptoms are typically exhibited in a patient with ALS? Select all that apply. a) Muscle pain b) Slurred speech c) Muscle spasticity d) Decreased sensation e) Difficulty swallowing

a) Muscle pain b) Slurred speech c) Muscle spasticity e) Difficulty swallowing

The physician has ordered a Tensilon test to aid in diagnosing a patient. What disease does the physician most likely suspect? a) Myasthenia gravis b) Multiple sclerosis c) Guillain-Barré syndrome d) Huntington's disease

a) Myasthenia gravis

During the acute stage of Guillain-Barré syndrome, what is the priority goal of nursing and medical treatment? a) Sustenance of life b) Promotion of rest c) Reduction of fever d) Prevention complications

a) Sustenance of life

The nurse is preparing a teaching session about Guillain-Barré syndrome. Which statement should be included in the presentation? a) The progressive muscle weakness will begin in the lower extremities and move upward. b) The disorder is normally fatal. c) The disorder is caused by a fungal infection. d) The disorder's most significant manifestations are muscle pain and stiffness.

a) The progressive muscle weakness will begin in the lower extremities and move upward.

paralytic ileus s/s

absence of bowel sounds, abdominal pain, considerable abdominal bloating with lack of passage of stool

parkinsons pathophisology

affects the extrapyramidal system, in motor structures in basal ganglia (part of the brain that controls balance and coordination)

parkinsons drug therapy

anticholinergics, dopamine agonists, MAOIs (block metabolism of dopamine leaving more dopamine in circulation)

myasthenia gravis tx

anticholinesterase therapy (temporarily increase muscle strength but dont cure problem), thymus gland removal, treat sx, manage underlying cause, plasmapheresis, restore muscle function, corticosteroids, immunosuppressants,

drugs commonly used for parkinsons

antiparkinsonian/adrenergic, antiviral, anticholinergic, MAOI, MAOIB, COMT inhibitor

myasthenia gravis assessment and data collection

ask about degree of fatigue, what body parts are affected and how severe the problem is, observe for ptosis and inquire about diplopia, determine pt knowledge about disorder and coping abilities, assess respiratory function, assess muscle strength in face, assess swallowing, speech volume and clarity, cough and gag reflexes, check strength of shoulder muscles and limbs, have pt look up at ceiling and see if eyelids start to move down (often early sign of MG or that meds arent working)

caution when administering MAOIs

avoid foods containing tyramine (aged cheese, fermented food, smoked fish or meat, yeast, beer, chianti wine, dietary protein supplements, soy sauce), meperidine and MAOI causes hyperpyrexia (excessive elevation of temp) and possibly death

parkinsons exercise interventions

avoid moving quickly and in backward direction, be aware of shuffling and stop and check posture is upright before continuing, look ahead not down

The patient has recently been diagnosed with amyotrophic lateral sclerosis (ALS). When planning care for this patient, the nurse is aware that the prognosis for death is usually within how long after the onset of symptoms? a) 1 year b) 3 years c) 5 years d) 7 years

b) 3 years

A 55-year-old patient is diagnosed with Huntington's disease. What percentage of the patient's children will inherit the disease? a) 25% b) 50% c) 75% d) 100%

b) 50%

The student nurse is caring for a patient with MG. The student demonstrates adequate learning when identifying which pathophysiologic factors regarding the disease? Select all that apply. a) The disease is an acute disorder. b) The cranial nerves are involved in the disease process. c) Muscle weakness is the major characteristic of the disorder. d) The etiology of the majority of cases of the disease is autoimmune. e) Progressive degeneration of the spinal cord occurs as the disease advances.

b) The cranial nerves are involved in the disease process. c) Muscle weakness is the major characteristic of the disorder. e) Progressive degeneration of the spinal cord occurs as the disease advances.

A patient has recently been diagnosed with MS. The family asks the nurse about the common manifestations of the disease. The nurse is correct by identifying which as the most common clinical manifestation of the disease? a) Urinary incontinence b) Weakness of the limbs c) A loss of the sense of smell d) Decreased intellectual function

b) Weakness of the limbs

When teaching the patient with multiple sclerosis (MS) about how to best manage his disease, the nurse determines the patient requires further instruction when making which statement? a) "It is important that I attend all of my physical therapy sessions." b) "I should eat adequate fiber to prevent constipation." c) "It is a good idea for me to take a hot shower in the morning to relax my muscles." d) "The injections of interferon beta-1b (Betaseron) will help manage my symptoms."

c) "It is a good idea for me to take a hot shower in the morning to relax my muscles."

Why should the nurse check with the physician to be sure that she knows a patient has MG when prescribing medications? a) Because the patient needs sublingual medications due to excessive salivation. b) Because when the patient is in remission, certain drugs should not be prescribed. c) Because the myasthenic patient can suffer from exaggerated and bizarre effects from a variety of drugs. d) Because the patient's MG medication, selegiline (Eldepryl), needs to be carefully monitored for patient reactions.

c) Because the myasthenic patient can suffer from exaggerated and bizarre effects from a variety of drugs.

When assisting the patient who is taking MAOI medications to make dietary selections, what may be included in the patient's intake? a) Smoked salmon b) Beer c) Catfish d) Aged cheeses

c) Catfish

Interventions to prevent which problem are the priority for a patient with myasthenia gravis (MG)? a) Accidental injury b) Uncontrolled pain c) Inability to maintain own airway d) Decreased functional ability and mobility

c) Inability to maintain own airway

For which condition would a patient most need to have medical alert identification? a) Poliomyelitis b) MS c) MG d) Cerebrovascular accident (CVA)

c) MG

A patient with multiple sclerosis (MS) is displaying an initial period of relapsing-remitting of the disease followed by steady worsening of the course of the disease. The nurse is aware that the patient is most likely in which clinical progression of MS? a) Relapsing-remitting b) Primary-progressive c) Secondary-progressive d) Relapsing-progressive

c) Secondary-progressive

parkinsons balance interventions

change positions slowly, when turning around dont pivot move forward and slowly walk in a circle, use sturdy single cane with wide rubber tip to maintain balance

multiple sclerosis/MS etiology

chronic inflammatory disease that causes demyelination (myelin is eroded by inflammation and replaced by scar tissue) in the CNS, autoimmune, idiopathic, most common type has periods of remission and exacerbation, another type is progressive without remission periods, no cure, most common in northern europeans, more common in females, genetic factor

Which statement concerning Parkinson's disease is most accurate? a) It will have a slow onset followed by a rapid advancement. b) It affects more women than men. c) It is most common after age 75. d) 50,000 people in the U.S. are diagnosed every year.

d) 50,000 people in the U.S. are diagnosed every year.

Following a viral respiratory infection, a patient develops symptoms of Guillain-Barré syndrome. What is most closely associated with this disorder? a) Emotional lability b) Hyperactive deep tendon reflexes c) Flapping tremors of the hands and feet d) Paresthesia and weakness of the lower extremities

d) Paresthesia and weakness of the lower extremities

A patient has been admitted to an acute care facility during the acute phase of Guillain-Barré syndrome. The practical nurse is assisting the registered nurse with the plan of care. Which problem statement/nursing diagnosis will have the highest priority? a) Impaired Verbal Communication b) Knowledge deficit c) Fear d) Risk for aspiration

d) Risk for aspiration

Bradykinesia refers to a) rapid, slurred speech. b) involuntary muscle tremors. c) dizziness. d) slow speech and movement.

d) slow speech and movement.

parkinsons etiology

degeneration of dopamine producing neurons in the substantia nigra of the midbrain and the presence of lewy bodies, progressive disorder, more common in men, occurs mostly after age 60, secondary parkinsons can be drug induced

poliomyelitis syndrome

destroys motor cells of anterior horn of spinal cord, brainstem and motor strip located in frontal lobe

MS clinical progression: relapsing progressive

disease steadily worsens from onset but theres clear acute relapses with or without recovery, disease progresses between relapses

feeding a pt with dysphagia

dont rush, small bites, finish swallowing before offering another bite, sit upright, turn on suction, drop chin when swallowing

parkinsons tx

drug therapy, PT, emotional support, complementary and alternative therapy, surgery (DBS, electrical shocks that controls tremors by blocking them), SSRIs for depression

complications of parkinsons

dysphagia, constipation, immobility, incontinence, insomnia

MS pt teaching

education about unpredictability of disease and need to prevent stress, infections and fatigue to maintain independence as long as possible, referral to support groups,

MS dx

elevated IgG levels in CSF and oligoclonal bands, MRI shows white matter lesions scattered in brain and spinal cord,

guillain barre syndrome dx

elevated protein in CSF, depend on clinical presentation, nerve conduction studies, electromyography

MS implementation and evaluation

emotional support for pt and family, ongoing care from interdisciplinary team focusing on safety, prevention of complications, assisting with PT and emotional support, dont expose pt to excessive heat or hot baths, adequate nutrition and fluid intake, increase fiber in diet, prevent constipation and UTIs, include vitamin D and calcium in diet to prevent osteoporosis, give PPIs to prevent stomach acid and prevent ulcers, help pt and family establish a consistent daily routine to promote optimum levels of functioning including daily physical exercise balanced by rest periods to prevent fatigue

postpolio syndrome

experience a new onset of weakness, pain and fatigue with pts who have had polio more then 30yrs ago, disability may be temporary or permanent

alzheimers

form of dementia, caused by pathologic changes in brain tissue, idiopathic, can occur during middle age or during later decades of life, slow onset, progresses at varying rates of speed through several stages, eventually fatal

myasthenia gravis cholinergic crisis s/s

generalized weakness within 1hr of dose, dyspnea, increased bronchial secretions, poor tongue control producing difficulty chewing, dysphagia, excessive salivation, restlessness, anxiety, irritability, diaphoresis, abdominal cramps, n/v/d

huntington disease

genetically transmitted degenerative neurologic disorder, characterized by abnormal movements (chorea) with decline in intellectual capacity and emotional disturbances, caused by abnormal gene on short arm of chromosome 4, autosomal dominant disorder, no known tx to alter course, signs become evident during fourth or fifth decade of life, progressive, causes disability and death within 15-25yrs after signs appear, death is from neurologic degeneration, dx by genetic testing

guillain barre syndrome rehab phase

gradual recovery, pt may become elated over change in their condition and must be prevented from overexertion which can lead to relapse, slowly increase exercise as muscle function returns, may take up to 2yrs for maximal improvement with return to normal functioning

myasthenia gravis implementation

infection, surgery, physical and emotional stresses can precipitate crisis and cause hospitalization, rehab goals include education and support for pt and family so that pt remains as independent as possible, suctioning, intubation and mechanical ventilation may be necessary during crisis, educate pt and family with instruction about the nature of illness and adverse effects of emotional upsets, respiratory infections and stresses, care focuses on neurologic deficits and their effect on daily activities, pt and family should know sx of OD of anticholinesterase meds and sx of crisis caused by underdosage of meds, precipitating illness or stress factors, avoid steroids, thyroid compounds, sedatives, antibiotics, beta blockers, cardiac drugs and respiratory depressants, check each drug pt takes for interactions

MS clinical progression: secondary progressive

initial period of relapsing remitting disease followed by steadily worsening course, may or may not have occasional relapses, minor remissions or plateaus

parkinsons dx

labs, MRI, SPECT

poliomyelitis tx

lifestyle modifications to preserve energy and physiologic function, swimming in warm water

MS pathophysiology

lymphocytes and macrophages infiltrate the CNS, IgG increases in CSF indicating humoral response with B cell activation, plaques form on myelin sheath causing inflammation, nerve impulses cant travel along damaged neurons, sometimes remyelination occurs but is incomplete so nerve transmission isnt normal

guillain barre syndrome tx

mainly supportive, plasmapheresis, IVIG, nutritional support via tube feedings, parenteral nutrition if paralytic ileus occurs, most recover and walk independently within 6mo with full motor recovery within 1yr, some have incomplete recovery after 18mo, most common cause of death with older pts is dysrhythmias

guillain barre syndrome goals/expected outcomes

maintain adequate ventilation, control pain, prevent damage from aspiration, maintain communication, maintain adequate nutritional status, return pt to normal function, prevent skin breakdown

pt teaching for pts taking antiparkinsonian drugs

may cause dizziness move slowly, be aware of orthostatic hypotension, urine may turn dark, may cause drowsiness, check liver function regularly, increase fiber, fluids and exercise, monitor BM frequency

guillain barre syndrome s/s

mild sensations of numbness and tingling in feet and hands followed by muscle pain, tenderness and aching especially in shoulder, pelvis and thighs, progressive muscle weakness usually starting in lower extremities and moving upward over 24-72hrs, demyelination, inflammation, edema, nerve root compression, paralysis, pain, paresthesia, orthostatic hypotension, htn, abnormal vagal response, bowel and bladder dysfunction, facial flushing, diaphoresis, facial muscles move downward, hyperesthesia, pain often worse at night when theres less distraction (sx peak in about 14 days)

nursing implications for possible side effects or adverse effects of parkinsons drugs

monitor for orthostatic hypotension and urinary retention, assess pts taking carbidopa-levodopa for excessive or inappropriate sexual behavior, report observed changes in mental status. dont give amantadine at bedtime it may cause insomnia, assess for nausea, dyspepsia and abdominal pain, anticholinergics are contraindicated in pts with acute narrow angle glaucoma, anticholinergics can cause dry mouth and constipation so increase fluids and add fiber to diet, monitor BP and pulse during med initiation and adjustment of anticholinergics reporting tachycardia

guillain barre syndrome assessment and data collection

monitor progression of ascending paralysis, assess respiratory function, assess gag, corneal and swallowing reflex, monitor ABGs and o2 sat, observe vitals, watch for orthostatic hypotension and dysrhythmias,

MS clinical progression: relapsing remitting

most common type, relapses of acute worsening neurologic function, partial or complete recovery occurs in remission period

MS relapsing remitting*

most common, myeline sheath destroyed, motor and sensory dysfunction (loss of coordination, fatigue, numbness, *ataxia*, uncoordinated unstable gait, *areas of paresthesia, involuntary eye movements*)

MS s/s

motor dysfunction (weakness, paralysis, diplopia from oculomotor weakness, muscle spasms), sensory dysfunction (numbness, tingling, burning, painful sensations, patchy or total blindness, blurry vision, dizziness, tinnitus, hearing loss), coordination problems (ataxia, tremor of limbs and eyes, slurred speech, dysphagia), mental changes (depression), cognitive problems (impaired judgment, decreased ability to solve problems, memory loss), fatigue (worsened by heat or high humidity), unpredictable flare ups, periods of partial or complete remission, incontinence, altered sexual function, loss of self esteem, physical impotence in men, diminished sensation in women

myasthenia gravis s/s

muscular weakness either mild (causes minor inconvenience) or so severe it can be life threatening because of its effect on muscles needed for breathing and swallowing, ptosis (drooping upper eyelid), diplopia (double vision), difficulty chewing and swallowing, hoarse or nasal voice, voice volume decreased towards end of sentence, muscle weakness improves with rest, facial and oropharyngeal muscle weakness with blank facial expression and smile resembling a snarl (bulbar myasthenia), swallowing and speaking difficulty, muscles stronger in morning and become weaker with activity

ALS tx

no cure, totally dependent from muscle paralysis (inability to move, swallow, speak and breathe), Riluzole/rilutek (glutamate antagonist), impaired breathing requires trach or mechanical ventilation, noninvasive ventilation can extend life and delay the need for artificial airway,

parkinsons*

not alot of dopamine so it affects motor function, affects balance and coordination

huntington disease s/s

progresses from being fidgety and restless to a state of constant movement (chorea), voluntary movement deteriorates until pt is completely incapable of independent movement, intellectual decline, depression, suspiciousness, dementia,

amyotrophic lateral sclerosis/ALS/Lou Gehrig disease etiology and pathophysiology

progressive neuromuscular disease characterized by degeneration of gray matter in anterior horns of the spinal cord and lower cranial nerves, after degeneration electrical and chemical messages generated in the brain cant reach the muscles to activate them, most common in ages 40 and 70, more common in men, classified as familial or sporadic idiopathic, usually progresses rapidly resulting in death within about 3yrs of onset of sx

which position should a pt with parkinsons sleep*

prone

MS nursing management

proper nutrition, adequate fluids and fiber, maintain proper bowel function, decrease UTIs

guillain barre syndrome etiology and pathophysiology

rare immune mediated polyneuropathy disease that affects the PNS especially spinal nerves outside spinal cord, affects cranial nerves, idiopathic, usually follows simple viral respiratory infection or gastroenteritis in adults within 2-4wks, could be triggered by immunizations, surgery, trauma, bone marrow transplant, viral infection, HIV or neoplasm of lymphatic system, linked to cytomegalovirus and epstein barr virus

parkinsons s/s

rest tremor/pill rolling, bradykinesia, rigidity, postural instability, shuffling gait, poor balance, decrease arm swinging when walking, foot drag or stiff, limp, lean slightly to one side, fall backwards, propel forward spontaneously, stiff bent forward posture when walking, face is masklike/blank, speech low in tone mono sounding and slow, difficulty enunciation, drooling, decreased tearing, constipation, incontinence, excessive sweating, heat intolerance, decreased sexual ability, mood disturbance, depression (rigidity and trembling of head, forward tilt of trunk, reduced arm swinging, rigidity and trembling of extremities, shuffling gait with short steps)

MS most probable dx*

s/s of pt and what pt reports

restless leg syndrome/RLS

sensory motor disorder, more common in women, characterized by uncontrollable urge to move legs or arms more often in evening, idiopathic, underlying genetic component, sudden onset, linked to lyme disease, RA, COPD, hypothyroidism, hyperthyroidism, fibromyalgia and deficiencies in iron, folate, vitamin b12 or magnesium, usually have low iron levels, indicate iron replacement therapy, tx includes exercise, avoid aggravating factors, leg massage and decrease caffeine, drug therapies such as dopamine agonists, gabapentin, lyrica, monitor meds closely and for orthostatic hypotension

parkinsons preventing drooling or salivating

sit upright when eating, close lips and keep chin up, swallow often, use straw when drinking to strengthen muscles of lips, mouth and throat

MS clinical progression: primary progressive

slow but almost continuous worsening with occasional plateaus and temporary minor improvements

guillain barre syndrome acute phase

sustain life, prevent complications related to immobility, promote rest and comfort, respiratory problems are troublesome and may require suctioning, trach care, artificial ventilation and other life support measures, check vitals frequently (watch for hypotension and dysrhythmias), paralysis and loss of control come on suddenly and are overwhelming so pt becomes frightened, because the disease extends for months with slow recover pt begins feeling hopeless, despair and isolated

parkinsons healthy eating

take adequate time to eat comfortably without rushing, eat foods high in fiber, adequate fluids

parkinsons aids for daily living

use adjustable tables and reacher bars, provide gentle exercise in household chores like folding laundry, provide relaxation from music or to promote exercise

parkinsons writing tips

use big strokes and lined paper, use large pen or marker and change writing position often, if hand tires change to a different pen

poliomyelitis cause

virus, can be prevented by immunization with Salk (killed virus) or Sabin (attenuated live virus) polio vaccine

ALS*

weakness of involuntary muscles, muscle atrophy, dysphagia, diaphragm ceases to function end up needing vent

ALS s/s

weakness of voluntary muscles especially in distal muscles of extremities, dysphagia, difficulty speaking clearly, atrophy of muscles, eventual impaired breathing, paresthesia, abnormal muscle spasms and contractions, pain, depression, (death usually occurs from respiratory infection and dysfunction)

Injury is a possible problem statement for patients with RLS. Which nursing intervention(s) would help prevent injury? (Select all that apply.) 1. Educate the patient about daytime drowsiness, possibly severe, that may occur with the treatment for RLS. The patient should not drive or operate machinery until reaction to treatment is determined. 2. Apply leg braces for the patient at night. 3. Advise the patient to rise slowly to a standing position from a sitting or lying position. 4. Install grab bars in the shower and tub. 5. Use a two-wheeled walker for balance. 6. Remove throw rugs from the environment.

1. Educate the patient about daytime drowsiness, possibly severe, that may occur with the treatment for RLS. The patient should not drive or operate machinery until reaction to treatment is determined. 3. Advise the patient to rise slowly to a standing position from a sitting or lying position.

A patient is admitted for progressive muscle weakness in the lower extremities. The patient complains of tingling and numbness in the hands. The patient recovered from the flu a week ago. Which intervention(s) should be anticipated in the care of this patient? (Select all that apply.) 1. Medication for pain and discomfort 2. Immediate need for physical therapy exercise 3. Possible need for ventilatory assistance 4. Need for airway suctioning 5. Administration of muscle relaxants 6. Seizure precautions

1. Medication for pain and discomfort 3. Possible need for ventilatory assistance 4. Need for airway suctioning

You reinforce pharmacy instructions regarding safe use of pyridostigmine (Mestinon), an anticholinesterase, by a patient newly diagnosed with MG. Which patient statement indicates a need for further teaching? 1. "I need to take the medication after meals on a full stomach." 2. "I can adjust the drug dosage and times depending on daily activities." 3. "I shouldn't take over-the-counter medications without health care provider approval." 4. "I should balance rest and activity throughout the day."

2. "I can adjust the drug dosage and times depending on daily activities."

A patient presenting with numbness and tingling of the hands and feet, muscle pain, and weakness in the legs would be evaluated for: 1. multiple sclerosis 2. Guillain-Barré syndrome 3. Parkinson disease 4. Myasthenia gravis

2. Guillain-Barré syndrome

You observe a nursing assistant feeding a dysphagic patient. Which action by the nursing assistant indicates a need for further instruction and guidance? 1. The wall suction is turned on and readily available. 2. The patient is propped up with one pillow. 3. The food is cut into small, bite-size pieces. 4. The nursing assistant coaches the patient to drop the chin.

2. The patient is propped up with one pillow.

A female patient with MG may need additional teaching when she makes the following statement: 1. "I should pace my activities to allow for rest periods." 2. "I need to be careful when drinking liquids." 3. "Pregnancy hormones will control my symptoms." 4. "I must take my medications on a strict schedule."

3. "Pregnancy hormones will control my symptoms."

The priority nursing assessment of a patient with MG would be to: 1. determine the degree of fatigue. 2. assess the level of knowledge about the disease. 3. monitor the adequacy of respiratory function. 4. check the patient's swallowing, speech, and protective reflexes.

3. monitor the adequacy of respiratory function.

A 45-year-old patient newly diagnosed with MS asks about their prognosis for the future. Teaching about the future might include stating: 1. "The condition is a progressive neurologic disease, and you will likely end up using a wheelchair or scooter. You might start equipping your house to be wheelchair accessible." 2. "With the new immune-modifying drugs available as treatment, you will not even be able to tell you have the disease." 3. "MS may begin with exacerbations and remissions, but it will eventually develop into a progressive disease, affecting your entire neurologic system and thus your whole body." 4. "The condition is a periodic demyelination of the central nervous system, often with periods of remissions and exacerbations. It is a manageable disease, and there are many patients who live active and rewarding lives. Use of the new immune-modifying agents will help reduce exacerbations."

4. "The condition is a periodic demyelination of the central nervous system, often with periods of remissions and exacerbations. It is a manageable disease, and there are many patients who live active and rewarding lives. Use of the new immune-modifying agents will help reduce exacerbations."

parkinsons planning, implementation and evaluation

nursing care focuses on prevent complications, drug therapy, enhance voluntary movement and safety, add fiber to diet and increase fluids, teach pt to grasp coins or other objects to decrease tremors, walking can be improved by having pt think about an imaginary line to walk on and imagine stepping over something to help prevent freezing when walking, teach pt to consciously assume correct posture, dont use pillow when resting to prevent flexion of spine, learn to sleep prone, need extra time to finish tasks, provide warming tray during meals, have patience and understanding to help pt cope with frustrations of deteriorating body control and inability to do things they formerly could easily do, degeneration of cognitive skills occurs late stage, at risk for falls, safety major factor, use walker, cane, leg and foot braces, remove loose carpets, install grab bars and raised toilet seat, pts with tremors should avoid carrying hot liquids to prevent burns,

nursing implications when giving drugs for parkinsons

pay attention to dosage, check other meds pt is taking for interactions, give meds close to the time ordered as possible to maintain blood level, discuss new onset of sx when giving carbidopa-levodopa because it may cause neurologic disturbances, give anticholinergics with food, selegiline may increase side effects of carbidopa-levodopa, monitor effectiveness of drugs, assess pt for worsening sx

guillain barre syndrome static phase

plateau thats reached 1-3wks after onset, motor loss and paresthesias no longer progress, pt condition becomes somewhat stabilized, pt gets no better and no worse, this phase can last for few days to months, prevent complications of immobility, help pt deal with feelings of anger, depression and anxiety, exercises are limited to passive and gentle ROM and stretching, balance rest and exercise, avoid sudden changes in posture or position, provide meticulous skin care, monitor for thrombophlebitis, provide elastic stockings or compression devices and anticoagulant therapy

myasthenia gravis pts taking anticholinesterase meds

take with food or fluid, take 45mins before meals to promote chewing and swallowing, adjust dosage to pattern of weakness and daily activities, dont take OTCs or other prescriptions without approval, report signs of cholinergic crisis quickly, modify diet for ease of chewing and swallowing (soft foods), eat slowly and in calm environment and take small bites, balance rest and activity throughout day, figure out ways to conserve energy while doing usual activities, compensate with extra rest during periods of extra stress, illness, hormone swings during menses and environmental temp extremes, wear medical alert bracelet/necklace or have card in wallet stating you have MG and list of contact numbers, be aware of crisis sx and report immediately

myasthenia gravis dx

tensilon test, blood test for antibodies to acetylcholine receptors and MuSK, electrodiagnostic testing, chest radiography, CT scan,

MS assessment and data collection

test extremity strength, look for visual problems, get pt hx, check reflexes,

ALS nursing management

thorough neuro assessment, understanding of the progression to pt and family to make care decisions, while still being able to function pt should make their wishes known to family and HCP, assist pt and family with guidance to maintain some level of independence and comfort for pt, rehab using walker, wheelchair, hospital bed, suction and NG or G tube feeding supplies, pt and family will experience issues related to terminal illness, death and grieving, toward end of life get home visiting nurse and hospice for physical and emotional support, share support groups and prevent caregiver burnout, make sure advanced directives are available to caregivers