Peripheral Neuropathy
In generally what can cause peripheral neuropathy?
Damage from disease process such as metabolic and endocrine disorders affects the body's ability to process waste products and utilize nutrients conditions that decrease o2 supply, cause thickening of the walls and decrease blood flow to nerves Autoimmune disorders and infection Viruses and bacteria can attack nerve tissues resulting in destruction of nerve axons or the myelin sheath alcoholic neuropathy Inflammation Cancer Toxins Inflammation and swelling in tendon sheaths
Neuropathies are classified by three causes what are they?
Acquired Hereditary Idiopathic
Name complementary therapies for pain and anxiety are
Acupuncture Biofeedback Transcutaneous electrical nerve stimulation and massage
S/s of Polyneuropathies
Appear first in the toes and feet and progress upward. Also depends on the nerve fibers involved The fingers and hands also may be involved, usually only in later stages of diabetes. Most common is diabetes.. Works it's way up from the toes distal paresthesias, pain described as aching, burning or shooting and feelings of cold feet. impaired sensations of pain, temperature, light touh, two point discrimination and vibrations.
Name complementary therapies for pain and anxiety
Application of heat/cold Guided imagery Relaxation techniques Massage
Peripheral neuropathy is classified in what two predominant pathology?
Axon degeneration Segmental Demyelination
Hereditary or inherited neuropathies include
Charcot-Marie-Tooth disease
What is the most common inherited peripheral neuropthay syndrome?
Charcot-Marie-Tooth syndrome
The main focuse in the Nursing care of a client with Peripheral neuropathy?
Client safety and comfort
Polyneuropathies is commonly associated with what chronic disease?
Diabetes
What are the risk factors for Acquired Peripheral Neuropathies?
Diabetes Alcohol abuse Vitamin Deficiencies (Vitamin B) Immune system suppression Autoimmune disease Kidney, liver or thyroid disorders Exposure to toxins, medications
What diagnostics test are performed for peripheral neuropathy?
Electromyolgraphy CBC Thyroid function tests Serum levels for B12 and thaimin Metabolic Panel Urine screening Nerve biopsy
Preventing injuries and Teachings include
Foot care Excercise smoking cessation avoidance of toxic chemicals nutrition stressing B12 Avoidance of repetitive motion and prolonged pressure Massage to improve circulation stimulate nerves and reduce pain Referrals as appropriate
What is one of the most serious polyneuropathies?
Guillain-Barre syndrome (GBS)
S/S of Peripheral Neuropathy
Impaired sensations of pain, temperature, light touch, two-points discrimination and vibration Weakness in arms or legs (damage of motor nerves) Difficulty walking or running stumbling, dropping things, tiring easily General feeling of lack of coordination or clumsiness Client may compensate by changing the walking pattern to maintain balance.
What is the most common cause of mononeuropathies?
Injury or trauma, Repetitive motions such as carpal tunnel syndrome.
Pain relievers
Mild=Acetaminophen or Ibuprofen More severe=opiate
Polyneuropathies
Most common types of neuropathy associated with diabetes are bilateral sensory disorders
Medications used are
Pain relievers Anticonvulsants Antidepressants
Questions to ask during an assessment would pertain to what kind of subject?
Past history : seizures, fainting, dizziness, headaches, infection and any trauma, tumors and surgery of the brain, spinal cord or nerves Illness that can cause neuroloical S/S: cardiac disease, strokes, pernicious anemia, sinus infection, liver disease, and or renal failure Occupational hazards exposure to toxic cheicals or materials amount of time spent performing repetitive motions. c==diet, use of tobaco, alcohol or durgs.
Mononeuropaties
isolated peripheral neuropathies that affect a single nerve. Will only affect a single nerve ...what you see will be what's affected
In clients with GBS what side effects are monitored while on analgesics?
Respiratory depression Assess repirations and lung sounds Pulmonary care measures and monitor for aspirations Frequent respiratory monitoring is indicated
What kind of infection would you normally see before you start seeing S/S of neuropathy?
Respiratory infection
PNS is divided into 2 division.. what are they?
Sensory (afferent) division Motor (efferent) division
Hereditary.. Aquired Idiopathic are the
The types of peripheral neuropathy
Antidepressants
Tricyclic-thought to activate descending serotonergic antinociceptive pathway Serotonin-Norepinephrine Reuptake Inhibitors - block the depletion of serotonin and norepinephrine in the CNS help modulate pain both tricylic antidepressants and SNRIs takes 4-6 weeks to reach therapeutic plasma levels.
Alcoholic neuropathy is damaged to the nerves that results from a long term excessive use of alcohol...... what are the complications... of chronic alcoholism..??
With Thiamine (B1) deficiency and malnutrition
Guillain-Barre syndrome (GBS)
acute inflammatory demyelinating disorder of the peripheral nervous system characterized by an acute onset of motor paralysis (usually ascending) Classification Acute inflammatory demyelinating polyradiculoneuropathy Acute axonal motor neuropathy Acute motor and sensory azonal neuropathy
What is the primary goal of treatment for a client with peripheral neuropathy?
correct or manage the underlying cause so that symptoms are controlled and further nerve damage is minimized.
Acquired neuropathies include
disease or illness nutrional deficits Infections Trauma Toxins
S/S GBS
frequently "stocking-glove" pattern feeling as though stockings and gloves are being worn when they are not. pain in hands feet and legs
How does Neuropathy develop?
overall effectiveness of blood vessels decreases, superficial blood vessels constrict to divert blood to larger vessels constriction of peripheral blood vessels, peripheral nerve endings in the constricted area suffer affects of DECREASED BLOOD FLOW and NEUROPATHY develops.
PNS is responsible for?
receiving and transmitting information from and about the external environment
Peripheral Neuropathy
results when trauma or a disease process interferes with innervation of peripheral nerves.
Charcot-Marie-Tooth syndrome
slowly progressive degeneration of the muscles of the foot, lower leg, hand and forearm usually present between adolescence and young adulthood.
Anticonvulsants
the action is not understood but believe to block pain receptors in the CNS
Idopathic Neupathies
unknown cause and account for an up to 30% of neuropathies
