NURS 352 Mod 7

Parkinsons Stage 2

-bilateral limb tremors, shaking -balance & walking is hard -masklike face -shuffling gait -slow

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance?

Make sure the client is sitting with the head of bed elevated to 90 degrees.

ALS Risk Factors

•Age •Autoimmune disease •Environmental exposures to toxins •Family history •Smoking •Viral infections

Parkinsons Stage 5

-can't stand or walk -dependent -maybe dementia

anticholinergics Benztropine Trihexyphenidyl

-control tremors & rigidity -monitor for anticholinergic effects (dry mouth, constipation, confusion, urinary retention)

acetycholinesterates § Pyridostigmine bromide (Mestinon)

-drug of choice for MG -inhibits the destruction of acetylcholine to enable the transmission of impulses across the neuromuscular junction. -adverse: abdominal cramping, diarrhea, increased salivation and bronchial secretions, nausea, sweating, and bradycardia

MS Lab test & diagnostic

-elevated protein & slight increase in WBC -MRI shows plaque

baclofen Muscle relaxant

-for muscle spasticity in MS -for combating fatigue that impacts/ ADLs -can be used for severe cases -Monitor weakness, drowsy & dizzy -do not stop abruptly -report increased weakness & jaundice -Report painful or frequent urination, constipation, headache, insomnia, or confusion Adverse: transient drowsiness, dizziness, weakness, fatigue, confusion, headache, insomnia, hypotension, and urinary frequency. Elevated blood sugar -avoid alcohol -Monitor for CNS depression

Multiple Sclerosis

-immune-mediated, progressive demyelinating disease of the CNS -peak onset is between 20-50 yrs -affects women 3x more Clinical Manifestations: Common: Fatigue depression weakness numbness difficulty in coordination loss of balance spasticity pain Visual disturbances: - blurring of vision -diplopia (double vision) -scotoma (patchy blindness) - total blindness. Fatigue: Heat depression anemia deconditioning medication Intervention: Avoiding hot temperatures treatment of depression and anemia change in medication OT & PT Pain/Sensory: pain due to lesions on sensory pathways paresthesias dysesthesias proprioception loss. Intervention: Daily analgesic - pain is managed with opioids, anticonvulsant medications, or antidepressants Perimenopausal women: pain related to osteoporosis estrogen loss immobility and corticosteroid therapy play a role in the development of osteoporosis among women with MS. Intervention: Bone mineral density testing is recommended for this high-risk group Spasticity: muscle hypertonicity with increased resistance to stretch often associated with weakness increased deep tendon reflexes diminished superficial reflexes Brain Related: cognitive change (e.g., memory loss, decreased concentration, dementia), Bladder, bowel, and sexual dysfunctions, Other: urinary tract infections (UTIs) constipation pressure injury contracture deformities dependent pedal edema pneumonia osteoporosis Intervention:increased fluid intake and good perineal care help reduce the risk of UTI. Nursing interventions: Mobility: If motor dysfunction causes problems of incoordination and clumsiness, or if ataxia is apparent, then the patient is at risk for falls. To overcome this risk, the patient is instructed to walk with feet apart to widen the base of support and to increase walking stability. If loss of position sense occurs, the patient is instructed to watch their feet while walking. Gait training may require assistive devices (walker, cane, braces, crutches, parallel bars). If incoordination is a problem and tremor of the upper extremities occurs when voluntary movement is attempted (intention tremor), weighted wrist weights or neuromodulation devices may be used. Cognitive: risk of suicide as 50% of patien

carbidopa-levodopa (Sinemet)

-most effective drug for the symptomatic treatment of idiopathic Parkinson's disease-uses a smaller dose -increases dopamine -'wearing off'= adjust dose -Benefits often diminish after 1 or 2 years of treatment. adverse: -common:headache and anxiety -older pts: hallucinations, dementia, and drowsiness. -most severe: depression with suicidal tendencies -cardiovascular adverse: ectopic beats, tachycardia, anginal pain, palpitations, hypotension, vasoconstriction, dyspnea, bradycardia -orthostatic hypotension usially subsides -anorexia, bruxism, and nausea and vomiting Admin: -with or right after food -not crushed -not given w/iron or multivitamin -not given w/high-protein diet -adequate hydration -avoid alcohol -monitor BP Report: -fainting, light-headedness, irregular heart rate, uncontrolled facial movements, urinary retention, nausea, and vomiting to the prescriber. -any increase in static gait, altered mobility, and "pill rolling." Therapeutic: improvement in mobility, balance, posture, gait, speech, handwriting, and self-care ability. Elimination of drooling and seborrhea. Mood elevation.

Expected findings of a new diagnosis of MS?

-parasthesia -Nystagmus (unvoluntary eye movement) -ataxia

Parkinsons Stage 3

-physical movements significantly slower -impaired walking -postural instability -Use assistive device (walker)

Parkinsons Stage 4

-tremors may decrease -akinesia & rigidity make daily task hard -provide small frequent meals -record I&O, & increase fluids -weekly weights -thick/cold fluids are tolerated easier -give nutritional supplements

Parkinsons Stage 1

-unilateral shaking or tremor of one limb

Myasthenia Gravis

-weakness of the voluntary muscles -purely a motor disorder with no effect on sensation or coordination. Clinical Manifestations: Eyes: diplopia (double vision) and ptosis (eyelid drooping) Face: bland facial expression Throat: dysphonia (voice impaired) and dysphagia, risk of choking and aspiration Intercostal Muscles: decreasing vital capacity and respiratory failure - this is myasthenic crisis Diagnostic acetylcholinesterase inhibitor test: administering edrophonium chloride IV; 30 seconds after injection, facial muscle weakness and ptosis should resolve for about 5 minutes (have atropine available for adverse effects: bradycardia, asystole, bronchoconstriction, sweating, and cramping.) Ice test: indicated in patients who have cardiac conditions or asthma. With this test, an ice pack is held over the patient's eyes for 1 minute; the ptosis should temporarily resolve in a patient with myasthenia gravis Nursing Interventions: Conserve Energy: frequently used items (e.g., hygiene products, cleaning products, snacks) be kept on each floor to minimize travel between floors in multilevel homes handicapped license plate to minimize walking schedule activities to coincide with peak energy and strength levels. consistent routines, scheduling periods of rest, monitoring for depression, maintaining good sleep patterns, Aspiration: mealtimes should coincide with the peak effects of anticholinesterase medication Rest before meals sit upright during meals, with the neck slightly flexed to facilitate swallowing Soft foods in gravy or sauces can be swallowed more easily Eating larger meals in the morning and smaller meals in the evening Suction should be available at home Vision: Impaired vision results from ptosis of one or both eyelids, decreased eye movement, or double vision to prevent corneal damage when the eyelids do not close completely, the patient is instructed to tape the eyes closed for short intervals and to regularly instill artificial tears. Patients who wear eyeglasses can have "crutches" attached to help lift the eyelids.

Parkinson's Disease

Cardinal Signs: tremor rigidity bradykinesia/akinesia postural instability -decreased dopamine Clinical Manifestations Resting Tremor: Resting tremor characteristically disappears with purposeful movement and during sleep but is evident when the extremities are motionless or at rest. The tremor may manifest as a rhythmic, slow turning motion (pronation-supination) of the forearm and the hand and a motion of the thumb against the fingers as if rolling a pill between the fingers. Rigidity: Resistance to passive limb movement, Passive movement of an extremity may cause the limb to move in jerky increments, referred to as lead-pipe or cogwheel movements. Involuntary stiffness of the passive extremity increases when another extremity is engaged in voluntary active movement. Early in the disease, the patient may complain of shoulder pain due to rigidity. Bradykinesia: overall slowing of active movement. difficulty initiating movement, such as rising from a sitting position or turning in bed, and taking longer to complete activities Postural Instability: loss of postural reflexes causes head bent forward and walks with a propulsive gait, shuffling gait, Difficulty in pivoting causes loss of balance, either forward (propulsion) or backward (retropulsion). Other: autonomic symptoms that include excessive and uncontrolled sweating, drooling, paroxysmal flushing, orthostatic hypotension, gastric and urinary retention, constipation, and sexual dysfunction. Dysphagia, Psychiatric changes include depression, anxiety, dementia, delirium, hallucinations, and psychosis. contribute to the cognitive changes of diminished executive functions, dementia, attention difficulties, decreased thinking, and word-finding challenges. Hypokinesia (abnormally diminished movement): may appear after the tremor, freezing phenomenon refers to a transient inability to perform active movement shuffle and exhibits a decreased arm swing as well micrographia (small handwriting) develops face becomes increasingly masklike and expressionless, frequency of blinking decreases Dysphonia: voice impairment or altered voice production, monotone dysphagia, begins to drool, and is at risk for choking and aspiration Risks: risk for respiratory and urinary tr

Amyotrophic Lateral Sclerosis

Clinical Manifestations depend on the location of the affected motor neurons chief symptoms are fatigue, progressive muscle weakness, cramps, fasciculations (twitching), and lack of coordination. Affected Spinal Nerves: results in progressive weakness and atrophy of the muscles of the arms, trunk, or legs. Spasticity usually is present, and the deep tendon stretch reflexes become brisk and overactive. Usually, the function of the anal and bladder sphincters remains intact, because the spinal nerves that control muscles of the rectum and urinary bladder are not affected. Weakness, difficulty in talking, swallowing, and ultimately breathing patient ingests liquids, soft palate and upper esophageal weakness cause the liquid to be regurgitated through the nose. Weakness of the posterior tongue and palate impairs the ability to laugh, cough, or even blow the nose. If bulbar muscles are impaired, speaking and swallowing are progressively difficult, and aspiration becomes a risk. The voice assumes a nasal sound, and articulation becomes so disrupted that speech is unintelligible. Some emotional lability may be present Death usually occurs as a result of infection, respiratory insufficiency, or aspiration. Nursing Interventions: The main focus of medical and nursing management is on interventions to maintain o r improve function, well-being, and quality of life. The most common reasons for hospitalization are dehydration and malnutrition, pneumonia, and respiratory failure End-of-life issues include pain, dyspnea, and delirium A patient experiencing aspiration and swallowing difficulties may require enteral feeding. A PEG tube is inserted before the forced vital capacity drops below 50% of the predicted value. Mechanical ventilation (using negative-pressure ventilators) is an option if alveolar hypoventilation develops. Noninvasive positive-pressure ventilation is also an option. The use of noninvasive positive-pressure ventilation is particularly helpful at night and postpones the decision about whether to undergo a tracheotomy for long-term mechanical ventilation

Myasthenic Crisis

Respiratory distress and varying degrees of dysphagia, dysarthria, eyelid ptosis, diplopia, and prominent muscle weakness are symptoms of myasthenic crisis. ventilatory assistance takes precedence The nurse assesses the respiratory rate, depth, and breath sounds and monitors pulmonary function parameters (vital capacity and negative inspiratory force). Blood is drawn for arterial blood gas analysis. Endotracheal intubation and mechanical ventilation may be needed. If the abdominal, intercostal, and pharyngeal muscles are severely weak, the patient cannot cough, take deep breaths, or clear secretions. Chest physiotherapy, including postural drainage to mobilize secretions and suctioning to remove secretions, may have to be performed frequently. (Postural drainage should not be performed for 30 minutes after feeding.) Sedative and tranquilizing agents are avoided, because they aggravate hypoxia and hypercapnia and can cause respiratory and cardiac depression.

A client with a brain tumor is experiencing changes in cognition that require the nurse to reorient the client frequently. When performing this task, which devices would be appropriate for the nurse to use?

clock calendar clients clothing picture of family

Riluzole (Rilutek)

only medication that is approved for use in treating ALS. It is used for its neuroprotective effect in the early stages of the disease