Parkinsons Disease/ Multiple Sclerosis

How is MS diagnosed?

Assessing the symptoms and ruling out other diseases MRI to look for lesions Lumbar puncture to test CSF for Oligclonal bands Evoked potential studies electrical signals sent to CNS to see if there is a response

What is Multiple Sclerosis?

Autoimmune disease that affects the myelin sheath

What are some meds used to help with the symptoms of MS?

BETA INTERFERON Ex. Avonex, Betaferon decrease the relapse risk of infection b/c it decreases WBC Corticosteroids Ex. methylprednisolone, prednisone Bladder meds: OXYBUTYNIN anticholinergic overactive bladder (prevents contractions) BETHANECHOL cholinergic Empties bladder (promotes contractions) Fatigue meds: Ex. Amatadine, Modafinil CNS stimulants Spasm meds: Ex. baclofen, diazepam Tremor meds: Ex. propranolol (beta blocker) isoniazid (antibiotic)

Medications for parkinsons disease

CARBIDOPA/LEVODOPA combination Ex. Sinemet takes up to 3 wks to decrease symptoms body fluids can turn dark DON'T take with MAO inhibitor (hypertensive crisis) Avoid Vit B6 Avoid high protein S/E: nausea, involuntary movements ROPINIROLE Ex. Requip improves movement S/E: drowsiness AMANTADINE antiviral stimulates dopamine ANTICHOLINERGIC Ex. Benztropine, Cogentin blocks acetylcholine decreases excitability decreases rigidity decreases drooling NOT FOR PT. WITH GLAUCOMA S/E: never abruptly stop taking no ALCOHOL dry mouth MAO Inhibitor Type B Ex. Rasagiline, Azilect increases dopamine limit foods with tyramine: aged cheese smoked/cured meats fermented foods beer COMT Inhibitors Ex. Entacapone, Comtan prevents wearing off of levodopa/carbidopa

Signs and symptoms that are non-motor in a pt with parkinsons

Depression Constipation Loss of smell

True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease.

False

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.

False: MS affects WOMEN more than men and shows up during the ages of 20-40 years.

True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system.

False: Yes, patients with MS have different signs and symptoms because lesions can present at different locations in the CENTRAL NERVOUS SYSTEM....hence the brain and spinal cord (not the peripheral nervous system).

What are the EMOTIONAL AND COGNITIVE signs and symptoms?

Fatigue Depression Dysarthria (trouble speaking) Mood swings Trouble thinking

What as a nurse would you teach the pt to prevent symptoms from getting worse?

Keep rm cool Avoid infection Stress free environment Don't over exert Maintain exercise (swimming, water aerobics)

What are the VISUAL signs and symptoms?

Nystagmus Optic neuritis (dbl vision) Blurry vision Dark spots in vision Pain when they move their eyes

What are the ELIMINATION signs and symptoms?

Overactive bladder Urinary retention Bowel constipation/diarrhea/incontinence

When symptoms of MS appear and then disappear this is called

Relapsing-remitting MS (RRMS)

Nursing interventions for a pt with parkinsons disease

SAFETY avoid rubber soles move slowly use cane or walker with a laser walk as though you are marching DON'T push through a freeze up Remove rugs elevated toilet seats PSYCHOSOCIAL use special utensils for PD pts. support groups exercise don't hurry the pt no buttons or zippers NUTRITION Avoid taking antiparkinson meds with protein Soft foods drink plenty of fluids Fresh fruits and veggies to prevent constipation

List some nursing interventions for a pt with MS

SAFETY (due to vision, coordination, decreased perception) (Declutter, use assistive devices) Preventing symptoms from getting worse BLADDER and BOWEL (bathroom accessible, drink plenty of fluids, high fiber diet, learn how to self cath) Administer meds

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

The answer is A. The patient should have a diet of soft foods that are easy to swallow and chew. Option A is the only option that meets that specification.

A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying. A. Bethanechol B. Oxybutynin C. Avonex D. Amantadine

The answer is A. This medication is a cholinergic medication that will help with bladder emptying.

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

The answer is A. This medication is contraindicated for patients with glaucoma.

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

The answer is A. This medication is known to cause sudden drowsiness that can cause a person to randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc...to prevent injury.

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

The answer is A. This option is the only one that is INCORRECT. Tremors in Parkinson's Disease tend to occurs at rest and will actually improve with movement.

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress

The answer is B, C, and F. The patient should also avoid extreme heat, which can increase symptoms.

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present. A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

The answer is B. These specific proteins, oligoclonal bands, which are immunoglobulins will be found in the CSF. This demonstrates there is inflammation in the CNS and is a common finding in multiple sclerosis.

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing: A. Romberg's Sign B. Lhermitte's Sign C. Uhthoff's Sign D. Homan's Sign

The answer is B. This finding is known as Lhermitte's Sign

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

The answer is B. This is an example of a positive Romberg's Sign.

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

The answer is B. This is known as cogwheel rigidity, and occurs when the arms are passively moved, which will cause them to jerk slightly.

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________. A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

The answer is C.

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

The answer is C. All the other options are CORRECT about this medication. However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

The answer is C. Interferon Beta decreases the number of relapses of symptoms in MS patients by decreasing the immune system response, but it lowers the white blood cells count. Hence, there is a risk of infection. It is very important the nurse stresses the importance of hand hygiene and avoiding infection.

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agnoists (Ropinirole) C. MAO Inhibitor Type B (Rasagiline) D. COMT Inhibitor (Entacapone)

The answer is D. Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the "wearing off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

The answer is D. Rubber sole shoes can make walking difficulty, especially when the patient has a shuffling gait because these type of shoes tend to stick to the floor and can cause the patient to trip. It is best to wear low heel, smooth soles (not slick or hard).

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

The answer is D. This is known as bradykinesia.

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

The answers are A, B C, D, and H. If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

The answers are A, B, D. These are correct teaching points on how to deal with freeze ups in Parkinson's Disease.

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

The answers are B and D. Constipation (not diarrhea) is a common symptom with Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetable and drinking 2 L of fluid per day (unless contraindicated). In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine (hence decreasing it absorption).

You're developing a plan of care for a patient with multiple sclerosis who presents with Uhthoff's Sign. What interventions will you include in the patient's plan of care? Select all that apply: A. Avoid movements of the head and neck downward B. Keep room temperature cool C. Encourage patient to use warm packs and heating pads for symptoms D. Educate the patient on three ways to avoid overheating during exercise

The answers are B and D. Uhthoff's Sign is where when the patient experiences too much heat their symptoms increase and get worst. Therefore, it is important the patient stays cool and doesn't overheat (overheating can come from outside temperatures, exercise, emotional events etc.). The room should be cool and the patient should be encouraged to exercise but to avoid overheating.

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

The answers are B, C, E, F, H. These are all signs and symptoms experienced with PD (they vary among patients). There is NOT increased salivation (although drooling occurs...this is due to the decreased ability to swallow. There are tremors at REST (not movement) along with depression rather the euphoria

A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply: A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish

The answers are B, D, and E. Rasagiline "Azilect" is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

The answers are C and D. These medications treat muscle spasms in patients with MS.

What are the SENSORY signs and symptoms

Tremors Spasms Clumsiness Numbness/tingling Lhermitte's sign (electric shock sensation) Dizzy +Rombergs sign

What are the signs and symptoms of Parkinsons disease?

Tremors at rest (most common) ex. pill rolling Stiffness of extremities (arms don't swing with gait) akinesia (inability to move the muscles voluntarily) Shuffling gait COGWHEEL rigidity (when arms are adducted they jerk) Bradykinesia (slow movements) Coordination issues (stoop to compensate) Issues with speech and swallowing

When symptoms get worse due to heat this is called?

Uhthoff's sign

MS tends to affect people of what gender and age

Women between 20-40

A loss of dopamine in the parkinsons pt. means an increase in what chemical that produces an excitatory affect?

acetycholine

dysphagia

difficulty swallowing

diplopia

double vision

dysarthria

slow or slurred speach

In a pt with Parkinsons disease what neuron in the brain has started to die?

substantia nigra (controls movement)