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Chapter 50

Chapter 50. Nursing Care of Patients with Peripheral Nervous System Disorders. Multiple Sclerosis. Pathophysiology Degeneration of Myelin Sheath Inflamed Nerves Slowed or Blocked Nerve Impulses Etiology Unknown Possible Autoimmune Response Possible Viral Infection Heredity.

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Chapter 50

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  1. Chapter 50 Nursing Care of Patients with Peripheral Nervous System Disorders

  2. Multiple Sclerosis • Pathophysiology • Degeneration of Myelin Sheath • Inflamed Nerves • Slowed or Blocked Nerve Impulses • Etiology • Unknown • Possible Autoimmune Response • Possible Viral Infection • Heredity

  3. Myelin Sheath Breakdown

  4. Signs and Symptoms • Muscle Weakness • Numbness • Fatigue • Slurred Speech • Vision Disturbances • Vertigo • Ataxia • Dysphagia • Bowel/Bladder Problems • Sexual Dysfunction • Mood Alterations

  5. Additional Manifestations • Remissions • Exacerbations • Due to Stress or Illness • Immobility • Death Usually from Infection

  6. Diagnosis • History and Physical • CSF Analysis • MRI • gMS DX

  7. Therapeutic Interventions • Steroids • Interferon Therapy • Immunosuppressant Agents • Anticonvulsants • Muscle Relaxants • Plasmapheresis • Physical, Occupational, Speech Therapies

  8. Myasthenia Gravis • Pathophysiology • Antibodies Destroy ACh Receptors • ACh Unable to Stimulate Muscle Contraction • Loss of Voluntary Muscle Strength

  9. Neuromuscular Junction

  10. Etiology • Unknown • Autoimmune • Thymus Disorders • Possible Viral Origin

  11. Signs and Symptoms • Progressive Muscle Weakness • Fatigue with Activity • Ptosis • Difficulty Chewing, Swallowing • Difficulty Breathing

  12. Signs and Symptoms (cont’d) • Remissions • Exacerbations • Stress

  13. Complications • Aspiration • Respiratory Infection and Failure • Mysathenic Crisis • Cholinergic Crisis • SLUDGE

  14. Diagnosis • History and Physical • Tensilon Test • Anti-ACh Receptor Antibodies • EMG

  15. Therapeutic Interventions • Thymectomy • Anticholinesterase Agents • Steroids • Plasmapheresis

  16. Nursing Process • Activity Intolerance • Teach Methods to Conserve Energy • Teach Avoidance of Infection • Teach Signs and Symptoms of Crisis • Teach Medications to Avoid • Support Group

  17. Amyotrophic Lateral Sclerosis:Lou Gehrig’s Disease • Pathophysiology • Motor Neurons Degenerate • Nerve Impulse Transmission Blocked • Muscle Weakness and Atrophy

  18. Etiology • Unknown • Possible Genetic Predisposition

  19. Signs and Symptoms • Progressive Muscle Weakness and Atrophy • Decreased Coordination • Muscle Spasm • Difficulty Chewing and Swallowing

  20. Signs and Symptoms (cont’d) • Emotional Lability • Speech Difficulty • Pulmonary Compromise • Death in 2 to 5 Years, up to 20 Years

  21. Diagnosis • History and Physical • LP with CSF Analysis • EEG • Nerve Biopsy • EMG

  22. Therapeutic Interventions • Muscle Relaxants • Riluzole • Physical, Occupational, Speech Therapies • Pain Control • Tube Feedings • Prevention of Infection • Augmentative Alternative Communication

  23. Patient Education • Support Groups • Importance of Avoiding Infection • Teach Family to Provide Care

  24. Guillain-Barre Syndrome (GBS) • Pathophysiology • Inflammation of Spinal and Cranial Nerves • Segmental Demyelination in Ascending Pattern • Lymphocyte Infiltration • Descending Remyelination

  25. GBS Variants • Ascending • Descending • Miller-Fisher Syndrome • Motor Guillain-Barre

  26. Etiology • Unknown • Possible Autoimmune Response to Virus

  27. Signs and Symptoms • Stage 1: 24 Hours to 3 Weeks • Abrupt Onset Weakness and Paralysis • May Affect Respiration • ANS Effects • Stage 2: 2 to 14 Days • Plateau • Progression Stopped • Stage 3: 3 to 24 Months • Recovery

  28. Complications • Respiratory Failure • Infection • Depression • Pneumonia • UTI • Complications of Immobility

  29. Diagnosis • LP with CSF Analysis • EMG • Nerve Conduction Velocity • Pulmonary Function Testing

  30. Therapeutic Interventions • Plasmapheresis • Oxygen • Mechanical Ventilation • Emotional Support • Rehabilitation

  31. Nursing Care • Monitor Vital Capacity and ABGs • Provide Supportive Care • Manage Pain • Maintain Nutrition • Assist with Communication • Provide Diversional Activities

  32. Post-Polio Syndrome • Affects Polio Victims 10 to 40 Years Later • Signs and Symptoms • Muscle Weakness • Fatigue • Pain • Respiratory Compromise • Treatment: Rest

  33. Nursing Diagnoses: Neuromuscular Disorders • Ineffective Airway Clearance • Impaired Physical Mobility • Risk for Imbalanced Nutrition • Impaired Verbal Communication

  34. Cranial Nerve Disorders • Trigeminal Neuropathy • Bell’s Palsy

  35. Trigeminal Neuralgia • Pathophysiology • Irritation of the Trigeminal Nerve • Affects Sensory Portion of Nerve • Etiology • Irritation or Chronic Compression

  36. Trigeminal Innervation

  37. Signs and Symptoms • Intense Pain on One Side of Face • Forehead, Cheek, Nose, Jaw • Triggered by Touch, Talking, Other Stimulation

  38. Diagnosis • History and Physical • CT Scan • MRI

  39. Therapeutic Interventions • Anticonvulsants • Nerve Blocks • Surgery to Block Pain Signals

  40. Bell’s Palsy • Pathophysiology/Etiology • Inflammation and Edema of Facial Nerve • Loss of Motor Control • Etiology Unknown

  41. Signs and Symptoms • One-Sided Facial • Pain • Weakness • Speech Difficulty • Drooling • Tearing of Eye • Inability to Blink

  42. Diagnosis • History and Physical • EMG • Rule Out Stroke

  43. Therapeutic Interventions • Prednisone • Analgesics • Antiviral Medication • Moist Heat • Gentle Massage • Facial Sling

  44. Nursing Diagnoses: Cranial Nerve Disorders • Pain • Imbalanced Nutrition • Risk for Injury to Eyes (Bell’s Palsy)

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