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M6 13-005
Exam 15: Multiple Sclerosis & Parkinson's Disease
| Term | Definition |
|---|---|
| Multiple Sclerosis (MS) | A common, progressive degenerative neurological disease. The myelin sheath, the covering around the axon, is destroyed with inflammation and scarring. |
| Causes of MS | Cause is unknown: Viral infection? Onset 15 – 50 years old. Women > Men. Greater incidence in temperate climates. Higher rate among relatives – genetic link inconclusive. |
| Etiology/Pathophyiology of MS | Proliferation of gamma/delta T-cells in CSF. Moderators of the Immune System. In MS, T-Cells attack the body End result is damage to the myelin sheath. |
| Clinical Manifestations of MS | Visual problems. Urinary incontinence. Fatigue. Weakness or uncoordination of an extremity. Sexual problems such as impotence in men. Difficulty swallowing. |
| Assessment of MS (Subjective Data) | Patient's understanding of the disease process. Presence of eye problems. Weakness or numbness of a part of the body. Fatigue, Emotional instability. Bowel bladder problems. Vertigo, Ataxia , Tremor. Loss of joint sensation. Impotence. Pain is unc |
| Assessment of MS (Objective Data) | Nystagmus. Muscle weakness and spasms. Changes in coordination. Spastic, ataxic gait. Evidence of behavior changes. Urinary incontinence. Difficulty swallowing. Intention tremors of the upper extremities. |
| Diagnosis of MS: CSF | Shows elevated gamma globulin and a proliferation of gamma/delta T cells |
| Diagnosis of MS: CT Scan | May show enlargement of the ventricles |
| Diagnosis of MS: MRI | May be helpful in the final diagnosis. Identifying certain hallmark changes in the brain. |
| Medical Management of MS | No cure, no single treatment for all symptoms. Control of symptoms: -Adrenocorticotropic hormone (ACTH). -Corticosteroids Effects of ACTH and steroids are unknown. |
| Spasticity (Skeletal Muscle Relaxants) | For MS. diazepam (Valium). dantrolene (Dantrium). baclofen (Lioresal). |
| Immunomodulating Agents | Interferon beta-1b (Betaseron). Interferon beta-1a (Avonex). |
| Interferon beta-1b (Betaseron) | SQ q every other day. Used in ambulatory patients with relapsing-remitting. MS to reduce frequency of exacerbations. |
| Interferon beta-1a (Avonex) | Given IM once a week. Decreases the frequency of exacerbations in select patients and slows the progress of physical disability. |
| Immunomodulator: glatiramer acetate (Copaxone) | For use in relapsing MS. Believed to interrupt the inflammatory cycle. |
| Antineoplastic / Immunosuppresant mitoxantrone (Novantrone) | Reduces both B and T lymphocytes. Given intravenously monthly. Cannot be used for more than 2-3 years due to cardiac toxicity. |
| Propantheline bromide (Pro-Banthine) | Promotes elimination. For urinary frequency and urgency. |
| Cholinergic drugs-bethanechol chloride (Urecholine) | promotes Elimination. neurogenic bladder-exerts a direct antispasmodic effect on smooth muscles. |
| With MS Stool softener | docusate sodium (Colace) and prune juice are recommended. |
| Common problem with MS | UTIs |
| Interferons therapeutic effects __________ incidence of neurological dysfunction. | reduce |
| nutrition with MS | Well Balanced High fiber foods with adequate fluids Obesity makes it more difficult for patient |
| Skin Care with MS | Prevent breakdown Sensory impairment reduces sensation of discomfort. |
| Activity with MS | Regular exercise with rest periods Bedrest may be ordered during exacerbations Physical therapy |
| Control of Environment with MS | Avoid hot baths Prevent traveling during the warmest part of the day Provide air-conditioned surroundings during the summer Provide a peaceful and relaxed environment. |
| With MS prepare patients and family for | explosive emotional outbursts slowness in speech and slowness in ability to respond |
| Parkinson's Disease | Syndrome that consists of A slowing down in the initiation and execution of movement (bradykinesia), -Increased muscle tone (rigidity) -Tremor -Impaired postural reflexes. No known cure. |
| Dopamine is a | neurotransmitter |
| Causes of Parkinson's Disease | Possible genetic link. Encephalitis lethargica, or type A encephalitis. Intoxication with a variety of chemicals. Drug-induced parkinsonism. Patients with cerebrovascular disease often have parkinsonism-like symptoms. |
| Patients with cerebrovascular disease often have | parkinsonism-like symptoms |
| Most patients with Parkinsonism have | Degenerative or idiopathic form, for which the term Parkinson’s disease is usually reserved. |
| Onset of Parkinson's Disease | Gradual and Insidious |
| Beginning stages of Parkinson's Disease show | Mild tremor, slight limp, decreased arm swing, change in handwriting |
| Later stages of Parkinson's Disease show | Shuffling, propulsive gait with arms flexed. Loss of postural reflexes. Slight change in speech patterns. |
| Subjective data with Parkinson's Disease | Fatigue. Presence of uncoordination. Judgement defects. Emotional instability. Anxiety. Depression. Heat intolerance. |
| Objective data with Parkinson's disease. | Tremor (Pill rolling). Bradykinesia. Rigidity & loss of postural reflexes (cogwheel). Mask-like appearance on the face. Drooling. Moist, oily skin. Constipation. Scaly, erythematous rash. |
| Diagnosis of Parkinson's Disease | No specific test. Clinical examination. history. Pt response to medication confirm. CT scan (may show Cerebral atrophy). EEG may show slurring. Upper GI may show decreased motility. |
| Treatment for Parkinson's | Based on easing the S&S of the disease. |
| Surgical interventions for Parkinson's Disease | Destroy portions of the brain controlling rigidity or tremor. Human Fetal Dopamine Cell Transplant. |
| Anti-Parkinson Agents | Aimed at increasing the levels of dopamine and/or antagonizing the effects of acetylcholine |
| Anti-Parkinson Agents Action | Aimed at restoring natural balance of acetylcholine and dopamine in the CNS |
| Dopamine Receptor Agonists (Anticholinergic)-Indirect acting | Blocks central cholinergic receptors Is indicated in treatment of mild cases of Parkinson’s disease and control of extrapyramidal reactions. Examples: benztropine mesylate (Cogentin) and trihexyphenidyl HCL (generic only-formally called Artane). |
| Presynaptic Dopamine release enhancer | Potentiates the action of dopamine in the CNS-Indirect acting. Example- amantadine HCL (Symmetrol). Interacts with anticholinergic drugs, sulfonamide antibiotics, quinidine, and thiazide diuretics. |
| Dopaminergic: Direct acting. Bromocriptine (Parlodel) and pergolide (Permax) | Direct stimulation of the dopamine receptors |
| Dopaminergic: Direct acting Carbidopa-levodopa (Sinemet) | Increases levels of dopamine and levodopamine. lower dosage is needed than with single-dose therapy). Efficiency may increase 75% |
| Dopaminergic decrease effectiveness if taken with | Metoclopramide or Phenothiazines. |
| Levodopa (Dopar, Larodopa, L-Dopa) | Increases balance between cholinergic and dopaminergic activity Allows more normal body movements and alleviate signs and symptoms. |
| Anti-Parkinson Agents. Pramipexole (Mirapex) and ropinirole (Requip)-direct acting. | Act by direct stimulation of the dopamine receptors in the brain. They may be used alone in early Parkinson’s disease or as adjuncts to levodopa in advanced stages. |
| Anti-Parkinson Agents. Monoamine Oxidase (MAO) Inhibitor-indirect acting. | May slow Parkinson’s disease and need for increased medication. May prolong life span Examples: selegiline HCL (Eldepryl) |
| Anti-Parkinson Agents Contraindications | Check individual drugs. Anticholinergics and Dopaminergic: narrow-angle/angle closure glaucoma. |
| Anti-Parkinson Agents Side Effects: CNS | Involuntary movements Headache Numbness Insomnia Nightmares |
| Anti-Parkinson Agents Side Effects: CV | Orthostatic Hypotension. Palpitations. Tachycardia. |
| Anti-Parkinson Agents Side Effects: GI | Nausea. Vomiting. Dry Mouth. |
| Anti-Parkinson Agents Side Effects: GU | Urinary hesitancy. Urine Retention. |
| Anti-Parkinson Agents Nursing Implications | Assess parkinsonian and extrapyramidal symptoms before and throughout therapy. Monitor BP frequently. Give w/ food unless contraindicated. |
| Nutrition concerns with Parkinson's Disease | As illness progresses aspiration is a real concern |
| Elimination Concerns with Parkinson's Disease | Diet is well balanced with high-fiber foods and roughage Assure adequate fluids Stool softeners are usually prescribed Suppositories Prune juice Mild cathartics such as MOM |
Created by:
jtzuetrong
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