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Chapter 10

Unit 2: Nursing care of clients with neurosensory disorders

Multiple Sclerosis, Amyotrophic Lateral Sclerosis, & Myasthenia Gravis (Pg. 100) Neuro diseases that typically result in impaired & worsening function of voluntary muscles
Multiple Sclerosis: Define Autoimmune disorder characterized by development of plaque in the white matter of the CNS -Plaque damages the myelin sheath & interferes w impulse transmission between the CNS & the body
What is MS marked by? r&r Relapsing & remitting (common courses) -Overtime client may progress to quadriplegia
Is there a known cure to MS? No & it's chronic
Risk factors: Age, gender, family 20-40 yrs old onset, 2x likely in women -Family hx
What can trigger relapses? (Autoimmune disease) Viruses/infectious agents, cold, physical injury, emotional stress, pregnancy, fatigue, overexertion, temperature extremes, hot shower/bath.
S/s of MS (Pg. 101) -Fatigue, pain, vision Fatigue (lower extremities), pain/paresthesia, diplopia, changes in peripheral vision
What is diplopia and paresthesia? Diplopia: double vision Paresthesia: tingling sensation "pins & needles"
S/s of MS con't (Pg. 101) -What is uhthoff's sign? -Hearing, mouth -Temporary worsening of vision & other neuro functions just after exertion or situation where they are exposed to heat -Tinnitus, vertigo, decreased hearing acuity -dysphagia, dysarthria
What is tinnitus? Ringing or buzzing in the ears
What is dysarthria? for MS Slurred & nasal speech
S/s of MS con't -muscles, bowels/bladder Muscle spasms, ataxia, nystagmus, constipation/incontinence, areflexia, sexual dysfunction
What is ataxia? Loss of full control of bodily movements
What is nystagmus? Rapid involuntary movement of the eyes
What is areflexia? Absence of reflexes
MS lab tests? CSF analysis ^ protein level & slight ^ WBC
Dx procedures for MS? MRI reveals plaques of the brain & spine
MS meds: -Azathioprine (Imuran) & Cyclosporine (Sadimmune) & s/e Immunosuppresive agents; to reduce frequency of relapses -htn, kidney dysnfunction (s/e)
MS meds: -Prednisone (Deltasone) & s/e Corticosteroid; reduce inflx in acute exacerbations -^ risk of infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, personality changes
MS meds: -Dantrolene (Dantrium), Tizanidine (Zanaflex), Baclofen (Lioresal), & Diazepam (Valium) -s/e Antispasmodics; tx muscle spasticity -^ weakness, liver damage, jaundice
MS meds: -Interferon beta (Betaseron) Immunomodulators; prevent/tx relapses
MS meds: -Carbamazepine (Tegretol) Anticonvulsants; tx paresthesia
MS meds: -Docusate sodium (Colace) Stool softners; constipation
MS meds: -Propantheline (Pro-Banthine) Anticholinergics; bladder dysfunction
MS meds: -Primidone (Mysoline) & Clonazepam (Klonopin) Beta-blockers used for tremors
Amyotrophic Lateral Sclerosis: (Pg. 103) Define & what does this cause Degenerative neuro disorder of the upper & lower motor neurons = death & deterioration of the motor neurons -Progressive paralysis & muscle wasting that eventually causes respiratory paralysis & death
Does ALS usually affect cognitive function? Cognitive function not usually affected
ALS is also known as: Lou Gehrig's disease
How does death usually occur? and when? ALS D/t respiratory failure, within 3-5 years
Is there a cure for ALS? No & the cause is unknown
Risk factors for ALS? gender, ages More men than women, 40-70 onset
S/s of ALS? Fatigue, twitching/cramping muscles, muscle weakness, muscle atrophy, dysphagia, dysarthria, hyperreflexia of DTR
Lab tests for ALS? Increased CK-BB level; creatine kinase
Dx procedures for ALS? -Electromyogram (EMG): reduction in # of functioning motor neurons of peripheral nerves -Muscle biopsy: reduction in # of motor units of peripheral nerves & atrophic muscle fibers
Nursing care w ALS? (Pg. 103) -airway, HOB, speech, intake, nutrition Maintain patent airway; suction/intubate, ABGs, o2, bpap, vent, etc. -HOB 45, TCDB q2h, IS, chest physiotherapy -Communication method -Swallow reflex, oral intake.. thicken liquids -Enteral nutrition when you can't swallow
Meds for ALS: Riluzole (Rilutek) Glutamate antagonist; can slow the deterioration of motor neurons by decreasing the release of glutamic acid. -Can add 2-3 months of lifespan, take early in disease
S/e of Rilutek: Hepatotoxic (monitor LFTs) Dizzy, vertigo, somnolence
Educating on Rilutek: -Avoid, take, store Avoid alcohol Take med at evenly spaced intervals (q12h ex) Store away from bright light
Meds for ALS: Baclofen (Lioresal), Dantrolene sodium (Dantrium), Diazepam (Valium) Antispasmodics are used to decrease muscle spasticity
Complications of ALS: -Think airway Pneumonia & respiratory failure
Myasthenia Gravis: (Pg. 105) Progressive autoimmune disease; produces muscular weakness. -Periods of exacerbation & remission
MG, muscle weakness improves with ___ & worsens with ____ Rest, increased activity
What causes MG? Antibodies that interfere w the transmission of acetylcholine at the neuromuscular junction
Risks to MG: -Causes Coexisting autoimmune disorder, hyperplasia of the thymus gland
Risks to MG: -Triggers Infection, stress, fatigue, pregnancy, ^ in body temperature
S/s of MG: Progressive muscle weakness, diplopia, dysphagia & chewing, respiratory dysfunction, bowel/bladder issues (incontinence), poor posture
For MG where is the decreased muscle strength usually seen? Face, eyes & proximal portion of major muscle groups -drooping eyelids
Dx testing for MG: Tensilon testing: baseline assessment of cranial nerve strength is done & Edrophonium (Tensilon) is administered -Positive test; marked improvement in muscle strength that lasts approximately 5 minutes
What does Tensilon do? MG Inhibits the breakdown of acetylcholine
Complications of the Tensilon test? Fasciculations around the yes & face, cardiac arrhythmias
What is the antidote for Tensilon? Atropine
Another dx test for MG? Electromyography: shows the neuromuscular transmission characteristics of MG
Nursing care for MG? (Pg. 106) basics, types of meals, eyes, ID Airway, rest, swallowing precautions -Small, frequent, high-calorie meals -eye drops day & night if client can't close eyes, might need to tape eyes shut at night to prevent damage to the cornea -med ID band
First line therapy for MG? Anticholinesterase agents -Usually given 4x a day
Client education for anti cholinesterase agents? Hx of asthma, cardiac dysrhythmias (be careful) -Take w food, eat within 45 mins of taking the med to strengthen chewing & reduce the risk for aspiration, maintain therapeutic levels
Meds for MG: Pyridostigmine (Mestinon) & Neostigmine (Prostigmin) Used to increase muscle strength in the symptomatic tx of MG -Inhibits breakdown of acetylcholine and prolongs its effects -Careful w asthma, seizures, cvd
Meds for MG: Prednisone (Deltasone) & Azathioprine (Imuran) Immunosuppressants given during exacerbations when Mestinon is not effective -they decrease the production of antibodies -prednisone (corticosteroid) is the 1st med of choice
S/e of immunosuppressants: Monitor for infection, taper off slowly
Therapeutic procedures for MG: Plasmapheresis: removes circulating antibodies from the plasma -VS, wt, labs before -lasts 2-5 hrs
Plasmapheresis intraprocedure nursing care: -Assess for Dizziness & hypotension -Maintain shunt patency (usually 1 in each upper extremity)
Post procedure for plasmapheresis: Apply a pressure dressing, monitor for infection, labs, monitor for hypokalemia,volemia,calcemia
Surgical interventions for MG: Thyectomy- removal of thymus gland; attain better control & complete remission
How long until you can see the results of a thyectomy? Months to years d/t the life of circulating T cells
Nursing action postop thyectomy? -Airway Client may have had a chest tube or intubated -TCDB q2hr -Pneumo/hemothorax (observe for s/s)
Complications of MG: Myasthenic crisis & cholinergic crisis
What is myasthenic crisis? S/S pg. 108 Occurs when client is experiencing a stressor that causes an exacerbation of MG; i.e.. infection -Or taken too little cholinesterase inhibitor
What is cholinergic crisis? S/S pg. 108 Occurs when the client has taken too much cholinesterase inhibitor
Created by: mary.scott260!