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 |