Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 50 Nursing Care of Patients with Peripheral Nervous System Disorders

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Multiple Sclerosis  Pathophysiology  Degeneration of Myelin Sheath  Inflamed Nerves  Slowed or Blocked Nerve Impulses  Etiology  Unknown  Possible Autoimmune Response  Possible Viral Infection  Heredity

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Myelin Sheath Breakdown

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Muscle Weakness  Numbness  Fatigue  Slurred Speech  Vision Disturbances  Vertigo  Ataxia  Dysphagia  Bowel/Bladder Problems  Sexual Dysfunction  Mood Alterations

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Additional Manifestations  Remissions  Exacerbations  Due to Stress or Illness  Immobility  Death Usually from Infection

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  CSF Analysis  MRI  gMS DX

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Steroids  Interferon Therapy  Immunosuppressant Agents  Anticonvulsants  Muscle Relaxants  Plasmapheresis  Physical, Occupational, Speech Therapies

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Myasthenia Gravis  Pathophysiology  Antibodies Destroy ACh Receptors  ACh Unable to Stimulate Muscle Contraction  Loss of Voluntary Muscle Strength

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Neuromuscular Junction

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Unknown  Autoimmune  Thymus Disorders  Possible Viral Origin

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Progressive Muscle Weakness  Fatigue with Activity  Ptosis  Difficulty Chewing, Swallowing  Difficulty Breathing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms (cont’d)  Remissions  Exacerbations  Stress

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Aspiration  Respiratory Infection and Failure  Mysathenic Crisis  Cholinergic Crisis  SLUDGE

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  Tensilon Test  Anti-ACh Receptor Antibodies  EMG

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Thymectomy  Anticholinesterase Agents  Steroids  Plasmapheresis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Amyotrophic Lateral Sclerosis: Lou Gehrig’s Disease  Pathophysiology  Motor Neurons Degenerate  Nerve Impulse Transmission Blocked  Muscle Weakness and Atrophy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Unknown  Possible Genetic Predisposition

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Progressive Muscle Weakness and Atrophy  Decreased Coordination  Muscle Spasm  Difficulty Chewing and Swallowing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms (cont’d)  Emotional Lability  Speech Difficulty  Pulmonary Compromise  Death in 2 to 5 Years, up to 20 Years

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  LP with CSF Analysis  EEG  Nerve Biopsy  EMG

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Muscle Relaxants  Riluzole  Physical, Occupational, Speech Therapies  Pain Control  Tube Feedings  Prevention of Infection  Augmentative Alternative Communication

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Support Groups  Importance of Avoiding Infection  Teach Family to Provide Care

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Guillain-Barre Syndrome (GBS)  Pathophysiology  Inflammation of Spinal and Cranial Nerves  Segmental Demyelination in Ascending Pattern  Lymphocyte Infiltration  Descending Remyelination

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition GBS Variants  Ascending  Descending  Miller-Fisher Syndrome  Motor Guillain-Barre

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Unknown  Possible Autoimmune Response to Virus

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Respiratory Failure  Infection  Depression  Pneumonia  UTI  Complications of Immobility

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  LP with CSF Analysis  EMG  Nerve Conduction Velocity  Pulmonary Function Testing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Plasmapheresis  Oxygen  Mechanical Ventilation  Emotional Support  Rehabilitation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care  Monitor Vital Capacity and ABGs  Provide Supportive Care  Manage Pain  Maintain Nutrition  Assist with Communication  Provide Diversional Activities

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Post-Polio Syndrome  Affects Polio Victims 10 to 40 Years Later  Signs and Symptoms  Muscle Weakness  Fatigue  Pain  Respiratory Compromise  Treatment: Rest

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Neuromuscular Disorders  Ineffective Airway Clearance  Impaired Physical Mobility  Risk for Imbalanced Nutrition  Impaired Verbal Communication

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cranial Nerve Disorders  Trigeminal Neuropathy  Bell’s Palsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Trigeminal Neuralgia  Pathophysiology  Irritation of the Trigeminal Nerve  Affects Sensory Portion of Nerve  Etiology  Irritation or Chronic Compression

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Trigeminal Innervation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Intense Pain on One Side of Face  Forehead, Cheek, Nose, Jaw  Triggered by Touch, Talking, Other Stimulation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  CT Scan  MRI

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Anticonvulsants  Nerve Blocks  Surgery to Block Pain Signals

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Bell’s Palsy  Pathophysiology/Etiology  Inflammation and Edema of Facial Nerve  Loss of Motor Control  Etiology Unknown

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  One-Sided Facial  Pain  Weakness  Speech Difficulty  Drooling  Tearing of Eye  Inability to Blink

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  EMG  Rule Out Stroke

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Prednisone  Analgesics  Antiviral Medication  Moist Heat  Gentle Massage  Facial Sling

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Cranial Nerve Disorders  Pain  Imbalanced Nutrition  Risk for Injury to Eyes (Bell’s Palsy)