Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Demyelination of peripheral nerves Result of immune-mediated pathologic processes Symptoms:  Initial muscle weakness and pain  Ascending paralysis  Autonomic dysfunction

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Diagnostic testing Priority nursing care  Respiratory care  Pain management  Communication and emotional  Nutritional Involvement of family, other team members Education Medical treatments—plasmapheresis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Removes circulating antibodies assumed to cause disease Plasma selectively separated from whole blood; blood cells returned to patient without plasma Plasma usually replaces itself, or patient is transfused with albumin

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Include anticholinesterase and antimyasthenics Enhance neuromuscular impulse transmission by preventing decrease of ACh by enzyme ChE Administer with food Observe drug interactions

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes Prostigmin

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Tensilon crisis  Atropine sulfate Cholinergic crisis  Maintain respiratory function  Anticholinergic drugs withheld while on ventilator  Atropine Myasthenic crisis  Maintain respiratory function  Cholinesterase-inhibiting drugs withheld

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Immunosuppression Plasmapheresis Respiratory support Promoting self-care guidelines Assisting with communication Nutritional support Eye protection Surgical management usually involving thymectomy

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Factors in exacerbation—infection, stress, surgery, hard physical exercise, sedatives, enemas, strong cathartics Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes Teach warning signs and importance of compliance

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Common causative agents  Vehicular or sports injury  Wounds to peripheral nerves Degeneration/retraction of nerve distal to injury within 24 hr Cold phase vs. warm phase Perioperative and postoperative care Rehabilitation through physiotherapy

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Leg paresthesias  Irresistible urge to move  Peripheral and central nerve damage in legs/spinal cord Management  Symptomatic  Nonmedical treatment  Drug therapy effective for some patients

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Trigeminal or fifth cranial nerve Pain management  Nonsurgical management  Surgical management  Microvascular decompression  Radiofrequency thermal coagulation  Percutaneous balloon microcompression Postoperative care

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Seventh cranial nerve Interventions  Medical management  Prednisone, analgesics, acyclovir  Protection of eye  Nutrition  Massage, warm/moist heat, facial exercises

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 20-year-old female college student presents at the university health clinic with manifestations that include fatigue, muscle aches, numbness and tingling, double vision, and difficulty swallowing. The patient is transferred to an acute care facility with a diagnosis of r/o myasthenia gravis (MG). Which diagnostic tests would you expect to be performed?

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. During the evening shift, you note that the patient is having difficulty mobilizing secretions. Which interventions should be implemented for this problem? (Select all that apply.) A. Oropharyngeal suctioning as needed B. Coughing and deep breathing C. Oxygen at 2 L per nasal cannula D. Chest physiotherapy E. Plasmapheresis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. During morning care, the patient is able to brush her teeth, wash her face, and brush her hair. She becomes fatigued after performing these actions. What is your best action? A. Encourage her to continue with her own morning care to increase her strength. B. Let her rest for 15 minutes and then continue self morning care. C. Document that the patient refuses morning care because of fatigue. D. Provide assistance in completing the patient’s morning care.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Later that day, the patient asks you about activities after her recovery. Which activity will you discourage? A. Sunbathing B. Wearing sunglasses C. Walking in her neighborhood D. Taking medication as directed

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Three days later, the patient is stable and the plan is to discharge her to home where her mother will provide care for her. Which preparations are essential before discharge? (Select all that apply.) A. Arrange for special equipment in the home. B. Arrange for home modifications, such as a ramp. C. Teach the mother how to provide physical therapy. D. Arrange for the patient to go to a rehabilitation facility before going home. E. Teach family members how to use special equipment.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What health history question will give the nurse the most information when evaluating a patient for Guillain-Barré syndrome (GBS)? A. “Have you had a respiratory virus in the past 2 weeks?” B. “Have you ever been exposed to Epstein-Barr virus?” C. “Has anyone else in your family ever had GBS?” D. “Did you get a flu vaccine in the past year?”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. For a patient with Bell’s palsy, when are symptoms the most severe? A. 12 hours after onset B. 48 hours after onset C. 96 hours after onset D. 1 week after onset

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What conditions might the nurse expect to see in a patient with restless leg syndrome? A. Diabetes and kidney failure B. Peripheral vascular disease and multiple sclerosis C. Myasthenia gravis and decreased vision D. Trigeminal neuralgia and facial paralysis