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Nursing Care of Patients with Peripheral Nervous System Disorders
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Multiple Sclerosis Pathophysiology Degeneration of Myelin Sheath, inflamed nerves cannot transmit impulse to muscles Etiology Unknown Possible Autoimmune Response Possible Viral Infection Heredity
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Signs & Symptoms Muscle Weakness Numbness Fatigue Slurred Speech Vision Disturbances Vertigo Ataxia Dysphagia Bowel/Bladder Problems Sexual Dysfunction Mood Alterations
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Additional Manifestations Remissions Exacerbations Due to Stress or Illness Immobility Death Usually from Infection Dx: H&P, CSF, anaylsis, MRI
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Therapeutic Interventions Steroids- medrol, predisone, decadron Immunosuppressant Agents- Imeran, Cytoxan- depress immune system Anticonvulsants- Dilantin, tegretol Muscle Relaxants- Flexaril, valium Plasmapheresis PT, OT, ST
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Myasthenia Gravis Pathophysiology In MG, antibodies destroy ACh receptors,ACh unable to stimulate muscle contraction, causing loss of muscle strength Dx: H&P, Tensilon test, Anti-Ach receptor antibodies
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Neuromuscular Junction
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Signs & Symptoms Progressive Muscle Weakness Fatigue with Activity Ptosis Difficulty Chewing, Swallowing Difficulty Breathing Remissions and exacerbations- stress
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Complications Aspiration Respiratory Infection and Failure Mysathenic Crisis- not enough med Cholinergic Crisis- too much med SLUDGE
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Therapeutic Interventions Thymectomy- < production of actecycholine antibodies Cholinergic Agents- prostigmin, mestinon Steroids- predisone Plasmapheresis- remove antibodies from the blood
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Patient Education Methods to Conserve Energy Well- balanced nutritious meals Avoidance of Infection S&S of Crisis Medications to Avoid Support Group
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Amyotrophic Lateral Sclerosis Lou Gehrig’s Disease Progressive, degenerative disease where motor neurons are destroyed, nerve impulse transmission is blocked causing muscle weakness and atropy. Etiology is unknown, possible genetic
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Signs & Symptoms Progressive muscle weakness, atrophy < coordination, muscle spasms Difficulty chewing and swallowing Emotional lability, speech difficulty Pulmonary compromise- death in 3-5 yrs Dx: H&P, LP, EEG, EMG, nerve biopsy
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Therapeutic Interventions Muscle Relaxants Riluzole PT/ OT/ ST Pain Control Tube Feedings Prevention of Infection Augmentative Alternative Communication
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Patient Education Support Groups Importance of Avoiding Infection Teach Family to Provide Care
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Guillain-Barre Syndrome Pathophysiology Inflammation of Spinal and Cranial Nerves Demyelination in Ascending Pattern Lymphocyte Infiltration Descending Remyelination Etiology: unknown or autoimmune response to virus
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Signs & Symptoms Stage 1 – 24 h 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- remylination occuring
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Complications Respiratory Failure Infection Depression Pneumonia UTI Complications of Immobility
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Therapeutic Interventions Plasmapheresis Oxygen Mechanical Ventilation Emotional Support Rehabilitation
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Nursing Care Monitor Vital Capacity and ABGs Provide Supportive Care Manage Pain Maintain Nutrition Assist with Communication Provide Diversional Activities
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Post-Polio Syndrome Affects Polio Victims 10 – 40 Years Later Signs and Symptoms Muscle Weakness Fatigue Pain Respiratory Compromise Treatment - Rest
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Trigeminal Neuralgia Pathophysiology Irritation of the trigeminal nerve (5 th cranial nerve), affects sensory portion of nerve Etiology Irritation or Chronic Compression Dx: H&P, CT, MRI
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Trigeminal Innervation
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Signs & Symptoms Intense Pain on One Side of Face Forehead, Cheek, Nose, Jaw Triggered by Touch, Talking, Other Stimulation
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Therapeutic Interventions Anticonvulsants Nerve Blocks Surgery to Block Pain Signals
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Bell’s Palsy Pathophysiology/Etiology Inflammation and Edema of Facial Nerve Loss of Motor Control Etiology Unknown Dx: H&P, EMG, rule out stroke
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Signs & Symptoms One Sided Facial Pain Weakness Speech Difficulty Drooling Tearing of Eye Inability to Blink
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Therapeutic Interventions Prednisone Analgesics Antiviral Medication Moist Heat Gentle Massage Facial Sling
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Nursing Diagnoses: Cranial Nerve Disorders Pain Imbalanced Nutrition Risk for Eye Trauma (Bell’s Palsy) Body Image Disturbance
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