1. Understanding Medical Surgical Nursing, 4th Edition CHAPTER 50 Nursing Care of Patients with Peripheral Nervous System Disorders

2. 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

3. Understanding Medical Surgical Nursing, 4th Edition MYELIN SHEATH BREAKDOWN

4. Understanding Medical Surgical Nursing, 4th Edition  Muscle Weakness  Numbness  Fatigue  Slurred Speech  Vision Disturbances  Vertigo SIGNS AND SYMPTOMS  Ataxia  Dysphagia  Bowel/Bladder Problems  Sexual Dysfunction  Mood Alterations

5. Understanding Medical Surgical Nursing, 4th Edition ADDITIONAL MANIFESTATIONS  Remissions  Exacerbations Due to Stress or Illness  Immobility  Death Usually from Infection

6. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  History and Physical  CSF Analysis  MRI  gMS DX

7. Understanding Medical Surgical Nursing, 4th Edition THERAPEUTIC INTERVENTIONS  Steroids  Interferon Therapy  Immunosuppressant Agents  Anticonvulsants  Muscle Relaxants  Plasmapheresis  Physical, Occupational, Speech Therapies

8. Understanding Medical Surgical Nursing, 4th Edition MYASTHENIA GRAVIS  Pathophysiology Antibodies Destroy ACh Receptors ACh Unable to Stimulate Muscle Contraction Loss of Voluntary Muscle Strength

9. Understanding Medical Surgical Nursing, 4th Edition NEUROMUSCULAR JUNCTION

10. Understanding Medical Surgical Nursing, 4th Edition ETIOLOGY  Unknown  Autoimmune  Thymus Disorders  Possible Viral Origin

11. Understanding Medical Surgical Nursing, 4th Edition SIGNS AND SYMPTOMS  Progressive Muscle Weakness  Fatigue with Activity  Ptosis  Difficulty Chewing, Swallowing  Difficulty Breathing

12. Understanding Medical Surgical Nursing, 4th Edition SIGNS AND SYMPTOMS (CONT’D)  Remissions  Exacerbations Stress

13. Understanding Medical Surgical Nursing, 4th Edition COMPLICATIONS  Aspiration  Respiratory Infection and Failure  Mysathenic Crisis  Cholinergic Crisis SLUDGE

14. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  History and Physical  Tensilon Test  Anti-ACh Receptor Antibodies  EMG

15. Understanding Medical Surgical Nursing, 4th Edition THERAPEUTIC INTERVENTIONS  Thymectomy  Anticholinesterase Agents  Steroids  Plasmapheresis

16. 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

17. 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

18. Understanding Medical Surgical Nursing, 4th Edition ETIOLOGY  Unknown  Possible Genetic Predisposition

19. Understanding Medical Surgical Nursing, 4th Edition SIGNS AND SYMPTOMS  Progressive Muscle Weakness and Atrophy  Decreased Coordination  Muscle Spasm  Difficulty Chewing and Swallowing

20. 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

21. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  History and Physical  LP with CSF Analysis  EEG  Nerve Biopsy  EMG

22. 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

23. Understanding Medical Surgical Nursing, 4th Edition PATIENT EDUCATION  Support Groups  Importance of Avoiding Infection  Teach Family to Provide Care

24. 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

25. Understanding Medical Surgical Nursing, 4th Edition GBS VARIANTS  Ascending  Descending  Miller-Fisher Syndrome  Motor Guillain-Barre

26. Understanding Medical Surgical Nursing, 4th Edition ETIOLOGY  Unknown  Possible Autoimmune Response to Virus

27. 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

28. Understanding Medical Surgical Nursing, 4th Edition COMPLICATIONS  Respiratory Failure  Infection  Depression  Pneumonia  UTI  Complications of Immobility

29. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  LP with CSF Analysis  EMG  Nerve Conduction Velocity  Pulmonary Function Testing

30. Understanding Medical Surgical Nursing, 4th Edition THERAPEUTIC INTERVENTIONS  Plasmapheresis  Oxygen  Mechanical Ventilation  Emotional Support  Rehabilitation

31. 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

32. 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

33. Understanding Medical Surgical Nursing, 4th Edition NURSING DIAGNOSES: NEUROMUSCULAR DISORDERS  Ineffective Airway Clearance  Impaired Physical Mobility  Risk for Imbalanced Nutrition  Impaired Verbal Communication

34. Understanding Medical Surgical Nursing, 4th Edition CRANIAL NERVE DISORDERS  Trigeminal Neuropathy  Bell’s Palsy

35. Understanding Medical Surgical Nursing, 4th Edition TRIGEMINAL NEURALGIA  Pathophysiology Irritation of the Trigeminal Nerve Affects Sensory Portion of Nerve  Etiology Irritation or Chronic Compression

36. Understanding Medical Surgical Nursing, 4th Edition TRIGEMINAL INNERVATION

37. 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

38. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  History and Physical  CT Scan  MRI

39. Understanding Medical Surgical Nursing, 4th Edition THERAPEUTIC INTERVENTIONS  Anticonvulsants  Nerve Blocks  Surgery to Block Pain Signals

40. Understanding Medical Surgical Nursing, 4th Edition BELL’S PALSY  Pathophysiology/Etiology Inflammation and Edema of Facial Nerve Loss of Motor Control  Etiology Unknown

41. Understanding Medical Surgical Nursing, 4th Edition SIGNS AND SYMPTOMS  One-Sided Facial Pain Weakness Speech Difficulty Drooling Tearing of Eye Inability to Blink

42. Understanding Medical Surgical Nursing, 4th Edition DIAGNOSIS  History and Physical  EMG  Rule Out Stroke

43. Understanding Medical Surgical Nursing, 4th Edition THERAPEUTIC INTERVENTIONS  Prednisone  Analgesics  Antiviral Medication  Moist Heat  Gentle Massage  Facial Sling

44. Understanding Medical Surgical Nursing, 4th Edition NURSING DIAGNOSES: CRANIAL NERVE DISORDERS  Pain  Imbalanced Nutrition  Risk for Injury to Eyes (Bell’s Palsy)