Medical Surgical Nursing: Care Of Patients With Peripheral Nervous System Disorders

Front 1

Multiple Sclerosis

Back 1

Chronic progressive disease that affects the myekin sheaths of the neurons in the CNS.

Front 2

Multiple Sclerosis (MS)

Back 2

chronic, progressive disease of the central nervous system characterized by the destruction of myelin. Myelin is the fatty and protein material that covers certain nerve fibers in the brain and spinal cord.
(1) The cause of MS is unknown. Research is investigating the possibilities of infection by slow virus, alteration in the immune system, and genetic factors.
(2) Multiple Sclerosis primarily affects adults between 20 and 40 years of age.

Front 3

Signs and Symptoms Multiple Sclerosis (MS).

Back 3

(1) Weakness.
(2) Visual disturbances (nystagmus, blurred vision, blindness).
(3) Slurred, hesitating speech.
(4) Intention tremor.
(5) Abnormal reflexes (absent or hyperactive).
(6) Ataxia.
(7) Paraplegia.
(8) Urinary and bowel incontinence/retention.
(9) Emotional lability; (depressed, euphoric).

Front 4

Medical and Nursing Management Multiple Sclerosis (MS)

Back 4

1) Objectives of care.

(a) To keep the patient as active and functional as possible in order to lead a purposeful life.
(b) To relieve the patient's symptoms and provide him/her with continued support.
(2) Instruct patient to perform muscle stretching exercises to minimize join contractu res.

(a) Particular emphasis on hamstrings, gastrocnemius, hip adductors, biceps, wrist and finger flexors.
(b) Instruct family about passive range of motion exercises for patients with severe spasticity.
(c) Advise patient to prevent muscle fatigue with frequent rest periods.
(d) Instruct patient to participate in walking exercises to improve gait affected by loss of position sense in legs.
(e) Administer muscle relaxants as ordered.
(f) Utilize braces, canes, crutches, walkers when necessary to keep patient ambulatory.
(3) Avoid skin pressure and immobility.

(a) Pressure sores will accompany severe spasticity in an immobile patient due to sensory loss.
(b) Change patient's position every 2 hours even if patient is in wheelchair.
(c) Give careful attention to sacral and perineal hygiene.
(4) Support the patient with bladder disturbances.

(a) Observe patient closely for retention and catheterize, as ordered.
(b) Patient may need to be taught self-catheterization.
(c) Administer urinary antiseptics, as ordered.
(d) Support the patient with bladder incontinence by initiating a bladder training program.
(e) Meticulous skin care is required for the incontinent patient.
(5) Assist the patient to establish a routine of regular bowel evacuation.
(6) Administer corticosteroids, as ordered during periods of exacerbation.
(a) May reduce severity of exacerbation by reducing edema and inflammation.
(b) Encourage bedrest during the acute stage as activity seems to worsen attack.
(c) Keep in mind that the residual effects of the disease may increase with each exacerbation.
(7) Support the patient with optic and speech defects.

(a) Eye patch to block vision impulses for patient with diplopia.
(b) Obtain services of speech therapist.

Front 5

Amyotrophic lateral sclerosis (ALS)

Back 5

is a progressive, incapacitating, and fatal disease of unknown cause. It is characterized by loss of motor neurons in the anterior horns of the spinal cord and lower brain stem. Amyotrophic lateral sclerosis is commonly known as Lou Gehrig's Disease

Front 6

Signs and Symptoms Amyotrophic lateral sclerosis (ALS)

Back 6

(1) Symptoms vary, depending upon the location of affected motor neurons.
(2) Progressive weakness and atrophy of muscles of arms, trunk, or legs.
(3) Progressive difficulty in speaking and swallowing, speech may be nasal and unintelligible.
(4) Excessive drooling.
(5) Muscle twitching.
(6) Mental facilities are not affected.
(7) Death usually occurs 3-5 years after onset.

Front 7

Medical and Nursing Management of Amyotrophic lateral sclerosis (ALS)

Back 7

1) Objective--to support the patient and improve quality of life.
(2) Instruct the patient to perform active exercises and range of motion exercises to strengthen uninvolved muscles and prevent disuse atrophy.
(3) Utilize braces, splints, canes, etc., to keep patient mobile as long as possible.
(4) Assist the patient to prevent complications that may result from symptoms.

Front 8

Parkinson's disease

Back 8

progressive neurological disorder affecting the brain centers that are responsible for control of movement.

(1) Primary degenerative changes of the basal ganglia and their connections prevent motor transmission of automatic movements (blinking, facial expressions, muscle tone).
(2) The exact cause of Parkinson's is unknown. Suspected causes include genetic factors, viruses, chemical toxicity, encephalitis, and cerebrovascular disease

Front 9

Signs and Symptoms of Parkinson's disease

Back 9

(1) Bradykinesia, which usually becomes the most disabling symptom.
(2) Tremor which tends to decrease or disappear on purposeful movements.
(3) Rigidity, particularly of large joints.
(4) Classic shuffling gait.
(5) Muscle weakness which affects eating, chewing, swallowing, speaking, writing.
(6) Mask-like facial expression with unblinking eyes.
(7) Depression.
(8) Dementia.

Front 10

Medical and Nursing Management of Parkinson's disease

Back 10

(1) Treatment is based on a combination of the following:
(a) Drug therapy.
(b) Physical therapy.
(c) Rehabilitation techniques.
(d) Patient and family education.
(2) Encourage patient to participate in physical therapy and an exercise program to improve coordination and dexterity.
(a) Emphasize importance of a daily exercise program.
(b) Instruct patient in postural exercises and walking techniques to offset shuffling gait and tendency to lean forward.
(c) Encourage warm baths and showers to help relax muscles and relieve spasms.
(3) Instruct patient to establish a regular bowel routine with a high fiber diet and plenty of fluids. Constipation is a problem due to muscle weakness, lack of exercise, and drug effects.
(4) Eat a well-balanced diet. Nutritional problems develop from difficulty chewing and swallowing and dry mouth from medications.
(5) Encourage patient to be an active participant in his/her therapy and in social and recreational events, as Parkinsonism tends to lead to withdrawal and depression.
(6) Inform patient about American Parkinson's Disease Foundation for patient education and group support.

Front 11

Myasthenia Gravis

Back 11

autoimmune disorder affecting the neuromuscular transmission of impulses in the voluntary muscles of the body. In normal individuals, transmission of impulses from the nerve to the motor end plate of the muscle is accomplished by the transmitter substance acetylcholine.

(1) Acetylcholine is released at the nerve ending and moves to the muscle end plate, causing muscle contraction.

(2) Acetylcholine is then broken down into acetate and choline by the substance cholinesterase.

(3) In myasthenia gravis, one of three physiological abnormalities may exist:

(a) There may be too much cholinesterase present, and acetylcholine is destroyed too quickly.

(b) There may be too little acetylcholine released from the nerve fiber, resulting in inadequate depolarization of the motor end plate.

(c) The motor end plate is not sensitive to the action of acetylcholine.

Front 12

Signs and Symptoms of Myasthenia Gravis

Back 12

(1) Diplopia (double vision).

(2) Ptosis (dropping of one or both eyelids).

(3) Abnormal muscle weakness; characteristically worse after effort and improved by rest.

(4) Sleepy, mask-like facial expression with difficulty smiling.

(5) Speech weakness (high-pitched nasal voice).
(6) Difficulty swallowing

Front 13

Medical and Nursing Management of Myasthenia Gravis

Back 13

(1) Primary drug therapy (anticholinesterase drugs to enhance the action of acetylcholine at the myoneural junction).

(a) Drug must be given exactly on time to control symptoms.

(b) After initial medication adjustments are made, patient learns to take his medication according to his/her needs.

(2) Patient needs explicit instructions regarding medications.

(3) Have mealtimes coincide with peak effect of anticholinergics, when ability to swallow is best.

(4) Obtain medic alert bracelet signifying that patient has myasthenia gravis.



(5) Wear an eyepatch over one eye (alternating from side to side) if diplopia occurs.

(6) Control factors which lead to fatigue.

(7) Emphasize importance of avoiding contact with individuals with colds or respiratory infections, since these conditions could be devastating to the myasthenic patient.

(8) Instruct patient to inform dentist of myasthenia condition since Novocaine is usually poorly tolerated.

(9) Instruct patient to rest at frequent intervals and avoid fatigue. d. Management of the Crises of Myasthenia.

Front 14

Bell's Palsy

Back 14

Peripheral involvement of the 7th cranial nerve (facial nerve) produces weakness or paralysis of the facial muscles. The cause of this condition is unknown, but the majority of patient's have experienced a viral upper respiratory infection 1 to 3 weeks prior to the onset of symptoms. Complications associated with Bell's palsy include facial weakness, facial spasm with contracture, corneal ulceration, and blindness.

Front 15

Bell's Palsy Signs and Symptoms

Back 15

Distortion of face.
Numbness of face and tongue.
Overflow of tears down the cheek from keratitis caused by drying of cornea and lack of blink reflex.

Front 16

Bell's Palsy Medical and Nursing

Back 16

Prednisone, analgesics and antiviral medications. If blink reflex is absent, eye is vulnerable to dust and foreign; Instill artificial tears (methylcellulose) to protect the cornea.
Increase environmental humidity.
Instruct patient to close affected eye frequently using accessory
Instruct patient to wear a protective patch at night

Front 17

Trigeminal neuralgia

Back 17

is a disorder of the 5th cranial nerve (trigeminal nerve). It is characterized by sudden paroxysms of burning pain along one or more of the branches of the trigeminal nerve. The pain alternates with periods of complete comfort. Irratation or compression of nerve is thought to initiate onset and generally occurs at 50 -60 years of age

Front 18

Signs and Symptoms of Trigeminal neuralgia

Back 18

(1) Sudden, severe pain appearing without warning. (Along one or more branches of trigeminal nerve.)
(2) Numerous individual flashes of pain, ending abruptly and usually on one side of the face only.
(3) Attacks provoked by pressure on a "trigger point" (the terminals of the affected branches of the trigeminal nerve). Such triggers include:
(a) Shaving.
(b) Talking.
(c) Yawning.
(d) Chewing gum.
(e) Cold wind.

Front 19

Trigeminal neuralgia Care Considerations

Back 19

(1) Instruct patient to avoid exposing affected cheek to sudden cold if this is known to trigger the nerve. For example, avoid:

(a) Iced drinks.
(b) Cold wind.
(c) Swimming in cold water.
(2) Administer drug therapy, as ordered.

(a) Tegretol or Dilantin--relieves and prevents pain in some patients.
(b) Serum blood levels of drug are monitored in long term use.
(3) Surgical procedures to sever the affected nerve provide optimum pain relief with minimum impairment.
(4) Instruct patient in methods to prevent environmental stimulation of pain.
(a) Eat foods that are easily chewed and are served at room temperature.
(b) Avoids drafts and breezes.

Front 20

Guillain-Barre Syndrome (inflamatory polyneuropathy)

Back 20

Inflamatory disorder of the nervous system that affects peripheral nerves and spinal nerve roots. b. Cause. The exact cause of Guillain-Barre syndrome is unknown. Many patients give a history of a recent infection, especially of the upper respiratory tract. There is also evidence of a connection with the Swine flu vaccination. Diagnosis is made on the basis of the history and symptoms. Additionally, lumbar puncture will reveal increased protein in the CSF