Transcript File

Chapter 46
Care of Patients with
Problems of the
Peripheral Nervous
System
Mrs. Marion Kreisel MSN, RN
NU230 Adult Health 2
Fall 2011
Guillain-Barré Syndrome
• Demyelination of the peripheral nerves,
progressive motor weakness and sensory
abnormalities
• Ascending paralysis
• Result of a variety of related immunemediated pathologic processes
Clinical Manifestations
• Muscle weakness and pain have abrupt
onset; cause remains obscure.
• Cerebral function or pupillary signs are not
affected.
• Cranial nerve involvement.
• Autonomic dysfunction.
• Weakness and paresthesia begin in the
lower extremities and progress upward
toward the trunk, arms, and cranial nerves
in ascending GBS.
Interventions
• Drug therapy
• Plasmapheresis
• Monitoring respiratory status and
managing the airway
• Managing cardiac dysfunction
• Improving mobility and preventing
complications of immobility
• Managing pain
• Promoting communication
• Providing emotional support
Plasmapheresis
• Plasmapheresis removes the circulating
antibodies assumed to cause the disease.
• Plasma is selectively separated from
whole blood; the blood cells are returned
to the patient without the plasma.
• Plasma usually replaces itself, or the
patient is transfused with albumin.
Myasthenia Gravis
• Chronic disease characterized by
weakness primarily in muscles innervated
by cranial nerves, as well as in skeletal
and respiratory muscles
• Thymoma—encapsulated thymus gland
tumor
• Progressive paresis of affected muscle
groups that is partially resolved by resting
• Most common symptoms—involvement of
eye muscles, such as ocular palsies,
ptosis, diplopia, weak or incomplete eye
closure
Tensilon Testing
• Within 30 to 60 sec after injection of
Tensilon, most myasthenic patients show
marked improvement in muscle tone that
lasts 4 to 5 minutes.
• Prostigmin is also used.
• Cholinergic crisis is due to overmedication.
• Myasthenic crisis is due to
undermedication.
• Atropine sulfate is the antidote for Tensilon
complications.
Nonsurgical Management
• Respiratory support
• Promoting mobility
• Drug therapy:
• Cholinesterase inhibitor drugs
• Immunosuppression
• Plasmapheresis
Cholinesterase Inhibitor Drugs
• Drugs include anticholinesterase and
antimyasthenics.
• Enhance neuromuscular impulse
transmission by preventing decrease of
ACh by the enzyme ChE.
• Administer with food.
• Observe drug interactions.
Emergency Crises
• Myasthenic crisis—an exacerbation of the
myasthenic symptoms caused by
undermedication with anticholinesterases
• Cholinergic crisis—an acute exacerbation
of muscle weakness caused by
overmedication with cholinergic
(anticholinesterase) drugs
Myasthenic Emergency Crisis
• Tensilon test is performed.
• Priority for nursing management is to
maintain adequate respiratory function.
• Cholinesterase-inhibiting drugs are
withheld because they increase respiratory
secretions and are usually ineffective for
the first few days after the crisis begins.
Cholinergic Emergency Crisis
• Anticholinergic drugs are withheld while
the patient is maintained on a ventilator.
• Atropine may be given and repeated, if
necessary.
• Observe for thickened secretions due to
the drugs.
• Improvement is usually rapid after
appropriate drugs have been given.
Management
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Immunosuppression
Plasmapheresis
Respiratory support
Promoting self-care guidelines
Assisting with communication
Nutritional support
Eye protection
Surgical management usually involving
thymectomy
Health Teaching
• Factors in exacerbation include infection,
stress, surgery, hard physical exercise,
sedatives, enemas, and strong cathartics.
• Avoid overheating, crowds, overeating,
erratic changes in sleeping habits, and
emotional extremes.
• Teach warning signs.
• Teach importance of compliance.
Peripheral Nerve Trauma
• Vehicular or sports injury or wounds to the
peripheral nerves
• Degeneration and retraction of the nerve
distal to the injury within 24 hours
• Perioperative and postoperative care
• Rehabilitation through physiotherapy
Peripheral Nerves
Peripheral Nerve Injury
Restless Legs Syndrome
• Leg paresthesias associated with an
irresistible urge to move; commonly
associated with peripheral and central
nerve damage in the legs and spinal cord
• Management—symptomatic, involving
treating the underlying cause or
contributing factor, if known
• Nonmedical treatment
• Drug therapy effective for some patients
Trigeminal Neuralgia
• Affects trigeminal or fifth cranial nerve
• Nonsurgical management of facial pain—
drug therapy
• Surgical management—microvascular
decompression, radiofrequency thermal
coagulation, percutaneous balloon
microcompression
• Postoperative care—monitoring for
complications
• Characterized by intermittent episodes of
severe pain with sudden onset
Trigeminal Nerve
Facial Paralysis or Bell’s Palsy
• Acute paralysis of seventh cranial nerve
• Medical management—prednisone,
analgesics, acyclovir
• Protection of the eye
• Nutrition
• Massage; warm, moist heat; facial
exercises
• Pt education important: Usually symptoms
disappear or get better within a few weeks
NCLEX
TIME
Question 1
Who is the typical patient who develops
myasthenia gravis?
A. A man whose age of onset is between 60
and 70 years
B. A woman whose age of onset is between
20 and 30 years
C. A man whose age of onset is between 40
and 50 years
D. A woman whose age of onset is between
40 and 50 years
Question 2
Which assessment variable is the best early
indicator of compromised neurovascular
function?
A.
B.
C.
D.
Pallor
Decreased pulses
Tingling sensation
Coolness of the extremity
Question 3
The effects of chemotherapy-induced
peripheral neuropathy are expected to be:
A. Temporary and short-lived
B. Dose-limiting and may cause permanent
disability
C. Controlled with steroids such as
prednisone
D. Not dose-limiting but may cause
temporary disability
Question 4
What conditions might the nurse expect to
see in the patient with restless leg
syndrome?
A. Diabetes and renal failure
B. Peripheral vascular disease and multiple
sclerosis
C. Myasthenia gravis and decreased vision
D. Trigeminal neuralgia and facial paralysis
Question 5
A patient complains of eye dryness and
acute pain of her face and behind her ear.
The nurse should perform a focused
assessment of which cranial nerve?
A.
B.
C.
D.
III
V
VII
VIII