Transcript Understanding Medical Surgical Nursing, 4th Edition

Understanding Medical Surgical Nursing, 4th Edition
CHAPTER 50
Nursing Care of Patients with Peripheral Nervous System Disorders
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
Understanding Medical Surgical Nursing, 4th Edition
MYELIN SHEATH
BREAKDOWN
Understanding Medical Surgical Nursing, 4th Edition
SIGNS AND SYMPTOMS
 Muscle Weakness
 Ataxia
 Numbness
 Dysphagia
 Fatigue
 Bowel/Bladder Problems
 Slurred Speech
 Sexual Dysfunction
 Vision Disturbances
 Mood Alterations
 Vertigo
Understanding Medical Surgical Nursing, 4th Edition
ADDITIONAL
MANIFESTATIONS
 Remissions
 Exacerbations
• Due to Stress or Illness
 Immobility
 Death Usually from Infection
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 History and Physical
 CSF Analysis
 MRI
 gMS DX
Understanding Medical Surgical Nursing, 4th Edition
THERAPEUTIC
INTERVENTIONS
 Steroids
 Interferon Therapy
 Immunosuppressant Agents
 Anticonvulsants
 Muscle Relaxants
 Plasmapheresis
 Physical, Occupational, Speech Therapies
Understanding Medical Surgical Nursing, 4th Edition
MYASTHENIA GRAVIS
 Pathophysiology
• Antibodies Destroy ACh Receptors
• ACh Unable to Stimulate Muscle Contraction
• Loss of Voluntary Muscle Strength
Understanding Medical Surgical Nursing, 4th Edition
NEUROMUSCULAR
JUNCTION
Understanding Medical Surgical Nursing, 4th Edition
ETIOLOGY
 Unknown
 Autoimmune
 Thymus Disorders
 Possible Viral Origin
Understanding Medical Surgical Nursing, 4th Edition
SIGNS AND SYMPTOMS
 Progressive Muscle Weakness
 Fatigue with Activity
 Ptosis
 Difficulty Chewing, Swallowing
 Difficulty Breathing
Understanding Medical Surgical Nursing, 4th Edition
SIGNS AND SYMPTOMS
(CONT’D)
 Remissions
 Exacerbations
• Stress
Understanding Medical Surgical Nursing, 4th Edition
COMPLICATIONS
 Aspiration
 Respiratory Infection and Failure
 Mysathenic Crisis
 Cholinergic Crisis
• SLUDGE
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 History and Physical
 Tensilon Test
 Anti-ACh Receptor Antibodies
 EMG
Understanding Medical Surgical Nursing, 4th Edition
THERAPEUTIC
INTERVENTIONS
 Thymectomy
 Anticholinesterase Agents
 Steroids
 Plasmapheresis
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
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
Understanding Medical Surgical Nursing, 4th Edition
ETIOLOGY
 Unknown
 Possible Genetic Predisposition
Understanding Medical Surgical Nursing, 4th Edition
SIGNS AND SYMPTOMS
 Progressive Muscle Weakness and Atrophy
 Decreased Coordination
 Muscle Spasm
 Difficulty Chewing and Swallowing
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
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 History and Physical
 LP with CSF Analysis
 EEG
 Nerve Biopsy
 EMG
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
Understanding Medical Surgical Nursing, 4th Edition
PATIENT EDUCATION
 Support Groups
 Importance of Avoiding Infection
 Teach Family to Provide Care
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
Understanding Medical Surgical Nursing, 4th Edition
GBS VARIANTS
 Ascending
 Descending
 Miller-Fisher Syndrome
 Motor Guillain-Barre
Understanding Medical Surgical Nursing, 4th Edition
ETIOLOGY
 Unknown
 Possible Autoimmune Response to Virus
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
Understanding Medical Surgical Nursing, 4th Edition
COMPLICATIONS
 Respiratory Failure
 Infection
 Depression
 Pneumonia
 UTI
 Complications of Immobility
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 LP with CSF Analysis
 EMG
 Nerve Conduction Velocity
 Pulmonary Function Testing
Understanding Medical Surgical Nursing, 4th Edition
THERAPEUTIC
INTERVENTIONS
 Plasmapheresis
 Oxygen
 Mechanical Ventilation
 Emotional Support
 Rehabilitation
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
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
Understanding Medical Surgical Nursing, 4th Edition
NURSING DIAGNOSES:
NEUROMUSCULAR DISORDERS
 Ineffective Airway Clearance
 Impaired Physical Mobility
 Risk for Imbalanced Nutrition
 Impaired Verbal Communication
Understanding Medical Surgical Nursing, 4th Edition
CRANIAL NERVE
DISORDERS
 Trigeminal Neuropathy
 Bell’s Palsy
Understanding Medical Surgical Nursing, 4th Edition
TRIGEMINAL NEURALGIA
 Pathophysiology
• Irritation of the Trigeminal Nerve
• Affects Sensory Portion of Nerve
 Etiology
• Irritation or Chronic Compression
Understanding Medical Surgical Nursing, 4th Edition
TRIGEMINAL
INNERVATION
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
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 History and Physical
 CT Scan
 MRI
Understanding Medical Surgical Nursing, 4th Edition
THERAPEUTIC
INTERVENTIONS
 Anticonvulsants
 Nerve Blocks
 Surgery to Block Pain Signals
Understanding Medical Surgical Nursing, 4th Edition
BELL’S PALSY
 Pathophysiology/Etiology
• Inflammation and Edema of Facial Nerve
• Loss of Motor Control
 Etiology Unknown
Understanding Medical Surgical Nursing, 4th Edition
SIGNS AND SYMPTOMS
One-Sided Facial
•
•
•
•
•
•
Pain
Weakness
Speech Difficulty
Drooling
Tearing of Eye
Inability to Blink
Understanding Medical Surgical Nursing, 4th Edition
DIAGNOSIS
 History and Physical
 EMG
 Rule Out Stroke
Understanding Medical Surgical Nursing, 4th Edition
THERAPEUTIC INTERVENTIONS
 Prednisone
 Analgesics
 Antiviral Medication
 Moist Heat
 Gentle Massage
 Facial Sling
Understanding Medical Surgical Nursing, 4th Edition
NURSING DIAGNOSES:
CRANIAL NERVE DISORDERS
 Pain
 Imbalanced Nutrition
 Risk for Injury to Eyes (Bell’s Palsy)