CHRONIC NEUROLOGIC PROBLEM
Multiple Sclerosis:
• What is multiple sclerosis?
o Chronic & progressive
o Degenerative disease of CNS
o Characterized by widespread demyelination of nerve fibers in brain and spinal cord
o Autoimmune
o Cause unknown
o May develop in genetically susceptible person as a result of environmental exposure à infection
• Pathophysiology:
o Aacks on myelin sheaths of neurons result in damage to the myelin sheath à initially caused by inflammation
o Transmission is slowed
o Initially myelin can regenerate à remission
§ As ongoing inflammation occurs, myelin can no longer regenerate
o Damage to underlying nerve fiber (axon)
o Nerve impulse is disrupted
o Permanent loss of nerve function
o Glial scar tissues replace the damaged tissue à hard, sclerotic plaques
• Clinical manifestations:
o Motor problems
§ Weakness of limbs, trunk, head, diplopia (double vision), scanning speech, spasticity of muscles
o Sensory problems
§ Numbness/ tingling, patchy blindness, blurred vision, vertigo, decreased hearing
o Cerebellar problems
§ Nystagmus, ataxia, dysarthria, dysphagia
o Emotional problems
§ Anger, depression, euphoria
o Bowel and bladder problems à sclerotic plaques are located in CNS that controls elimination
§ Constipation, spastic bladder (incontinence), flaccid bladder (retention)
o Sexual dysfunction
§ Erectile dysfunction, decreased libido
o Cognitive manifestations
§ Difficulty w short term memory, aention information processing, word finding
• Diagnostic studies:
o History
o Clinical manifestations
o MRI à lesions
o CSF analysis
§ Increase in immunoglobulin G
§ Presence of oligoclonal banding
o Evoked responses à often relayed
§ Tests how much time it takes for a nerve to respond to stimulation
, • Management:
o Exacerbations can be triggered by:
§ Infections à upper respiratory, UTI's
§ Trauma
§ Immunization
§ Childbirth
§ Stress
§ Change in climate
o Drug therapy:
§ Corticosteroids à most helpful to treat exacerbations à reduces edema and acute inflammation
§ Immunomodulator à slows progression and prevents relapse
• Interferons
§ Immunosuppressant drugs à keep immune system from destroying myelin sheaths
§ Muscle relaxants à muscle spasticity
§ Stimulants (ghrelin) à fatigue
§ Anticholinergics à bladder symptoms
§ Anti-seizure à chronic pain
o Exercise à can improve overall function
§ Decrease spasticity
§ Increase coordination
o Physical and speech therapy
o Nutritional therapy
§ High fiber à constipation
o Minimize caffeine
o Educate on triggers
• Nursing implications:
o Assess skin, turn the pt
o Cough and deep breath, IS
o Ambulation
• Patient teaching:
o Meds à why they are taking it, side effects
o Nutrition
o Avoidance of triggers
o Aware of resources
Parkinson's Disease:
• What is parkinson's disease:
o Chronic, progressive, nondegenerative disorder
o Characterized by bradykinesia, rigidity, tremor at rest, gait changes
o Exact cause unknown
o Complex interplay of environmental & genetic factors involved
§ Family hx, incidence increases with age, men are more likely to have PD
Multiple Sclerosis:
• What is multiple sclerosis?
o Chronic & progressive
o Degenerative disease of CNS
o Characterized by widespread demyelination of nerve fibers in brain and spinal cord
o Autoimmune
o Cause unknown
o May develop in genetically susceptible person as a result of environmental exposure à infection
• Pathophysiology:
o Aacks on myelin sheaths of neurons result in damage to the myelin sheath à initially caused by inflammation
o Transmission is slowed
o Initially myelin can regenerate à remission
§ As ongoing inflammation occurs, myelin can no longer regenerate
o Damage to underlying nerve fiber (axon)
o Nerve impulse is disrupted
o Permanent loss of nerve function
o Glial scar tissues replace the damaged tissue à hard, sclerotic plaques
• Clinical manifestations:
o Motor problems
§ Weakness of limbs, trunk, head, diplopia (double vision), scanning speech, spasticity of muscles
o Sensory problems
§ Numbness/ tingling, patchy blindness, blurred vision, vertigo, decreased hearing
o Cerebellar problems
§ Nystagmus, ataxia, dysarthria, dysphagia
o Emotional problems
§ Anger, depression, euphoria
o Bowel and bladder problems à sclerotic plaques are located in CNS that controls elimination
§ Constipation, spastic bladder (incontinence), flaccid bladder (retention)
o Sexual dysfunction
§ Erectile dysfunction, decreased libido
o Cognitive manifestations
§ Difficulty w short term memory, aention information processing, word finding
• Diagnostic studies:
o History
o Clinical manifestations
o MRI à lesions
o CSF analysis
§ Increase in immunoglobulin G
§ Presence of oligoclonal banding
o Evoked responses à often relayed
§ Tests how much time it takes for a nerve to respond to stimulation
, • Management:
o Exacerbations can be triggered by:
§ Infections à upper respiratory, UTI's
§ Trauma
§ Immunization
§ Childbirth
§ Stress
§ Change in climate
o Drug therapy:
§ Corticosteroids à most helpful to treat exacerbations à reduces edema and acute inflammation
§ Immunomodulator à slows progression and prevents relapse
• Interferons
§ Immunosuppressant drugs à keep immune system from destroying myelin sheaths
§ Muscle relaxants à muscle spasticity
§ Stimulants (ghrelin) à fatigue
§ Anticholinergics à bladder symptoms
§ Anti-seizure à chronic pain
o Exercise à can improve overall function
§ Decrease spasticity
§ Increase coordination
o Physical and speech therapy
o Nutritional therapy
§ High fiber à constipation
o Minimize caffeine
o Educate on triggers
• Nursing implications:
o Assess skin, turn the pt
o Cough and deep breath, IS
o Ambulation
• Patient teaching:
o Meds à why they are taking it, side effects
o Nutrition
o Avoidance of triggers
o Aware of resources
Parkinson's Disease:
• What is parkinson's disease:
o Chronic, progressive, nondegenerative disorder
o Characterized by bradykinesia, rigidity, tremor at rest, gait changes
o Exact cause unknown
o Complex interplay of environmental & genetic factors involved
§ Family hx, incidence increases with age, men are more likely to have PD
