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Adult Health IINeurological Diseases

Jerry Carley RN, MSN, MA, CNESummer 2010

Multiple Sclerosis (MS)

Concept Map: Selected Topics in Neurological Nursing

PATHOPHYSIOLOGY

Traumatic Brain InjurySpinal Cord Injury

Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Huntington’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease

PHARMACOLOGY

--Decrease ICP--Disease / Condition Specific Meds

ASSESSMENTPhysical Assessment Inspection Palpation Percussion Auscultation

ICP Monitoring“Neuro Checks” Lab Monitoring

Care PlanningPlan for client adl’s, Monitoring, med admin.,Patient education, more…basedOn Nursing Process: A_D_P_I_E

Nursing Interventions & EvaluationExecute the care plan, evaluate for Efficacy, revise as necessary

Progressive

Degenerative

No Cure

Affects nerve fibers in the brain and spinal cord

Most common neurological cause of debilitation in young people (ages20 - 40)

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Multiple Sclerosis

Probably autoimmune disease

Antibodies and white blood cells attack the proteins in the neuron’s myelin sheath

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Pathology

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Inflammation in the nervous system destroys myelin, Schwann cells, and the oligodendrocytes. After tissue destruction a scar or hardening forms, the MS plaque. This can be visualized on MRI to aid in diagnosis of multiple sclerosis..

MyelinSheathAround nerve

“demyelinization” “demyelinating” “demyelinizing”

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Inflammation and injury to the sheath and ultimately to the nerves that it surrounds

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SchwannCell

Myelin Sheath

Dendrite

Axonterminal

Multiple areas of scarring…+

Hardening (Sclerosis) of nerve fibers...usually in spinal cord, brain stem and optic nerves

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What’s in a Name?

More women than men

More common in Caucasians

Children of parents with MS have a higher rate of incidence (15 – 50% depending on data source)

Geographic location --- Cold climate…?

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Risk Factors…

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Northern Europe and the northern United States have the highest prevalence, with more than 30 cases per 100,000 people

Based on the presence of CNS lesions that are disseminated in time and space (neurologic dysfunction in more than 2 sites at least one month apart), with no better explanation for the disease process

Because no single test is totally reliable in identifying MS, and a variety of conditions can mimic the disease, diagnosis depends on clinical features supplemented by the findings of certain studies such as:

- MRI (visualize plaques)- CSF analysis (increases protein and slight increase

WBCs)- Evoked potentials (define extent of disease and

monitors)

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Diagnosis

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"Turbo FLAIR" MRI

Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body

This disease is unpredictable and varies in severity

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Disease Progression – Erratic !

Intermittent damage to myelin…intermittent severity

Scarring and sclerosis of nerve fibers usually in the spinal cord, brain stem, and optic nerves…

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Hallmark Characteristics…

Fatigue - Muscle Weakness

Muscle Spasticity - Dyarthria

Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of extremities)

Lhermitte's sign (Electrical sensation down the spine on neck flexion)

Dysphagia - Tinnitis

Uhthoff’s Sign (Exertion or Heat causes sudden exacerbation of S&S)

Numbness, tingling (Paresthesia) - Pain

Bowel, bladder and sexual dysfunction

Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)

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Common S & Ss

Emotional labile

Depression (suicide increased 7.5%, usually in first 5 years)

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Common S & Ss

MS can progress steadily… or cause acute attacks (exacerbation) followed by partial or complete reduction in symptoms (remission)

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Course of Disease

Returns to baseline + recovery Increasing severity … maybe minor plateaus or remissions

85% 10-20%

Control symptoms

Prevent complications

Provide adaptive devices to increase mobility and self-care

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Collaborative Tx Goals

Avonex IM Weekly (interferon beta – 1a)

Betaseron SQ Daily (interferon beta 1b)

Copaxone SQ Daily

Rebif SQ given 3 x week

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Meds specific for MS disease

Baclofen / Dantrium (for spasms)

NSAIDS (for flu-like side effects and pain)

Analgesics

Corticosteroids (limit severity by modulating immune response which decreases inflammation)

Antidepressants (like Prozac)

Beta blockers for tremors (like Inderal)

Anticonvulsants for parethesia (like Tegretol)

Anticholinergics for bladder dysfunction (Pro-Banthine)

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Symptom Management Meds

Bacterial infections (lung, bladder)

Disturbed thought processes Impaired bladder & bowel function

Contractures

Seizures

Impaired mobility / speech / swallowing

Sensory & visual impairment

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Complications

In some people, MS is a mild illness, but, for others, it results in permanent

disability

Most patients have a normal lifespan

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Prognosis