Download Chapter 47

Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 50
Nursing Care of Patients with
Peripheral Nervous System
Disorders
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Multiple Sclerosis
 Pathophysiology
 Degeneration of Myelin Sheath
 Inflamed Nerves
 Slowed or Blocked Nerve Impulses
 Etiology
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Unknown
Possible Autoimmune Response
Possible Viral Infection
Heredity
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Myelin Sheath Breakdown
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
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Muscle Weakness
Numbness
Fatigue
Slurred Speech
Vision Disturbances
Vertigo
 Ataxia
 Dysphagia
 Bowel/Bladder
Problems
 Sexual Dysfunction
 Mood Alterations
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Additional Manifestations
 Remissions
 Exacerbations
 Due to Stress or Illness
 Immobility
 Death Usually from Infection
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
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History and Physical
CSF Analysis
MRI
gMS DX
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
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Steroids
Interferon Therapy
Immunosuppressant Agents
Anticonvulsants
Muscle Relaxants
Plasmapheresis
Physical, Occupational, Speech Therapies
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Myasthenia Gravis
 Pathophysiology
 Antibodies Destroy ACh Receptors
 ACh Unable to Stimulate Muscle Contraction
 Loss of Voluntary Muscle Strength
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Neuromuscular Junction
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Etiology
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Unknown
Autoimmune
Thymus Disorders
Possible Viral Origin
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
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Progressive Muscle Weakness
Fatigue with Activity
Ptosis
Difficulty Chewing, Swallowing
Difficulty Breathing
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms (cont’d)
 Remissions
 Exacerbations
 Stress
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Complications
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Aspiration
Respiratory Infection and Failure
Mysathenic Crisis
Cholinergic Crisis
 SLUDGE
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
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History and Physical
Tensilon Test
Anti-ACh Receptor Antibodies
EMG
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
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Thymectomy
Anticholinesterase Agents
Steroids
Plasmapheresis
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Process
 Activity Intolerance
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Teach Methods to Conserve Energy
Teach Avoidance of Infection
Teach Signs and Symptoms of Crisis
Teach Medications to Avoid
 Support Group
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Amyotrophic Lateral Sclerosis:
Lou Gehrig’s Disease
 Pathophysiology
 Motor Neurons Degenerate
 Nerve Impulse Transmission Blocked
 Muscle Weakness and Atrophy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Etiology
 Unknown
 Possible Genetic Predisposition
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
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Progressive Muscle Weakness and Atrophy
Decreased Coordination
Muscle Spasm
Difficulty Chewing and Swallowing
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms (cont’d)
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Emotional Lability
Speech Difficulty
Pulmonary Compromise
Death in 2 to 5 Years, up to 20 Years
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
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History and Physical
LP with CSF Analysis
EEG
Nerve Biopsy
EMG
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
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Muscle Relaxants
Riluzole
Physical, Occupational, Speech Therapies
Pain Control
Tube Feedings
Prevention of Infection
Augmentative Alternative Communication
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Patient Education
 Support Groups
 Importance of Avoiding Infection
 Teach Family to Provide Care
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Guillain-Barre Syndrome (GBS)
 Pathophysiology
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Inflammation of Spinal and Cranial Nerves
Segmental Demyelination in Ascending Pattern
Lymphocyte Infiltration
Descending Remyelination
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
GBS Variants
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Ascending
Descending
Miller-Fisher Syndrome
Motor Guillain-Barre
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Etiology
 Unknown
 Possible Autoimmune Response to Virus
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
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
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Complications
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Respiratory Failure
Infection
Depression
Pneumonia
UTI
Complications of Immobility
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
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LP with CSF Analysis
EMG
Nerve Conduction Velocity
Pulmonary Function Testing
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
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Plasmapheresis
Oxygen
Mechanical Ventilation
Emotional Support
Rehabilitation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Care
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Monitor Vital Capacity and ABGs
Provide Supportive Care
Manage Pain
Maintain Nutrition
Assist with Communication
Provide Diversional Activities
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Post-Polio Syndrome
 Affects Polio Victims 10 to 40 Years Later
 Signs and Symptoms
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Muscle Weakness
Fatigue
Pain
Respiratory Compromise
 Treatment: Rest
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses:
Neuromuscular Disorders
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Ineffective Airway Clearance
Impaired Physical Mobility
Risk for Imbalanced Nutrition
Impaired Verbal Communication
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cranial Nerve Disorders
 Trigeminal Neuropathy
 Bell’s Palsy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Trigeminal Neuralgia
 Pathophysiology
 Irritation of the Trigeminal Nerve
 Affects Sensory Portion of Nerve
 Etiology
 Irritation or Chronic Compression
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Trigeminal Innervation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
 Intense Pain on One Side of Face
 Forehead, Cheek, Nose, Jaw
 Triggered by Touch, Talking, Other
Stimulation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
 History and Physical
 CT Scan
 MRI
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Anticonvulsants
 Nerve Blocks
 Surgery to Block Pain Signals
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Bell’s Palsy
 Pathophysiology/Etiology
 Inflammation and Edema of Facial Nerve
 Loss of Motor Control
 Etiology Unknown
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
 One-Sided Facial
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Pain
Weakness
Speech Difficulty
Drooling
Tearing of Eye
Inability to Blink
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
 History and Physical
 EMG
 Rule Out Stroke
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
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Prednisone
Analgesics
Antiviral Medication
Moist Heat
Gentle Massage
Facial Sling
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses: Cranial
Nerve Disorders
 Pain
 Imbalanced Nutrition
 Risk for Injury to Eyes (Bell’s Palsy)
Copyright © 2011. F.A. Davis Company