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Nursing Interventions for Clients with Problems of the Peripheral Nervous System

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					        Chapter 47
Interventions for Clients with
 Problems of the Peripheral
      Nervous System


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Guillain-Barré Syndrome
• An acute autoimmune disorder characterized by
  varying degrees of motor weakness and
  paralysis
• The client’s life and ultimate potential for
  rehabilitation dependent upon appropriate
  interventions and effectiveness of nursing care
• Chronic inflammatory demyelinating
  polyneuropathy



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Clinical Manifestations
• Muscle weakness and pain have abrupt onset;
  cause remains obscure.
• Cerebral function or pupillary signs are not
  affected.
• The most common clinical pattern is that the
  immune system starts to destroy the myelin
  sheath surrounding the axons.
                                                                             (Continued)




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Clinical Manifestations (Continued)
• Weakness and paresthesia begin in the lower
  extremities and progress upward toward the
  trunk, arms, and cranial nerves in ascending
  GBS.




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Ineffective Breathing Pattern Interventions
• Priority: maintain adequate respiratory function;
  implement interdisciplinary actions
• Airway management:
  – Elevate head of bed at least 45 degrees
  – Suction
                                                                             (Continued)




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Ineffective Breathing Pattern Interventions
(Continued)

   – Chest physiotherapy
   – Incentive spirometer
   – Oxygen
   – Monitor arterial blood gas and vital capacity
   – Keep equipment for endotracheal intubation
     at the bedside




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Interventions for Cardiac Dysfunction
• Can affect both the sympathetic and
  parasympathetic systems
• Client placed on cardiac monitor because of the
  risk for arrhythmias
• Hypertension treated with beta blocker or
  nitroprusside
• IV fluids for hypotension; client placed in supine
  position
• Atropine may be used for bradycardia

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Drug Therapy
• Plasmapheresis or IV immunoglobulin
• Plasma exchange
• IV immunoglobulin
• No corticosteroids




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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 client
  without the plasma.
• Plasma usually replaces itself, or the client is
  transfused with albumin.




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Acute Pain Interventions
• Assess pain, which is often worse at night
• Pain usually only relieved with opiates
• Use of analgesia pump or continuous IV drip
• Frequent repositioning, massage, ice, heat,
  relaxation techniques, guided imagery, and
  distraction (such as music or visitors)




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Impaired Physical Mobility and Self-Care
Deficit
• Interventions include:
  – Assess muscle function every 2 to 4 hours.
  – Provide assistive devices and instructions for
    their use.
  – Ensure safety in ambulation, position
    changes.
  – Encourage independence.
                                                                             (Continued)



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Impaired Physical Mobility and Self-Care
Deficit (Continued)
  – ROM exercises every 2 to 4 hours
  – Diet plan to guard against malnutrition
  – Prevention of pressure ulcers
  – Prevention of pulmonary embolic and deep
    vein thrombosis




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Impaired Verbal Communication
• Interventions include:
  – Develop a communication system that meets
    the needs of client.
  – Devise simple techniques—eye blinking and
    moving a finger to indicate yes and no
    responses.
  – Develop a board using letters of the alphabet.




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Powerlessness
• Interventions include:
  – Encourage client to verbalize feelings about
    the illness and its effects.
  – Examine patterns of decision-making, roles
    and responsibilities, and usual coping
    mechanisms.
  – Refer client to other health care professionals
    as needed.


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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
                                                                            (Continued)




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Myasthenia Gravis (Continued)
• 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




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Tensilon Testing
• Within 30 to 60 sec after injection of Tensilon,
  most myasthenic clients show marked
  improvement in muscle tone that lasts 4 to 5
  minutes.
• Prostigmin is also used.
• Cholinergic crisis is due to overmedication.
                                                                             (Continued)




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Tensilon Testing (Continued)
• Myasthenic crisis is due to undermedication.
• Atropine sulfate is the antidote for Tensilon
  complications.




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Diet Therapy and Interventions
• Cholinesterase-inhibitor drugs
• Immunosuppressants
• Corticosteroids for immunosuppression
• Plasmapheresis
                                                                            (Continued)




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Diet Therapy and Interventions (Continued)
• Respiratory support
• Nonsurgical management
• Assistance with activities and communication




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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.




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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




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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.




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Cholinergic Emergency Crisis
• Anticholinergic drugs are withheld while the
  client 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.


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Management
• Immunosuppression
• Plasmapheresis
• Respiratory support
• Promoting self-care guidelines
• Assisting with communication
• Nutritional support
• Eye protection
• Surgical management usually involving
  thymectomy
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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, or emotional
  extremes.
• Teach warning signs.
• Teach importance of compliance.


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Polyneuritis and Polyneuropathy
• Syndromes whose clinical hallmarks are muscle
  weakness with or without atrophy; pain that is
  stabbing, cutting, or searing; paresthesia or loss
  of sensation; impaired reflexes; autonomic
  manifestations
• Example: diabetic neuropathy




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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




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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 clients

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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


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Facial Paralysis or Bell’s Palsy
• Acute paralysis of seventh cranial nerve
• Medical management: prednisone, analgesics
• Protection of the eye
• Nutrition
• Massage; warm, moist heat; facial exercises




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Description: Nursing care for patients with nervous diseases for nursig students.