Nursing Management of the Adult Client with Neurologic Alterations: DNDs
Tracy Heberlig, MSN, RN, CNE NURS 228 – Spring 2008
Multiple Sclerosis (MS)
Chronic, Abnormal immune response Demyelination (destruction of myelin)
Classifications
Relapsing-Remitting
common (85%) Exacerbations w/ full or partial recovery
Most
Primary-Progressive
Steady
worsening
Secondary-Progressive
50%
w/ R-R will develop S-P within 10 years of initial diagnosis
Progressive-Relapsing
Symptoms
Mixed or Generalized (50%)
Visual
deficits Brainstem lesions
Spinal Type (25%) Cerebellar Type Amaurotic Form
Interdisciplinary Care
Goal – optimal functioning Rehabilitation Treatment of exacerbations Diagnosis
Manifestations
– most definitive CSF analysis CT (brain), PET Evoked response testing
MRI
Interdisciplinary Care
Medications – exacerbations
Adrenocorticosteroids Immunosuppressants Immunomodulators
Medications – symptom mgmt
Anticholinergics Cholinergics Muscle
relaxants
baclofen, dantrolene, diazepam Muscle spasms – Soma, Flexeril, Skelaxin, Robaxin
Interdisciplinary Care
Rehabilitation
– retain independence Muscle strength Treatment of spasticity
LTG
Nsg Care
Psychosocial Health promotion Assessment
Nsg Diagnoses & Interventions
Self-care deficit Fatigue Impaired physical mobility Ineffective breathing pattern Risk for injury Impaired elimination (urinary or bowel) Ineffective individual coping
Huntington’s Disease (HD)
Progressive & degenerative Dementia & chorea Unknown cause, No cure Familial disease Pathophysiology
Cellular
destruction Atrophy of other areas Neurotransmitter imbalance
Huntington’s Disease (HD)
Manifestations
effects – early vs late Psychosocial effects – early vs late
Motor
Interdisciplinary Care
– genetic testing Meds
Dx
Antipsychotics Antidepressants
Huntington’s Disease (HD)
Nsg Care
Physiologic,
Psychosocial, Ethical challenges Nsg Dx & Interventions
Risk for aspiration Impaired verbal communication Impaired skin integrity Imbalanced nutrition: < body requirements
Myasthenia Gravis (MG)
Autoimmne disorder Antibody destruction of Ach receptors Skeletal muscle weakness
muscles Facial, speech, mastication
Eye
Exacerbations
MG
Complications
Pneumonia
Myasthenia
Crisis Cholinergic Crisis
Diagnosis
H&P Anticholinesterase
(Tensilon) test Nerve stimulation studies Analysis of AChE receptors
Interdisciplinary Care
Medication Mgmt
meds (Mestinon, Prostigmin) Immunosuppressive therapy
Corticosteroids Cytotoxic meds (Imuran)
Anticholinesterase
Plasmapheresis, Surgery
IVIG (exacerbations)
Thymectomy
Nsg Care
Patient and Family Teaching Medication Management Energy Conservation Aspiration Risk Reduction Eye Safety
Nsg Diagnoses & Interventions
Ineffective airway clearance Impaired swallowing Risk for aspiration Fatigue
Guillain-Barré Syndrome (GBS)
Acute inflammatory demyelination in PNS Precipitating Event Paralysis, Paresthesia, & Numbness
Manifestations
Acute Stage Stabilizing / Plateau Stage Recovery Stage
Interdisciplinary Care
Diagnosis via H&P, clinical exam Acute Phase
Foci
Oxygenation Preventing complications
Meds
Antibiotics Morphine
Anticoagulants Vasopressors
Interdisciplinary Care
Management
ventilation Plasmapheresis ECG monitoring IV fluids – hypotension
Mechanical
PT & OT
Nursing Care
Nsg Dx & Interventions
Ineffective
airway clearance Ineffective breathing pattern Anxiety Powerlessness Impaired mobility Risk for impaired skin integrity Imbalanced nutrition: < body requirementsw Impaired verbal communication
Amyotrophic Lateral Sclerosis (ALS)
Lou Gerig’s Disease Rapidly progressing, Fatal Weakness & wasting
Muscles
– voluntary control
Death 2 to 5 yrs after onset
Manifestations
Lower motor neuron involvement Cognition not impacted Early symptoms Progression
Interdisciplinary Care
Diagnosis – r/o other disorders Medications
Rilutek
(riluzole)
Nursing Care
Focus
& Communication End-of-life issues
Education
Nsg Dx & Interventions
Ineffective
breathing pattern Risk for disuse syndrome