1. Nursing Care of Patients with Peripheral Nervous System Disorders

2. Multiple Sclerosis Pathophysiology Degeneration of Myelin Sheath, inflamed nerves cannot transmit impulse to muscles Etiology Unknown Possible Autoimmune Response Possible Viral Infection Heredity

3. Signs & Symptoms Muscle Weakness Numbness Fatigue Slurred Speech Vision Disturbances Vertigo Ataxia Dysphagia Bowel/Bladder Problems Sexual Dysfunction Mood Alterations

4. Additional Manifestations Remissions Exacerbations Due to Stress or Illness Immobility Death Usually from Infection Dx: H&P, CSF, anaylsis, MRI

5. Therapeutic Interventions Steroids- medrol, predisone, decadron Immunosuppressant Agents- Imeran, Cytoxan- depress immune system Anticonvulsants- Dilantin, tegretol Muscle Relaxants- Flexaril, valium Plasmapheresis PT, OT, ST

6. Myasthenia Gravis Pathophysiology In MG, antibodies destroy ACh receptors,ACh unable to stimulate muscle contraction, causing loss of muscle strength Dx: H&P, Tensilon test, Anti-Ach receptor antibodies

7. Neuromuscular Junction

8. Signs & Symptoms Progressive Muscle Weakness Fatigue with Activity Ptosis Difficulty Chewing, Swallowing Difficulty Breathing Remissions and exacerbations- stress

9. Complications Aspiration Respiratory Infection and Failure Mysathenic Crisis- not enough med Cholinergic Crisis- too much med SLUDGE

10. Therapeutic Interventions Thymectomy- < production of actecycholine antibodies Cholinergic Agents- prostigmin, mestinon Steroids- predisone Plasmapheresis- remove antibodies from the blood

11. Patient Education Methods to Conserve Energy Well- balanced nutritious meals Avoidance of Infection S&S of Crisis Medications to Avoid Support Group

12. Amyotrophic Lateral Sclerosis Lou Gehrig’s Disease Progressive, degenerative disease where motor neurons are destroyed, nerve impulse transmission is blocked causing muscle weakness and atropy. Etiology is unknown, possible genetic

13. Signs & Symptoms Progressive muscle weakness, atrophy < coordination, muscle spasms Difficulty chewing and swallowing Emotional lability, speech difficulty Pulmonary compromise- death in 3-5 yrs Dx: H&P, LP, EEG, EMG, nerve biopsy

14. Therapeutic Interventions Muscle Relaxants Riluzole PT/ OT/ ST Pain Control Tube Feedings Prevention of Infection Augmentative Alternative Communication

15. Patient Education Support Groups Importance of Avoiding Infection Teach Family to Provide Care

16. Guillain-Barre Syndrome Pathophysiology Inflammation of Spinal and Cranial Nerves Demyelination in Ascending Pattern Lymphocyte Infiltration Descending Remyelination Etiology: unknown or autoimmune response to virus

17. Signs & Symptoms Stage 1 – 24 h 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- remylination occuring

18. Complications Respiratory Failure Infection Depression Pneumonia UTI Complications of Immobility

19. Therapeutic Interventions Plasmapheresis Oxygen Mechanical Ventilation Emotional Support Rehabilitation

20. Nursing Care Monitor Vital Capacity and ABGs Provide Supportive Care Manage Pain Maintain Nutrition Assist with Communication Provide Diversional Activities

21. Post-Polio Syndrome Affects Polio Victims 10 – 40 Years Later Signs and Symptoms Muscle Weakness Fatigue Pain Respiratory Compromise Treatment - Rest

22. Trigeminal Neuralgia Pathophysiology Irritation of the trigeminal nerve (5 th cranial nerve), affects sensory portion of nerve Etiology Irritation or Chronic Compression Dx: H&P, CT, MRI

23. Trigeminal Innervation

24. Signs & Symptoms Intense Pain on One Side of Face Forehead, Cheek, Nose, Jaw Triggered by Touch, Talking, Other Stimulation

25. Therapeutic Interventions Anticonvulsants Nerve Blocks Surgery to Block Pain Signals

26. Bell’s Palsy Pathophysiology/Etiology Inflammation and Edema of Facial Nerve Loss of Motor Control Etiology Unknown Dx: H&P, EMG, rule out stroke

27. Signs & Symptoms One Sided Facial Pain Weakness Speech Difficulty Drooling Tearing of Eye Inability to Blink

28. Therapeutic Interventions Prednisone Analgesics Antiviral Medication Moist Heat Gentle Massage Facial Sling

29. Nursing Diagnoses: Cranial Nerve Disorders Pain Imbalanced Nutrition Risk for Eye Trauma (Bell’s Palsy) Body Image Disturbance