1 Adult Health II Neurological Diseases Jerry Carley RN, MSN, MA, CNE Summer 2010

Concept Map: Selected Topics in Neurological Nursing PATHOPHYSIOLOGY Traumatic Brain Injury Spinal 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 ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation ICP Monitoring “Neuro Checks” Lab Monitoring Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_P_I_E Nursing Interventions & Evaluation Execute 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 (ages ) 3

 Probably autoimmune disease  Antibodies and white blood cells attack the proteins in the neuron’s myelin sheath 4

5 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.. Myelin Sheath Around nerve “demyelinization” “demyelinating” “demyelinizing”

6

Inflammation and injury to the sheath and ultimately to the nerves that it surrounds 7 Schwann Cell Myelin Sheath Dendrite Axon terminal

Multiple areas of scarring… + Hardening (Sclerosis) of nerve fibers...usually in spinal cord, brain stem and optic nerves 8

 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…? 9

10

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) 11

12 "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 13

 Intermittent damage to myelin…intermittent severity  Scarring and sclerosis of nerve fibers usually in the spinal cord, brain stem, and optic nerves… 14

 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) 15

 Emotional labile  Depression (suicide increased 7.5%, usually in first 5 years) 16

MS can progress steadily… or cause acute attacks (exacerbation) followed by partial or complete reduction in symptoms (remission) 17

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 19

 Avonex IM Weekly (interferon beta – 1a)  Betaseron SQ Daily (interferon beta 1b)  Copaxone SQ Daily  Rebif SQ given 3 x week 20

 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) 21

 Bacterial infections (lung, bladder)  Disturbed thought processes  Impaired bladder & bowel function  Contractures  Seizures  Impaired mobility / speech / swallowing  Sensory & visual impairment 22

 In some people, MS is a mild illness, but, for others, it results in permanent disability  Most patients have a normal lifespan 23