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MULTIPLE SCLEROSIS
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DISEASES/ DISORDERS:
Multiple Sclerosis Myasthenia Gravis Parkinsons Disease Guillain-Barr Syndrome
Multiple Sclerosis
Chronic, progressive degenerative disease affecting the myelin sheath of the white matter of the brain & spinal cord
Plaques form on myelin sheath causing inflammation, edema, & demyelination, eventually scarring nerve transmission becomes erratic, and slows down Age onset: 20 -40 yrs; affects women 2:1; whites are affected more often than Hispanics, blacks or Asians. More prevalent in colder climates: North America & Northern Europe. Norther Australia
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Multiple Sclerosis
Common affectation: white matter of the spinal cord optic nerve brainstem cerebrum cerebellum Exacerbation and remissions.
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3. Promote bladder & bowel control Urinal/bedpan readily available PO fluids intake schedule/voiding schedule increase fiber in diet intermittent self-catheterization
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Vision
eye patch for diplopia; prism glasses for reading; talking books
Speech
slurred, low volume, problems with phonation speech therapist
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Myasthenia Gravis
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Myasthenia Gravis
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Clinical Manifestations
Initially, symptoms involve ocular muscles, causing conditions such as diplopia and ptosis Weakness of facial muscles, swallowing and voice impairment (dysphonia), Generalized weakness
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Myasthenia Gravis
Chronic autoimmune neuromuscular disease characterized by weakness of voluntary muscles Unknown etiology Autoimmune Causes:
Decreased number of ACh receptors Thymus gland
Myasthenia Gravis
Initial Diagnosis Anticholinesterase test Edrophonium chloride (Tensilon) IV Antidote Atropine 0.4 mg should be available to control the side effects of edrophonium:
Sweating Cramping Bradycardia
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Plasmapheresis - blood is removed and replaced to remove the antibodies Thymectomy removal of the thymus gland
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Myasthenic Crisis
Undermedication with cholinesterase inhibitors Result of disease exacerbation or a precipitating event, most commonly a respiratory infection Severe generalized muscle weakness with respiratory and bulbar weakness (weakness of the facial and pharyngeal muscles) Patient may develop respiratory compromise failure
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Cholinergic Crisis
Caused by overmedication with cholinesterase inhibitors Severe muscle weakness with respiratory and bulbar weakness Patient may develop respiratory compromise and failure
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Myastinic crisis
Cholinergic crisis
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Parkinsons Disease
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Parkinsons Disease
A progressively degenerative neurological disorder affecting the brain centers (substantia nigra and basal ganglia) responsible for control & regulation of movement
Occurs in 1% of pop.
Over 50, affects men > women
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Involuntary tremors
course, rest tremor of the fingers & thumb (pill-rolling movement) of one hand, occurs during rest, & intensifies w/ stress, fatigue, cold, disappears during sleep, the tremor can occur in tongue, lip, jaw, chin; eventually Powerpoint Templates spreads to the foot on the same side Page 44
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Hypothalmic dysfunction: perspiration, heat intolerance, seborrhea, & oil production Psychosocial : does not affect intellectual ability
20% of pts will end up having dementia (Alzheimers)
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Parkinsonian Crisis
Sudden or inadvertent withdrawal of anti-PK drugs or emotional trauma Severe exacerbation of tremor, rigidity and bradykinesia, along w/ acute anxiety, sweating, tachycardia. Interventions: respiratory & cardiac support, subdued lighting, mild barbiturates, anti PK drugs
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Enhance walking walk erect, watch horizon, wide-based gait, heel-toe gait, long strides. Use cane or walker prevent falls
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Improve communication
Speech therapy: speak slowly, use board, mechanical voice synthesizer
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Parkinsons Disease Evaluation The client is able to perform physical activity according to ability. The client is able to perform self care The client is able to maximize the ability to communicate.
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Guillain-Barr Syndrome
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Guillain-Barr Syndrome
Autoimmune disorder with acute attack of peripheral nerve myelin Rapid demyelination may produce respiratory failure and autonomic nervous system dysfunction with CV instability Most often follows a viral infection (respiratory/ GI: Campilobacter jejuni) Affects both men & women equally & of all ages.
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Administer IV and parenteral nutrition as prescribed Assess swallowing and gag reflex and take measures to prevent aspiration
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Causes progressive weakness and atrophy of the muscles of the extremities and trunk; weakness of the bulbar muscles impairs swallowing and talking; and respiratory function is also impaired
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Diagnosis:
clinical signs & symptoms EMG changes muscle biopsies CSF analysis CT MRI Powerpoint Templates
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