Nursing Care of Patients With Peripheral Nervous System Disorders

Multiple Sclerosis

Degeneration of the myelin sheath, resulting in slowed or blocked nerve impulses

Multiple Sclerosis Etiology

The cause of multiple sclerosis is unknown, but it is believed to be related to an autoimmune response or viral infection

Multiple Sclerosis Signs and Symptoms

Muscle weakness, numbness, fatigue, slurred speech, vision disturbances, vertigo, ataxia, dysphagia, bowel/bladder problems, sexual dysfunction, and mood alterations

Multiple Sclerosis Additional Manifestations

The disease may have periods of remission and exacerbation, which can be triggered by stress or illness. Immobility is common, and death is usually caused by infection

Multiple Sclerosis Diagnostic Tests

Diagnosis is based on a history and physical examination, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI)

Multiple Sclerosis Therapeutic Interventions

Treatment options include steroids, interferon therapy, immunosuppressant agents, anticonvulsants, muscle relaxants, plasmapheresis, and physical/occupational/speech therapies

Myasthenia Gravis

An autoimmune disorder where antibodies destroy acetylcholine receptors, resulting in a loss of voluntary muscle strength

Myasthenia Gravis Etiology

The cause of myasthenia gravis is unknown, but it is believed to be related to an autoimmune or viral origin, as well as thymus disorders

Myasthenia Gravis Signs and Symptoms

Progressive muscle weakness, fatigue with activity, ptosis (drooping of the eyelids), difficulty chewing/swallowing/breathing, and periods of remission and exacerbation, which can be triggered by stress

Myasthenia Gravis Complications

Complications of myasthenia gravis include aspiration, respiratory infection and failure, myasthenic crisis, cholinergic crisis, and SLUDGE (salivation, lacrimation, urination, defecation, gastrointestinal upset, and emesis)

Myasthenia Gravis Diagnostic Tests

Diagnosis is based on a history and physical examination, Tensilon test, anti-acetylcholine receptor antibodies, and electromyography (EMG)

Myasthenia Gravis Therapeutic Interventions

Treatment options include thymectomy (removal of the thymus), anticholinesterase agents, steroids, and plasmapheresis

Myasthenia Gravis Nursing Process

Nursing care focuses on managing activity intolerance, teaching energy conservation techniques, infection prevention, recognizing signs and symptoms of crisis, medication avoidance education, and providing support group resources

Amyotrophic Lateral Sclerosis (ALS)

A progressive neurodegenerative disease where motor neurons degenerate, leading to muscle weakness and atrophy

ALS Etiology

The cause of ALS is unknown, but there may be a genetic predisposition

ALS Signs and Symptoms

Progressive muscle weakness and atrophy, decreased coordination, muscle spasm, difficulty chewing/swallowing, emotional lability, speech difficulty, pulmonary compromise, and death due to pulmonary complications

ALS Diagnostic Tests

Diagnosis is based on a history and physical examination, lumbar puncture with cerebrospinal fluid (CSF) analysis, electroencephalogram, nerve biopsy, and electromyography (EMG)

ALS Therapeutic Interventions

Treatment options include muscle relaxants, Riluzole (Rilutek), physical/occupational/speech therapies, pain control, enteral feedings, infection prevention, and augmentative alternative communication

Guillain-Barre Syndrome

An inflammatory disorder that affects the spinal and cranial nerves, causing ascending demyelination and descending remyelination

Guillain-Barre Syndrome Etiology

The cause of Guillain-Barre syndrome is unknown, but it is believed to be related to an autoimmune response triggered by a viral infection

Guillain-Barre Syndrome Signs and Symptoms

Stage 1: Abrupt onset of weakness and paralysis, which may affect respiration and the autonomic nervous system. Stage 2: Plateau phase, where the progression of symptoms stops. Stage 3: Recovery phase, where improvement occurs

Guillain-Barre Syndrome Complications

Complications of Guillain-Barre syndrome include respiratory failure, infection, depression, pneumonia, urinary tract infection, and complications related to immobility

Guillain-Barre Syndrome Diagnostic Tests

Diagnosis is based on lumbar puncture with cerebrospinal fluid (CSF) analysis, electromyography (EMG), nerve conduction velocity tests, and pulmonary function testing

Guillain-Barre Syndrome Therapeutic Interventions

Treatment options include plasmapheresis, oxygen therapy, mechanical ventilation, emotional support, and rehabilitation

Postpolio Syndrome

A condition that affects individuals who previously had polio, causing muscle weakness, fatigue, pain, and respiratory compromise. Treatment involves rest and symptom management

Nursing Diagnoses for Neuromuscular Disorders

Common nursing diagnoses for neuromuscular disorders include ineffective airway clearance, impaired physical mobility, imbalanced nutrition, and impaired verbal communication

Cranial Nerve Disorders

Conditions affecting the cranial nerves, such as trigeminal neuropathy and Bell's palsy

Trigeminal Neuralgia

A condition characterized by irritation of the trigeminal nerve, resulting in intense pain on one side of the face triggered by touch, talking, or stimulation

Trigeminal Neuralgia Diagnostic Tests

Diagnosis is based on a history and physical examination, computed tomography (CT) scan, and magnetic resonance imaging (MRI)

Trigeminal Neuralgia Therapeutic Interventions

Treatment options include anticonvulsants, nerve blocks, and surgery to block pain signals

Bell's Palsy

An inflammatory condition that causes inflammation and edema of the facial nerve, resulting in a loss of motor control

Bell's Palsy Signs and Symptoms

One-sided facial pain, weakness, speech difficulty, drooling, tearing of the eye, and inability to blink

Bell's Palsy Diagnostic Tests

Diagnosis is based on a history and physical examination, electromyography (EMG), and ruling out a stroke

Bell's Palsy Therapeutic Interventions

Treatment options include prednisone, analgesics, antiviral medication, moist heat, gentle massage, and a facial sling for support

Nursing Diagnoses for Cranial Nerve Disorders

Common nursing diagnoses for cranial nerve disorders include acute pain, imbalanced nutrition, and the risk for injury to the eyes (in the case of Bell's palsy)