Nursing Care of Patients With Peripheral Nervous System Disorders

Chapter 50: Nursing Care of Patients With Peripheral Nervous System Disorders

Learning Outcomes

  • Identification of Disorders: Identify disorders caused by disruption of the peripheral nervous system.
  • Pathophysiology Explanation: Explain the pathophysiology, major signs and symptoms, and complications of selected peripheral nervous system disorders.
  • Therapeutic Measures: Identify therapeutic measures used for selected peripheral nervous system disorders.
  • Nursing Diagnoses: List common nursing diagnoses associated with peripheral nervous system disorders.
  • Nursing Interventions: Assist in planning prioritized nursing interventions for patients with peripheral nervous system disorders.
  • Care Evaluation: Evaluate the effectiveness of nursing care.

Multiple Sclerosis (MS)

Pathophysiology
  • Definition: A demyelinating disease characterized by degeneration of the myelin sheath surrounding nerves.
  • Consequences:
    • Inflammation of nerves.
    • Slowed or blocked nerve impulses.
Etiology
  • Causes:
    • Etiology is unknown.
    • Possible autoimmune response.
    • Possible viral infection.
    • Genetic factors may play a role (heredity).
Myelin Sheath Breakdown
  • Stages of Breakdown:
    • Normal Myelin: A typical myelin sheath surrounding a neuron.
    • Beginning Breakdown: Initial signs of myelin degradation.
    • Total Disruption: Complete loss of myelin sheath leading to severe neurological deficits.
Disease Progression
  • Types of MS:
    • Relapsing-Remitting MS (RRMS): Relapses resolve completely.
    • Secondary Progressive MS (SPMS): Worsening symptoms not completely resolving after relapse.
    • Primary Progressive MS (PPMS): Gradual worsening of neurological function from the onset without defined relapses.
Additional Manifestations
  • Symptoms:
    • Remissions and exacerbations can be triggered by stress or illness.
    • Risk of immobility.
    • Death usually occurs due to infections.
Diagnostic Tests
  • Testing Methods:
    • Detailed patient history and physical examination.
    • Cerebrospinal Fluid (CSF) Analysis: To detect inflammation.
    • Magnetic Resonance Imaging (MRI): To identify lesions in the nervous system.

Myasthenia Gravis (MG)

Pathophysiology
  • Definition: A chronic autoimmune neuromuscular disease leading to "grave muscle weakness".
  • Mechanism: Antibodies destroy acetylcholine (ACh) receptors, preventing muscle contraction and causing loss of voluntary muscle strength.
Structure of Neuromuscular Junction
  • Components:
    • Normal View: A typical neuromuscular junction with healthy ACh receptors.
    • Damaged State: Presence of damaged ACh receptor sites in patients with MG.
Etiology
  • Causes:
    • Unknown etiology.
    • Autoimmune processes involved.
    • Possible thymus disorders or viral origins.
Symptoms
  • Manifestations:
    • Muscle weakness, especially in the eyes (often causing drooping eyelids).
Diagnostic Tests
  • Testing Methods:
    • Comprehensive history and physical examination.
    • Tensilon Test: Tests for transient improvement in muscle strength.
    • Anti-ACh Receptor Antibodies Test: Identifies presence of specific antibodies.
    • Electromyography (EMG): Evaluates electrical activity in muscles.
Therapeutic Interventions
  • Treatment Options:
    • Thymectomy: Removal of thymus gland.
    • Anticholinesterase Agents: Medications ending in -stigmine to enhance ACh activity.
    • Steroids: To reduce inflammation.
    • Plasmapheresis: A treatment to remove antibodies from the plasma.
Nursing Process
  • Common Nursing Diagnoses:
    • Activity intolerance.
  • Interventions:
    • Teach methods to conserve energy.
    • Educate on avoiding infections.
    • Teach signs and symptoms of MG crisis.
    • Discuss medications to avoid.
    • Encourage participation in support groups.

Amyotrophic Lateral Sclerosis (ALS)

Pathophysiology
  • Definition: Also known as Lou Gehrig's disease, ALS is characterized by the degeneration of motor neurons leading to muscle weakness and atrophy.
  • Mechanism: As nerve impulses are blocked, muscle strength declines.
Etiology
  • Causes:
    • Unknown causes.
    • Possible genetic predisposition identified.
Prognosis
  • Progression: Generally leads to profound neuromuscular impairment, with a life expectancy of about 2-4 years post-diagnosis.
  • Note: Cognition remains intact while motor functions decline significantly.
Diagnostic Tests
  • Testing Methods:
    • Patient history and physical examination.
    • Lumbar Puncture with CSF Analysis: To rule out other conditions.
    • Electroencephalogram (EEG): To assess brain activity.
    • Nerve Biopsy: To evaluate nerve damage.
    • EMG: Evaluates muscle electrical activity.
Patient Education
  • Focus Areas:
    • Stress the importance of avoiding infections.
    • Teach family members to provide effective care and support.

Guillain-Barré Syndrome (GBS)

Pathophysiology
  • Definition: An acute inflammatory demyelinating polyneuropathy characterized by the inflammation of spinal and cranial nerves.
  • Features: Ascending pattern of segmental demyelination, often following a viral infection.
  • Infiltrative Process: Involvement by lymphocytes, leading to remyelination of descending nerves.
Etiology
  • Causes:
    • Unknown, but thought to involve an autoimmune response, particularly following viral infections.
Complications
  • Potential Risks:
    • Respiratory failure, resulting from weakened respiratory muscles.
    • Infection risks, which may include pneumonia and urinary tract infections.
    • Psychological impacts, such as depression.
    • Complications related to immobility.
Diagnostic Tests
  • Testing Methods:
    • Lumbar Puncture with CSF Analysis: Notable for elevated protein with normal white blood cell count.
    • Electromyography (EMG): Assesses electrical activity in movement and response in muscles.
    • Nerve Conduction Velocity Tests: Determine the speed of nerve signals.
    • Pulmonary Function Testing: Evaluate respiratory capability and function.
Therapeutic Interventions
  • Management Strategies:
    • Plasmapheresis: To replace or filter plasma to remove aberrant antibodies.
    • Oxygen Therapy: If respiratory function is compromised.
    • Mechanical Ventilation: Necessary for severe respiratory failure.
    • Emotional Support & Rehabilitation: Essential components of patient care.
Nursing Care
  • Monitoring Needs:
    • Regular assessment of vital capacity and arterial blood gases.
    • Provide supportive care including pain management and nutrition assistance.
    • Facilitate communication and provide diversional activities to enhance patient morale.

Case Study: Ms. Sakae Li

  • Presentation:
    • 32-year-old patient with loss of sensation and weakness in both legs and feet.
    • A lumbar puncture revealed elevated CSF protein with a normal white blood cell count, confirming GBS diagnosis.
    • Experienced recent flu-like illness prior to symptoms.
    • Progression of symptoms necessitated maximum assistance for daily living activities and precautions for skin care and urinary retention.
    • Observed for respiratory issues and blood pressure fluctuations.
  • Progression: Required intubation and enteral feedings as symptoms worsened.

Cue Recognition Activities

Activity 50.1
  • Scenario: Patient with ALS is coughing and sneezing during meals.
  • Response:
    • Place the patient NPO (nothing by mouth).
    • Notify the healthcare provider (HCP) regarding aspiration risk.
    • Collaborate with speech therapy for a swallowing assessment.
Activity 50.2
  • Scenario: Patient with myasthenia gravis is too fatigued for evening shower.
  • Response:
    • Change to a morning bath.
    • Collect vital signs and assess lung sounds, ruling out illness-related fatigue.
Rationale for Activities
  • ALS Concern: Aspiration can pose significant risks due to swallowing difficulties as ALS progresses.
  • Myasthenia Gravis Focus: This condition typically leads to increased fatigue later in the day; adjusting activities to the patient's energy levels may provide better management.