Alterations in Spinal Cord Function and Neurological Disorders

Central Nervous System and Peripheral Nervous System Overview

  • Central Nervous System (CNS) Components:
    • Brain.
    • Spinal cord.
    • Meninges:
      • Pia mater (innermost layer).
      • Arachnoid mater (middle layer).
      • Dura mater (outermost, toughest layer).
    • Cerebral spinal fluid (CSF).
  • Nervous System Physiology:
    • Central: Brain and Spinal cord.
    • Peripheral: Spinal nerves and Cranial nerves.
    • Autonomic:
      • Sympathetic system.
      • Parasympathetic system.
      • Enteric system (nervous system of the digestive tract).

Multiple Sclerosis (MS)

  • Pathophysiology:
    • Disease of the CNS characterized by demyelination of the sheath surrounding nerves.
    • Areas affected include vision, muscles, nerves, cognition, memory, coordination, and balance.
  • Diagnostic Criteria (The 2017 McDonald Criteria):
    • Used for patients with an attack at onset to determine a diagnosis based on clinical attacks and objective clinical evidence of lesions.
    • Scenario 1: ≥2\ge 2 clinical attacks and ≥2\ge 2 lesions with objective clinical evidence require no additional data.
    • Scenario 2: ≥2\ge 2 clinical attacks and 11 lesion (with clear historical evidence of a previous attack involving a lesion in a distinct anatomical location) require no additional data.
    • Scenario 3: ≥2\ge 2 clinical attacks and 11 lesion require dissemination in space (DIS) demonstrated by an additional clinical attack implicating a different CNS site or by MRI.
    • Scenario 4: 11 clinical attack and ≥2\ge 2 lesions require dissemination in time (DIT) demonstrated by an additional clinical attack or by MRI OR demonstration of CSF-specific oligoclonal bands.
    • Scenario 5: 11 clinical attack and 11 lesion require DIS (additional clinical attack or MRI) AND DIT (additional clinical attack, MRI, or CSF-specific oligoclonal bands).
  • Types of Multiple Sclerosis:
    • Relapse remitting.
    • Primary progressive.
    • Secondary progressive.
    • Clinically isolating.
  • Epidemiology and Etiology:
    • Etiology is unknown.
    • Contributing factors include autoimmune responses, genetic predispositions, and environmental triggers.
    • Epidemiological focus includes comorbidities.
  • Impact on Overall Health:
    • Physiological: Visual impairment, immune system dysfunction, pain, and mobility issues.
    • Cognitive/Psychosocial: Impact on cognition; higher risk for anxiety and depression requiring specific treatment.
    • Life Factors: Aging, sexual function, and the impact of relapses.
    • Triggers and Management: Temperature sensitivity and the importance of diet.
  • Role of the Nurse and Nursing Process:
    • Assessment/Recognizing Cues: Identifying clinical manifestations and environmental factors.
    • Safety Considerations: Prioritizing mobility and accessibility resources.
    • Implementation/Action:
      • Management of spasticity.
      • Addressing bladder and bowel dysfunction.
      • Cognitive rehabilitation.
      • Interprofessional therapy and pharmacology.
      • Client education on health promotion and disease prevention.

Seizure Disorders

  • Definition: Abnormal and unregulated electrical impulses in the brain.
  • Classification:
    • Acute or Chronic: Chronic seizure disorders are referred to as epilepsy.
    • Categories: Generalized, Focal, and Unknown.
    • Types: Motor or nonmotor.
  • Etiological Risk Factors:
    • Structural changes in the brain.
    • Genetic factors.
    • Infectious diseases.
    • Metabolic issues.
    • Immune system triggers.
    • Unknown etiology.
  • Stages of a Seizure:
    • Prodromal: Period leading up to the seizure.
    • Early Ictal (Aura): Warning signs preceding the main event.
    • Ictal: The seizure activity itself (Generalized or Focal).
    • Postdromal (Postictal): Recovery period after the seizure.
  • Clinical Presentation by Onset:
    • Focal Onset:
      • Level of awareness: Aware or Impaired Awareness.
      • Motor manifestations: Automatisms, atonic, clonic, epileptic spasms, hyperkinetic, or tonic.
      • Non-motor manifestations: Autonomic, behavior arrest, cognitive, emotional, or sensory.
    • Generalized Onset:
      • Motor: Tonic-clonic, clonic, tonic, myoclonic, myoclonic-tonic-clonic, myoclonic-atonic, atonic, or epileptic spasms.
      • Non-motor (Absence): Typical, atypical, myoclonic, or eyelid myoclonia.
    • Unknown Onset:
      • Motor: Tonic-clonic, epileptic spasms.
      • Non-motor: Behavior arrest.
    • Unclassified: Seizures that do not fit other categories.
  • Nursing Role:
    • Focus on environmental factors and safety considerations.
    • Patient and family education.

Febrile Seizures

  • Pathophysiology: Seizures triggered by a sudden, rapid rise in body temperature.
  • Classifications: Simple or Complex.
  • Risk Factors:
    • Ages: 66 months to 55 years.
    • Temperature: Over 38∘C38^{\circ}\text{C} (100.4∘F100.4^{\circ}\text{F}).
    • Previous history of febrile seizures or family history.
  • Clinical Manifestations: Seizure activity occurring with a fever; typically brief, lasting up to 22 minutes.
  • Treatments and Nursing Actions:
    • Diagnostic Research: Determine the underlying cause of the fever.
    • Fever Reduction: Implement methods to lower body temperature.
    • Safety/Procedure during Seizure:
      • Lay the child on their side with the head tilted back.
      • Do not restrain the child.
      • Do not place anything in the child’s mouth.
      • Note the timing and keep a detailed record of the seizure.
    • Hospitalization: Necessary if there is a serious infection, prolonged seizure activity, or if the child is unresponsive post-seizure.
    • Prevention: Vaccinations to prevent illnesses that cause high fevers.

Epilepsy

  • Definition: Two or more unprovoked seizures occurring at least 2424 hours apart.
  • Etiology/Risk Factors:
    • Genetic mutations.
    • History of trauma or infection.
    • Developmental disorders.
    • Alcohol exposure.
    • Structural changes in the brain.
    • Epidemiology: More frequent in children than in young adults.
  • Clinical Presentation:
    • Generalized: Jerking, weakness, spasms, eyelid movements, and staring.
    • Focal: Often starts with an aura; characterized by impaired awareness, automatisms, and muscle spasms.
  • Diagnostics: Electroencephalogram (EEG) is the primary tool.
  • Treatments and Therapies:
    • Pharmacology: Anti-seizure medications (nursing goal: start with one medication).
    • Dietary: High fat, low carbohydrate, moderate protein diet (Ketogenic diet).
    • Vagus Nerve Stimulation (VNS).
    • Surgery: Reserved for severe cases unresponsive to other treatments.
  • Nursing Process & Pedagogy:
    • Recognize cues through a thorough medical history.
    • Analyze cues for signs of auras.
    • Take actions to help patients avoid specific triggers.
    • Support social and personal development, especially in pediatric clients.

Parkinson's Disease (PD)

  • Pathophysiology:
    • Loss of the substantia nigra.
    • Loss of neurotransmitters: Dopamine and Norepinephrine.
  • Risk Factors:
    • Unknown primary cause.
    • Genetic and environmental factors (exposures and occupational factors).
    • Comorbidities and aging.
  • Manifestations:
    • Symptoms vary according to the stage of the disease (Stages 11 through 55).
    • Physiological and psychosocial impacts.
  • Nursing and Management:
    • Clinical diagnosis based on symptoms; lab testing and diagnostic studies.
    • Nursing focus on safety, individualized care factors, and client education.

Questions & Discussion

  • Multiple Sclerosis Contrast: Compare and contrast the types of multiple sclerosis, including clinical manifestations and prognosis.
  • Epilepsy Transition: Discuss the unique challenges that adolescents who have epilepsy might face as they transition to adulthood. How can nurses facilitate this transition to ensure continuity of care and support for the patient's developmental needs?