Monday, December 04, 2006


Neuro Disorders
Myasthenia Gravis
The problem is with neurotransmission, a defect in acetylcholine receptors sites. Fatigue of the voluntary muscles. Dry eye corneal abrasion. Eyes droop. Fatigue of the resp muscles and limb muscles. The pt eventually choke on food because of difficulty swallowing. The tensilon test= pt given short acting anti-cholinesterase (tensilon or edrophonium chloride) this enhances neurotransmission and improves symptoms, this is short term. Atropine is given to reduce the side effects of the tensilon which is bradycardia, sweating, and cramping. If the pt has a positive test, the pt may be ordered drug therapy with anticholinesterase meds. Mestinon, Prostigmin. MUST be given on time. Side effects=abd pain, diarrhea, increased Oropharyngeal secretions. Other treatments=Corticosteroids given. Cytotoxic meds may be given, such as Imuran and cytoxan…why they work is still unknown. IVIG. Plasmapheresis. No cure. Surgical Tx= thymectomy results in clinical improvement. Produces antigen specific immunosuppression. It takes a year to start working because of the life span of the circulating T cells.
Myasthenic CRISIS
Severe generalized weakness and respiratory failure. After stress such as infection, high temp, surgery. Need Ventilatory support. ADLs, chest PT, suctioning.
Cholinergic CRISIS
From overmedicating with Anticholinergics. Can mimic the s/s of myasthenic crisis. It is differentiated by the tensilon test…ie…the pt in myasthenic crisis will improve after the tensilon. Stop all anticholinesterase med! Atropine sulfate to reduce increased, excessive secretions.
Nsg Care= teaching….use of meds on time and to keep a diary. .s/s of crisis. How to save energy, space activity, organize the house.…how to avoid aspiration soft food, neck slightly flexed
…eye care.
Parkinsons disease
Reduced amount of dopamine. Signs and symptoms= rigid, resting tremor, bradykinesia, a loss of postural reflexes. Bradyphrenia. Memory problems. Drooling dysphagia, speech problems, constipation, urinary frequency. Treatment= Eldepryl--protects the neurons and reduces the need for Levodopa till later. Levodopa--provides the missing dopamine. Amantadine--Anticholinergics that is given to reduce the symptoms and increases the release of dopamine from the storage sites. Sometimes pt need a drug holiday to find other drugs that may work when the current treatment not working.
Nsg care= routine for personal care. Safety. AROM, PROM, rigid facial expressions may hide true feelings. Thicken liquids. Eat sitting up…..
Multiple Sclerosis.
Demyelinating disease…nerve fibers of brain and spinal cord. Lesions throughout the white matter…some in the grey matter. There is an inflammatory response that attacks the myelin. Could be an autoimmune problem with a viral trigger…unknown. Exacerbations and remissions. MRI will demonstrate white matter lesions. New drug therapy= Avinex--interferon beta-1a--weekly IM
Betaseron--interferon beta 1b recombinant every other day SQ. Major side effect = suicidal tendency, depression. Older drug therapy= Corticosteroids. Cytoxan may produce temporary remission. Signs and symptoms= blurry vision, double vision, dysphagia, facial weakness, numbness, pain, paralysis, abnormal gait, tremor, vertigo, incontinence, short term memory loss, trouble finding words. Other meds to reduce the symptoms.
Nsg Care= self care balance. Urinary retention--straight cath or texas. Bowel routine. Skin integrity.

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