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Disease Multiple Sclerosis is an immune-mediated progressive demyelinating disease of the CNS. It refers to the destruction of myelin, the fatty & protein material that surround certain nerve fibers in the brain & spinal cord resulting in impaired transmission of nerve impulses.

Etiology Cause is unknown, but most common theories point to a virus or genetic defect, or a combination of both. Geographic studies indicate there may be an environmental factor involved of which shows that Environmental exposure at a young age may play a role in the development of MS in later life.

Manifestation Fatigue Muscle spasms Depression Weakness Numbness Difficulty in coordination Loss of balance Pain Spasticity Visual disturbances such as: diplopia, patchy blindess, blurring of vision, & total blindess Incontinence Constipation Trouble in speech and swallowing

Medical Intervention No cure exists for MS. Medications are to treat symptoms and to delay progression of the disease. Medications used to slow the progression of multiple sclerosis are: Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), Mitoxantrone (Novantrone), and Natalizumab (Tysabri) Fingolimod (Gilenya ) Medicines to reduce muscle spasms: Lioresal (Baclofen), tizanidine (Zanaflex) Cholinergic medications to reduce urinary problems

Surgical Intervention

Nursing Intervention Provide emotional and psychological support for the patient and family. Assess patients neurologic status for deficits. 1. Monitor bowel and bladder function during hospitalization. 2. Keep bedpan or urinal readily accessible because the need to void is immediate. Promote and emphasize importance of physical mobility through exercises Prevent injury Minimize spasticity & contractures 3. Watch for adverse reactions to administered medications.

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Antidepressants for mood or behavior symptoms Amantadine for fatigue

Help the patient establish a daily routine to maintain optimal functioning.

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Myasthenia Gravis an autoimmune disorder affecting the myoneural junction, & is characterized by varying degrees of weakness of the voluntary muscles.

Diplopia Occurs when the immune system produces antibodies that Ptosis (dooping of eyelids) blocks or attacks acetylcholine receptors Fatigue which are components Generalized weakness of the neuromuscular junction.

Neostigmine Bromide (Prostigmin) or Pyridostigmine Bromide (Mestinon) to improve the communication between the nerves and the muscles. Corticosteroids: Prednisone to suppress immune response Plasmapheresis to treat exacerbations

1. 2. Establish accurate neurologic and can produce antigenrespiratory baseline. specific 3. immunosuppression and Stay alert for signs of result in clinical impending myesthenic improvement crisis. 4. 5. Administer medications on time. Thymectomy 6. When swallowing is difficult, give semi-solid foods instead of liquids to lessen the risk of choking. Minimize risk of aspiration. 7. 8. Plan exercise, meals, patient care, and activities to make the most of energy peaks. Help the patient plan daily activities to coincide with energy peaks. Stress the need for

The muscle weakness can lead to a variety of symptoms, including:

Breathing difficulty Chewing or swallo wing difficulty Difficulty talking Facial paralysis or weakness of the facial muscles Dysphonia

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frequent rest periods. 9. Patient should be taught strategies to conserve energy. Patient should be reminded of important of maintaining health promotion practices.

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Guillain-Barre Syndrome Cause is unknown. is a disorder in which the body's immune system attacks part of the peripheral nervous system. Muscle weakness Diminished reflexes of lower extremities that can lead to Quadriplegia Paresthesia Dyskinesia Hyporeflexia Dysphagia Paralysis of the ocular muscles Instability of Cardiovascular system Short-acting medications such as alpha-adrenergic blocking agents to treat tachycardia & hypertension Respiratory therapy or mechanical ventilation Use of anticoagulant agents to prevent thrombosis and pulmonary emboli. Plasmapheresis Continuous ECG monitoring. Enhance physical mobility by performing ROM exercises to patient. Provide adequate nutrition; if patient cannot swallow due to bulbar paralysis (immobility of muscles), a gastrostomy tube may be placed to administer nutrients. Improve communication by establishing or providing means to Maintain respiratory function. Monitor for change in vital capacity. Suctioning may be performed to maintain a clear airway.

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communicate, collaboration with speech therapist can also be done. Decrease fear and anxiety to patient & family. Provide emotional support to the patient and his family.

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Trigeminal Neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It is a condition of the 5th cranial nerve characterized by paroxysms of pain in the area innervated by any of the 3 branches, but it most commonly occurs in the 2nd and 3rd branches of the trigeminal nerve. The cause is not certain, but chronic compression or irritation of the trigeminal nerve or degenerative changes in the gasserian ganglion are the suggested causes.

Symptoms may include one or more of these patterns: Episodes of severe, shooting or jabbing pain that may feel like an electric shock Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth Bouts of pain lasting from a few seconds to several seconds Episodes of several attacks lasting days, weeks, months or longer. Pain in areas supplied by the trigeminal nerve, including the cheek, jaw,

Anti-seizure agents such as Carbamazepine (Tegretol) to relieve pain by reducing transmission of impulses at certain nerve terminals. Gabapentin (Neurontin) & Baclofen ( Lioresal) are also used for pain control. Alcohol or phenol injection of the gasserian ganglion & peripheral branches of the trigeminal nerve could relieve pain for several months.

Microvascular Decompression of the Trigeminal Nerve

Instruct the client to avoid factors that can trigger the attack and result in exhaustion and fatigue. Percutaneous Assist the patient in Radiofrequency preventing and reducing Trigeminal Gangliolysis pain by providing choice of surgical preventive strategies. procedure Administer pain medications as needed. Use cotton pads gently, wash face and for oral hygiene. Avoid giving foods to client that are too cold or too hot. Explain to the client and his family the disease and its treatments.

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teeth, gums, lips, or less often the eye and forehead

Pain affecting one side of your face at a time Attacks becoming more frequent and intense over time.

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Bells Palsy Bells Palsy or facial paralysis is due to inflammation of the 7th cranial nerve, which results in weakness or paralysis of the facial muscles of the affected side. The cause is unknown, although possible causes may include vascular ischemia, viral disease, autoimmune disease, or a combination of all these factors. Distortion of the face Loss of wrinkling in the forehead Painful sensations in the face, behind the ear, & in the eye Facial spasms Increased lacrimation (tearing) Inability to close eyes Speech difficulty Occasional dysphagia Corticosteroid therapy (Prednisone) to reduce inflammation & edema; appears to diminish severity of disease, relieve the pain, & prevent or minimize denervation. Analgesic agents to control facial pain Electrical stimulation may be applied to the face to prevent muscle atrophy. Surgical decompression of the facial nerve Assess facial nerve function regularly. Maintain muscle tone of the face. Prevent or minimize denervation. Provide for pain relief with analgesics and local application of heat. Provide soft diet with supplementary feedings as indicated. Provide special eye care to protect the cornea. Provide support and reassurance. Administer medications as ordered.

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Parkinsons Disease is a slowly progressing neurologic movement disorder that eventually leads to disability. The cause of most cases is unknown, but research suggests several causative factors, including genetics, atherosclerosis, excessive accumulation of oxygen free radicals, viral infections, head trauma, chronic antipsychotic medication use & some environmental exposures. Tremor Bradykinesia Rigid muscles Impaired posture and balance Loss of automatic movements Speech changes Dementia Antiviral therapy: Amantadine hydrochloride (Symmetrel_ used in early Parkinsons tx to reduce 3 cardinal signs of Parkinsons disease. Antidepressants: Tricyclic antidepressants to alleviate the depression. Antihistamines Dopamine Agonists Anticholinergic Agents such as Trihexyphenidyl, Cycrimine, Procyclidine, Biperiden, & Benztropine Mesylate) effective in controlling tremor & rigidity. Antiparkinsoninan Medications: Levodopa (Dopar, Larodopa) the most effective agent & the mainstay of tx. Thalamotomy and Pallidotomy are effective in relieving many symptoms of Parkinsons disease; the procedure interrupt nerve pathways, thereby alleviating tremor or rigidity Neural Transplantation Deep Brain Stimulation Improve mobility by encouraging the patient to participate in daily exercise, such as walking, riding stationary bike, swimming, or gardening. Advise the patient to perform stretching and postural exercises as outlined by a physical therapist. Teach the patient walking techniques to offset parkinsonian shuffling gait and tendency to lean forward. Monitor drug treatment to note adverse reactions. Monitor the patients nutritional intake and check weight regularly. Monitor the patients ability to perform activities of daily living.

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Monoamine Oxidase Inhibitors (MAO INHIBITORS) Catechol-OMethyltransferase (COMT) Inhibitors

Encourage the patient to take warm baths and massage muscles to help relax muscles. Instruct the patient to rest often to avoid fatigue and frustration. Obtained a raised toilet seat to help the patient sit and stand. Teach the patient facial exercises and breathing methods to obtain appropriate pronunciation, volume, and intonation. Teach the patient about the medication regimen and adverse reaction.