MS and Parkinson's Disease

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Multiple Sclerosis

-Chronic, progressive, degenerative disorder of the central nervous system (CNS)
-Characterized by disseminated demyelination of nerve fibres of the brain and spinal cord
-Disease usually affects young to middle-aged adults
• Onset is between 15 and 50 years of age
• Women are affected more than men

15 and 50 years of age, women

What is the onset of MS? who does it affect more men or women?

o Loss of myelin
o Disappearance of oligodendrocytes
o Proliferation of astrocytes

Disease process consists of:

Myelin, glial, slow down, blocked, permanent

-_____ can regenerate, and symptoms disappear, resulting in a remission
-Myelin can be replaced by _____ scar tissue
-Nerve impulses ____ ____ without myelin
- With destruction of axons, impulses are totally _______ which results in _______ loss of nerve function

o Motor problems
o Sensory problems
o Cerebellar problems
o Emotional problems

Multiple Sclerosis: Clinical Manifestations (signs and symptoms)
•Vague symptoms occur intermittently over months and years
•Disease may not be diagnosed until long after the onset of the first symptoms Which include:

o Relapsing-remitting
o Benign
o Primary-progressive
o Secondary-progressive
o Progression-relapsing

Clinical courses of MS are:

• Cerebral spinal fluid (CSF) analysis
o ↑ In oligoclonal immunoglobulin G
o Contains a higher number of lymphocytes and monocytes

Multiple Sclerosis: Diagnostic Studies
• Based primarily on history, clinical manifestations, and presence of multiple lesions over time measured by MRI
• Certain laboratory tests are used as adjuncts to clinical examination such as:

• Viral infections or vaccinations
• Residence in cold or temperate climates
• Physical and emotional stress
• Medications
• Elimination problems
• Weight loss, dysphagia
• Muscle weakness or fatigue, tingling or numbness, muscle spasms
• Blurred or lost vision, diplopia, vertigo, tinnitus
• Decreased libido, impotence
• Anger, depression, euphoria, isolation

What should you ask the client about their Health history?

o Objective data

These are all what kind of data collected by nurse for the client with MS:
 Apathy, inattentiveness
 Pressure ulcers
 Scanning speech
 Tremor
 Nystagmus
 Ataxia
 Spasticity
 Hyperreflexia
 ↓ hearing
 Muscular weakness
 Paresis
 Paralysis
 Foot dragging
 Dysarthria

o Impaired physical mobility
o Dressing/grooming self-care deficit
o Risk for impaired skin integrity
o Impaired urinary elimination pattern
o Sexual dysfunction
o Interrupted family processes

• Nursing Diagnosis of MS could include:

Nursing Implementation

These are all considered what in reference to MS
o Help client identify triggers and develop ways to avoid them or minimize their effects
o Reassure client during diagnostic phase
o Assist client in dealing with anxiety caused by diagnosis
o Prevent major complications of immobility
o Focus teaching on building general resistance to illness

Parkinson's Disease (PD)

-Disease of basal ganglia
-Diagnosis increases with age, with peak onset being in the sixth decade
-More common in men, ratio of 3:2

dopamine-producing, dopamine-acetylcholine, 80%

Parkinson's Disease: Etiology and Pathophysiology
•Pathological process of PD involves degeneration of ______ ______ neurons in substantia nigra of the midbrain
•Disrupts _______ _______ balance in basal ganglia
•Symptoms of the disease do not occur until __% of neurons in the substantia nigra are lost

Cerebellar manifestations
o Nystagmus
o Ataxia
o Dysarthria
o dysphagia
o Tremor
o Rigidity
o Bradykinesia
• Emotional manifestations
• Bowel and bladder functions may be impaired (Constipation, Spastic bladder:small capacity for urine results in incontinence, Flaccid bladder: large capacity for urine and no sensation to urinate)
• Progression may involve only one side of the body, initially
• Beginning stages may involve only mild tremor, slight limp, or ↓ arm swing
• Later stages may have shuffling, propulsive gait with arms flexed, and loss of postural reflexes

Parkinson's Disease: Clinical Manifestations (signs and symptoms) include:
•Onset is gradual and insidious

• Classic triad of PD
o Tremor
o Rigidity
o Bradykinesia

Tremor, Rigidity, Bradykinesia

•The Classic triad of PD are:
o Tremor
o Rigidity
o Bradykinesia

• Nonmotor symptoms
• As disease progresses, complications increase
• Dementia occurs in 40% of clients
• Dysphagia may result in malnutrition and aspiration
• General debilitation may lead to pneumonia, UTIs, and skin breakdown
• Orthostatic hypotension may occur
• Sleep disorders are common and potentially severe

Parkinson's Disease:Complications include:

o Depression, anxiety, apathy, fatigue, pain, constipation, impotence, short-term memory impairment

Nonmotor symptoms can include:

o Motor symptoms, weakness, akinesia, neurological problems, neuropsychiatric problems

As disease progresses, complications increase such as:

• No specific tests
• Based primarily on history, clinical manifestations...
• CSF analysis
o Increased in oligoclonal immuniglobulin
o Test for increase nerve conduction

Parkinson's Disease:Diagnostic Tests include:

Antiparkinsonian drugs, Levodopa with carbidopa (Sinemet), Coticosteroids: (Treat acute exacerbations by reducing edema and inflammation), Immnosuppresive therapy (Beneficial effects in client with progressive-relapsing)

Parkinson's Disease: Collaborative Care
• Drug therapy
Aimed at correcting imbalances of neurotransmitters within the CNS

o Health history (Past CNS damage, medications, Viral infections or vaccinations, Residence in cold temperate climates)
o Symptoms (Excessive salivation, dysphagia, constipation, incontinence, fatigue, sleep problems, diffuse pain, depression, mood swings, hallucinations)
*muscle weakness or fatigue
Blurred lost vision, diplopia, vertigo

Parkinson's Disease Nursing Management
• Nursing Assessment will include:

history and clinical features

What is the Diagnosis based solely on?

2

A Firm diagnosis can be made when at least __ of 3 characteristics of the classic triad (tremor, rigidity, and bradykinesia) are present

o Procedures aimed at relieving symptoms
o Used in clients who are usually unresponsive to drug therapy or have developed severe motor complications
o Ablation

Parkinson's Disease
• Some Surgical therapy include and are used when?:

o Megavitamin and diets consisting of low fat, gluten free food, and raw vegetables
o High protein..

Nutritional therapy for PD include:

o Relieve spasticity
o Increase coordination
o Train the client to substitute unaffected muscles for impaired ones

Physical therapy in PD clients is useful for:

• Nursing Diagnosis

These are all examples of what for PD?
o Impaired physical mobility
o Imbalanced nutrition: Less than body requirements
o Impaired verbal communication
o Deficient diversional activity

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