27 terms

MS and Parkinson's Disease

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
↓ hearing
Muscular weakness
Foot dragging
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?
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