DNM

• Which disorders affect both motor and sensory nerves?

  Parkinson's, Multiple Sclerosis and Guillain-Barre
• Which disorders affect just motor nerves?

  ALS and Myasthenia gravis
• What are the primary symptoms of Parkinson's disease?

  T - Tremors 

   

  R – Rigidity of muscles 

   

  A - Akinesia/Bradykinesia   

   

  P – Postural instability  
• Which conditions do exacerbations and crisis occur?

  Parkinson's, Multiple Sclerosis and Myasthenia Gravis
• What are the primary symptoms of multiple sclerosis?

  • mental status changes: attention deficit, memory loss
  • patchy blindness
  • physical and mental fatigue
  • Muscle weakness
  • paraesthesia
  • bladder/bowel dysfunction
  • loss of balance
  • muscle tremors
• What are symptoms of ALS?

  Spinal Sx

  • limb weakness
  • muscle twitching/spasicity
  • ASSYMETRIC muscle weakness progressing to paralysis
  • Respiratory muscle weakness

  Bulbar Sx:

  • dysarthria
  • dysphagia
  • atrophy of tongue
• What are symptoms of myasthenia gravis?

  Bulbar Sx:

  • dysarthria
  • dysphagia
  • limited facial expressions

  Other Sx:

  • dilopia
  • drooping of eyelids (ptosis)
  • weakness in extremities
  • weakness in chest muscles
• What are the symptoms of Guillain Barre syndrome?

  • symmetrical muscle weakness
  • can affect respiratory
  • paresthesia
  • neuropath
  • CNS facial/vagus nerve affected
• What are the priority nursing diagnoses for Parkinson's disease?

  Falls Prevention, altered nutrition, risk for aspiration, communication
• What is plasmapheresis?


  separation of plasma from blood cells; cells returned to body, plasma is discarded
• Which of the DNM conditions can use plasmapheresis as a form of treatment?

  Guillain-Barré syndrome, Multiple sclerosis, myasthenia gravis
• What are the major adverse effects of plasmapheresis?

  hypovolemia, hypokalemia, hypocalcemia
• How often is plasmapheresis done?

  done daily and tapered to monthly
• What are some primary nursing actions for the care of a client undergoing plasmapheresis?

  • hold meds until after the procedure
  • Monitor for hypotension = freq VS
  • Assess for bleeding
  • Monitor signs of electrolyte imbalance
• How does electrolyte imbalance occur during the treatment of plasmapheresis?

  • Electrolytes become diluted w/ replacement fluid  
  • Hypocalcemia d/t citrate used during procedure that binds w/ CA 
  • Monitor for numbness, tingling, muscle cramps, arrhythmias  
  • Urticaria also observed  
• What two medications are used in multiple sclerosis?

  Glatiramer (Copaxone), Fingolimid
• What are the medications used for myasthenia gravis?

  Acetylcholinesterase inhibitors, immunosuppressants, corticosteroids.
• What is Pyridostigmine ?

  • A: acetylcholinesterase inhibitor – prevents cholinesterase from inactivating acetylcholine  
  • S: GI Sx [cramps, diarrhea], drooling, bradycardia, muscle twitching 
• What are some nursing care and teaching to be given with a client on Pyridostigmine?

  • Given PO, IV, IM, SQ; dose varies according to pt need 
  • Administer meds 1 hr AC (30min onset so that muscle strength to eat and decrease aspiration risk & inc absorption of food  
  • Hold med for HR < 60 
  • Monitor respiratory status  
  • Encourage pt to keep symptom diary  
  • Does w/ caution in those w/ asthma d/t bronchoconstriction 
  • Atropine = antidote  
• What is Edrophonium (Tensilon)?

  • P: increase available Ach at myoneural junction by preventing breakdown; used a dx test for MG 
  • A: acetylcholinesterase inhibitor  
  • S: bronchospasm, arrhythmias, sweating, cramping  
• What are some nursing care considerations for the administration of edrophonium (tensilon)?


  • Administer 2 mg of edrophonium IV; if no adverse rx give the remaining 8 mg within 5 min
  • If there is improved muscle strength lasting ~ 10 min, the test is positive to MG 
  • Pt on cardiac monitor & emergency airway equipment available 
  • Airway @ risk d/t respiratory muscle weakness
  • Monitor d/t bradycardia/asystole/VF
  • Have deliberator/pacer available 
• What is the primary tx med for Parkinson's?

  Levodopa/carbidopa 
• What is levodopa and cardipoda?

  Levodopa: medication for Parkinson's disease. Carbidopa: medication used with levodopa to treat Parkinson's disease.

  • P: primary tx for PD 
  • A: metabolic precursor of dopamine combined with carbidopa to cross BBB to restore dopamine lvls in the brain  
  • S: dyskinesias [abnormal involuntary movement ~ head bobbing, lip-smacking/grimacing], orthostatic hypotension, arrhythmias, N/V, constipation; many food & drug interactions  
• What are some nursing care considerations for the patient on levodopa/carbidopa?

  • Safety precautions ~ unsteady gait w/ orthostasis increases fall risk; contraindicated in glaucoma 
  • Observe for sudden loss of effectiveness 
  • Medication teaching 
  • Take on time; don’t skip or stop suddenly or will have a PD crisis 
  • Has short half-life 
  • If NPO will see worsening of PD Sx w/in 24H 
  • Need low protein diet 
  • Many drug-drug interactions
• What are common triggers for myasthenia crisis?

  infection, stress, temperature extremes, medications 
• What are symptoms of a myasthenic crisis?

  respiratory distress, difficulty swallowing, muscle weakness  
• What are the treatments for myasthenic crisis?

  Plasmapheresis and IV immunglobulin daily x5
• How does IV immunoglobulin work compared to plasmapheresis?

  • IV immunoglobulin daily x 5 days  
  • Slower to work but quicker and easier than plasmapheresis  
  • P: suppresses T cell function 
  • S: same as transfusion rxn  
• What does a cholinergic crisis in myasthenia gravis mean?

  Cholinergic Crisis (med overdose) 

  • Sx: respiratory distress, drooling, muscle twitching, GI Sx [cramping, diarrhea], bradycardia  
  • Sx occur 30 – 60 min after taking meds 
  • Antidote is atropine 
• What are your priority nursing problems for parkinson's disease?

  Falls prevention, Altered Nutrition, Communication, Aspiration Risk
• What is your main focus for interventions for ALS?

  maintaining quality of life
• What do all of the degenerative neuromuscular diseases have in common?

  muscle weakness, risk for aspiration, no cure, and progressive