Neuromuscular

• Parkinson's Disease (PD)


  Progressive, neurodegenerative disease of the CNS

  
• Parkinson's Disease


  • Multiple proposed causative factors
  • Increased occurrence in males
  • 40-70 yrs. of age

  
• Pathophysiology of PD


  • Resting tremors
  • Muscle rigidity
  • Slowness of movement (bradykinesia)
  • Loss of movement (akinesia)
  • Postural instability
  • Mood changes
  • Cognitive variations
  • Behavioral fluctuations

  
• Medical Management of PD

  1. Diagnosis: ≥ two cardinal symptoms present

  2. Medications: Levodopa, Anticholinergics, Dopamine-receptor agonists
• Surgical Management of PD

  Deep brain stimulation (DBS): Electrode placement in the thalamus, Generator placement in the upper chest, Reduces increased neuronal activity
• Nursing Management of PD

  • Risk for falls: r/t ataxia, muscular rigidity & orthostatic hypotension
  • Imbalanced nutrition: r/t inability to ingest food
  • Risk for aspiration: r/t neuromuscular impairment
  • Impaired verbal communication: r/t dysarthria, tremor, & bradykinesia
  • Risk for constipation: r/t decreased mobility & medication side effects
  • Powerlessness: r/t diagnosis of a chronic & progressive disorder
• Multiple Sclerosis (MS)

  • Chronic neurological disorder
  • Autoimmune disease
  • Increased occurrence in females
  • 20-50 yrs. of age

  
• Types of MS


  • Relapsing-remitting
  • Secondary progressive
  • Progressive relapsing
  • Primary progressive
• Pathophysiology of MS


  • Myelin is a protective cover over the spinal cord and nerves, Aids the travel of nerve impulses
  • CNS contains a blood-brain barrier, Restricts movement of solutes from the blood stream
  • Demyelination is the loss of the myelin sheath, Begins with breakdown of blood-brain barrier, Permits T-lymphocytes to penetrate and attack the myelin
  • MS: the immune system attacks the brain and spinal cord

  
• Clinical Manifestations of MS

  • Numbness/weakness
  • Complete or partial loss of vision
  • Double or blurred vision
  • Fatigue
  • Dizziness
  • Tremor
  • Lack of coordination or balance
  • Speech problems—articulation
  • Memory loss
• Medical Management & Treatment of MS

  1. Diagnosis: difficult to diagnosis

  2. Medication management: Medications used to modify the course of the disease, Strategies used to treat attacks, Medications used to treat clinical manifestations, Medications used to treat additional symptomatology
• Nursing Management of MS


  • Assessment areas: Neuromuscular function, Vision/eye movement, Skin integrity, Ability to perform ADLs, Bowel and bladder function
  • Teaching: Take medications as prescribed, Signs and symptoms of exacerbations, Review disease process & prognosis
• Myasthenia Gravis (MG)


  • Acquired autoimmune neuromuscular junction disorder
  • Characterized by skeletal muscle weakness
  • Outpatient management
  • Varies from mild to severe
  • More common in men
  • 60-80 yrs. of age
  • Women: 20-30 yrs. of age
  • No known risk factors

  
• Pathophysiology of MG


  • Serotypes: Anti-AChR (80%), MuSK (10%), Seronegative MG (SNMG) (10%)
  • 70% have thymic hyperplasia
  • 10% have thymoma
• Clinical Manifestations of MG

  • Eye muscle weakness
  • Difficulty swallowing
  • Slurred speech
  • Chewing, talking, and swallowing become weaker
  • Affects muscle that control breathing and neck and limb movement

  
• Medical Management of MG

  1. Laboratory & Diagnostic Tests: Serological testing, Electromyography, Tensilon test, CT scans

  2. Medications: Pyridostigmine, Neostigmine, Immunotherapy
• Myasthenic Crisis


  • Cause: often infection
  • Symptoms: Respiratory failure, Tachycardia, Flaccid muscles, Pale, cool skin
  • Duration: 2 weeks
  • Treatment: Ventilatory support, IV immunoglobulin, Plasmapheresis
• Cholinergic Crisis


  • Cause: too much anticholinesterase
  • Symptoms: Bradycardia, small pupils, Fasciculations, Sweating and pallor, Excessive secretions
  • Differentiation: Tensilon test
  • Treatment: Discontinue anticholinesterase medications
• Amyotrophic Lateral Sclerosis (ALS)


  • 80% of cases begin between 40-70
  • Life expectancy between 2-5 yrs.
  • 5-10 % are familial
  • A-myo-trophic originates from the Greek language. "A" means no. "Myo" refers to muscle, and "Trophic" means nourishment – "No muscle nourishment."

  
• Pathophysiology of ALS


  • Degeneration of upper and lower motor neurons
  • Progressive loss of voluntary muscle contraction and functional capacity. Involves legs, feet, arms, hands, swallowing & breathing

  
• Tongue Fasciculation
• Medical Management of ALS

  1. No cure exists

  2. No therapy to prevent or reverse the course of the disease

  3. Riluzole may prolong survival

  4. Treatments are palliative & symptomatic

  5. Depression screening

  6. Gastrostomy feeding

  7. Tracheostomy & mechanical ventilation
• Nursing Management of ALS

  • Maintaining respiration
  • Optimizing mobility
  • Meeting nutritional requirements
  • Minimizing fatigue
  • Maintaining social interaction
  • Preventing aspiration and infection
  • Community and home care considerations
  • Patient education and health maintenance