NSG INCO 2

Medical-Surgical Nursing
NEUROLOGIC NURSING (DISORDERS)
MULTIPLE SCLEROSIS ASSESSMENT
o An autoimmune disorder that causes destruction of the 1. Fatigue and weakness
myelin sheath of nerve fibers in the CNS 2. A and V
o INCIDENCE: 20-40 years and consist of periods of 3. Tingling and Spasticity of the lower extremities
remissions and exacerbations 4. Paresthesia
o CAUSES: unknown, but the disease is thought to be the 5. Blurring of Vision, Diplopia, and TB
result of an immune response or viral infection 6. Nystagmus
o PRECIPITATING FACTORS 7. Decreased perception to pain, touch, and temperature
a. Pregnancy 8. Bladder and bowel disturbances, including urgency,
b. Fatigue frequency, retention
c. Stress 9. Hyperreflexia
d. Infection 10. Emotional changes: apathy/anxiety, I, depression
e. T 11. Memory changes and confusion
o Assessment of a lumbar puncture indicates an increased
INTERVENTIONS
IgG level
a. Provide energy conservation measures during
o CHARCOT’S TRIAD
exacerbation
a. Scanning Speech (repetition of the first syllable of
b. Protect the client from injury
each word)
c. Place and eye patch on the eye
b. Intention tremors
d. Promote regular elimination by bladder and bowel
c. Nystagmus
training
e. Instruct the client to balance moderate activity with rest
periods
f. Physical and speech therapy (to improve muscle strength,
avoid contractures, and relieve scanning of speech)
g. Instruct the client to avoid fatigue, stress, infection,
overheating, and chilling
h. Instruct the client to increase fluid intake and eat a
balanced diet, including low-fat, high fiber foods and foods
high in potassium (to prevent constipation)
i. Instruct the client in safety measures such as regulating the
temperature of bath water and avoiding heating pads.
AVOID HOT BATHS

PHARMACOTHERAPY
GLUCOCORTICOIDS
To relieve inflammation of damaged myelin sheath

a. Prednisone
b. Decadron (Dexamethasone)
c. Corticotropin

MUSCLE RELAXANT
To relieve muscle spasm

a. Lioresal (Baclofen)
b. Betaseron – an interferon that reduces spasticity

IMMUNOSUPPRESSANTS
To reduce relapse of MS

a. Imuran (Azathioprine)
b. Cytoxan (Cyclophosphamide)
A

Kolayn
Joanna Coline D. Montoya
 NSG INCO 2
Medical-Surgical Nursing
MYASTHENIA GRAVIS PHARMACOTHERAPY
o A defect or failure in the transmission of nerve impulses at 1. Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors
the myoneural junction a. Ambenonium chloride (Mytelase)
b. Neostigmine bromide (Prostigmine)
CAUSES:
c. Pyridostigmine (Mestion)
a. Insufficient secretion of 2. Glucocorticoids
acetylcholine  For anti-inflammatory effects
b. Autoimmune disorders 3. Antacids
 To prevent gastrointestinal upset due to
ASSESMENT glucocorticoids
1. Weakness and Fatigue – relieved by rest
2. Difficulty chewing and speaking NURSING INTERVENTIONS FOR ACETYLCHOLINESTERASE
3. Diplopia INHIBITORS
4. Ptosis a. Monitor improvement of muscle strength and respirations
5. Strabismus b. Observe the client for signs and symptoms of cholinergic
6. Weak and Hoarse voice crisis
7. Dysphagia c. Have readily available on antidote for cholinergic crisis
8. Diminished Breath Sounds d. Encourage the client to wear Medic-Alert bracelet
9. Respiratory paralysis and failure e. Instruct the client to take the medication before meals
10. Impaired Speech, Snarl Smile, Mask-like expression f. Observe and report possible side effects and adverse
reactions: nausea and vomiting, diarrhea, abdominal
EDROPHONIUM TEST cramps, increased salivation, tearing
o Diagnostic Test
o AKA TENSILON TEST SURGERY
o This test is performed by the neurologist to diagnose THYMECTOMY
o Surgical removal of the thymus gland
myasthenia gravis
o 25% of people with MG have been found to have
o Tensilon – short acting cholinergic administered per IV;
thymoma (tumor of the thymus gland)
2mg first, then 8 mg
o The surgery achieves remission for 5 to 10 years
o Positive Tensilon test is observed as improvement in
muscular strength 2 MAJOR COMPLICATIONS OF MG
o Muscle weakness returns in 3-5 minutes MYASTHENIC CRISIS
o ANTIDOTE: Atropine Sulfate (anticholinergic) o An acute exacerbation of the disease
o The test places the client at risk for o Causes: delayed or inadequate amount of medication,
infection, fatigue, or stress
NURSING INTERVENTIONS
a. Monitor respiratory status and ability to cough and deep ASSESSMENT:
breath adequately
b. Maintain suctioning and emergency equipment at the a. Increased pulse rate, respiratory rate, and blood pressure
bedside b. Dysarthria, a, cyanosis, severe respiratory distress
c. Monitor GAG REFLEX and swallowing abilities (To prevent c. Bowel and Bladder Incontinence
aspiration) d. Decreased Urine Output
d. Administer meds 20-30 minutes before meals (to improve e. Absent cough and swallow reflex
ability to swallow and prevent choking) f. Restlessness
e. Administer meds at EXACT TIME (to prevent myasthenic
INTERVENTIONS
crisis that results to respiratory distress)
f. Start meal with cold beverage (To contract muscles of the a. Increase dose of anticholinesterase medication, as
throat and improve ability to swallow) prescribed
g. Encourage the client to sit up when eating b. Mechanical Ventilation of respiratory paralysis is acute
h. Protect client from falls
i. Provide rest with alternating activity
j. Instruct the client to avoid stress, infection, fatigue, and
over-the-counter meds. (Infections may trigger
exacerbation of MG)
A

Kolayn
Joanna Coline D. Montoya
 NSG INCO 2
Medical-Surgical Nursing
CHOLINERGIC CRISIS
o Caused by excessive or overmedication with
anticholinesterase

ASSESSMENT

a. Weakness with difficulty of swallowing, chewing, speaking

and breathing
b. Abdominal cramps
c. Diarrhea
d. Nausea and vomiting
e. Increased salivation
CAUSES
f. Blurring of vision
a. Unknown
g. Hypotension
b. Viral Infection
h. Lacrimation, sweating
c. Encephalitis
NURSING INTERVENTION d. Carbon Monoxide Poisoning
e. Arteriosclerosis
a. Withhold anticholinesterase medication
b. Prepare to administer the antidote (atropine 1mg/IV) ASSESSMENT
c. Avoid the following medications (they potentiate muscle a. INITIAL SIGN:
weakness) b. Bradykinesia, Akinesia
 Muscle relaxants c. Shuffling, Festinating steps, stooped position, and
 Barbiturates propulsive gait
 Morphine Sulfate d. Monotonous speech
 Tranquilizers e. Handwriting that becomes progressively smaller
 Neomycin f. Tremors increasing when fatigued and decreasing with
purposeful activity or sleep
SURVIVAL GUIDE FOR MYASTHENIA GRAVIS g. Rigidity with jerky movements
a. Reschedule daily task (to prevent weakness) h. Restlessness and pacing
b. Frequent rest periods i. Blank facial expression; masklike faces
c. Have alarm clock to take medications on time (prevents j. Drooling
myasthenic crisis) k. Difficulty swallowing and speaking
d. Patch eye alternately for diplopia l. Loss of coordination and balance
e. Start meal with cold beverage (to contract muscles of the m. Moist and oily skin
throat and prevent aspiration) n. Emotional instability
f. Avoid factors that affect respiratory function and cause o. Fatigue
respiratory infection:
 Very cold and very hot beverages NURSING INTERVENTIONS
 Aerosol a. Assess neurological status
 Alcohol b. Assess ability to swallow and chew
 Cigarette smoke c. Provide calorie, protein, high fiber soft diet with small,
 Pesticide frequent feedings
d. Increase fluid intake to mL/day
PARKINSON’S DISEASE e. Thickened Liquid diet
o A degenerative disease caused by the depletion of f. Aspiration precautions – position while feeding
dopamine, resulting in a dysfunction of the extrapyramidal g. Instruct the client to wear low-heeled shoes
system
PHARMACOTHERAPY
ANTICHOLINERGICS
Reduce rigidity and some of the tremors

a. Artane (Trihexyphenidyl)
b. Cogentin (Benztropine)
c. Akineton (Biperiden)
A

Kolayn
Joanna Coline D. Montoya
 NSG INCO 2
Medical-Surgical Nursing
d. Kemadrin (Procyclidine)  Monoamine oxidase inhibitors (MAOI)
e. Parsidol (Ethopropazine) Marplan (Isocarboxacid)
f. Norflex (Orphenadrin) Parnate (Tranylcypromine)
Nardil (Phenelzine)
CONSIDERATIONS:
MAOIS enhance norepinephrine activity
a. Contraindicated in clients with glaucoma MAOIS + Carbidopa-Levodopa = Hypertensive
b. Assess client with chronic obstructive lung disease can crisis
develop thick mucus secretions  Aldomet (methydopa) – this potentiates effect of
Carbidopa-Levodopa
SIDE/ADVERSE EFFECTS
AVOID THE FOLLOWING FOODS WHEN ON CARBIDOPA-
a. Blurred vision LEVODOPA THERAPY:
b. Dryness of the nose, mouth, throat, and respiratory
secretions a. Vitamin B6-rich foods: block effects of Levodopa
c. Increased pulse rate, palpitations, and dysrhythmias  Tuna, pork, dried beans, salmon, beef liver
d. Constipation b. Tyramine-rich food: may cause hypertensive crisis
e. Urinary retention  Cheese cream, yogurt, coffee, chocolate,
f. Restlessness, confusion, depression, and hallucinations bananas, raisins, liver, pickled herring, sausage
g. Photophobia soy sauce, yeast, beer red wine, Italian green
beans
NURSING INTERVENTIONS
SIDE EFFECTS OF LEVODOPA
a. Monitor vital signs, Urinary output, and bowel sounds
b. Instruct to avoid alcohol, cigarette, caffeine and aspirin a. Nausea and vomiting
c. Instruct the client to increase fluid intake and increase b. Orthostatic Hypotension
intake and using ice chips, hard candy or gum c. Insomnia, Agitation
(anticholinergics decrease salivation) d. Mental Confusion
d. Instruct the client to increase fiber in the diet
DOPAMINE AGONISTS
e. Instruct the client to use sunglasses These medications act on the dopamine receptors and produce
f. Instruct to void before taking medications improvement in symptoms of Parkinsonism
g. Instruct the client to have routine eye examinations to
assess intraocular pressure a. Symmetrel (Amantadine HCl)
h. Do not discontinue meds abruptly b. Parlodel (Bromocriptine Mesylate)
c. Requip (Ropinirole HCl)
DOPAMINERGICS
Improves muscle flexibility NURSING INTERVENTION

a. Levodopa a. Advise the client to report signs of skin lesions, seizures or

 A precursor of dopamine can cross the blood- depression and lightheadedness when changing positions
brain barrier b. Avoid alcohol
b. Carbidopa with Levodopa (sinemet) c. Advise client not to abruptly stop the drug without
 Reduces destruction of levodopa at the notifying the health care provider
periphery

INTERVENTIONS

a. Monitor the client’s vital signs and ECG

b. Check for weakness, dizziness or syncope
c. Advise client to practice gradual change of position
d. Inform the client that urine may discolor and will darken
(reddish brown) with exposure to air. Perspiration may also
be discolored.
e. Advise client to avoid the following drugs:
 Phenothiazines, Reserpine, pyridoxine (Vit B6) –
block the effects of Levodopa
A

Kolayn
Joanna Coline D. Montoya