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Neuropathies: Mrs. Keerthana.B Assistant Professor MSN, PSG Con
Neuropathies: Mrs. Keerthana.B Assistant Professor MSN, PSG Con
Mrs. KEERTHANA.B
ASSISTANT PROFESSOR
MSN, PSG CON
BELL’S PALSY
Inflammation
Pathophysiology
Edema
Ischemia
Demyelination of
Nerve
Gentle Massage
Exercises
Acyclovir
Paresthesia
Hypotonia
Areflexia
hypertension
Facial flushing
Diaphoresis
1. Plasmapheresis
2. IV administration high dose immunoglobulin
3. Corticosteroids
4. Airway Management (Ventilatory support)
NURSING MANAGEMENT
Assessment
Routine assessment
Monitor ascending paralysis
Assess respiratory function
Monitor ABG
Assess gag, swallowing and corneal reflexes
Monitor Blood pressure, cardiac rate and rhythm
Intervention
Airway Management (may need ventilatory support)
If fever develops, antibiotic therapy may be needed
Nutritional needs (Enteral / Parenteral)
Support and encouragement to patient and caregiver
TRIGEMINAL
NEURALGIA
DEFINITION
Trigeminal neuralgia is sudden, usually unilateral, severe, brief, stabbing, recurrent
episodes of pain in the distribution of the trigeminal nerve.
Epidemiology:
Age over 40
ETIOLOGY
RISK FACTORS:
◦ Multiple Sclerosis
◦ Hypertension
Other Causes:
◦ Herpesvirus infection
Neurologic assessment
◦ 6-18 months
Alternative therapies:
Microvascular decompression
◦ Characteristics
◦ Frequency
◦ Nutritional status
◦ Hygiene
◦ lifestyle
Nursing intervention
Pain management
Environmental management
Nutrition
Hygiene
Epidemiology:
Both gender
Men: 50 – 70 years
Etiology and Pathophysiology
Antibodies are proteins that attack foreign, harmful substance, attack the
neuromuscular junction (acetylcholine receptors)
Muscles involved: used for moving the eyes and eyelids, chewing, swallowing,
speaking, and breathing
Peek sign
Precipitating factors for MG
exacerbations
Emotional stress Aminoglycoside
Pregnancy Antibiotics
Menstruation Beta-adrenergic blockers
Trauma Procainamide
Illness
Quinidine
Temperature extremes
Phenytoin
Hypokalemia
Psychotropic drugs (Lithium carbonate, phenothiazines,
benzodiazepines, tricyclic antidepressants)
MYASTHENIA CRISIS
Drug therapy:
◦ Anticholinesterase drugs (enhancing neuromuscular junction)
◦ Immunosuppressants
◦ Thymectomy
Other therapies:
Plasmapheresis
IV Immunoglobulin G
NURSING MANAGEMENT
Assessment:
Fatigability
Severity
Coping Abilities
Vital signs
Saturation
ABG
PFT
Muscle strength
Nursing Diagnosis
Ineffective airway clearance related to intercostal muscle weakness and
impaired cough and gag reflex
Disturbed body image related to inability to maintain usual lifestyle and role
responsibilities.
Nursing Intervention
Maintaining adequate ventilation
Continuing drug therapy
Side effects
Myasthenia crisis and Cholinergic crisis
Easily chewed and swallowed foods (Semi solids)
Diversional activities
Education on complication
MULTIPLE
SCLEROSIS
Definition
Multiple Sclerosis (MS) is a chronic, progressive, degenerative disorder of the CNS
characterized by disseminated demyelination of nerve fibers of the brain and spinal cord.
Epidemiology:
Women are affected two to three times more often than men.
Precipitating factors:
Infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy and
poor state of health.
PATHOPHYSIOLOGY
Chronic inflammation, demyelination and gliosis in the CNS
The activated T cells in the systemic circulation migrate to the CNS, disrupting
the blood brain barrier
This is the initial event in the development of Multiple sclerosis
Initially attacks on the myelin sheaths of the neurons in the brain and spinal cord
results in damage to the myelin sheath
Clinical manifestations vary with each patient according to the CNS area involved
Patterns of Multiple Sclerosis
Category Characteristics
Relapsing-remitting Clearly defined relapses with full recovery or sequelae and residual deficit
on recovery
85%
Primary Progressive Slowly worsening neurologic function from the beginning with no distinct
relapses or remissions
10%
Secondary- A relapsing-remitting initial course, followed by progression with or
Progressive without occasional relapses, minor remissions and plateaus
50%
Progressive- Progressive disease from onset, with clear acute relapses, with or without
Relapsing full recovery. Periods between relapses are characterized by continuing
progression.
5%
Clinical Manifestation
Motor problems
Sensory Problems
Cerebellar Problems
Emotional Problems
Motor Problems
Diplopia
Scanning speech
MRI of the brain and spinal cord – plaques, inflammation, atrophy, tissue breakdown and destruction
Confirmatory factors:
1. Evidence of at least two inflammatory demyelinating lesions in at least two different locations within the CNS
◦ Bethanacol ◦ Diazepam
◦ Neostigmine ◦ Baclofen
◦ Dantrolene
Anticholinergics
◦ Tizanidine
◦ Propantheline
◦ Pain
◦ Medication
◦ Family history
◦ Nutritional history
◦ Elimination
◦ Activity exercise
◦ Cognitive perceptual
◦ Sexuality
◦ Coping stress tolerance
Nursing Diagnosis
Impaired physical mobility related to muscle weakness or paralysis and muscle
spasticity
Support to caregiver of MS