NEURO
DEGENERATIVE DISORDERS
1. Neurotransmitters – required to conduct neuro impulses = movement
a. Acetylcholine
↓ Myasthenia Gravis
b. Dopamine
↓ Parkinson’s Disease
ACTH and Dopamine are inversely related to each other
2. Myelin Sheath damage/Demyelination
• Pathway of the neurons for conduction
a. Multiple Sclerosis – demyelination of the CNS
not capable of regeneration = IRREVERSIBLE
b. Guillain-Barre syndrome – demyelination of the PNS
capable of regeneration by Schwann cells = REVERSIBLE
MYASTHENIA GRAVIS PARKINSON’S DISEASE
↓ ACTH levels = motor problems ↓ Dopamine levels = movement disorder
WHY: autoimmune damage to ACTH WHY: ↓ production due to damage to
receptors substania nigra
Females Males
Autoimmune DO, IRREVERSIBLE DAMAGE Autoimmune DO, IRREVERSIBLE DAMAGE
Clinical Symptoms: Clinical Symptoms:
• Ptosis (incomplete closing of eyelids) • Bradykinesia (slow movement) =
➢ risk for dryness = artificial tears progress to akinesia
➢ risk for injury = glasses • Resting tremors = fidget spinner,
• Descending paralysis coins, stress ball
➢ MG (Mouth to Ground) paralysis ➢ Cogwheel rigidity, shuffling gait,
• FOCUS: Respiratory Failure stooped posture
➢ Mask-like face (flat affect)
• FOCUS: Safety
MYASTHENIA GRAVIS
• WHAT: autoimmune damage to ACTH receptors -- ↓ ACTH availability =
movement disorders
• WHY: Autoimmune – Idiopathic
• BEST TEST: Tensilon/Edrophonium Chloride Test
o Edrophonium Chloride – short-acting anticholinesterase = increase ACTH
availability
o Cholinesterase – autoimmune responses that destroy ACTH receptors
RESULTS:
a. If there is brief ↑ in muscle strength = POSITIVE MG
b. Further weakness = CHOLINERGIC CRISIS (overmedication of
cholinesterase)
• Clinical Symptoms:
o Difficulty speaking and swallowing
▪ Aspiration precautions = thick fluids
▪ Do not rush patient when eating
▪ Avoid distraction during eating
▪ Small frequent feeding
▪ Suctioning equipment at bedside
o Ptosis and Diplopia (double vision) = strains the eye
Diplopia
▪ Patch one eye every 2 hours
o Descending Paralysis
MANAGEMENT:
1. Monitor respiratory status and ability to cough and deep breathe
2. Suctioning and emergency equipment at bedside
3. Monitor VS – to determine early symptoms of respiratory arrest
4. Aspiration Precautions
5. Assess gag reflex and swallowing – speech therapist > occupational therapist (fine
motor movement)
6. Schedule in the AM (more ACTH availability in the morning)
7. When to feed client? At the peak effect of the anticholinesterase
8. MOST IMPORTANT: Medication Adherence (dose and timing of drug) (long-acting
anticholinesterase: neostigmine, pyridostigmine)
a. OVERDOSE OF THE DRUG = CHOLINERGIC CIRIS
b. UNDERDOSE OF THE DRUG = MYASTHENIC CRISIS
ANTICHOLINERGIC (SYMPATHETIC) CHOLINERGIC (PARASYMPATHETIC)
• Fight-or-flight response – DANGER • Rest or Digest – AFTER DANGER
RESOLUTION
• INC HR, RR, BP, INC GLUCOSE, INC • DEC HR, RR, BP
MUSCLE STRENGTH
• DEC GIT – dry mouth, constipation • INC GIT – salivating, diarrhea
• DEC GUT – bladder distention • INC GUT – urination
MYASTHENIC CRISIS CHOLINERGIC CRISIS
UNDERmedication, stress, infection, OVERmedication
sickness
Sympathetic symptoms: Parasympathetic symptoms:
• INC HR, RR, BP, bladder distention, • DEC HR, RR, BP, urination, diarrhea,
constipation, dry mouth, weak cough salivation (risk for aspiration) =
reflexes, weak swallowing = respiratory respiratory failure
failure
Management: Give Medication Management: HOLD Medication
Anticholinesterase (-stigmine) ANTIDOTE: ANTICHOLINERGIC =
ATROPINE SULPHATE
PARKINSON’S DISEASE
• WHAT: decrease dopamine levels
• WHY: decrease production related to damage to substantia nigra
• Irreversible, usually starts after 50 years old, gradual degeneration
• Clinical Symptoms:
o Bradykinesia – akinesia
o Pill rolling tremors, cogwheel rigidity
o Shuffling gait, stooped posture
Risk for injury 3Ws
Walk upright
Walker
Wide based gait
o Difficulty swallowing, diaphragm involvement
MANAGEMENT:
1. Assess neurologic status
2. Assess gag and swallowing
3. Pill rolling tremors = give activity
4. 3Ws of management for gait and posture
5. DONT rush patient
6. Promote independence
7. Diet: INC fluid intake to prevent constipation
High caloric, High protein (more energy)
8. Aspiration Precautions
9. Anticholinergic drugs (Kemadrin, Akineton, Benadryl, Artane, Cogentin)
Effect: DEC ACTH LEVELS = INC DOPAMINE
ACTH and Dopamine are inversely related to each other
S/E: sympathetic responses
10. BEST DRUG: Dopaminergic (Levodopa, Carbidopa)
Effect: INC Dopamine
WOF: Orthostatic Hypotension (low BP with respect to rapid change in position)
S/E: lethargy, excessive daytime sleepiness, priapism (prolonged and painful
erection), Psychosis, confusion, vomiting
MULTIPLE SCLEROSIS GUILLAIN BARRE SYNDROME
• Demyelination of the CNS – • Demyelination of the PNS -
IRREVERSIBLE REVERSIBLE
• Females > males • Males > female
Risk Factor: Risk Factor:
• Autoimmune, Idiopathic • History of viral respiratory or GIT
infection
Clinical symptoms: Clinical symptoms:
• CHARCOT’S TRIAD • Ascending paralysis
S – Scanning/Staccato speech ➢ GBS = Ground to Brain paralysis
I – Intentional tremors ➢ Early sx: paresthesia at legs
N – Nystagmus FOCUS: Diaphragm failure
• Diplopia Respiratory Failure
FOCUS OF CARE: Respiratory failure
MULTIPLE SCLEROSIS
• WHAT: chronic, progressive, degenerative disorder, demyelination of the CNS --
IRREVERSIBLE
• WHY: common to 20-40 years old, autoimmune, idiopathic
• Precipitating factors = worsens MS Sx – STIFF
Stress
Temperature extremes – hot/cold
Infection
Fatigue, trauma
Fregnancy
• Clinical Symptoms:
o CHARCOT’S TRIAD
S – Scanning/Staccato speech
I – Intentional tremors
N – Nystagmus
MANAGEMENT:
1. Promote rest = schedule/space nursing activities – prevent fatigue
2. Promote safety (tinnitus and vertigo) = assistive device
3. Diplopia = patch one eye every 2 hours
4. Bowel and bladder training
5. Promote independence
6. FOCUS: Respiratory Failure
7. BEST DRUG: IMMUNOSUPPRESSANTS – steroids, azathioprine, cyclosporine
➢ It can also be given post-transplant
➢ S/E: risk for infection
o Handwashing
o Avoid crowded places
o Limit visitors
o Avoid fresh/raw foods
o Monitor for fever
o Sterile technique
o Positive pressure room
GUILLAIN BARRE SYNDROME
• WHAT: acute infectious neuritis
• WHY: triggered by viral/respiratory GIT infection
• FOCUS: Respiratory Failure = mechanical ventilation and intubation tray at
bedside
• Early symptom: paresthesia/weakness at lower extremities = ascending
paralysis
MANAGEMENT: symptomatic treatment (viral infection = self-limiting)
1. Monitor and maintain respiratory status
2. Prevent complication of immobility – bed sores, DVT, muscle atrophy, muscle
contractures (functional position to prevent contractures: extension), constipation,
decrease bone density/osteoporosis – high risk for fractures, atelectasis//alveolar
collapse, stasis of secretions = PNEUMONIA
