DEMYELINATING DISEASES

Nurse Licensure Examination

Review
MULTIPLE SCLEROSIS
 An auto-immune mediated
progressive demyelinating
disease of the CNS
 The myelin sheath is destroyed
and replaced by sclerotic
tissue (sclerosis)
MULTIPLE SCLEROSIS
 CAUSE- unknown
 Multiple factors- viral infection,
environmental factors,geographic
location and genetic
predisposition

 Common in WOMEN ages 20-40

MULTIPLE SCLEROSIS
PATHOPHYSIOLOGY
 Sensitized T cells will enter the

brain and promote antibody

production that damages the
myelin sheath
 Plaques of sclerotic tissues appear

on the demyelinated axons

interrupting the neuronal
transmission
MULTIPLE SCLEROSIS
PATHOPHYSIOLOGY
 The most common areas affected

are
 Optic nerves and chiasm
 Cerebrum
 Cerebellum
 Spinal cord
MULTIPLE SCLEROSIS
CLINICAL MANIFESTATIONS
 1. visual problems such as

diplopia, blurred vision and

nystagmus
 2. motor dysfunction

 3. Fatigue

 4. Mental changes like mood

swings, depression
 5. spasticity
MULTIPLE SCLEROSIS
 DIAGNOSTIC TESTS
 1. MRI- primary diagnostic study
 2. CSF Immunoglobulin G
MULTIPLE SCLEROSIS
NURSING INTERVENTIONS
1. Promote physical mobility
 Exercise

 Schedule activity and rest periods

 Warm packs over the spastic area

 Swimming and cycling are very

useful
MULTIPLE SCLEROSIS
NURSING INTERVENTIONS
2. Prevent injuries
 Wide stance walking

 Use of walking aids

 Wheelchair
MULTIPLE SCLEROSIS
3. Enhance bladder and bowel
control
 Set a voiding schedule

 Intermittent bladder

catheterization
 Use of condom catheter

 Adequate fluids, dietary fibers and

bowel training program

MULTIPLE SCLEROSIS
4. Manage speech and
swallowing difficulties
 Careful feeding, proper positioning,

suction machine availability

 Speech therapist
MULTIPLE SCLEROSIS
5. Improve Sensory and
Cognitive function
 Vision- use eye patch for diplopia

 Obtain large printed reading

materials
 Offer emotional support

 Involve the family in the care

MULTIPLE SCLEROSIS
6. Strengthen coping mechanism
 Alleviate the stress

 Referral to the appropriate

agencies
MULTIPLE SCLEROSIS
7. improve self-care abilities
 Modify activities according to

physical strength
 Provide assistive devices
MULTIPLE SCLEROSIS
8. promote sexual functioning
 Refer to sexual counselor
MULTIPLE SCLEROSIS
MEDICAL MANAGEMENT
Pharmacotherapy
 Interferons
 Immunomodulators
 Corticosteroids
 BACLOFEN for muscle spasms
 NSAIDS for pain
Guillian-Barre’ Syndrome
 An auto-immune attack of the
peripheral nerve myelin
 Acute, rapid segmental
demyelination of peripheral
nerves and some cranial
nerves
Guillian-Barre’ Syndrome
 CAUSE: post-infectious
polyneuritis of unknown origin
commonly follows viral
infection
Guillian-Barre’ Syndrome
 PATHOPHYSIOLOGY
 Cell-mediated imune attack to
the myelin sheath of the
peripheral nerves
 Infectious agent may elicit
antibody production that can also
destroy the myelin sheath
Guillian-Barre’ Syndrome
CLINICAL MANIFESTATIONS
 1. Ascending weakness and

paralysis
 2. diminished reflexes of the lower

extremities
 3. paresthesia

 4. potential respiratory failure

Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
2. Maintain respiratory function
 Chest physiotherapy and
incentive spirometry
 Mechanical vetnilator
Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
 2. Enhance physical mobility

 Support paralyzed extremities

 Provide passive range of motion
exercise
 Prevent DVT and pulmonary
embolism
 Padding over bony prominences
Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
 3. Provide adequate nutrition

 IVF
 Parenteral nutrition
 Assess frequently return o gag refelx
Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
 4. Improve communication

 Use other means of communication

Guillian-Barre’ Syndrome
NURSING INTERVENTIONS
 5. Decrease fear and anxiety

 Provide Referrals
 Answer questions
 Provide diversional activities
 6. Monitor and manage
complications
 DVT, Urinary retention, pulmonary
embolism, respiratory failure
Guillian-Barre’ Syndrome
MEDICAL MANAGEMENT
 ICU admission

 Mechanical Ventilation

 TPN and IVF

 PLASMAPHERESIS

 IV IMMUNOGLOBULIN
ALZHEIMER’S disease
 A progressive neurologic
disorder that affects the brain
resulting in cognitive
impairments
ALZHEIMER’S disease
CAUSES:
 Unknown

 Potential factors- Amyloid

plaques in the brain, Oxidative

stress, neurochemical
deficiencies
ALZHEIMER’S disease
 CLINCAL MANIFESTATIONS
 1. Forgetfulness
 2. Recent memory loss
 3. Difficulty learning
 4. Deterioration in personal
hygiene
 5. Inability to concentrate
ALZHEIMER’S disease
 LATE CLINICAL MANIFESTATIONS
 6. Difficulty in abstract thinking
 7. Difficulty communicating
 8. Severe deterioration in memory,
language and motor function
 9. repetitive action- perseveration
 10. personality changes
ALZHEIMER’S disease
DIAGNOSTIC TEST
 Neurologic examination

 PET scan

 EEG, CT and MRI

 Other tests to rule out Vit B

deficiencies and hypothyroidism

 Autopsy is the most definitive
ALZHEIMER’S disease
Drug therapy
 1. drugs to treat behavioral

symptoms- antipsychotics
 2. anxiolytics

 3. Donepezil

 4. Tacrine
ALZHEIMER’S disease
Nursing Interventions
 1. Support patient’s abilities

 2. Provide emotional support

 ALZHEIMER’S disease
Nursing Interventions
3. Establish an effective communication
system with the patient and family
 Use short simple sentences, words

and gestures
 Maintain a calm and consistent

approach
 Attempt to analyze behavior for

meaning
 ALZHEIMER’S disease
4. protect the patient from injury
 Provide a safe and structured

environment
 Requests a family member to

accompany client if he wanders

around
 Keep bed in low position

 Provide adequate lightning

 Assign consistent caregivers

ALZHEIMER’S disease
5. Encourage exercise to maintain
mobility
PARKINSON’s Disease
 A slowly progressing
neurologic movement disorder
 The degenerative idiopathic
form is the most common form
PARKINSON’s Disease
CAUSATIVE FACTORS: unknown
 Potential factors: genetics,

atherosclerosis, free radical

stress, viral infection, head
trauma and environmental
factors
PARKINSON’s Disease
Pathophysiology
 Decreased levels of dopamine due

to destruction of pigmented
neuronal cells in the substantia
nigra in the basal ganglia
 Clinical symptoms do not appear

until 60% of the neurons have

disappeared
PARKINSON’s Disease
CLINICAL MANIFESTATIONS
 1. Tremor- resting, pill-rolling

 2. Rigidity- cog-wheel, lead-pipe

 3. Bradykinesia- abnormally slow

movement
 4. Dementia, depression, sleep

disturbances and hallucinations

 5. excessive sweating, paroxysmal

flushing, orthostatic hypotension

PARKINSON’s Disease
Medical management
 1. Anti-parkinsonian drugs-

Levodopa, Carbidopa
 2. Anti-cholinergic therapy

 3. Antiviral therapy- Amantadine

 4. Dopamine Agonists-

bromocriptine and Pergolide,

Ropirinole anmd Pramipexole
PARKINSON’s Disease
 Medical management
 5. MAOI
 6. Anti-depressants
 7. Antihistamine
PARKINSON’s Disease
 NURSING INTERVENTIONS
 1. Improve mobility
 2. Enhance Self- care activities
 3. Improve bowel elimination
 4. Improve nutrition
 5. Enhance swallowing
 6. Encourage the use of assistive
devices
PARKINSON’s Disease
 NURSING INTERVENTIONS
 7. improve communication
 8. Support coping abilities
EPILEPSY
 A group of syndromes characterized by
recurring seizures
CAUSES
1. idiopathic 6. brain tumors
2. Birth trauma 7. head Injury
3. perinatal infection 8. metabolic
disorders
4. infectious disease 9. CVA
5. ingestion of toxins
EPILEPSY
 Recurring seizures may be
classified as GENERALIZED or
PARTIAL SEIZURES
 Generalized Seizures- cause a
generalized electrical abnormality
within the brain
 Partial seizures- these seizures
arise from a localized part of the
brain and cause specific symptoms
GENERALIZED SEIZURES
 1. General Tonic-Clonic seizure-
(Grand mal) characterized by loss
of consciousness and alternating
movements of the extremities
 2. Absence Seizure (Petit mal)-
common in children, begins with a
brief change in the LOC, indicated
by blinking, rolling of eyes and
blank stares
GENERALIZED SEIZURES
 3. Myoclonic seizure- characterized
by brief, involuntary muscular jerks
of body extremities
 4. Akinetic seizure- general loss of
postural tone and a temporary loss
of consciousness- a drop attack
PARTIAL SEIZURES
 1. Simple partial seizure- typically
limited to one cerebral hemisphere
 2. Complex partial seizure- begins
with an aura, then with impaired
consciousness, with purposeless
behaviors like lip-smacking,
chewing movements
Epilepsy
 DIAGNOSTIC TESTS
 1. EEG
 2. CT
 3. MRI
 4. LP
 5. Angiography
Epilepsy
 Medical treatment
 1. Anticonvulsants- most
commonly phenytoin,
phenobarbital and carbamazepine
 Ethosuximide and valproic acid for
absence seizure
 2. surgery
Epilepsy
 Nursing Intervention
 1. Care of patients during seizure
 2. care of patients after seizures
 3. patient teaching
BELL’S PALSY
 Causes
 1. infection
 2. hemorrhage
 3. tumor
 4. local traumatic injury
BELL’S PALSY
 MANIFESTATIONS
 1. Unilateral facial weakness
 2. Mouth drooping
 3. Distorted taste perception
 4. Smooth forehead
 5. Inability to close eyelid on the affected side
 6. Incomplete eye closure
 7. excessive tearing when attempting to close
the eyes
 8. Inability to raise eyebrows, puff out the
cheek
BELL’S palsy
 Diagnostic tests
 EMG
 Medical management
 1. Prednisone
 2. Artificial tears
BELL’S palsy
 Nursing Interventions
 1. Apply moist heat to reduce pain
 2. Massage the face to maintain
muscle tone
 3. Give frequent mouth care
 4. protect the eye with an eye
patch. Eyelid can be taped at night
 5. instruct to chew on unaffected
side
Trigeminal neuralgia
 Also called Tic Douloureux
 Painful disorder that affects one or
more branches of the fifth cranial
nerve

 CAUSES: repetitive pulsation of an

artery as it exits the pons is the
usual cause
Trigeminal neuralgia
 ASSESSMENT
 1. Pain history
 2. Searing or burning jabs of pain
lasting from 1-15 minutes in an
area innervated by the trigeminal
nerve
 DIAGNOSTIC TESTS
Skull x-ray or CT scan
Trigeminal neuralgia
 NURSING INTERVENTIONS
 1. provide emotional support
 2. encourage to express feelings
 3. provide adequate nutrition in
small frequent meals at room
temperature
Myasthenia gravis
 A sporadic, but progressive
weakness and abnormal
fatigability of striated muscles
which are exacerbated by
exercise and repetitive
movements
Myasthenia gravis
ETIOLOGY
 Autoimmune disease

 Thymoma

Women suffer at an earlier age and

are more affected
Myasthenia gravis
Pathophysiology:
 1. Acetylcholine receptor

antibodies interfere with impulse

transmission
 2. Follows an unpredictable course

of periodic exacerbations and

remissions
Myasthenia gravis
 CAUSE: autoimmune disorder that
impairs transmission of nerve impulses
ASSESSMENT FINDINGS
 Gradually progressive skeletal muscle
weakness and fatigue
 Weakness that worsens during the day
 Ptosis, diplopia and weak eye
closure
 Blank, mask-like facies
 Difficulty chewing and swallowing
 Respiratory difficulty
Myasthenia gravis
DIAGNOSTIC TESTS
 1. EMG

 2. TENSILON TEST

 3. CT scan

 4. Serum anti-AchReceptor

antibodies
Myasthenia gravis
MEDICAL THERAPY
 Anticholinesterase drugs-

pyridostigmine and
neostigmine
 Corticosteroids

 Immunosuppresants

 Plasmapheresis

 Thymectomy
Myasthenia gravis
NURSING INTERVENTIONS
 1. Administer prescribed medication as

scheduled
 2. Prevent problems with chewing and

swallowing
 3. Promote respiratory function

 4. Encourage adjustments in lifestyle to

prevent fatigue
 5.maximize functional abilities
Myasthenia gravis
 6. Prepare for complications like
myasthenic crisis and cholinergic
crisis
 7. prevent problems associated
with impaired vision resulting from
ptosis of eyelids
 8. provide client teaching
 9. promote client and family
coping
Meningitis
 Infection or inflammation of the
meninges covering the brain and
spinal cord.
 Caused by bacterial, viral and
fungal agents
Brain Abscess
 A free or encapsulated collection of
pus in the brain parenchyma
 Causes: usually secondary to
another infection like- sinusitis,
meningitis, dental abscess,
mastoiditis, bacteremia and
trauma
Encephalitis
 Intense inflammation of the brain
tisssue with lymphocytic
infiltration, cerebral edema,
degeneration of brain cells and
diffuse nerve cell destruction
CNS infections
 ASSESSMENT FINDINGS
 Meningitis
 1. fever, headache, vomiting
 2. positive meningeal sings
 Brain abscess
 1. headache, N/V, seizures, changes in
LOC
 2. Focal neurologic deficits
CNS infections
 DIAGNOSTIC TESTS
 1. CT scan
 2. MRI
 3. EEG
 MEDICAL TREAMENT
 1. Antibiotics
 2. Surgical drainage
 3. Drugs to reduce increased ICP
CNS infections
 NURSING INTERVENTIONS
 1. Frequent monitoring of
neurologic status
 2. Monitor intake and output
 3. Administer antibiotics
 4. Administer mild laxative to
prevent constipation
 5. maintain quiet environment
Neoplastic diseases
 A brain tumor is a localized
intracranial lesion that occupies
space within the skull
 Primary brain tumors originate
from cells and structures within the
brain.
Neoplastic disease
 The cause of brain tumors is
unknown
 The only risk factor accepted is
radiation exposure to ionization
rays
Neoplastic disease
 CLINICAL MANIFESTATIONS
 1. increased ICP
 Vomiting
 Headache. Especially early in the
morning
 Vomiting
 Visual disturbances
Neoplastic disease
 2. Localized symptoms
 Hemiparesis
 Seizures
 Mental status changes
Neoplastic disease
 DIAGNOSTIC TESTS
 1. CT scan
 2. MRI
 3. PET
 4. EEG
Neoplastic disease
 MEDICAL MANAGEMENT
 Surgery
 Chemotherapy
 Radiotherapy
Neoplastic disease
 NURSING INTERVENTIONS
 1. promote self-care independence
 2. improve nutrition
 3. relieve anxiety
 4. enhance family processes
 5. provide pre-operative and post-
operative care
 6. manage pain