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NEUROLOGIC DISORDERS. Myasthenia Gravis Parkinsons Disease Multiple Sclerosis Amyotrophic Lateral Schlerosis Spinal Cord Injury Intervertebral Disc Herniation Cranial Nerve Problems 2009. Myasthenia Gravis. DEFINITION. problem in neurotransmission

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neurologic disorders

NEUROLOGIC DISORDERS

Myasthenia Gravis

Parkinsons Disease

Multiple Sclerosis

Amyotrophic Lateral Schlerosis

Spinal Cord Injury

Intervertebral Disc Herniation

Cranial Nerve Problems

2009

definition
DEFINITION
  • problem in neurotransmission
  • severe fatigue of voluntary muscles
  • defect of acetylcholine receptor sites
    • at the myoneuronal junction
  • theories indicate autoimmune problem
  • Remissions/exacerbations
  • Progressive proximal muscle weakness

improving with rest

clinical manifestations
CLINICAL MANIFESTATIONS
  • Patients indicate abnormal fatigue of the voluntary muscles of the eye, the respiratory tract and the limb muscles
  • Also have difficulty with speech and swallowing
  • End up choking with meals
  • Ptosis, diplopia, dysphagia
  • MOST ADVANCED: all muscles weakened: no respiratory function, no bladder and bowel function
diagnostic tests
DIAGNOSTIC TESTS
  • Tensilon test:
    • give patient a short acting anticholinesterase (Tensilon or edrophonium chloride) that enhances neurotransmission and results in abrupt, but short term improvement of symptoms
      • Atropine : antidote for Tensilon
  • EMG: electromyography:
laboratory assessment
LABORATORY ASSESSMENT
  • THYROID FUNCTION STUDIES DONE: thyrotoxicosis seen with MG
  • Serum protein electrophoresis: for immunologic disorders
  • Acetylcholine receptor antibodies (AChR): important diagnositic criterion 80-90% of clients with MG have elevated AChR
  • Often have thymoma or hyperplasia of thymus gland
drug therapy
DRUG THERAPY

Anticholinesterase medications:

  • Pyridostigmine bromide (Mestinon), neostigmine bromide (Prostigmin) Increases acetylcholine at the neuromuscular junction
  • Dosage regulated based on improved strength and less fatigue
  • MUST BE GIVEN ON TIME to keep stable blood levels
    • RESULT: pt weakness worse
drugs to avoid increase weakness
DRUGS TO AVOID: increase weakness
  • Magnesium
  • Morphine
  • Curare
  • Quinine
  • Quinidine
  • Procainamide
  • Hypnotics
  • sedatives
  • Antibiotics:
  • Neomycin
  • Kanamycin
  • Polymyxin B
  • tetracyclines
drug therapy1
DRUG THERAPY
  • Corticosteroids used to control and improve symtoms:
  • prednisone(Deltasone, Winpred)
    • As steroids increased anticholinesterase dosage decreased
  • Cytotoxic medications used:
    • why they work unknown
treatment
TREATMENT
  • PLASMAPHERESIS: plasma exchange
    • Used to treat exacerbations
    • HOW IS THIS DONE: Blood cells and antibody containing plasma separated out then the cells and a plasma substitute reinfused
    • Improves symptoms in 75% of patients
treatment continued
TREATMENT CONTINUED
  • IV immune globulin (IVIG)
  • Works as well as plasmapheresis during exacerbations
summary of therapies
Summary of therapies
  • Not a cure
  • Does not stop the production of acetylcholine receptor antibiodies
surgical treatment
SURGICAL TREATMENT
  • Thymectomy continues to be associated with improvement in 50-92%% of patients
  • RESULT:
    • produces antigen specific immunosuppression
    • Results in clinical improvement
    • Decreases need for medication
    • Takes a year for benefit to be seen because of the long life of circulating T cells
myasthenic crisis
MYASTHENIC CRISIS
  • SEEN WITH UNDERMEDICATION WITH CHOLINESTERASE INHIBITORS
  • Severe generalized weakness and respiratory failure
  • Seen after stress (URI, infection, medication change, surgery, obstetrical delivery, high environmental temperature)
  • Patient needs ventilatory support
  • Patient will need help with all ADL
  • Suctioning, chest PT
cholinergic crisis
CHOLINERGIC CRISIS
  • RESULT OF OVERMEDICATION WITH ANTICHOLINESTERASE DRUGS
  • Can mimic symptoms of myasthenic crisis
  • Differentiated via Tensilon test
  • Pt with Myasthenic Crisis will show immediate improvement following Tensilon administration
  • Pt with Anticholinergic Crisis will show no improvement and may get worse
treatment of cholinergic crisis
TREATMENT OF CHOLINERGIC CRISIS
  • STOP ALL ANTICHOLINESTRASE MEDICATIONS
  • Give Atropine sulfate given IV
  • SE: secretions thickened
thymectomy
THYMECTOMY:
  • REMOVAL OF THYMUS GLAND DONE EARLY IN DISEASE
  • May take several years for remission to occur if it occurs at all
  • Review p 1017 Iggy
nursing care
NURSING CARE
  • Most pts seen on outpatient basis
  • Teaching:
    • use of medications
    • S&S of myasthenic crisis and choinergic crisis
    • How to conserve energy
    • Ways to avoid aspiration
    • Have suction at home
    • Gastrostomy feeding instruction
    • Avoid factors that increase crisis
    • Eye care
defined
DEFINED

Presence of motor dysfunction with 4 cardinal symptoms

  • resting tremor
  • akinesia (slowness of body movement)
  • rigidity
  • Postural instability

NO PREVENTION, NO CURE

AGE RANGE: 40-70, PEAK 60

Michael J. Fox dx at age 30

pathophysiology
PATHOPHYSIOLOGY

Reduced amount of dopamine

  • Result: inhibition effect lost
  • Excitatory effect predominant

Reduced norepinephrine in sympathetic NS of the heart:

  • Orthostatic hypotension
assessment
ASSESSMENT:
  • Initially: one limb involved with mild weakness and arm and hand trembling
  • Progresses to both limbs involved, slow shuffling gait
  • Continues to worsen: gait disturbances(slow shuffling, short hesitant steps, propulsive gait
  • Severe involvement: akinesia, rigidity, CANNOT GET OOD
further assessment
FURTHER ASSESSMENT:
  • Rigidity of facial muscles:
  • masklike facies
  • Drooling
  • Dysphagia
  • Dysarthria: Rapid slurred speech
  • Echolalia: repetition
assessment continued
ASSESSMENT CONTINUED
  • PSYCHOSOCIAL
    • Emotionally labile
    • Delayed reaction time
drugs
DRUGS
  • ANTIPARKINSON AGENT: monoamine oxidase type b inhibitor: selegiline (Eldepryl, Carbex, Novo-Selegiline): used to protect the neurons, successful in reducing the use of Levodopa until later
  • Catechol O-methyltransferase (COMT) inhibitors:
    • Tolcapone (Tasmar)
    • Entacapone (Comtan)

Block breakdown of levodopa in body so more can go to brain and convert to dopamine

drugs1
DRUGS
  • DOPAMINE AGONISTS: providing dopamine that is missing
    • Levodopa (Dopar, L-dopa) and
    • carbidopa (Sinemet):

ANTIPARKINSON AGENT/ANTIVIRAL:

  • amantadine (Symmetrel): potentiates action of dopamine in CNS, treats tremor; also treats symptoms of “wearing off”
treatment1
TREATMENT
  • Meds may need drug holiday - effectiveness after used for long time; admit to hospital to try other drugs
  • p693 FOR SURGICAL tx
  • Stereotactic Pallidotomy/Thalamotomy

Deep brain stimulation

fetal Tissue transplant

nursing diagnosis1
NURSING DIAGNOSIS
  • Self-care deficit related to slowness of movement and muscle rigidity
  • Risk for injury related to postural instability and muscular rigidity
  • Impaired verbal communication related to slowness of movement
  • Altered nutrition related to poor muscle control
nursing diagnosis continued
NURSING DIAGNOSIS CONTINUED
  • Knowledge deficit related to complexity of and fluctuations in treatment regimen
  • Ineffective coping relate to progressive nature of illness
implementation
IMPLEMENTATION
  • Establish routine for personal care
  • Safety in bathing, transferring, walking
  • AROM, PROM
  • Encourage pt to take a deep breath before initiating a conversation, using gestures
  • Rigidity of facial expression hides pts true feelings
implementation1
IMPLEMENTATION
  • Meals thickened liquids, semisolids
  • Eat sitting up
  • Suction
  • Daily wgts
  • Increase fluids/day for constipation
  • Drug flowsheet to document response to medications
  • Keep patient active as long as possible
multiple sclerosis

MULTIPLE SCLEROSIS

AUTOIMMUNE DISORDER

defined1
DEFINED
  • Demyelinating disease affecting nerve fibers of the brain and spinal cord
  • CAUSE unknown. Thought to be an autoimmune problem with a viral trigger
  • Lesions scattered through the white matter of the brain around the ventricles; some in grey matter
  • Inflammatory response triggers phagocytosis with myelin as the target
older drug therapy
OLDER DRUG THERAPY
  • The most widely accepted drug treatment is corticosteroids :
  • Methylprednisolone(Solumedrol)
  • Given IV followed by oral prednisone
    • Steroids decrease the inflammatory response, decrease the edema, improvement of symptoms
  • Cyclophosphamide (Cytoxan) used for chronic progressive disease to produce temporary remission from 1-3 years
definition continued
DEFINITION CONTINUED
  • Edema around lesions
  • Eventually a hard plaque forms
  • Characterized by exacerbations and remissions
  • Progressive from benign with few symptoms to chronic with complete paralysis.
  • 70% of pts lead active productive lives with long periods of remission
diagnosis
DIAGNOSIS
  • lumbar puncture: CSF shows increase protein, lymphocytes, IgG, presence of oligoclonal bands and increased myelin basic protein
  • EMG: prolonged impulse conduction
  • MRI: demonstrates white matter lesions (plaques) of brain, brainstem and spinal cord
new drug therapy
NEW DRUG THERAPY

BIOLOGICAL RESPONSE MODIFIERS: recommended to use one of these three:

  • Interferon beta -1a (Avonex) - weekly IM
  • Interferon beta-1b recombinant (Betaseron) - every other day SQ
  • PURPOSE AND SIDE EFFECTS OF BOTH
    • Slows physical disability, decreases physical worsening of disease
    • Major SE: suicidal tendency, depression
  • Glatiramer acetate (formerly Copolymer I) (Copaxone) - every other day SQ
symptoms
SYMPTOMS
  • Blurred vision
  • Double vision
  • Dysphagia
  • Facial weakness
  • Numbness
  • Pain
  • Weakness
symptoms continued
Symptoms Continued
  • paralysis
  • abnormal gait
  • tremor
  • vertigo
  • fecal and urinary incontinence
  • decreased short term memory
  • word finding trouble
symptoms continued1
Symptoms Continued
  • decreased concentration
  • mood alteration
  • decreased libido for women
  • ejaculatory dysfunction for men
  • overwhelming weakness
drugs2
DRUGS
  • Baclofen (Lioresal), Diazepam (Valium), Dantrolene sodium(Dantrium) - for spasticity
  • Carbamazepine (Tegretol), tricyclic antidepressants (amitriptyline),: paresthesia
  • propranolol (Inderal), clonazepam (Klonopin) – used for cerebral ataxia
  • Amantadine hydrochloride (Symmetrel): fatigue
  • oxybutynin chloride (Ditropan), propantheline bromide (ProBanthine) - decreased urinary urgency, incontinence
  • Bulk additives (Metamucil) - constipation
  • Colace - improved bowel control
  • Dulcolax – stimulant
  • Tizanidine (Sanaflex) antispasmodic for pain
nursing interventions
NURSING INTERVENTIONS
  • Self-care deficit: balance assistance with independence; promote own routine
  • Urinary retention/incontinence: intermittent catherization, Texas catheter for men
  • Bowel incontinence: regular routine, high fiber diet, and fluids
  • Impaired skin integrity related to immobility: skin assessment
nursing intervention
NURSING INTERVENTION
  • Fatigue related to disease process: pace self
amyotrophic lateral sclerosis

AMYOTROPHIC LATERAL SCLEROSIS

Lou Gerhig’s Disease

amyotrophic lateral sclerosis or lou gehrig s disease
Amyotrophic Lateral Sclerosis or Lou Gehrig’s disease
  • Progresive degenerative disease involving the motor system (motor neurons)
  • Sensory and autonomic systems not involved
  • No mental status changes
cause
Cause
  • Excess of glutamate: chemical responsible for relaying messages between the motor neurons
  • As the motor neurons die the muscle cells they supply undergo atrophic changes leading to paralysis
progression of disease
PROGRESSION OF DISEASE
  • Muscle weakness and atrophy develop leading to flaccid quadriplegia
  • Eventually respiratory muscles become affected leading to respiratory compromise, pneumonia and death
  • No known cure, treatment symptomatic
what do you see
FATIGUE

Fatigue while talking

Muscle weakness/atrophy

Tongue atrophy

Dysphagia (difficulty swallowing)

Weakness hands and arms

Fasciculations (twitching) of face

Nasal quality of speech

Dysarthria (difficulty speaking)

WHAT DO YOU SEE?
slide50
CARE
  • Focus on symptoms
  • Monitor respiratory status
  • Prepare to initiate respiratory support
  • Assess complications of immobility
defined2
DEFINED
  • Fractures, contusions, or compression of the vertebral column with damage to the spinal cord
  • The injury affects motor and sensory function at the level of injury and below

SPINAL CORD INJURIES are classified as complete or incomplete

  • Complete: total cord transection
  • Incomplete: partial transection
four types of injuries occur
FOUR TYPES OF INJURIES OCCUR
  • HYPERFLEXION: compresses vertebral bodies and disrupts ligaments and discs
  • HYPEREXTENSION: disrupts ligaments and causes vertebral fractures
  • AXIAL LOADING: application of excessive vertical force and may cause compression fractures
  • EXCESSIVE ROTATION: tears ligaments and fractures articular surfaces and causes compression fractures
spinal shock
SPINAL SHOCK
  • With cord damage spinal shock occurs and areflexia (temporary loss of reflex functioning)
  • Loss of motor sensory, and autonomic activity below the level of injury
  • Then leads to decrease in blood pressure and bradycardia
  • The parts of body below the level of the cord injury are paralyzed without sensation or diaphoresis
  • Lasts days or months after injury
definitions of paralysis
DEFINITIONS OF PARALYSIS
  • PARAPLEGIA: paralysis of the lower portion of the body; occurs when the injury level is in the thoracic spine or lower
  • Tetraplegia: formerly quadriplegia is paralysis of the arms, trunk, legs and pelvic portion; occurs when the level of injury is in the cervical spine
emergency treatment
EMERGENCY TREATMENT
  • DO NOT MOVE THE CLIENT until adequate personnel and equipment are available
  • Keep the neck aligned
  • Immobilize the head and neck
  • Maintain a patent airway (with cervical injury edema may cause respiratory difficulty
administer drugs
ADMINISTER DRUGS
  • High dose corticosteroids:
    • reduces disability in 8hrs of injury
  • Osmotic diuretics: mannitol (Osmitrol)
    • Decreases edema around spinal cord
  • Muscle relaxants: baclofen (Lioresal)
    • Reduces spasticity
  • Dextran
    • prevents BP; improves capillary blood flow
  • dopamine hydrochloride (Intropin) and isoproterenol (Isuprel): inotropic and sympathomimetic agents for severe hypotension
immobilization
IMMOBILIZATION
  • Goal: reduce dislocations and stabilize cervical vertebral column

HOW?

  • Skeletal traction (skeletal tongs such as Gardner–Wells tongs or Crutchfield tongs)
  • Halo traction

CARE: weights hang freely, never remove weights, clean tongs, assess for infection

surgery
SURGERY
  • Surgical immobilization via anterior and posterior decompression and fusion with bone grafts
  • DECOMPRESSION WITH LAMINECTOMY: remove bony fragments that cause compression, remove foreign body causing compression
  • FUSION: anterior, posterior or anterior/posterior using Harrington rods
autonomic dysreflexia
AUTONOMIC DYSREFLEXIA

DEFINED:

  • Exaggerated sympathetic response that occurs in clients with T6 injuries or higher
  • Response seen after spinal shock occurs when stimuli cannot ascend the cord
  • Stimulus (urge to void) triggers massive vasoconstriction below the injury, vasodilation above the injury, and bradycardia
causes of autonomic dysreflexia
CAUSES OF AUTONOMIC DYSREFLEXIA

MOST COMMON: overdistended bladder

  • Bowel impaction, rectal exam
  • UTI, bladder spasms, renal calculi
  • Pressure sores, ingrown toenail
  • Burns, blows to body
  • Tight clothing, tight cast
s s autonomic dysreflexia
S & S AUTONOMIC DYSREFLEXIA
  • Sudden pounding severe HA
  • Severe hypertension, bradycardia
  • Flushing, sweating above the level of injury
  • Piloerection (goose bumps)
  • Nasal congestion
  • Apprehension
  • Blotching above the level of injury
tx of autonomic dysreflexia
TX OF AUTONOMIC DYSREFLEXIA

SERIOUS MEDICAL EMERGENCY! ACT QUICKLY! DO NOT WAIT!

  • Identify/remove the stimulus
  • Reduce the BP
  • Administer drugs
  • Teach pt how to deal with it
tx of autonomic dysreflexia1
TX OF AUTONOMIC DYSREFLEXIA
  • REQUEST HELP
  • HOB up!
  • Check BP q 5 minutes
  • Do straight cath of bladder; eval bowel
  • Remove tight clothing, check orthotics
  • Check skin, toenails
  • Report to MD if BP still won’t decrease
drugs for autonomic dysreflexia
DRUGS FOR AUTONOMIC DYSREFLEXIA

ACUTE PHASE:

  • Nitropaste (vasodilator)
  • Arfonad IV (ganglionic blocker to lower BP fast)
  • Apresoline IV (relaxes arterolar smooth muscle)
  • Low spinal anesthetic at L4 if no results with drugs

PREVENTION: antihypertensives

bladder problems
BLADDER PROBLEMS
  • INCONTINENCE
  • UTI
  • URINARY CALCULI
  • BLADDER SPASMS
spastic bladder
SPASTIC BLADDER
  • Clients have Injury above the sacrum
  • End up with upper motor neuron spastic bladder
  • May be able to stimulate voiding by
    • Stroking inner thigh
    • Pullin on pubic hair
    • Pouring warm water over perineum
    • Tapping bladder to stimulate detrusor muscle
    • Taking bethanechol chloride (Urecholine); cholinergic agent which helps contraction of detrusor mucle: take 1 hour before trying to void
flaccid bladder
FLACCID BLADDER
  • Clients with lumbosacral injury
  • Have lower motor neuron flaccid bladder
  • Able to empty bladder by:
    • Tightening abdominal muscles
    • Intermittent cath two or three times daily
treatment of the urinary problems
TREATMENT OF THE URINARY PROBLEMS
  • Intermittent catherization :Clean cath
  • Prevents incontinence, dysreflexia, UTI, calculi

CAUTION: never drain more than 700cc/ leads to hypovolemic shock

  • increase fluid, water, high acidity fluids, no alcohol, low soda (hi salt), low milk, avoid alkaline fluids
drugs for elimination problems
DRUGS FOR ELIMINATION PROBLEMS
  • oxybutynin (Ditropan) : decreases urinary incontinence
  • propantheline(Pro Banthine): reduces bladder spasms
  • ascorbic acid (Vitamin C): increases urine acidity; prevents UTI; works with Mandelamine
  • methenamine (Mandelamine): urinary tract antisepticto prevent UTI; do not combine with carbonic annhydrase inhibitors, sulfa drugs or diuretics
  • Imipramine (Tofranil) antidepressant used to tx urinary incontinence (side effect: urinary retention))
bowel elimination problems
BOWEL ELIMINATION PROBLEMS

Constipation

Loss of bowel control

TREATMENT: Bowel Program

  • Combination of stool softeners, bulk formers, laxatives
  • High fiber diet, high fluids
bowel program
Bowel Program
  • Consitent time
  • High fluid intake
  • High fiber diet
drugs for bowel elimination problems
DRUGS FOR BOWEL ELIMINATION PROBLEMS
  • docusate sodium(Colace): stool softener
  • senna (Senekot): laxative
  • bisacodyl (Dulcolax): laxative
  • dibucaine (Nupercainal): ointment anesthetic used prior to beginning bowel program to prevent autonomic dysreflexia
  • psyllium (Metamucil): bulk forming agent
other problems
OTHER PROBLEMS

Mostly related to immobility

  • RESPIRATORY: pneumonia, PE
  • MOBILITY: contractures, spasticity, decubitus, burns, bruises, fractures, osteoporosis
  • CIRCULATORY: DVT/edema, postural hypotension, GI bleed
  • SEXUAL: males have decreased fertility, females can bear children
defined3
DEFINED
  • Disorder involving impingement of a vertebral disk’s nucleus pulposus on spinal nerve roots causing pain and possible neuromuscular deficit

TREATMENT conservative:

  • with muscle relaxants: cyclobenzaprine hydrochloride (Flexeril)
  • Nonsteroidal anti-inflammatory drugs (NSAIDS): naproxen (Naprosyn)
  • Epidural or local steroid injection
  • Rest, heat, muscle strengthening exercises, pelvic tilts, straight leg raises
minimally invasive surgery see page 980 of iggy
MINIMALLY INVASIVE SURGERY(see page 980 of Iggy)

ADVANTAGE: ambulatory procedure or shortened hospital stay with less spinal cord complications

  • Percutaneous lumbar diskectomy
  • Microdiskectomy
  • Laser-assisted laparoscopic lumbar diskectomy
surgery see p980 of iggy
SURGERY see p980 of Iggy
  • Diskectomy: spinal nerve is lifted to remove the offending portion of the disk
  • Laminectomy: removal of 1 or more vertebral lamina and the herniated nucleus pulposus
  • Spinal fusion (arthrodesis): to stabilize area using chips of bone from iliac crest grafted to vertebrae
surgical management
SURGICAL MANAGEMENT

LAMINECTOMY: surgical incision of the lamina to relieve symptoms related to herniated intervertebral disc

POST OP CARE:

  • Neurological and neurovascular assessment, assessment of bowel and bladder function
  • Assess for c/o severe HA or leakage of CSF
  • Log roll, proper alignment
  • Bedrest 24-48 hours; rise as a unit when getting OOB first time
  • Paresthesias may not be relieved immediately
types of prostheses
TYPES OF PROSTHESES
  • TOTAL CONTACT RIGID DRESSING: applied in OR to protect stump swelling
  • PERMANENT LEG PROSTHESIS: rigid dressing that connects to an adjustable pylon and foot ankle assembly to permit walking; need 3-4 of these, stump shrinks with healing
  • SOFT DRESSING: when frequent inspection needed; may have drainage device
complications
COMPLICATIONS
  • Bleeding
  • Infection
  • Skin breakdown
  • PHANTOM LIMB PAIN
  • FLEXION CONTRACTURES
nursing care1
Proper positioning to minimize contractures

Watch use of pillow under stump

Lie prone

Phantom limb pain

Monitor for excessive bleeding

Prevent stump edema

Assess for infection

Assess for hematoma formation

Teach stump care

Teach use of prosthesis

Provide referral to National Amputee Foundation and Amputee Shoe and Glove Exchange

NURSING CARE
cranial nerve disorders

CRANIAL NERVE DISORDERS

Trigeminal Neuralgia

Bells Palsy

Guillan-Barre Syndrome

trigeminal neuralgia
Trigeminal Neuralgia
  • DEFINED: chronic disease of the trigeminal nerve causing severe facial pain unknown cause
  • Pain occurs briefly, intense skin surface pain 100 times/day or a few times a year
  • Starts peripherally and advances centrally
  • Some trigger zones initiate pain
  • TREATED WITH: seizure drugs: carbamazepine (Tegretol); phenytoin (Dilantin)
  • SURGICAL TREATMENT: removal of blood vessel from posterior trigeminal root or severing nerve root
  • NURSING DX: risk for imbalanced nutrition; pain
bell s palsy
Bell’s Palsy
  • DEFINED: unilateral paralysis of facial muscles; unknown cause; inflammation of the nerve and viral cause suggested; recover within few weeks/months, some have permanent paralysis
  • SEE: one sided paralysis of facial muscles and upper eyelid, loss of taste on affected side, increased tearing of eye on affected side
  • TREATMENT: corticosteroids (decreases edema of nerve tissue) – Prednisone; and antiviral medications
  • NURSING DX: altered body image; altered nutrition
guillain barre syndrome
GUILLAIN BARRE SYNDROME
  • Autoimmune attack of the peripheral nerve myelin
  • RESULT: acute rapid demyelination of peripheral nerves and some cranial nerves
  • PRODUCES:
    • ***Ascending weakness with dyskinesia (inability to execute voluntary movements)
    • Weaknss starts in legs and progresses upward for 1 month
    • ***Hyporeflexia
    • Paresthesias (numbness and pain)
    • MAXIMUM WEAKNESS:
      • neuromuscular respiratory failure and
      • bulbar muscle weakness (demylelination of glossopharyngeal and vagus nerves leads to inability to swallow or clear secretions)
s s continued
S & S CONTINUED
  • VAGUS NERVE DEMYELINATION:
    • Leads to autonomic dysfunction
    • Manifested by instability of cardiovascular system
    • S & S: tachycardia, bradycardia, hypertension, orthostatic hypotension
  • NO COGNITIVE DYSFUNCTION
symptoms continued2
SYMPTOMS CONTINUED
  • PRECIPITATING EVENT: respiratory or GI infection, vaccination, surgery, pregnancy
  • DURATION OF SYMPTOMS: may take up to two years to recover; some symptoms are permanent due to damage to nerves
treatment2
TREATMENT
  • MEDICAL EMERGENCY: ICU
  • Rapid progression
  • Neuromuscular respiratory failure
  • May need mechanical ventilation
  • suctioning
  • Prevention of complications of immobility
for cardiovascular risks
FOR CARDIOVASCULAR RISKS
  • EKG
  • beta blocking agents for tachycardia and hypertension
  • IV fluid for hypotension