Management of Neurological Infections and Disorders

Management of Patients With Neurological Infections, Autoimmune Disorders, and Neuropathies

• This chapter covers the management of patients with neurological conditions, including infections, autoimmune disorders, and neuropathies.
• The fourth edition of the chapter is referenced.
• The text is adapted by a registered nurse with a bachelor of science in nursing and a master's degree.
• The text discusses autoimmune neurological disorders, specifically Multiple Sclerosis (MS), Myasthenia Gravis, and Guillain-Barré syndrome.

Autoimmune Neurological Disorders

• Multiple Sclerosis (MS): A progressive immune-related demyelination disease of the central nervous system (CNS).
• Clinical presentation of MS: Clinical presentation varies and has different patterns, frequently relapsing, remitting, and exacerbating.
• MS process: The myelin sheath becomes inflamed, triggering an inflammatory cascade.
• Damage in MS: Multi-focal plaque-like lesions damage the myelin sheath.
• Result of demyelination in MS: Resulting demyelination and scar tissue cause changes in electrical impulses.
• Types of MS: Includes relapsing-remitting, primary progressive, secondary progressive, and progressive-relapsing forms.
• Cause of MS: The cause of MS is unknown, but theories include autoimmune, viral, and genetic factors.
• MS demographic: Women are affected more frequently than men, and onset usually emerges between ages 20-40.
• Symptoms of MS: Visual challenges (optic nerve lesions), fatigue, changes in sensory ability (paresthesia, pain), changes in motor ability (fine and gross motor), changes in bowel/bladder patterns, emotional changes, changes in balance/proprioception, changes in libido.

Multiple Sclerosis (MS) Assessment and Diagnosis

• History: Includes personal and family history, signs and symptoms.
• Neurological assessment: Part of the diagnostic evaluation.
• MRI: Shows smaller irregularites, useful for the assessment.
• CSF studies: Shows multiple plaques, CSF studies may reveal changes.
• Evoked potentials: Takes time to assess response of the nerves.

Multiple Sclerosis (MS) Medical Management

• Treatment: There is no cure for MS.
• Disease-modifying therapies: Interferon beta-1a and interferon beta-1b, glatiramer acetate (Copaxone), and intravenous methylprednisolone are used to reduce inflammation and reduce the inflammatory cells crossing the blood-brain barrier.
• Symptom management: Managing muscle spasms, fatigue, ataxia, and bowel and bladder control issues is important.

Myasthenia Gravis

• Description: An autoimmune disorder affecting the myoneural junction within the CNS.
• Mechanism of the disorder: Antibodies target acetylcholine at the myoneural junction, impairing the transmission of impulses.
• Demographic: More common in women aged 20-40 years, while men typically experience onset between ages 60-70.

Myasthenia Gravis Symptoms

• Early symptoms: Often start with ocular muscles, such as diplopia (double vision), ptosis (drooping eyelids).
• Diagnostics: Tensilon test is used, along with other assessments & studies.
• Symptoms: Facial muscle weakness, swallowing difficulties, voice impairment (dysphonia), generalized weakness.
• Chronic symptoms: Bradycardia, profuse sweating, and abdominal cramping.

Myasthenia Gravis Medical Management

• Pharmacological Therapy: Cholinesterase inhibitors (e.g., pyridostigmine bromide/Mestinon)
• Immunomodulating Therapy: Suppressive therapies.
• Cytotoxic Medications: E.g., cyclosporine, azathioprine.
• Plasmapheresis: To remove circulating antibodies.
• Thymectomy: Removal of the thymus gland.

Myasthenic Crisis

• Description: A result of disease exacerbation or precipitating event (e.g., respiratory infection), characterized by severe generalized muscle weakness and bulbar weakness.
• Potential Outcome: Respiratory compromise and failure.

Cholinergic Crisis

• Cause: Due to overmedication with cholinesterase inhibitors
• Symptoms: Severe muscle weakness and respiratory and bulbar weakness.
• Patient outcome: Respiratory compromise and failure.
• Differentiation: Tensilon test can help differentiate myasthenic vs cholinergic crisis.

Guillain-Barré Syndrome

• Description: An autoimmune disorder with acute attack on peripheral nerve myelin, often following a viral infection.
• Outcome: Rapid demyelination, resulting in potential respiratory failure and autonomic nervous system dysfunction with cardiovascular instability.
• Symptoms: Variable, including weakness, paralysis, paresthesia, pain, decreased/absent reflexes, bulbar weakness, cranial nerve symptoms, tachycardia, bradycardia, hypertension, and hypotension.
• Diagnosis & Treatment: Requires intensive care with continuous monitoring and respiratory support.
• Plasmapheresis & IVIG: Used to reduce circulating antibodies.
• Recovery: Most patients recover completely but some may have residual deficits.

Nursing Process - MS, MG, GBS—Assessment, Diagnosis, Planning, Interventions and Important Considerations

• Assessment: Includes conducting ongoing assessments, focusing on early detection of life-threatening complications (respiratory failure, cardiac dysrhythmias, deep vein thrombosis (DVT)). Monitor for respiratory and cardiovascular changes, and perform regular vital signs and assessments.
• Diagnosis: Develop a diagnosis plan tailored to the patient's individual needs, assessing for potential complications.
• Planning: Major goals include improved respiratory function, increased mobility, improved nutritional status, effective communication, reduced fear/anxiety, and absence of complications.
• Interventions: Support limbs in functional positions, perform passive range of motion (ROM) exercises, support mobility, provide elastic compression boots, provide adequate hydration, administer IV and parenteral nutrition (as prescribed), assess swallowing and gag reflex and develop an aspiration prevention plan, develop a communication plan, provide patient and family education and support, implement relaxation measures to decrease fear and anxiety, avoid stress, maintain a positive attitude and atmosphere, avoid or manage infections, adjust environmental temperature, manage medications/treatments.

Additional Important Notes

• Risk for falls, risk of aspiration, and respiratory failure are also important considerations in all three conditions.
• The provision of medication in a timely manner.
• Recognizing that there may be instances of relapse and remission in these conditions are crucial to successful nursing care.

This quiz focuses on the management of patients with neurological infections, autoimmune disorders, and neuropathies, specifically targeting conditions like Multiple Sclerosis, Myasthenia Gravis, and Guillain-Barré syndrome. Derived from the fourth edition of the referenced chapter, this content is essential for nursing professionals dealing with complex neurological cases.