Week 10 Med-Surg: Neurological Disorders Quiz

Clinical Manifestations of ALS

• Progressive symptomology that will progress to affect generalized muscle activity/movement, speech, swallowing, breathing
• Impaired/absent mobility, worsening dysphasia, dysphagia, dysarthria, and airway insufficiency
• Impaired mood and cognition, including labile affect, depression, anger, and grief

Diagnostics and Interventions for ALS

• Differential diagnosis using electromyography (EMG) and nerve conduction studies to rule out other causes of musculoskeletal dysfunction
• Interdisciplinary care including occupational therapy, drug therapies, and nursing considerations for alternative communication needs, impaired airway clearance, fall risk, aspiration risk, impaired mobility, depression, and risk for respiratory insufficiency

Clinical Manifestations of Multiple Sclerosis (MS)

• Progressive deterioration of the central nervous system (CNS) leading to progressive loss of cognition, sensation, and movement
• Early symptoms include diplopia, blurred vision, pain with eye movement, and unilateral loss of vision
• Common symptoms include peripheral paresis, paresthesia, and/or paralysis, electric-shock sensations, tremors, ataxia, and fatigue
• Other symptoms include slurred speech, dizziness/vertigo, neuropathic pain, problems with sexual, bowel and bladder function, tinnitus, dysphagia, dysarthria, nystagmus, brain fog, and memory deficits
• Psychological effects include labile affect, depression, anger, and grief

Diagnostics and Interventions for MS

• Differential diagnosis to rule out other causes of CNS dysfunction
• Serum tests, evoked potential tests, and MRI to detect demyelination along spine and brain
• Interdisciplinary care including drug therapy, plasmapheresis, and muscle relaxants to slow disease progression
• Goal of symptom management and slow disease progression

Clinical Manifestations of Parkinson's Disease (PD)

• Progressive, neurodegenerative disease of the CNS
• Presence of TRAP (Tremors, Rigidity, Akinesia, Postural instability)
• Early symptoms include unilateral presentation, pain, and tremors
• Common symptoms include bradykinesia, rigidity, postural instability, and resting tremors
• Other symptoms include dysphagia, dysarthria, nystagmus, brain fog, and memory deficits
• Psychological effects include labile affect, depression, anger, and grief

Diagnostics and Interventions for PD

• Differential diagnosis using anti-Parkinson's medication challenge
• Interdisciplinary care including drug therapies, surgical interventions, and psychological and social supports
• Goal of symptom control and improvement of quality of life

Clinical Manifestations of Myasthenia Gravis (MG)

• Progressive, autoimmune disease that destroys acetylcholine (ACh) receptors
• Causes miscommunication between neuro and musculoskeletal systems
• Rapid onset of voluntary muscle fatigue with use, leading to voluntary muscle weakness
• Onset typically in women under 40 years old and men over 60 years old

Seizures

• Abnormal, sudden, excessive, uncontrolled electrical discharge within brain
• Risks include metabolic disorders, fever, ETOH withdrawals, substance abuse, electrolyte imbalances, heart diseases, and decreased CO
• Stages of seizure events include aura, seizure activity, and postictal period
• Types of seizures include generalized, partial, tonic, clonic, tonic-clonic, absence, and myoclonic seizures

Long-Term Management of Seizures

• Look for signs of aura for prevention of seizure activity
• Nursing considerations and patient teaching for anticonvulsant medication therapy