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MCC Nursing Med Surg Neuro Notes
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-disease that affects CNS, vision, muscles, coordination, fall risk, over time total loss. -immune system attacks myelin sheath between spinal chord and muscle. Nerve impulses are unable to get to muscle and person looses function -more exacerbations leads to worse MS -affects women MS ASSESSMENT -can progress slowly with remission or rapidly with lots of exacerbation -MUSCLES: fatigue, depression, weakness, numbness, loss of coordination, balance, spasticity -EYES: optic nerves affected, blurry vision, diploplia, scotoma (patchy blindness), blindness -PAIN- from lesions on sheath -FATIGUE- depression, loss of function, meds -SPASTICITY: ataxia, loss of bladder , bowel, sexual function AT FIRST: VISUAL CHANGES (diplopia) FATIGUE: pt. can’t hold arms up, can’t do their hair or regular ADL’s are exhausting COORDINATION ISSUES: pt. states they are off balance, clumsy SPEECH: messing up words, dysarthria INCONTINENCE: suddenly out of nowhere they pee themselves, the bed bowel and bladder issues
-Scans looking for scarring on myelin sheath -rule out other things with blood testing -spinal tap for biomarkers MS TREATMENT MEDS MTHOTREXATE: DMARD, immunosuppressant -kills all cells -can kill baby in pregnancy BIRTH CONTROL CORTICOSTEROIDS: for acute exacerbations EDUCATION -you need to be on birth control to not conceive -conserve energy, use assistive devices -nutrition, exercise, get cleared to dirve, visual testsing GRIEF -deal with depression -anticipatory grieving over not being able to get pregnant/ have kids MS VS MG (both nervous system) MS= whole body + extremities (eyes, speech, B&B, extremities)
MG= body core only (face, torso, respiratory, throat)
-our own antibodies attack the impulses to our voluntary muscles causing weakness -AFFECTS BODY CORE -face, torso, respiratory -affects middle aged women, is induced by stress -affects MOTOR neurons only not sensory. Doesn’t affect coordination GRAVE WEAKNESS
HARD TO SWALLOW: choking when eating, cant swallow, regurgitations, aspirations, impaired ventillation HARD TO BREATH: weak lungs, labored breathing, aspirations into lungs WEAKNESS: I’m not feeling myself, im middle aged and shouldn’t feel this way, im tired, weak and under stress in my life FACE: droopy eye lid & mouth, visual issues INTERVENTIONS -speech evaluation -swallow studies -NPO, thickened liquids -sitting up for drinking/ eating -lower chin to swallow
Dysphagia, dysarthria, ptosis, diplopia, respiratory decline, -patient will need intubation with ventilation and be put into the ICU
-WATCH OUT FOR CRISIS- can lead to serious respiratory issues that could lead to intubation which can lead to secondary issues like infection -teach the patient to GO TO THE HOSPITAL if they start to feel it exasperating because they can easily loose their airway -TEACH that TRIGGERS may lead to this and you will need to be intubated
Cholinesterase Inhibitors PYRIDOSTIGMINE (Mestonin) a muscle strengthener given for Myasthenia gravis and after anesthesia. Given to strengthen muscles under voluntary control CORTICOSTEROIDS: for acute exaserbations