flowchart TD
1(Demyelinating Disease)
1-->2
2(Destruction of Myelin Sheath)
2-->3.1
2-->3.2
3.1(CNS)
3.2(PNS)
3.1-->4.1
3.2-->4.2
4.1(Multiple Sclerosis)
4.2(Guillain-Barre's Syndrome)
Parkinson’s Disease
Degenerative patchy demyelination and damage to the basal ganglia, affecting movement. Tremors and a shuffling gait is present.
Myasthenia Gravis
A chronic autoimmune disease. Results in ptosis and descending paralysis.
Multiple Sclerosis
A chronic autoimmune disease. Main concern: memory, fatigue, and sensation. Individuals become spastic and display constant muscular rigidity, resulting in fatigue.
Diagnostic Examination
- CT Scan
- Fatigue
Treatment
- Corticosteroids: IV methylprednisone
- Baclofen for muscle spasms
Nursing Care
- Avoid hot baths. Priority nursing management.
- Teach the patient for the use of assistive devices
Guillain-Barre Syndrome
An acute autoimmune attack on the peripheral myelin, which results in ascending paralysis. Memory is unaffected.
Diagnosis
Treatment
- Intravenous Immunoglobulin (IV Ig)
- Plasmapheresis
- Prevent immobility and protect the airway of the patient.
Nursing Care
- Prepare suctioning and endotracheal tube.
Spinal Shock
A decreased blood pressure, heart rate (prep. atropine), cardiac output, and developing flaccid paralysis.
- Paralytic ileus (and constipation) may develop. Auscultate for bowel sounds. Prepare for NGT decompression.
- Autonomic Dysreflexia occurs only after spinal shock is resolved, with cord lesions above T6.
- S/S: pounding headache, profuse sweating, paroxysmal hypertension, nasal congestion, sweating, bradycardia.
- Management:
- Maintain high back rest (sitting) to lower blood pressure.
- A urinary catheter is applied to empty the bladder. Check for fecal impaction. Examine the skin for pressure ulcers, irritation, and other immobility precautions.
- Examine room temperature.
- Antihypertensive medication
Cardiovascular Accident
Either hemorrhagic (rupture) or ischemic (due to blood clot).
Risk Factors
- Race and family history
- Advanced Age
- Gender: male
- Modifiable: cardiac diseases, diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking.
Diagnostic Examination
- CT Scan identifies and differentiates stroke into ischemic or hemorrhagic forms.
- EEG
- Cerebral arterio
Transient Ischemic Attack
A warning sign of a stroke. A temporary neural loss lasting less than one hour.
Management
- Thrombolytics to dissolve clot given within 3 hours of an episode: tPA (Alteplase), Streptokinase, Urokinase
- Monitor Airway, VS, GCS, ICP, Pupil Size, and Seizures
- IVF, NGT
- Mannitol, Diazepam