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INCO 2
NEUROLOGIC NURSING (DISORDERS) g. Instruct the client to avoid fatigue, stress, infection,
overheating, and chilling
MULTIPLE SCLEROSIS h. Instruct the client to increase fluid intake and eat a
balanced diet, including low-fat, high fiber foods
 an autoimmune disorder that causes destruction of
and foods high in potassium (to prevent
the myelin sheath of nerve fibers in the CNS
constipation)
 INCIDENCE: 20-40 years and consist of periods of i. Instruct the client in safety measures such as
remissions and exacerbations regulating the temperature of bath water and
 CAUSES: unknown, but the disease is thought to avoiding heating pads. AVOID HOT BATHS
be the result of an immune response or viral
infection PHARMACOTHERAPY
 PRECIPITATING FACTORS
a. Pregnancy GLUCOCORTICOIDS
b. Fatigue To relieve inflammation of damaged myelin sheath
c. Stress
d. Infection a. Prednisone
e. T
b. Decadron (Dexamethasone)
 Assessment of a lumbar puncture indicates an
increased c. Corticotropin
 IgG level
 CHARCOT’S TRIAD MUSCLE RELAXANT
a. Scanning Speech (repetition of the first syllable
To relieve muscle spasm
of each word)
b. Intention tremors a. Lioresal (Baclofen); a gaba agonist, given
c. Nystagmus PO/INTRATECHAL

ASSESSMENT b. Betaseron – an interferon that reduces

spasticity; given SQ, EVERY OTHER DAY
a. Fatigue and weakness
b. A and V IMMUNOSUPPRESSANTS
c. Tingling and Spasticity of the lower extremities
d. Paresthesia To reduce relapse of MS
e. Blurring of Vision, Diplopia, and TB
a. Imuran (Azathioprine)
f. Nystagmus
g. Decreased perception to pain, touch, and b. Cytoxan (Cyclophosphamide)
temperature
h. Bladder and bowel disturbances, including OTHER MEDICATION
urgency, frequency, retention
1. Interferon beta-1a (Avonex)
i. Hyperreflexia
-reduces frequency of relapse by 30% on MRI by
j. Emotional changes: apathy/anxiety, I, depression
80%, given IM once a week
k. Memory changes and confusion
2. Glatiramer Acetate (Copaxone)
INTERVENTIONS
- reduces lesions on MRI and relapse; inhibits antigen-
a. Provide energy conservation measures during
specific T-cells activation; given SQ everyday
exacerbation
b. Protect the client from injury 3. REBIF - for relapsing MS; given SQ 3 times a week
c. Place and eye patch on the eye
d. Promote regular elimination by bladder and bowel 4. mitoxantrone (novantrone)- anticholinergic agent used
training for leukemia; treats secondary MS
e. Instruct the client to balance moderate activity
5. Benzodiazepine (Diazepam), Trizanidine (Zanaflex),
with rest periods
Dantrium (Dantrolene)
f. Physical and speech therapy (to improve muscle
strength, avoid contractures, and relieve scanning - for MUSCLE SPASMS
of speech)

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 Nsg. INCO 2
6. Amentadine (Cymmetrel), Permoline (Cylert), or e. Administer meds at EXACT TIME (to prevent
Fluoxetine (Prozac): for FATIGUE myasthenic crisis that results to respiratory distress)
f. Start meal with cold beverage (To contract muscles
7. Inderal, Neurontin, and Klonopin: for ATAXIA of the throat and improve ability to swallow)
g. Encourage the client to sit up when eating
h. Protect client from falls
MYASTHENIA GRAVIS i. Provide rest with alternating activity
j. Instruct the client to avoid stress, infection, fatigue,
o A defect or failure in the transmission of nerve and over-the-counter meds. (Infections may trigger
impulses at the myoneural junction exacerbation of MG)
CAUSES: PHARMACOTHERAPY
a. Insufficient secretion of acetylcholine 1. Acetylcholinesterase Inhibitors/Cholinesterase
b. Autoimmune disorders Inhibitors

ASSESMENT a. Ambenonium chloride (Mytelase)

a. Weakness and Fatigue – relieved by rest b. Neostigmine bromide (Prostigmine)

b. Difficulty chewing and speaking c. Pyridostigmine (Mestion)
c. Diplopia
d. Ptosis 2. Glucocorticoids
e. Strabismus
f. Weak and Hoarse voice a. For anti-inflammatory effects
g. Dysphagia 3. Antacids
h. Diminished Breath Sounds
i. Respiratory paralysis and failure a. To prevent gastrointestinal upset due to
j. Impaired Speech, Snarl Smile, Mask-like glucocorticoids
expression
NURSING INTERVENTIONS FOR
EDROPHONIUM TEST ACETYLCHOLINESTERASE INHIBITORS

 Diagnostic Test a. Monitor improvement of muscle strength and

 AKA TENSILON TEST respirations
 This test is performed by the neurologist to diagnose b. Observe the client for signs and symptoms of
myasthenia gravis cholinergic crisis
 Tensilon – short acting cholinergic administered per IV; c. Have readily available on antidote for cholinergic
2mg first, then 8 mg crisis
 Positive Tensilon test is observed as improvement in d. Encourage the client to wear Medic-Alert bracelet
muscular strength e. Instruct the client to take the medication before
 Muscle weakness returns in 3-5 minutes meals
 ANTIDOTE: Atropine Sulfate (anticholinergic) f. Observe and report possible side effects and
 the test places the client at risk for adverse reactions: nausea and vomiting, diarrhea,
abdominal cramps, increased salivation, tearing
NURSING INTERVENTIONS
SURGERY
a. Monitor respiratory status and ability to cough and
deep breath adequately THYMECTOMY
b. Maintain suctioning and emergency equipment at
a. Surgical removal of the thymus gland
the bedside
b. 25% of people with MG have been found to have
c. Monitor GAG REFLEX and swallowing abilities (To
thymoma (tumor of the thymus gland)
prevent
c. The surgery achieves remission for 5 to 10 years
a. aspiration)
d. Administer meds 20-30 minutes before meals (to
improve ability to swallow and prevent choking)

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 Nsg. INCO 2
2 MAJOR COMPLICATIONS OF MG b. Frequent rest periods

MYASTHENIC CRISIS c. Have alarm clock to take medications on time

(prevents myasthenic crisis)
a. An acute exacerbation of the disease
b. Causes: delayed or inadequate amount of d. Patch eye alternately for diplopia
medication, infection, fatigue, or stress
e. Start meal with cold beverage (to contract muscles of
ASSESSMENT: the throat and prevent aspiration)

a. Increased pulse rate, respiratory rate, and blood f. Avoid factors that affect respiratory function and cause
pressure respiratory infection:
b. Dysarthria, a, cyanosis, severe respiratory distress
c. Bowel and Bladder Incontinence  Very cold and very hot beverages
d. Decreased Urine Output  Aerosol
e. Absent cough and swallow reflex  Alcohol
f. Restlessness  Cigarette smoke
 Pesticide
INTERVENTIONS

a. Increase dose of anticholinesterase medication,

as prescribed
b. Mechanical Ventilation of respiratory paralysis is
acute

CHOLINERGIC CRISIS

o Caused by excessive or overmedication with

anticholinesterase

ASSESSMENT

a. Weakness with difficulty of swallowing, chewing,

speaking and breathing
b. Abdominal cramps
c. Diarrhea
d. Nausea and vomiting
e. Increased salivation
f. Blurring of vision
g. Hypotension
h. Lacrimation, sweating

NURSING INTERVENTION

a. Withhold anticholinesterase medication

b. Prepare to administer the antidote (atropine
1mg/IV)
c. Avoid the following medications (they potentiate
muscle weakness)
 Muscle relaxants
 Barbiturates
 Morphine Sulfate
 Tranquilizers
 Neomycin

SURVIVAL GUIDE FOR MYASTHENIA GRAVIS

a. Reschedule daily task (to prevent weakness)

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