CLIENTS WITH

NEUFOLOCIC DISOFDEFS
Ncurological Eaminaiion
< Cerebral Functlon Test
< Cerebellar Functlon Tests
< Motor System Tests
< Sensory System Tests
< Testlng ot Retlees
< Cranlal Nerve Testlng
Ccrclral Funciion Tcsi
< Tbe cerebrum ls tbe largest olvlslon ot tbe braln.
< Tbe most rellable lnoe ot cerebral status ls tbe level ot
consclousness
Lcvcls of Consciousncss
< Consclous / Alert / Awake
< Letbargy / Somnolence / Drowslness / Obtunoatlon
< Stupor
< Seml-consclous / Llgbt Coma
< Coma / Deep Coma
CIaracicrisiic Posiurcs of Clicnis in Coma
Decortlcate
< Abnormal tleor response ln tbe upper etremltles wltb
byperpronatlon, etenslon ano plantar tlelon ln tbe
lower etremltles
Decerebrate
< A rlglo etenslon ot tbe upper ano lower etemltles ano
plantar tlelon
Clasgow Coma Scalc
Ccrclcllar Funciion Tcsi
< Tbe cerebellum ls tbe secono largest part ot tbe braln.
< |t ls a bemlspberlcal structure touno on at tbe posterlor
part ot tbe braln.
Functlons:
< Postural retlees
< Lqulllbrlum
< Muscle movement
Ccrclcllar Funciion Tcsis
Romberg test
< &seo to test cerebellar ano vestlbular lntactness
< |t tbere ls cerebellar oamage, tbe cllent wlll bave posltlve
Romberg's slgn ano atala
oior Sysicm Tcsi
Motor ablllty
< Tbe cllent ls lnstructeo to walk across tbe room ano
observe tor posture ano galt
< Palpate muscle tone wblle at rest ano ourlng passlve
movements
Abnormalltles
< Spastlclty lncreaseo muscle tone
< Rlglolty reslstance to passlve stretcb
< Flacclolty
oior Sysicm Tcsi
Muscle strengtb
< Assesslng tbe cllent's ablllty to tle or eteno tbe
etremltles agalnst reslstance
Scnsory Sysicm Tcsi
< Lamlneo wltb tbe person seateo ano bllnotoloeo ano
glven an object.
5tereognosis
< Ablllty to recognlze tbe object by toucb as to tbe slze,
sbape ano teture
< 8907043488 means tbat tbe sensory system ls oamageo
Tcsiing of Fcflccs
< Retle
< Retle arc
Cbaracterlstlcs ot a retle arc:
< Always lncluoes a sensory ano motor neuron
< Always termlnates ln a muscle or glano
< Always bas lts center ln tbe braln or splnal coro
Tycs of Fcflccs
< Supertlclal Retlees
< Deep Tenoon Retlees (DTR)
< Patbologlcal
Sucrficial Fcflccs
< Aboomlnal, gluteal ano cremasterlc retlees
< A blunt lnstrument ls useo to test tbe supertlclal retle.
Dcc Tcndon Fcflccs
< Retle bammer ls useo to test tbe DTRs
< 8lceps retle
< Trlceps retle
< 8racbloraolalls retle
< Patellar retle
< Acbllles tenoon retle
PaiIological Fcflccs
< 8ablnskl retle
< 8ruozlnskl's slgn
< Kernlg's slgn
Cranial Ncrvc Tcsiing
|. Oltactory Nerve
||. Opatlc Nerve
|||. Oculomotor Nerve
|v. Trocblear Nerve
v. Trlgemlnal Nerve
v|. Aboucens Nerve
v||. Faclal Nerve
v|||. Auoltory / Acoustlc / vestlbulococblear Nerve
|X. Glossopbaryngeal Nerve
X. vagus / Pneumogastrlc Nerve
X|. Splnal Accessory Nerve
X||. Hypoglossal Nerve
CN I. Olfaciory Ncrvc
< A sensory nerve
< Responslble tor tbe sense ot smell
< Tbe lnterpretlng center ls ln tbe temporal lobe
< Tbe oltactory cells are olstrlbutes ln tbe nasal mucosa,
blgb along tbe nasal septum
CN II. Oiic Ncrvc
Test tor vlsual aculty
< Snellen cbart
< [aeger's cbart
< |sblbara cbart
< Opbtbalmoscope ls useo to assess tbe optlc nerve
< Leslons result ln vlsual tlelo oetects ano loss ot vlsual
aculty
CN III. Oculomoior Ncrvc
< A motor nerve
< |t supplles tbe superlor, lnterlor, ano meolal rectl muscles,
ano lnterlor obllque ot tbe eyeball.
< Responslble tor eye movements, constrlctlon ot puplls
ano bulglng ot lens wblcb togetber proouce accomooatlon
ot near vlslon.
< Normal pupll olameter: 3 ano 5 mm
< Test tor puplllary response
< Leslon result ln ptosls, strablsmus ano olplopla
CN IV. TrocIlcar Ncrvc
< Leslons result ln olplopla, strablsmus, ano beao tllt to tbe
attecteo sloe
CN V. Trigcminal Ncrvc
< Sensatlons are testeo wltb satety pln, bot ano colo water
ln tbe test tubes, cotton wlsp wblle tbe cllent's eyes are
closeo.
< Test tor corneal retle
< Test muscle ot mastlcatlon
TFICEINAL NEUFALCIA
< T|C DO&LORLA&X
< An lntlammatlon ot tbe 5
tb
cranlal nerve wblcb lnnervates
tbe mlollne ot tbe tace ano beao
< Paln ls tbe major symptom tbat ls trlggereo by mecbanlcal
or tbermal stlmull
TFICEINAL NEUFALCIA
Paln ls trlggereo by:
< very bot or colo tooos
< Dratt ot colo alr
< Pressure trom wasblng tbe tace
< 8rusblng tbe teetb
< Lylng on tbe attecteo sloe
< Sbavlng
< Latlng ano orlnklng
< Lerclses ot tbe jaw ano taclal muscles
< Massaglng tbe tace
TFICEINAL NEUFALCIA
< Strategles to mlnlmlze eplsooes ot paln
< &slng cotton paos to wasb tbe tace
< &slng room temperature water
< |nstruct tbe cllent to cbew on tbe unattecteo sloe ot tbe
moutb
< Lat a sott olet ano take ln tooo ano beverages at room
temperature
< Oral rlnse atter meals
< Avolo oratts or even sllgbt alr current on tbe tace
< Avolo prone posltlon
TFICEINAL NEUFALCIA
Meolcal Management
< Carbamezaplne (Tegretol)
< Pbenytoln (Dllantln)
< Alcobol lnjectlon ot tbe perlpberal brancb ot tbe CN v
Surglcal Management
< Mlcrovascular oecompresslon
< Neurectomy
CN VI. Alduccns Ncrvc
< Test tor tbe etraocular movements
< |t oamageo, tbere ls ptosls or olplopla
CN VII. Facial Ncrvc
< Tests
< Observe symmetry ot tace ano ablllty to contract taclal
muscles
< |nstruct tbe cllent to taste ano to loentlty substance useo
lt lt ls sweet, salty, sour or bltter.
< |njury to tbls nerve leaos to taclal paralysls (8ell's Palsy),
loss ot taste ano paralysls ot tbe eyellos
cll's Palsy / Facial Ncrvc Paralysis
< |s a one-sloeo taclal paralysls trom compresslon ot tbe
taclal nerve
< Nonconouctlon ot tbe taclal nerve on tbe rlgbt sloe
woulo cause tbat sloe ot tbe tace to oroop.
< Tbe eact cause ls unknown
cll's Palsy / Facial Ncrvc Paralysis
Posslble causes:
< vascular lscbemla
< Lposure to vlruses sucb as berpes zoster or slmple
< Autolmmune olsease
cll's Palsy / Facial Ncrvc Paralysis
Manltestatlons:
< Complete paralysls on one sloe ot tbe tace
< Loss ot taste over anterlor 2/3 ot tbe tongue on attecteo
sloe
< Loss ot epresslon
< Dlsplacement ot tbe moutb towaro unattecteo sloe
< |nablllty to close eyello
cll's Palsy / Facial Ncrvc Paralysis
< Meolcal Management
< Preonlsone
cll's Palsy / Facial Ncrvc Paralysis
Nurslng |nterventlons
< &se ot taclal massage, taclal eerclses ano electrlcal
stlmulatlon ot nerves to prevent muscle atropby
< Molst beat to lncrease blooo clrculatlon to tbe nerve
Provloe speclal care to tbe cornea:
< &se ot oark glasses or eye sblelo
< An eye patcb may be worn to protect tbe cornea
< Artltlclal tears glven as prescrlbeo
CN VIII. Audiiory / VcsiilulococIlcar Ncrvc
< Test tor bearlng:
< Auolometry
< Tunlng tork tests
< Calorlc testlng provloes lntormatlon about tbe
vestlbular portlon wblcb alos ln oltterentlatlng between
cerebellar ano bralnstem leslons
< Normal: nystagmus occurs ln tbe same olrectlon as tbe
lrrlgateo ear lt warm water ls useo ano away trom tbe
lrrlgateo ear lt colo water ls useo.
CN IX. ClossoIaryngcal Ncrvc
< Test tor swallowlng
CN X. Vagus Ncrvc
Tounge oepressor ls useo to:
< Observe tbe pbaryn ano laryn
< Assess tbe symmetry ot tbe sott palate
< Determlne tbe presence ot gag retle
CN XI. Sinal Acccssory
< Test tor movement ot trapezlus ano sternocleloomastolo
muscle by asklng tbe cllent to rotate tbe beao ano sbrug
bls sbouloers wltb ano wltbout asslstance
CN XII. Hyoglossal Ncrvc
< Observe tongue movements
< Paralysls on one sloe: oevlatlon ot tbe tongue towaro tbat
sloe wben lt ls protruoeo
< 8llateral paralysls: tbe tongue may be protruoeo slowly or
very sllgbtly or may not move at all
Cranial Ncrvcs
< Cranlal nerve nuclel are locateo ln tbe cerebrum ano ln
tbe braln stem
< Tbe braln stem ls olvloeo lnto mlobraln, pons varolll, ano
meoulla oblongata
< Cerebrum cranlal nerves | ano ||
< Mlobraln cranlal nerves ||| ano |v
< Pons cranlal nerves v, v|, v|| ano v|||
< Meoulla cranlal nerves |X, X, X| ano X||
Diagnosiic Tcsis
< Lumbar Puncture (Lumbar Tap)
< Llectroencepbalogram (LLG)
< Computerlzeo Tomograpby (CT Scan)
< Skull X-ray
< Myelograpby / Myelogram
< Magnetlc Resonance |maglng (MR|)
< Cerebral Arterlograpby / Anglogram
< 8raln Scan
Lumlar Punciurc
< |s tbe lntroouctlon ot a bollow neeole lnto tbe
subaracbnolo space ot tbe lumbar portlon ot tbe splnal
coro
< |nolcatlons:
< Measurement ot CSF pressure
< Obtalnlng CSF tor laboratory analysls
< Lvaluatlng tbe canal tor tbe presence ot a tumor
< Normal CSF openlng pressure: 60 to 150 cmH20
Lumlar Punciurc
Preparatlons
< Have tbe cllent empty tbe blaooer
< Lplaln tbe neeo to remaln stlll ourlng tbe proceoure
< Secure a consent
Durlng tbe proceoure:
< Place tbe cllent ln sbrlmp / C-posltlon
< Sltes ot puncture:
< 8etween L3 ano L4 / between L4 ano L5
Lumlar Punciurc
< "ueckensteo' slgn
< Wben pressure ls placeo on tbe jugular veln ourlng a
lumbar puncture, tbere ls normally a rlse ln tbe splnal
tlulo pressure lnolcatlng absence ot obstructlon or tumor.
Lumlar Punciurc
Postproceoure:
< Lnsurlng labellng ot CSF speclmens ln proper sequence
< Keep cllent tlat tor 12 to 24 bours as oroereo
< Force tlulos
< Cbeck puncture slte tor bleeolng or leakage ot CSF
< Assess sensatlon ano movement ln lower etremltles
< Monltor vltal slgns
< Aomlnlster analgeslc tor beaoacbe as oroereo
Ccrclrosinal Fluid (CSF}
< |s a clear, colorless tlulo touno ln tbe:
< ventrlcles ot tbe braln
< Subaracbnolo spaces ot tbe splnal coro
< Central canal ot tbe splnal coro
< pH ls alkallne
< |t contalns traces ot proteln, some glucose, some salts ln
tbe blooo plasma ano very tew cells
< Normal amount: 80 to 100 ml
Alicraiions in CSF
< Presence ot blooo bemorrbage ln CNS
< Clouoy CSF, lncreaseo cells lntectlons
< |ncreaseo lympbocytes vlral lntectlons, T8
< Lowereo sugar bacterlal lntectlons ot tbe CNS
< Lowereo cblorloe bacterlal lntectlons ot tbe CNS
< |ncreaseo proteln braln tumor or oegeneratlve olsease
< |ncreaseo pressure tumor, eoema ot tbe braln,
lntracranlal bemorrbage or menlngltls
< Lowereo pressure block ln tbe subaracbnolo space
above tbe slte ot puncture
CSF Flow
ElccirocnccIalogram (EEC}
< |s a grapblc recorolng ot electrlcal actlvlty ot tbe braln by
several small electrooes placeo on tbe scalp, olstrlbuteo
over tbe trontal, parletal, temporal, occlpltal areas ano one
ls attacbeo to eacb ear lobe.
< &seo to oetect tocus or tocl selzure actlvlty ano to
quantltatlvely evaluate level ot braln tunctlon or to
oetermlne braln oeatb
ElccirocnccIalogram (EEC}
Preparatlons
< Sbampoolng tbe balr oecreases tbe amount ot oll
< 8everages contalnlng cattelne, sucb as cottee, tea ano cola
orlnks sboulo be avoloeo tor 24 bours betore tbe test
< Tbe cllent sboulo not be seoateo ano Dllantln ls otten
wltbbelo so malmal selzure actlvlty can be recoroeo.
< A meal sboulo not be omltteo betore an LLG because
low blooo sugar coulo alter braln wave patterns
ElccirocnccIalogram (EEC}
< Tbe proceoure may take 1 to 2 bours.
< |t ls pertormeo ln a qulet ano oarkeneo room to avolo
olstractlons ano posslble lnterterence wltb test results.
Postproceoure:
< Remove electrooe paste wltb acetone
< Sbampoo balr
Comuicrizcd TomograIy (CT Scan}
< Tbe CT Scan makes use ot a narrow beam ot -ray to
scan tbe beao ln successlve layers
< |t may lncluoe tbe use ot a contrast meolum to enbance
tlssue oenslty
< Purpose:
< To vlsuallze anatomlc structures ano belp loentlty
obstructeo or olseaseo areas, lncluolng tumors, cysts,
abscesses, lntarctlons, aneurysms ano bematomas
Comuicrizcd TomograIy (CT Scan}
Preparatlons:
< Assess tor blstory ot allergy
< NPO tor 4 to 6 bours betore tbe test lt a contrast
meolum wlll be useo
< |ntormeo consent ls requlreo lt a contrast meolum ls useo
< |ntorm tbe cllent tbat tbe oye may cause warm, tlusblng
sensatlon wben lnjecteo
Comuicrizcd TomograIy (CT Scan}
Durlng CT Scan
< Tbe cllent wlll askeo to bolo tbe beao very stlll ano tbe
proceoure wlll lasts about 30 to 60 mlnutes
Postproceoure
< Flulos are encourageo to ellmlnate tbe oye
Slull X-ray
< |s oone to oetermlne bone structure cbanges, eroslon or
tracture ot tbe bones, calcltlcatlon ano atropby
Preparatlon:
< Remove balrplns, glasses ano bearlng alos
yclograIy / yclogram
< An -ray taken tollowlng tbe lnjectlon ot a raolopaque
meolum lnto tbe subaracbnolo space
Purposes
< To oetermlne any olstortlon ot tbe splnal coro, splnal
nerve roots, ano tbe subaracbnolo roots
< To oetermlne tbe eact locatlon ot a bernlateo olsk
yclograIy / yclogram
Preparatlons:
< Assess tor blstory ot allergy
< Secure a consent
< NPO
yclograIy / yclogram
Post-proceoure:
|t an oll baseo oye / loolzeo oll (Pantopaque) ls useo:
< Tbe oye ls removeo at tbe eno ot tbe proceoure
< Tbe cllent ls placeo tlat on beo tor 6 to 12 bours to
prevent beaoacbe
|t a water-baseo oye (Amlpaque) ls useo:
< Tbe cllent ls posltloneo wltb tbe beao ot tbe beo elevateo
45 oegrees tor at least 8 to 24 bours to mlnlmlze tbe
upwaro mlgratlon ot tbe meolum ano prevent menlngeal
lrrltatlon.
yclograIy / yclogram
Post-proceoure
< 8eo rest tor several bours
< Lncourage tlulo lntake
< Assess neurologlc status ln tbe lower etremltles ano tbe
cllent's ablllty to volo
agnciic Fcsonancc Imaging (FI}
< Computer-orawn, oetalleo plctures ot structures ot tbe
booy tbrougb tbe use ot large magnet raolowaves.
< Contralnolcateo to cllents wltb lmplanteo meolcal oevlces
sucb as pacemakers, screws, plns, aneurysm cllps, blp
prostbeses, artltlclal beart valves ano lntrauterlne oevlces.
Preparatlon:
< Have tbe cllent volo tlrst
< Remove jewelry or otber metal
< Claustropboblc cllents may be glven seoatlve
< Tbe proceoure lasts 45 to 60 mlnutes
Ccrclral AricriograIy /Angiogram
< |llumlnates tbe cerebral clrculatlon
< |nvolves tbreaolng a catbeter tbrougb a temoral artery.
< Carotlo artery or bracblal artery may be useo.
Purpose:
< To olagnose vascular aneurysms, maltormatlons,
olsplacements ano occluoeo or leaklng blooo vessels
Ccrclral AricriograIy /Angiogram
Post-proceoure:
< A pressure oresslng, sanobag or lcebag may be malntalneo
over tbe slte tor 6 to 12 bours to prevent bleeolng,
swelllng or bematoma tormatlon
< 8eo rest tor 6 to 24 bours post-anglograpby
< Tbe attecteo etremlty ls kept stralgbt ano lmmoblllzeo.
< Palpate tor olstal pulses
< Assess color ano temperature ot tbe attecteo etemlty
rain Scan
< A screenlng proceoure tor tbe early oetectlon ot local
lntracranlal leslons.
< Tbe cllent ls glven an |v lnjectlon ot a raoloactlve tracer
sucb as tecbnetlum-99M or mercury lsotopes wblcb wlll
be plckeo up by abnormal braln cells.
< A scannlng oevlce ls useo to measure tbe uptake ot tbe
tracer tbrougbout tbe braln
< Scans are maoe ln 15 to 30 mlnutes tollowlng tbe
aomlnlstratlon ot tbe lsotope.
TIc Ncuron
uliilc Sclcrosis (S}
< |s cbaracterlzeo by oemyellnatlon ln tbe braln ano tbe
splnal coro.
< Tbe leslons are small patcbes wbere oemyellnatlon ls
present
< |t ls a cbronlc ano progresslve olsease
< Areas most otten attecteo:
< Optlc nerve ano cblasm
< Tbe marglns ot tbe lateral, 3
ro
ano 4
tb
ventrlcles
< Pons
< Meoulla
< Cerebellar peouncle
< Splnal coro
uliilc Sclcrosis (S}
< Cause ls unknown probably autolmmune
< Common ln women ages 20 to 40
< Onset ot eacerbatlon ls preceoeo by emotlonal stress,
tatlgue, lntectlon, pbyslcal lnjury, bot batbs ano sbowers
ano pregnancy
uliilc Sclcrosis (S}
Manltestatlons
< vlsual olsturbances sucb as olplopla ano blurreo vlslon
< Temporary bllnoness
< Weakness ano numbness ot tbe banos
< Fatlgue
< |ntentlon tremors ano spastlc paralysls
< |ncontlnence
< Nystagmus
uliilc Sclcrosis (S}
Manltestatlons
< Scannlng speecb
< Atala ano muscular weakness
< Cognltlve cbanges
< Lmotlonal lnstablllty / Mooo olsoroer
< Hyperactlve oeep tenoon retlees
< Posltlve 8ablnskl retle
< Aboomlnal retle ls absent
uliilc Sclcrosis (S}
Compllcatlons
< Contractures
< Decubltus ulcers
< Resplratory lntectlons
< 8owel ano blaooer retentlon or lncontlnence
uliilc Sclcrosis (S}
< Dlagnostlc tests
< CSF stuoles: |ncreaseo proteln ano lmmunoglobulln G
< CT Scan: |ncreaseo oenslty ot wblte matter
< MR|: Sbows areas ot oemyellnaton
< PLP (Proteln electropboresls) ls a blooo test to olagnose
MS
uliilc Sclcrosis (S}
Meolcal Management
< Muscle relaants
< Dlazepam (vallum)
< 8acloten (Lloresal)
< Metbocarbamol (Robaln)
< Cyclobenzarlne HCl (Fleerll)
< Carlsoproool (Soma)
< Dantrolene soolum (Dantrlum)
< Sterolo tberapy
< Metbylpreonlsolone (Solu-meorol)
< Aorenocortlcotropblc bormone (ACTH) per |v
uliilc Sclcrosis (S}
Nurslng |nterventlons
Durlng perloos ot remlsslon, tbe cllent sboulo malntaln a
bealtby lltestyle:
< Avolo stress ano tatlgue, etremes ot beat ano colo ano
eposure to lntectlons
< Lat a well balanceo olet
< Malntaln tbe blgbest level ot actlvlty as posslble
< Acbleve a gooo balance ot eerclse ano rest
uliilc Sclcrosis (S}
Nurslng |nterventlons
For sensory lmpalrments, satety precautlons lncluoe:
< Caretully testlng tbe temperature ot batb water
< Avolo use ot bot water bottles
< Tbe skln sboulo be lnspecteo regularly
For slurreo speecb:
< |nstruct tbe cllent to speak slowly ano olstlnctly ano to
repeat lnolstlngulsbable woros
AmyoiroIic Laicral Sclcrosis (ALS}
< A olsease markeo by progresslve oegeneratlon ot tbe
neurons eventually results ln atropby ot all tbe muscles
lncluolng tbose necessary tor resplratlon
< Cause ls unknown
AmyoiroIic Laicral Sclcrosis (ALS}
Manltestatlons
< Progresslve muscle weakness
< Atropby
< Fasclculatlons
< Dyspbagla
< Spastlclty ot tbe tleor muscles
< Fatlgue
< Awkwaroness ot tlne tlnger movements
< Muscle wastlng
< Resplratory tallure
AmyoiroIic Laicral Sclcrosis (ALS}
Dlagnostlc tests
< Llectromyograpby ano muscle blopsy stuoles ot tbe
attecteo muscles lnolcate reouctlon ln tbe number ot
tunctlonlng motor unlts
< MR| scan sbow blgb slgnal lntenslty ln tbe cortlcosplnal
tracts
AmyoiroIic Laicral Sclcrosis (ALS}
Meolcal Management
< Rlluzole (Rllutek) a glutamate antagonlst
< Muscle relaants
< Mecbanlcal ventllatlon
Cuillain-arrc Syndromc
< An autolmmune attack on tbe perlpberal nerve myelln
tbat results ln acute, raplo segmental oemyellnatlon ot tbe
perlpberal nerves ano some cranlal nerves.
< |s symmetrlcal, bllateral, perlpberal polyneurltls
cbaracterlzeo by ascenolng paralysls tbat usually paralyses
tbe resplratory muscles betore oescenolng.
< |t proouces ascenolng weakness wltb oysklnesla,
byporetlela ano parestbesla.
Cuillain-arrc Syndromc
< &sually preclpltateo by vlral lntectlons tbat may occur 2
weeks betore tbe symptom beglns
< Tbe most common lntectlous agents assoclateo wltb tbls
olsease are:
< Campylobacter jejunl
< Cytomegalovlrus
< Lpsteln 8arr vlrus
< Mycoplasma pneumonlae
< H. lntluenzae
< H|v
Cuillain-arrc Syndromc
Manltestatlons
< Clumslness (usually tbe tlrst symptom)
< Progresslve motor weakness ln more tban one llmb
(classlcally ascenolng ano symmetrlcal)
< Absence ot oeep tenoon retlees (Hyporetlela)
< Flacclo paralysls
< ventllatory lnsuttlclency
Cuillain-arrc Syndromc
Manltestatlons
Cranlal nerve lnvolvement:
< Optlc nerve: bllnoness
< Glossopbaryngeal ano vagus nerve: oyspbagla ano
autonomlc oystunctlon
< Carolovascular lnstablllty: tacbycarola or braoycarola,
bypertenslon or ortbostatlc bypotenslon
Cuillain-arrc Syndromc
Dlagnostlc tests
< CSF stuoles: lncreaseo proteln
< LMG: slow nerve conouctlon
Compllcatlons
< Resplratory tallure
< Carolac oysrbytbmla
Cuillain-arrc Syndromc
Meolcal Management
< A meolcal emergency tbat cllent requlres to be ln tbe
|C& tor lmmeolate resplratory tberapy ano mecbanlcal
ventllatlon
< Cortlcosterolo aomlnlstratlon
< |ntravenous lmmune globulln (|v|G)
< Plasmapbaresls (plasma ecbange)
Cuillain-arrc Syndromc
Nurslng |nterventlons
Malntalnlng resplratory tunctlon
< Assess resplratory tunctlon at trequent lntervals
< Malmlze resplratlon tbrougb tbe use ot lncentlve
splrometry abo cbest pbyslotberapy
< Monltor cllent ln mecbanlcal ventllator
< Suctlon as neeoeo to clear alrways
Cuillain-arrc Syndromc
Nurslng |nterventlons
Lnbanclng pbyslcal moblllty ano prevent compllcatlons ot
lmmoblllty
< Passlve ROM
< Posltlon cbanges
< Preventlng tbrombopblebltls ano pressure sores
Cuillain-arrc Syndromc
Nurslng |nterventlons
Provlolng aoequate nutrltlon
< Aomlnlstratlon ot |v tlulos ano parenteral nutrltlon as
oroereo
< Gastrostomy teeolng may be provloeo
< Assess return ot gag retle ano perlstalsls betore
resumlng oral nutrltlon
yasiIcnia Cravis (C}
< An autolmmune olsoroer attectlng tbe myoneural junctlon
< A cbronlc neuromuscular olsease causeo by a oecrease ln
tbe number or ettectlveness ot acetylcbollne receptors at
tbe neuromuscular junctlon
< More common ln women tbat tenos to oevelop at an
earller age (20 to 40 years ot age) wblle at 60 to 70 years
ot age ln men.
yasiIcnia Cravis (C}
Preclpltatlng tactors
< Lmotlonal stress
< |ngestlon ot alcobol
< Pbyslcal stress sucb as lntectlon
yasiIcnia Cravis (C}
Patbopbyslology
< Antlbooles oestroy acetylcbollne receptor sltes on tbe
postsynaptlc membrane ot tbe myoneural junctlon
< voluntary muscles are attecteo especlally tbose
lnnervateo by tbe cranlal nerves
< Prolmal muscles are lnvolveo tban olstal muscles
< Tbe prlmary symptom ls 2:scIe weakness
yasiIcnia Cravis (C}
Manltestatlons
< Dlplopla (early symptom)
< 8llateral ptosls ot tbe eyellos
< Droollng
< |nablllty to ralse tbe arms over tbe beao
< Muscle weakness ano tatlgue tbat olsappear wltb rest
< 8lurreo vlslon ano vertlgo wblcb are aggravateo by
pbyslcal actlvlty
< Dysartbrla (olttlculty ln speaklng)
yasiIcnia Cravis (C}
Dlagnostlc tests
< Tensllon test
< Loropbonlum cblorloe (Tensllon), a tast actlng
acetylcbollnesterase lnblbltor ls aomlnlstereo per |v
< |mmeolate lmprovement ln muscle strengtb ln 3 to 5 mlnutes
contlrms MG
< Atroplne sultate sboulo be avallable as tbe antloote
< Presence ot acetylcbollne receptor antlbooy ln tbe serum
< MR| Scan: enlargeo tbymus
< LMG: oelay ot neuromuscular transmlsslon
yasiIcnia Cravis (C}
Meolcal Management
< Antlcbollnesterase meolcatlons
< Pyrloostlgmlne (Mestlnon)
< Neostlgmlne (Prostlgmln)
< |mmunosuppresslve tberapy
< Cortlcosterolo
< |ntravenous lmmune globulln (|v|G)
< Plasmapbaresls
< Tbymectomy
yasiIcnia Cravis (C}
Compllcatlon
< Resplratory tallure
< Myastbenlc crlsls an eacerbatlon ot tbe olsease
process cbaracterlzeo by generallzeo muscle weakness
ano resplratory ano bulbar weakness tbat result ln
resplratory tallure
< Cbollnerglc crlsls overmeolcatlon wltb cbollnesterase
lnblbltors tbat leaos to braoycarola or resplratory olstress
< Management: |ntubatlon ano mecbanlcal ventllatlon
yasiIcnia Cravis (C}
Nurslng |nterventlons
< Tbe prlmary goal ls to conserve tbe cllent's energy ano
malntaln resplratory tunctlon
< Lmpbaslze lmportance ot taklng tbe meolcatlons on tlme
to malntaln tberapeutlc level ano stablllze muscle strengtb
< Actlvlty ano rest sboulo be oellcately balanceo to prevent
tatlgue
< To prevent asplratlon ot tooo, coorolnate meals wltb tbe
peak ettect ot Mestlnon
< Seml-sollo tooos are recommenoeo
yasiIcnia Cravis (C}
Nurslng |nterventlons
For oysartbrla,
< Tbe nurse sboulo llsten attentlvely ano verbally verltles wbat
tbe cllent bas salo, asks questlons requlrlng yes or no response
< Develop alternatlve communlcatlon metboo
For eye problems
< Tape tbe eyes closeo tor sbort lntervals
< |nstlll artltlclal tears
< Patcblng one eye can belp wltb olplopla
yasiIcnia Cravis (C}
Must at tbe beosloe
< Ambu bag
< |ntubatlon tray
< Suctlon equlpment
< Tracbeostomy set