Multiple Sclerosis & Parkinson's Flashcards
(19 cards)
What is multiple sclerosis ?
chronic, progressive degenerative disease that affects the myelin sheath and conduction pathways of the CNS
- myelin is destroyed which slows nerve conduction
What is the pathophysiology of MS ?
- Triad of: inflammation, demyelination, and scarring in CNS
- autoimmune driven by activated T-cells
- myelin can regenerate when pt is in remission
- as inflammation continues, myelin loses ability to regenerate (nerve function lost permanently at this point)
What are some S&S of MS ?
- sensory, motor, and cerebellar dysfunction
- optic neuritis (inflammation of optic nerve)
- Lhermitte’s sign (electric shock sensation down spine into limbs)
- bowel and bladder problems
- sexual dysfunction
- cognitive sequela
- emotional changes
- overwhelming fatigue
- clumsiness
- diplopia
- halting speech
- intention tremors
What are some diagnostic studies of MS ?
- no definitive test (mostly based on S&S)
- MRI: can show plaque, inflammation, or tissue breakdown
- CSF analysis: increase in immunoglobulin G, and oligoclonal banding
How is someone diagnosed with MS ?
- at least 2 inflammatory demyelinating lesions in 2 different locations in the CNS
- damage of an attack occurring at different times
- all other diagnosis have been ruled out
What is the purpose of Glatiramer Acetate with MS ?
immunomodulator injection
- given SubQ either daily or 3x per week
- rotate injection sites
What is the purpose of corticosterioids with MS ?
treats symptoms of exacerbation
- prednisone & methylprednisolone
How can PT help with MS ?
- helps relieve spasticity
- improve coordination
- trains pt to substitute unaffected muscles for impaired muscles
What are interventions to help with spasticity in MS ?
- surgery
- dorsal column electrical stimulation
- intrathecal baclofen pump
What meds help with spasticity with MS ?
- dantrolene
- diazepam
- baclofen
What are some pt teachings for MS ?
- identify and avoid triggers
- avoid fatigue
- avoid extreme hot and cold
- avoid exposure to infection
- pregnancy
- changes in climate
- med management
What is some RN care for the bowel and bladder for MS ?
- may need to teach to self-catherization
- instruct on S&S of UTI
- good skin care if incontinent
- high fiber diet
- consult HCP before OTC bowel meds
What is the etiology of Parkinson’s ?
- exact cause unknown
- lack of dopamine and lewy bodies
- environmental especially rural residence is a risk factor
What is some S&S of Parkinson’s ?
- tremors
- rigidity/cog wheel
- akinesia (inability to move extremities voluntarily) & bradykinesia
- postural instability
- mask-like expression
- slow monotonous speech
- pin rolling tremors
- shuffling gait
What are some safety measures of Parkinson’s ?
- preventing falls
- risk for freezing then fall
- rock from side to side
- safe environment: remove rugs
- elevated toilet seat with rails
- simple clothing and shoes
What are some physical exercise considerations for Parkinson’s ?
- limits the consequences of decreased mobility
- aim is strengthening and stretching
- exercise will not halt progression
- OT for functional adapations
What are some nutritional considerations for Parkinson’s ?
- diet is important
- malnutrition & constipation can be serious
- dysphagia diet so it can be easily chewed
- adequate fiber and fruits
- six small meals
- ample time to eat
What are some surgical therapies for Parkinson’s ?
- deep brain stimulation
- ablation thalamotomy or pallidontomy: destroys tissue that produces abnormal chemical impulses
- transplantation: fetal neural tissue is placed into the basal ganglia
What is the purpose of Carbidopa/Levodopa (Sinemet) ?
corrects imbalance of neurotransmitters in the CNS
- enhances the release of dopamine
- levodopa: can cross the BBB
- Carbidopa: inhibits the enzymes that breaks down levodopa
