Multiple sclerosis is an autoimmune disease that destroys the myelin sheath protecting nerve fibers in the central nervous system. It causes symptoms like visual problems, motor dysfunction, fatigue, and mood changes. Diagnosis involves MRI and lumbar puncture. Nursing care focuses on promoting mobility, preventing injuries, managing symptoms, and strengthening coping. Guillain-Barré syndrome is an autoimmune disorder where the body's immune system attacks the peripheral nervous system, causing muscle weakness and sometimes paralysis. It is usually triggered by a viral or bacterial infection. Nursing care includes maintaining respiratory function, enhancing physical mobility, providing adequate nutrition, and managing complications. Alzheimer's disease is a progressive brain disorder causing cognitive decline. Sympt

1. DEMYELINATING DISEASES Nurse Licensure Examination Review

2. MULTIPLE SCLEROSIS An auto-immune mediated progressive demyelinating disease of the CNS The myelin sheath is destroyed and replaced by sclerotic tissue (sclerosis)

3. MULTIPLE SCLEROSIS CAUSE- unknown Multiple factors- viral infection, environmental factors,geographic location and genetic predisposition Common in WOMEN ages 20-40

6. MULTIPLE SCLEROSIS PATHOPHYSIOLOGY Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission

7. MULTIPLE SCLEROSIS PATHOPHYSIOLOGY The most common areas affected are Optic nerves and chiasm Cerebrum Cerebellum Spinal cord

8. MULTIPLE SCLEROSIS CLINICAL MANIFESTATIONS 1. visual problems such as diplopia, blurred vision and nystagmus 2. motor dysfunction 3. Fatigue 4. Mental changes like mood swings, depression 5. spasticity

9. MULTIPLE SCLEROSIS DIAGNOSTIC TESTS 1. MRI- primary diagnostic study 2. CSF Immunoglobulin G

10. MULTIPLE SCLEROSIS NURSING INTERVENTIONS 1. Promote physical mobility Exercise Schedule activity and rest periods Warm packs over the spastic area Swimming and cycling are very useful

11. MULTIPLE SCLEROSIS NURSING INTERVENTIONS 2. Prevent injuries Wide stance walking Use of walking aids Wheelchair

12. MULTIPLE SCLEROSIS 3. Enhance bladder and bowel control Set a voiding schedule Intermittent bladder catheterization Use of condom catheter Adequate fluids, dietary fibers and bowel training program

13. MULTIPLE SCLEROSIS 4 . Manage speech and swallowing difficulties Careful feeding, proper positioning, suction machine availability Speech therapist

14. MULTIPLE SCLEROSIS 5. Improve Sensory and Cognitive function Vision- use eye patch for diplopia Obtain large printed reading materials Offer emotional support Involve the family in the care

15. MULTIPLE SCLEROSIS 6. Strengthen coping mechanism Alleviate the stress Referral to the appropriate agencies

16. MULTIPLE SCLEROSIS 7. improve self-care abilities Modify activities according to physical strength Provide assistive devices

17. MULTIPLE SCLEROSIS 8. promote sexual functioning Refer to sexual counselor

18. MULTIPLE SCLEROSIS MEDICAL MANAGEMENT Pharmacotherapy Interferons Immunomodulators Corticosteroids BACLOFEN for muscle spasms NSAIDS for pain

19. Guillian-Barre’ Syndrome An auto-immune attack of the peripheral nerve myelin Acute, rapid segmental demyelination of peripheral nerves and some cranial nerves

20. Guillian-Barre’ Syndrome CAUSE: post-infectious polyneuritis of unknown origin commonly follows viral infection

21. Guillian-Barre’ Syndrome PATHOPHYSIOLOGY Cell-mediated imune attack to the myelin sheath of the peripheral nerves Infectious agent may elicit antibody production that can also destroy the myelin sheath

23. Guillian-Barre’ Syndrome CLINICAL MANIFESTATIONS 1. Ascending weakness and paralysis 2. diminished reflexes of the lower extremities 3. paresthesia 4. potential respiratory failure

24. Guillian-Barre’ Syndrome NURSING INTERVENTIONS Maintain respiratory function Chest physiotherapy and incentive spirometry Mechanical vetnilator

25. Guillian-Barre’ Syndrome NURSING INTERVENTIONS 2. Enhance physical mobility Support paralyzed extremities Provide passive range of motion exercise Prevent DVT and pulmonary embolism Padding over bony prominences

26. Guillian-Barre’ Syndrome NURSING INTERVENTIONS 3. Provide adequate nutrition IVF Parenteral nutrition Assess frequently return o gag refelx

27. Guillian-Barre’ Syndrome NURSING INTERVENTIONS 4. Improve communication Use other means of communication

28. Guillian-Barre’ Syndrome NURSING INTERVENTIONS 5. Decrease fear and anxiety Provide Referrals Answer questions Provide diversional activities 6. Monitor and manage complications DVT, Urinary retention, pulmonary embolism, respiratory failure

29. Guillian-Barre’ Syndrome MEDICAL MANAGEMENT ICU admission Mechanical Ventilation TPN and IVF PLASMAPHERESIS IV IMMUNOGLOBULIN

30. ALZHEIMER’S disease A progressive neurologic disorder that affects the brain resulting in cognitive impairments

31. ALZHEIMER’S disease CAUSES: Unknown Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies

34. ALZHEIMER’S disease CLINCAL MANIFESTATIONS 1. Forgetfulness 2. Recent memory loss 3. Difficulty learning 4. Deterioration in personal hygiene 5. Inability to concentrate

35. ALZHEIMER’S disease LATE CLINICAL MANIFESTATIONS 6. Difficulty in abstract thinking 7. Difficulty communicating 8. Severe deterioration in memory, language and motor function 9. repetitive action- perseveration 10. personality changes

36. ALZHEIMER’S disease DIAGNOSTIC TEST Neurologic examination PET scan EEG, CT and MRI Other tests to rule out Vit B deficiencies and hypothyroidism Autopsy is the most definitive

37. ALZHEIMER’S disease Drug therapy 1. drugs to treat behavioral symptoms- antipsychotics 2. anxiolytics 3. Donepezil 4. Tacrine

38. ALZHEIMER’S disease Nursing Interventions 1. Support patient’s abilities 2. Provide emotional support

39. ALZHEIMER’S disease Nursing Interventions 3. Establish an effective communication system with the patient and family Use short simple sentences, words and gestures Maintain a calm and consistent approach Attempt to analyze behavior for meaning

40. ALZHEIMER’S disease 4. protect the patient from injury Provide a safe and structured environment Requests a family member to accompany client if he wanders around Keep bed in low position Provide adequate lightning Assign consistent caregivers

41. ALZHEIMER’S disease 5. Encourage exercise to maintain mobility

42. PARKINSON’s Disease A slowly progressing neurologic movement disorder The degenerative idiopathic form is the most common form

43. PARKINSON’s Disease CAUSATIVE FACTORS: unknown Potential factors: genetics, atherosclerosis, free radical stress, viral infection, head trauma and environmental factors

45. PARKINSON’s Disease Pathophysiology Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia Clinical symptoms do not appear until 60% of the neurons have disappeared

47. PARKINSON’s Disease CLINICAL MANIFESTATIONS 1. Tremor- resting, pill-rolling 2. Rigidity- cog-wheel, lead-pipe 3. Bradykinesia- abnormally slow movement 4. Dementia, depression, sleep disturbances and hallucinations 5. excessive sweating, paroxysmal flushing, orthostatic hypotension

48. PARKINSON’s Disease Medical management 1. Anti-parkinsonian drugs- Levodopa, Carbidopa 2. Anti-cholinergic therapy 3. Antiviral therapy- Amantadine 4. Dopamine Agonists- bromocriptine and Pergolide, Ropirinole anmd Pramipexole

49. PARKINSON’s Disease Medical management 5. MAOI 6. Anti-depressants 7. Antihistamine

50. PARKINSON’s Disease NURSING INTERVENTIONS 1. Improve mobility 2. Enhance Self- care activities 3. Improve bowel elimination 4. Improve nutrition 5. Enhance swallowing 6. Encourage the use of assistive devices

51. PARKINSON’s Disease NURSING INTERVENTIONS 7. improve communication 8. Support coping abilities

52. EPILEPSY A group of syndromes characterized by recurring seizures CAUSES 1. idiopathic 6. brain tumors 2. Birth trauma 7. head Injury 3. perinatal infection 8. metabolic disorders 4. infectious disease 9. CVA 5. ingestion of toxins

54. EPILEPSY Recurring seizures may be classified as GENERALIZED or PARTIAL SEIZURES Generalized Seizures- cause a generalized electrical abnormality within the brain Partial seizures- these seizures arise from a localized part of the brain and cause specific symptoms

55. GENERALIZED SEIZURES 1. General Tonic-Clonic seizure- ( Grand mal ) characterized by loss of consciousness and alternating movements of the extremities 2. Absence Seizure ( Petit mal )- common in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares

56. GENERALIZED SEIZURES 3. Myoclonic seizure- characterized by brief, involuntary muscular jerks of body extremities 4. Akinetic seizure- general loss of postural tone and a temporary loss of consciousness- a drop attack

58. PARTIAL SEIZURES 1. Simple partial seizure- typically limited to one cerebral hemisphere 2. Complex partial seizure- begins with an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements

59. Epilepsy DIAGNOSTIC TESTS 1. EEG 2. CT 3. MRI 4. LP 5. Angiography

60. Epilepsy Medical treatment 1. Anticonvulsants- most commonly phenytoin, phenobarbital and carbamazepine Ethosuximide and valproic acid for absence seizure 2. surgery

61. Epilepsy Nursing Intervention 1. Care of patients during seizure 2. care of patients after seizures 3. patient teaching

62. BELL’S PALSY Causes 1. infection 2. hemorrhage 3. tumor 4. local traumatic injury

64. BELL’S PALSY MANIFESTATIONS 1. Unilateral facial weakness 2. Mouth drooping 3. Distorted taste perception 4. Smooth forehead 5. Inability to close eyelid on the affected side 6. Incomplete eye closure 7. excessive tearing when attempting to close the eyes 8. Inability to raise eyebrows, puff out the cheek

65. BELL’S palsy Diagnostic tests EMG Medical management 1. Prednisone 2. Artificial tears

66. BELL’S palsy Nursing Interventions 1. Apply moist heat to reduce pain 2. Massage the face to maintain muscle tone 3. Give frequent mouth care 4. protect the eye with an eye patch. Eyelid can be taped at night 5. instruct to chew on unaffected side

67. Trigeminal neuralgia Also called Tic Douloureux Painful disorder that affects one or more branches of the fifth cranial nerve CAUSES: repetitive pulsation of an artery as it exits the pons is the usual cause

69. Trigeminal neuralgia ASSESSMENT 1. Pain history 2. Searing or burning jabs of pain lasting from 1-15 minutes in an area innervated by the trigeminal nerve DIAGNOSTIC TESTS Skull x-ray or CT scan

70. Trigeminal neuralgia NURSING INTERVENTIONS 1. provide emotional support 2. encourage to express feelings 3. provide adequate nutrition in small frequent meals at room temperature

71. Myasthenia gravis A sporadic, but progressive weakness and abnormal fatigability of striated muscles which are exacerbated by exercise and repetitive movements

72. Myasthenia gravis ETIOLOGY Autoimmune disease Thymoma Women suffer at an earlier age and are more affected

73. Myasthenia gravis Pathophysiology: 1. Acetylcholine receptor antibodies interfere with impulse transmission 2. Follows an unpredictable course of periodic exacerbations and remissions

76. Myasthenia gravis CAUSE: autoimmune disorder that impairs transmission of nerve impulses ASSESSMENT FINDINGS Gradually progressive skeletal muscle weakness and fatigue Weakness that worsens during the day Ptosis, diplopia and weak eye closure Blank, mask-like facies Difficulty chewing and swallowing Respiratory difficulty

77. Myasthenia gravis DIAGNOSTIC TESTS 1. EMG 2. TENSILON TEST 3. CT scan 4. Serum anti-AchReceptor antibodies

78. Myasthenia gravis MEDICAL THERAPY Anticholinesterase drugs- pyridostigmine and neostigmine Corticosteroids Immunosuppresants Plasmapheresis Thymectomy

80. Myasthenia gravis NURSING INTERVENTIONS 1. Administer prescribed medication as scheduled 2. Prevent problems with chewing and swallowing 3. Promote respiratory function 4. Encourage adjustments in lifestyle to prevent fatigue 5.maximize functional abilities

81. Myasthenia gravis 6. Prepare for complications like myasthenic crisis and cholinergic crisis 7. prevent problems associated with impaired vision resulting from ptosis of eyelids 8. provide client teaching 9. promote client and family coping

82. Meningitis Infection or inflammation of the meninges covering the brain and spinal cord. Caused by bacterial, viral and fungal agents

83. Brain Abscess A free or encapsulated collection of pus in the brain parenchyma Causes: usually secondary to another infection like- sinusitis, meningitis, dental abscess, mastoiditis, bacteremia and trauma

85. Encephalitis Intense inflammation of the brain tisssue with lymphocytic infiltration, cerebral edema, degeneration of brain cells and diffuse nerve cell destruction

86. CNS infections ASSESSMENT FINDINGS Meningitis 1. fever, headache, vomiting 2. positive meningeal sings Brain abscess 1. headache, N/V, seizures, changes in LOC 2. Focal neurologic deficits

88. CNS infections DIAGNOSTIC TESTS 1. CT scan 2. MRI 3. EEG MEDICAL TREAMENT 1. Antibiotics 2. Surgical drainage 3. Drugs to reduce increased ICP

89. CNS infections NURSING INTERVENTIONS 1. Frequent monitoring of neurologic status 2. Monitor intake and output 3. Administer antibiotics 4. Administer mild laxative to prevent constipation 5. maintain quiet environment

90. Neoplastic diseases A brain tumor is a localized intracranial lesion that occupies space within the skull Primary brain tumors originate from cells and structures within the brain.

91. Neoplastic disease The cause of brain tumors is unknown The only risk factor accepted is radiation exposure to ionization rays

92. Neoplastic disease CLINICAL MANIFESTATIONS 1. increased ICP Vomiting Headache. Especially early in the morning Vomiting Visual disturbances

93. Neoplastic disease 2. Localized symptoms Hemiparesis Seizures Mental status changes

94. Neoplastic disease DIAGNOSTIC TESTS 1. CT scan 2. MRI 3. PET 4. EEG

95. Neoplastic disease MEDICAL MANAGEMENT Surgery Chemotherapy Radiotherapy

96. Neoplastic disease NURSING INTERVENTIONS 1. promote self-care independence 2. improve nutrition 3. relieve anxiety 4. enhance family processes 5. provide pre-operative and post-operative care 6. manage pain