Amyotrophic Lateral Sclerosis

(S/S)

• Between 40-70 years of age
• Weakness of upper extremities, dysarthria, dysphagia
• Pain, sleep disorders, spasticity, drooling, emotional lability, depression, constipation and esophageal reflux

Amyotrophic Lateral Sclerosis

(Diagnostics)

• Creatinine Kinase level - increased
• Electromyogram- reduction in number of functioning motor units of peripheral nerves.
• Muscle Biopsy - Reduction in number of motor units of peripheral nerves and atrophic muscle fibers.

Amyotrophic Lateral Sclerosis

(Nursing Implications)

• Maintain airway, suction and/or intubate as needed
• Monitor ABG's and administer O2 - mechanical ventilation as needed
• Keep bed at 45 degrees, turn, cough, deep breathe q2h, incentive spirometry
• facilitate effective communication
• Assess coping/depression
• advance directives/living wills
• Nutrition-enteral when no longer able to swallow

Aneurysm

(S/S)

• Often asymptomatic
• elevated blood pressure
• neurological deficits

Aneurysm

(Diagnosis)

• Xray
• CT scan
• ultrasound

Aneurysm

(Nursing Implications)

• Take vitals every 15 min, until stable, then every hour.
• Assess onset, quality, duration, severity of client's pain
• assess temperature, function, circulation of all extremities
• Monitor ABG's, CBC's, electrolytes
• Monitor hourly urine output - >30 ml hour=adequate renal perfusion

Bell's Palsy

(S/S)

• accompanied by an outbreak of herpes vesicles in and around the ear (pain)
• fever, tinnitus, hearing deficit
• drooping of one side of the face/mouth with drooling
• inability to close eyelid
• inability to smile, frown or whistle

Bell's Palsy

(Diagnosis)

Exclusion - no definitive test

electromyography test for percutaneous nerve excitability

Bell's Palsy

(Nursing Implications)

• Protect face from extreme heat/cold
• Treat pain with analgesics
• Maintenance of good nutrition-teach them to chew on good side of face
• Thorough oral hygiene
• Hot/wet packs can be applied to face
• Antivirals for herpes virus
• Artificial tears for dry eyes
• recovery w/in 6 wks can be expected

Stroke

(S/S)

• dizziness, slurred speech, weakness of an extremity
• Left cerebral hemisphere: language, math, analytic thinking, right side of body
• Right cerebral hemisphere: Visual, spatial, proprioception and left side of body

Stroke

(Diagnostics)

• MRI, CT to identify edema, ischemia, necrosis
• MRA or cerebral angiography to identify cerebral hemmorhage
• Lumbar puncture to assess for blood in CSF
• GCS is used when client has decreased LOC < 8 indicates possible increased ICP

Stroke

(Nursing Implications)

• Elevate client's bed 30 degrees to reduce ICP and promote venous drainage
• Institute seizure precautions
• Assist with client communication if speech is impaired
• Assist with safe feeding
• Maintain skin integrity
• PROM q2h
• reduce risk for falls

Stroke (2)

(Nursing Implications)

• Monitor for dysphagia and risk for aspiration
• Assess gag reflex-thick liquids better than thin
• self care deficit r/t unilateral neglect of the affected side

Epilepsy

(S/S)

• May begin with an aura
• 15-20 second tonic episode and loss of consciousness
• 1-2 min. clonic episode follows
• breathing may stop (tonic)or be irregular (clonic)
• cyanosis
• incontinence
• sleepiness and weakness during postictal phase

Epilepsy

(Diagnostics)

• test for illicit drugs/alcohol, excessive toxins
• Electroencephalogram (EEG)

no caffeine for 6-9 hr

wash hair before procedure

sleep may be with-held before the procedure

• MRI, CT, PET scan, CSF analysis can all be used to identify type of seizure

Epilepsy

(Nursing Implications)

During seizure

• Protect client from injury
• Provide patent airway
• be prepared to suction
• turn client on side to prevent aspiration
• loosen restrictive clothing
• document onset and duration of seizure

Epilepsy (2)

(Nursing Implications)

Post seizure

• Maintain client in a side lying position
• check vitals
• assess for injuries
• perform neuro checks
• allow client to rest
• reorient and calm patient

Guillane Barre Syndrome

(S/S)

• Increasing weakness with no recollection of injury
• virus within 1-3 wks previous
• acute progressive muscle weakness and paralysis
• muscle flaccidity w/o muscle atrophy
• decreased or absent DTRs
• signs of respiratory compromise when symptoms reach thoracic cage
• autonomic dysfunction

Guillane Barre Syndrome

(Diagnostics)

• Electromyography and nerve conduction velocity
• WBC count
• Lumbar puncture - shows increase in protein within CSF w/o increase in cell count

Guillane Barre Syndrome

(Nursing Implications)

• Monitor respiratory status, have O2, suction and intubation equipment ready
• keep head of the bed at 45 degrees, turn, cough, deep breathe q2h
• Monitor heart rhythm for bradycardia
• monitor BP and respond as necessary
• assess for dysarthria/dysphagia
• Assess pain, provide measures to prevent skin breakdown

Headache

(S/S)

Tension

• No prodrome
• may involve photo or phonophobia
• pain is band around head

Migraine

• preceded by prodrome and aura
• 4-72 hours in length
• steady, throbbing pain synchronous with pulse
• unilateral, by one temple

Cluster

• sharp and stabbing pain
• few min-3 hrs, several times a day, for 2-3wks
• located around the eye
• alcohol, napping and strong odors are triggers

Headache

(Diagnostics)

Tension

• History. EMG

Migraine

• History

Cluster

• History-headache diary
• CT, MRI are done to rule out other conditions

Headache

(Nursing Implications)

• Stress coping techniques
• exercise, relaxation and socializing should be encouraged
• Migraines-keep environment quiet and dimly lit
• Analgesics for pain
• dietary counseling if headaches are triggered by certain foods

Multiple Sclerosis

(S/S)

• Fatigue-esp. of the lower extremities
• pain or parathesia
• Diplopia, changes in peripheral vision, decreased visual acuity
• Uhthoff's sign-temp. worsening of vision when tired or exposed to heat
• dysphagia, dysarthria
• Muscle spasticity
• bladder or bowel dysfunction
• cognitive changes

Multiple Sclerosis

(Diagnostics)

• CSF analysis-elevated protein and WBC count
• MRI - looking for diagnostic plaques

Multiple Sclerosis

(Nursing Implications)

• Encourage fluid intake to prevent UTI - assist client with urinary elimination
• Monitor cognitive changes and take interventions to maintain function (i.e. reorient client, place objects in routine places)
• facilitate effective communication
• exercise and stretch involved muscles
• Promote and maintain safe environment

Myasthenia Gravis

(S/S)

• Progressive muscle weakness
• Diplopia
• Difficulty chewing and swallowing
• respiratory dysfunction
• bowel and bladder dysfunction
• fatigue after exertion
• drooping eyelids(ptosis)

Myasthenia Gravis

(Diagnostics)

• Baseline assessment of cranial muscle
• Edrophonium chloride is administered (+ if muscle strength improves)

Myasthenia Gravis

(Nursing Implication)

• Assess and intervene as necessary to maintain a patent airway
• Assess swallowing to prevent aspiration
• use energy conservation, rest periods
• provide small, frequent, high calorie meals when medication is peaking
• have client sit upright and use thickener for liquids as necessary
• Use eyedrops to lubricate eyes that are unable to close completely

Parkinson's Disease

(S/S)

• Stooped posture
• Slow, shuffling, propulsive gait
• slow, monotonous speech
• tremors, pill-rolling
• bradykinesia
• difficulty chewing/swallowing
• progressive difficulty with ADL's
• Mood swings

Parkinson's Disease

(Diagnostics)

• No definitive diagnostic procedures
• based on symptoms, their progression, ruling out other diseases

Parkinson's Disease

(Nursing Implications)

• Monitor swallowing and maintain adequate nutrition (Wt., Diet journal, smaller, frequent meals)
• Maintain client mobility for as long as possible (ROM, exercise, ADLs)
• Promote client communication for as long as possible (speak slowly, pause frequently, alternate forms of communication)
• Monitor client's mental and cognitive status

Acute Arterial Ischemia

(S/S)

• Six P's: Pain, pallor, paralysis, pulselessness, paresthesia, poikilothermia
• Foot drop occurs as a result of nerve damage

Acute Arterial Ischemia

(Diagnostics)

• Symptoms are Diagnostic

Acute Arterial Ischemia

(Nursing Implications)

• Anticoagulant therapy
• Monitor vitals
• Examine urine and stool for blood
• Inspect platelet count for signs of thrombocytopenia
• minimize venipunctures
• Avoid IM injections
• Notify health care provider of any abnormalities in assessments, vital signs or lab values

Chronic Venous Insufficiency

(S/S)

• skin of lower leg is leathery
• Edema has usually been present for a long time
• Eczema, stasis dermatitis
• higher skin temp in the ankle area
• pain worse when leg is the dependent position

Chronic Venous Insufficiency

(Diagnostics)

Chronic Venous Insufficiency

(Nursing Implications)

• compression therapy (assess for PAD before instituting)
• Moist environment dressings for wound care
• evaluate nutritional status-adequate protein, calories and micronutrients are essential for healing
• assess for signs of infection
• teach patient about self care because venous ulcers often reoccur
• proper foot and leg care, elevate legs above level of heart to reduce edema; begin a walking program
• avoid standing or sitting for long periods

Deep Vein Thrombosis

(S/S)

• Virchow's Triad: venous stasis, damage of endothelium, hypercoagulability of blood
• may have unilateral leg edema
• extremity pain
• sense of fullness in thigh or calf
• paresthesias, warm skin or temp greater than 100.4 deg.
• positive Homan's sign (classic, but unreliable)

Deep Vein Thrombosis

(Diagnostics)

• Blood lab studies: ACT, aPTT, INR, bleeding time, Hb, Hct, platelet count, fibrin monomer complex
• venous compression ultrasound(veins fail to collapse with application of external pressure)
• Computed tomography venography, MR venography, Contrast venography (phlebogram)

Deep Vein Thrombosis

(Nursing Implications)

• Prevention is the best treatment, Pts on bed rest need to change position q2h, ambulate 4-6x per day as tolerated
• Graduated compression stockings (TED hose)-worn properly and removed for assesment at least 1xday
• Sequential compression devices (SCDs)-not during active DVT
• Anticoagulant therapy
• education on modification of DVT risk factors, how to recognize PE

Intermittent Claudication

(S/S)

• Muscle pain precipitated by activity relieved by rest (w/in 10 min)
• aortoilliac artery-pain in buttocks/thigh
• femoral/popliteal artery-pain in calf
• symptom of PAD

Intermittent Claudication

(Diagnostics)

• Doppler ultrasound
• Segmental blood pressures-at thigh, below knee, at ankle
• ankle/brachial index=ankle systolic/brachial systolic
• Angiography and MRIA

Peripheral Artery Disease

(PAD)

(S/S)

• intermittent claudication (pain on exercise/relieved by rest)
• parasthesia-numbness/tingling of hands or feets
• skin is thin, shiny, taut, hair loss on lower legs
• diminished or absent pedal, popliteal and/or femoral pulses
• elevation pallor -extremity is pale when elevated
• reactive hyperemia-redness of the foot when limb is down
• rest pain at night

Peripheral Artery Disease

(Diagnostics)

• Doppler ultrasound
• Segmental blood pressures-at thigh, below knee, at ankle
• ankle/brachial index=ankle systolic/brachial systolic
• Angiography and MRIA