Introduction to Nursing Interventions for Neurological Disorders

In this NCLEX Review, the main focus will be Multiple sclerosis (MS), Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, Amyotrophic lateral sclerosis (ALS), and Guillain-Barre syndrome (GBS).

Multiple sclerosis (MS) is a disorder that affects the central nervous system, and is not contagious or inherited. It can cause muscle weakness, numbness, vision problems, and other related symptoms. 

Parkinson’s disease is a progressive neurological disorder affecting movement and balance. It’s caused by a loss of nerve cells in specific areas of the brain.

Alzheimer’s disease is a type of dementia that causes memory loss, confusion, and difficulty thinking clearly and concentrating. 

It’s thought to be caused by an abnormal buildup of proteins. This buildup of naturally occurring proteins clump together to form plaques that collect between neurons and disrupt cell function. Another protein forms tangles within the cells, which disrupts connections.

Huntington’s disease is an inherited genetic disorder affecting muscles and coordination. It’s caused by a breakdown (degeneration) of the nerve cells of the brain.

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease or motor neuron disease (MND), is a fatal progressive neurodegenerative disease. It causes muscle weakness and difficulty with movement due to damage to motor neurons in the brain and spinal cord. 

Guillain-Barre syndrome (GBS) is an immune reaction that causes paralysis after infection with bacteria or viruses, usually at least two weeks after exposure to an infection somewhere in the body.

The good news is that nursing interventions can help treat neurological disorders by identifying symptoms and providing supportive care.

Multiple Sclerosis (MS) Pathophysiology

MS is an autoimmune disease where the body attacks myelin sheaths, the sheets of fatty tissue around nerve cells that help the body move.

Memory Trick

MS – Myelin Sheath destruction

MS – Muscle Spasm & Stiffness

Multiple Sclerosis Causes

The exact cause of MS is unknown, but researchers believe it may be related to autoimmune disorders in which the immune system attacks healthy tissue. Other risk factors include:

• Female more common 
• Infections
  • Viruses such as the Epstein-Barr virus
• Vitamin D deficiency
• Smoking
• Genetics

Multiple Sclerosis Signs and Symptoms 

While signs and symptoms vary from person to person, they typically start gradually and worsen over time. The most common first symptom is numbness or tingling in one area of the body (often the toes or fingers). Other initial symptoms include:

• Loss of balance and coordination
• Muscle weakness or stiffness
• Vision problems (blurred or double vision) 
• Fatigue
• Muscle spasms

As MS progresses, symptoms can include: 

• Difficulty walking
• Bladder problems
• Sexual dysfunction
• Bowel incontinence
• Depression
• Pain
• Cognitive problems (memory loss or difficulty concentrating)

Multiple Sclerosis Client Education & Nursing Interventions

Because of this wide range of symptoms, nurses must educate their clients about managing their own care. Some clients may need more assistance than others, while others must be aware of their specific needs.

• Encourage a balance of exercise and rest, as well as independence.
• Provide accessibility and mobility assistance, such as canes, walkers, and wheelchairs.
• Avoid the four Ss, which can trigger flare-ups:
  • Stress (exercise, surgery, injury)
  • Sickness or Sepsis
  • Smoking
  • Sun and extreme heat (hot tub, bath, sauna)
• Report signs of infection & bleeding with medications.

Multiple Sclerosis Medications (Pharmacology)

Cyclosporine 

Cyclosporine is a crucial immunosuppressant that prevents the release of cytokines. It works by inhibiting calcineurin, an enzyme that activates T-cells. As a result, it binds to cyclophilin and inhibits calcineurin activation.

Cyclosporine is a potent immunosuppressant drug used in the treatment of organ transplant rejection and graft versus host disease. It’s also used to treat autoimmune diseases such as psoriasis and rheumatoid arthritis.

An important point to remember:  Cyclosporine is not safe for pregnant clients.

Azathioprine

Azathioprine is a medication used to treat organ transplant recipients. It is also prescribed in the treatment of rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and psoriasis.

Azathioprine works by suppressing the immune system, which means it blocks certain cells from attacking healthy tissue. This can help reduce the symptoms of autoimmune diseases.

Mechanism of action for Azathioprine include: 

• Inhibition of purine synthesis
• Inhibition of de novo thymidine synthesis
• Inhibition of DNA synthesis

Intravenous Immune Globulin (IVIG) 

Intravenous Immune Globulin (IVIG) is a blood product used to treat primary immunodeficiency disorders, such as MS. 

It’s a type of antibody that helps the body fight infections and foreign substances in the bloodstream. IVIG provides the body with extra antibodies when it cannot make its own. It blocks the body from attacking itself to maintain the myelin sheaths.

The mechanism of action of IVIG is boosting the immune system by providing antibodies against various pathogens that are not present within the body. These antibodies neutralize bacteria and viruses before they can cause disease.

Other medications can also be prescribed to MS clients, including: 

• Interferon to interfere with the body attacking itself.
• Steroids to decrease body swelling.
• Muscle relaxants to reduce muscle spasms.

Parkinson’s Disease Pathophysiology

Parkinson’s Disease is a movement disorder with the progressive death of neurons in the brain resulting in low dopamine and high acetylcholine. It occurs when there’s dysfunction in the extrapyramidal system (damage to or presumed dysfunction of the basal ganglia and their brainstem and cerebellar connections).

Parkinson’s comes with involuntary movement disorders and excess stimulation, which affects movement and posture.

Memory Trick

• Think no dope in the park – low DOPamine – in PARK-insons
• High acetylCCCholine – we get high seCCCretions with lots of drooling

Signs & Symptoms 

• Resting tremors
• Delay in the initiation of movement (Bradykinesia)
• Shuffling gait 
• Decreased arm swinging
• Pill rolling
• Difficulty swallowing (Dysphagia)
• Muscle rigidity
• Impaired speech (Dysarthria)
• Mask-like facial appearance
• Drooling

Nursing Interventions for Parkinson’s Disease

Provide

• Suction set up at bedside (excess drooling)
• Pureed diet and small, bite-sized pieces
• Assistance with dressing
• Education about home care and safety

Monitor

• Swallowing
• Client’s balance (they may not be able to sense when they’re about to fall)
• Food and fluid intake

Position

• High Fowler’s, upright

Encourage 

• Clients to use assistive devices 

Parkinson’s Drugs (Pharmacology)

The main goal of administering these medications is to increase dopamine and decrease acetylcholine.

Carbidopa & Levodopa 

Both Carbidopa and Levodopa work by blocking the breakdown of dopamine in the brain, which helps to control symptoms of Parkinson’s disease. Carbidopa conserves dopamine, while Levodopa leaves more dopamine in the brain.

Carbidopa is a medication that inhibits the enzyme DOPA decarboxylase, which is responsible for converting levodopa into dopamine. This conversion is necessary for the drug to work as a dopamine agonist by increasing the amount of dopamine produced in the brain. (It prevents levodopa from being broken down before reaching the brain)

Levodopa is a precursor to dopamine, and it must be converted into dopamine before it can be used in the body.

Memory Trick: – If you want to jump rope, you need more DOP-amine

Benztropine 

Benztropine is a medication that has been used in the treatment of Parkinson’s disease and restless leg syndrome. It works by blocking dopamine receptors in the brain, which helps to control movement.

Benztropine is a medication that slows the movement of impulses in the brain. It corrects the imbalance between dopamine and acetylcholine in Parkinson’s clients.

Benztropine works by affecting the transmission of nerve impulses in the brain. This causes side effects such as drowsiness, confusion, and potentially dangerous changes in heart rate or blood pressure. The risk of side effects increases with each dose taken.

Pramipexole 

Pramipexole is a dopamine agonist used to treat Parkinson’s disease by restoring dopamine levels to healthy levels in the brain.

Pramipexole works by binding to dopamine receptors in the brain and spinal cord, causing them to become less sensitive. This helps reduce the symptoms, including resting tremors, shaking, rigidity, and poor balance.

Unlike Levodopa, Pramipexole doesn’t increase the amount of the neurotransmitter dopamine in the brain. Instead, it counteracts dopamine loss that occurs in Parkinson’s disease.

Pathophysiology of Alzheimer’s Disease

Alzheimer’s Disease is an incurable, progressive disease, where plaques build up in neuronal synapses of the brain, disrupting brain signaling. Alzheimer’s disease is the most common cause of dementia which causes a persistent decline in thinking, behavioral and social skills that affects a person’s ability to carry out activities of daily living consistently.

Risk Factors & Causes 

• Family history 
• Dementia (a general term for brain damage)
  • Memory Trick: DeMentia = DaMage to the brain

Stages

• Stage 1 – No impairment
• Stage 2 – Forgetfulness and short-term memory loss
• Stage 3 – Long-term memory loss
• Stage 4 – Bedridden

Nursing Interventions for Alzheimer’s Disease

Fall Safety

• Remove throw rugs and clutter from the floor
• Assist in showers & tubs
• Utilize night lights

Location & Locked Down

• Provide safe return bracelet on wrist
• Lock doors
  • Including hazards: toxic chemicals, gas, sharp objects, medications

Living Areas

• Allow for free movement
• Place frequently used items within easy reach
• Install pictures or symbols:
  • Bathrooms
  • Hot vs. cold water

Simple Communication

• Avoid open-ended questions, yes or no questions instead
• Limit choices, not too many options 
• Do not rush the client
  • Allow plenty of time for ADLs and tasks

Alzheimer’s Medications

Donepezil – A cholinesterase inhibitor that can treat mild to moderate Alzheimer’s disease. 

Memantine – Another cholinesterase inhibitor that works similarly to Donepezil. 

Rivastigmine – A  transdermal patch that delivers cognition-enhancing medication through the skin instead of the bloodstream.

Galantamine – Another type of cholinesterase inhibitor that works similarly to other drugs on this list, but comes in extended-release form instead of immediate-release form.

Huntington Disease Pathophysiology

Huntington’s disease is a genetic disorder in which the brain degenerates over time. It’s  characterized by uncontrolled movements and loss of intellectual abilities, which are often accompanied by behavioral changes.

Huntington’s affects each individual differently. Symptoms can begin as early as thirty years old or as late as the eighth decade. The disease typically progresses in stages and eventually leads to death within fifteen to twenty years after symptoms appear (if left untreated).

Huntington’s Disease Nursing Interventions 

Assess

• Client’s physical status (including weight loss, muscle wasting, and tremors)

Encourage

• Client to engage in social interactions with family and friends.

Assist

• In meal preparation, housekeeping, transportation, and other activities of daily living.

Medications used to treat Huntington’s Disease

There are currently no cures for Huntington’s disease, but some medications can help manage symptoms:

• Antipsychotics (typical or atypical) to control agitation, anxiety, and psychosis.
• Antidepressants for depression and anxiety disorders.
• Anti-anxiety medications such as benzodiazepines (e.g., Valium) to treat severe anxiety episodes.
• Anticonvulsants to prevent seizures.

Amyotrophic Lateral Sclerosis ALS Pathophysiology

Also called Lou Gehrig’s disease, ALS presents as the deterioration of motor neurons in the brain and spinal cord. This results in progressive total body paralysis – the prognosis is poor, and those with the disease die from respiratory failure in three to five years.

Memory trick

Think ALS like Advanced Life Support (clients will progress to the need of respiratory support from a ventilator)

Signs & Symptoms 

• Difficulty breathing (Dyspnea)
• Progressive muscle weakness
• Difficulty swallowing (Dysphagia)
• Constipation
• Difficulty speaking (Dysphasia)
• Respiratory failure

ALS Nursing Interventions

Monitor for pneumonia, infection, fever, and lung sounds (Rhonchi).

Provide comfort and emotional support.

Encourage independence, communication, and self-expression.

ALS Medications

The main types of ALS medications include: anticholinesterases and riluzole.

Anticholinesterases work by slowing the breakdown of acetylcholine in the body, which prevents its effects from being too strong. 

Riluzole works by inhibiting glutamate receptors in the brain that cause neuronal death. 

Guillain-Barre Syndrome Pathophysiology

Guillain-Barre Syndrome (GBS) involves rapid ascending paralysis, starting in the legs and eventually reaching the respiratory system. The disease prognosis can be poor, resulting in death within hours to a few days.

Memory Trick

Ground up barees – paralysis from the legs up.

Causes 

GBS is caused by an autoimmune response in which the body’s immune system attacks parts of the nervous system, and is typically triggered by an infection.

Signs & Symptoms

• Muscle weakness
• Absent deep-tendon reflexes
• Respiratory failure 
  • Early signs of respiratory failure:
    • Inability to cough 
    • Inability to lift the head or
    • Shallow respirations
    • Dyspnea and hypoxia

Guillain-Barre Syndrome Nursing Interventions

Assess the client’s level of consciousness to determine if they are alert and responsive; if not, notify the medical team.

Monitor the client’s vital signs every four hours, including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.

Provide assistance with ADLs, such as bowel and bladder care and feeding.

Perform plasmapheresis (plasma exchange) to remove antibodies contributing to neuron destruction.

Guillain-Barre Syndrome Medications

Corticosteroids are drugs that reduce inflammation in the body by slowing down how fast the client’s immune system works. These medications assist with pain and respiratory issues, but they are not very effective for GBS clients who are still feeling symptoms after three weeks of treatment.

Immunoglobulins, also known as antibodies, are glycoprotein molecules produced by plasma cells (white blood cells). They are an integral part of the immune response by specifically recognizing and attaching to particular antigens, such as bacteria or viruses, to assist in their destruction.

Neurological Disorders Conclusion

Among several neurological disorders, multiple sclerosis (MS) is a condition that impacts the central nervous system. It can result in symptoms like numbness, visual issues, and muscle weakness. Parkinson’s disease is a degenerative neurological condition that impairs balance and mobility. It results from the loss of nerve cells in particular parts of the brain.

Alzheimer’s disease is a form of dementia that impairs memory, causes confusion, and makes it difficult to focus and think effectively. Huntington’s disease is an inherited genetic illness that affects muscles and coordination. A protein-making deficiency brings it on in a subset of brain cells, which over time becomes poisonous to those cells and eventually kills them off.

Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s disease or Motor Neuron Illness (MND), occurs when there’s damage to motor neurons in the brain and spinal cord. It’s a deadly neurodegenerative disease resulting in muscle weakness and difficulty moving. 

Guillain-Barre syndrome (GBS) is an immunological response that results in paralysis following infection with bacteria or viruses. It usually occurs at least two weeks after exposure to an infection somewhere in the body.

Detecting symptoms and offering supportive care is essential in the treatment of these neurological disorders.

Sources

https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/multiple_sclerosis/ 

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055 

https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/alzheimer-disease 

https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447 

https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/huntington-disease 

https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/als/conditions/als_amyotrophic_lateral_sclerosis.html 

https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes/syc-20362793