Neurology Diseases: Parkinson’s, MS, MG & ALS Nursing Goals

Whether it’s Parkinson’s disease, myasthenia gravis, multiple sclerosis, or amyotrophic lateral sclerosis, the nursing goals for all clients are the same – to maintain healthy well-being. The pathophysiology will not matter for as long as the client’s healthy lifestyle is adequately addressed because the issues will not be reversed.

The chief nursing goals when taking care of clients with neurological issues are the following:

  1. Maximizing motor function
  2. Maintaining activities of daily living (ADL)
  3. Prevent depression
  4. Maintain airway, breathing, and circulation (ABC)

Let’s discuss each goal below.

Motor Function

One of the primary goals for clients suffering from neurological disorders is maximizing their motor function. Since neurology problems are favorite NCLEX® topics, here’s a scenario:

When dealing with Parkinson’s disease, myasthenia gravis, or multiple sclerosis clients, as a nurse, should you help them with their ADLs, or would you give them assistive devices so they can help themselves and become more independent?

Since the priority nursing goal is to maximize motor function, the best possible answer is to allow the clients to be as independent as possible. Nurses should try not to do everything for the clients especially if they are living inside a home care facility. However, if they are completely unable to perform the task, assisting them is fine.

Activities of Daily Living

As mentioned, it is essential that clients who have neurological dysfunctions practice their full potential with their ADLs. Whether it’s getting dressed, combing their hair, tying their shoelaces, or brushing their teeth, nurses should allow their clients to do all these activities with less or no intervention whatsoever; unless the clients are totally incapable of doing so.

Depression

Because the conditions are irreversible, the psychosocial aspect must be taken into great consideration because clients tend to fall into depression knowing that their situation is not going to get any better. Furthermore, due to their diminished motor functions, clients are bound to think that they are useless, which increases their depressive mood. For this reason, it is essential that clients are given independence when it comes to their ADLs and activities that can improve their social skills.

Airway, Breathing, and Circulation

Lastly, and the most important goal, is making sure that the client’s airway, breathing, and circulation are not compromised. When developing a care plan, the nurse in charge should prioritize the ABCs.  Difficulty swallowing can lead to choking and can block airway; therefore, ventilation must be on standby.

Summary

As a summary, the nursing goals with clients who have neurological disorders like Parkinson’s disease, myasthenia gravis, multiple sclerosis, and amyotrophic lateral sclerosis should primarily focus on their independence and motor functions, but most importantly, their ABCs and psychosocial status.

Effective nurses must not only focus on their clients’ pathophysiology and diagnosis but their overall well-being as well especially when taking care of clients with neurological issues.

For our next topic, we’ll be focusing on the four conditions mentioned here, their pathophysiology, causes, and treatments. And for more useful nursing-related lectures and videos, check out our Simple Nursing website and YouTube channel.

MS: Nursing Management, Pharmacology, & Considerations

In this multiple sclerosis lecture, we’ll be discussing the condition’s nursing management, pharmacology, nursing considerations, and more.

Multiple Sclerosis: Defined

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) which involves the brain and the spinal cord. The main component that is affected with multiple sclerosis is the myelin sheath.

Multiple sclerosis is an autoimmune condition wherein the body attacks itself, and in this case, the myelin sheath of the brain and the spinal cord.

Tip: How can you easily associate multiple sclerosis with myelin sheath? You can remember this by thinking of their acronyms – both are MS.

Functions of Myelin Sheaths

Myelin sheaths primarily aid in the action potential of the neurons. An action potential is just a fancy word for electrical impulses. Without myelin sheaths covering the neurons, electricity won’t be able to travel efficiently through multiple systems; therefore, function, movement, and range of motion are affected and disrupted.

In multiple sclerosis, there is a degradation of myelin sheaths, and this condition usually occurs in people who are 20 to 30 years old.

Multiple Sclerosis: Diagnosis

Multiple sclerosis is diagnosed by analyzing specimens taken from the brain stem and spinal cord. What is the process of diagnosis?

  1. A CT scan is done to check for plaques on neurons of the central nervous system.
  2. A lumbar puncture or lumbar spinal puncture is done to the client to get samples of the cerebrospinal fluid (CSF).

The CSF will be tested for gamma globulins or immunoglobulin to assess if the body is making an immune response that affects the myelin sheath to the point of degradation. This degradation will present as plaques around the neurons where the myelin sheaths are located.

Multiple Sclerosis: Signs and Symptoms

When thinking about the signs and symptoms of certain diseases, you should always consider its pathophysiology. In the case of multiple sclerosis, the components responsible for transferring electrical impulses are compromised, resulting to slow energy transfer. Therefore, the apparent manifestations would be the following:

  • Fatigue
  • Numbness and tingling
  • Low dexterity
  • Altered sensations
  • Burning or hot feeling

Multiple Sclerosis versus Other Neurological Diseases

Unlike other types of neurological diseases, like amyotrophic lateral sclerosis (ALS) or popularly known as Lou Gehrig’s disease, that are progressive, multiple sclerosis is a neurodegenerative disorder that causes problematic relay with episodes of remissions.

Multiple sclerosis is similar to Cushing’s disease or Lupus wherein some triggers can cause outbreaks; like an intermission or ebb and flow. So, the body will attack itself then will back down, then attack itself again due to specific triggers that healthcare providers should watch out for.

Multiple Sclerosis: Medications

There are different types of medications given to MS clients.

  1. Interferon

The most common medication that is given to MS clients is Interferon. Interferon interferes with the body’s attack on the myelin sheaths. By getting in the way of these recurring attacks on the myelin sheaths, Interferon helps in preventing myelin sheath degradation.

  1. IVIG

Intravenous immunoglobulin (IVIG) is another medication given to MS clients. When IVIG is given to an MS client, it acts as bait; deceiving the body and convincing it to attack the IVIG instead of the myelin sheaths. IVIG is given every two to three months.

Though effective, IVIG is quite expensive that medical insurance companies, like Medicare, do not like it when they see this medication in their statement. 

  1. Copaxone

Another drug of choice for MS is Copaxone. You can remember this by thinking of the drug packing the myelin sheaths, coating and protecting them from attacks. Copaxone is composed of amino acids that create a protective layer around the myelin sheaths, allowing repair and regeneration.

  1. Steroids

Acting as an anti-inflammatory, steroids like Solu-Medrol, are effective in decreasing immune response; thus, preventing the body from attacking the myelin sheaths.

  1. Stool Softeners

To help MS clients address constipation brought about by the condition, stool softeners are also prescribed.

Multiple Sclerosis: Considerations

Client goals for MS clients include the following:

  1. Keep a functional state, maintaining a good range of motion.
  2. Avoid exacerbations due to the intermittent nature of the disease.
  3. Avoid stress or aggravating situations that will trigger or push the body to increase immune response.
  4. Strenuous activities like marathons or exercises like CrossFit.
  5. Instruct clients to keep up with their medication regimen.
  6. Alternate activities with periods of rest.

For more easy-to-understand nursing-related topics, drop by our SimpleNursing website and our YouTube channel.

Neurological Disorder Overview: Parkinson’s, MS, MG, & ALS

Here’s a quick rundown of the four primary neurological disorders mainly Parkinson’s disease (PD), multiple sclerosis (MS), myasthenia gravis (MG), and amyotrophic lateral sclerosis (ALS). We will be touching on the signs and symptoms, pathophysiology, and client goals. After which, we will go into specific details and dissect every disease.

Right now, we will be focusing on the basic overview of MS and Parkinson’s disease.

CNS and PNS

The nervous system is basically divided into two: the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists of the brain and the spinal cord while the peripheral nervous system includes the ganglia and the nerves that are mainly outside the brain and spinal cord.

                        Nervous system = CNS and PNS

  • CNS = brain and spinal cord
  • PNS = ganglia and nerves (everything outside the brain and spinal cord)

It is essential to take note that multiple sclerosis and Parkinson’s disease primarily occurs in your central nervous system while myasthenia gravis and amyotrophic lateral sclerosis affect the peripheral nervous system. ALS is just a fancy word for Lou Gehrig’s disease.

  • CNS = MS and PD
  • PNS = MG and ALS

Pathophysiology of CNS Diseases

To easily remember your central nervous system diseases, think of C-M-P. CMP stands for CNS, MS, and PD.

  • C – CNS
  • M – MS
  • P – PD

Multiple Sclerosis

When you think of MS, automatically relate it to myelin sheath because there is myelin sheath degradation in multiple sclerosis.

            MS = myelin sheath = degradation

What are myelin sheaths and how important are they in your client’s CNS?

If you remember your nursing physiology pre-requisites, a particular topic specifically in the brain is knowing what a nerve cell is and identifying its parts. The axon, or what is also known as a nerve fiber, is responsible for conduction of motor impulses. On each neuron, are attached myelin sheaths that look like a small choo-choo train.

A neuron or nerve cell would look like a palm tree if you wanted something substantial to compare it to.

Aside from protecting the nerve fibers, the myelin sheaths are also responsible for electrical impulse conduction. Moving your fingers or twitching your hands happen due to normal myelin sheaths; this is referred to as an action potential.

In MS, the myelin sheaths have degraded causing problems in the transport of impulses. Some of the notable signs and symptoms are:

  • Numbness
  • Cramping
  • Muscle weakness

Parkinson’s Disease

In Parkinson’s disease, there is a significant decrease in the amount of dopamine in your brain. You can think of it this way: There is decreased dope in the park.

            PD = decreased dopamine

What is dopamine and what’s its importance to your CNS?

Again, in your pre-requisites, it was established that dopamine in your brain helps in regulating a few key aspects in your CNS and one of those things is your blood pressure. Which is why, every time a client codes or has a hypotensive episode, dopamine is given because it is a potent vasoconstrictor. Dopamine helps in increasing the amount of blood flow to the brain, into the heart, and dilating your kidneys. But one thing that you have to take note of regarding dopamine is that it helps with your CNS and a person’s ability to move.                                                             

What are the classic signs of clients with PD?

  • Shuffling gait – moving slowly while having a shuffling walk
  • Pill rolling – due to impaired dopamine levels the motor reflexes are affected
  • Tremors in your peripherals

Part two of our lecture we will be tackling about myasthenia gravis and amyotrophic lateral sclerosis or Lou Gehrig’s disease.

See you there!