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.

Neurology Lecture: An Insight into Myasthenia Gravis

Myasthenia gravis (MG) is a neuromuscular condition involving the skeletal muscles; wherein there is decreased acetylcholine. This decrease is due to the inappropriate creation of antibodies that go against acetylcholine receptors.

Muscles fail to contract because of the absence of the neurotransmitters that are responsible for contraction, leading to the manifestations of drooping eyelids, paralysis of the face, and difficulty breathing.

Medications

If the body is attacking itself, how do we tell it to stop? The obvious answer is through medications. What are the different medicines given to clients who are suffering from myasthenia gravis?

  1. Intravenous Immunoglobulin (IVIG)

Intravenous immunoglobulin is the kind of drug that is given to clients with myasthenia gravis, similar to what is given to multiple sclerosis clients, that helps in decreasing the body’s immune response. IVIG serves as bait for the antibodies; that, instead of attacking the neurotransmitter or acetylcholine receptors, the antibodies turn on the IVIG.

Intravenous immunoglobulin is one of the bait-and-switch things that the medical field does for clients.

  1. Steroids (Prednisone)

Steroids like prednisone are anti-inflammatory drugs that are also given to clients suffering from COPD and Cushing’s disease because, aside from decreasing inflammation, prednisone also weakens the immune response.

  1. Cholinergic

A notable effect of cholinergic drugs to MG clients is that it’s going to increase the amount of saliva production; thus, helping the client’s ability to swallow. Because the body targets acetylcholine, saliva production will reduce, and reduced saliva would result to difficult muscle movement, specifically around the mouth and esophagus.

Thymectomy: Surgery for MG

If medication is not enough, another route that doctors would consider is doing a surgery called thymectomy. Now, some doctors believe that the thymus causes an over-immune response that attacks the acetylcholine receptors; on the other hand, there are those who don’t agree.

Nursing Considerations

When taking care of a client suffering from myasthenia gravis, there are a couple of nursing considerations that you have to keep in mind, primarily:

  1. The positive cholinergic, pyridostigmine, should be given before meals to ensure that swallowing is adequately facilitated.
  2. Prednisone is going to cause a decreased immune response; therefore, nurses have to watch out for clients developing an infection because, much like those who are undergoing chemotherapy, MG clients taking prednisone will not show signs and symptoms of infection.
  3. The client is going to have an increased risk for aspiration or will experience swallowing difficulties while on medication. Thick liquids must be given instead of just water or thin liquids.

Client Teaching

Very important teaching that you have to emphasize to myasthenia gravis clients who are taking prednisone and IVIG is that they have to immediately contact their physician if they show even the slightest increase in temperature.

Even if the temperature is just slightly above 100 Fahrenheit, let’s say 100.5 Fahrenheit, you have to contact the doctor at once. This is because clients who are taking prednisone and IVIG are immune-compromised and the little increase in temperature will have severe effects on the client.

Neurology Review: A Quick Rundown of Myasthenia Gravis and ALS

In this neurology review, we’ll be determining what myasthenia gravis and ALS is.

Myasthenia Gravis (MG)

This condition affects the functions of the peripheral nervous system and not the central nervous system which is composed of the brain and spinal cord. The peripheral nervous system is mostly comprised of the muscles and nerves that control the lungs and body movement.

Trivia: Walt Disney created the dwarf, Sleepy, who is a character from Snow White and the Seven Dwarves as a tribute to one of his good friends who has had myasthenia gravis.

And Sleepy’s character is an accurate representation of people who have myasthenia gravis because this condition is manifested as severe muscle weakness that can affect the eyes (droopiness), the lungs, the face, and the throat.

Acetylcholine

The major factor that is affected in myasthenia gravis is a chemical called acetylcholine. Acetylcholine is a potent neurotransmitter that helps the neurons to communicate and thereby, creating a normal body reaction. Due to ineffective secretion of acetylcholine, the body can develop myasthenia gravis.

Signs and Symptoms

People who have myasthenia gravis would appear like gravity is making a huge pull on parts of the client’s body, specifically on the face. The apparent signs and symptoms are:

  • Drooping of the eyelids
  • Difficulty swallowing and chewing
  • Muscle weakness
  • Airway and diaphragm issues.

Since difficulty swallowing is included in the manifestations, as a nurse, you have to watch out for aspiration precautions; which is always a huge factor when answering a myasthenia gravis question in your major exams.

Myasthenia gravis is not a progressive disease and mostly occurs due to some triggering factors which would prompt this response.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is also known as Lou Gehrig’s disease. This condition is considered as the worst neurological disease that a person can get. Why? For the following reasons:

  • ALS is incurable.
  • ALS has no remissions.
  • ALS is depressing.
  • ALS clients have a life expectancy of about three to five years.

A Prisoner of Your Own Body

The scary part about having ALS is that it’s a disease which makes the client feel like a prisoner of his or her own body. This is because, with ALS, the motor neurons become sclerotic and stiff. While the sensory neurons are still intact and you still think and feel normally, your body cannot move due to motor neuron destruction.

The 3 D’s of ALS

To easily distinguish ALS from the other neurological diseases, you have to remember the three D’s, namely:

  • Dysarthria – difficulty moving
  • Dysphagia – difficulty swallowing
  • Drooling

Complications Leading to Death

As mentioned, ALS affects the motor neurons as they become sclerotic and stiff. Though the brain is still functioning and the senses are still intact, the motor functions are compromised to the point of uselessness. ALS is quite a depressing condition because, aside from feeling trapped in their bodies, clients are also given a life sentence of three to five years.

The progression of this disease will eventually create a domino effect of complications like lung dysfunction and infection, and clients are required to go on a vent to facilitate mechanical breathing.  

Clients with ALS don’t die from the disease itself but from the failure of organs to perform their responsibilities.

So, what are some goals for nurses in taking care of the client with neurological diseases? We’ll get into that on our next lecture. So, check it out on our SimpleNursing website or YouTube channel.

Essential NCLEX® Practice Question for Myasthenia Gravis

Question:

A nurse is caring for a client newly diagnosed with myasthenia gravis; understand that teaching has been effective when the client states _______.

Let the question above sink in as we move forward on our discussion about myasthenia gravis (MG) because later, we’ll be revealing the answers and thoroughly discussing their rationales.

Now, there are two reasons why myasthenia gravis is a tough subject to deal with because first, it has a lot of biochemistry involved; and second, the questions asked about MG are usually select-all-that-apply questions. It’s like a double whammy.

To help you with MG, we’ll first go through its pathophysiology, then start answering the question above.

Myasthenia Gravis – Description

Myasthenia gravis is a type of neuromuscular disorder that causes weakening of the muscles, especially those smaller muscles like that of the eyes. As per Mike, he calls it “myasthenia gravity” because the eyes of a person who has MG are always droopy like gravity is always acting on them.

Myasthenia gravis is also an autoimmune disorder wherein the body is attacking itself. It’s like having your platoon working in the same direction, and due to specific factors, the same platoon turns on the body and starts attacking it.

Myasthenia Gravis – Pathophysiology

The main reason why the muscles contract with all the action potential and nerve endings is because of neurotransmitters. Neurotransmitters communicate and send messages to your neurons, which basically tells the body what to do like:

  • Grabbing things
  • Smiling
  • Blinking
  • Lifting weights
  • Running
  • Writing
  • And anything and everything the body does

The synapses are playing a telephone game and are mainly responsible for sending neurotransmitters across.

In myasthenia gravis, the body blocks messages from going through, and one of the primary messages or neurotransmitters that relay messages along this gap is called acetylcholine (ACH).

With MG, there is sufficient amount of ACH in the body, but because the illness causes the body to attack the ACH receptors, no messages can go through and be relayed to certain parts of the body like the eyes; thus, the droopy, tired eyes.

Even though ACH levels are normal, if there is a shortage of reuptake receptors due to the attack, the messages will not be relayed, and the receiver on the other end of the line will not be getting any orders or messages which is why the muscles get very weak when you have myasthenia gravis.

The Role of Stress

As per Mike, myasthenia gravis is an ebb and flow type of diagnosis. Stress plays a huge part in causing the body to attack itself. Which is why, if a client puts themselves under a lot of pressure and stress, the body reacts negatively by becoming angrier leading to an attack on the acetylcholine receptors that causes muscle weakness. Therefore, it is important to take note that stress will do further damage to the client and will worsen myasthenia gravis.

The Plan

So, in dealing with myasthenia gravis, the primary goal is decreasing the body’s immune system or function by providing pharmacologic interventions.

The NCLEX Practice Question

Okay, so going back to the question posted above, we will go through all the answers one by one, and we’ll figure out the rationale behind every answer or non-answer. Take note that this is a select-all-that-apply question, meaning there is more than one answer to this question.

Q: A nurse is caring for a client newly diagnosed with myasthenia gravis; understand that teaching has been effective when the client states _______.

  1. My immune system is attacking my healthy tissues
  2. Prednisone and immunosuppressant are helping cure my disease
  3. My condition may cause life-threatening breathing problems called myasthenia crisis
  4. I am now at high risk of developing rheumatoid arthritis
  5. Heat exposure will help relax my muscles and decrease the symptoms

Okay, so let’s break the options down one-by-one. Take note that this is an effective teaching moment question which would prompt you that your client teaching has been effective if he or she stated the correct answers identified below.

A: Correct.

Rationale: As previously stated, myasthenia gravis is an autoimmune, neuromuscular disorder wherein the body attacks itself by targeting the acetylcholine receptors.

B: Incorrect.

Rationale: Unfortunately, there is no cure for myasthenia gravis. The symptoms, however, are treatable with drugs like Prednisone, a steroid that brings down inflammation and reduces stress exerted on the immune system, causing it to calm down and stop attacking the receptors. Immunosuppressants also help in decreasing the immune response that leads to less attacking.

Additional info: Prednisone is also used in Lupus and Cushing’s syndrome to bring down inflammation primarily. There is a video discussion about this if you’re interested. Check it out at simplenursing.com

C: Correct.

Rationale: Myasthenia gravis can cause life-threatening breathing problems because of muscle weakness. Taking in deep breaths require a lot of muscle movement; therefore, having MG can severely affect this action.

D: Correct.

Rationale: This needs a bit of explaining. But this one’s simple. So, when you think about rheumatoid arthritis (RA), it’s the same immune response but, instead of the body attacking the neurons, it’s striking the joints where your cartilages are located. The attack on the cartilages can cause inflammation or puffiness; therefore, prednisone and immunosuppressants are administered to decrease swelling and inflammation. Because of that, there is a possibility that when a client has MG, he or she can also develop RA.

E: Incorrect.

Rationale: Heavy sunlight, rigorous activities, exposure to indisposed people, getting the flu, over-exercising, and any tiring activity will stress out the immune system. So when a person gets exposed to heat, the immune system gets stressed out because it will prompt the need to defend itself.

Additional info: There are three S’s that causes stress – sepsis, sickness, smoking.

Important Note

Remember that every time a question about myasthenia gravis pops out, the first thing that must come to mind is respiratory issues since the condition primarily affects the muscles.

So, that’s a quick myasthenia gravis info for you and a favorite NCLEX practice test question. Drop by simplenursing.com for a more detailed presentation and review of myasthenia gravis and other nursing topics that are NCLEX favorites.

See you!