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.

Neurological Disorders: What is Parkinson’s Disease? – Part 1

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Parkinson’s disease is a progressive disorder that is primarily focused on the body’s dopamine production. It is not about the body attacking itself like that of multiple sclerosis or myasthenia gravis.

What happens in Parkinson’s disease?

Parkinson’s disease, much like ALS, is a progressive disorder that is just a fancy word for the continuous cessation of creating a substance primarily involved in the condition. In the case of Parkinson’s disease, the body has stopped making dopamine.

No dopamine, what does it mean?

Dopamine is a potent neurotransmitter that helps in controlling the brain’s pleasure and reward centers; it signals or transmits messages across the synapses. When dopamine is decreased or absent in the body, messages do not get relayed which will result in a central nervous system breakdown regarding motor function and dexterity of the muscles.

“No Dope in the Park”

Remember this phrase when you are trying to recall what Parkinson’s disease is.

When there is decreased dopamine or none at all, there’s “no dope in the park” because of the progressive nature that directly affects the brain’s communication with major parts of the body.

Signs and Symptoms

As a nurse, how are you going to fix the decrease in dopamine?

Well, there are a whole bunch of drugs that one can give to stimulate dopamine increase but before we discuss the kinds of drugs, we’ll first focus on the signs and symptoms and deviate a bit on how to diagnose Parkinson’s disease.

With all your other type of diseases, you have diagnostics like withdrawing certain chemicals from the body then sending it to the lab to be checked. With multiple sclerosis, there will be certain pathogens that will be present in the sample which creates an immune response, attacking the myelin sheath. A lumbar puncture and a CAT scan are done to assess how much of your body is creating this immune response to itself.

However, with Parkinson’s disease, diagnosis is based on the neurological signs and symptoms which mainly comprise of:

  1. Progressively slow movements
  2. Rigidity or freezing while walking
  3. Shuffling gait
  4. Pill rolling
  5. Expressionless face, like wearing a mask
  6. Balance problems – dopamine is one of those neurotransmitters that helps in maintaining the brain’s equilibrium
  7. Tremors (shaking)

One of the tests done to diagnose someone with Parkinson’s disease is to have the client write anything – their name or a line from a song. Once the client starts to write, their penmanship will be normal at first, but as the writing goes on, the letters will become progressively smaller. This is what experts use to diagnose Parkinson’s disease.

Nurse Considerations

What can you do as a nurse to help your client with Parkinson’s disease? It’s the regular things – exercise and diet.

Losing weight, breaking a sweat, or exercising release dopamine. Though this is not a definitive cure, it can help in producing dopamine that can lessen the abovementioned signs and symptoms; but since this condition is progressive, exercise is just a control measure. Passive range of motion exercises can prevent joint stiffness.

Another nursing consideration that you have to wolteach to your client is to eat healthily. Consuming foods that are high in antioxidants – green tea and veggies – as well as foods that are high in fiber and low in sugar will slow the progression of Parkinson’s disease. So, diet and exercise are the two main things that you can ask your client to do.

For your Parkinson’s disease drugs, they will be discussed in our next lecture.

Drop by SimpleNursing.com for a wide range of nursing topics that will help with your study habits and pass the NCLEX®.

See you on our next Parkinson’s disease discussion!

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!