MS
Patho
Autoimmune, chronic,
degenerative, &
progressive Demyelination
(loss of the myelin sheath )
of CNS nerve fiberseventually nerve function
is lost permanently.
Plaques (scar tissue) seen
on MRI-nerve impulse
can’t be conducted
across scar tissue. Women
affected more than men
S/S
The onset of MS is often slow and gradual. Vague
symptoms occur over months or years. For some
patients, MS is marked by rapid, progressive
deterioration. Others have remissions and
exacerbations.
Blurred or double vision, red-green color distortion, or
even blindness in one eye may be the first symptom
experienced by a person with MS. Weakness, muscle
spasticity, nystagmus, ataxia, dysarthria, dysphagia,
bowel and bladder issues, fatigue, impaired
sensation, 50% have cognitive deficits, labile
emotions. Short term memory, word finding,
worsening visual changes may occur in later stages
Death usually occurs due to infection like pneumonia
o Cardiomyopathies
o Aortic Disorders
Valve disorders
MG
Autoimmune, chronic.
Remissions and
Exacerbations,
progressive
Antibodies attack
acetylcholine (ACh)
receptor sites= not
enough sites to have
nerve transmission
Weakness worsens during
the day or at times of
stress; improves with rest.
Thymus gland may be
involved- thymectomy
Diplopia-(double vision), eye lid drooping (ptosis),
difficulty chewing and swallowing, respiratory
paralysis & failure. Face & mouth most affectedSnarling appearance
- Myasthenia Crisis- is an acute exacerbation of
muscle weakness triggered by infection, stress,
surgery, emotional distress, or inadequate
medication (pyrostigmine).
 S/S: Hypoxia, tachycardia, HTN, tachypnea,
dyspnea, ↓ UO, absence of cough/gagairway crisis, ptosis (droopy eyelid), diplopia
(double vision), May need intubation and
mechanical ventilation
 Tensilon test used to diagnose myasthenia
crisis versus cholinergic crisis (caused by too
much medication). A positive Tensilon test the
symptoms get better when Tensilon given.
Atropine needed at bedside during test for
possible severe bradycardia and resp failure
Cholinergic Crisis-
Nursing Care
Nursing Considerations
Accommodate room and nursing care for vision
changes during an exacerbation. For constipation give
diet ↑ fiber & fluids
- Provide safety
-Fall risk, balance issues
-Monitor for dysphagia/eating issues
-Monitor resp status b/c ↓ diaphragm strength
Patient Teaching
- Teach to avoid over-fatigue and triggers (infection,
trauma, after childbirth, stress)
-Teach to take medications prior to more active or
stressful times
-Pregnancy- s/s may improve while pregnant
-Plan rest periods throughout the day
Nursing Considerations
-Prevent aspiration
- Assess and monitor:
* Respiratory failure
* Nutrition due to impaired swallowing
- Communication
- Visual Changes
- Avoid/ Assess fatigue & make sure patient gets rest
- Plan activities at times of max muscle strength
Patient Teaching:
- Follow medical regimen closely
- Cluster care
- Teach about complications of the disease & therapy
(crisis conditions) & what to do about them.

S/S: caused by too much medication, causes
SLUD: salivation, lacrimation, urination,
defecation/diaphoresis (all increased).
PD
Chronic, Progressive
Dopamine deficiencydegeneration of
dopamine producing
neurons in substantia nigra
disrupts balance of ACh &
dopamine in basal
ganglia
Mild tremor at rest, slight limp, ↓ arm swing
shuffling, propulsive gait w/ arms flexed & loss of
postural reflexes, slight change in speech patterns
1. Tremor- 1st sign (affect handwriting); worse at rest &
is aggravated by emotional stress or ↑ concentration;
hand tremor- pill rolling- circular movements of the
fingers in a circular motion, akinesia (loss of voluntary
muscle movement. Loss of voluntary muscle
movement
2. Rigidity- ↑ resistance to passive motion when the
limbs are moved through their range of motion. Cog
wheel→ jerky rigidity
3. Bradykinesia- slowness of all voluntary movements
& speech; stooped posture (kyphosis), masked faces
(difficulty controlling facial movements, can’t catch
up, dead pan expression), drooling of saliva→
depression, & shuffling gait; difficulty in initiating
movement, uncontrolled backward motion
- Secondary S/S: Muscle Weakness (difficulty
speaking, slowness of speech, dysphagia- airway &
lungs are at risk),
GB
An acute form of
polyneuritis (inflammation
of many nerves) that
results in a temporary,
flaccid paralysis lasting for
weeks to months; is
reversible; may progress
rapidly and become an
emergency
Usually develops 1-3 wks after upper respiratory or GI
infection. Ascending paralysis starts in lower
extremities and is symmetrical; paresthesia
(numbness & tingling); hypotonia (reduced muscle
tone); areflexia (lack of reflexes) facial weakness,
extraocular eye movement difficulties, dysphagia, &
paresthesia of face
Normal CSF protein- 5-45 mg/dL- will be high with GB
- hallmark sign- ascending paralysis (to chest),
including diaphragm = resp. arrest
Avoid Complications
* Injury→ FALLS, FALLS, FALLS!!
Malnutrition (trouble swallowing) & drooling
Impaired Verbal Communication Social Isolation
(drooling)
-Airway obstruction r/t dysphagia Depression (don’t be
afraid to ask)
- Assess and Monitor: swallowing difficulties
-Encourage independence, encourage assistive
devices as needed,
-Provide a safe environment Promote sleep and rest
-Encourage ROM Assist with ADL/maximize
communication
-Keep patient physically active,
Patient Teaching:
- Remove area rugs & excess furniture to avoid
stumbling, handrails and ramps at home
- Clothing: use slip-on shoes & Velcro hook-&-loop
fasteners or zippers instead of buttons & hooks
- Maintain activity has much as possible
- Taking medications everyday
Sinemet- levodopa/carbidopa combination drug;
Levodopa crosses the blood-brain barrier and is
converted to dopamine while carbidopa that inhibits
enzyme break down of dopamine. Side effects of
levodopa include nausea, vomiting, and occasional
heart rhythm disturbance
Be aware of caregiver fatigue-physical and mental
health may decline as the disease progresses and stress
increases.
-Monitor for respiratory failure (most serious
complication) r/t paralysis of thoracic nerves- may need
intubation.
-Treat with immunoglobulin, plasmapheresis
-Without tx: total paralysis → ventilator support
-Good chance of FULL recovery w/ good care
-Patient is fully awake & alert→ no cognitive impairment
-Assess for ascending paralysis and ↓cranial nerve
function
SLE
Autoimmune multisystem
inflammatory disease
(chronic and progressive)
that is unpredictable
associated with
abnormalities of immune
system.
It affects the skin, joints,
serous membranes
(pleura, pericardium);
renal, hematologic, &
neurologic systems.
More common in women
(childbearing years or
post-partum), affects
African Americans, Asians,
Hispanics, & Native
Americans more than
Caucasians
Unpredictable, alternating periods of exacerbations
& remissions. Mostly affects the lining of the lungs,
heart, nervous tissue, kidneys, MS & skin
Skin- discoid lesions; Butterfly rash on face/cheeks;
alopecia, polyarthralgia with morning stiffness;
arthritis- Swan neck fingers, weakness, Tachypnea,
pleurisy, dysrhythmias, Lupus nephritis (Ranging from
mild proteinuria to glomerulonephritis).
Primary goal in treatment is slowing the progression of
nephropathy & preserve renal function,
generalized/focal seizures, peripheral neuropathy;
cognitive dysfunction, disorientation, memory
deficits, Psychiatric symptoms (depression, mood
disorders, anxiety, & psychosis); headaches
(exacerbation of disease)
Formation of antibodies against blood cells
(erythrocytes, leukocytes, thrombocytes, &
coagulation factors), Anemia, mild leukopenia,
thrombocytopenia, excessive bleeding or blood clot
development, Increased susceptibility to infections.
Fever should be considered serious. Infections such
as pneumonia are a common cause of death.
Fatigue & weight loss
Nursing Care:
- Monitor skin integrity & provide frequent oral care
- During exacerbation, patient will become abruptly,
dramatically ill. Record severity of symptoms and
response to therapy
- Observe for fever pattern, Joint inflammation,
Limitation of motion, Location and degree of
discomfort, Fatigability
-Infection (b/c steroids & poor immune) - Strict asepsis,
Monitor WBC, protect against infection, adequate
nutrition
- Monitor for potential GI & renal effects due to NSAIDs
(Observe for signs of bleeding from meds- pallor, skin
bruising, petechiae, or tarry stools)
- Monitor BUN & creatinine levels frequently for signs of
renal impairment
Patient Teaching:
- Reiterate that adherence to treatment does not
necessarily halt progression or exacerbations, disease is
unpredictable
- Minimize exposure to precipitating factors – fatigue,
stress, people with infection, sun exposure. Wear SPF
loose clothing w/ long sleeves, wide brimmed hats,
avoid going outside 10a-3p
Report fever, increased fatigue, and/or rash to HCP