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Parkinson >unknown>viral infections

>a progressive, degenerativedisease

causing destruction of nerve cells

in the basal ganglia of the brain

depigmentation of the substantianigra of the BASAL GANGLIA

loss of neurons

dec. Dopamine

>Pillrolling tremors ofthe fingers

>Rigidity with muscle

weakness-bradykinesia/akinesia

-cogwheel rigidityabsence of arm swing

in normal rhythmic gait>Parkinsons mask

>Drooling of saliva

>Dysphagia>Shuffling,festinating

gait>Defects in judgment

>Emotional instability

-deppression, paranoiaand eventually confusion

>Excessive sweating>No intellectual

impairment

Diagnostic Tests:

>EEG, CT Scan>No test is diagnostic of

Parkinsons dse.

1.Encourage pt to maintainindependence as much

as possible in hygiene

and dressing.2.Position to prevent

contractures; firm bed,no pillows, prone

position when lying inbed, hold hands folded

at the back when

walking.3.Diet: residue, calorie, soft

diet4.Aspiration precaution

5. fluid intake to prevent

constipation6.Anticholinergics. To reduce

tremors.Anti_Parkinsonian

(Dopaminergics)-improves muscle

flexibility

AntiviralAntispasmodics

Antihistamines

7.Gradual change ofposition,wear elastic

stockings to prevent postural hypotension.

8.Reddish brown urine harmless.

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DISORDER ETIOLOGY PATHOPHYSIOLOGY CLINICAL

MANIFESTATION

MANAGEMENT

Huntington

chorea

>transmitted as anautosomal dominant

trait

>hereditary, familyhx

>affects men andwomen of all races

>a chronic, progressive,hereditary disease of the

nervous system that

result in progressiveinvoluntary choreiform

(dancelike) movementand dementia.

Genetic dse inherited as

an autosomal dominant

trait

gene is present onchromosome 4

the gene encodes aprotein known as

huntingtin

gradually, accumulateswithin brain cells

brain cells are damaged

when levels ofhuntingtin rise

Early S/Sx:>personality changes

> cognitive abilities

>irritability, anger orparanoia

>difficulty in decision-making

>mild balance problem>clumsiness

>involuntary facial

movementsS/Sx as the dse

progress:>sudden jerky,

involuntary movements

(chorea) throughout thebody

>a wide, prancing gait>severe problems with

balance andcoordination

>difficulty shifting

your gaze without

moving your head>hesitant, halting orslurred speech

>inability to swallow

>dementia

Diagnostic Test:>positive family hx

>CT Scan and MRI

N/I:

1.prevent injury2.maintain proper nutrition

3.maintain fluid intake4.reduce stress

5.employ relaxation techniques

6.proper hygiene7.skin care

8.encourage exercise9.moral support

Treatment:>management is aimed to control

signs and symptoms>long-term home care

Medications:

>tranquilizers

>anti-psychotic

>anti-depressant

DISORDER ETIOLOGY PATHOPHYSIOLOGY CLINICAL

MANIFESTATION

MANAGEMENT

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Myasthenia

Gravis

>caused by anacquired

immunologic

abnormality or by agenetic abnormality

>between ages 20-50,

> in women, youngadults

>is an auto immunedisease which is

characterized by

fluctuating, sometimesfatal, muscle weakness.

> neuromusculardisorder that results in

the failure to transmitnerve impulses at the

myoneural junction

> acethylcholinesecretion by the motor

end plate> cholinesterase at the

nerve ending

>specific muscleweakness, particularly

in the eyes, face and

neck>dysphagia

>dyspnea> physical activity

>double vision,strabismus

>fatigue

>ptosis>diplopia

>impaired speech>snarl smile(smile

slowly)

>masklike facialexpression

>drooling

Diagnostic Test:>EMG

>Tensilon Test

(EndrophoniumChloride Test)

1.Assess swallowing/gag reflexbefore feeding the client

2.Administer medications 20-30

mins a.c. to prevent aspiration3.Protect from falls.

4.Aspiration precaution5.Star meal with cold beverage.

6.Adequate ventilation7.Plasmapheresis

Medications:>cholinergics(Anticholinesterase)

Antacids

Surgery:>Thymectomy

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DISORDER ETIOLOGY PATHOPHYSIOLOGY CLINICALMANIFESTATION

MANAGEMENT

Amyotrophic

Lateral Sclerosis

Lou Grehrigs

Disease

Unknown

Viral Infection

Myelin Sheath

Destruction

Scar Tissue Formation

Distortion / Blocking of

nerve Impulse

Fatigue

Awkwardness of fine

fingers

Muscle weakness

Atrophy

Fasciculations

Dysarthia

Jaw clonus

Respiratory

difficulty

Spasticity of flexor

muscle

Unilateral disability

of upper extremities

Death: 5 to 10 Years

Diagnostic test EMG

( no definite test )

Gastrostomy feeding

Assist with ADL

Prosthesis to support

weakened muscle

Promote effective

airway clearance

Avoid Aspiration

Tucked chin position

when eating drinkingto facilitateswallowing

Emotional support

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DISORDER ETIOLOGY PATHOPHYSIOLOGY CLINICAL

MANIFESTATION

MANAGEMENT

Guillian Bare

Syndrome

Infectious

Polyneuritis

Relatively rare

disease affecting the

peripheral andcranial nerves

Usually follows a viral

infection

Infectious Polyneuritis

Ascending or

descending paralysis

which may progressto respiratory muscle

paralysis

Paralysis ascends

and stay at

maximum level 2 3weeks then slowly

descendsAbnormal sensation of

tingling or nubness

No specific therapy,

symptomatic,

supportive care ofthe paralyze

immobilized patient

ROM

Skin care

Full recovery oftenoccurs if good

supportive care duringillness is adequate

implemented