Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)

Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome)

Definition:

Neuron dysfunction delays messages to muscles

Neuron:

• Primary component of nervous system
• Myelin sheath – allows electrical impulses to transmit quickly and efficiently
• Neurotransmitters
• Excitatory: norepinephrine, acetylcholine
• Inhibitory: serotonin, dopamine, GABA

Multiple sclerosis-

Definition:

• Autoimmune condition
• Attacks CNS
• Demyelination of axon

Clinical manifestations:

• Changes in sensation in the arms, legs, and face
• Complete or partial vision loss, double vision
• Weakness, unsteady gait/balance

Interventions:

• Steroids
• Immunosuppressants
• Antineoplastics

Myasthenia Gravis: (mouth to ground)

Definition:

• Autoimmune disease of the neuromuscular junction
• Decreased receptor sites for acetylcholine binding

Clinical manifestations:

• Slowed innervation → muscle fatigue
• Weak eye muscles → ptosis
• Weak pharyngeal muscles → dysphagia
• Impaired verbal communication
• Weak respiratory muscles → respiratory paralysis

Guillain-Barré: (from ground to brain)

Definition:

• Acute peripheral neuropathy causing ascending weakness
• Autoimmune disease
• Damage to the myelin sheath

Clinical manifestations with disease progression:

• Tingling in the extremities
• Loss of deep tendon reflexes
• Symmetric paralysis beginning in lower extremities and moving upward

Interventions:

• 25% require mechanical ventilation
• Care is supportive

Evaluation | Patient Monitoring | Education:

• Fall risk!
• Impaired ADLs
• Continuously monitor and treat as indicated
• Be prepared to support airway!
• Monitor patient response/outcomes, and modify nursing care plan as appropriate
• If positive patient outcomes are not demonstrated, reevaluate assessment and/or plan of care

Linchpins: (Key Points)

• Multiple Sclerosis – Demyelination of axon, overall weakness
• Myasthenia Gravis (mouth to ground), neuromuscular junction, decreased receptor sites for acetylcholine (excite) binding
• Guillain-Barré (from ground to brain) acute peripheral neuropathy, myelin sheath damage