Multiple Sclerosis: ALS, Guillain-Barre Syndrome & Myasthenia Gravis- Medical Surgical | @LevelUpRN

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Hi. I'm Cathy with Level Up RN. In this video,  I'm going to continue my coverage of nervous   system disorders. Specifically, I will be  talking about Multiple Sclerosis or MS,   as well as Amyotrophic Lateral Sclerosis  or ALS, and Guillain-Barre Syndrome or GBS,   and Myasthenia Gravis or MG. At the end of the  video, I'm going to give you guys a little quiz   to test your knowledge of some of the key facts  I'll be covering in this video. So definitely   stay tuned for that. And if you have our Level  Up RN medical-surgical nursing flashcards,   definitely pull those out so  you can follow along with me.   Multiple sclerosis or MS is an autoimmune disorder  that causes damage to the myelin sheath, which is   that fatty substance that surrounds and protects  the axon of the nerve. So it damages the sheath,   and then it also damages the underlying nerve.  And where that damage occurs, we have inflammation   and the formation of scar tissue or plaques. If  you look at the disease name multiple sclerosis,   that means many scars. So sclerosis means  scars. Because we have all this scar tissue   formation from that damage. So multiple  sclerosis is characterized by periods of   relapsing and remitting. So a patient may go  a while without any problems and then relapse   again. This disease is more common in women than  men. And it is most common between the ages of 20   and 40. In terms of signs and symptoms, patients  with MS often have vision issues such as diplopia,   which is double vision. Or nystagmus, which is the  involuntary movement of an eye. And then patients   will also have muscle spasticity and/or weakness.  It can also cause balance issues as well as   bowel and bladder dysfunction. It can cause  fatigue as well as cognitive changes, such   as difficulty concentrating. It can also cause  emotional changes, such as depression or anxiety.   And it causes pain as well as difficulty  swallowing in many cases. So dysphagia.   In terms of diagnosis, with an MRI, we  can see those plaques that I referred to.   Also, if we do a lumbar puncture, the patient's  CSF will show increased protein levels.   In terms of treatment, we're going to treat MS  with immunosuppressants because it's an auto   immune disorder. So during an exacerbation, we  would typically treat that with corticosteroids.   Long-term, we would treat it with a  medication such as interferon beta,   which will help to prevent relapses of MS. We  can also use other anti-inflammatories as well as   muscle relaxants if the patient is having that  muscle spasticity. In terms of patient teaching,   you want to advise your patient to avoid  triggers. So triggers can include temperature   extremes such as very hot or very cold. Triggers  can also include stress, fatigue, and illness.   Next, let's talk about ALS, which is a  neurodegenerative disease that causes progressive   muscle weakness. So the exact cause of ALS is not  known, but it results in the gradual deterioration   of the upper and lower motor neurons such that  we have the loss of voluntary movement and muscle   control. So the patient will lose their ability  to speak, eat, move, and eventually breathe. So   symptoms of ALS will include muscle weakness and  atrophy as well as muscle cramps and twitching.   Dysphagia is another symptom. So difficulty  swallowing. And then eventually the patient   will have respiratory paralysis, which typically  occurs between three and five years after they   are diagnosed. In terms of diagnosis, there's  no one definitive test that can point to ALS.   So diagnosis is done based on the patient's  symptoms and ruling out other causes. In terms   of treatment, there's no cure. Medications  such as Riluzole can be used to help   slow the deterioration of those motor neurons,  but it won't cure ALS. In terms of nursing care,   your number one priority is to maintain a patent  airway. So you want to monitor the patient for   pneumonia as well as respiratory failure. Those  respiratory muscles will get progressively weaker,   such that the patient will eventually become  dependent on a ventilator. So in addition,   you want to initiate a consult to the  palliative team for the patient with ALS.   Next, let's talk about Guillain-Barre Syndrome or  GBS. This is an autoimmune disorder that affects   the peripheral nervous system and causes the  sudden onset of weakness and paralysis. So   the pathophysiology behind this disorder, is  that patients typically have a viral infection,   such as influenza or pneumonia that triggers  the autoimmune destruction of the myelin sheath   and of the axons in the motor and sensory  nerves. And you may be thinking to yourself,   this sounds a lot like multiple sclerosis. Well,  with MS, we have destruction of the myelin sheath   and of the nerves, but this occurs in the central  nervous system. Here with GBS, this occurs in the   peripheral nervous system. So signs and symptoms  of GBS include tingling in the feet and hands   as well as symmetric weakness. So we're not  talking about one-sided weakness like we would   see with a stroke. It's going to be on both sides  of the body. The patient may also have decreased   deep tendon reflexes as well as paralysis.  Symptoms typically occur at the feet and move up   the body. In terms of treatment, we can do a  plasmapheresis, which basically is going to filter   the blood and get rid of those bad antibodies  that are attacking the nerves. And we can provide   IVIG, which is intravenous immunoglobulin,  which are good antibodies for the patient.   In terms of nursing care, because that muscle  weakness can affect the respiratory muscles,   we want to be sure to maintain a patent airway.  And we want to monitor the patient for aspiration,   pneumonia, as well as respiratory failure. Finally, let's talk about Myasthenia Gravis or MG.   This is an autoimmune disorder that causes severe  muscle weakness. And it is characterized by   periods of exacerbation and periods of remission.  So the pathophysiology behind this condition,   is that we have antibodies that are blocking  and destroying acetylcholine receptors at   the neuromuscular junction. And this is  causing symptoms such as muscle weakness,   which is worse with exercise and improves with  rest. Myasthenia Gravis can also cause diplopia,   so double vision. As well as dysphagia, difficulty  swallowing. It can cause shortness of breath   as well as thymus hyperplasia. So the thymus gland  is located here in the chest between the lungs   and it's part of the immune system and produces  T cells. If that thymus gland is enlarged,   then that may be indicative of MG. In addition,  the patient with MG may have drooping eyelids,   which is definitely a unique feature of  this disorder. So in terms of diagnosis,   we can help diagnose MG using electromyography  as well as a repetitive nerve stimulation test.   And then we can do something called an edrophonium  or Tensilon test. And the purpose of this test   is to differentiate between Myasthenia Gravis and  a cholinergic crisis. So both of these things can   cause extreme muscle weakness, but they're  very different conditions. So edrophonium   is a cholinergic agent. So it's going to increase  levels of acetylcholine, which is going to   help a patient with Myasthenia Gravis. Because  we have too little acetylcholine because of that   destruction of the acetylcholine receptors  at the neuromuscular junction. So if we give   the patient edrophonium, it's going to increase  acetylcholine and make the patient feel better.   However, if the patient is having a cholinergic  crisis, meaning there's too much acetylcholine,   by giving them more acetylcholine, it's  actually going to make things worse. So if   things get worse, then we know the patient had  a cholinergic crisis, and we need to provide an   antidote, which would be atropine, which is an  anticholinergic agent. Treatment for Myasthenia   Gravis can include medications such as neostigmine  and pyridostigmine, which are cholinergic   agents. So they help to prevent the breakdown of  acetylcholine. We can also use immunosuppressants   such as prednisone to help suppress the  immune response. And then the patient can get   a plasmapheresis, which will filter the patient's  blood to get rid of those bad antibodies. And then   a thymectomy may be helpful as well. So that is  removal of the thymus gland and has been shown to   improve symptoms in patients with MG. In terms  of nursing care, because the patient will have   muscle weakness and this includes the respiratory  muscles, we want to make sure we are maintaining a   patent airway. We want to assist the patient with  ambulation. And encourage lots of rest periods.   And then because the muscles that are involved in  chewing and mastication are also potentially weak,   we want to provide the patient with  frequent small, high calorie meals,   and then monitor them for aspiration and  choking because of the risk for dysphagia.   Patients with MG often have trouble closing  their eyes at night, and this can cause drying   and damage to the cornea. Because that is the  case, we want to administer eye drops and then   tape their eyes shut at night to  prevent that drying and irritation.   All right, it's time for a quiz. I actually  had trouble narrowing down what I wanted to   ask you because there's a lot of bold red text  on these cards, which means there's a lot of   important points you need to know about these  disorders. But here we go. Question number one,   Multiple sclerosis is characterized by periods  of relapsing and remitting, true or false?   The answer is true. Question number two, with  Guillain-Barre Syndrome, patients will have   unilateral muscle weakness, true or false? The  answer is false. So they will have symmetrical   muscle weakness. Question number three,  what medication is administered to determine   if a patient is having a Myasthenia  Gravis crisis or a cholinergic crisis?   The answer is it edrophonium. All right, I  hope that was helpful. Hope you enjoyed the   video. If so, be sure to like it and leave me  a comment. Take care and I'll see you soon.
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Channel: Level Up RN
Views: 202,298
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Keywords: ati testing, cathy parkes, hesi exam, med surg ati, med surg nclex review, med surg review, medical surgical nursing, medical surgical nursing lecture, medical surgical nursing review, nclex comprehensive exam, nclex rn, nursing school, nursing student, practical nurse, student nurse, studying for ati, nervous system medical surgical nursing, myasthenia gravis nursing, guillain barre syndrome nursing, amyotrophic lateral sclerosis nursing, multiple sclerosis nursing
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Length: 12min 37sec (757 seconds)
Published: Tue Nov 09 2021
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