Questions and answers
- Multiple sclerosis
Multiple sclerosis involves formation of lesions in the central nervous system, destruction of myelin sheaths and inflammation. These features get to interact in a complex manner and finally lead to breaking down of the nerve tissue causing the signs and symptoms characteristic of multiple sclerosis. The white matter is the part of the nervous system mostly affected. The tissues affected include the brainstem, the optic nerve, the basal ganglia, and the spinal cord. The white matter carries signals between the grey matter and the other body parts. Lesions in the optic nerve causes vision changes, ataxia and difficulty walking is caused by the spinal cord involvement. The basal ganglion controls the emotional state of an individual and so the individual presented with emotional symptoms.
The following are some of the subjective data
Easy fatigability, muscle spasms and recent alteration in the emotional status.
B. Objective data
The following are some of the objective data obtained on examination
Hyperactive deep tendon flexes, clonus and positive Babinski reflex and positive Romberg’s sign
C. Patient needs
Based on the presentation of the patient, the following are the pertinent needs
Mobility, vision problems, emotional problems.
A nursing diagnosis
- Impaired physical movement related to jerky movements as evidenced by limited range of motion
Goal
The patient will be able to adjust to the situation as will be evidenced by making steps so as to maximize moving capability
Actions
Encourage movement with monitoring of gait and assistance
Gullaine barre syndrome is a disorder of the peripheral nervous system. It is characterized by ascending paralysis where weakness begins from the hands and feet and progress towards the torso. One mechanism by which the pathology occurs is the evoking of the immune system by a pre-existing infection, which thereafter reacts with the components of the peripheral nerve with which it shares the cross-reactive isotopes. A situation called polyneuropathy results. The immune attack can target the axon or myelin sheath of peripheral nerves.
A condition referred to as acute inflammatory demyelinating neuropathy occurs when epitopes on the surface of Schwann cell membrane begin to react in response. An inflammatory multifocal demyelination process begins on the nerve roots. Changes occur initially at the nodes of Ranvier as a result of the involvement of both humoral and cellular immune responses.
A. The subjective data include
The patient comes complaining of weakness of facial muscles, difficulty walking and incontinence
B. Objective data include
Deep tendon reflexes, low or high blood pressure and difficulty walking
Some of the patient needs include
Mobility
Elimination needs
Nursing diagnosis
Altered urinary pattern; incontinence related to loss of voluntary control of urinary elimination as evidenced by verbalized complaints and soiled clothes
Actions
The actions/nursing interventions include
Monitoring the patient’s intake and output chart and taking measures to reduce the risk of the patient soiling like indwelling catheter fixation.
3.
Neuroinflammation is involved in the complex process that leads to Alzheimer’s disease’s symptoms and pathology. There are pathological and clinical findings that point that there are immunological associated changes. Such changes include inflammatory- associated increase in the concentrations of cytokine levels in the cerebrospinal fluid and the blood. The cause-consequence continuum of this relationship is not well established. However, inflammatory changes in the brain and increased reaction of microglia to amyloid deposits is highly implicated in the development of Alzheimers’ disease. These changes are believed to be the causes of confusion, short term memory and ritualistic behaviors.
- Subjective data include
Confusion, loss of short term memory and poor judgment
- Objective data
Repetitive/ ritualistic movements, forgetting the name of the relative who brought them
Needs
Self-care needs, nutritional needs and elimination needs
A nursing diagnosis
Risk for injury related to inability to be able to make decision, confusion and disorientation
Actions
Education of the individuals closest to the patient to be able to identify hazards in the environments
Remove the hazards from the environment
