Date post: | 04-Apr-2018 |
Category: |
Documents |
Upload: | cedric-villalba |
View: | 225 times |
Download: | 0 times |
of 78
7/31/2019 Autoimmune Disorders(1)
1/78
7/31/2019 Autoimmune Disorders(1)
2/78
7/31/2019 Autoimmune Disorders(1)
3/78
MULTIPLE SCLEROSISAn immune-mediated,
progressivedemyelinating diseaseof the CNS
7/31/2019 Autoimmune Disorders(1)
4/78
DEMYELINATIONRefers to the destruction ofmyelin, the fatty and proteinmaterial that surrounds certainnerve fibers in the brain and
spinal cord, it results inimpaired transmission of nerveimpulses.
7/31/2019 Autoimmune Disorders(1)
5/78
7/31/2019 Autoimmune Disorders(1)
6/78
MULTIPLE SCLEROSISMay occur in any age but
typically manifests in youngadults between the ages of 20to 40 years;
It affects women morefrequently than men
7/31/2019 Autoimmune Disorders(1)
7/78
CAUSE OF MSIt is currently unknown Many believe it to be the result
of a combination of genetic,environmental, and infectiousorigins.
Not considered a hereditary orgene transmitted disease.
7/31/2019 Autoimmune Disorders(1)
8/78
PATHOPHYSIOLOGY
Sensitized T and BLymphocytes cross theblood brain barrier, theirfunction is to check theCNS for antigens and thenleave
7/31/2019 Autoimmune Disorders(1)
9/78
In MS, sensitized T cellsremain in the CNS and
promote the infiltrationof other agents that
damage the immunesystem
7/31/2019 Autoimmune Disorders(1)
10/78
7/31/2019 Autoimmune Disorders(1)
11/78
The immune system
attack leads toinflammation that
destroys myelin and theoligodendroglial cells
that produce myelin inthe CNS
7/31/2019 Autoimmune Disorders(1)
12/78
Demyelinationinterrupts the flow ofnerve impulses andresults in variety ofmanifestations,depending on the nerve
affected
7/31/2019 Autoimmune Disorders(1)
13/78
Plaques appear onthe myelinated
axons, furtherinterrupting theimpulses
7/31/2019 Autoimmune Disorders(1)
14/78
The areas most
frequently affected are theoptic nerves, optic chiasm
and tracts, the cerebrum,the brain stem, andcerebellum and the spinalcord
7/31/2019 Autoimmune Disorders(1)
15/78
The axondegenerates,resulting in
permanent andirreversible damage.
7/31/2019 Autoimmune Disorders(1)
16/78
CLINICAL
MANIFESTATION
7/31/2019 Autoimmune Disorders(1)
17/78
7/31/2019 Autoimmune Disorders(1)
18/78
CLINICAL SYMPTOMSFatigue
Depression
WeaknessNumbness
7/31/2019 Autoimmune Disorders(1)
19/78
Difficulty incoordination
Loss of balancePain
Blurring of vision
7/31/2019 Autoimmune Disorders(1)
20/78
Diplopia
Patchyblindness
Total blindness
7/31/2019 Autoimmune Disorders(1)
21/78
DIAGNOSTIC EXAMS
MRI
ELECTROPHORESIS OFCSF
URODYNAMICSTUDIES
7/31/2019 Autoimmune Disorders(1)
22/78
MRI OF MULTIPLE SCLEROSIS
7/31/2019 Autoimmune Disorders(1)
23/78
7/31/2019 Autoimmune Disorders(1)
24/78
MEDICAL MANAGEMENT
No cure exists for MS
Supportive measures
to relieve patientssymptoms
7/31/2019 Autoimmune Disorders(1)
25/78
PHARMACOLOGIC MNGT.Interferon beta-1a (Rebif)and
Interferon beta 1-b (Betaseron) are
administered subcutaneouslyAvonex(interferon 1-a) is administered
intramuscularly
Glatiramer Acetate (Copaxone)
Methlprednisolone
7/31/2019 Autoimmune Disorders(1)
26/78
NURSING DIAGNOSIS
Impaired bed and physical mobilityrelated to weakness and muscle
paresis
Impaired home maintenance
management related to physical,psychological and social limitsimposed by MS
7/31/2019 Autoimmune Disorders(1)
27/78
7/31/2019 Autoimmune Disorders(1)
28/78
MYASTHENIA GRAVISAn autoimmune disorder
affecting the myoneuraljunction, is characterized by
varying degrees of weaknessof the voluntary muscles.
7/31/2019 Autoimmune Disorders(1)
29/78
Women are affected morefrequently than men, and
they tend to develop at anearly age 20 to 40 years ofage, versus 60 to 70 years formen.
7/31/2019 Autoimmune Disorders(1)
30/78
PATHOPHYSIOLOGY
Normally, a chemical impulseprecipitates the release ofacetylcholine from vesicles onthe nerve terminal at themyoneural junction.
7/31/2019 Autoimmune Disorders(1)
31/78
The acetylcholine attaches to
receptor sites on the motorendplate and stimulates musclecontraction.
Continuous binding ofacetylcholine to the receptor
site is required for muscularcontraction to be sustained.
7/31/2019 Autoimmune Disorders(1)
32/78
In myasthenia gravis, antibodies
directed at the acetylcholinereceptor sites impair transmissionof impulses across the myoneural
junction.Fewer receptors are available for
stimulation , resulting in voluntarymuscle weakness that escalateswith continued activity.
7/31/2019 Autoimmune Disorders(1)
33/78
7/31/2019 Autoimmune Disorders(1)
34/78
CLINICAL MANIFESTATIONS
Initial manifestation:
Two thirds of patients involves the ocular muscles
Diplopia (double vision)
Ptosis (drooping of eyelids)
7/31/2019 Autoimmune Disorders(1)
35/78
Weakness of the muscles of
the face and throat (Bulbarsymptoms) results in blandfacial expression.
Generalized weakness affectsall extremities and intercostal
muscles resulting in decreasingvital capacity and respiratory
failure
7/31/2019 Autoimmune Disorders(1)
36/78
Laryngeal involvement
produces dysphonia andincreases the risk of choking
and aspirationMyasthenia Gravis is purely
a motor disorder with noeffect on sensation orcoordination.
7/31/2019 Autoimmune Disorders(1)
37/78
DIAGNOSTIC TEST
ACETYL CHOLINESTERASE
INHIBITOR TEST
Used to diagnose myasthenia gravisStops the breakdown of acetylcholine
thereby increasing availability at the
neuromuscular junctionEdrophonium chloride (Tensilon) is
administered IV
7/31/2019 Autoimmune Disorders(1)
38/78
30 secs after injection, facialmuscle weakness and Ptosis shouldresolve for about 5 minutes.
Improvement in muscle strength
represents a positive test andconfirms the diagnosis.
Atropine should be available tocontrol the side effects ofEdrophonium.
7/31/2019 Autoimmune Disorders(1)
39/78
MRI SCAN
The enlargement of thymus glandmaybe detected through this
diagnostic testThe thymus gland is a site of Ach
receptor antibody production andmay be enlarged in myastheniagravis
7/31/2019 Autoimmune Disorders(1)
40/78
SINGLE FIBER
ELECTROMYOGRAPHY
Detects a delay or failure of
neuromuscular transmissionand is about 99% sensitive in
confirming the diagnosis ofmyasthenia gravis
7/31/2019 Autoimmune Disorders(1)
41/78
MEDICAL MANAGEMENT
Administration of anticholinesterase medications andimmunosuppressive therapy
Plasmapheresis-
-(plasma exchange)-to treat exacerbations
7/31/2019 Autoimmune Disorders(1)
42/78
Thymectomy-removal of
thymus gland
No cure for myasthenia gravis,treatment do not stop the
production of acetylcholinereceptor antibodies
7/31/2019 Autoimmune Disorders(1)
43/78
PHARMACOLOGIC THERAPY
Pyridostigmine bromide (Mestinon)
First line of therapy
Inhibits breakdown of Ach
Increases relative concentration of
Ach at the neuromuscular junction
7/31/2019 Autoimmune Disorders(1)
44/78
NURSING MANAGEMENT
Educational management
- Medication management
- Energy conservation
- Strategies to help with ocular
manifestations- Prevention and management of
complications
7/31/2019 Autoimmune Disorders(1)
45/78
NURSING DIAGNOSES
Risk forAspiration
Risk for Injury
7/31/2019 Autoimmune Disorders(1)
46/78
Guillain- Barr Syndrome
7/31/2019 Autoimmune Disorders(1)
47/78
7/31/2019 Autoimmune Disorders(1)
48/78
7/31/2019 Autoimmune Disorders(1)
49/78
7/31/2019 Autoimmune Disorders(1)
50/78
7/31/2019 Autoimmune Disorders(1)
51/78
7/31/2019 Autoimmune Disorders(1)
52/78
7/31/2019 Autoimmune Disorders(1)
53/78
7/31/2019 Autoimmune Disorders(1)
54/78
7/31/2019 Autoimmune Disorders(1)
55/78
7/31/2019 Autoimmune Disorders(1)
56/78
7/31/2019 Autoimmune Disorders(1)
57/78
7/31/2019 Autoimmune Disorders(1)
58/78
7/31/2019 Autoimmune Disorders(1)
59/78
7/31/2019 Autoimmune Disorders(1)
60/78
7/31/2019 Autoimmune Disorders(1)
61/78
7/31/2019 Autoimmune Disorders(1)
62/78
7/31/2019 Autoimmune Disorders(1)
63/78
7/31/2019 Autoimmune Disorders(1)
64/78
7/31/2019 Autoimmune Disorders(1)
65/78
7/31/2019 Autoimmune Disorders(1)
66/78
7/31/2019 Autoimmune Disorders(1)
67/78
7/31/2019 Autoimmune Disorders(1)
68/78
7/31/2019 Autoimmune Disorders(1)
69/78
7/31/2019 Autoimmune Disorders(1)
70/78
7/31/2019 Autoimmune Disorders(1)
71/78
7/31/2019 Autoimmune Disorders(1)
72/78
7/31/2019 Autoimmune Disorders(1)
73/78
7/31/2019 Autoimmune Disorders(1)
74/78
7/31/2019 Autoimmune Disorders(1)
75/78
7/31/2019 Autoimmune Disorders(1)
76/78
7/31/2019 Autoimmune Disorders(1)
77/78
7/31/2019 Autoimmune Disorders(1)
78/78