12.4 Disorders of the Peripheral Nervous System

Peripheral nervous system disorders can wreak havoc on the body's communication network. From Guillain-Barré syndrome to myasthenia gravis and peripheral neuropathy, these conditions disrupt nerve function, causing weakness, sensory issues, and even respiratory problems.

Nurses play a crucial role in managing these disorders. They administer meds, monitor for complications, and educate patients on disease management. A multidisciplinary approach, including physical therapy and psychological support, helps patients navigate the physical and emotional challenges of living with these conditions.

Pathophysiology and Clinical Manifestations of Peripheral Nervous System Disorders

Pathophysiology of peripheral nervous disorders

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• Guillain-Barré syndrome (GBS)
  • Autoimmune disorder attacks peripheral nerves leading to demyelination of nerve fibers
  • Ascending paralysis progresses from legs upward affecting muscle strength and function
  • Areflexia occurs due to nerve damage disrupting normal reflex pathways
  • Sensory disturbances manifest as tingling, numbness, or pain (paresthesia)
  • Potential respiratory failure results from paralysis of respiratory muscles
• Myasthenia gravis (MG)
  • Autoimmune disorder targets neuromuscular junction as antibodies attack acetylcholine receptors
  • Fluctuating muscle weakness worsens with activity and improves with rest
  • Ocular symptoms include double vision (diplopia) and drooping eyelids (ptosis)
  • Bulbar symptoms manifest as difficulty swallowing (dysphagia) and speaking (dysarthria)
  • Fatigue and exercise intolerance stem from impaired neuromuscular transmission
• Peripheral neuropathy
  • Damage to peripheral nerves caused by various factors (diabetes, toxins, infections)
  • Sensory symptoms include numbness, tingling, and pain in extremities (glove-and-stocking distribution)
  • Motor symptoms present as muscle weakness and atrophy, particularly in distal limbs
  • Autonomic dysfunction leads to sweating abnormalities and blood pressure regulation issues (orthostatic hypotension)

Risk factors and diagnostic tests

• Risk factors
  • Infections trigger immune response (Campylobacter jejuni, Epstein-Barr virus)
  • Autoimmune disorders increase susceptibility (rheumatoid arthritis, lupus)
  • Diabetes mellitus causes nerve damage through prolonged high blood sugar levels
  • Toxin exposure damages nerves (heavy metals, chemotherapy drugs)
  • Nutritional deficiencies impair nerve function (vitamin B12, vitamin E)
  • Genetic predisposition influences disease susceptibility (Charcot-Marie-Tooth disease)
  • Aging naturally increases risk of nerve degeneration
• Diagnostic tests
  • Nerve conduction studies measure electrical activity in nerves
  • Electromyography (EMG) assesses muscle electrical activity and nerve-muscle communication
  • Lumbar puncture analyzes cerebrospinal fluid for protein levels and antibodies
  • Blood tests detect specific autoantibodies (anti-acetylcholine receptor antibodies in MG)
  • Imaging studies visualize nerve structures and rule out other conditions (spinal cord compression)
  • Nerve biopsy examines nerve tissue for structural changes or inflammation
  • Tensilon test evaluates muscle strength improvement with edrophonium chloride (for myasthenia gravis)

Nursing management for peripheral disorders

• Medication administration
  • Immunosuppressants reduce immune system activity (prednisone, azathioprine)
  • Intravenous immunoglobulin (IVIG) modulates immune response
  • Plasma exchange removes harmful antibodies from blood
  • Anticholinesterase inhibitors improve neuromuscular transmission in MG (pyridostigmine)
  • Pain management medications alleviate neuropathic pain (gabapentin, pregabalin)
• Monitoring for complications
  • Respiratory function assessment includes vital capacity and negative inspiratory force measurements
  • Swallowing evaluation prevents aspiration risk in bulbar involvement
  • Skin integrity checks prevent pressure ulcers in immobilized patients
  • Fall risk assessment ensures patient safety during mobility challenges
  • Autonomic dysfunction monitoring includes blood pressure, heart rate, and temperature regulation
• Patient education
  • Disease process and prognosis explanation tailored to patient's understanding
  • Medication regimen and side effects discussion emphasizes adherence and monitoring
  • Energy conservation techniques help manage fatigue (pacing activities, prioritizing tasks)
  • Safety measures prevent falls (removing hazards, using assistive devices)
  • Importance of follow-up appointments stresses ongoing care and monitoring
  • Recognizing signs of exacerbation or complications enables prompt intervention

Impact on quality of life

• Impact on quality of life
  • Physical limitations and disability affect independence and daily activities
  • Emotional and psychological effects include anxiety, depression, and frustration
  • Social isolation results from mobility issues and communication difficulties
  • Occupational challenges lead to job loss or career changes
  • Financial burden stems from medical expenses and potential loss of income
• Multidisciplinary care
  • Neurologists manage disease progression and treatment plans
  • Physical therapists improve mobility and strength through targeted exercises
  • Occupational therapists enhance independence in activities of daily living
  • Speech therapists address swallowing difficulties and communication issues
  • Respiratory therapists provide breathing support and pulmonary hygiene
  • Psychologists or counselors offer emotional support and coping strategies
  • Social workers coordinate resources and assist with financial planning
  • Nutritionists manage dietary needs and address nutritional deficiencies
• Optimizing outcomes
  • Early diagnosis and intervention improve prognosis and prevent complications
  • Personalized treatment plans address individual patient needs and goals
  • Regular follow-up and monitoring allow for timely adjustments in care
  • Patient and family education empowers active participation in treatment
  • Support groups and community resources provide peer support and practical assistance
  • Adaptive equipment and assistive devices enhance independence and safety
  • Vocational rehabilitation supports return to work or career transition