NLE Neurosensory Nursing — Seizure, Infectious, and Degenerative Neurologic DisordersRevision Notes

Exam Tips

• If the question asks what to do FIRST during a seizure, the answer is almost always: TURN TO THE SIDE (lateral position) to protect the airway.
• Status epilepticus = FIRST-LINE drug is IV benzodiazepine (lorazepam or diazepam), not phenytoin — phenytoin is the follow-up.
• Phenytoin clues: Normal Saline, slow rate, 10–20 mcg/mL, gingival hyperplasia, oral hygiene teaching.
• If the stem mentions a rash in a patient on lamotrigine, think Stevens-Johnson syndrome — the nurse should WITHHOLD the drug and notify the physician.
• Absence seizure question clue: child, brief staring spell, no postictal period — do NOT confuse with a complex focal seizure.

Key Points

• A seizure is a sudden, abnormal, excessive electrical discharge of neurons. Epilepsy means recurrent, unprovoked seizures.
• Seizures are broadly classified as GENERALIZED (both hemispheres involved, loss of consciousness) or FOCAL (starts in one area).
• Classic generalized tonic-clonic seizure: AURA → TONIC phase (stiffening) → CLONIC phase (rhythmic jerking) → POSTICTAL period (confusion, drowsiness, fatigue).
• Absence seizures: brief staring spells, no aura, no postictal phase — most common in children.
• STATUS EPILEPTICUS = seizure lasting 5 minutes or more, OR repeated seizures without regaining consciousness in between. This is a MEDICAL EMERGENCY.
• During a seizure: TURN the patient to the LATERAL (side-lying) position to prevent aspiration — this is the TOP nursing priority.
• NEVER restrain the patient and NEVER force anything into the mouth during a seizure.
• TIME the seizure, document characteristics (eye movements, progression, incontinence), and stay with the patient throughout.
• After the seizure: keep lateral position, reorient, allow rest, assess for injury.
• Status epilepticus management: Airway + O2 → IV access → IV BENZODIAZEPINES (lorazepam or diazepam first-line) → loading dose of phenytoin/fosphenytoin/levetiracetam → check glucose and treat reversible causes.
• Phenytoin: give IV in NORMAL SALINE ONLY (precipitates in dextrose), rate no faster than 50 mg/min, therapeutic level 10–20 mcg/mL, monitor for hypotension and dysrhythmias.
• Phenytoin side effect: GINGIVAL HYPERPLASIA — teach meticulous oral hygiene.
• Valproic acid: monitor liver function and platelet count.
• Lamotrigine: risk of Stevens-Johnson syndrome (serious rash — stop drug immediately).
• Benzodiazepines: watch for RESPIRATORY DEPRESSION when used to abort acute seizures.
• NEVER stop antiseizure drugs abruptly — can trigger status epilepticus.
• Patient/family teaching: wear medical ID, avoid alcohol, follow driving restrictions, maintain consistent dosing schedule.

Definitions

Section Title

Seizures and Epilepsy

Common Mistakes

• Placing something in the patient's mouth during a seizure — this causes injury, not protection.
• Restraining the patient — increases risk of fractures and soft tissue injury.
• Confusing status epilepticus threshold: some students say 10 or 15 minutes — it is 5 MINUTES.
• Mixing phenytoin with dextrose solutions — causes precipitation and renders the drug ineffective while clogging the IV line.
• Stopping antiseizure medication once seizures are controlled — abrupt withdrawal can precipitate status epilepticus.
• Forgetting the postictal period — students describe the seizure as over when convulsions stop, neglecting ongoing nursing care needs.

Exam Tips

• Memory aid for bacterial meningitis CSF: THINK 'CLOUDS OVER THE PHILIPPINES' — Cloudy CSF, High Protein, Low Glucose, High Neutrophils = BACTERIAL.
• Mnemonic for meningitis signs: 'Kernig = Knee, Brudzinski = Bending' — helps during quick recall under exam pressure.
• Droplet precautions for meningococcal meningitis until 24 hours of antibiotics — common NLE question on duration of isolation.
• If the question says 'herpes encephalitis,' the drug is ACYCLOVIR — always.
• Japanese Encephalitis is Philippine-context relevant — expect questions on mosquito control and vaccination as prevention strategies aligned with the DOH disease control programs.

Key Points

• MENINGITIS = inflammation of the MENINGES (not brain tissue itself).
• ENCEPHALITIS = inflammation of the BRAIN TISSUE itself.
• Classic triad of bacterial meningitis: FEVER + SEVERE HEADACHE + NUCHAL RIGIDITY (stiff neck).
• Additional signs: photophobia, phonophobia, altered LOC, seizures, petechial or purpuric rash (meningococcal — think WATERHOUSE-FRIDERICHSEN SYNDROME if septic shock develops).
• KERNIG'S SIGN: Patient lies supine, hip and knee flexed to 90°; pain or resistance when examiner tries to extend the knee.
• BRUDZINSKI'S SIGN: Involuntary flexion of the hips and knees when the nurse passively flexes the patient's neck.
• Causative organisms: Neisseria meningitidis (especially in young adults, can be epidemic) and Streptococcus pneumoniae (most common in adults).
• LUMBAR PUNCTURE (LP) is the definitive diagnostic test — BACTERIAL meningitis CSF: CLOUDY, HIGH PROTEIN, LOW GLUCOSE, HIGH NEUTROPHILS, HIGH PRESSURE.
• VIRAL meningitis CSF: CLEAR, NORMAL GLUCOSE, NORMAL-TO-HIGH LYMPHOCYTES, NORMAL PRESSURE.
• Treatment of bacterial meningitis: start EMPIRIC IV ANTIBIOTICS IMMEDIATELY — do NOT wait for culture results. Add DEXAMETHASONE (corticosteroid) to reduce inflammation and complications.
• Isolation: Place on DROPLET PRECAUTIONS for meningococcal and Haemophilus meningitis — until 24 hours of effective antibiotic therapy have been completed.
• Environmental modifications: quiet, dimly lit room to reduce stimulation (photophobia and headache).
• Monitor ICP: elevated HOB 30°, avoid Valsalva, avoid neck flexion, monitor neurologic status closely.
• Prophylaxis: close contacts of meningococcal meningitis should receive rifampin, ciprofloxacin, or ceftriaxone.
• ENCEPHALITIS: most common sporadic cause = HERPES SIMPLEX VIRUS (HSV). In the Philippines, ARBOVIRUSES (e.g., Japanese Encephalitis) are epidemiologically important.
• Encephalitis treatment: IV ACYCLOVIR for herpes encephalitis — give promptly; delay worsens prognosis.
• Prevention of arboviral encephalitis: vector control (mosquito eradication, consistent in Philippine DOH programs) and VACCINATION against Japanese Encephalitis.
• Nursing priority for encephalitis: maintain airway, manage ICP, monitor LOC and seizures, prevent secondary infections.

Definitions

Section Title

Central Nervous System Infections: Meningitis and Encephalitis

Common Mistakes

• Confusing droplet precautions with airborne precautions for meningitis — meningitis is DROPLET, not airborne (airborne = TB, measles, varicella).
• Waiting for culture results before starting antibiotics in suspected bacterial meningitis — delay is life-threatening; start empiric antibiotics IMMEDIATELY.
• Mixing up CSF findings: students often get viral and bacterial meningitis CSF results reversed — remember BACTERIAL = 'BAD' (Cloudy, High protein, Low glucose, High neutrophils).
• Forgetting to dim the room and reduce noise — photophobia and phonophobia are major sources of discomfort that the nurse can directly address.
• Using acyclovir for bacterial meningitis — acyclovir is antiviral (for herpes encephalitis), not antibacterial.

Exam Tips

• Remember the PD triad with the mnemonic 'TRB': Tremor (resting, pill-rolling), Rigidity (cogwheel), Bradykinesia.
• Dopamine DOWN, Acetylcholine UP in Parkinson's — this explains why ANTICHOLINERGICS help tremor (they restore balance by reducing the over-dominant acetylcholine).
• If the question asks about a Parkinson's patient's priority nursing diagnosis: RISK FOR FALLS.
• Levodopa + high protein = reduced absorption — expect a question about dietary teaching.
• Deep brain stimulation is the surgical option for ADVANCED disease not responding adequately to medication.

Key Points

• Parkinson's disease (PD) is a progressive degenerative disorder caused by loss of DOPAMINE-producing neurons in the SUBSTANTIA NIGRA of the basal ganglia.
• The imbalance created: DOPAMINE decreases → ACETYLCHOLINE becomes relatively dominant → motor dysfunction results.
• Classic TRIAD: TREMOR (resting 'pill-rolling' tremor) + RIGIDITY (cogwheel) + BRADYKINESIA (slow movement).
• Other features: POSTURAL INSTABILITY (high fall risk), SHUFFLING FESTINATING GAIT (increasingly rapid small steps), MASK-LIKE FACE (hypomimia), MICROGRAPHIA (small handwriting), STOOPED POSTURE.
• Autonomic dysfunction: orthostatic hypotension, constipation, seborrhea (oily skin), drooling.
• LEVODOPA-CARBIDOPA (Sinemet) is the CORNERSTONE of pharmacotherapy: levodopa is converted to dopamine in the brain; carbidopa prevents its peripheral breakdown, reducing nausea and peripheral side effects.
• HIGH-PROTEIN MEALS interfere with levodopa absorption across the blood-brain barrier — teach consistent dietary protein distribution.
• Watch for DYSKINESIAS (involuntary movements) as a long-term complication of levodopa therapy.
• 'ON-OFF PHENOMENON' and 'WEARING-OFF' are levodopa complications — periods when the drug is working versus not working.
• Other drugs: DOPAMINE AGONISTS (pramipexole, ropinirole), MAO-B INHIBITORS (selegiline — do NOT combine with meperidine or tyramine-rich foods), COMT INHIBITORS (entacapone — extends levodopa effect), ANTICHOLINERGICS (benztropine — primarily for tremor, useful in mild early disease).
• SURGICAL OPTION: Deep Brain Stimulation (DBS) — implanted electrode delivers electrical stimulation to basal ganglia; used in advanced disease.
• Priority nursing diagnosis: RISK FOR FALLS related to postural instability and gait disturbance.
• Nursing care: fall prevention (remove hazards, low bed, call light), encourage EXERCISE and range of motion, allow EXTRA TIME for all activities, small frequent nutrient-dense meals with swallowing precautions.
• Swallowing precautions: thicken liquids if needed, chin-tuck maneuver, sit upright for meals, avoid distractions while eating.
• Psychosocial: depression is common in PD — assess and address. Encourage independence to preserve self-esteem.

Definitions

Section Title

Parkinson's Disease

Common Mistakes

• Forgetting that the RESTING tremor of Parkinson's disappears with intentional movement — distinguishes it from the intention tremor of cerebellar disorders.
• Not associating high-protein foods with reduced levodopa absorption — a common NLE teaching scenario.
• Confusing anticholinergics (benztropine) as the primary PD drug — they are adjuncts for tremor, not primary therapy.
• Overlooking orthostatic hypotension as a Parkinson's/levodopa complication — teach patients to change positions slowly.
• Neglecting swallowing assessment — dysphagia in PD increases aspiration risk, which is a life-threatening complication.

Exam Tips

• MS clue words in NLE: young woman, relapsing-remitting, fatigue, optic neuritis, MRI plaques, Uhthoff's — when you see these, think MS.
• Priority teaching for MS patients: AVOID HEAT (Uhthoff's), conserve energy, recognize relapse signs.
• Acute relapse = IV METHYLPREDNISOLONE (corticosteroids); long-term prevention = INTERFERON BETA or GLATIRAMER.
• MS is CNS (central) demyelination; GBS is PNS (peripheral) demyelination — this distinction is heavily tested.
• Lhermitte's sign: remember 'electric shock when neck flexes' = spinal cord demyelination = MS.

Key Points

• Multiple Sclerosis (MS) is a CHRONIC AUTOIMMUNE DISEASE in which the MYELIN SHEATH of CNS neurons is DESTROYED (demyelination), disrupting nerve conduction.
• Demyelinating plaques (lesions) form in the white matter of the brain and spinal cord — MRI is the primary diagnostic tool.
• Demographics: most often affects YOUNG TO MIDDLE-AGED ADULTS (20–40 years), MORE COMMON IN WOMEN, higher incidence in temperate climates (less common in the Philippines but tested on the NLE).
• Most common course: RELAPSING-REMITTING MS (RRMS) — periods of exacerbation (relapse) alternating with periods of partial or complete recovery (remission).
• Most common and disabling symptom: FATIGUE (often described as an overwhelming, disproportionate exhaustion — not relieved by rest).
• Other manifestations: OPTIC NEURITIS (blurred vision, pain with eye movement, unilateral vision loss), DIPLOPIA (double vision), LHERMITTE'S SIGN (electric shock sensation down the spine when the neck is flexed), WEAKNESS and SPASTICITY, NUMBNESS and TINGLING (paresthesias), ATAXIA, INTENTION TREMOR, BLADDER DYSFUNCTION (urgency, frequency, retention), SEXUAL DYSFUNCTION, DEPRESSION.
• KEY TRIGGER: HEAT (Uhthoff's phenomenon — symptom worsening with elevated body temperature); STRESS, INFECTION, FATIGUE are also triggers.
• Diagnosis: MRI (demyelinating plaques — 'white matter lesions disseminated in time and space'), CSF analysis (oligoclonal bands of IgG), evoked potentials.
• ACUTE RELAPSE treatment: IV CORTICOSTEROIDS (methylprednisolone) — shortens the duration and severity of relapse but does not change long-term prognosis.
• DISEASE-MODIFYING THERAPIES (DMTs): INTERFERON BETA (Avonex, Betaseron, Rebif), GLATIRAMER ACETATE — reduce relapse frequency and slow progression.
• Nursing priorities: ENERGY CONSERVATION (schedule activities during peak energy times, use adaptive devices), AVOID HEAT (cool showers, avoid hot tubs, air-conditioned environments), stress management, infection prevention.
• Bladder management: timed voiding, fluid management, intermittent catheterization if needed, monitor for UTI (most common infection in MS).
• Spasticity management: physical therapy, baclofen (antispasmodic), stretching exercises.
• Psychosocial: depression is very common — screen regularly, support groups, counseling.
• Patient teaching: recognize relapse signs and report promptly, manage fatigue, avoid overheating, protect from infections, medication adherence for DMTs.

Definitions

Section Title

Multiple Sclerosis

Common Mistakes

• Confusing MS (CNS demyelination — brain and spinal cord) with Guillain-Barré Syndrome (PERIPHERAL nerve demyelination) — the anatomical location is the key differentiator.
• Listing pain as the most common MS symptom — FATIGUE is the most common and disabling symptom.
• Telling an MS patient to exercise vigorously in the afternoon — exercise is beneficial, but must be timed to avoid heat accumulation and fatigue; recommend early morning or cool environments.
• Using corticosteroids as long-term disease-modifying therapy — they treat ACUTE relapses only; DMTs are for long-term management.
• Forgetting bladder dysfunction as a major MS complication — many students focus on motor and sensory symptoms and overlook the bladder.

Exam Tips

• ALS key phrase: 'motor neurons only, sensation intact' — if the question mentions preserved sensation with progressive motor weakness, think ALS.
• The nurse's priority for ALS respiratory decline: MONITOR RESPIRATORY STATUS (vital capacity), prepare for ventilatory support, facilitate advance directive discussions.
• Riluzole = ALS drug. No other disease — only drug for this disease on the NLE.
• Cause of death = RESPIRATORY FAILURE — this directs the priority nursing assessment (respiratory rate, O2 saturation, vital capacity, dyspnea).
• Compare ALS vs. GBS for the exam: Both cause motor weakness, but GBS is REVERSIBLE and ACUTE; ALS is PROGRESSIVE and FATAL.

Key Points

• ALS (Lou Gehrig's Disease) is a progressive degeneration of BOTH UPPER AND LOWER MOTOR NEURONS, leading to worsening muscle weakness, atrophy, and eventual paralysis.
• Upper motor neuron signs: spasticity, hyperreflexia. Lower motor neuron signs: flaccidity, fasciculations (muscle twitching), atrophy.
• KEY FEATURE: SENSATION, COGNITION, AND EYE MOVEMENTS ARE TYPICALLY PRESERVED — the patient is 'locked in' as motor function fails while the mind remains intact.
• Progressive symptoms: muscle weakness (usually begins in one limb), DYSPHAGIA (difficulty swallowing), DYSARTHRIA (difficulty speaking), eventually respiratory muscle weakness.
• CAUSE OF DEATH: RESPIRATORY FAILURE from paralysis of breathing muscles.
• ALS is uniformly FATAL — no cure exists. RILUZOLE (Rilutek) is the only FDA-approved drug shown to MODESTLY SLOW PROGRESSION by reducing glutamate toxicity; it extends survival by a few months.
• Nursing priorities (in order of urgency): AIRWAY AND RESPIRATORY SUPPORT → NUTRITION (aspiration risk, consider PEG tube) → COMMUNICATION (as speech fails, use alternative communication devices) → ADVANCE CARE PLANNING.
• Ventilatory support: non-invasive ventilation (BiPAP) first; the patient and family decide on mechanical ventilation based on advance directives — the nurse advocates for patient autonomy.
• Swallowing: position upright, modify food texture, refer to speech-language pathologist; percutaneous endoscopic gastrostomy (PEG) tube when swallowing becomes unsafe.
• Communication: early referral to speech-language pathology for augmentative and alternative communication (AAC) devices (eye-tracking computers, voice-output devices).
• Psychosocial: ALS patients experience anticipatory grief, depression, and fear of suffocation — provide emotional support, connect with palliative care and ALS support groups.
• Caregiver support is essential — ALS eventually requires 24-hour care; coordinate with social work and community resources in the Philippine healthcare setting.
• Differentiate from MS: ALS = motor neuron death (no demyelination, no sensory loss, no cognitive loss); MS = CNS demyelination with varied sensory and motor findings.

Definitions

Section Title

Amyotrophic Lateral Sclerosis (ALS)

Common Mistakes

• Forgetting that sensation is PRESERVED in ALS — a question describing sensory loss along with motor weakness in the same patient is NOT pointing to ALS.
• Thinking cognition is always lost in ALS — typically preserved in classic ALS (though ALS-FTD variant exists, this is less commonly tested).
• Expecting riluzole to stop or reverse ALS — it only MODESTLY SLOWS progression; manage expectations in patient teaching.
• Not planning for advance directives early — given the progressive and fatal nature of ALS, advance care planning must begin at diagnosis, not crisis.
• Neglecting communication planning — students focus on mobility and breathing but forget that dysarthria progresses to anarthria, requiring early AAC referral.

Exam Tips

• Crisis differential table: Myasthenic = too LITTLE drug, Tensilon IMPROVES; Cholinergic = too MUCH drug, SLUDGE, Tensilon WORSENS, give ATROPINE.
• Priority in ANY MG crisis = AIRWAY first, then differentiate with Tensilon test.
• Remember: MG weakness WORSENS throughout the day (patients are strongest in the morning after rest).
• Pyridostigmine must be given ON TIME — missing a dose can trigger myasthenic crisis, especially during illness or perioperative period.
• Thymectomy = surgical treatment associated with MG (thymoma connection); expect at least one question about this association.

Key Points

• Myasthenia Gravis (MG) is an AUTOIMMUNE DISEASE in which ANTIBODIES ATTACK AND DESTROY ACETYLCHOLINE RECEPTORS at the NEUROMUSCULAR JUNCTION (NMJ).
• Result: acetylcholine cannot bind adequately → MUSCLE WEAKNESS AND FATIGABILITY that WORSENS WITH ACTIVITY and IMPROVES WITH REST.
• HALLMARK SIGNS: PTOSIS (drooping eyelids), DIPLOPIA (double vision), DIFFICULTY CHEWING AND SWALLOWING (dysphagia), WEAK NASAL VOICE, facial weakness.
• DANGER: weakness of RESPIRATORY MUSCLES → respiratory failure (myasthenic crisis).
• Bulbar symptoms (swallowing, speech) worsen as the day progresses — patients are strongest in the morning.
• Diagnosis: ACETYLCHOLINE RECEPTOR ANTIBODY TEST (most specific), EDROPHONIUM (TENSILON) TEST, ELECTROMYOGRAPHY (EMG — shows decremental response), CT chest for thymoma.
• THYMOMA is associated with MG — thymectomy may improve or cure MG in some patients.
• PHARMACOTHERAPY: PYRIDOSTIGMINE (Mestinon) — an ANTICHOLINESTERASE that inhibits breakdown of acetylcholine, increasing its availability at the NMJ, improving muscle strength.
• Give pyridostigmine ON TIME and 30 MINUTES BEFORE MEALS to improve chewing and swallowing.
• IMMUNOSUPPRESSION: corticosteroids, azathioprine for long-term control.
• ACUTE MANAGEMENT of severe exacerbations: PLASMAPHERESIS (removes antibodies) or IV IMMUNOGLOBULIN (IVIG — modulates immune response).
• DRUGS THAT WORSEN MG: aminoglycosides, fluoroquinolones, beta-blockers, magnesium, neuromuscular blocking agents — AVOID these in MG patients.
• MYASTHENIC CRISIS: caused by INSUFFICIENT medication (or triggered by infection, surgery, stress, or omission of doses) → MUSCLE WEAKNESS WORSENS → respiratory failure.
• CHOLINERGIC CRISIS: caused by TOO MUCH anticholinesterase medication (overdose) → excess acetylcholine → SLUDGE symptoms + muscle fasciculations, weakness, miosis.
• SLUDGE mnemonic for cholinergic crisis: SALIVATION, LACRIMATION, URINATION, DEFECATION, GI UPSET, EMESIS.
• TENSILON (EDROPHONIUM) TEST DIFFERENTIATES THE TWO CRISES: gives a SHORT-ACTING anticholinesterase IV — IMPROVES strength = MYASTHENIC CRISIS (needs more drug); WORSENS strength = CHOLINERGIC CRISIS (already too much drug).
• PRIORITY IN BOTH CRISES: AIRWAY AND VENTILATORY SUPPORT — the nurse must be ready for intubation and mechanical ventilation.
• ANTIDOTE FOR CHOLINERGIC CRISIS: ATROPINE (an anticholinergic that counteracts excess acetylcholine effects).
• WITHHOLD pyridostigmine during cholinergic crisis.

Definitions

Section Title

Myasthenia Gravis and the Crisis Differential

Common Mistakes

• Mixing up myasthenic vs. cholinergic crisis — the most common error on MG questions. Always ask: too little drug (myasthenic) or too much drug (cholinergic)?
• Giving MORE pyridostigmine in a cholinergic crisis — this worsens the situation and can be fatal; withhold the drug and give ATROPINE.
• Forgetting atropine as the antidote for cholinergic crisis — this is a critical medication safety point.
• Not timing pyridostigmine before meals — giving it after meals means the patient has already struggled to chew and swallow without adequate muscle strength.
• Forgetting that drugs like aminoglycosides (gentamicin, tobramycin) WORSEN MG — a frequently tested drug interaction.

Exam Tips

• GBS trigger: ask about RECENT INFECTION (especially gastroenteritis or flu) before ascending weakness — the 2–4 week post-infection timeline is a key NLE clue.
• Priority assessment in GBS = VITAL CAPACITY and respiratory rate — respiratory failure is the primary threat.
• Treatments: PLASMAPHERESIS or IVIG — both acceptable; corticosteroids are NOT used for GBS.
• GBS vs. MS: GBS = peripheral, acute, reversible; MS = central, chronic, relapsing. GBS = areflexia; MS = varied reflexes.
• Prognosis in GBS is GENERALLY GOOD — most patients recover, though it takes time. This is a common NLE question point that distinguishes GBS from ALS (fatal) and MS (chronic).

Key Points

• Guillain-Barré Syndrome (GBS) is an ACUTE AUTOIMMUNE DISORDER in which the IMMUNE SYSTEM ATTACKS THE MYELIN OF PERIPHERAL NERVES (not CNS).
• COMMONLY TRIGGERED by a preceding viral or bacterial infection (most commonly CAMPYLOBACTER JEJUNI gastroenteritis, also influenza, CMV, EBV).
• The attack usually occurs 2–4 weeks after the triggering infection — think 'infection then ascending paralysis a few weeks later.'
• PATHOGNOMONIC FEATURE: ASCENDING SYMMETRIC WEAKNESS AND PARALYSIS beginning in the LEGS and moving UPWARD toward the trunk, arms, and cranial nerves.
• Reflexes are DIMINISHED or ABSENT (hyporeflexia or areflexia) — distinguishes GBS from upper motor neuron disorders.
• SENSORY SYMPTOMS: tingling and paresthesias in the feet and legs (usually precede weakness), but sensory loss is less profound than motor loss.
• AUTONOMIC INSTABILITY is common and dangerous: labile blood pressure, cardiac arrhythmias, tachycardia, urinary retention, ileus.
• CHIEF DANGER: ASCENDING PARALYSIS REACHING RESPIRATORY MUSCLES → respiratory failure → MECHANICAL VENTILATION may be needed.
• PRIORITY NURSING ASSESSMENT: SERIAL MONITORING OF RESPIRATORY FUNCTION, especially VITAL CAPACITY (VC) — if VC falls below 15–20 mL/kg, prepare for intubation.
• Watch for dysphagia and aspiration as cranial nerve involvement progresses.
• TREATMENT: PLASMAPHERESIS (plasma exchange — removes circulating antibodies) and INTRAVENOUS IMMUNOGLOBULIN (IVIG) — both equally effective and the standard of care in severe GBS.
• STEROIDS alone are NOT effective in GBS (unlike MS) — do not administer corticosteroids as primary GBS treatment.
• PROGNOSIS: Most patients RECOVER — GBS is usually SELF-LIMITING; recovery is slow (weeks to months to years).
• Supportive care during hospitalization: ventilatory support, cardiac monitoring, DVT prophylaxis (anticoagulation, compression devices), skin integrity (repositioning every 2 hours), bowel and bladder management, pain management (neuropathic pain is common), nutritional support (NG or PEG tube if dysphagia).
• Rehabilitation: extensive physical and occupational therapy during recovery phase is essential.
• Psychosocial: patients are aware but paralyzed — communication, emotional support, and honest prognosis discussion are critical nursing responsibilities under RA 9173.

Definitions

Section Title

Guillain-Barré Syndrome

Common Mistakes

• Confusing GBS (peripheral demyelination, acute, reversible) with MS (central demyelination, chronic, relapsing-remitting) — the anatomical location and course are opposite.
• Using O2 saturation alone to monitor GBS respiratory status — O2 sat drops LATE in respiratory failure; VITAL CAPACITY is the priority early monitor.
• Giving steroids (corticosteroids) as treatment for GBS — NOT effective in GBS; this error could appear in an NLE question.
• Expecting rapid recovery — GBS recovery is measured in weeks to months; patients and families need realistic expectations.
• Forgetting autonomic instability — arrhythmias and blood pressure fluctuations can be fatal if not monitored closely on cardiac telemetry.

Exam Tips

• Dementia vs. Delirium differential: Acute + Fluctuating = DELIRIUM (reversible); Gradual + Stable decline = DEMENTIA (irreversible).
• Drug mnemonics for AD: 'Don't Forget Risky Galant' = Donepezil, Rivastigmine, Galantamine (cholinesterase inhibitors) + Memantine (NMDA antagonist) for moderate-to-severe.
• SAFETY is always the top priority nursing diagnosis in Alzheimer's — wandering, falls, inability to recognize danger.
• Sundowning intervention: INCREASED LIGHT in the late afternoon, structured activity, limit daytime napping.
• In the Philippines, the DSWD and barangay health centers are community resources relevant to dementia caregiver support — Philippine context questions may reference these.

Key Points

• Alzheimer's Disease (AD) is the MOST COMMON CAUSE OF DEMENTIA, accounting for 60–80% of all dementia cases.
• It is PROGRESSIVE, IRREVERSIBLE, and DEGENERATIVE — there is no cure.
• PATHOPHYSIOLOGY: Beta-amyloid plaques accumulate extracellularly and neurofibrillary tangles (abnormal tau protein) form intracellularly, destroying neurons — particularly in the hippocampus (memory center) first.
• STAGES: EARLY (mild forgetfulness, misplacing objects, difficulty with complex tasks), MIDDLE (significant memory loss, confusion, wandering, personality changes, needs help with ADLs), LATE (total dependence, loss of ability to speak, swallow, and control bodily functions).
• PHARMACOLOGY: CHOLINESTERASE INHIBITORS — donepezil (Aricept), rivastigmine (Exelon), galantamine — increase acetylcholine levels in the brain; used in mild-to-moderate AD. They SLOW DECLINE but do NOT REVERSE or CURE the disease.
• MEMANTINE (an NMDA receptor antagonist) — used in moderate-to-severe AD; reduces glutamate-mediated excitotoxicity. Often used in COMBINATION with cholinesterase inhibitors.
• NURSING PRIORITIES: SAFETY (wandering, falls, injury, fire hazards), ADEQUATE NUTRITION AND HYDRATION, COMMUNICATION, CAREGIVER SUPPORT.
• SAFETY MEASURES: door alarms, bed alarms, bed rails, low bed height, remove environmental hazards, use ID bracelets, supervise constantly in late stages.
• COMMUNICATION: use SHORT, SIMPLE SENTENCES, one question at a time, speak slowly and calmly, maintain eye contact, avoid arguing or correcting (use VALIDATION THERAPY — acknowledge feelings without reinforcing delusions).
• ROUTINE: provide a CONSISTENT, STRUCTURED DAILY ROUTINE — reduces confusion and agitation.
• SUNDOWNING: increased agitation, confusion, and disorientation in the late afternoon and evening — provide increased lighting, structured afternoon activities, avoid napping late in the day.
• CAREGIVER BURDEN is MAJOR — the nurse assesses for caregiver stress, teaches respite care, and connects the family with support groups and community resources (barangay health centers, Department of Social Welfare and Development programs in the Philippine context).
• DISTINGUISH ALZHEIMER'S (DEMENTIA) FROM DELIRIUM: Dementia = gradual onset, chronic, IRREVERSIBLE, relatively stable LOC. Delirium = ACUTE onset, FLUCTUATING LOC, often REVERSIBLE when the cause is treated.

Definitions

Section Title

Alzheimer's Disease

Common Mistakes

• Telling families that cholinesterase inhibitors will CURE or REVERSE Alzheimer's — they only SLOW the progression modestly.
• Confusing delirium with dementia — always remember DELIRIUM is ACUTE and FLUCTUATING; DEMENTIA is GRADUAL and CHRONIC.
• Arguing with or correcting an Alzheimer's patient about their delusions — this increases agitation; use validation therapy instead.
• Forgetting sundowning as a specific syndrome with targeted nursing interventions — not just 'general confusion.'
• Neglecting caregiver assessment — caregiver burnout is a major real-world and NLE concern; the nurse has a duty to assess and support caregivers.