Bio 101 ppt

CHAPTER 26
Chronic Disabling Conditions
and Rehabilitation

Ethan Bergman
and Nancy Buergel

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Goals of Supportive Care and Role of the
Dietitian

 Prevention of further disability
 Restoration of potential function
 Initial screening to identify clients with nutrition
problems potentially leading to malnutrition
 Evaluate nutritional status of the client by using
medical, dietary, and medication histories;
laboratory data; and anthropometric
measurements

Slide 2

Goals of Supportive Care and Role of the
Dietitian – Cont’d

 Plan developed to care for the client’s short-term
and long-term needs
 Nutrition education and counseling, involving work
with the individual client, family, and other caregivers
 Periodic evaluation
 Make necessary adjustments

Slide 3

Team Approach Method
 Rehabilitation team specialists include the
physician (physiatrist), clinical nutritionist,
nurse, occupational therapist, physical
therapist, psychologist, speech pathologist,
and social worker
 Most important member of the team is the client

Slide 4

Social Attitudes
 Persons have varying special needs
 Avoidance of these needs manifests itself as
obstacles to basic mobility
 Overprotection robs a person of his or her
selfhood and smothers the will to fight against
surrounding odds and develop self-
acceptance

Slide 5

Economic Problems
 Care for a person with a disabling injury or
severe illness can be a long and costly
process
 Major area of exploration for the healthcare team
is one of financial resources
 Long-term economic problems may revolve
around the client’s employment capabilities or
earning capacities
 Cost of providing care

Slide 6

Living Situation
 Disabled persons may need long-term
hospital care
 Independent living with or without an
attendant
 Activities of daily life can be difficult
 Can cause problems with food quality, maintaining
desirable food temperatures, and maintaining an
adequate intake

Slide 7

Psychologic Barriers
 Every person with physical body trauma
struggles with self-image and may withdraw
in defeat and exhaustion
 Changes test both inner strength and physical
stamina
 Positive resolution of many practical and
emotional problems requires tremendous
psychologic adjustment

Slide 8

Psychosocial Implications
of the Inability to Self-Feed

 Unable to make transition to self-feeding due to
an inability to physically move the food to the
mouth or the inability to swallow
 May feel anger, frustration, fear, sadness, and a
sense of grief because of inability to complete
this fundamental task
 May become clinically depressed

Slide 9

Special Needs of Older Disabled Persons

 By 2050 there will be almost 87 million people
65 years old or older living in the United States
 With older age comes an increased number of
disabled older adults

Slide 10

Special Needs of Older Disabled Persons
– Cont’d
 About 79% of people age 70 years or older have
at least one of seven potentially disabling
conditions
 Arthritis
 Hypertension
 Heart disease
 Diabetes
 Respiratory diseases
 Stroke
 Cancer

Slide 11

Vocational Rehabilitation
 After a lifetime of active involvement in a
familiar working environment, retirees
suddenly lack a sense of stability and identity
 Supportive activities focus on vocational
planning and the effective use of leisure time

Slide 12

Vocational Rehabilitation – Cont’d
 Vocational programs can help persons find
gainful employment after they retire from work
 Programs can help them find ways of
contributing their wisdom and skills to
younger workers in their field of specialty

Slide 13

Physical Decline in Aging

 In persons from 75 to 85 years of age and older,
disability increases sharply
 Falls and resulting fractures, chronic brain failure,
disorders in locomotion, impaired senses of
perception, and increased problems with drug
reactions and interactions

Slide 14

Physical Decline in Aging – Cont’d

 In this age-group, minor disabilities often result
in major handicaps
 Arthritis, cardiorespiratory and cardiovascular
insufficiency, depression, sensory deprivation,
infections, skin and foot disorders, and nutritional
deficiencies from poor dental health and fad diets
require nutrition care

Slide 15

Prevention of Malnutrition

Calories
 Excess calories must be avoided to prevent
obesity, but sufficient energy for physical activity
and tissue metabolism is essential

Slide 16

Prevention of Malnutrition – Cont’d

Protein
 Tissue and organ integrity protects against
catabolism, infections, negative nitrogen
balance, and pressure sores
 Optimal quantity (15% to 20% of total
calories) and quality

Slide 17


Carbohydrates
 Dietary carbohydrate is the body’s major fuel
source
 Sufficient carbohydrate-rich foods are
important to provide the needed energy, as
well as to prevent protein catabolism and
negative nitrogen balance

Slide 18


Fat
 Calorically dense form of energy that supplies
essential fatty acids and adds palatability to
the diet

Slide 19


Vitamins and Minerals
 Optimal intake of vitamins and minerals is
needed for metabolic activity and
maintenance of tissue reserves
 Normal Dietary Reference Intake (DRI,
including Recommended Daily Allowance
[RDA] and Adequate Intake [AI]) standards
for age and sex are adequate in most cases
 Some states indicate supplementation

Slide 20

Restoration of Eating Ability
 The disabled person works with the
professional team of occupational and
physical therapists, nutritionists, and nurses
to find adaptive procedures to restore basic
eating ability
 Eating process will require individual attention
to the following aspects:
 Nature and degree of motor control, eating
position, use of adaptive utensils, and support of
individual needs

Slide 21

Restoration of Eating Ability – Cont’d

 Personal food plan must fulfill basic nutritional
needs, and amounts must be increased
accordingly to additional metabolic demands

Slide 22

Independence in Daily Living
 Goal is to achieve as much independence in
daily living as possible
 U.S. Department of Health and Human
Services, Bureau of Primary Care provides a
list of assistive devices
 Large number of creative devices are
available

Slide 23

Rheumatoid Arthritis

Clinical Characteristics
 Underlying chronic, systemic, inflammatory
disease process usually begins in the young
adult years
 Severe type of autoimmune disorder in which
the body’s immune system acts against its
own tissue

Slide 24

Rheumatoid Arthritis – Cont’d

Clinical Characteristics – cont’d
 Severe type of autoimmune disorder in which
the body’s immune system acts against its
own tissue – cont’d
 Attacks joints of the hands, arms, and feet,
causing them to become extremely painful, stiff,
and even deformed
 Synovium becomes inflamed and secretes more
fluid, leaving the joint swollen and fatigued
 Dramatically affects activities of daily living

Slide 25


Medical Management
 Emphasis is put on early diagnosis and
treatment
 Use of combinations of disease-modifying
antirheumatic drugs (DMARDs)
 Use of agents that target cytokines

Slide 26

 Treatment outcomes should include an
analysis of important coexisting illnesses,
particularly cardiovascular disease and
osteoporosis

Slide 27

 Corticosteroids are effective at slowing the
progression of rheumatoid arthritis (RA)
 Used in 30% to 60% of RA patients
 Side effects, including thinning skin, cataracts,
osteoporosis, hypertension, and hyperlipidemia

Slide 28


Nutritional Management
 Energy
 Varies widely and must be determined on an
individual basis
• Stress of disease activity, sepsis, fever, skeletal injury, or
surgery

Slide 29


Nutritional Management – cont’d
 Protein
 Well-nourished adult patient needs about 0.5 to 1
g of protein/kg/day during quiet disease periods
 An increase to 1.5 to 2 g/kg/day is needed during
active inflammatory disease periods

Slide 30


 Vitamins and minerals
 Standard recommendations for vitamins and
minerals are used
• Supplementation may be used if needed

Slide 31


 Special enteral or parenteral feeding
 Enteral used to either supplement oral intake or to
supply total nutrition support
 Parenteral nutrition support is reserved for
preoperative and postoperative needs

Slide 32

Osteoarthritis
 Degenerative joint disease (DJD)
encompasses between 60% and 70% of joint
diseases overall
 Affects approximately 44% of persons over the
age of 40 years in the United States
 Chronic and may progress
 Hands, knees, and hips

Slide 33

Osteoarthritis – Cont’d
 No cure for the disease process, which
ultimately destroys cartilage between the
rubbing heads of bones in involved joints
 Damaged joints can be replaced by arthroplasty,
surgical removal of the degenerated joint, and
replacement with a joint made of metal or plastic
components

Slide 34

Osteoporosis
 Most common skeletal disorder in the United
States
 Referred to as the “silent disease” because
bone loss occurs without symptoms
 Hip fracture results in significant morbidity
and mortality

Slide 35

Osteoporosis – Cont’d
 Thoracic spinal fracture can also result in
pain; deformity; loss of independence; and
reduced function of the cardiovascular,
respiratory, and digestive systems
 Result of the body not forming sufficient new
bone or of the body reabsorbing too much
bone, or both

Slide 36

 If calcium intake is not sufficient throughout
the early years in life or if the body does not
absorb sufficient calcium from the diet, bone
tissue may suffer
 Other causes include hyperparathyroidism,
hyperthyroidism, Cushing’s syndrome,
immobilization, bone malignancies, certain genetic
disorders, and excessive corticosteroid use

Slide 37

 Best line of defense against osteoporosis is
prevention
 Treatment of postmenopausal osteoporosis in
women is often managed with estrogen
replacement therapy (ERT)
 Controversial among different groups

Slide 38


Medical Management
 Number of new medications for prevention
and treatment of osteoporosis are currently
available and approved by the Food and Drug
Administration (FDA)

Slide 39


 Peak bone mass occurs around age 30 and
needs to be sustained through a healthy diet
and physical activity

Slide 40


 Well-balanced diet with a calcium intake of at
least 1000 mg/day and 5 µg/day of vitamin D
for adults 19 to 50 years old
 Increase for adults over 50 years old to 1200
mg/day of calcium and 10 μg/day of vitamin D
 Tolerable Upper Intake Level (UL) for calcium of
2500 mg/day and for vitamin D of no greater than
50 µg daily for anyone over the age of 1

Slide 41


 Weight-bearing activity such as running tends
to cause the most trauma to the bones,
stimulating osteoblast activity and boosting
bone density and mass

Slide 42

Traumatic Brain Injury
 Occurs when an outside force impacts the
head hard enough to cause the brain to move
within the skull or if the force causes the skull
to break and directly hurts the brain
 May produce a diminished or altered state of
consciousness
 Results in impaired cognitive abilities or physical
functioning

Slide 43

Acquired Brain Injury
 An injury that is not hereditary, congenital,
degenerative, or induced by birth trauma

Slide 44

Traumatic or Acquired Brain Injury

Postinjury Metabolic Alterations
 There is a primary injury and a resultant set of
secondary injuries
 Brain injury brings an immediate cascade of
systemic metabolic and protective responses
that affect the entire body and its resources
 If the process continues unchecked, a
sequence of organ failures may follow

Slide 45

Traumatic or Acquired Brain Injury –
Cont’d
Initial Nutritional Management
 Immediate goals of the care team are control
of the injury, maintenance of oxygen
transport, and metabolic support

Slide 46

Cont’d
Initial Nutritional Management – cont’d
 Vital to meet the hypermetabolic drain on the
body tissue resources for increased energy,
protein, and fluid demands
 May be delivered via the enteral or parenteral
route
 Total parenteral nutrition (TPN) and enteral
nutrition in combination therapy is commonly used
to preserve gut integrity

Slide 47

Cont’d
Rehabilitative Nutrition
 To develop individual nutrition care plans, the
rehabilitation dietitian works closely with other
team members

Slide 48

Cont’d
Rehabilitative Nutrition – cont’d
 Assess the degree of dysphagia, difficulty
with chewing and swallowing, level of
language deficit and communication, and
ability to perform basic activities of daily living
skills, including food preparation and eating

Slide 49

Spinal Cord Injury

Postinjury Management
 Cervical region most vulnerable site for spinal
cord injuries (SCIs)

Slide 50

Spinal Cord Injury – Cont’d
 Four strategies exist for repairing the injured
spinal cord
 1. Promoting regrowth of the injured nerves by
using nerve growth stimulants or substances that
suppress inhibitors of neuronal extensions
 2. Bridging spinal cord lesions with scaffolds that
are saturated with nerve growth factors to promote
axon growth

Slide 51

 Four strategies exist for repairing the injured
spinal cord – cont’d
 3. Repairing damaged myelin in order to restore
nerve impulse conductivity in the damaged area
 4. Enhancing central nervous system plasticity by
enhancing the growth of spared, intact nerve fibers
above and below the site of injury

Slide 52


 Protein-energy malnutrition is common in
individuals with SCI
 Enteral feeding tubes placed beyond the
pylorus usually make it possible to start
nutrition support within 3 to 5 days

Slide 53


Nutritional Management – Cont’d
 Daily guidelines for energy needs are
approximately 23 kcal/kg for quadriplegics
and 28 kcal/kg for paraplegics

Slide 54


Rehabilitation Nutrition
 Designed to restore the client to the best
functional capacity possible and to promote
independent living
 Individual assessment and care of basic energy-
nutrient needs and feeding capacities and
complications associated with SCI

Slide 55


Basic Nutritional Needs
 Sufficient calories to maintain an ideal body
weight somewhat below that for a
comparative person given in standard weight-
height tables for healthy populations
 Standard multiple vitamin-mineral preparation
is often recommended to ensure nutritional
adequacy

Slide 56


Associated Complications
 Pressure sores
 Loss of pressure sensation around bony
prominences, involving decreased blood
circulation, skin breakdown, and ulcer formations
that are open to infection and difficult to heal

Slide 57


Associated Complications – cont’d
 Hypercalciuria
 Imbalance in calcium metabolism with a loss of
bone calcium and its increased excretion in the
urine

Slide 58


 Kidney stones
 Problems of urinary reflux, retention, incontinence,
infection, and stone formation
 High fluid intake of 2 to 3 L/day must be a part of
the overall nutrition care plan

Slide 59


 Neurogenic bowel
 Decreased peristalsis and loss of bowel control
 Regularly scheduled program for emptying the
bowel is necessary

Slide 60


 Depression
 Period of depression, even anger, is a normal part
of the personal grieving and healing process
 Severity and duration depend in large measure on
the patient’s personal strengths and resources

Slide 61


 Depression – cont’d
 Even subtle improvements in muscle mass and
function from nutrition therapy can be a source of
strength to the client’s mind and body

Slide 62

Cerebrovascular Accident (Stroke)
 Causes varying degrees of nerve damage
and body paralysis
 Dysphagia occurs in up to half of patients
after a stroke
 It is transient with only about 1 in 10 patients
having any swallowing problems at 6 months

Slide 63

Cerebral Palsy
 General term for nonprogressive disorders of
muscle control of movements and posture
 Training and therapy can help to improve
function

Slide 64

Cerebral Palsy – Cont’d
 Many causes
 Brain damage that occurs during fetal
development or shortly after birth
 Premature birth
 Low birth weight
 Rh or A-B-O blood type incompatibility between
mother and infant
 Infection of the mother with German measles or
other viral diseases in early pregnancy
 Bacteria that directly or indirectly attack the
infant’s central nervous system

Slide 65

 Spastic
 Muscles of one or more limbs permanently
contracted, making normal movements very
difficult or impossible
 Athetoid
 Involuntary writhing movements
 Ataxic
 Disturbed sense of balance and depth perception

Slide 66

 An individual may possess more than one
type
 Research reports indicate increased resting
metabolic rates that are approximately 15% higher
than those of non–cerebral palsy (CP) control
subjects

Slide 67

 Mental retardation, with an IQ below 70,
occurs in about 75% of persons with CP
 Exceptions occur, mostly among those with the
athetoid type; some of these individuals are highly
intelligent

Slide 68

 Early nutrition therapy for CP patients focuses
mainly on feeding problems
 Nutritional status, health, and body growth
are most impacted in children with the
greatest motor dysfunction
 Malnutrition and growth failure are common
 Exercise helps promote better nutrition

Slide 69

 When oral feeding is interrupted for a
prolonged period because of illness or
surgery, enteral nutrition support via
nasoenteric or gastrostomy tube feeding may
be necessary
 Other nutritional concerns are food intolerance,
food allergies, drug-nutrient interactions,
constipation, and reflux

Slide 70

Epilepsy
 Neuromuscular disorder in which abnormal
electrical activity in the brain causes recurring
transient seizures
 During an epileptic seizure, an unregulated,
chaotic electrical discharge occurs

Slide 71

Epilepsy – Cont’d
 Usually, the disorder starts in childhood or
adolescence
 Plateaus from ages 15 to 65 years and then rises
again among older adults

Slide 72

 More drug options than ever before to treat
epilepsy
 Each client needs to be evaluated for the
most effective and appropriate means of
controlling his or her seizures
 Factors such as drug side effects must be
considered

Slide 73

 Vagal nerve stimulation (VNS)
 Flat, round battery about the size of a silver dollar
is surgically implanted in the chest wall
 Therapy works by sending small regular pulses of
electrical energy to the brain via the vagus nerve

Slide 74


 Helps to ensure an appropriate diet for
normal growth during childhood and
adolescence and for health maintenance in
adulthood

Slide 75


 If a ketogenic diet is used, the clinical
nutritionist is responsible for its calculations
and education of staff, patient, and family in
its use

Slide 76


 Special high-fat, low-carbohydrate diet was
developed to control epilepsy before current
anticonvulsant drugs became widely available
in the 1940s
 The mechanism may involve a threshold level
of ketones to be present, which may help
control seizures by disrupting nerve
transmission at the synapse

Slide 77

Spina Bifida
 Most commonly occurring type of neural tube
defect (NTD), a congenital malformation of
the spine that contributes to serious
developmental disabilities
 Congenital defect can often be diagnosed
early in the pregnancy by ultrasound
scanning or by high levels of alpha fetoprotein

Slide 78

Spina Bifida – Cont’d

 Folic acid (folate) and vitamin B12
supplementation at time of conception
through the first few months of pregnancy
reduces a woman’s risk that the baby will
develop this devastating neural tube defect

Slide 79

 Spina bifida occulta
 Least serious and most common form
 Often goes unnoticed in otherwise healthy children

Slide 80

 Myelomeningocele
 Most severe form
 Child is usually severely disabled
 The spinal cord (myelo) and its enveloping
membranes (meninges) protrude from the spine in
a sac

Slide 81

 Meningocele
 Nerve tissue of the spinal cord usually remains
intact
 Surgical repairs are performed in the first few days
of life

Slide 82


 Focuses on growth pattern and individual
degree of problems of growth retardation and
short stature, low muscle mass and
weakness, deformities or paralysis of lower
extremities, and reduced ability to control
bladder and bowels

Slide 83


 Obesity can be a problem
 Low basal metabolic rate related to lowered
amount of lean body mass
 Little physical activity related to the disabled
condition and dependency on a wheelchair
 Use of food and overfeeding by parents or other
caregivers to reward or show love

Slide 84

Down Syndrome
 Chromosomal abnormality accounts for the
mental retardation and characteristic
appearance of children with Down syndrome
 Event is more likely if the mother is over 35
years of age, indicating that defective egg
formation, rather than sperm formation, is
usually the cause

Slide 85

Down Syndrome – Cont’d
 Up to 50% have congenital heart defects,
which can be surgically corrected
 These children are usually affectionate,
cheerful, and friendly and get along well with
family and friends

Slide 86

 Nutrition therapy for individuals with Down
syndrome focuses on delayed feeding skills;
inappropriate, excessive, or inadequate
intakes of food energy and nutrients; and
poor eating habits
 Thyroid disease and celiac disease are
common, and development of diabetes may
also occur with Down patients

Slide 87

 Encouraging physical activity is important to
helping reduce the risk of obesity and
diabetes

Slide 88

Parkinson’s Disease
 Appears to be a genetic influence, in some
cases, as well as an environmental influence
 Degeneration of key parts of the basal
ganglia causes a lack of dopamine within this
part of the brain, thus preventing the basal
ganglia from modifying nerve pathways that
control muscle function

Slide 89

Parkinson’s Disease – Cont’d
 Muscles become overly tense, causing joint
rigidity and a general body stiffness, a fine
constant tremor even at rest, and slow
movements

Slide 90


Medical Management
 Medications include those that promote
dopamine synthesis
 Other drugs prolong levadopa availability
 Other medications include those that activate
specific receptors such as dopamine agonists and
those that prolong dopamine availability

Slide 91


Medical Management – cont’d
 Neurosurgery is done to restore functional
balance in affected nervous tissue
 Thalamus, globus pallidus, and subthalamic
nucleus

Slide 92


 Main emphasis should be on meeting
nutritional needs of the individual, though
general concerns include providing enough
energy and protein to prevent weight loss and
muscle atrophy

Slide 93


 Emphasize sufficient fiber and fluid to reduce
risk of constipation
 Other points of emphasis are bowel
dysfunction; dysphagia; nausea, vomiting,
and anorexia; delayed gastric emptying;
hypotension when standing; bradykinesia;
depression; and impaired cognitive function

Slide 94


 More than 50% of Parkinson’s patients
experience dysphagia
 Assessment may result in changes to food texture,
fluid viscosity, and temperature
 Unintentional weight loss and body
composition changes are common

Slide 95

Huntington’s Chorea
 Uncommon genetic disease in which
degeneration of basal ganglia of the brain
results in chorea (rapid, jerky, involuntary
movements) and dementia
 Gene mutation causes an abnormal protein
product; insoluble proteins invade nuclei of
nerve cells, which eventually shut down
function of the cell and may cause cell death

Slide 96

Huntington’s Chorea – Cont’d

Medical Management
 A test is available for young adults whose
parents have Huntington’s chorea to learn if
they carry the gene and thus have the
disorder
 95% accuracy

Slide 97


 Medical management helps to lessen the
characteristic chorea, which affects face,
arms, and trunk with random grimaces,
twitches, and general clumsiness

Slide 98


 Excessive muscular activity requires
adequate energy and nutrient intake to
prevent malnutrition and excess weight loss
 As the disease progresses, patients become
cachectic

Slide 99


 1.2 to 1.5 g of protein per kilogram of body
weight
 Advanced disease accompanied by
dysphagia, marasmus, and depression may
best be supported with an enteral formula

Slide 100

Guillain-Barré Syndrome
 Rare form of damage to peripheral nerves in
which the myelin sheaths covering nerve
axons, and sometimes the axons themselves,
deteriorate, causing loss of nerve conduction
and partial or complete paralysis
 Low-grade fever persists, and there may be
urinary tract infection, respiratory failure requiring
a ventilator, and personality changes

Slide 101

Guillain-Barré Syndrome – Cont’d
 Acute syndrome is an autoimmune reaction,
often following a viral infection or sometimes
an immunization

Slide 102


Medical Management
 Most people recover completely from Guillain-
Barré without specific treatment other than
general supportive care
 Some are left with permanent weakness in
affected areas

Slide 103


 During early acute phases, enteral or
parenteral nutrition support may be necessary
 Crucial not to overfeed the patient
 Food consistency and texture may need to be
adjusted in early oral feedings to accommodate
any chewing and swallowing problems

Slide 104


 During early acute phases, enteral or
parenteral nutrition support may be necessary
– cont’d
 Attention to energy and nutrient needs during
convalescence is required to restore lost body
weight and muscle mass

Slide 105

Amyotrophic Lateral Sclerosis

Medical Management
 Most common of the motor neuron diseases
 Riluzole remains the only drug to slow
disease progression, although interventions
such as noninvasive ventilation and
gastrostomy also extend survival

Slide 106

Amyotrophic Lateral Sclerosis – Cont’d
 Focus on increased energy intake and adjusting
nutrient needs as the disease progresses
 Weakness of hands and arms, as well as
problems with chewing, swallowing, delayed or
absent response of gag reflex, and risk of
aspiration, will require eating assistance and
modification of food textures
 Frequent small meals

Slide 107

Multiple Sclerosis
 Progressive disease of the central nervous
system that destroys scattered patches of
insulating myelin, the fatty covering of nerve
fibers in the brain and spinal cord that
protects the neurons and facilitates the
passage of neuromuscular impulses

Slide 108

Multiple Sclerosis – Cont’d
 Autoimmune disease
 Important to rule out other potential
contributors to the symptoms such as
vascular disease, spinal cord compression,
vitamin B12 deficiency, central nervous cord
infection such as Lyme disease or syphilis,
and lupus

Slide 109


Medical Management
 Five disease-modifying drugs approved by
the FDA to treat multiple sclerosis (MS)
patients
 Four of the treatments are used in initial
management of the disease to help slow
progression and reduce symptoms
 Fifth is used for worsening forms when the
individual with MS is in relapse

Slide 110


 The best time to start treatment is early after
diagnosis to reduce lesion progression and
irreversible damage

Slide 111


 Patients respond to basic nutrition therapy
that supplies adequate energy and nutrients
to achieve optimal nutritional status

Slide 112


 Assistance with symptomatic gastrointestinal
problems, elimination, and dysphagia is
instituted as needed
 Nasoenteric or gastrostomy tube feeding may be
needed in advanced stages of the disease to
provide enteral nutrition support

Slide 113

Myasthenia Gravis
 Eventually causes the affected person to
become paralyzed as a result of inability of
neuromuscular junctions to transmit nerve
fiber signals to the voluntary muscles

Slide 114

Myasthenia Gravis – Cont’d
 Facial muscles are usually affected first,
causing drooped eyelids, double vision, and
sometimes a lack of facial animation with an
absent stare appearance
 Weak muscles of the face, throat, larynx, and neck
cause difficulties in speaking and eating

Slide 115


Medical Management
 Administration of corticosteroids and
immunosuppressive drugs
 Disease is caused by circulating
autoantibodies; exchanges of the patient’s
antibody-containing blood for antibody-free
blood may be helpful in warding off a crisis

Slide 116


 Maintain optimal energy-nutrient intake for
muscle strength and good nutritional status
 Solve any associated eating problems
 Help counteract drug side effects of nausea
and vomiting

Slide 117

Alzheimer’s Disease
 The disease is a form of progressive
dementia in which nerve cells degenerate in
the brain and the brain substance shrinks
 Tremendous social and financial burden

Slide 118

Alzheimer’s Disease – Cont’d
 No absolute diagnostic test for the disease
during life
 Assessment instrument, the Mini-Mental State
Examination (MMSE)
• Assesses six areas of function: orientation, registration,
attention and calculation, recall, language, and ability to
copy a figure

Slide 119

 Stage one
 Early period of increasing forgetfulness and
anxious depression
 Stage two
 Middle period of severe memory loss of recent
events, disorientation, and personality changes

Slide 120

 Stage three
 Final period of severe confusion, psychosis,
memory loss, personal neglect, inability to leave
the bed, feeding problems, full-time nursing care,
and finally death from an infection

Slide 121


Medical Management
 Plan should include methods for slowing the
decline in cognitive function
 Treatment of behavior and mood symptoms
also important
 No treatment for the disease itself, except for
suitable day-to-day nursing and social care
for both the patient and the family

Slide 122


 Cognitive losses may have profound effects
on nutritional intake

Slide 123

 Adequate nutrition throughout the course of
the disease is essential to improving physical
well-being, helping maximize the patient’s
functioning, and improving quality of life
 Using skillful individual feeding techniques
 Selecting appropriate food consistency
 Providing adequate time in which to feed
 Focusing on the midday meal, when peak
cognitive abilities occur

Slide 124

Health Promotion
 In disability and rehabilitation, a commonly
reported standard is the Functional
Independence Measure (FIM)
 Objective method of obtaining functional
performance information from a patient

Slide 125

Health Promotion – Cont’d
 Traditional assessment method is
determining the patient’s activities of daily
living (ADLs)
 As with any assessment tool, reliability and
validity between users is of primary
significance

Slide 126

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