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Chapter: Medical Surgical Nursing: Management of Patients With Oncologic or Degenerative Neurologic Disorders

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Post-Polio Syndrome

Patients who survived the polio epidemic of the 1950s, many now elderly, are developing new symptoms of weakness, fatigue, and musculoskeletal pain.

POST-POLIO SYNDROME

Patients who survived the polio epidemic of the 1950s, many now elderly, are developing new symptoms of weakness, fatigue, and musculoskeletal pain. It is estimated that between 60% and 80% of the 640,000 polio survivors are experiencing the phe-nomenon known as post-polio syndrome. Men and women appear to be equally at risk (Chasens & Umlauf, 2000).

Pathophysiology

The exact cause of post-polio syndrome is not known, but re-searchers suspect that with aging or muscle overuse the neurons not destroyed originally by the poliovirus cannot continue gen-erating axon sprouts. These new terminal axon sprouts reinner-vated the affected muscles following the initial insult but may be more vulnerable as the body ages (Chasens & Umlauf, 2000).

Assessment and Diagnostic Findings

No specific diagnostic test exists for this syndrome. The clinical diagnosis is made on the basis of the history and physical exami-nation and exclusion of other medical conditions that may be causing the new symptoms. Patients report a history of paralytic poliomyelitis with partial or complete recovery of function with a plateau of function for at least 10 years and then the recurrence of symptoms (Chasens & Umlauf, 2000; Chasens, Umlauf, Valappil et al., 2001).

Management

No specific medical or surgical treatment is available for this syndrome, and therefore nursing plays a pivotal role in the team approach to assisting patients and families in dealing with the symptoms of progressive loss of muscle strength and significant fatigue. Other health care professionals who may assist in patient care include physical, occupational, speech, and respiratory ther-apists. Nursing interventions are aimed at slowing the loss of strength and maintaining the patient’s physical, psychological, and social well-being.

 

Patients need to plan and coordinate activities to conserve energy and reduce fatigue. Rest periods should be planned and assistive devices used to reduce weakness and fatigue. Important activities should be planned for the morning, as fatigue often increases in the afternoon and evening (Chasens & Umlauf, 2000).

 

One study investigated the barriers (internal and external en-vironmental phenomena) that created further disability in polio survivors (Harrison & Stuifbergen, 2001). Disability, the inabil-ity to perform societal roles, was correlated with perceived barri-ers to health but not with functional limitations, comorbidity, or secondary conditions. Secondary conditions were correlated with the number of years that the patient had lived with the condition.

 

Pain in muscles and joints may be a problem. Nonpharmaco-logic techniques such as the application of heat and cold are most appropriate because these patients tend to have strong reactions to medications (Chasens & Umlouf, 2000).

 

Maintaining a balance between adequate nutritional intake yet avoiding excess calories that can lead to obesity in this seden-tary group of patients is a challenge. Pulmonary hygiene and ad-equate fluid intake can help with airway management. Several interventions can improve sleep, including limiting caffeine in-take before bedtime and assessing for nocturia. If nocturia is an issue, the patient needs to be evaluated for obstructive sleep apnea (Chasens et al., 2001). Supportive ventilation may be appropri-ate with continuous positive airway pressure if sleep apnea is a problem.

 

Bone density testing in patients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the impor-tance of identifying risks, preventing falls, and treating osteo-porosis must be discussed with patients and families. The nurse also needs to remind patients and family members of the need for health promotion activities and health screening.

 

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