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Adult Health 1 - (Josh) > T3 - Probs of PNS (Josh) > Flashcards

T3 - Probs of PNS (Josh) Flashcards

1
Q

Guillian Barre is a problem of the —

A

PNS

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2
Q

Guillian Barre is caused by what?

A

demylenation of peripheral nerves which leads to disruption of sensory and motor pathways

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3
Q

Etiology of Guillian Barre

A

Immune mediated response (IgG antibodies)

Viral Infections

Bacterial Infections

Vaccines

Lymphoma

Surgery

Trauma

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4
Q

Patho of Guillian Barre

A

T cells migrate to peripheral nerves

Macrophages break down myelin

Inflammation can cause axonal damage (mostly temporary)

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5
Q

What are the stages of Guillian Barre?

A

Initial (1-4 wks)

Plateau (several days to 2 yrs)

Recovery (4-6 mths up to 2 yrs)

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6
Q

S/S of Guillian Barre

A

Initial muscle weakness and pain

ASCENDING paralysis

Autonomic dysfunction

Motor weakness

Cranial nerve dysfunction

Resp dysfunction

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7
Q

Guillian Barre:

What is the Ascending paralysis?

A

symmetric, bilateral, ascending motor loss

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8
Q

Guillian Barre:

What is the Autonomic Dysfunction caused by GB?

A

BP fluctuations

Dysrhythmias

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9
Q

Guilliian Barre:

Which cranial nerves are typically affected?

A

III: Occulomotor

VII: Facial

IX: Glossopharyngeal

X: Vagus

XI: Accessory

XII: Hypoglossal

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10
Q

Guillian Barre:

What happens to respiratory function?

A

changes in Tidal Volume

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11
Q

Treatment plan of Guililan Barre:

A

Plasmapheresis

Intravenous Immune Globulin (IVIG)

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12
Q

Guillian Barre:

What is Plasmapheresis?

A

removes circulating antibodies assumed to cause the disease

Plasma is selectively separated from whole blood

Plasma usually replaces itself or is transfused with albumin

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13
Q

Guillian Barre:

What is the treatment regimen if the use IVIG?

A

daily dose based on body weight for 5 consecutive days

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14
Q

Nursing care for Guillian Barre.

A

Treat the symptoms

Monitor for complications

Early Mobility

Enteral Feedings

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15
Q

Guillian Barre:

What are the cardio complications?

A

Acute Dysautonomia (HR, BP)

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16
Q

Guillian Barre:

What are the things we need to monitor for with respiratory care?

A

Atelectasis

VAP

Pneumothorax

ARDS

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17
Q

Guillian Barre:

What are the GI complications we need to monitor for?

A

decreased motility (paralytic ileus)

  • **give Reglin
  • **listen to bowel sounds
  • **keep up with BMs
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18
Q

— — is an autoimmune disease characterized by muscle weakness.

A

Myasthenia Gravia

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19
Q

What is Myasthenia Gravis caused by?

A

antibodies interfere with the transmission of ACh at the neuromuscular junction

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20
Q

What are the different types of Myasthenia Gravis?

A

Occular

Generalized

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21
Q

What is Tensilon Testing?

A

baseline assessment of cranial muscle strength

**tested with Myasthenia Gravis

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22
Q

What is a positive Tensilon Test?

A

onset of muscle tone improvement within 30-60 secs after Tensilon injection

***lasts 4-5 mins

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23
Q

Tensilon Test:

Nursing care

A

Observe for:

  • facial fasciculations
  • cardiac arrhythmias
  • bradycardia
  • sweating
  • abdominal pain
24
Q

Tensilon Test:

What drug do we need to have at bedside when doing the test?

A

Atropine

25
Q

Myasthenia Gravis:

Why could you have a Cholinergic Crisis?

A

too much cholinisterase inhibitor drug (overmedication)

**remember that MG is a problem with too little ACh so cholinsterase inhibitors are used to treat

26
Q

Myasthenia Gravis:

What are s/s of Cholinergic Crisis?

A

Increased weakness

Hypersalivation

Sweating

Increased Bronchial secretions

N/V/D

Hypotension

27
Q

Myasthenia Gravis:

What is the treatment for Cholinergic Crisis?

A

Maintain resp function

Withhold anticholinergic drugs while on vent

Atropine

28
Q

Myasthenia Gravis:

What is a Myasthenia Crisis?

A

too little cholinisterase inhibitor drug (undermedication)

29
Q

Myasthenia Gravis:

S/S of Myasthenia Crisis?

A

Flare of MG symptoms

Increased weakness

HTN

Increased HR

30
Q

Myasthenia Gravis:

Treatment for Myasthenia Crisis?

A

Maintain resp function

Withold cholinisterase inhibiting drugs

31
Q

Myasthenia Gravis:

How does Tensilon work?

A

inhibits the breakdown of ACh, making it available for use at the neuromuscular junction

32
Q

S/S of Myasthenia Gravis

A

Progressive muscle weakness

Diplopia

Difficulty chewing/swallowing

Resp dysfunction

Bowel/Bladder dysfunction

Poor posture

Fatigue after exertion

33
Q

Myasthenia Gravis clients will have decreased muscle strenght, especially of which part of body?

A

face, eyes, and proximal portion of major muscle groups

34
Q

Myasthenia Gravis:

With cholinisterase inhibitors, what should we teach client?

A

Take with food (for GI s/e)

Eat within 45 mins of taking med to increase chewing strength and reduce risk of aspiration

Take med at same time each day

***Use cautiously with clients who have asthma or cardiac dysrhythmias

35
Q

— — is facial paralysis associated with cranial nerve VII.

A

Bell’s Palsy

36
Q

S/S of Bell’s Palsy

A

Droop in one half of face

Forehead doesn’t wrinkle (stroke victims can wrinkle)

Can’t raise eyelid

37
Q

Treatment for Bell’s Palsy

A

Medical mgmt (prednison, analgesics, acyclovir)

Protect eye

Nutrition

Massage, warm/moist heat, facial exercises

38
Q

– – is characterized by severe pain that can be triggered by chewing or brushing teeth.

A

Trigemenal Neuralgia

39
Q

With Trigeminal Neuralgia, what type of pain do they fee?

A

severe, sudden spurt of pain with twitches in face

40
Q

Medication mgmt of Trigeminal Neuralgia

A

Carbamazepine

Amitryptiline (TCA)

41
Q

Surgical mgmt of Trigeminal Neuralgia

A

Microvascular decompression

Radiofrequency Thermal Coagulation

Percutaneous Balloon Microcompression

***goal of each is to take pressure off of the Trigeminal Nerve

42
Q

Myasthenia Gravis:

What improves muscle weakness?

What worsens it?

A

rest

activity

43
Q

Myasthenia Gravis:

Which type of crisis causes muscle twitching so severe that you lose resp function and need a mechanical vent?

A

Cholinergic Crisis

44
Q

Myasthenia Gravis:

Hypermotility (abdominal cramps) are a s/e of which crisis?

A

Cholinergic Crisis

45
Q

Myasthenia Gravis:

What affect does Tensilon have on Cholinergic Crisis?

What affect does it have on Myasthenia Crisis?

A

worsens findings

temporarily decreases findings

46
Q

Cholinergic Crisis:

Why have Atropine available?

A

it is an anticholinergic

47
Q

Myasthenia Gravis:

Which type of crisis (Cholinergic or Myasthenia) will lead to Mechanical Ventilation?

A

BOTH

48
Q

When are Bell’s Palsy symptoms most severe?

A

after 48 hrs

49
Q

Myasthenia Gravis:

What are exacerbating factors?

A

Infection

Stress

Surgery

Hard physical exercise

Sedatives

Enemas

OVERHEATING (no sunbathing)

50
Q

Myasthenia Gravis:

What type of schedule do the meds need to be given on?

A

Strict schedule

51
Q

What is the classic presentation of Myasthenia Gravis?

A

muscle weakness that increases when patient is fatigued

52
Q

When you think Myasthenia Gravis, think — —

When you think Guillian Barre, think — —

A

muscle weakness

ascending paralysis

53
Q

Myasthenia Gravis:

What should we teach about Pyridostigmine?

A

take with small amount of food

eat within 45-60 mins after taking

54
Q

GBS:

What should we ask about a client who presents with Guillian Barre?

A

have they had any respiratory virus in past 2 weeks

55
Q

GBS:

What usually triggers Guillian Barre?

A

respiratory or GI viral infection

***sometimes, surgery and vaccination can also trigger

Adult Health 1 - (Josh) (26 decks)

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