ATI Ch 10 MS ALG MG Flashcards Preview

Nursing 281 > ATI Ch 10 MS ALG MG > Flashcards

Flashcards in ATI Ch 10 MS ALG MG Deck (57):
1

Multiple Sclerosis description

autoimmune disorder where plaques develop in the white matter of the CNS, interferes w/ impulse transmission
can relapse and remit

2

Amyotrophic Lateral Sclerosis ALS description

disease of the upper and lower motor neurons with muscle weakness progressing to muscle atrophy and eventually paralysis and death

3

Myasthenia Gravis description

autoimmune disorder with loss of ACH receptors at the neuromuscular junction

4

MS onset

2x more likely in women
between ages 20-40

5

Factors that trigger MS relapse

Viruses and infectious agents, Living in a cold climate, Physical injury, Emotional stress, Pregnancy, Fatigue, Overexertion, Temperature extremes, Hot shower/bath

6

MS sx

lower extremity fatigue, vision changes (Uhthoff's sign), muscle spacity, nystagmus, cognative changes, bowel/bladder dysfunction

7

Lab test for MS

Cerebrospinal fluid analysis (elevated protein level and a slight increase in WBCs)

8

How to diagnose MS

MRI reveals plaques of the brain and spine

9

Credé maneuver

placing manual pressure on abdomen over the bladder to expel urine, used in MS PTs

10

Tx for diplopia

apply alternating eye patches and teach scanning maneuvers, used for MS PTs

11

Immunosuppressive agents ex

Azathioprine (Imuran) and cyclosporine (Sandimmune)

12

Immunosuppressive agents use

reduce the frequency of MS relapses

13

Immunosuppressive agents nursing considerations

Assess for hypertensionand kidney dysfunction

14

Corticosteroids ex

Prednisone

15

Corticosteroids use

reduce inflammation in acute MS exacerbations

16

Corticosteroids nursing considerations

Monitor for infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, and personality changes

17

Antispasmodics ex

Dantrolene (Dantrium), tizanidine (Zanaflex), baclofen (Lioresal), and diazepam (Valium)

18

Antispasmodics use

treat muscle spasticity in MS

19

Antispasmodics nursing considerations

Observe for increased weakness, liver damage if on tizanidine or dantrolene, do not stop baclofen abruptly

20

Immunomodulators ex

Interferon beta (Betaseron)

21

Immunomodulators use

prevent or treat relapses of MS

22

Anticonvulsants ex

Carbamazepine (Tegretol)

23

Anticonvulsants use

paresthesia in MS

24

Anticholinergics ex

Propantheline

25

Anticholinergics use

bladder dysfunction in MS

26

Beta-blockers ex

Primidone (Mysoline) and clonazepam (Klonopin)

27

Beta-blockers use

treat tremors in MS

28

ALS progression rate

death usually due to resp failure within 3-5 years from first manifestation

29

ALS onset

effects more women than men, seen between ages 40-70

30

ALS Sx

fatigue, twitching, cramping, atrophy, dysphagia, hyperreflexia of deep tendon reflexes

31

ALS lab tests

Increased creatine kinase (CK-BB) level
Need to r/o other causes, there is no specific test

32

ALS diagnostic tests

Electromyogram (EMG) – Reduction in number of functioning motor units of peripheral nerves, Muscle biopsy – Reduction in number of motor units of peripheral nerves and atrophic muscle fibers

33

What ALS mostly effects

Respiratory!
Nursing interventions should be geared to respiratory functions

34

glutamate antagonist ex

Riluzole (Rilutek) (this is the only one)

35

glutamate antagonist use

slow the deterioration of motor neurons in ALS. It must be taken early in process, will add 2 to 3 months to the client’s lifespan

36

glutamate antagonist nursing considerations

Monitor LFTs, no ETOH, assess dizziness, vertigo and somnolence, keep meds away from light

37

Antispasmodics ex

Baclofen (Lioresal), dantrolene sodium (Dantrium), diazepam (Valium)

38

ALS complications

pneumonia due to respiratory weakness/paralysis

39

Causes of Myasthenia Gravis

Coexisting autoimmune disorder
hyperplasia of the thymus gland

40

Factors that trigger MG exacerbations

Infection, Stress, emotional upset, and fatigue, Pregnancy, Increases in body temp

41

Finding from MG assessment

impaired resp function, dysphagia, decreased muscle strength (especially in the face), incontinence, drooping eyelids

42

Diagnostic procedures for MG

Tensilon testing/ anticholinesterase (edrophonium)

43

Electromyography

Shows the neuromuscular transmission characteristics of MG

44

Tensilon testing function

Baseline assessment of the cranial muscle strength

45

Tensilon testing procedure

Edrophonium (Tensilon) is administered which improves muscle strength for 5 min by inhibiting breakdown of ACh

46

Anticholinesterase agents for MG

are the first line of therapy
given 4x daily

47

Anticholinesterase agents for MG cautions

clients who have hx of asthma or cardiac dysrhythmias

48

Pyridostigmine (Mestinon) and neostigmine (Prostigmin) for MG function

increase muscle strength
inhibits breakdown of ACh and prolongs its effects

49

Use of immunosuppressants with MG

given durring exacerbations when other meds are not sufficient because MG is an autoimmune disease

50

When are IV immunoglobulins (IVIg) used?

for acute management in clients who do not respond to the above treatments

51

Plasmapheresis

used in MG tx
removes circulating antibodies from the plasma
usually done several times over a period of days and may continue on a regular basis

52

Plasmapheresis intraprocedure nursing actions

assess for dizziness and hypotension
maintain patence of shunts

53

Thymectomy

surgical procedure for MG
removal of thymus gland

54

Thymectomy complications

Myasthenic crisis and cholinergic crisis
pneumo or hemothorax

55

Myasthenic crisis occurance

client is experiencing a stressor that causes an exacerbation of MG, such as infection, or is taking inadequate amounts of cholinesterase inhibitor

56

cholinergic crisis occurance

the client has taken too much cholinesterase inhibitor

57

Myasthenic crisis and cholinergic crisis sx

muscle weakness, respiratory failure