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med/surg 2 > class 12 multiple sclerosis & parkinson's > Flashcards

class 12 multiple sclerosis & parkinson's Flashcards

1
Q

what is multiple sclerosis

A

chronic inflammation, demyelination and scarring of the CNS

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2
Q

what causes multiple sclerosis

A

-unknown
-could be: immunological, infectious, genetic, dietary

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3
Q

pathology of multiple sclerosis

A

-activated T-cells migrate to CNS, causing blood brain barrier disruption
-subsequent antigen-antibody reaction leads to demyelination of axons

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4
Q

MS disease process consists of:

A

-loss of myelin
-disappearance of oligodendrocytes
-proliferation of astrocytes
-changes result in plaque formation (seen on MRI)
-plaques scattered throughout CNS

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5
Q

relapsing remitting MS

A

has a MS relapse after diagnosis
-full recovery after relapse

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6
Q

primary progressive MS

A

every relapse the MS gets worse
-continues to be more disabled after each exacerbation (no recovery after relapse)

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7
Q

secondary progressive MS

A

relapse & progression are more frequent and quicker

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8
Q

progressive relapsing MS

A

causes steady damage to nerves when symptoms first appear and continues to cause progressive worsening

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9
Q

what group is MS typically seen in

A

women ages 20-40

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10
Q

diagnostic studies for MS

A

-history
-clinical manifestations
-MRI (for plagues)
-cerebral spinal fluid (CSF) analysis (inc oligoclonal immunoglobulin G, inc # of lymphocytes, monocytes, and proteins)
-evoked potentials
-NO definitive dx test

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11
Q

motor manifestations of MS

A

-weakness or paralysis of limbs, trunk, and head
-tremors/spasms
-positive babinski
-diplopia
-scanning speech
-unsteady gait

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12
Q

sensory manifestations of MS

A

-numbness and tingling
-patchy blindness (scotoma)
-blurred vision
-vertigo and tinnitus
-dec hearing
-chronic neuropathic pain
-lhermitte’s sign

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13
Q

cerebellar manifestations of MS

A

-nystagmus
-ataxia
-dysarthria
-dysphagia
-severe fatigue
-cranial nerve impairment

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14
Q

bowel and bladder function with MS

A

-constipation
-incontinence
-spastic bladder (freq, small urination)
-flaccid bladder (distended bladder w no urge)

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15
Q

respiratory function with MS

A

-diminished cough reflex
-respiratory infections

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16
Q

goals of treatment with MS

A

-delay the progress of the disease
-manage chronic symptoms and maintain quality of life
-treat exacerbations

17
Q

drug therapy for MS

A

-steroids (first line)
-immunosuppressive
-immunomodulators
-antidepressants
-CNS stimulants
-anticholinergics
-cannabinoids

18
Q

nonpharmacologic treatments for MS

A

physiotherapy
relieve spasticity
improve coordination
train client to substitute unaffected muscles for impaired muscles
-exercise
-nutritious well-balanced diet high in roughage

19
Q

nursing care for MS

A

-maximize neuro-muscular function
-maintain independence in ADL’s
-manage disabling fatigue
-optimize psychosocial well-being
-adjust to illness
-identify triggers

20
Q

what is Parkinson’s disease

A

-disease of basal ganglia
-affects motor ability
-diagnosis increases with age, with peak onset in the sixth decade
-more common in men, slow progression

21
Q

characteristics of parkinson’s disease

A

-slowing down in the initiation and execution of movement
-inc muscle tone
-tremor at rest
-impaired postural reflexes

22
Q

risk factors for parkinson’s

A

-advancing age
-male>female
-family hx
-environmental factors
-exposure to toxins

23
Q

pathophysiology of parkinsons

A

-associated with degeneration of dopamine-producing neurons in substantial nigra of the midbrain
-normal function requires balance b/t acetylcholine & dopamine in basal ganglia
-any shift balance creates parkinsonism symptoms

24
Q

manifestations of parkinsons

A

onset is gradual and insidious
-classic triad: tremor, rigidity, bradykinesia
-“pill rolling” finger motion

25
Q

diagnosis of parkinsons

A

-no specific tests
-diagnosis based solely on hx and clinical features
-firm dx can be made when bradykinesia is present and at least two of the following characteristics: limb muscle rigidity -resting tremor or postural instability

26
Q

what is bradykinesia

A

-slowing down in initiation and execution of movement
-evident in loss of autonomic movements
-blinking, swinging arms while walking, swallowing saliva, facial movement, minor postural adjustment

27
Q

tremor with parksinsons’

A

so minimal only the client may notice it
-more prominent at rest and is aggravated by emotional stress or inc concentration
-decsribed as “pill rolling”
-benign essential tumor, which occurs during voluntary movement, has been misdx’d as PD

28
Q

rigidity with parkinson’s

A

rigidity is typified by a jerky quality when the joint is moved “like cranking a gear”
increased resistance to passive ROM when limbs move
-caused by sustained muscle contraction and consequently elicits the following
-inhibits the alternating contraction and relaxation in opposite muscle groups thus slowing movement

29
Q

nonmotor symptoms of parkinson’s

A

-depression, anxiety
-apathy
-fatigue
-pain
-constipation
-impotence
-short term memory impairment
-sleep problems

30
Q

comorbidites as a result from parkinson’s

A

dysphagia->may cause malnutrition and aspiration
may cause pneumonia, UTI’s skin breakdown
-orthostatic hypotension
-falls/injuries

31
Q

medical management of parkinson’s

A

-controlling symptom’s
-maintaining functional indepence
-pharmacologic management

32
Q

pharmacologic therapy for parksinson’s

A

-dopaminergic agent’s
-anticholinergic agents
-COMT inhibitors
-MAO inhibitors
-initally only 1 is used, combination tx is needed as disease progresses

33
Q

excessive dopaminergic drugs can lead to

A

paradoxical intoxication

34
Q

surgical therapy for parkinsons

A

-procedures aimed at reliving symptoms
-used in clients who are usually unresponsive to drug therapy or have developed severe motor complications

35
Q

deep brain stimulation for parkinsons

A

-involved placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus
-connected to a generator placed in the upper chest
-device is programmed to deliver specific current to targeted brain location

36
Q

management for parkinson’s

A

-exercise/ambulation
-self care
-nutrition
-adequate chewing
-psychosocial support

37
Q

nonpharmacologic managment for parkinsons

A

-physical exercise and a well-balanved diet
-limit consequences of dec mobility
-specific exercises to strengthen muscles involved w speaking and swallowing
-teach maintenance of good health, independence, avoid complications

med/surg 2 (17 decks)

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