Cyndi - Week 15 - Exam 7 Flashcards
(54 cards)
1
Q
what is multiple sclerosis?
A
Chronic, progressive, disseminated demyelination of nerve axons
- Most common of the demyelinating disorders
- Age usually 20-50, temperate climate, women 2-3 x men
2
Q
what are the risk factors of MS?
A
- genetic
- viral/bacterial
- exposure to heavy metals
- *all cause inflammation → scarring/injury
3
Q
T/F: MS is an autoimmune destruction of CNS myelin where ACTIVATED T cells cross into the BBB.
A
TRUE - and kill oligodendrocytes
4
Q
what are the three stages of the pathophysiology of MS?
A
- chronic inflammation
- demyelination
- gliosis
5
Q
what are the characteristics of the “chronic inflammation” in MS?
A
- slows transmission
- Nodes of Ranvier
- *inflammation in the Nodes of Ranvier → harder for info to get through
6
Q
what are the characteristics of “demyelination” in MS?
A
- can regenerate
- oligodendrocytes → make myelin
7
Q
what is the characteristic of “gliosis” in MS?
A
- sclerotic plagues
- *injured tissue
- hypertrophy of oligodendrocytes → gliosis → dead/not working
8
Q
MS involves a gradual onset of vague symptoms, they include:
A
- motor
- sensory (debilitating fatigue)
- cerebral (ataxia, tremor)
- emotional
9
Q
what are the common sxs of MS?
A
- weakness
- numbness
- tingling
- balance problems
- fatigue
- blurred vision
- vision problems
- cognitive impairment
- bladder problems
10
Q
what is the most common/early sxs?
A
eye problems
- heavily covered in myelin → impairment, color perception, pain with eye movement
11
Q
what are the different types of MS?
A
- intermittent (most common)
- chronic
- degenerative
12
Q
TEACHING POINT: how does pregnancy affect MS?
A
- may improve, but worsen during postpartum period
13
Q
what are the goals when it comes to MS?
A
Goals: maximize neuromuscular function and independence; manage pain and fatigue;
optimize health and avoid triggers, educate
14
Q
what are the diagnostic tests used for MS?
A
- MRI of brain and spine
- Evoked potential
- Cerebrospinal fluid
- Oligoclonal bands – 90-95%
- Immunoglobulin G – 70-90%
15
Q
TEACHING POINT: what are the 3 characteristics the patient must have for an MS diagnosis?
A
- At least 2 inflammatory demyelinating lesions in at least 2 different locations in the CNS
- Damage or attacks occurring at different times
- All other diagnoses ruled out
16
Q
what are the complications of MS?
A
- Acute exacerbations
- Decreased mobility
- Respiratory tract infection
- Urinary tract infection
- Pressure ulcers
- Constipation
- Bladder control
- Depression
17
Q
T/F: there is a cure for MS
A
FALSEY FALSE
• MS varies individually
• Drugs can modify/slow disease process
• Drugs can help improve an exacerbation
• Drugs can provide day to day symptom relief
• People who do better:
• Young, female, infrequent attacks with relapsing pattern
18
Q
what is the pt education in regards to MS?
A
- Identify triggers
- Med compliance and teaching
- Plan for fatigue and spasms/pain (mod exercise helps)
- Support emotionally, encourage independence
- Bladder control (self cath, meds → independence)
- Lifestyle decisions (stress, keep journal/calendar)
19
Q
what are the 3 different types of meds given for MS?
A
- meds that modify the disease process
- meds that help an exacerbation
- meds that provide symptom relief
20
Q
what are the meds that modify the disease process for MS?
A
- Immunomodulators (Interferon)
- Immunosuppressant
- Sphingosine 1-Phospate Receptor Modulator (↓ frequency of relapse)
- Monclonal Antibody (bind to neutrophil → delay crossing into CNS)
21
Q
what are the meds that help an exacerbation?
A
- Steroids
- Adrenocorticotropic hormone (↓ edema/inflam at the site)
22
Q
what are the meds that provide symptom relief?
A
- Cholinergics – (urecholine)
- Anticholinergics (ditropan)
- Muscle relaxers (valium, baclofen)
- Nerve conductor enhancers (ampyra)
- Antidepressants
- Others
23
Q
TEACHING POINT: for a hypotonic bladder, what type of med would be used?
A
cholinergics
24
Q
TEACHING POINT: for a HYPERactive bladder, what type of med would be used?
A
anticholinergics
25
what is parkinson's disease?
Chronic progressive neurodegenerative
| disease of dopamine receptors
26
what does dopamine do in regards to parkinson's disease?
Neurotransmitter essential for extrapyramidal system
- Posture
- Support
- Voluntary movement
27
T/F parkinson's is a disease of basal ganglia in the midbrain
TRUE
- Death of dopamine-producing neurons in substantia nigra of the basal ganglia
- Disruption in dopamine-acetylcholine balance in basal ganglia
- Onset is gradual and insidious
28
what are the causes of Parkinson's disease?
Cause is a combo of genetics and environmental factors
- Drug or chemical induced (Reglan, haldol, lithium, Thorazine, amphetamines, Carbon monoxide, manganese, copper)
- Hydrocephalus
- Hypoxia
- Infections
- Stroke
- Tumor
- Repeated head trauma (destroyed part of brain that has dopamine)
29
TEACHING POINT: what is the classic triad of PD?
* Tremor, rigidity, bradykinesia
* Gait disturbance
* Progression
30
what are the non-motor symptoms of parkinson's disease?
- Dementia (40% develop)
- Depression
- Anxiety
- Apathy
- Fatigue
- Pain
- Constipation
- Impotence
- Short-term memory impairment
- Sleep problems
31
what are the diagnostic tests for PD?
* No specific tests!
* Diagnosis based solely on history and clinical features
* At least 2 of classic triad
* Confirmation with positive response to Parkinson's meds
* Mood, dementia
* Weight loss, drooling, pill-rolling ***TP***
* Incontinence, constipation
32
what are the complications of PD?
* Motor symptoms
* Dysphagia
* Malnutrition
* Skin breakdown
* Infections
* Falls
* Neurological, neuropsychiatric problems, severe dementia
33
there are two types of medications used for parkinson's disease. what do they do?
Type 1 - Improves the supply of dopamine
| Type 2 - Blocks the effects of cholinergic neurons
34
what are the type 1 meds for PD?
* Dopamine precursors -
* Levodopa with carbidopa (Sinemet)
* Dopamine Receptor agonist - stimulates
* Dopamine agonist – blocks reuptake
* MAO inhibitors – block breakdown of dopamine
35
what are the type 2 meds for PD?
• Anticholinergics - Cogentin
36
what are the other meds for PD?
* Antihistamines - used to manage tremors
| * Antiviral agent - exact mechanism unknown
37
what are the different parkinson's surgeries?
* Transplantation of fetal neural tissue into the basal ganglia
* Ablation surgery
* Deep brain stimulation
38
it's important for PD pts to maximize: ?
* Neurologic function
* Psychosocial well-being
* Nutrition - assess for swallowing/ability to feed self **TP**
* Safety
* Independence in ADLs for as long as possible **TP - ambulating and sitting in chair
39
those with PD may involve collaborative care, like: ...
* PT
* Speech/language pathologist
* Dietician
* Social services
* Home health
* Family support
40
what is myasthenia gravis?
Neuromuscular disorder of weakness (acetylcholine)
• Autoimmune disease
• 15% have thymic tumor, most have abnormal thymus
• Antibodies attack acetylcholine receptors
• Nerves can’t stimulate the muscular response
41
what are the clinical manifestations for MG?
• Fluctuating weakness of skeletal muscles
- Due to ↓ ACh receptors at neuromuscular junction
- Exacerbation periods or progressive/variable symptoms
*** Rest improves symptoms
• ↓ Strength of facial muscles
• 90% eye movement problems
• Also:
• Swallowing
• Speaking
• Breathing
42
what are the diagnostics used for MG?
* Tensilon test –brief improvement of muscle strength
* Electromygraphy (EMG) – shows muscle fatigue
* Acetylcholine Receptor Antibody- 90% positive
43
what are the complications for MG?
* Myasthenic crisis
* Muscle weakness that affects swallowing and breathing
* Aspiration pneumonia
* Respiratory insufficiency
* Respiratory tract infection
44
TEACHING POINT: It's important to check for competence of muscles effecting breathing, swallowing → aspiration and respiratory tract infection
TRUE YAS I GET IT
45
Is there a cure for MG? **TP**
no known cure
| medications though! must be sure to take their meds on time ***TP***
46
what types of meds are given for MG?
```
• Acetylcholinesterase drugs
- Tensilon, others
• Immune suppression
- Imuran
- CellCept
- Sandimmune
- Corticosteroids
```
47
what are the other tx for myasthena gravis?
* Thymectomy - Surgery to remove thymus
| * Plasmapheresis -Removal of abnormal antibodies from the blood
48
what is guillain-barre syndrome?
Ascending, symmetrical paralysis due to an
autoimmune attack on cranial and peripheral nerves
• Loss of myelin
• Edema, inflammation of nerve
• Distal to proximal paralysis
Danger of respiratory arrest
49
what are the sxs of GBS?
* Ascending, symmetrical weakness
* May progress rapidly to ascending paralysis
* Inability to execute voluntary movement
* Diminished reflexes, dyskinesia, paresthesias
* Diaphragm and intercostal function weakens
50
what are the nursing interventions for GBS?
* Assess and monitor respiratory status
* BP, rate and rhythm; dysrhythmias
* Support person psychologically
* Emergent intubation may be life saving
51
TEACHING POINT: it's important to question what when it comes to GBS?
question: did they have respiratory/gastro infection lately?
52
what are the diagnostics for GBS?
```
History of viral, bacterial illness, trauma, surgery,
gastroenteritis, vaccination
• ABGs
• CSF
• EMG
• Nerve conduction velocity
• Pulmonary Function Test
• MRI of brain
```
53
what are the complications for GBS?
```
• Pneumonia
• Infection
• DVT/PE
• Pain Control
• Immobility
Excellent preventative and collaborative care needed to avoid complications!
```
54
what is the tx for GBS?
```
- Treat underling cause:
• Antibiotics
• Antivirals
• IVIG – immunoglobulin
• Plasmapheresis
- Protection of airway
• Mechanical ventilation
• VAP prevention
- Nutritional support
- ROM, physical therapy
- DVT prophylaxis
- Patient and family education
```
