DEGENERATIVE DISEASE

Question 1

-↓ Dopamine; ↑ Acetylcholine

Due to damage in basal ganglia
Substancia Nigra
↓
Produces: Dopamine
1. Sympathetic Stimulation
2. Mood
3. Fine motor movement

Answer 1

Parkinson’s Disease
AKA Paralysis Agitans

Question 2

Causes of Parkinon’s Dse

Answer 2

-Unknown
-Viral Infection
-Head Trauma

Question 3

Manifestation of Parkinson’s DSE

Answer 3

1) PARKINSON’S TRIADS
T-R-B
*Tremor: Unintentional resting tremors
:1st sign
*Rigidity: Cogwheel Rigidity: series of
interrupted jerk
*Bradykinesia: Slow movement that ↑ in
speed; Festinating Gait: Tip-Toe

2) Mask-like face
3) Monotonous Voice
*Microphonia: Small tone of voice
4) Micrographia
*Small Shaky Handwriting

Question 4

1st sign of parkinson’s triad:

Answer 4

Tremor

Question 5

PLAN OF CARE: PARKINSON’S DISEASE

Answer 5

1. Priority: SAFETY!!!!
   Bed: Siderails
   Stairs: Railings
   Walking: Walker
2. Parkinson’s Crisis
   ↓Dopamine= Priority: AIRWAY
   -due to obstruction
3. To initiate a walk
   -Rock the body; back & forth

Question 6

CONTRAINDICATION

Answer 6

1. Methyldopa: Prevent conversion of
   dopamine
2. Vitamin B6: Reverse Levodopa
3. MAIOs: PA-NA-MA
   -Muscle irritability/Pill rolling
   -MAIO’s + Levodopa= Hypertensive Crisis

Question 7

MAIO’s + Levodopa

Answer 7

Hypertensive Crisis

Question 8

DOC for Parkinson’s Disease

Answer 8

1) DOPAMINERGIC
-Levodopa

2) ANTICHOLINERGIC
A-C-A
-Akineton
-Cogentin
-Artane

Question 9

1st sign of Parkinsons disease :

Answer 9

First sensory: Anosmia (loss of smell)
First Motor: Tremor

Question 10

-Destruction & lesion of “myelin sheath” of CNS.
-common: women (20-40 y.o.)
-Remission (on & off) & Exacerbation
↓
Flare-up symptoms
↓
if ↓ immunity
(immunosuppressed)

Answer 10

MS (MULTIPLE SCLEROSIS)

Question 11

Causes of MS

Answer 11

-Unknown (Idiopathic)
-Autoimmune
-Viral Infection

Question 12

Manifestation of MS:

Answer 12

1. CHARCOT’S TRIAD
   S-I-N
   *Scanning speech
   *Intentional Tremors
   Ataxia-Uncoordinated Movement
   -“swaying manner in walking”
   *Nystagmus: Visual Disturbance
   1st sign :Ptosis & Diplopia
2. SCLEROSIS: (+) Muscle Spasm

Question 13

Diagnostic Test for MS:

Answer 13

LUMBAR PUNCTURE: CSF
-↑ Protein: Cloudy
-↓ Glucose: (+) Antibody
: IgG: causes manifestation

(+) LHERMETTE’S RESPONSE
-introduction of electricity in the spinal cord, causes weakness & paralysis.

Question 14

PLAN OF CARE MS:

Answer 14

1. AVOID STRESS: ↓IMMUNITY
   Stress Management:
   -Relaxation technique
   -Avoid Pregnancy: stressful

2.ATAXIA: PRONE TO FALL
-avoid obesity
-control weight

3.SCANNING SPEECH
-take time to listen

4. PROVIDE SAFE ENVIRONMENT

5.PLASMAPHERESIS: (-) antibody in plasma

Question 15

DOC for MS

Answer 15

STEROIDS (PREDNISONE)
-autoimmune

BACLOFEN (LIORESAL)
-muscle spasm

Question 16

SIMPLE PATHOPHYSIO IN MS

Answer 16

Destroyed myelin sheath: CNS
↓
↓sensitivity to stimulus
↓
↓body resistance
↓
↓immunity
↓
Flare-up of symptoms

Question 17

-Demyelination of “Myelin sheath of Peripheral N.S.” with “Neuritis”.

CAUSE:
-Unknown (idiopathic)
-Viral Infxn: after Swine Flu Vaccine
-Autoimmune

Answer 17

GBS (Guillan-Barre Syndrome)

Question 18

1st sign of GBS:

Answer 18

Clumsiness
Weakness of ↓ extremities

Question 19

ASCENDING PARALYSIS ↑

Answer 19

GBS

Question 20

S/Sx of GBS:

Answer 20

1) Early sign: Clumsiness
Weakness of ↓ extremities

2) Numbness of extremities

3) fluctuating BP

Question 21

Diagnostic Test

Answer 21

1) Lumbar Puncture: CSF
↑Protein: Cloudy
↓Glucose
(+) Antibody: IgG

2) EMG : measures electricity of muscles
-Determines muscle weakness

Question 22

Common cause of death in GBS

Answer 22

-GUT INFX
-RESPIRATORY INFX

Question 23

PLAN OF CARE FOR GBS

Answer 23

PRIORITY: SAFETY
-Wheelchair

RESPIRATORY PARALYSIS
-mechanical ventilator
-Assist The breathing

Question 24

DOC for GBS

Answer 24

1) STEROIDS (PREDNISONE)

2) IVIG: IV Immunoglobulin
-Treat viral infection

3) VITAMIN B6
-treat peripheral neuritis

4) PLASMAPHERESIS
-removal of antibody in plasma

Question 25

-↓ acetylcholine due to damage in the acetylcholine receptor. at the point of "Myoneural Junction" : where skeletal muscle met.

Answer 25

MG (Myasthenia Gravis)

Question 26

Manifestations of MG:

Answer 26

Descending Paralysis ↓ 1st sign: -Ptosis: Drooping of eyelids -Diplopia: Double visions -Facial paralysis -drooling -dysphagia -dyspnea (Respi Paralysis)

Question 27

Diagnostic Test for MG

Answer 27

TENSILON TEST: IV (Endophonium Chloride)/ Anti-cholinesterase Tensilon test- IV ↓ (+) Muscle contractions ↓ (+) MG Effect: Short-Acting: 3-5 minutes

Question 28

TENSILON TEST IS NOT MEDICATION BECAUSE:

Answer 28

HALF-LIFE OR SHORT-ACTING 3-5 Minutes

Question 29

PLAN OF CARE FOR MG:

Answer 29

1) DIPLOPIA: Patch one eye 2) DYSPHAGIA: -Diet: Small frequent feeding 3)Respiratory Paralysis -Mechanical ventilator 4) Activities best given in morning -Muscle is still strong

Question 30

DIET FOR GBS (DYSPHAGIA)

Answer 30

Small frequent feeding start with cold drink beverage ↓ causes muscle contraction ↓ Stimulates gag/swallowing reflex ***Offer thickened liquids

Question 31

DOC for MG:

Answer 31

ANTI-CHOLINESTERASE P-N-M Prostigmin Neostigmine Mestinon

Question 32

-signs of MG -Underdose of acetylcholine -DOC: Anti-cholinesterase (P-N-M)

Answer 32

Myasthenic Crisis

Question 33

-Signs of parasympathetic -overdose of acetylcholine -DOC: Anticholinergic (Atropine sulfate)

Answer 33

Cholinergic Crisis

Question 34

Acetylcholine in brain

Answer 34

↑ Memories

Question 35

Acetylcholine in muscle

Answer 35

↑Muscle Contraction

Question 36

Nurse caring for pt. with MG, when is the best time to give activities?

Answer 36

Morning ↑muscle power

Question 37

MG will/might die first than GBS due to?

Answer 37

Respiratory Paralysis

Question 38

What to introduce first in diet for MG:

Answer 38

-COLD WATER: Muscle Contractions -First Thickened Liquid

Question 39

↓ Dopamine; ↑Acetylcholine

Answer 39

Parkinson's

Question 40

↑ Dopamine; ↑ Acetylcholine

Answer 40

Schizophrenia