Exam 4- Peripheral Nervous System Flashcards Preview

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Flashcards in Exam 4- Peripheral Nervous System Deck (32):
1

Guillain-Barre´ Syndrome

-Acute onset
-Monophasic immune-mediated disorder of the peripheral nervous system
-Demyelination of peripheral nerves
-Result of immune-mediated pathologic processes

-Symptoms:
Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction

-Incidence: 1-2 cases per 100,000

-Variants
Acute inflammatory demyelinating polyradicularneuropathy (AIDP) most common in the US

2

Guillain-Barre´ Syndrome: Etiology

-Immune mediated response:IgG antibodies
-Viral infections
-Bacterial infection-have you been sick with any type of infection?
-Vaccines
-Lymphoma
-Surgery
-Trauma

3

GB Patho

-Segmental demyelination process of the peripheral nerves

-T cells migrate to the peripheral nerves: Edema & inflammation

-Macrophages:
Break down myelin
Inflammation
axonal damage

4

Stages of Guillain-Barre: Initial

-1-4 weeks
-onset til no new symptoms present

5

Stages of Guillain-Barre: Plateau

-several days to 2 weeks
-no deterioration and no improvement

6

Stages of Guillain-Barre: Recovery

-4-6 months and up to 2 years
-remyelination and return of muscle strength
-Recovery much faster in young adults

7

GB Signs & symptoms

-Motor weakness, parathesias

-Cranial nerve dysfunction:
Oculomotor, facial, glossopharyngeal, vagal, spinal accessory, hypoglossal

-Autonomic dysfunction:
BP fluctuation
dysrhythmias

-Motor loss:
*Symmetric, bilateral, ascending(eventually have the inability to take a deep breath)*
*Measure tidal volume, chest rise (RR) q4h*

-Respiratory function:
Inspiratory force, tidal volume

8

GB: Diagnosis

-CSF analysis:
Elevated CSF proteins with normal cell counts (wbc & rbc okay)

-Nerve conduction studies:
Electromyeography (EMG)
Nerve conduction velocity

9

GB: Management

-Plasmapheresis:
Exchanges occur ~ three to four treatments, 1 to 2 days apart
IV access in hospital
Need intubation

-Intravenous Immune globulin (IVIG):
Daily dose based on body weight for 5 consecutive days

10

Plasmapheresis

-Removes circulating antibodies assumed to cause disease

-Plasma selectively separated from whole blood; blood cells returned to patient without plasma

-Plasma usually replaces itself, or patient is transfused with albumin

11

GB: Collaborative management

-Survey for complications
-Acute dysautonomia
-HR, BP
-Respiratory care
-Atelectasis, VAP,
pneumothorax, ARDS
-Skin & musculoskeletal - support
-Decubiti, ROM
-Gastrointestinal
-Ileus

-Initiating rehab in the ICU
-Early mobility
-Nutritional support
-enteral
-Emotional support
-Due to sudden paralysis
-Patient education

12

GB: Plan of Care

-Diagnostic testing

-Priority nursing care
Respiratory care
Pain management
Communication and emotional (altenate methods, specialized call button)
Nutritional

-Involvement of family, other team members

-Education

-Medical treatments—plasmapheresis

13

Myasthenia Gravis

-An acquired autoimmune disease characterized by muscle weakness

-Caused by antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction

14

Types of MG

Ocular & Generalized

15

MG Risk factors

-Coexisting autoimmune disorder

-Hyperplasia of the thymus gland

16

MG Triggers

Infection
Stress, fatigue
Pregnancy
Heat

17

MG Symptoms

Progressive muscle weakness
Diplopia
*Drooping eyelids, one or both (ptosis)*
Difficulty chewing and swallowing (dysphagia)
Respiratory dysfunction
Bowel & bladder dysfunction
*Fatigue*

18

Tensilon Testing

-Baseline assessment of cranial muscle strength
Edrophonium (Tensilon) administered
Monitor eyelid
Give a small amount to assess tolerance

-Positive test:
Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes

-Nursing care:
Observe for facial fasciculations, cardiac arrhythmias
Observe for bradycardia, sweating, abdominal cramps
Atropine at bedside

19

MG: Cholinesterase Inhibitor Drugs

-Anticholinesterase (antimyasthenics)
Enhance neuromuscular impulse transmission by preventing decrease of ACh by enzyme ChE
Improves muscle strength

-Pyridostigmine (Mestinon)
Administer with small amount of food-time it an hr before a meal so that they will have strength to eat the meal
Eat meal 45 to 60 minutes after med
Observe drug interactions
Magnesium, morphine, sedatives, neomycins

**Medication given on a strict schedule**

20

MG: treatments

-Immunosuppressants Prednisone or Azathioprine (Imuran)
Given during periods of exacerbations
Monitor for infections

-Plasmapheresis

-Thymectomy=if it involves the thymus

21

MG: Management

Respiratory support

Promoting self-care guidelines

Assisting with communication

Nutritional support

Eye protection

22

Cholinergic crisis

T-oo much ChE inhibitor drug
Increased weakness
Hypersalivation
Sweating
Increased bronchial secretions
N,V&D
Hypotension

-Maintain respiratory function
-Anticholinergic drugs withheld while on ventilator
-Atropine
-Supportive care

23

Myasthenic Crisis

-Not enough ChE inhibitor drug
-Flare of sx, increased weakness
-Hypertension
-Increased HR, RR




-Maintain respiratory function
-Cholinesterase-inhibiting drugs withheld
-Supportive w/other conditions that cause complications with the disease

24

MG Health Teaching

-Factors in exacerbation—infection, stress, surgery, hard physical exercise, sedatives, enemas, strong cathartics

Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes

-Teach warning signs and importance of compliance

25

Peripheral Nerve Trauma: Common causative agents

-Vehicular or sports injury
-Wounds to peripheral nerves

26

Peripheral Nerve Trauma

-Degeneration/retraction of nerve distal to injury within 24 hr

-Cold phase vs. warm phase

-Perioperative and postoperative care

-Rehabilitation through physiotherapy

27

Restless Legs Syndrome (RLS)

-Leg paresthesias
Irresistible urge to move
Peripheral and central nerve damage in legs/spinal cord

28

Restless Legs Syndrome (RLS): Management

Symptomatic
Nonmedical treatment
Drug therapy effective for some patients

29

Trigeminal Neuralgia

Trigeminal or fifth cranial nerve

30

TN Pain management

-Nonsurgical management
Gabapentin
-Surgical management
Microvascular decompression
Radiofrequency thermal coagulation
Percutaneous balloon microcompression

31

TN post-op care

Infection, intense pain, bleeding

32

Facial Paralysis (Bell’s Palsy

-Seventh cranial nerve
-Interventions
-Medical management
-Prednisone, analgesics, acyclovir (if there is a viral etiology
-Protection of eye
-Nutrition – my have trouble swallowing
-Massage, warm/moist heat, facial exercises