Exam 4: Problems of the Peripheral Nervous System (7 questions) Flashcards Preview

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Flashcards in Exam 4: Problems of the Peripheral Nervous System (7 questions) Deck (15):
1

Guillain-Barre syndrome pathophysiology

- Segmental demyelination process of the peripheral nerves

- T cells migrate to the peripheral nerves
Edema & inflammation

- Macrophages
Break down myelin
Inflammation
axonal damage

- Temporary condition

- Acute onset

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

2

Guillain-Barre syndrome etiology

- Immune mediated response
IgG antibodies

- Viral infections
- Bacterial infection
- Vaccines
- Lymphoma
- Surgery
- Trauma

3

Guillain-Barre syndrome stages

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

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

- Recovery:
4-6 months and up to 2 years
remyelination and return of muscle strength

4

Guillain-Barre syndrome symptoms

- Motor weakness, parathesias

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

- Autonomic dysfunction
BP fluctuation
dysrhythmias

- Motor loss
Symmetric, bilateral, ascending

- Respiratory function
Inspiratory force, tidal volume

5

Guillain-Barre syndrome treatment

- Plasmapheresis
Exchanges occur ~ three to four treatments, 1 to 2 days apart

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

6

Plasmapheresis for Guillain-Barre syndrome

- 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

7

Guillain-Barre syndrome nursing care/management

- Survey for complications

- Early mobility

- Enteral Nutrition

- Emotional support

- Patient education

8

Myasthenia Gravis pathophysiology

- An acquired autoimmune disease characterized by muscle weakness

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

- Types: Ocular & Generalized

9

Myasthenia Gravis- Tensilon Testing

- Baseline assessment of cranial muscle strength

- Edrophonium (Tensilon) administered

10

Myasthenia Gravis- Tensilon Testing: Positive test

Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes (look at eyelids)

11

Myasthenia Gravis- Tensilon Testing: complications/nursing care`

- Observe for facial fasciculations, cardiac arrhythmias

- Observe for bradycardia, sweating, abdominal cramps

- Atropine at bedside

12

Myasthenia Gravis- Cholinergic crisis

- Too much ChE inhibitor drug (Anticholinesterase (antimyasthenics)) and (Pyridostigmine (Mestinon))

- Increased weakness
- Hypersalivation
- Sweating
- Increased bronchial secretions
- N,V&D
- Hypotension

13

Myasthenia Gravis- Cholinergic crisis: treatment

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

14

Myasthenia Gravis- Myasthenia crisis

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

15

Myasthenia Gravis- Myasthenia crisis: treatment

- Maintain respiratory function
- Cholinesterase-inhibiting drugs withheld