Exam 7 (Neuro) Flashcards
(105 cards)
1
Q
Phases of Migraines
A
Phase One: (prodromal phase)
Aura develops over a period of several minutes and last no more than 1 hour
Pain may be preceded by visual disturbances, flashing lights, lines, spots, shimmering or zig- zag lights
Pain may be preceded by neurologic changes including numbness, tingling of lips, tongue
Second Phase:
Increase in intensity/nausea & vomiting
Pain usually begins in temple and increases in intensity
Third Phase:
Pain becomes dull
2
Q
Mild treatment of Migraines
A
Mild
simple analgesics - Tylenol
NSAIDS –decrease inflammation
Narcotic analgesics
3
Q
Severe treatment for migraines
A
- Triptan Preparations (vasoconstiction)
Imitrex
Relapax
Zomig - Ergotamine preparations
Cafergot: do not give within 24 hrs of triptan medications - Isometheptene Combination
Midrin (APAP, Isometheptene, dichloralphenazone)
4
Q
Drug therapy for Migraines
A
Drug Therapy Beta blockers Antidepressants Calcium channel blockers Depakote – promising new Tx Topamax (low dose)
5
Q
Drugs that could trigger a migraine
A
Tagamet
Estrogens
Nitroglycerin
Nifedipine
6
Q
Cluster headaches
A
More common in men
Seasonal in nature
Headaches shorter duration
Vasoreactivity & neurogenic inflammation
Imaging studies suggest:
Overactive and enlarged Hypothalamus
7
Q
Symptoms of cluster headaches
A
Pain is unilateral deep and around eyes Ipsilateral tearing of eyes Rhinorrhea Flushing/pallor of face Pace, walks, rocks sit or stand during HA
8
Q
Treatment for cluster headaches
A
100% Oxygen via mask at 5 liters/min with client in sitting position x 15 minutes
Consistent sleep/wake cycle
Decrease precipitating factors
9
Q
Define epilepsy and seizures
A
Epilepsy: A chronic disorder characterized by recurrent, unprovoked seizure activity
Seizure: An abnormal, sudden, excessive discharge of electrical activity in the brain.
10
Q
Tonic clonic seizures
A
Lasts 2-5 minutes
Tonic phase -> stiffening or rigidity of muscles, particularly the arms and legs and immediate loss of consciousness
Clonic phase -> rhythmic jerking of all extremities
11
Q
Absence seizures
A
More common in children and tends to run in families
Blank staring
Returns to baseline immediately after seizure
May interfere with daily activities (work, school
Automatism
12
Q
Myoclonic seizures
A
Brief jerking or stiffening of the extremities, which occur singly or in groups
Lasts a few seconds
13
Q
Atonic seizures
A
Sudden loss of muscle tone, lasting for seconds followed by postictal (after seizure) confusion
Seizure may cause client to fall
Most resistant to drug therapy
14
Q
Partial seizures: simple
A
Client remains conscious
Reports aura (unusual sensation before occurrence)
Client may have unilateral movement of an extremity
Client may experience unusual sensations
15
Q
Partial seizures complex
A
Lose consciousness – black out for 1-3 minutes
Automatisms may occur- client is not aware of the behavior such as lip smacking, patting, picking at clothes
After seizure, client may experience amnesia
Area most affected is
temporal lobe
16
Q
Drugs used in seizure management
A
Dilantin
Ativan
Depakote
Klonopin
17
Q
Seizure precautions
A
Oxygen and suctioning equipment available
Insert saline lock
Raise side rails, lower bed
Never insert padded tongue blade after seizure begins
Turn client on side, turn head during tonic-clonic and complex partial seizures
Do not restrain the client
18
Q
What is status epilepticus?
A
Characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes. Causes: Acute alcohol withdrawal Head trauma Cerebral edema Metabolic disturbances
**Neurologic emergency – treat promptly and
aggressively
19
Q
Drug treatment for status epilepticus
A
Drug Treatment IV Diazepam (Valium) IV Lorazepam (Ativan) * drug of choice Diazepam gel (Diastat) Phenytoin (Dilantin) * not compatible with many drugs or D5W….flush IV with normal saline
20
Q
Drug precautions
A
Be aware of Drug-Drug interactions
Do not give Coumadin with Dilantin
Be aware of Food-Drug interactions
Citrus fruits such as grapefruit can interfere with metabolism
21
Q
Viral meningitis
A
Inflammation of meninges and CSF
Infected through bloodstream following viral infection
Exudate does not form
22
Q
Bacterial Meningitis
A
Bacterial is a medical emergency
Infected through bloodstream following a bacterial infection: upper respiratory tract, sinuses or otitis media) or via direct route
Exudate forms which may further irritate spinal and cranial nerves
Meningococcal meningitis: can be epidemic in nature
23
Q
Encephalitis
A
Inflammation of the brain tissue
Usually viral in nature and preceded by a viral infection and transmitted to brain through bloodstream
Inflammation does not form exudate but causes degeneration of the neurons of the cortex
Demyelization of axons occurs and leads to hemorrhage, edema, necrosis and further can develop into compression of vessels and ICP
24
Q
Symptoms of meningitis and encephalitis
A
Clinical Manifestations:
Photophobia
Headache, nausea, vomiting & fever
Nuccal Rigidity, seizures and focal neurologic deficits may occur.
25
Meningitis and encephalitis cont...
May lead to ICP – herniation of the brain – death
Stimulation of hypothalamus may lead to SIADH (water retention)
Septic emboli may result in gangrene, DIC, hemiparesis and death.
26
Neurologic infection precautions
```
Administer medications and IV fluids
Strict I & O
HOB elevated 30 degrees
Reduce stimuli
Maintain isolation for meningitis
```
27
What is huntingtons disease?
Hereditary disorder
Decrease in GABA and acetylcholine (excitatory)
No change in dopamine (inhibitory)
The shift in balance between dopamine and GABA leads to uninhibited motor activity
28
Symptoms of huntingtons disease
Symptoms
Progressive mental status change leading to dementia
Choreiform movements (rapid, jerky) in limbs, trunk and facial muscles
No cure or treatment
Prevent transmission by not having children
Antipsychotic agents-to manage movements
Administer meds to treat depression etc
Collaborative care – speech therapy, dietician,PT/OT, SW
29
Seizures
• Recognize that generalized seizures, such as the tonic-clonic seizure, involve both cerebral hemispheres. Partial seizures, also called focal or local seizures, usually involve only one hemisphere.
30
Status epilepticus
* Status epilepticus is a medical emergency characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes.
* Causes of status epilepticus may include withdrawal from antiepileptic drugs, alcohol or other drugs, head trauma, infections, cerebral edema, and metabolic disturbances
31
• Meningitis
* Meningitis is an inflammation of the meninges surrounding the brain and spinal cord.
* Bacterial and viral organisms are most often responsible for meningitis, although fungal meningitis and protozoal meningitis also occur.
* Viral meningitis is usually self-limiting and the patient has a complete recovery; but bacterial meningitis is potentially life-threatening.
* Increased intracranial pressure may occur as a result of blockage of the flow of CSF, change in cerebral blood flow, or thrombus formation.
* Analysis of the cerebrospinal fluid is used to diagnose meningitis.
* Patients who are older than 60 years of age, immunocompromised, or with signs of increased intracranial pressure (ICP) usually have a CT scan performed before the lumbar puncture.
* For patients with meningitis, carefully monitor neurologic status, including vital signs and neurovascular checks. Observe for signs and symptoms of increased intracranial pressure (ICP).
32
Parkinson disease
* Parkinson disease, also referred to as paralysis agitans, is a progressive neurodegenerative disease, which most often is idiopathic in origin.
* It is a debilitating disease affecting motor ability and is characterized by four cardinal symptoms: tremor, rigidity, bradykinesia or akinesia, and postural instability
33
Alzheimer’s disease
* Alzheimer’s disease is a chronic, progressive, degenerative disease accounting for 60% of the dementias occurring in people older than 65 years of age, eventually causing complete disorientation and total dependence on others for care.
* It is characterized by loss of memory, judgment, and visuospatial perception, and by a change in personality.
* The most important risk factors are age, female gender, and family history.
* Recall that familial Alzheimer’s disease has a genetic predisposition.
34
• Huntington disease
* Huntington disease is a chronic, hereditary illness that is transmitted as an autosomal dominant trait at the time of conception. Refer patients with the disease for genetic counseling.
* The triad of dominant inheritance, choreiform movements or rapid, jerky movements, and dementia are hallmarks of the disease.
* There is no known cure or treatment, therefore genetic counseling is important.
* The first drug to be approved to decrease chorea associated with HD is tetrabenazine (Xenazine).
35
The client has Parkinson disease (PD). Which nursing intervention best protects the client from injury?
Monitoring the client's sleep patterns .
Clients with PD tend to not sleep well at night because of drug therapy and the disease itself. Some clients nap for short periods during the day and may not be aware that they have done so. This sleep misperception could put the client at risk for injury (e.g., falling asleep while driving).
36
The client has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place?
Intravenous access
Suction equipment at the bedside
Siderails up
37
The client with a migraine is lying in a darkened room with a wet cloth on the head after receiving analgesic drugs. What will the nurse do next?
Allow the client to remain undisturbed.
38
Which is the most effective way for the college student to minimize the risk for bacterial meningitis?
Getting the meningitis polysaccharide vaccine
39
The nurse is caring for the client with advanced Alzheimer's disease. Which communication technique is best to use with this client?
Assuming that the client is not totally confused
40
The client is admitted into the emergency department with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What does the nurse suspect may be occurring?
Classic migraine
41
The female client with newly diagnosed migraine is being discharged with a prescription for sumatriptan (Imitrex). Which comment by the client indicates an understanding of the nurse's discharge instructions?
I must report any chest pain right away."
42
The parents of a young child report that their child sometimes stares blankly into space for just a few seconds and then gets very tired. The nurse anticipates that the child will be assessed for which seizure disorder?
Absence seizures are more common in children and consist of brief (often just seconds) periods of loss of consciousness and blank staring, as though he or she is daydreaming.
43
The nurse is administering the intake assessment for a newly admitted client with a history of seizures. The client suddenly begins to seize. What does the nurse do next?
Turning the client on the side during a generalized tonic-clonic or complex partial seizure is indicated because he or she may lose consciousness.
44
The client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client?
The most important nursing intervention for clients with meningitis is the accurate monitoring and recording of their neurologic status, vital signs, and vascular assessment. The client's neurologic status and vital signs should be assessed at least every 4 hours, or more often if clinically indicated. The priority for care is to monitor for early neurologic changes that may indicate increased intracranial pressure (ICP), such as decreased level of consciousness (LOC).
45
The client is being discharged to home with progressing stage I Alzheimer's disease. The family expresses concern to the nurse about caring for their parent. What is the priority for best continuity of care?
Assigning a case manager
46
The spouse of the client with Alzheimer's disease (AD) is listening to the hospice nurse explaining the client's drug regimen. Which statement by the spouse indicates an understanding of the nurse's instruction?
Cholinesterase inhibitors (e.g., donepezil) are approved for the symptomatic treatment of Alzheimer's disease.
47
The client has been diagnosed with Huntington disease. The nurse is teaching the client and her parents about the genetic aspects of the disease. Which statement made by the parents demonstrates a good understanding of the nurse's teaching?
"If she has children, she'll pass the gene on to her kids."
48
The nursing instructor asks the student nurse caring for a client with Alzheimer's disease who has been prescribed donepezil (Aricept) how the drug works. Which response by the nursing student best explains the action of donepezil?
"It delays the destruction of acetylcholine by acetylcholinesterase."
49
The nurse has received report on a group of clients. Which client requires the nurse's attention first?
Young adult who has experienced four tonic-clonic seizures within the past 30 minutes
50
A client receiving sumatriptan (Imitrex) for migraine headaches is experiencing adverse effects after taking the drug. Which adverse effect is of greatest concern to the nurse?
Chest tightness
Triptan drugs are contraindicated in clients with coronary artery disease because they can cause arterial narrowing; the nurse should instruct the client to not take the medication until the nurse can talk with the prescribing health care provider.
51
Which change in the cerebrospinal fluid (CSF) indicates to the nurse that the client may have bacterial meningitis?
Cloudy, turbid cerebrospinal fluid is a sign of bacterial meningitis. Clear fluid is a sign of viral meningitis.
52
The nurse is reviewing the history of a client who has been prescribed topiramate (Topamax) for treatment of intractable partial seizures. The nurse plans to contact the health care provider if the client has which condition?
Bipolar disorder
53
• Multiple sclerosis (MS) i
• Multiple sclerosis (MS) is a chronic autoimmune disease that affects the myelin sheath and conduction pathway of the central nervous system and is a leading cause of neurologic disability in young adults.
• This chronic disease is characterized by periods of remission and exacerbation of an inflammatory response that results in demyelinization.
• The four major types of MS include:
o Relapsing-remitting
o Primary progressive
o Secondary progressive
o Progressive-relapsing
• Since there is genetic predisposition, having a first-degree relative such as a parent or sibling with MS increases a person’s risk of developing the disease.
54
Amyotrophic lateral sclerosis
* Amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, is an adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting, and spasticity eventually leading to paralysis.
* There is no known cure for ALS, but an interdisciplinary approach is used to develop an individualized treatment plan to maintain optimum functioning.
* Monitor respiratory status carefully in patients with amyotrophic lateral sclerosis. Patients experience respiratory failure in terminal stages of the disease. Consider their advance directives to assist in planning care
55
The client is admitted with a spinal cord injury at the fifth thoracic vertebra secondary to a gunshot wound. Which nursing intervention is the priority for this client's care?
Positioning the client to maximize ventilation potential
56
To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the health care team is a nursing priority?
Respiratory therapy
Pneumonia, pulmonary emboli, and atelectasis have replaced kidney failure as the leading causes of death in clients with spinal cord injury. Respiratory therapy helps prevent complications such as these from arising.
57
The client with amyotrophic lateral sclerosis (ALS) is degenerating rapidly and will soon need respiratory support. What will the nurse plan to review with this client?
Advance directive
58
The client has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the client indicates understanding of the nurse's instruction?
"I can go home the day of the procedure."
59
Which nursing intervention is best for preventing complications of immobility when caring for the client with spinal cord health problems?
Regular turning and repositioning
60
A client with serve muscle spasticity has been prescribed tizanidine (Zanaflex, Sirdalud). The nurse plans to instruct the client about which adverse effect of tizanidine?
Tizanidine (Zanaflex, Sirdalud) is a centrally acting skeletal muscle relaxant, and drowsiness and sedation are common adverse effects.
61
The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the health care provider will request which medication?
Hydralazine (Apresoline)
This client is experiencing autonomic dysreflexia, which is a neurologic medical emergency that causes severe hypertension and bradycardia. Hydralazine (Apresoline) is an antihypertensive drug used to treat autonomic dysreflexia.
62
Guillain-Barré syndrome
* Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) that affects the peripheral nervous system, causing motor weakness and sensory abnormalities.
* Guillain-Barré syndrome, also called acute idiopathic polyneuritis and polyradiculoneuropathy, is an uncommon disorder affecting middle-aged men slightly more than women.
* Demyelination of the peripheral nerves occurs to varying degrees.
* This is an immune-mediated pathological process where the immune system starts to destroy the myelin sheath that surrounds the axons of the peripheral nerves or attacks the axons themselves.
* Symptoms typically begin in the legs and spread to the arms and upper body, referred to as an ascending paralysis.
* Recall that patients with GBS have ascending paralysis, sensory changes, cranial nerve involvement, and autonomic manifestations as a result of demyelination of neurons.
* Paralysis can increase in intensity until the muscles cannot be used and the patient is almost totally immobile, sometimes requiring mechanical ventilation.
* Three stages make up the acute course: the acute or initial period of 1 to 4 weeks beginning with the onset of the first symptoms and ending when no further deterioration occurs, the plateau period, and the recovery phase which coincides with remyelination and axonal regeneration.
* In general, it is self-limiting and the paralysis temporary, but patients may experience depression throughout the recovery period.
63
Myasthenia gravis
* Myasthenia gravis (MG) is a chronic disease characterized by remissions and exacerbations of fatigue and weakness primarily in muscles innervated by the cranial nerves, as well as in skeletal and respiratory muscles.
* This autoimmune disease of the neuromuscular junction may take many forms—from mild disturbances of the ocular muscles to a rapidly developing, generalized weakness that may lead to death from respiratory failure
* Pharmacologic tests with the cholinesterase inhibitors edrophonium chloride (Tensilon) and neostigmine bromide (Prostigmin) helps to confirm diagnosis.
64
The client with myasthenia gravis (MG) is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates correct understanding of the nurse's instruction?
A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the client is experiencing crisis. The family member should call 911 for emergency assistance.
65
The client arrives to the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease?
Myasthenia gravis (MG)
66
The client is being evaluated for signs associated with myasthenia crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the client is experiencing a cholinergic crisis?
Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs.
67
The client has returned to the unit after a thymectomy and is extubated. The client begins to report chest pain. What will the nurse do next?
The client's chest pain is a symptom of a hemothorax or a pneumothorax and must be reported to the surgeon immediately.
68
The nurse is caring for a client with Guillain-Barré syndrome (GBS) who is receiving immunoglobulin (IVIG). Which client finding warrants immediate evaluation?
Headache with stiff neck
| This may be a sign of aseptic meningitis, a possible serious complication of IVIG therapy.
69
The nurse admits a client with suspected myasthenia gravis (MG). The nurse anticipates that the physician will request which medication to aid in the diagnosis of MG?
```
Edrophonium chloride (Tensilon)
Edrophonium chloride (Tensilon) is used most often for testing for MG because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors
```
70
The nurse is reviewing the medication history of a client diagnosed with myasthenia gravis (MG) who has been prescribed a cholinesterase inhibitor (ChE). The nurse plans to contact the physician if the client is taking which medication?
Procainamide (Pronestyl) should be avoided because it may increase the client's weakness.
71
Interventions for Back Pain
```
Avoid opiod analgesics
Chronic pain – use antiepileptic such as Neurontin (gabapentin)
Heat/ice
Weight control
Diskectomy-spinal nerve lifted to
remove offending
portion of disk
Laminectomy – removal of one or more vertebral laminae plus the herniated nucleus pulposus
```
72
Spinal cord injury
Initial injury
Hemorrhage – microscopic bleeding into gray matter
Edema – spreads along cord
Vasospasm
73
True or false
| Incomplete spinal cord injuries are more common than complete ones
True
74
Most common causes of spinal cord injuries
```
Most common cause is from trauma:
MVA
Acts of violence
Falls
Sports
```
Most common vertebrae include:
Cervical 5,6 and 7
Thoracic 12
Lumbar 1
75
Neurogenic shock
Neurogenic shock
May occur within the first 24 hours after injury
Characterized by hypotension and bradycardia
Associated with cervical spine injuries and caused by loss of autonomic function
Hemodynamic Instability
(Results from injury to the descending sympathetic pathways in the spinal cord (loss of vasomotor tone and sympathetic innervation to the heart.)
76
Autonomic dysreflexia
```
Autonomic dysreflexia (hyperreflexia)
Characterized by :
Severe hypertension
Bradycardia
Severe headache
Nasal stuffiness
Flushing
```
Caused by noxious stimuli
Reflex vasoconstriction leading to hypertensive crisis
Noxious stimuli: kinked foley, full bladder, hang nail, fecal impaction, pressure sore, ingrown toe nail (can all lead to seizures, stroke, death if not treated)
77
What is autonomic dysreflexia caused by?
Caused by a massive sympathetic response to any noxious stimuli (full bladder, line insertions, fecal impaction), which results in bradycardia, hypertension, facial flushing , and headache. Immediate intervention is needed to prevent cerebral hemorrhage, seizures, and acute pulmonary edema. Treatment is aimed at relieving noxious stimuli. Prevention is key!!
78
Definition of incomplete spinal cord injury?
Incomplete: Results in mixed loss of voluntary motor activity and sensation below the level of injury
Central Cord Syndrome
Loss of motor function in upper extremities
79
Anterior cord syndrome
Anterior Cord Syndrome
Motor, pain and temp are lost below the injury
Touch, position, vibration are intact
Patient can FEEL toes but cannot MOVE them
80
Brown-Sequard Syndrome
Brown-Sequard Syndrome
Motor function, proprioception and deep touch lost on same side as injury
Pain, temp and light touch are lost on opposite side
81
Posterior Cord Syndrome
Posterior Cord Syndrome
Motor function is intact
Loss of touch, position, vibration below level of injury
( Patient can MOVE toes but cant FEEL them)
82
Drug therapy for spinal cord injuries
Drug Therapy
Vasopressors
Methylprednisolone
83
Rehabilitation
Neurogenic bladder- use valsalva maneuver and check post void residual, some need intermittent cath several times per day, some need indwelling catheter
Risk for renal complications (hydronephrosis, renal failure, kidney stones, UTI’s) These patients may not feel symptoms of infection (dysuria, urgency, back pain)
Bowel schedule- include stool softeners and high fiber diet, increased fluids
Digital stimulation ONLY if requested by healthcare provider- could cases vagal response (bradycardia, syncope)
84
What is MS?
What is MS?
Chronic, progressive degenerative disease that affects the myelin sheath of the brain and spinal cord from viruses, allergies, or an autoimmune response.
MS stands for many scars
Most common demyelinating disease of the CNS
Gliosis means death of cell
Plaques of demyelination
Onset: 10-50 years with average age of 30
85
Pathophisiology of MS?
Inflammatory response destroys myelin leading to axon dysfunction
Myelin sheaths of the spinal cord, brain and optic nerve are destroyed in patches, called plaques along the axon
Demyelination of nerve fibers slows and distorts conduction of nerve impulses or causes total absence of the impulse
86
Symptoms of MS?
```
FATIGUE
Most common initial symptoms:
Sensory loss 37%
Optic neuritis 36%
Weakness 35%
Paraesthesias 24%
Diplopia 15%
Ataxia 11%
Vertigo 6%
Bladder dysfunction 4%
```
87
Types of MS
Relapsing Remitting
Most common form of MS at time of initial diagnosis
Acute worsening with complete or partial recovery
85% most common
During relapse the person is free of disease
Secondary Progressive
Experience an initial period of relapsing-remitting disease
Followed by a steadily worsening disease course
Primary Progressive and Progressive Relapsing
Relatively rare
88
Tests for clients with MS?
No single test can reliably diagnose MS
CSF shows elevated proteins, WBC cells and IgG bands due to the immune response
CT scan shows atrophy and white matter lesions
Oligoclonal bands are band of immunoglobulins that are seen when a patient’s blood plasma or CSF is analyzed
CSF sample and blood sample obtained at the same time to compare bands
Oligoclonal bands present in CSF, but not in blood serum, indicate central nervous system production of immunoglobulins
These bands are indicators in the diagnosis of MS
Approx 80-90% of all patients with MS have bands
Most consistent with diagnosis of MS
From two to five bands can be seen
Bands disappear from CSF as a person recovers from the neuro disease
89
Pharmalogical measures for those with MS?
Corticosteroids – help decrease symptoms and induce remissions through anti-inflammatory effects
Solu-Medrol (Methylprednisolone drug of choice for acute exacerbations of MS)
1000 mg IV daily for 3 days high dose
followed by oral Prednisone (Orasone)
Novantrone (Mitoxantrone)
Given IV
Antineoplastic agent effective for MS
Agent can cause CHF and life threatening dysrhythmias
```
Tysabri (Natalizumab)
Humanized Monoclonal Antibody
Use for pts who don’t tolerate other MS drugs
IV piggyback
No flu symptoms!
```
90
What is ALS or Lou Gehrig’s Disease?
Most common progressive motor neuron disease of muscular atrophy
ALS is often called Lou Gehrig's disease after Lou Gehrig, a hall-of-fame baseball player for the New York Yankees who was diagnosed with ALS in the 1930s. People in England and Australia call ALS motor neurone disease (MND). The French refer to it as maladie de Charcot, after the French doctor Jean-Martin Charcot, who first wrote about ALS in 1869.
spinal cord. Motor neurons are nerve cells that control muscle movement. Upper motor neurons send messages from the brain to the spinal cord, and lower motor neurons send messages from the spinal cord to the muscles. Motor neurons are an important part of the body's neuromuscular system.
The neuromuscular system enables our bodies to move and is made up of the brain, many nerves, and muscles. Things that we do every day — like breathing, walking, running, lifting stuff, and even reaching for a glass of water — are all controlled by the neuromuscular system.
Here's how the neuromuscular system works: If you want to make a fist, your brain first sends signals through upper motor neurons to the area in your spinal cord that controls your hand muscles. Then lower motor neurons in your spinal cord signal the muscles in your hand to move and make a fist.
Over time, Lou Gehrig's disease causes these motor neurons in the brain and spinal cord to shrink and disappear, so that the muscles no longer receive signals to move. As a result, the muscles become smaller and weaker. Gradually the body becomes paralyzed, which means that the muscles no longer work.
However, someone with ALS, even at an advanced stage, can still see, hear, smell, and feel touch. The nerves that carry feelings of hot, cold, pain, pressure, or even being tickled, are not affected by Lou Gehrig's disease. In some people with ALS, the parts of the brain that allow us to think, remember, and learn also are affected by the disease.
91
Cause of death for ALS?
Progressive, debilitating, neuromuscular disorder
No cure
Degeneration of both upper (central nervous system) and lower motor neurons (central and peripheral nervous system)
Progressive wasting and atrophy of all voluntary muscles
Characterized by weakness, fasciculations, and hyperactive reflexes
Cause of death:
Respiratory insufficiency from weakness of muscles
Starvation from an inability to eat
92
Incidence of ALS
Age of onset is between 40 and 70 yrs
More prevalent in men
Death occurs 2-5 years after the onset
93
Cause of ALS
Causes
Unknown
May be related to increased levels of glutamate
10% have inherited form of the disease
Viral infection creates a disturbance in motor neurons
Autoimmune response
94
Characteristics of ALS
Characteristics
Progressive loss of motor neurons in both the cerebral cortex and the spinal cord until flaccid quadriplegia occurs
Atrophy of the hands, forearms and legs
Impairment of the respiratory muscles distinguishes it from MS
Results in paralysis and death
95
Gullian Barre syndrome
Pathophysiology
Immune system attacks ascending or descending peripheral nerves
Myelin sheath surrounding axons is destroyed
Myelin can regenerate in PNS
Motor, sensory and autonomic functions may be involved
Affects motor, sensory, autonomic nerves and spinal roots
Demyelination accompanied by edema and inflammation of peripheral nerves
Lymphocytes and macrophages are responsible for actually stripping the myelin between the Nodes of Ranvier – patchy
Remyelination occurs slowly – can take years
96
What is the most common form of gullian barre syndrome?
Ascending GBS (most common)
Weakness, paresthesia in lower extremities
Weakness progresses upward to trunk, arms and/or cranial nerves
Motor deficit may range from mild paresis to total quadriplegia
Respiratory compromise
Cardiac dysrhythmias
Labile BP
97
Descending GBS symptoms
Descending GBS
Weakness of facial muscles (cranial nerves)
Dysphagia
Ophthalmoplegia (paralysis or weakness of eye muscles)
Diplopia
Difficulty speaking
Respiratory compromise
98
Diagnosing GBS
```
Diagnosis
Lumbar puncture – increase in CSF protein level without an increase in cell count is a distinguishing feature
Moderate leukocytosis early in illness
EMG – decreased motor nerve conduction
MRI/CT to rule out other causes
```
99
Treatment of GBS
Prepare client for plasmaphoresis
Removes circulating antibodies that cause GBS
Plasma is separated from whole blood
Client receives 3 to 4 treatments 1-2 days apart
Can reduce recovery up to 50
100
Myasthenia Gravis incidence
Incidence
0.5 cases per 100,000 people
Affects most people between 20 and 30 yrs old
Women are affected three times more than men
May be preceded by infection, emotional upset, pregnancy, or anesthesia
101
Pathophysiology of MG?
Pathophysiology
Autoimmune disease of the neuromuscular junction
Affects cranial nerves, skeletal and respiratory muscles
Caused by an antibody attack on the acetylcholine receptors (AChR) in muscle end plate membranes
Overgrowth of thymus gland or thymoma
Characterized by remissions and exacerbations
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MG symptoms
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Weakness and fatigue
Difficulty chewing
Dysphagia
Ptosis
Diplopia
Weak, hoarse voice
Difficulty breathing
Diminished breath sounds
Respiratory paralysis and failure
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Diagnosing MG
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Diagnosis
AChR antibodies
Thyroid function tests
Chest CT
Tensilon testing – client shows improvement after administration
Inhibits breakdown of
Ach at postsynaptic
membrane
Antidote: Atropine
EMG
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104
Myasthenia crisis
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Myasthenia crisis
Acute exacerbation of the disease
Caused by rapid progression of MG, inadequate medication, infection, stress, fatigue
Symptoms
Restless
Weakness
Dyspnea
Dysphagia
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Cholinergic crisis
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Cholinergic crisis
Depolarization of motor end plates
Caused by overmedication with anticholinesterase drugs
Symptoms
Restlessness
Weakness
Dyspnea
Dysphagia
Nausea, vomiting, and diarrhea
Fasciculations
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