Exam II

Question 1

Myasthenia Gravis patho

Answer 1

Autoimmune - acetylcholine receptors in muscle = nerve impulse not transmitted

Question 2

Multiple Sclerosis patho

Answer 2

Autoimmune - mylein sheath (CNS so does not regenerate)

Question 3

Guillian Barre patho

Answer 3

Autoimmune - myelin sheath destroyed (PNS so regenerates = recovery)

Question 4

Amyotrophic Lateral Sclerosis patho

Answer 4

Autoimmune - muscle atrophy from loss of spinal cord nerves = scar tissue, motor neurons

Question 5

Myasthenia Gravis S&S

Answer 5

Early - facial / occular, chewing and swallowing difficulty, diplopia - double vision, ptosis - drooping of eyelids
Late - limb weakness, general muscle weakness, respiratory impairment

Question 6

Multiple Sclerosis S&S

Answer 6

Early - nystagmus - involuntary eye movement, fatigue, spasticity
Late - motor and sensory impairments in trunk and limbs, numbness and weakness
symptoms come and go, onset gradual / chronic

Question 7

Guillian Barre S&S

Answer 7

Ascending - lower extremity paresthesia, paresis to quadreplegia with 50% respiratory compromise, does not affect LOC
Descending - eye, facial and jaw muscle weakness, diplopia, dysphagia
sudden onset, acute, 3 stages
acute phase - onset, ends when no further deterioration 1-4 weeks
plateau phase - little change, several days to 2 weeks
recovery phase - remyelination and axonal regeneration 4-6 months

Question 8

Amyotrophic Lateral Sclerosis S&S

Answer 8

Early - fatigue, dysphagia & dysarthria - difficulty articulating, extremity weakness
Late - flacid quadreplegia, atrophy extremities, respiratory impairment
gradual onset - no cure

Question 9

Myasthenia Gravis diagnostics

Answer 9

AChR antibodies, thyroid function tests, Tensilon Test, EMG - repetitive nerve stimulation, pattern of response, serum blood test - acetylcholine receptor antibody

Question 10

Multiple Sclerosis diagnostics

Answer 10

lumbar puncture - detect oligoclonal bands, CSF, MRI - plaques in brain, nerve sheath demyelination, CT

Question 11

Guillian Barre diagnostics

Answer 11

Lumbar puncture, Leukocytosis, EMG, MRI, CT

Question 12

Amyotrophic Lateral Sclerosis diagnostics

Answer 12

Elevated CK, muscle biopsy

Question 13

Myasthenia Gravis nursing priorities

Answer 13

Risk for ineffective breathing pattern, activity intolerance related to fatigue / muscle weakness, self care deficit, deficient knowledge

Question 14

Multiple Sclerosis nursing priorities

Answer 14

fatigue, impaired physical mobility, urinary retention, constipation, disturbed sensory perception - visual, deficient knowledge

Question 15

Guillian Barre nursing priorities

Answer 15

airway, cardiac, acute pain, impaired physical mobility, self care deficit, risk for aspiration

Question 16

Amyotrophic Lateral Sclerosis nursing priorities

Answer 16

speech therapy, dietician, hospice, advance directives

Question 17

Myasthenia Gravis interventions

Answer 17

anticholinesterase agents - donepezil (aricept), memantine (nameda), mestinon immunosuppressives - prednisone, chemo - imuran, cytotoxan, plasmapheresis - remove abnormal antibodies, thymectomy - remove thymus gland

Question 18

Multiple Sclerosis interventions

Answer 18

corticosteroids, antispasmodics/muscle relaxants - tizaninde, baclofen, adjuncts - parethesias biologic response modifiers, CNS stimulant - Ritalin for fatigue, anticholinergics - probanthine, ditropan, oxybutynin - reduce urinary frequency / urgency, side effects - thrombocytopenia, leukopenia, depression, injection site reactions

Question 19

Guillian Barre interventions

Answer 19

plasmaphoresis - infection, hypovolemia, low K and Ca, paresthesias temporarily - abnormal sensations

IV immunoglobulin - safer

Question 20

Amyotrophic Lateral Sclerosis interventions

Answer 20

rilutex - increases lifespan, meds to manage symptoms

Question 21

Head injury

Answer 21

ABCs, vitals and neuro, basal skull fracture - CSF drainage (otorrhea/rhinorrhea), head of bed - 20-30 degrees

Question 22

Increased ICP

Answer 22

Early sign - LOC, Late signs - Cushing’s triad - widening pulse pressure, decreased RR - cheyne stokes - deep irregular respirations, decreased PR - bradycardia, personality change, behavior change, diplopia

Question 23

Seizure

Answer 23

Aura, LOC, incontinence, positioning - safety and airway, oxygen and suction, monitor, record, and report, padded side rails

Question 24

GCS score

Answer 24

Motor 6
no move, extension, abnormal flexion, withdrawal, localizes, obeys commands

Verbal 5
no sound, incomprehensible, inappropriate, confused, oriented

Eye 4
no open eyes, opens eyes pain, voice, spontaneously

Question 25

Types of strokes

Answer 25

TIA - 10 min - 48 hr, temporary, no damage, warning for ischemic strokes Ischemic - partial / complete occlusion Thrombotic - thrombus, plaques already narrowed blood vessels Embolic - sudden, clot dislodged, move elsewhere Hemorrhagic - bleeding into brain, intracerebral / subarachnoid

Question 26

Treatment ischemic stroke

Answer 26

IV thrombolytics - tPA, early treatment, within 3 hours from onset, BP > 185/110, older than 18, break up clots anticoags - heparin, lovenox, coumadin, prevent further clotting antiplatelet - aspirin, prevent future stroke antihypertensive - want to keep BP high, not too high embolectomy - remove emboli

Question 27

Treatment hemorrhagic stroke

Answer 27

interventional radiology - coiling, small hole starts in femoral / radial artery surgery lower BP

Question 28

Symptoms of stroke FAST

Answer 28

Facial droop Arm drift Slurred speech Time - when initial symptoms started

Question 29

Types of generalized seizures

Answer 29

generalized - distributed, loss of consciousness absence seizures - brief periods of impaired consciousness without convulsions myoclonic - brief jerky motor movements clonic - rhythmic jerky movements, upper/lower extremities tonic - sudden tonic extension/flexion of neck/head/trunk/extremities tonic/clonic or grand mal - rhythmic clonic movements with prolonged postictal phase atonic - loss of postural tone, falls injury status epilepticus - seizure more than 5 min, multiple seizures, emergency, lorazepam

Question 30

Types of partial seizures

Answer 30

partial seizures simple partial - sensory symptoms, motor symptoms, no loss of consciousness complex partial - psychomotor seizure, temporal lobe, altered behavior, loses consciousness for a few seconds

Question 31

Seizure patho

Answer 31

sudden, transient, alteration of brain function, a lot of energy, disorderly discharge

Question 32

Stroke patho

Answer 32

loss of perfusion to brain - blockage - ischemic, or bleed - hemorrhagic

Question 33

Stroke on right side of brain

Answer 33

paralyzed left side, left sided neglect, spatial perceptual deficits, deny/minimize problems, rapid performance, short attention span, impulsive, safety problems, impaired judgement, impaired time concepts

Question 34

Stroke on left side of brain

Answer 34

paralyzed right side, impaired speech/language aphasias, impaired right/left discrimination, slow performance, cautious, aware of deficits, depression, anxiety, impaired comprehension related to language, math

Question 35

Autonomic dysreflexia

Answer 35

caused by lesion / injuries above T6, or distended bladder or impacted rectum, emergency severe hypertension, bradycardia, severe headache, nasal stuffiness, flushing 1. raise head of bed, high fowler's 2. loosen tight clothing 3. check for bladder distension, noxious stimulus 4. admin HTN meds 5. document occurrence, treatment, response

Question 36

Cervical injuries

Answer 36

C2-C3 - fatal C4 - respiratory difficulty, paralysis all 4 extremities C5-C8 - movement in shoulder, decreased respiratory

Question 37

Thoracic injuries

Answer 37

loss of movement of chest, trunk, bowel, bladder, legs, leg paralysis above T6 - autonomic dysreflexia

Question 38

Lumbar and sacral injuries

Answer 38

S2-S3 - micturition, bladder contract but not empty above S2 - have erection, no ejaculation S2-S4 - no erection, no ejaculation, damage sympathetic and parasympathetic response loss of movement and sensation of lower extremities

Question 39

Antidote heparin

Answer 39

Protamine sulfate

Question 40

Antidote coumadin

Answer 40

Vitamin K

Question 41

Antidote tensilon

Answer 41

Atropine