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Flashcards in Neuro Deck (101):
1

Disease of the basal ganglia

Parkinson's Disease

2

What is Parkinson's characterized by?

Slowing down in the initiation and execution of movement, increased muscle tone, tremors at rest, and impaired postural reflexes

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Who is Parkinson's more common in?

Men older than 50

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What is the pathology of Parkinson's Disease?

Degeneration of dopamine-producing neurons in substantia nigra of the midbrain, disrupting the dopamine-acetylcholine balance in basal ganglia

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What is dopamine essential for the normal functioning of?

Posture, support, and voluntary motion

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When do the symptoms of Parkinson's begin?

After 80% of the neurons in the substantia nigra are gone

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What is the hallmark of Parkinson's?

Cogwheel rigidity

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What is the rigidity in Parkinson's caused by?

Sustained muscle contractions

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What are the nursing interventions for patients with Parkinson's?

Fall risk, aspiration risk, nutrition risk

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How is Parkinson's diagnosed?

Solely on history and clinical features

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What confirms a Parkinson's diagnosis?

A positive response to anti-parkinsonian medications

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What is the goal of drug therapy for Parkinson's?

Enhance or release the supply of Dopamine and block the effects of overactive cholinergic neurons

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Dopamine receptor antagonist that promotes the release of dopamine

Parlodel

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In which patients is Parlodel used?

Patients who experience dyskinesias or orthostatic hypotension while receiving Sinemet

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Precursor of dopamine the can cross the blood brain barrier and convert to dopamine in the basal ganglia

Levodopa with carbidopa

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What does long term use of levodopa with carbidopa lead to?

dyskinesia

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How should levodopa with carbidopa be used?

Before meals to increase absorption and transport across the blood brain barrier

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Drug used to block specific enzymes that inactivate dopamine

MAO Inhibitor

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What teachings should accompany MAO Inhibitors?

There are many food interactions that continue for 14 days after discontinuation

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Why are anticholinergic drugs used to manage Parkinson's?

They decrease the activity of acetylcholine

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What does surgery to to treat Parkinson's?

Decrease the increased neuronal activity produced by dopamine depletion

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Which surgeries are used in the treatment of Parkinson's?

Ablation and Deep Brain Stimulation

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What are the nutritional concerns in patients with Parkinson's?

Malnutrition, constipation, and aspiration

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How should the nutritional concerns of Parkinson's patients be addressed?

Food easy to chew, thicken, small frequent meals, and adequate roughage

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What is the cause of Parkinson's?

Possible genetic component, stress

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What do Parkinson's patients look like?

Hunched over, shuffled gait and pill rolling fingers

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What sensory impairment do patients with Parkinson's have?

Dry eyes do to excessive blinking

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What do Parkinson's patients usually die of?

Pneumonia due to aspiration and immobility

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What are the five Fs of Neurodegenerative diseases?

Fatigue and immobility, fluctuations in function, frequent medication changes, fecal, and flow

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Chronic demyelinating disease of the entire central nervous system caused by plaque, inflammation, edema and recovery of the nerve cells

Multiple Sclerosis

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Where are people more likely to develop MS?

Not near the equator

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Who is more likely to develop MS?

Young caucasian women

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What causes MS?

Possible post-viral stimuli, possible genetic component, autoimmune disease

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What is the biggest impediment to adjusting to the diagnosis of MS?

The uncertain course of the disease and the inability to plan for the future

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How is MS diagnosed?

Rule out everything else, then look at an MRI for two areas of demyelination or two or more exacerbations

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What are the signs of MS?

Paresthesias, double vision, tremors, nystagmus, schitomas, Lhermitte's sign

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Seeing floaters in eyes

Schitomas

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Flexing neck causes shooting, electric like pain in the lower extremities

Lhermitte's sign

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What brings a patient with MS in initially?

Vision changes

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What is the goal for the drug therapy of patients with MS?

Keep the disease in remission

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What medications are used to treat MS?

IV and PO corticosteroids, Copaxone, and Baclofen

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What is Baclofen used to treat in MS patients?

Spasticity

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How are corticosteroids used in MS patients?

As a rescue treatment

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How is Copaxone used for MS patients?

It is an immunomodulator used to reduce the frequency of relapses

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What risk accompanies Copaxone and corticosteroids?

Risk for infection

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What considerations need to be taken when using steroids?

Low K, bleeds, psuedodiabetes

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Why are MS patients on antibiotics?

Frequent UTIs

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What do MS patients have to be taught about urination habits?

Use the Crede method

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What are the nursing interventions for patients with MS?

Impaired mobility, altered urinary elimination, risk for falls

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What are the major problems for MS patients?

Motor balance and coordination

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What are the sensory dysfunctions for patients with MS?

Loss of sensitivity or tingling, pins and needles, numbness

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What is the worst kind of MS?

Primary Progressive

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What is the main dysfunction of MS?

Urinary interruptions and muscle spasticity and weakness

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When do tremors occur in patients with MS?

With activity

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What causes a relapse of MS?

Stress to the body or mind

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What are the side effects of Levidopa?

Makes the patient extremely sexual and tar dive dyskinesia

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What is Requip used for in patients with Parkinson's?

It mimics dopamine

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What sensory dysfunction occurs with MS?

Loss of sensitivity, tingling, pins and needles and numbness in extremities

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What is TENS?

Low does electricity used to treat MS

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What is the nursing priority for patients with MS?

Prevent falls

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What part of the nervous system does MS attack?

CNS

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Destruction of the myelin sheath in peripheries caused by multiple immunizations or an autoimmune attack

Guillain Barre

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Who does Guillain Barre affect?

Men and women over 55

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What is the problem in Guillain Barre?

The lymphocytes are not making the distinction between self and non self cells

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What part of the nervous system does Guillain Barre affect?

PNS

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Where in the body does Guillain Barre start?

Starts at toes and works its way up

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What sensory dysfunctions does Guillain Barre cause?

Paresthesia, blindness, and a blank stare

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What is the major problem of Guillain Barre

Respiratory depression from paralysis of muscles

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How is Guillain Barre treated?

Plasmapheresis and IV-IG

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What are the side effects of IV-IG?

Chills, fever, myalgia, acute renal failure, and anaphylaxis

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What can patients with Guillain Barre never be given?

Corticosteroids

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What are the nursing interventions for patients with Guillain Barre?

Prepare to intubate, impaired mobility, ineffective airway clearance

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What is the prognosis for Guillain Barre?

The disease should remit and go away within 2 years

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Autoimmune disorder in which antibodies attack the acetylcholine receptors at neuromuscular junctions, impairing the transmission of impulses

Myasthenia Gravis

75

Who does MG affect?

Women younger than 40 and men older than 60

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What can cause MG?

Thymus problems, stress

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What are the motor dysfunctions in patients with MG?

Muscle fatigue and aches

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What are the sensory dysfunctions for patients with MG?

Impaired facial expressions, paresthesia, impaired chewing and swallowing, decreased smell and tastes, dysphonia, and ptosis

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What is the major problem for patients with MG?

Respiratory Failure

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What is used to treat MG?

Immunosuppressants, thyroidectomy and anticholenergases

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Name an anticholenergase drug

Mestinon

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What teaching needs to accompany a MG diagnosis?

Teach family CPR and how to respond to respiratory distress

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What causes a myasthenic crisis?

Too little acetylcholine

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What happens to patients in a myasthenic crisis?

Increased heart rate, increased respirations, and elevation in blood pressure

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What causes a cholenergic crisis?

Too much acetylcholine

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What happens to patients in a cholenergic crisis?

Nausea, vomiting, diarrhea, pallor, twitching, and hypotension

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What are the nursing interventions for patients with MG?

Keep the airway patent and keep the patient away from extremes in temperature

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How is MG diagnosed?

Tensilon Test

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What is a Tensilon Test?

Give the patient an injection of acetylcholine and see if their symptoms resolve

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What are the four major symptoms of Parkinson's?

Tremors, rigidity, bradykineisa, and postural imbalances

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Where does the demyelination of neurons take place in patients with Guillain Barre?

At the Nodes of Ranvier

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Which neuro patient is at risk for developing DVTs?

Guillain Barre

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Which neuro patients have hyporeflexia?

Guillain Barre

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What is the diagnostic tool for Guillain Barre?

Presence of protein in the CSF

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What are the complications associated with plasmapheresis?

Infection, hypovolemia, hypokalemia, hypocalcemia, temporary paresthesia

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How long can a patient be intubated before a trach is needed?

10-14 days

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Which gland is involved in MG?

Thymus

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What is the first symptom of MG?

Ptosis

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How should Mestinon be given?

Eat 45 minutes to an hour after administration

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Which MG crisis requires intubation?

Myasthenic

101

What do patients with Parkinson's have to be closely monitored for?

Drug toxicity