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Flashcards in Neurological disorders Deck (44):

Define multiple sclerosis

A chronic, progressive, degenerative disorder of the CNS characterized by demyelination of nerve fibers in the brain and spinal cord


Name the cause of multiple sclerosis

The causes unknown But suggest that it is related to infectious, immunologic, and genetic factors


Name the characteristics of multiple sclerosis

Demyelinization and gliosis in the CNS, activation of the inflammatory response that leads to demyelinization of axons leading toImpairment of function, myelin can regenerate (remission) But if axons are destroyed permanent loss of function results


Clinical manifestations of multiple sclerosis

Motor sensory cerebellar and emotional problems, weakness, paralysis of Men's trunk or head, diplopia, scanning speech, spasticity of the muscles, numbness, tingling, blurred vision, vertigo, tinnitus, decreased hearing, neuropathic pain, fatigue, ataxia, dysarthria, dysphagia


What is the relationship to multiple sclerosis and pregnancy

Women who become pregnant experience remission or an improvement but are at greater risk for exacerbation in the postpartum period.


What is the average life expectancy after onset of multiple sclerosis

More than 25 years


What aggravates/exacerbates multiple sclerosis

Physical and emotional trauma, fatigue, and infection


Name the diagnostic studies for multiple sclerosis

No definitive diagnostic tests, based primarily on history and clinical manifestations and the presence of multiple lesions over time as measured by MRI.


Collaborative care of multiple sclerosis

Care is aimed at treating the disease process and symptomatic relief. Steroids and immunomodulator drugs treat acute exacerbations


Define Parkinson's disease

A chronic, progressive neurodegenerative disorder characterized by bradykinesia, increased muscle tone, tremor at rest, and gait disturbance.


What is the etiology of Parkinson's disease

Genetic makeup, encephalitis is associated, chemical intoxication, carbon monoxide and manganese, Drug induced, hydrocephalus, hypoxia, infections, stroke, tumor, Huntington's disease, trauma


Clinical manifestations of Parkinson's disease

Also known as the triad of PD. Tremor, first sign, aggravated by emotional stress or increased concentration, pill rolling.
Rigidity, second sign, increased resistance to passive motion, jerky quality.
Bradykinesia, Loss of automatic movements, blinking, swinging arms, swallowing of saliva, self-expression, postural adjustment, masked face, drooling, shuffling gait


Complications of Parkinson's disease

Depression, anxiety, apathy, fatigue, pain, constipation, impotence, short-term memory impairment, dementia, malnutrition or aspiration, pneumonia, UTI, skin breakdown, orthostatic hypotension, loss of postural reflexes, sleep disorders


Diagnostic studies for Parkinson's disease

No specific diagnostic test. When at least two of the three triads are present. Ultimate confirmation is a positive response to anti-Parkinson's drugs.


Collaborative care for Parkinson's disease

Aimed at relieving the symptoms. Correcting an imbalance of neurotransmitters by enhancing the release or supply of dopamine, Sinemet.


Surgical therapy for Parkinson's disease

Deep brain stimulation - by electrode in the thalamus is adjustable and reversible, ablation - has been used but is replaced by deep brain stimulation, transplantation -Fetal neural tissue which provides dopamine producing cells


Nutritional therapy for Parkinson's disease

Food that's easily chewed and swallowed. Roughage and fruit to avoid constipation. Six small meals per day.


Define myasthenia gravis

In autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups


Etiology of myasthenia gravis

Autoimmune process in which antibodies attack acetylcholine receptors preventing muscle contraction


Clinical manifestations of myasthenia gravis

Fluctuating weakness of skeletal muscle, eyes, eyelids, chewing, swallowing, speaking, breathing, muscles are strongest in the morning but weak by end of the day


What is a myasthenic crisis and what triggers one

It is an acute exacerbation of muscle weakness. Triggered by infection, surgery, emotional distress, drug overdose, inadequate drugs.


Diagnostic studies for myasthenia gravis

Diagnosis is based on history and physical. If diagnosis still in doubt EMG or Tensilon test maybe used.


Drug therapy for myasthenia gravis

Corticosteroids suppress the immune response, anticholinesterase drugs enhance the function of the neuromuscular junction


Surgical therapy for myasthenia gravis

Removal of the finest gland - thymectomy


Other therapies for myasthenia gravis

Plasmapheresis is a short-term improvement indicated for patients in crisis or preparation for surgery


Define amyotrophic lateral sclerosis ALS

Hey where progressive neurologic disorder characterized by loss of motor neurons


ALS (Lou Gehrig's disease) life expectancy

Death within 2 to 6 years


ALS etiology/pathophysiology

For unknown reasons, motor neurons in the brain stem and spinal cord gradually degenerate leading to weakness of upper extremities, dysarthria, dysphagia, muscle wasting and fasciculations, Pain, sleep disorders, spasticity, drooling, emotional lability, depression, constipation, esophageal reflux, devastating because patient remains cognitively intact while wasting away.


Define Bell's palsy

I disorder characterized by the inflammation of the facial nerve on one side


Etiology of Bell's palsy

Unknown cause, but activation of herpes simplex one may be involved because it causes inflammation, edema, ischemia, eventually demyelination, creating pain and alterations in motor and sensory function


Clinical manifestations of Bell's palsy

Herpes vesicles in or around the ear, fever, tinnitus, hearing deficit, flaccidity, drooping of the mouth, drooling, inability to close eyelid, inability to smile frown or whistle, loss of taste, decreased muscle movement, excessive tearing


Bell's palsy collaborative care

Moist heat, Tampa massage, electrical stimulation exercises, relief of symptoms, corticosteroids, acyclovir, Full recovery after six months in most patients


Define Guillain-Barre syndrome

An acute rapidly progressing and potentially fatal form of polyneuritis characterized by ascending symmetric paralysis


Etiology and pathophysiology of Guillain-Barre

Etiology is unknown. It is a loss of Mylan and edema and inflammation of the affected nerves. Distal to proximal and in recovery function returns proximal to distal. The syndrome is often preceded by viral infection, trauma, surgery, viral immunizations, or HIV.


Clinical manifestations of Guillain-Barre

Symptoms develop 1 to 3 weeks after a upper respiratory or G.I. infection. Paresthesia, hypotonia, areflexia, deep sensitivity more effective, orthostatic hypotension, hypertension, abnormal vagal responses, Ballin bladder dysfunction, facial flushing, diaphoresis, pain is common, respiratory failure is a complication.


Diagnostic studies for Guillain-Barre

Diagnosis is based on H&P, but CSF and EMG can be evaluated.


Collaborative care of Guillain-Barre

Supportive care, ventilatory support, plasmapheresis, immunoglobulin, difficulty swallowing can lead to tube feedings or parenteral nutrition.


Guillain-Barre prognosis

Residual problems and relapses are uncommon, complete recovery can be anticipated, generally a slow process that takes months or years if axonal degradation occurs


Define fibromyalgia

Hey chronic disorder characterized by widespread nonarticular musculoskeletal pain and fatigue with multiple tender points


Etiology and pathophysiology of fibromyalgia

A disorder involving neuroendocrine/neurotransmitter dysregulation causing pain amplification due to abnormal sensory processing in the CNS


Clinical manifestations and complications of fibromyalgia

Widespread burning pain, tenderness at 11 or more of the 18 identified sites, difficulty concentrating, memory lapses, migraine, depression, anxiety, restless leg syndrome, Irritable bowel syndrome, constipation, diarrhea, abdominal pain, difficulty swallowing


Diagnostic studies for fibromyalgia

Diagnosis is difficult to establish. It's two criteria are met, pain experienced and 11 of 18 and history of widespread pain is noted at least three months. Muscle biopsy may show moth eaten appearance or fiber atrophy.


Collaborative care for fibromyalgia

Treatment is symptomatic. Rest, Flexeril Elavil, reuptake inhibitors, Ultram, SSRI, OTC analgesics, Xanax, Ambien, Neurontin


Nursing management for fibromyalgia syndrome

Massage, ultrasound, heat and cold packs, gentle stretching, yoga, tai chi, low impact aerobics, limiting sugar caffeine and alcohol, vitamin and mineral supplements, relaxation strategies