Neuromuscular Lecture

Question 1

Function of PNS

Answer 1

ANS - regulates activities of internal organs

Motor: weakness, fatigue, paralysis

Sensory: numbness, tingling, pain

Question 2

What is Multiple Sclerosis

Answer 2

T cells cross the BBB so other agents damage the immune system and myelin sheath gets inflamed and destroyed so action potentials are slow.

• remissions and exacerbations
• demyelination can be scattered across the CNS
• Gero patients usually have comorbidities
• can affect motor or sensory (motor:weakness, paralysis, tremors) (sensory:numbness, tingling, pain)

Question 3

Relapse Remitting MS

Answer 3

Exacerbations followed by Remissions

Question 4

Primary Progressive MS

Answer 4

Steady worsening from onset without remissions

Question 5

Secondary Progressive MS

Answer 5

Steady progression of disease with or without relapse.

Comes after Relapse Remitting MS.

Question 6

Progressive Relapse MS

Answer 6

Steady worsening of disease from onset but with flare ups.

Question 7

RRMS leads to SPMS

Answer 7

Remitting Relapse MS leads to Secondary Progressive MS

Question 8

Demyelination areas can remyelinate, but constant demyelination & remyelination again and again causes scar tissue and makes disabilities permanent.

Answer 8

Demyelination areas can remyelinate, but constant demyelination & remyelination again and again causes scar tissue and makes disabilities permanent.

Question 9

S/S of MS

Answer 9

Eye: optic neuritis
Ataxia: uncoordinated muscle and spasticity
Speech: slurred and slow
Tremor: intentional tremor (tremors when purposely moving)
Emotional: labile, depressed
Rectal: bowel/bladder problems, incontinent and constipated

Question 10

MS exacerbations

Answer 10

Stress
Fatigue
Overheating
Weather

Question 11

MS diagnostics

Answer 11

• H&P exam
• CSF: increase T cells and IgG
• MRI: visualize plaques and lesions in brain
• EEG
• VER
• BAER

Question 12

MS medical management

Answer 12

Steroids: acute exacerbations
Immunosuppressants
UTI: vitamin C and anti-biotics

Question 13

What is Parkinson’s disease

Answer 13

Decrease in dopamine causes Parkinson’s disease.

Ach is excitatory and dopamine is inhibitory, so when dopamine is decreased you are left with a lot more Ach or excitatory and you get the Parkinson’s shakes

Question 14

Parkinson’s S/S

Answer 14

Tremors: resting tremors
Rigidity: muscle stiffness
Akinesia: slow movement
Postural instability: stopped posture

• shuffling gait
• mask like face
• turn like a statue as a unit and cannot turn over their should
• hypotension
• pin rolling
• impaired memory
• dementia

Question 15

Parkinson’s diagnostics

Answer 15

2 out of the 4 Cardinal signs
T
R
A
P

or response to anti-Parkinson’s medications

Question 16

Parkinson’s medications

Answer 16

Sinemet-levodopa and carbidopa. Levodopa is the dopamine and carbidopa is the car that takes dopamine across the BBB. It is the number one drug of choice. Given adjunct with anti-viral drug because it helps treat dyskinesia which is a side effect of Sinemet (levodopa/carbidopa)

• dopamine agonists: stimulate dopamine in brain
• MAOB: slow progression
• anti-cholinergics: decreases Ach so it lessens the amount of Ach and that way Ach and dopamine are at the same level.

Question 17

Parkinson’s surgery

Answer 17

Palliodotomy: they put something that is heated to 80 degrees Celsius in the brain to kill a small amount of brain cells.

Deep brain stimulation

Question 18

Levodopa/carbidopa precaution

Answer 18

Drug holiday and they may have to be hospitalized for the drug holiday.

Drug holiday - when the brain is so saturated with levodopa/carbidopa that the drug stops working and it has to be stopped so it can clear from the brain and then be resumed.

Question 19

Levodpa/carbidopa S/S

Answer 19

• n/v
• sedation
• hallucination
• psychosis
• dyskinesia
• postural hypotension
• cardiac dysrrythmias
• athetoid movements
• on/off response: sudden inability to move

Question 20

Intentional movement helps with tremors

Answer 20

Intentional movement helps with tremors

Question 21

What is ALS

Answer 21

Demyelination of upper and lower motor neurons in brain and spinal cord

Affects motor only and not sensory so they don’t get spasms or pain but their muscles atrophy

Question 22

ALS S/S

Answer 22

Progresses to paralysis
brisk DTR
muscles atrophy
Progresses to trunk and legs
Drooling
Cough and gag reflex impaired or absent
Emotionally labile

Question 23

Complications of immobility lead to Resp. depression and death

ALS patients die from Resp. depression

Answer 23

Complications of immobility lead to Resp. depression and death

ALS patients usually die from Resp. depression

Question 24

Complications of ALS

Answer 24

Difficulty speaking that’s why Stephen Hawking uses a computer
Difficulty breathing that’s why they are traeched
Difficulty swallowing so they get aspiration, pneumonia, infection

Impaired skin integrity
Depression
50% of patients die within 5 years

Question 25

ALS Diagnostics

Answer 25

EMG: shows loss of nerve supply in muscle H&P rule out other diseases

Question 26

Nurse Interventions for ALS

Answer 26

Keep them independent for as long as possible | Prevent complications of immobility to keep them alive for as long as possible

Question 27

``` Stopped being able to dribble basketball Fell on the court Confined to wheelchair intubated Died from Resp. depression ``` This is an example of how a person with ALS deteriorated overtime and died within 5 years

Answer 27

``` Stopped being able to dribble basketball Fell on the court Confined to wheelchair Intubated Died from Resp. depression ``` This is an example of how a person with ALS deteriorated over time and died within 5 years.

Question 28

Medications for ALS

Answer 28

anti-spasmatics Rilutek: prevents damage to motor neurons

Question 29

What is Myasthenia Gravis

Answer 29

Decrease in ACH receptors Weakening of voluntary muscles 80% have thymic hyperplasia or thymus tumor Antibodies block ACH from ACH binding site so muscles weaken and muscles weaken more and more with movement and activity.

Question 30

Myasthenia Gravis S/S

Answer 30

- fluctuation weakness - ocular: ptosis, diplopia - onset insidious - die from Resp. failure Face: flat like and open mouth Speech: dysphonia (voice fades while talking) Affects upper extremities before lower Affects proximal more than distal

Question 31

Myasthenia Gravis Diagnostics

Answer 31

Tension test - IV inject anti-cholinesterase drug that disactivates cholinesterase and if you see muscle strength improvement within 5 minutes then it is positive

Question 32

Myasthenia Gravis medications

Answer 32

Mestinon - increases ACH at receptor sites Steroids to take them out of exacerbations Immunosuppressants because it is a autoimmune disease and it will suppress the immune system from attacking its own body Decrease anti-body production because antibodies block ACH from ACH binding site and that is the stem of the problem

Question 33

Thymectomy for Myasthenia Gravis

Answer 33

Removal of thymus gland so 40% of people get complete remission but it can take 3 years because of circulating T cells

Question 34

Plasmaphersis for Myasthenia Gravis

Answer 34

Plasma exchange Used for exacerbations and decrease circulating anti-bodies

Question 35

Nursing interventions for Myasthenia Gravis

Answer 35

Pace activities Have rest periods Check Resp. status

Question 36

Cholinergic Crisis

Answer 36

Cholinergic crisis happens due to taking Mistinon because it increases ACH ``` Salivation Lacrimation Urination Diaphoresis Gastrointestinal upset: diarrhea Emesis ```

Question 37

What is Guillain Barre

Answer 37

Inflammatory demyelination of nerves Symmetrical paralysis and ascends from feet to neck Triggered by viral or GI problems

Question 38

Acute phase S/S of Guillain Barre

Answer 38

``` Tachycardia Bradycardia Cardiac disarrythmias Fluctuating BP Urinary retention No change in LOC or thought ```

Question 39

Stabilizing phase of Guillain Barre

Answer 39

Days to weeks | Paralysis and symptoms stop

Question 40

Recovery phase of Guillain Barre

Answer 40

6 months - 2 years any paralysis left after recovery phase is permanent Often resolves quickly

Question 41

For Guillain Barre disease No influenza vaccine for history of Guillain Barre Paralyzed but still mentally fully alert and there Plasmaphersis to decrease circulating anti-bodies

Answer 41

For Guillain Barre No influenza vaccine for history of Guillain Barre Paralayzed but still mentally alert and fully there Plasmaphersis to decrease circulating anti-bodies