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Adult Health l > Peripheral Nerves > Flashcards

Peripheral Nerves Flashcards

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1
Q

Monophasic immune-mediated disorder of the peripheral nervous system
Demyelination of peripheral nerves
Result of immune-mediated pathologic processes

A

Guillain-Barre´ Syndrome

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2
Q

What is the onset?

A

acute

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3
Q

What are symptoms of Guillain-Barre´ Syndrome?

A

Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction

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4
Q

Variants of Guillain-Barre’ syndrome

A

Acute inflammatory demyelinating polyradicularneuropathy (AIDP) (most common in the US)

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5
Q

Causes of Guillain-Barre’ syndrome

A 
Immune mediated response (IgG antibodies)
Viral infections
Bacterial infection
Vaccines
Lymphoma
Surgery
Trauma
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6
Q

(Patho) What happen when T cells migrate to the peripheral nerves

A

edema and inflammation

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7
Q

(Patho) What happens to marcophages

A

break down myelin, inflammation, axonal damage

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8
Q

Stages of Guillian-Barre’

A

Initial, plateau, recovery

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9
Q

What is the initial stage

A

1-4 weeks

onset til no new symptoms present

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10
Q

What is the plateau stage

A

several days to 2 weeks

no deterioration and no improvement

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11
Q

What is the recovery stage

A

4-6 months and up to 2 years

remyelination and return of muscle strength

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12
Q

What are signs and symptoms of Guillian-Barre’

A

Motor weakness, paresthesias (pins & needles sensation), cranial nerve dysfunction, autonomic dysfunction, motor loss, respiratory dysfunction

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13
Q

Cranial nerve dysfunction

A

lll Oculomotor, Vll facial, Xl glossopharyngeal, X vagal, Xl spinal accessory, Xll hypoglossal

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14
Q

Autonomic dysfunction

A

BP fluctuation, dysrhythmias

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15
Q

Motor loss

A

symmetric. bilateral, ascending

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16
Q

Respiratory function

A

inspiratory force, tidal volume

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17
Q

How to diagnosis GB

A

CSF analysis (Elevated CSF proteins with normal cell counts)
Nerve conduction studies (Electromyeography (EMG)
Nerve conduction velocity)

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18
Q

Management for GB

A

Plasmapheresis (Exchanges occur ~ three to four treatments, 1 to 2 days apart)
Intravenous Immune globulin (IVIG)
(Daily dose based on body weight for 5 consecutive days)

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19
Q

Removes circulating antibodies assumed to cause disease
Plasma selectively separated from whole blood; blood cells returned to patient without plasma
Plasma usually replaces itself, or patient is transfused with albumin

A

Plasmapheresis

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20
Q

Collaborative management of GB

A 
Acute dysautonomia (HR, BP)
Respiratory care (Atelectasis, VAP, pneumothorax, ARDS)
Skin & musculoskeletal support
(Decubiti/ulcer, ROM)
Gastrointestinal (Ileus)
Initiating rehab in the ICU
(Early mobility)
Nutritional support (enteral)
Emotional support
Patient education
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21
Q

Priority nursing care of GB

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A

Respiratory care
Pain management
Communication and emotional
Nutritional

22
Q

Plan of care of GB

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A

diagnostic testing, involvement of family and team members, education, medical treatment=plasmapheresis

23
Q

An acquired autoimmune disease characterized by muscle weakness

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A

Myasthenia Gravis

24
Q

What causes Myasthenia Gravis

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A

antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction

25
Types of Myasthenia Gravis
Ocular and generalized
26
Risk factors for MG
Coexisting autoimmune disorder | Hyperplasia of the thymus gland
27
Triggers of MG
Infection Stress, fatigue Pregnancy Heat
28
Symptoms of MG
``` Progressive muscle weakness Diplopia Drooping eyelids, one or both (ptosis) Difficulty chewing and swallowing (dysphagia) Respiratory dysfunction Bowel & bladder dysfunction Fatigue ```
29
Baseline assessment of cranial muscle strength
Tensilon Testing
30
What is administered in a Tensilon test
Edrophonium
31
Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes
Positive test
32
Nursing care of Tensilon test
Observe for facial fasciculations, cardiac arrhythmias Observe for bradycardia, sweating, abdominal cramps Atropine at bedside
33
MG: Cholinesterase Inhibitor Drugs
Anticholinesterase (antimyasthenics) (Enhance neuromuscular impulse transmission by preventing decrease of ACh by enzyme ChE Improves muscle strength) Pyridostigmine (Mestinon) (Administer with small amount of food Eat meal 45 to 60 minutes after med Observe drug interactions-Magnesium, morphine, sedatives, neomycins)
34
How are MG medications given
on a strict schedule
35
MG treatments
``` Immunosuppressants (Prednisone or Azathioprine (Imuran) Given during periods of exacerbations Monitor for infections) Plasmapheresis Thymectomy ```
36
Management of MG
``` Respiratory support Promoting self-care guidelines Assisting with communication Nutritional support Eye protection ```
37
Crisis associated with MG
Cholinergic and Myasthenic
38
What is Cholinergic crisis
``` Too much ChE inhibitor drug Increased weakness Hypersalivation Sweating Increased bronchial secretions N,V&D Hypotension ```
39
How to treat cholinergic crisis
Maintain respiratory function Anticholinergic drugs withheld while on ventilator Atropine
40
What is Myastenic crisis
Not enough ChE inhibitor drug Flare of sx, increased weakness Hypertension Increased HR, RR
41
Hw to treat myathenic crisis
Maintain respiratory function | Cholinesterase-inhibiting drugs withheld
42
Health teaching of MG
Factors in exacerbation—infection, stress, surgery, hard physical exercise, sedatives, enemas, strong cathartics Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes Teach warning signs and importance of compliance
43
Degeneration/retraction of nerve distal to injury within 24 hr
Peripheral Nerve Trauma
44
Common causative agents of Peripheral Nerve Trauma
Vehicular or sports injury | Wounds to peripheral nerves
45
Nerves most commonly affected by trauma
radial, median, ulnar, femoral, deep peroneal, sciatic, common peroneal, superficial peroneal
46
Leg paresthesias (Irresistible urge to move Peripheral and central nerve damage in legs/spinal cord)
Restless leg syndrome
47
Management of RLS
Symptomatic Nonmedical treatment Drug therapy effective for some patients
48
3 divisions of trigeminal nerve (V)
ophthalmic, maxillary, mandibular
49
Pain management of Trigeminal Neuralgia
Surgical management Microvascular decompression Radiofrequency thermal coagulation Percutaneous balloon microcompression
50
What cranial nerve does Bell's palsy affect
Vll- Facial Paralysis
51
Interventions for Facial Paralysis
Medical management (Prednisone, analgesics, acyclovir) Protection of eye Nutrition Massage, warm/moist heat, facial exercises

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