Flashcards in T3 - Probs of PNS (Josh) Deck (55):
Guillian Barre is a problem of the ---
Guillian Barre is caused by what?
demylenation of peripheral nerves which leads to disruption of sensory and motor pathways
Etiology of Guillian Barre
Immune mediated response (IgG antibodies)
Patho of Guillian Barre
T cells migrate to peripheral nerves
Macrophages break down myelin
Inflammation can cause axonal damage (mostly temporary)
What are the stages of Guillian Barre?
Initial (1-4 wks)
Plateau (several days to 2 yrs)
Recovery (4-6 mths up to 2 yrs)
S/S of Guillian Barre
Initial muscle weakness and pain
Cranial nerve dysfunction
What is the Ascending paralysis?
symmetric, bilateral, ascending motor loss
What is the Autonomic Dysfunction caused by GB?
Which cranial nerves are typically affected?
What happens to respiratory function?
changes in Tidal Volume
Treatment plan of Guililan Barre:
Intravenous Immune Globulin (IVIG)
What is Plasmapheresis?
removes circulating antibodies assumed to cause the disease
Plasma is selectively separated from whole blood
Plasma usually replaces itself or is transfused with albumin
What is the treatment regimen if the use IVIG?
daily dose based on body weight for 5 consecutive days
Nursing care for Guillian Barre.
Treat the symptoms
Monitor for complications
What are the cardio complications?
Acute Dysautonomia (HR, BP)
What are the things we need to monitor for with respiratory care?
What are the GI complications we need to monitor for?
decreased motility (paralytic ileus)
***listen to bowel sounds
***keep up with BMs
--- --- is an autoimmune disease characterized by muscle weakness.
What is Myasthenia Gravis caused by?
antibodies interfere with the transmission of ACh at the neuromuscular junction
What are the different types of Myasthenia Gravis?
What is Tensilon Testing?
baseline assessment of cranial muscle strength
**tested with Myasthenia Gravis
What is a positive Tensilon Test?
onset of muscle tone improvement within 30-60 secs after Tensilon injection
***lasts 4-5 mins
- facial fasciculations
- cardiac arrhythmias
- abdominal pain
What drug do we need to have at bedside when doing the test?
Why could you have a Cholinergic Crisis?
too much cholinisterase inhibitor drug (overmedication)
**remember that MG is a problem with too little ACh so cholinsterase inhibitors are used to treat
What are s/s of Cholinergic Crisis?
Increased Bronchial secretions
What is the treatment for Cholinergic Crisis?
Maintain resp function
Withhold anticholinergic drugs while on vent
What is a Myasthenia Crisis?
too little cholinisterase inhibitor drug (undermedication)
S/S of Myasthenia Crisis?
Flare of MG symptoms
Treatment for Myasthenia Crisis?
Maintain resp function
Withold cholinisterase inhibiting drugs
How does Tensilon work?
inhibits the breakdown of ACh, making it available for use at the neuromuscular junction
S/S of Myasthenia Gravis
Progressive muscle weakness
Fatigue after exertion
Myasthenia Gravis clients will have decreased muscle strenght, especially of which part of body?
face, eyes, and proximal portion of major muscle groups
With cholinisterase inhibitors, what should we teach client?
Take with food (for GI s/e)
Eat within 45 mins of taking med to increase chewing strength and reduce risk of aspiration
Take med at same time each day
***Use cautiously with clients who have asthma or cardiac dysrhythmias
--- --- is facial paralysis associated with cranial nerve VII.
S/S of Bell's Palsy
Droop in one half of face
Forehead doesn't wrinkle (stroke victims can wrinkle)
Can't raise eyelid
Treatment for Bell's Palsy
Medical mgmt (prednison, analgesics, acyclovir)
Massage, warm/moist heat, facial exercises
-- -- is characterized by severe pain that can be triggered by chewing or brushing teeth.
With Trigeminal Neuralgia, what type of pain do they fee?
severe, sudden spurt of pain with twitches in face
Medication mgmt of Trigeminal Neuralgia
Surgical mgmt of Trigeminal Neuralgia
Radiofrequency Thermal Coagulation
Percutaneous Balloon Microcompression
***goal of each is to take pressure off of the Trigeminal Nerve
What improves muscle weakness?
What worsens it?
Which type of crisis causes muscle twitching so severe that you lose resp function and need a mechanical vent?
Hypermotility (abdominal cramps) are a s/e of which crisis?
What affect does Tensilon have on Cholinergic Crisis?
What affect does it have on Myasthenia Crisis?
temporarily decreases findings
Why have Atropine available?
it is an anticholinergic
Which type of crisis (Cholinergic or Myasthenia) will lead to Mechanical Ventilation?
When are Bell's Palsy symptoms most severe?
after 48 hrs
What are exacerbating factors?
Hard physical exercise
OVERHEATING (no sunbathing)
What type of schedule do the meds need to be given on?
What is the classic presentation of Myasthenia Gravis?
muscle weakness that increases when patient is fatigued
When you think Myasthenia Gravis, think --- ---
When you think Guillian Barre, think --- ---
What should we teach about Pyridostigmine?
take with small amount of food
eat within 45-60 mins after taking
What should we ask about a client who presents with Guillian Barre?
have they had any respiratory virus in past 2 weeks