T3 - Probs of PNS (Josh) Flashcards by Josh Miller

Guillian Barre is a problem of the —

PNS

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Guillian Barre is caused by what?

demylenation of peripheral nerves which leads to disruption of sensory and motor pathways

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Etiology of Guillian Barre

Immune mediated response (IgG antibodies)

Viral Infections

Bacterial Infections

Vaccines

Lymphoma

Surgery

Trauma

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Patho of Guillian Barre

T cells migrate to peripheral nerves

Macrophages break down myelin

Inflammation can cause axonal damage (mostly temporary)

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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)

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S/S of Guillian Barre

Initial muscle weakness and pain

ASCENDING paralysis

Autonomic dysfunction

Motor weakness

Cranial nerve dysfunction

Resp dysfunction

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Guillian Barre:

What is the Ascending paralysis?

symmetric, bilateral, ascending motor loss

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Guillian Barre:

What is the Autonomic Dysfunction caused by GB?

BP fluctuations

Dysrhythmias

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Guilliian Barre:

Which cranial nerves are typically affected?

III: Occulomotor

VII: Facial

IX: Glossopharyngeal

X: Vagus

XI: Accessory

XII: Hypoglossal

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Guillian Barre:

What happens to respiratory function?

changes in Tidal Volume

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Treatment plan of Guililan Barre:

Plasmapheresis

Intravenous Immune Globulin (IVIG)

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Guillian Barre:

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

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Guillian Barre:

What is the treatment regimen if the use IVIG?

daily dose based on body weight for 5 consecutive days

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Nursing care for Guillian Barre.

Treat the symptoms

Monitor for complications

Early Mobility

Enteral Feedings

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Guillian Barre:

What are the cardio complications?

Acute Dysautonomia (HR, BP)

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Guillian Barre:

What are the things we need to monitor for with respiratory care?

Atelectasis

VAP

Pneumothorax

ARDS

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Guillian Barre:

What are the GI complications we need to monitor for?

decreased motility (paralytic ileus)

**give Reglin
**listen to bowel sounds
**keep up with BMs

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— — is an autoimmune disease characterized by muscle weakness.

Myasthenia Gravia

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What is Myasthenia Gravis caused by?

antibodies interfere with the transmission of ACh at the neuromuscular junction

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What are the different types of Myasthenia Gravis?

Occular

Generalized

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What is Tensilon Testing?

baseline assessment of cranial muscle strength

**tested with Myasthenia Gravis

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What is a positive Tensilon Test?

onset of muscle tone improvement within 30-60 secs after Tensilon injection

***lasts 4-5 mins

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Tensilon Test:

Nursing care

Observe for:

facial fasciculations
cardiac arrhythmias
bradycardia
sweating
abdominal pain

Tensilon Test:

What drug do we need to have at bedside when doing the test?

Atropine

Myasthenia Gravis: 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

Myasthenia Gravis: What are s/s of Cholinergic Crisis?

Increased weakness Hypersalivation Sweating Increased Bronchial secretions N/V/D Hypotension

Myasthenia Gravis: What is the treatment for Cholinergic Crisis?

Maintain resp function Withhold anticholinergic drugs while on vent Atropine

Myasthenia Gravis: What is a Myasthenia Crisis?

too little cholinisterase inhibitor drug (undermedication)

Myasthenia Gravis: S/S of Myasthenia Crisis?

Flare of MG symptoms Increased weakness HTN Increased HR

Myasthenia Gravis: Treatment for Myasthenia Crisis?

Maintain resp function Withold cholinisterase inhibiting drugs

Myasthenia Gravis: 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 Diplopia Difficulty chewing/swallowing Resp dysfunction Bowel/Bladder dysfunction Poor posture 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

Myasthenia Gravis: 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.

Bell's Palsy

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) Protect eye Nutrition Massage, warm/moist heat, facial exercises

-- -- is characterized by severe pain that can be triggered by chewing or brushing teeth.

Trigemenal Neuralgia

With Trigeminal Neuralgia, what type of pain do they fee?

severe, sudden spurt of pain with twitches in face

Medication mgmt of Trigeminal Neuralgia

Carbamazepine Amitryptiline (TCA)

Surgical mgmt of Trigeminal Neuralgia

Microvascular decompression Radiofrequency Thermal Coagulation Percutaneous Balloon Microcompression ***goal of each is to take pressure off of the Trigeminal Nerve

Myasthenia Gravis: What improves muscle weakness? What worsens it?

rest activity

Myasthenia Gravis: Which type of crisis causes muscle twitching so severe that you lose resp function and need a mechanical vent?

Cholinergic Crisis

Myasthenia Gravis: Hypermotility (abdominal cramps) are a s/e of which crisis?

Cholinergic Crisis

Myasthenia Gravis: What affect does Tensilon have on Cholinergic Crisis? What affect does it have on Myasthenia Crisis?

worsens findings temporarily decreases findings

Cholinergic Crisis: Why have Atropine available?

it is an anticholinergic

Myasthenia Gravis: Which type of crisis (Cholinergic or Myasthenia) will lead to Mechanical Ventilation?

BOTH

When are Bell's Palsy symptoms most severe?

after 48 hrs

Myasthenia Gravis: What are exacerbating factors?

Infection Stress Surgery Hard physical exercise Sedatives Enemas OVERHEATING (no sunbathing)

Myasthenia Gravis: What type of schedule do the meds need to be given on?

Strict schedule

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 --- ---

muscle weakness ascending paralysis

Myasthenia Gravis: What should we teach about Pyridostigmine?

take with small amount of food eat within 45-60 mins after taking

GBS: What should we ask about a client who presents with Guillian Barre?

have they had any respiratory virus in past 2 weeks

GBS: What usually triggers Guillian Barre?

respiratory or GI viral infection ***sometimes, surgery and vaccination can also trigger