T3 - Probs of PNS (Josh) Flashcards Preview

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Flashcards in T3 - Probs of PNS (Josh) Deck (55):
1

Guillian Barre is a problem of the ---

PNS

2

Guillian Barre is caused by what?

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

3

Etiology of Guillian Barre

Immune mediated response (IgG antibodies)

Viral Infections

Bacterial Infections

Vaccines

Lymphoma

Surgery

Trauma

4

Patho of Guillian Barre

T cells migrate to peripheral nerves

Macrophages break down myelin

Inflammation can cause axonal damage (mostly temporary)

5

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)

6

S/S of Guillian Barre

Initial muscle weakness and pain

ASCENDING paralysis

Autonomic dysfunction

Motor weakness

Cranial nerve dysfunction

Resp dysfunction

7

Guillian Barre:

What is the Ascending paralysis?

symmetric, bilateral, ascending motor loss

8

Guillian Barre:

What is the Autonomic Dysfunction caused by GB?

BP fluctuations

Dysrhythmias

9

Guilliian Barre:

Which cranial nerves are typically affected?

III: Occulomotor

VII: Facial

IX: Glossopharyngeal

X: Vagus

XI: Accessory

XII: Hypoglossal

10

Guillian Barre:

What happens to respiratory function?

changes in Tidal Volume

11

Treatment plan of Guililan Barre:

Plasmapheresis

Intravenous Immune Globulin (IVIG)

12

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

13

Guillian Barre:

What is the treatment regimen if the use IVIG?

daily dose based on body weight for 5 consecutive days

14

Nursing care for Guillian Barre.

Treat the symptoms

Monitor for complications

Early Mobility

Enteral Feedings

15

Guillian Barre:

What are the cardio complications?

Acute Dysautonomia (HR, BP)

16

Guillian Barre:

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

Atelectasis

VAP

Pneumothorax

ARDS

17

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

18

--- --- is an autoimmune disease characterized by muscle weakness.

Myasthenia Gravia

19

What is Myasthenia Gravis caused by?

antibodies interfere with the transmission of ACh at the neuromuscular junction

20

What are the different types of Myasthenia Gravis?

Occular

Generalized

21

What is Tensilon Testing?

baseline assessment of cranial muscle strength

**tested with Myasthenia Gravis

22

What is a positive Tensilon Test?

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

***lasts 4-5 mins

23

Tensilon Test:

Nursing care

Observe for:

- facial fasciculations

- cardiac arrhythmias

- bradycardia

- sweating

- abdominal pain

24

Tensilon Test:

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

Atropine

25

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

26

Myasthenia Gravis:

What are s/s of Cholinergic Crisis?

Increased weakness

Hypersalivation

Sweating

Increased Bronchial secretions

N/V/D

Hypotension

27

Myasthenia Gravis:

What is the treatment for Cholinergic Crisis?

Maintain resp function

Withhold anticholinergic drugs while on vent

Atropine

28

Myasthenia Gravis:

What is a Myasthenia Crisis?

too little cholinisterase inhibitor drug (undermedication)

29

Myasthenia Gravis:

S/S of Myasthenia Crisis?

Flare of MG symptoms

Increased weakness

HTN

Increased HR

30

Myasthenia Gravis:

Treatment for Myasthenia Crisis?

Maintain resp function

Withold cholinisterase inhibiting drugs

31

Myasthenia Gravis:

How does Tensilon work?

inhibits the breakdown of ACh, making it available for use at the neuromuscular junction

32

S/S of Myasthenia Gravis

Progressive muscle weakness

Diplopia

Difficulty chewing/swallowing

Resp dysfunction

Bowel/Bladder dysfunction

Poor posture

Fatigue after exertion

33

Myasthenia Gravis clients will have decreased muscle strenght, especially of which part of body?

face, eyes, and proximal portion of major muscle groups

34

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

35

--- --- is facial paralysis associated with cranial nerve VII.

Bell's Palsy

36

S/S of Bell's Palsy

Droop in one half of face

Forehead doesn't wrinkle (stroke victims can wrinkle)

Can't raise eyelid

37

Treatment for Bell's Palsy

Medical mgmt (prednison, analgesics, acyclovir)

Protect eye

Nutrition

Massage, warm/moist heat, facial exercises

38

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

Trigemenal Neuralgia

39

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

severe, sudden spurt of pain with twitches in face

40

Medication mgmt of Trigeminal Neuralgia

Carbamazepine

Amitryptiline (TCA)

41

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

42

Myasthenia Gravis:

What improves muscle weakness?

What worsens it?

rest

activity

43

Myasthenia Gravis:

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

Cholinergic Crisis

44

Myasthenia Gravis:

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

Cholinergic Crisis

45

Myasthenia Gravis:

What affect does Tensilon have on Cholinergic Crisis?

What affect does it have on Myasthenia Crisis?

worsens findings

temporarily decreases findings

46

Cholinergic Crisis:

Why have Atropine available?

it is an anticholinergic

47

Myasthenia Gravis:

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

BOTH

48

When are Bell's Palsy symptoms most severe?

after 48 hrs

49

Myasthenia Gravis:

What are exacerbating factors?

Infection

Stress

Surgery

Hard physical exercise

Sedatives

Enemas

OVERHEATING (no sunbathing)

50

Myasthenia Gravis:

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

Strict schedule

51

What is the classic presentation of Myasthenia Gravis?

muscle weakness that increases when patient is fatigued

52

When you think Myasthenia Gravis, think --- ---

When you think Guillian Barre, think --- ---

muscle weakness

ascending paralysis

53

Myasthenia Gravis:

What should we teach about Pyridostigmine?

take with small amount of food

eat within 45-60 mins after taking

54

GBS:

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

have they had any respiratory virus in past 2 weeks

55

GBS:

What usually triggers Guillian Barre?

respiratory or GI viral infection

***sometimes, surgery and vaccination can also trigger