Test #1 Chapter 46 Care of patients with problems of the peripheral nervous system Flashcards Preview

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Flashcards in Test #1 Chapter 46 Care of patients with problems of the peripheral nervous system Deck (20):

Guillain-barre syndrome,

mobility and sensation problem. Acute inflammatory demyelinating polyneuropathy that affects the peripheral nervous system causing motor weakness and sensory abnormalities.

Ascending paralysis might start out not being able to walk and travels to be complete paralysis.


Key features of Guillain-barre syndrome,

Motor manifestations:
ascending symmetric muscle weakness, flaccid paralysis without muscle atrophy.

Decreased or absent deep tendon reflexes.

Respiratory compromise, dyspnea, diminished breath sounds, decreased tidal volume and vital capacity and respiratory failure.

Loss of bladder and bowel control (less common)


Sensory manifestations, paresthesia, pain, cramping

Cranial nerve manifestations, facial weakness, dysphasia, diplopia, difficulty speaking.

Autonomic manifestations, labile blood pressure, cardiac dysrhythmias, tachycardia.


Factors associated with development of Guillain-barre syndrome,

Acute illness,
gastrointestinal illness,
HIV infection,
mycoplasma pneumonia,
upper respiratory infection,
Hodgkin's disease.


Nursing interventions for Guillain-barre syndrome,

CSF, lumbar function, protein increased but not white count.

Plasmapheresis, like dialysis but it removes antibodies that they feel are attacking the Mylein sheath, hypertension and tachycardia are the main concerns during and after plasmapheresis

Monitor ABC's,

Recovery is very slow


Myasthenia gravis,

acquired autoimmune disease characterized by fatigue and weakness primarily in the muscles.

Auto antibody attack on the acetylcholine receptors, nerve impulses are not making it to the muscle. Worried about breathing. Think it is related to enlarge thymus.

Correlation between hyperplasia and the thymus gland


Myasthenia gravis diagnostic assessment,

lab for acetylcholine antibodies 90% will have elevated levels.

Tensilon testing, try to check the body into working. Doctors give med through the IV that prevents acetylcholine from breaking down. They can move for a few minutes, then it wears off. They can go into VFIB because of the medicine, have to give atropine to counteract the tensile to fix the problem. Need to be hooked to a heart monitor during the test.


Drug therapy, real important,

give immunosuppressive's to calm the body from attacking The acytlcholine receptors.

Give and teach to avoid crowds.

Give meds one hour before eating to prevent aspiration.


Myasthenic crisis,

not enough of the medication in their system.

Getting sick can throw them into this crisis.

Causes muscle issues and not being able to breathe.

Interventions are based on the patient's reactions.

Need more meds, and may need to be intubated.


Cholinergic crisis,

too much medication on board, give atropine which is the antidote.



cut the chest open, go in, remove the thymus.

They avoid deep breaths but need to be encouraged to use the incentive spirometer and to cough and deep breathe.

Worry about the airway and about infection with these patients.


Restless leg syndrome

leg paresthesias which with the irresistible urge to move.

Peripheral and Central  nerve damage in the legs and in the spinal cord.


Nursing interventions for restless leg syndrome

avoid caffeine and alcohol, no smoking, exercise, weight loss.

Caffeine and alcohol can cause hydration issues and smoking causes vasoconstriction.

Drug therapy is Lyrica.


Trigeminal neuralgia,

affects the trigeminal or fifth cranial nerve


Etiology of Trigeminal neuralgia,

impaired inhibitory mechanisms in the brain stem. This causes brainstem issues, signals get messed up, chronic pain, typically starts in 50 or older.

This is a chronic pain syndrome of the face. Teach the patient to use eyedrops at night, do not sleep on that side, eat on the good side.


Drug therapy for Trigeminal neuralgia,

Tegretol, and neurontin, so cannot drink alcohol will make too drowsy.


Percutaneous stereotactic rhizotomy,

destroys nerve fibers that are causing the pain. The entire nervous not destroyed just the irritated park.


Surgical management microvascular decompression

more serious surgery, craniotomy, reroutes the artery from the nerves. ICU Postoperative.


Bell's palsy,

disease of the cranial nerve number 7, causes acute paralysis unilateral.


Eitiology of Bells Palsy

implement inflammatory process triggered by herpes of the mouth.


Nursing interventions for Bells Palsy

- drug therapy, Valtrex and pain medication.

- Manage neurologic deficits, make sure that the eye is protected. Sleep with something over it..

- Diet, small meals, chew on unaffected side, educate the patient to eat soft foods.

Recovery in a few weeks. Most or recover and have no residual side effects. Some may have residual side effects but most do not.