Unit 18 Neuromuscular

Question 1

Ascending Tracts - Sensory Pathways

Answer 1

 6 tracts- perception of touch, pressure,
vibration, proprioception, pain, temperature
 Begin in the spinal cord and end in the brain
 Carry sensory input to higher levels of CNS

Question 2

Descending Tract - Motor Pathways

Answer 2

1. Pyramidal tract
   Voluntary movement
2. Extrapyramidal
   Automatic movement, posture

Question 3

Upper Motor Neurons

(UMN

Answer 3

– Entirely within the CNS

– Initiates voluntary movement

Question 4

 Lower Motor Neurons (LMN)

Answer 4

 Lower Motor Neurons (LMN)
– Directly innervate skeletal muscle
– Essential for muscle contraction
– Part of PNS

Question 5

UMN Lesions

Answer 5

Weakness: Distal to Injury
Tone: Spastic

Question 6

LMN Lesions

Answer 6

Weakness: Specific to Peripheral Nerve root
Tone: Flaccid

Question 7

Complete Spinal Cord Injury

Answer 7

Loss of all sensory, proprioception, and voluntary motor activity

Question 8

Incomplete Spinal Cord Injury

Answer 8

Part of the Spinal Cord is Intact

Question 9

Spinal Cord Mechanisms of Injury

Answer 9

 Hyperextension
 Hyperflexion
 Compression
 Flexion-rotation
 Penetrating

Question 10

Neurogenic Shock

Answer 10

Loss of vasomotor tone and impairment of autonomic function

Sx: Hypotension, bradycardia, warm and dry skin

Question 11

Spinal Shock

Answer 11

Loss of spinal reflexes –> Flaccid paralysis

Question 12

Multiple Sclerosis

Answer 12

A chronic disease of the CNS
characterized by degeneration & loss of
myelin in the brain, spinal cord, & cerebrum.

Early Stages: Nerve damage minimal.

Progressive: Nerve impulses are completely blocked.

Question 13

MS Clinical Manifestations (Motor)

Answer 13

Weakness
– Paralysis
– Diplopia
– Spasticity of
muscles
– Scanning speech
– Fatigue

Question 14

MS Clinical Manifestations (Sensory)

Answer 14

– Numbness &
tingling
– Patchy blindness
– Vertigo
– Tinnitus

Question 15

MS Clinical Manifestations (Cerebellar)

Answer 15

Ataxia
Nystagmus
Dysarthria
Dysphagia

Question 16

MS Clinical Manifestations (Other)

Answer 16

Bladder dysfunction
Sexual dysfunction
Emotional instability (anger, depression, euphoria)

Question 17

MS Pharma

Answer 17

Biological Response Modifiers:
  Interferons (beta-1a, beta-1b)
   Synthetic Immunomodulator
   (glatiramer acetate)
Steroids (methylprednisone, prednisone)
Immunosuppressants
Antispasmodics : baclofen

Question 18

Parkinsons Disease

Answer 18

Def: Injury or impairment of dopamineproducing
cells of the substantia nigra in
the mid-brain

Dopamine: a neurotransmitter that is essential for normal functioning of
extrapyramidal system (control of posture, support, & automatic movement

Question 19

Key Features of Parkinsons (TRAP)

Answer 19

Tremor
Rigidity
Akinesia/Bradykinesia
Postural Disturbances

Question 20

Parkinsons Pharma

Answer 20

Dopaminergics:
carbidopa/levadopa
Problems: Unpredictable, wears off. Paradoxical intoxication

Dopamine agonists: bromocriptine

Catechol O-methyltransferase COMT inhibitors:
entacapone

MAO-B inhibitors: rasagiline

Anticholinergics: benzotropine

Question 21

Deep Brain Stimulation (MS)

Answer 21

A permanent stimulating lead placed in
brain & connected to an impulse generator
that’s implanted in chest
 Controlled by radio frequency transmissions
from a computer
 DBS helps interrupt “short-circuits” in brain

Question 22

Myasthenia Gravis

Answer 22

Def: a disease of the neuromuscular
junction char. by fluctuating weakness
of certain skeletal muscles

Patho: An autoimmune process that
results in a decreased # of ACh receptor sites at the neuromuscular
junction –> therefore, prevents Ach molecules from
attaching & causing muscle contraction

Question 23

MG Diagnostics

Answer 23

History and S/S “Look to the ceiling” test

Tensilon test (edrophonium)

Blood test: Acetylcholine Receptor antibodies (AChR)

EMG Studies

CT scan for overgrown thymus

Question 24

MG S/S

Answer 24

Fatigability of skeletal Muscles, esp those involved in: 
Moving eyes and eyelids
Chewing/Swallowing
Speaking
Breathing

Question 25

MG Pharma and Mgmt

Answer 25

Anticholesterase inhibitors: pyridostigmine bromide Corticosteroids: prednisone Immunosuppressants Plasmapheresis Thymus gland removal

Question 26

Myasthenic Crisis

Answer 26

Due to undermedication or commonly, infection. Will + tensilon test S/S: Increased BP, Pulse, RR Severe resp. distress. Bowel and bladder incont.

Question 27

Cholinergic Crisis

Answer 27

Due to excessive meds Will test neg. tensilon test S/S: abdom Cramps Diarrhea Inc. Pulmonary secretions and bronchial spasms

Question 28

Amyotrophic Lateral Sclerosis ALS

Answer 28

 Degeneration of motor neurons in brain & spinal cord for unknown reasons  Electrical & chemical messages originate in brain but the dead motor neurons cannot produce or transport vital signals to muscles

Question 29

Clinical Manifestations of ALS

Answer 29

```  Weakness  Dysarthria  Dysphagia  Muscle wasting  Spastic muscles  Eventually - flaccid paralysis ** Cognitive - stays intact ```

Question 30

Guillain Barre Syndrome (Infectious Polyneuritis)

Answer 30

 Def: A paralysis affecting the myelinated neurons of the PNS  Segmental demyelination  Affects motor neurons more than sensory neurons  Thought to be a cell mediated immunologic reaction

Question 31

GB Dx

Answer 31

``` Clinical S/S Lumbar puncture EMG FVC Negative Inspiratory Force NIF ```

Question 32

GB 3 stages

Answer 32

``` 1. Initial Period usually 1 - 3 weeks 2. Plateau Period several days to 2 weeks 3. Recovery Phase 4-6 months, may be up to 2 years ```

Question 33

Clinical Variations of GB

Answer 33

Ascending- starts from feet goes up Descending - starts in head goes down

Question 34

Clinical Manifestations of GB

Answer 34

```  Fatigue while talking  Facial weakness  Cranial nerve involvement  Paresthesias  Pain resembling a “charlie horse”  Difficulty walking  Motor weakness (flaccid paralysis)  Respiratory compromise/failure ```

Question 35

GB Tx

Answer 35

 Plasmapheresis Whole blood is removed from body-> RBC’s & WBC’s are separated from plasma & returned to body without plasma. Body will reproduce plasma  High dose immunoglobulin therapy

Question 36

Neuro Pyschosocial Nsg Dxs

Answer 36

```  Anxiety  Coping, Ineffective  Grieving, Dysfunctional  Altered body image/Self Concept  Sexuality ```

Question 37

Neurogenic Bladder (Reflex/Spastic)

Answer 37

1. Impulses cannot travel from lower spinal cord to cortex because of UMN lesion 2. Reflex arc is intact 3. Result Uncontrolled expulsion of urine without complete emptying

Question 38

Neurogenic Bladder (Flaccid)

Answer 38

1. Message that bladder is full gets to brain but bladder cannot interpret the message so it remains flaccid. 2. Damage to reflex arc 3. Loss of sensation of bladder fullness, result  overfill & distention

Question 39

Spastic bladder Mgmt

Answer 39

1. Trigger reflex 2. Catheterization (PVR) 3. Meds

Question 40

Flaccid bladder mgmt

Answer 40

1. Valsalva maneuver 2. Crede 3. Catheterization (PVR) 4. Meds

Question 41

Spastic Bladder Meds

Answer 41

1. Anticholinergics: propantheline Oxybutynin 2. Skeletal Muscle relaxants: baclofen

Question 42

Flaccid bladder meds

Answer 42

1. Cholinergics : bethanechol

Question 43

Bladder problems w/ neuro

Answer 43

Urinary calculi Urinary Retention Autonomic Dysreflexia

Question 44

Autonomic Dysreflexia

Answer 44

Full bladder or stimulus from bowel --> Afferent stimulus --> Massive sympathetic response --> Widespread vasoconstriction -- > HTN -- > Baroreceptors in BVs detect HTN crisis - signal brain --> HR slowed --> Descending inhibitory signals blocked at site of spinal cord injury (T6 or above)

Question 45

AD assess and intervene

Answer 45

``` Assess: HTN HA or blurred vision Diaphoresis/Vasocilation above injury level Bradycardia ``` ``` Intervention: HOB High as possible Remove stimulus (bowel/bladder) ```

Question 46

Bowel Mgmt w. Neuro

Answer 46

Reflex (UMN) - Incontinence w/o warning Flaccind (LMN) infrequent small stools ``` Tx: Consistent time Suppository program High residue foods High fluid intake Stood softener ``` UMN Lesion -> Digital stimulation LMN Lesion ->> Manual removal

Question 47

Impaired mobility problems

Answer 47

``` Skin integrity- decubiti Thrombophlebitis Osteoporosis Muscle atrophy Contractures Fatigue Alteration in coordination, gait, posture Pain ```

Question 48

Pain from Neuro

Answer 48

Disruption of nerve endings Spasms/fatigue Inflammation Pain Mgmt- Physical Therapy Pharma Support Surgical Intervention

Question 49

Neuro Pain Pharma Teraphy

Answer 49

``` Muscle relaxants Anti inflammatory Non narcotic Analgesics Nerve blocks Epidurals ```

Question 50

Safety Nsg Dx Neuro

Answer 50

Risk for Infection Altered Sensory Perception Inability to Regulate body temp Prone to Hazards - drug therapy

Question 51

Neuro drug therapy

Answer 51

Anthcholinergics: benztropine Dopaminergics: carbi/levadopa CS: Prednisone Cholinergics: Pyridostigmine bromide

Question 52

Oxygen Nsg Dx Neuro

Answer 52

Alteration in resp. patterns Decrese in Circ to extremities Orthostatic Hypotension Increase Workload on Heart

Question 53

Nutrition Nsg Dx Neuro

Answer 53

``` Paralysis of mouth/tongue Difficulty chewing Dysphagia Anorexia Osteoporosis ```

Question 54

diplopia

Answer 54

double vision

Question 55

ptosis

Answer 55

upper eyelid droop

Question 56

extrapyramidal

Answer 56

r/t motor nerves descending from the cortex and spine that are not part of the pyramidal system

Question 57

intention tremor

Answer 57

a trembling of a part of the body when attempting a precise movement, associated especially with disease of the cerebellum.