409 Final 2

Question 1

MG is an acquired ___ disease

Answer 1

autoimmune

Question 2

MG: main characteristics are ___ and ___

Answer 2

fatigue and weakness

Question 3

MG: pattern

Answer 3

remission and flare up

Question 4

MG: the body is attacking itself, specifically the

Answer 4

motor nerves

Question 5

When you’re assessing the MG patient, an organ that could be abnormal is the

Answer 5

thymus

Question 6

Usually the onset of MG is

Answer 6

insidious, but it’s possible to have a sudden onset

Question 7

MG: anesthesia, pregnancy, infection can cause

Answer 7

a sudden onset of MG

Question 8

MG: characteristics of the fatigue

Answer 8

gets worse with exercise, better with rest

Question 9

MG: even though they have the drooping lids,

Answer 9

the pupil responses will be normal

Question 10

MG: they could have malnutrition and dysphagia because of

Answer 10

drooping jaw

Question 11

Fortunately 2 things that are usually not an issue in MG are

Answer 11

pain and LOC

Question 12

You can immediately confirm the dx of MG if

Answer 12

they respond to cholinergic drugs

Question 13

Tensilon Testing

Answer 13

If the patient responds with increased muscle strength, it means they have MG

Question 14

consideration for Tensilon Testing

Answer 14

have the antidote (atropine) ready

Question 15

the Interventions of MG include 2 broad categories

Answer 15

treat symptoms

induce remission

Question 16

MG interventions: treating symptoms category:

Answer 16

Anticholinesterase aka cholinergic drugs

Question 17

MG interventions: inducing remission category:

Answer 17

Steroids, PE, thymectomy

Question 18

MG: because of the fatigue, when should you schedule activities

Answer 18

schedule for times that they have energy, like in the morning or right after tx

Question 19

MG: the first line drugs are ____ which improve impulses

Answer 19

Anticholinesterase aka cholinergic drugs

Question 20

MG: Anticholinesterase aka cholinergic dose consideration

Answer 20

might need it adjusted day-today depending on symptoms

Question 21

MG: Anticholinesterase aka cholinergic drugs adverse effect

Answer 21

Cholinergic crisis, which means the drug is working to strong. Paradoxically this causes increased weakness

Question 22

MG: Even though cholinergic crisis and myasthenic crisis are opposite,

Answer 22

they look pretty much the same

Question 23

MG: cholinergic crisis and myasthenic crisis can be differentiated by

Answer 23

tensilon testing. If the tensilon allows the patient to improve, then it was a myasthenic crisis

Question 24

MG: in a cholinergic crisis give

Answer 24

atropine

Question 25

MG: the goal of immunosuppressive drugs is to

Answer 25

induce remission

Question 26

MG patients can have weakness in the face which makes ___ difficulty

Answer 26

talking

Question 27

MG: Not only do they have trouble with drooping eyes,

Answer 27

they also can't totally close the eye (so you might need artificial tears and tape them closed at night)

Question 28

MG: double vision tx

Answer 28

give them an eye patch and switch it back and forth

Question 29

MG: the goal of thymectomy is to

Answer 29

induce remission

Question 30

MG: because you could have weakness, keep the drugs

Answer 30

and a glass of water at the bedside in case you can't get OOB

Question 31

MG: the patient should avoid

Answer 31

heat (including sun) and big changes in sleeping habits

Question 32

MS: The body is attacking its own

Answer 32

myelin sheaths (like in GBS)

Question 33

Just like MG, MS has a pattern of

Answer 33

remission and flare up

Question 34

MS: after a long series of remission and flare up, the damage to the nerves becomes

Answer 34

permanent

Question 35

MS: they may have unusual reflexes like

Answer 35

Babinski

Question 36

MS: if the demyelination moves to the spine, they could have

Answer 36

bladder/bowel problems | sexual dysfunction

Question 37

MS: in the LATER part of the disease you could have

Answer 37

cognitive problems

Question 38

MS: The patient may need to give themselves injections via

Answer 38

SQ

Question 39

The MS patient may need b____, d___, or d___ for muscle tremors

Answer 39

baclofen diazepam dantrolene

Question 40

MS: nursing interventions for the cognitive problems

Answer 40

keep a calendar in the room | keep their belongings organized

Question 41

MS: you might need to teach the family discrete signs for

Answer 41

telling the patient they're acting inappropriately

Question 42

The main feature of ALS is

Answer 42

progressive muscle weakness that eventually leads to paralysis

Question 43

ALS: can you have cognitive changes

Answer 43

yes

Question 44

The only drug for ALS

Answer 44

Riluzole, which extends survival time

Question 45

ALS: think about referring them to

Answer 45

hospice

Question 46

A sz happens when

Answer 46

all of a sudden there's too much stimulation in the brain

Question 47

Epilepsy is when

Answer 47

someone has 2 or more szs

Question 48

General szs means

Answer 48

its in both hemispheres

Question 49

Response to drug therapy: partial vs general szs

Answer 49

partial tends to be less responsive to drugs

Question 50

Secondary sz means

Answer 50

it results from something specific (secondary to something else)

Question 51

The most common tx of primary epilepsy is

Answer 51

drug therapy

Question 52

Warfarin can't be mixed with

Answer 52

pheny

Question 53

The risk of break through szs can be decreased by having (3 obvious things)

Answer 53

a balanced diet rest stress reduction

Question 54

Part of sz precautions is making sure you have ___ ____ in case you need to give meds immediately to stop a sz

Answer 54

IV access

Question 55

Tonic-clonic sz: if the patient turns blue

Answer 55

that's not unusual, it tends to go away on its own

Question 56

Acute szing is when

Answer 56

the szs are worse than normal

Question 57

Status epilepticus is when

Answer 57

a sz is longer than 5 min

Question 58

A sz can be lethal if it lasts for

Answer 58

longer than 10 min

Question 59

In status epi there are metabolic changes, so the effects could be widespread, for example

Answer 59

kidney failure

Question 60

The drug of choice for status epi is

Answer 60

'pams via IV push (then as prevention of it happening again you'll give pheny)

Question 61

If drugs don't manage the szs, they may need surgery, for example

Answer 61

VNS

Question 62

You can't have VNS if you have

Answer 62

generalized szs

Question 63

PD: In addition to the classic signs you can have

Answer 63

hypotension because DA affects the sympathetic nerves

Question 64

PD: anticholinergic drugs should be avoided in

Answer 64

older adults

Question 65

PD: During drug therapy, they might need a holiday is

Answer 65

toxicity or tolerance begins