409 Final 2 Flashcards
MG is an acquired ___ disease
autoimmune
MG: main characteristics are ___ and ___
fatigue and weakness
MG: pattern
remission and flare up
MG: the body is attacking itself, specifically the
motor nerves
When you’re assessing the MG patient, an organ that could be abnormal is the
thymus
Usually the onset of MG is
insidious, but it’s possible to have a sudden onset
MG: anesthesia, pregnancy, infection can cause
a sudden onset of MG
MG: characteristics of the fatigue
gets worse with exercise, better with rest
MG: even though they have the drooping lids,
the pupil responses will be normal
MG: they could have malnutrition and dysphagia because of
drooping jaw
Fortunately 2 things that are usually not an issue in MG are
pain and LOC
You can immediately confirm the dx of MG if
they respond to cholinergic drugs
Tensilon Testing
If the patient responds with increased muscle strength, it means they have MG
consideration for Tensilon Testing
have the antidote (atropine) ready
the Interventions of MG include 2 broad categories
treat symptoms
induce remission
MG interventions: treating symptoms category:
Anticholinesterase aka cholinergic drugs
MG interventions: inducing remission category:
Steroids, PE, thymectomy
MG: because of the fatigue, when should you schedule activities
schedule for times that they have energy, like in the morning or right after tx
MG: the first line drugs are ____ which improve impulses
Anticholinesterase aka cholinergic drugs
MG: Anticholinesterase aka cholinergic dose consideration
might need it adjusted day-today depending on symptoms
MG: Anticholinesterase aka cholinergic drugs adverse effect
Cholinergic crisis, which means the drug is working to strong. Paradoxically this causes increased weakness
MG: Even though cholinergic crisis and myasthenic crisis are opposite,
they look pretty much the same
MG: cholinergic crisis and myasthenic crisis can be differentiated by
tensilon testing. If the tensilon allows the patient to improve, then it was a myasthenic crisis
MG: in a cholinergic crisis give
atropine
MG: the goal of immunosuppressive drugs is to
induce remission
MG patients can have weakness in the face which makes ___ difficulty
talking
MG: Not only do they have trouble with drooping eyes,
they also can’t totally close the eye (so you might need artificial tears and tape them closed at night)
MG: double vision tx
give them an eye patch and switch it back and forth
MG: the goal of thymectomy is to
induce remission
MG: because you could have weakness, keep the drugs
and a glass of water at the bedside in case you can’t get OOB
MG: the patient should avoid
heat (including sun)
and
big changes in sleeping habits
MS: The body is attacking its own
myelin sheaths (like in GBS)
Just like MG, MS has a pattern of
remission and flare up
MS: after a long series of remission and flare up, the damage to the nerves becomes
permanent
MS: they may have unusual reflexes like
Babinski
MS: if the demyelination moves to the spine, they could have
bladder/bowel problems
sexual dysfunction
MS: in the LATER part of the disease you could have
cognitive problems
MS: The patient may need to give themselves injections via
SQ
The MS patient may need b____, d___, or d___ for muscle tremors
baclofen
diazepam
dantrolene
MS: nursing interventions for the cognitive problems
keep a calendar in the room
keep their belongings organized
MS: you might need to teach the family discrete signs for
telling the patient they’re acting inappropriately
The main feature of ALS is
progressive muscle weakness that eventually leads to paralysis
ALS: can you have cognitive changes
yes
The only drug for ALS
Riluzole, which extends survival time
ALS: think about referring them to
hospice
A sz happens when
all of a sudden there’s too much stimulation in the brain
Epilepsy is when
someone has 2 or more szs
General szs means
its in both hemispheres
Response to drug therapy: partial vs general szs
partial tends to be less responsive to drugs
Secondary sz means
it results from something specific (secondary to something else)
The most common tx of primary epilepsy is
drug therapy
Warfarin can’t be mixed with
pheny
The risk of break through szs can be decreased by having (3 obvious things)
a balanced diet
rest
stress reduction
Part of sz precautions is making sure you have ___ ____ in case you need to give meds immediately to stop a sz
IV access
Tonic-clonic sz: if the patient turns blue
that’s not unusual, it tends to go away on its own
Acute szing is when
the szs are worse than normal
Status epilepticus is when
a sz is longer than 5 min
A sz can be lethal if it lasts for
longer than 10 min
In status epi there are metabolic changes, so the effects could be widespread, for example
kidney failure
The drug of choice for status epi is
‘pams via IV push (then as prevention of it happening again you’ll give pheny)
If drugs don’t manage the szs, they may need surgery, for example
VNS
You can’t have VNS if you have
generalized szs
PD: In addition to the classic signs you can have
hypotension because DA affects the sympathetic nerves
PD: anticholinergic drugs should be avoided in
older adults
PD: During drug therapy, they might need a holiday is
toxicity or tolerance begins
