ATI Ch 10 MS ALG MG Flashcards
Multiple Sclerosis description
autoimmune disorder where plaques develop in the white matter of the CNS, interferes w/ impulse transmission
can relapse and remit
Amyotrophic Lateral Sclerosis ALS description
disease of the upper and lower motor neurons with muscle weakness progressing to muscle atrophy and eventually paralysis and death
Myasthenia Gravis description
autoimmune disorder with loss of ACH receptors at the neuromuscular junction
MS onset
2x more likely in women
between ages 20-40
Factors that trigger MS relapse
Viruses and infectious agents, Living in a cold climate, Physical injury, Emotional stress, Pregnancy, Fatigue, Overexertion, Temperature extremes, Hot shower/bath
MS sx
lower extremity fatigue, vision changes (Uhthoff’s sign), muscle spacity, nystagmus, cognative changes, bowel/bladder dysfunction
Lab test for MS
Cerebrospinal fluid analysis (elevated protein level and a slight increase in WBCs)
How to diagnose MS
MRI reveals plaques of the brain and spine
Credé maneuver
placing manual pressure on abdomen over the bladder to expel urine, used in MS PTs
Tx for diplopia
apply alternating eye patches and teach scanning maneuvers, used for MS PTs
Immunosuppressive agents ex
Azathioprine (Imuran) and cyclosporine (Sandimmune)
Immunosuppressive agents use
reduce the frequency of MS relapses
Immunosuppressive agents nursing considerations
Assess for hypertensionand kidney dysfunction
Corticosteroids ex
Prednisone
Corticosteroids use
reduce inflammation in acute MS exacerbations
Corticosteroids nursing considerations
Monitor for infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, and personality changes
Antispasmodics ex
Dantrolene (Dantrium), tizanidine (Zanaflex), baclofen (Lioresal), and diazepam (Valium)
Antispasmodics use
treat muscle spasticity in MS
Antispasmodics nursing considerations
Observe for increased weakness, liver damage if on tizanidine or dantrolene, do not stop baclofen abruptly
Immunomodulators ex
Interferon beta (Betaseron)
Immunomodulators use
prevent or treat relapses of MS
Anticonvulsants ex
Carbamazepine (Tegretol)
Anticonvulsants use
paresthesia in MS
Anticholinergics ex
Propantheline
Anticholinergics use
bladder dysfunction in MS
Beta-blockers ex
Primidone (Mysoline) and clonazepam (Klonopin)
Beta-blockers use
treat tremors in MS
ALS progression rate
death usually due to resp failure within 3-5 years from first manifestation
ALS onset
effects more women than men, seen between ages 40-70
ALS Sx
fatigue, twitching, cramping, atrophy, dysphagia, hyperreflexia of deep tendon reflexes
ALS lab tests
Increased creatine kinase (CK-BB) level
Need to r/o other causes, there is no specific test
ALS diagnostic tests
Electromyogram (EMG) – Reduction in number of functioning motor units of peripheral nerves, Muscle biopsy – Reduction in number of motor units of peripheral nerves and atrophic muscle fibers
What ALS mostly effects
Respiratory!
Nursing interventions should be geared to respiratory functions
glutamate antagonist ex
Riluzole (Rilutek) (this is the only one)
glutamate antagonist use
slow the deterioration of motor neurons in ALS. It must be taken early in process, will add 2 to 3 months to the client’s lifespan
glutamate antagonist nursing considerations
Monitor LFTs, no ETOH, assess dizziness, vertigo and somnolence, keep meds away from light
Antispasmodics ex
Baclofen (Lioresal), dantrolene sodium (Dantrium), diazepam (Valium)
ALS complications
pneumonia due to respiratory weakness/paralysis
Causes of Myasthenia Gravis
Coexisting autoimmune disorder
hyperplasia of the thymus gland
Factors that trigger MG exacerbations
Infection, Stress, emotional upset, and fatigue, Pregnancy, Increases in body temp
Finding from MG assessment
impaired resp function, dysphagia, decreased muscle strength (especially in the face), incontinence, drooping eyelids
Diagnostic procedures for MG
Tensilon testing/ anticholinesterase (edrophonium)
Electromyography
Shows the neuromuscular transmission characteristics of MG
Tensilon testing function
Baseline assessment of the cranial muscle strength
Tensilon testing procedure
Edrophonium (Tensilon) is administered which improves muscle strength for 5 min by inhibiting breakdown of ACh
Anticholinesterase agents for MG
are the first line of therapy
given 4x daily
Anticholinesterase agents for MG cautions
clients who have hx of asthma or cardiac dysrhythmias
Pyridostigmine (Mestinon) and neostigmine (Prostigmin) for MG function
increase muscle strength
inhibits breakdown of ACh and prolongs its effects
Use of immunosuppressants with MG
given durring exacerbations when other meds are not sufficient because MG is an autoimmune disease
When are IV immunoglobulins (IVIg) used?
for acute management in clients who do not respond to the above treatments
Plasmapheresis
used in MG tx
removes circulating antibodies from the plasma
usually done several times over a period of days and may continue on a regular basis
Plasmapheresis intraprocedure nursing actions
assess for dizziness and hypotension
maintain patence of shunts
Thymectomy
surgical procedure for MG
removal of thymus gland
Thymectomy complications
Myasthenic crisis and cholinergic crisis
pneumo or hemothorax
Myasthenic crisis occurance
client is experiencing a stressor that causes an exacerbation of MG, such as infection, or is taking inadequate amounts of cholinesterase inhibitor
cholinergic crisis occurance
the client has taken too much cholinesterase inhibitor
Myasthenic crisis and cholinergic crisis sx
muscle weakness, respiratory failure
