ATI Ch 10 MS ALG MG

Question 1

Multiple Sclerosis description

Answer 1

autoimmune disorder where plaques develop in the white matter of the CNS, interferes w/ impulse transmission
can relapse and remit

Question 2

Amyotrophic Lateral Sclerosis ALS description

Answer 2

disease of the upper and lower motor neurons with muscle weakness progressing to muscle atrophy and eventually paralysis and death

Question 3

Myasthenia Gravis description

Answer 3

autoimmune disorder with loss of ACH receptors at the neuromuscular junction

Question 4

MS onset

Answer 4

2x more likely in women

between ages 20-40

Question 5

Factors that trigger MS relapse

Answer 5

Viruses and infectious agents, Living in a cold climate, Physical injury, Emotional stress, Pregnancy, Fatigue, Overexertion, Temperature extremes, Hot shower/bath

Question 6

MS sx

Answer 6

lower extremity fatigue, vision changes (Uhthoff’s sign), muscle spacity, nystagmus, cognative changes, bowel/bladder dysfunction

Question 7

Lab test for MS

Answer 7

Cerebrospinal fluid analysis (elevated protein level and a slight increase in WBCs)

Question 8

How to diagnose MS

Answer 8

MRI reveals plaques of the brain and spine

Question 9

Credé maneuver

Answer 9

placing manual pressure on abdomen over the bladder to expel urine, used in MS PTs

Question 10

Tx for diplopia

Answer 10

apply alternating eye patches and teach scanning maneuvers, used for MS PTs

Question 11

Immunosuppressive agents ex

Answer 11

Azathioprine (Imuran) and cyclosporine (Sandimmune)

Question 12

Immunosuppressive agents use

Answer 12

reduce the frequency of MS relapses

Question 13

Immunosuppressive agents nursing considerations

Answer 13

Assess for hypertensionand kidney dysfunction

Question 14

Corticosteroids ex

Answer 14

Prednisone

Question 15

Corticosteroids use

Answer 15

reduce inflammation in acute MS exacerbations

Question 16

Corticosteroids nursing considerations

Answer 16

Monitor for infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, and personality changes

Question 17

Antispasmodics ex

Answer 17

Dantrolene (Dantrium), tizanidine (Zanaflex), baclofen (Lioresal), and diazepam (Valium)

Question 18

Antispasmodics use

Answer 18

treat muscle spasticity in MS

Question 19

Antispasmodics nursing considerations

Answer 19

Observe for increased weakness, liver damage if on tizanidine or dantrolene, do not stop baclofen abruptly

Question 20

Immunomodulators ex

Answer 20

Interferon beta (Betaseron)

Question 21

Immunomodulators use

Answer 21

prevent or treat relapses of MS

Question 22

Anticonvulsants ex

Answer 22

Carbamazepine (Tegretol)

Question 23

Anticonvulsants use

Answer 23

paresthesia in MS

Question 24

Anticholinergics ex

Answer 24

Propantheline

Question 25

Anticholinergics use

Answer 25

bladder dysfunction in MS

Question 26

Beta-blockers ex

Answer 26

Primidone (Mysoline) and clonazepam (Klonopin)

Question 27

Beta-blockers use

Answer 27

treat tremors in MS

Question 28

ALS progression rate

Answer 28

death usually due to resp failure within 3-5 years from first manifestation

Question 29

ALS onset

Answer 29

effects more women than men, seen between ages 40-70

Question 30

ALS Sx

Answer 30

fatigue, twitching, cramping, atrophy, dysphagia, hyperreflexia of deep tendon reflexes

Question 31

ALS lab tests

Answer 31

Increased creatine kinase (CK-BB) level | Need to r/o other causes, there is no specific test

Question 32

ALS diagnostic tests

Answer 32

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

Question 33

What ALS mostly effects

Answer 33

Respiratory! | Nursing interventions should be geared to respiratory functions

Question 34

glutamate antagonist ex

Answer 34

Riluzole (Rilutek) (this is the only one)

Question 35

glutamate antagonist use

Answer 35

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

Question 36

glutamate antagonist nursing considerations

Answer 36

Monitor LFTs, no ETOH, assess dizziness, vertigo and somnolence, keep meds away from light

Question 37

Antispasmodics ex

Answer 37

Baclofen (Lioresal), dantrolene sodium (Dantrium), diazepam (Valium)

Question 38

ALS complications

Answer 38

pneumonia due to respiratory weakness/paralysis

Question 39

Causes of Myasthenia Gravis

Answer 39

Coexisting autoimmune disorder | hyperplasia of the thymus gland

Question 40

Factors that trigger MG exacerbations

Answer 40

Infection, Stress, emotional upset, and fatigue, Pregnancy, Increases in body temp

Question 41

Finding from MG assessment

Answer 41

impaired resp function, dysphagia, decreased muscle strength (especially in the face), incontinence, drooping eyelids

Question 42

Diagnostic procedures for MG

Answer 42

Tensilon testing/ anticholinesterase (edrophonium)

Question 43

Electromyography

Answer 43

Shows the neuromuscular transmission characteristics of MG

Question 44

Tensilon testing function

Answer 44

Baseline assessment of the cranial muscle strength

Question 45

Tensilon testing procedure

Answer 45

Edrophonium (Tensilon) is administered which improves muscle strength for 5 min by inhibiting breakdown of ACh

Question 46

Anticholinesterase agents for MG

Answer 46

are the first line of therapy | given 4x daily

Question 47

Anticholinesterase agents for MG cautions

Answer 47

clients who have hx of asthma or cardiac dysrhythmias

Question 48

Pyridostigmine (Mestinon) and neostigmine (Prostigmin) for MG function

Answer 48

increase muscle strength | inhibits breakdown of ACh and prolongs its effects

Question 49

Use of immunosuppressants with MG

Answer 49

given durring exacerbations when other meds are not sufficient because MG is an autoimmune disease

Question 50

When are IV immunoglobulins (IVIg) used?

Answer 50

for acute management in clients who do not respond to the above treatments

Question 51

Plasmapheresis

Answer 51

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

Question 52

Plasmapheresis intraprocedure nursing actions

Answer 52

assess for dizziness and hypotension | maintain patence of shunts

Question 53

Thymectomy

Answer 53

surgical procedure for MG | removal of thymus gland

Question 54

Thymectomy complications

Answer 54

Myasthenic crisis and cholinergic crisis | pneumo or hemothorax

Question 55

Myasthenic crisis occurance

Answer 55

client is experiencing a stressor that causes an exacerbation of MG, such as infection, or is taking inadequate amounts of cholinesterase inhibitor

Question 56

cholinergic crisis occurance

Answer 56

the client has taken too much cholinesterase inhibitor

Question 57

Myasthenic crisis and cholinergic crisis sx

Answer 57

muscle weakness, respiratory failure