Chapter 50 Flashcards
What are the two types of PNS disorders?
Neuromuscular
Cranial nerve disorders
What does the PNS involve?
The nerves of arms, legs, chest, abdomen
What are the 4 neuromuscular disorders we are talking about?
MS
Myasthenia Gravis
ALS
Gullian-Barre Syndrome
What do the neuromuscular disorders do?
They disrupt the transmission of impulses between neurons and the muscles they stimulate
What is the myelin sheath?
It covers the axons and is responsible for the smooth transmission of nerve impulses
What is MS?
involves the degeneration of myelin sheath
How can the myelin sheath be damaged?
It can be damaged due to inflammation, detachment or if it becomes swollen
How can myelin repair itself?
exacerbation followed by remission
What is the etiology of MS?
Unknown, could be possible autoimmune response, possible viral infection, or heredity
What are the two types of MS?
Relapsing remitting and progressive
What is relapsing remitting MS?
Worsening signs and symptoms followed with improvement
What is progressive MS?
gets worse without improvement
What is the most common type of MS?
relapsing remitting
What are some problems associated with MS? (S/S)
Weakness/paralysis of limbs Double/blurred vision Slurred speech Spasticity of muscles Numbness Tinnitus and vertigo Dysphagia Spastic or flaccid bladder Mood swings
What do the symptoms depend on for MS?
The symptoms depend on the area with the sclerosed myelin
What are some different factors that can trigger the onset of symptoms of MS?
Extreme heat, extreme cold, fatigue, infection and emotional stress
How does death usually occur in MS?
death usually results from infection
Therapeutic interventions for MS?
Steroids Immunosuppressants Anticonvulsants Muscle relaxants PT/OT
What is acetylcholine needed for?
Muscle contraction
What happens during myasthenia gravis?
If there is no acetylcholine or the receptors for acetylcholine are destroyed, the muscle contraction doesn’t take place
The muscle weakness in myasthenia gravis occurs during activity and improves with ____
rest
Myasthenia gravis affects ?
facial muscles, neck and limb movement
S/S of myasthenia gravis?
Progressive muscle weakness Fatigue with activity Ptosis Difficulty chewing and swallowing Difficulty breathing An early sign can be double vision or slurred speech
What is a myasthenic crisis?
Sudden onset of symptoms due to not enough medication or triggered by infection
What are two complications of myasthenia gravis?
Aspiration
Respiratory infection and failure
How does a cholinergic crisis occur?
Due to overmedication
What two meds are given for myasthenia gravis?
Anticholinesterase drugs
Corticosteroids
Why are corticosteroids given for myasthenia gravis?
Inhibit the immune system and the production of abnormal antibodies
Why are anticholinesterase drugs given for myasthenia gravis?
Help improve nerve-muscle communications and increase the muscle strength
What is a tension test that is used to diagnosed myasthenia gravis?
Anicholinergic med is given and there is a temporary improvement of droopy eyelids (ptosis). It is an injection of tensilon and muscle strength improves for 1-3 mins
Why would you remove the thymus as a therapeutic intervention for myasthenia gravis?
This will work on the immune system so it doesn’t work against the body
How are meds used as a therapeutic intervention for myasthenia gravis?
They improve neuromuscular transmission and increase muscle strength. They also slow down the time of acetylcholine breakdown
What is ALS (amyotrophic lateral sclerosis)
Motor neurons degenerate (they stop sending messages and nerve impulse transmission is then blocked)
This results in muscle weakness and atrophy
As ALS progresses, it effects the muscles that control ____ and ____
breathing, swallowing
What is the etiology for ALS?
Unknown, but it may be due to possible genetic disposition or possible auto-immune disorder
ALS does NOT effect the brain, only ?
motor neurons
ALS causes what?
both the upper and lower motor neurons that control voluntary movement to die off.
This then leads to weakness, muscle death and then paralysis
What is pulmonary compromise in ALS?
This is when the muscles of the diaphragm are effected. They eventually end up on a ventilator
When does death usually occur after diagnosis of ALS?
3-5 years
How can ALS be diagnosed?
assessment of symptoms and a nerve biopsy
S/S of ALS?
Progressive muscle weakness (gradual): The muscles weaken and waste away Decreased coordination Muscle spasms Difficulty chewing and swallowing Speech difficulty
Therapeutic interventions for ALS?
Muscle relaxants (to control muscle spasticity and cramps)
PT/OT/Speech therapy
Pain control
Infection precautions
Good skin care
Communication support
-All aimed at improving function as long as possible
Is there a cure for ALS?
no
What is Guillain-Barre syndrome?
Myelin sheath of the spinal cord and cranial nerves is destroyed due to an inflammatory reaction which cause a slowed or blocked nerve conduction
What are the two main categories of Guillain-Barre syndrome?
Ascending and descending
What is ascending Guillain-Barre syndrome?
Characterized by progressive weakness beginning in the legs and works it’s way up the body
What is descending Guillain-Barre syndrome?
Affects the cranial nerves of the brain stem first, making difficulty in swallowing and speaking and progresses downward to the legs (less common)
What are complications of Guillain-Barre syndrome?
Respiratory failure
Infection
Depression
Therapeutic interventions for Guillain-Barre syndrome?
The goal of therapy is to support body systems until the patient recovers Monitor respiratory status Manage pain Tube feedings if indicated Communication board
What is another name for trigeminal neuralgia?
Tic douloureux
What is the pathophysiology of trigeminal neuralgia?
Involved the 5th cranial nerve (has 3 different branches so it effects different parts of the face)
Affected are the forehead, nose, cheek and jaw
What might cause trigeminal neuralgia?
May be from irritation or chronic compression of the cranial nerve
S/S of trigeminal neuralgia?
Intense pain on one side of the face
Periods of pain last from seconds to minutes and can last several days
Triggered by items touching the face or talking
Sleep provides a period of relief
As time progresses, the episodes become more frequent
Why are anticonvulsants used as a treatment for trigeminal neuralgia?
They reduce transmission of nerve impulses
Why are nerve blocks used as a treatment for trigeminal neuralgia?
Provides a longer period of relief than meds
Why is surgery used as a treatment for trigeminal neuralgia?
It is used to remove the nerve or to pad it
What is the pathophysiology of Bell’s palsy?
Cranial nerve #7 is affected
Patient loses motor control on one side of the face
What is the action of the 7th cranial nerve?
It controls most facial muscles, ears, and salivation/tearing
What is the etiology of Bell’s palsy?
Unknown, but can be due to possible viral infection of nerve. Can also occur in 3rd trimester of pregnancy
S/S of Bell’s Palsy?
One sided facial nerve quits working
- Speech difficulties
- Weakness (mouth droops and can’t close eye)
__% of patients with Bell’s palsy will have complete recovery in a short period of time
50
Why is prednisone used for Bell’s palsy?
To decrease edema and swelling
Why is gentle massage used for Bell’s palsy?
Keeps the face flexible for when it heals
Why is an eye patch and drops used for Bell’s palsy?
Used to decrease the drying of the eyes
A patient with trigeminal neuralgia asks the nurse why carbamazepine (Tegretol) has been ordered. Which response is best?
a) “It will help decrease the inflammation in your nervous system”
b) “It will depress your immune system, which can slow the progression of the disease”
c) “It can help relieve nerve pain”
d) “It is an anticonvulsant to prevent seizures”
c) “It can help relieve nerve pain”
A patient with a myotrophic lateral sclerosis (ALS) expresses concern about not having enough breath to sing anymore. Which explanation by the nurse is best?
a) “ALS can damage the nerves to your bronchi and bronchioles, causing constriction and reduced airflow”
b) “The demyelination of your nerves caused by ALS causes confusion in the impulses to your lungs”
c) “ALS can affect your vocal cords, making it difficult to form sounds as you sing or speak”
d) “ALS may be affecting the nerves that go to your respiratory muscles, making them weak”
d) “ALS may be affecting the nerves that go to your respiratory muscles, making them weak”
A patient who is newly diagnosed with ALS says to the nurse, “I do not want to be kept alive on machines.” Which nursing action is best in response
a) Ask the patient if he has advance directives and provide information about preparing them
b) Reassure the patient that he will not need to make decisions about machines for a long time
c) Inform the patient that individuals with ALS are not candidates for artificial ventilation
d) Explain to the patient that a ventilator will be necessary to keep him breathing as his disease progresses
a) Ask the patient if he has advance directives and provide information about preparing them
When caring for a patient admitted with Guillain-Barre syndrome, which nursing diagnosis should take priority?
a) Anxiety
b) Imbalanced Nutrition
c) Impaired Gas Exchange
d) Impaired Mobility
c) Impaired Gas Exchange
Which nursing interventions are appropriate for the patient with Bell’s palsy? (Select all that apply)
a) Administer moisturizing eyedrops
b) Apply an eye patch
c) Avoid touching the patient’s face
d) Apply warm compresses
e) Provide facial massage
f) Teach the patient to protect the face from cool breezes
a, b, d, e
Which meal would be the best choice for patient with myasthenia gravis?
a) Baked chicken sandwich, fresh carrots, apple
b) Meatloaf, mashed potatoes, canned green beans
c) Steak, baked potato, green salad
d) Tacos, fresh vegetables, sliced peaches
b) Meatloaf, mashed potatoes, canned green beans
How will the visiting nurse caring for a patient with myasthenia gravis and severe muscle weakness know if interventions have been effective?
a) The patient verbalizes satisfaction with the plan of care
b) The patient states understanding of the medication regimen
c) The patient and family state that no further home visits are needed
d) The patient is able to perform ADLs with SaO2 remaining at 95%
d) The patient is able to perform ADLs with SaO2 remaining at 95%
Muscles that are not used become wasted, or ___
atrophied
Some diseases are characterized by remissions and _____
exacerbations
Nerve pain is also called ____
neuralgia
An early symptom of myasthenia gravis is drooping eyelids, also called ____
ptosis
Symptoms of Guillain-Barre syndrome are caused by ______ of axons
demyelination
Myasthenia gravis is sometimes treated with _____, which separates blood cells from plasma to remove antibodies
plasmaphoresis
Muscle twitching, or ______, occur in amyotrophic lateral sclerosis
fasciculations
Medications for myasthenia gravis that can increase acetylcholine at the neuromuscular junction are called _______ agents
anticholinesterase
Which drug class is used to reduce muscle symptoms of muscle weakness from myasthenia gravis?
a) Anticholinesterase drugs
a) Anticholinergic drugs
c) Adrenergic drugs
d) Beta-blocker drugs
a) Anticholinesterase drugs
Which of the following nursing interventions will help prevent complications in the patient with Bell’s palsy?
a) Megavitamin therapy
b) Elastic bandages
c) Application of ice to the affected are
d) Lubricating eyedrops
d) Lubricating eyedrops
Which data collection activity will help the nurse determine if the patient with Bell’s palsy is receiving adequate nutrition?
a) Monitor meal trays
b) Measure intake and output
c) Check twice-weekly weights
d) Evaluate swallowing reflex
c) Check twice-weekly weights
A 32-year-old patient is admitted to a medical unit with a diagnosis of Guillain-Barre syndrome. The patient’s legs are weak, causing difficulty walking without assistance. Which of the following is most likely responsible for this syndrome?
a) Bacterial infection
b) Heredity
c) High-fat diet
d) Autoimmune reaction
d) Autoimmune reaction
Patients with Guillain-Barre syndrome should be closely monitored. Which of the following lab results is most important to monitor for acute complications?
a) Blood urea nitrogen (BUN) and creatinine
b) Arterial blood gases (ABG)
c) Hemoglobin (HgB) and hematocrit (Hct)
d) Serum potassium
b) Arterial blood gases (ABG)
A woman sees her primary care provider because of extreme fatigue for the past 2 months; she has difficulty lifting even light objects. Her physician suspects myasthenia gravis. Which of the following tests should the nurse anticipate assisting with to confirm this diagnosis?
a) Mestinon test
b) Quinine tolerance test
c) Pulmonary function studies
d) Tensilon test
d) Tensilon test
A 39-year-old patient sees the physician after falling twice for seemingly no reason. Diagnostic tests are done, and the patient is diagnosed with multiple sclerosis. Which of the following explanations will help the patient understand the disease?
a) “You have a buildup of myelin in your nervous system, causing congestion and muscle weakness”
b) “You are missing a neurotransmitter that is important to muscle contraction”
c) “The receptor sites on your muscles are damaged, so they can’t contract correctly”
d) “The insulation on your nerve cells is damaged, which slows the impulses to the muscles”
d) “The insulation on your nerve cells is damaged, which slows the impulses to the muscles”
A patient who is newly diagnosed with multiple sclerosis asks what medications are used to help control symptoms and treat the disease. Which of the following medications would the nurse include in the teaching?
a) Acyclovir (Zovirax)
b) Adrenocorticotropic hormone (ACTH)
c) Thyrotropin
d) Diphenhydramine (Benadryl)
b) Adrenocorticotropic hormone (ACTH)
A home care nurse is developing a plan of care designed to prevent complications in a patient with impaired respiratory function. Which of the following would the nurse include in the plan?
a) Antibiotics as needed
b) Elevate the head of the bed
c) Bedrest
d) Suction q4h
b) Elevate the head of the bed
The nurse notes frequent muscle twitching when collecting admission data on a patient admitted for increasing muscle weakness. Which of the following terms should be used to document this?
a) Fasciculations
b) Atrophy
c) Chorea
d) Neuropathy
a) Fasciculations
A 19-year-old student develops trigeminal neuralgia. Which of the following actions is most likely to trigger pain?
a) Sleeping
b) Eating
c) Reading
d) Cooking
b) Eating
What do cholinesterase inhibitors do and what are some examples?
Increase acetylcholine at synapses
- neostigmine (Prostigmin)
- pyridostigmine (mestinon)
- edrophonium chloride (Tensilon, used in diagnosis)
What do glucocorticoids do and what are some examples?
Reduce inflammation
- prednisone
- prednisolone
- prednisolone acetate or sodium phosphate
What do immunosuppressants do and what are some examples?
Suppress immunity and antibody formation
- azathioprine (Imuran)
- cyclophosphamide (Cytoxan)
What do antispasmodics/muscle relaxants do and what are some examples?
Relax muscles, reduce pain
- dantrolene (Dantrium)
- baclofen (Lioresal)
- diazepam (Valium)
- tizanidine (Zanaflex)
What do anticonvulsants do and what are some examples?
Treat nerve pain
- phenytoin (Dilantin)
- carbamazepine (Tegretol)
- gabapentin (Neurontin)
What does a glutamate antagonist do and what is an example?
Delays progression of ALS
-riluzole (Rilutek)
Anticholinesterase drugs should be scheduled how?
They should be scheduled so that peak action occurs at times when increased muscle strength is need
What is another name for Guillain-Barre syndrome?
acute inflammatory polyneuropathy
