chronic neuro problems 2 Flashcards
multiple sclerosis (MS)
- chronic, progressive, degenerative dx of the CNS
- demyelination of nerve fibers of the brain and spinal cord occurs
population affected by MS
- ages 20-50
- women affected more than men
cause of MS
- infectious
- immunologic
- genetic
s/s of MS
- motor s/s
- sensory (tingling)
- Lhermitte’s sign
- lack of coordination
- depression
- constipation
- spastic or flaccid bladder
- lack of concentration and memory
- ED, decreased libido
Lhermitte’s sign
when neck is flexed, electric shock felt
diagnostic studies for MS
- H/P
- CSF analysis: increased IgG
- MRI: to look for scar tissue and demyelination
drug tx for MS
- prednisone
- betaseron (immunomodulator)
- imuran (immunosuppressants)
- lioresal (muscle relaxant)
- ritalin
- oxybutynin
- ampyra (nerve conduction enhancer)
nursing interventions for MS
- help pt ID triggers
- prevent major complications of immobility
- good balance of exercise and rest
- adeqaute intake of fiber
- avoiding the hazards of immobility
- self catherization
- avoid fatigue, extreme heat or cold, exposure to infection
Parkinson’s disease (PD)
- chronic, progressive neurodegenerative disorder
- bradykinesia
- muscle rigidity
- tremors at rest
- gait disturbance
s/s of PD
- onset is gradual and insidious
- classic triad: tremors, rigidity, bradykinesia
complications of PD
- nonmotor and motor symptoms
- dementia and neuropsychiatric problems
- dysphagia
- general debilitation may lead to pneumonia, UTIs, and skin breakdown
- orthostatic hypotension, falls/injury
diagnosing PD
- no specific tests
- firm dx made when 2/3 s/s seen of classic triad
- ultimate confirmation is positive response to antiparkinsons drugs
drug tx of PD
- sinemet (levodopa with carbidopa)
- parlodel
- artane
- cogentin
- benadryl
- symmetrel
- eldepryl
other tx for PD
- deep brain stimulation
- food easy to chew and swallow
- adeqaute roughage
- bite size pieces
- small meals
- limit protein and vitamin B6
myasthenia gravis (MG)
-autoimmune dx of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups
s/s of MG
- fluctuating weakness of skeletal muscles
- eyes, eyelids, chewing, swallowing, speaking, breathing
- peek’s sign: eyes don’t close completely
- impaired speech
- facial mobility and expression
diagnostic studies for MG
- H/P, neuro exam
- EMG
- tensilon
myasthenia crisis
- an acute exacerbation of muscle weakness
- aspiration
- respiratory insufficiency
- respiratory tract infection
cholinergic crisis
- OD of anticholinestrase drug
- muscle twitching
- sweating
- excessive salivation
- constricted pupils
drug tx of MG
- mestinon
- prednisone: to suppress immune system
- immunosuppressants: imuran, sandimmune
surgery for MG
thymectomy
other tx for MG
- plasmapheresis
- IV IgG
plasmapheresis
- replacement of antibodies, since antibodies are attacking you
- usually done in crisis situation