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Nursing Semester 3 > Cyndi - Week 15 - Exam 7 > Flashcards

Cyndi - Week 15 - Exam 7 Flashcards

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1
Q

what is multiple sclerosis?

A

Chronic, progressive, disseminated demyelination of nerve axons

  • Most common of the demyelinating disorders
  • Age usually 20-50, temperate climate, women 2-3 x men
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2
Q

what are the risk factors of MS?

A
  • genetic
  • viral/bacterial
  • exposure to heavy metals
  • *all cause inflammation → scarring/injury
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3
Q

T/F: MS is an autoimmune destruction of CNS myelin where ACTIVATED T cells cross into the BBB.

A

TRUE - and kill oligodendrocytes

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4
Q

what are the three stages of the pathophysiology of MS?

A
  • chronic inflammation
  • demyelination
  • gliosis
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5
Q

what are the characteristics of the “chronic inflammation” in MS?

A
  • slows transmission
  • Nodes of Ranvier
  • *inflammation in the Nodes of Ranvier → harder for info to get through
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6
Q

what are the characteristics of “demyelination” in MS?

A
  • can regenerate

- oligodendrocytes → make myelin

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7
Q

what is the characteristic of “gliosis” in MS?

A
  • sclerotic plagues
  • *injured tissue
  • hypertrophy of oligodendrocytes → gliosis → dead/not working
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8
Q

MS involves a gradual onset of vague symptoms, they include:

A
  • motor
  • sensory (debilitating fatigue)
  • cerebral (ataxia, tremor)
  • emotional
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9
Q

what are the common sxs of MS?

A
  • weakness
  • numbness
  • tingling
  • balance problems
  • fatigue
  • blurred vision
  • vision problems
  • cognitive impairment
  • bladder problems
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10
Q

what is the most common/early sxs?

A

eye problems

- heavily covered in myelin → impairment, color perception, pain with eye movement

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11
Q

what are the different types of MS?

A
  • intermittent (most common)
  • chronic
  • degenerative
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12
Q

TEACHING POINT: how does pregnancy affect MS?

A
  • may improve, but worsen during postpartum period
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13
Q

what are the goals when it comes to MS?

A

Goals: maximize neuromuscular function and independence; manage pain and fatigue;
optimize health and avoid triggers, educate

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14
Q

what are the diagnostic tests used for MS?

A
  • MRI of brain and spine
  • Evoked potential
  • Cerebrospinal fluid
  • Oligoclonal bands – 90-95%
  • Immunoglobulin G – 70-90%
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15
Q

TEACHING POINT: what are the 3 characteristics the patient must have for an MS diagnosis?

A
  1. At least 2 inflammatory demyelinating lesions in at least 2 different locations in the CNS
  2. Damage or attacks occurring at different times
  3. All other diagnoses ruled out
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16
Q

what are the complications of MS?

A
  • Acute exacerbations
  • Decreased mobility
  • Respiratory tract infection
  • Urinary tract infection
  • Pressure ulcers
  • Constipation
  • Bladder control
  • Depression
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17
Q

T/F: there is a cure for MS

A

FALSEY FALSE
• MS varies individually
• Drugs can modify/slow disease process
• Drugs can help improve an exacerbation
• Drugs can provide day to day symptom relief
• People who do better:
• Young, female, infrequent attacks with relapsing pattern

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18
Q

what is the pt education in regards to MS?

A
  • Identify triggers
  • Med compliance and teaching
  • Plan for fatigue and spasms/pain (mod exercise helps)
  • Support emotionally, encourage independence
  • Bladder control (self cath, meds → independence)
  • Lifestyle decisions (stress, keep journal/calendar)
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19
Q

what are the 3 different types of meds given for MS?

A
  • meds that modify the disease process
  • meds that help an exacerbation
  • meds that provide symptom relief
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20
Q

what are the meds that modify the disease process for MS?

A
  • Immunomodulators (Interferon)
  • Immunosuppressant
  • Sphingosine 1-Phospate Receptor Modulator (↓ frequency of relapse)
  • Monclonal Antibody (bind to neutrophil → delay crossing into CNS)
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21
Q

what are the meds that help an exacerbation?

A
  • Steroids

- Adrenocorticotropic hormone (↓ edema/inflam at the site)

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22
Q

what are the meds that provide symptom relief?

A
  • Cholinergics – (urecholine)
  • Anticholinergics (ditropan)
  • Muscle relaxers (valium, baclofen)
  • Nerve conductor enhancers (ampyra)
  • Antidepressants
  • Others
23
Q

TEACHING POINT: for a hypotonic bladder, what type of med would be used?

A

cholinergics

24
Q

TEACHING POINT: for a HYPERactive bladder, what type of med would be used?

A

anticholinergics

25
Q

what is parkinson’s disease?

A

Chronic progressive neurodegenerative

disease of dopamine receptors

26
Q

what does dopamine do in regards to parkinson’s disease?

A

Neurotransmitter essential for extrapyramidal system

  • Posture
  • Support
  • Voluntary movement
27
Q

T/F parkinson’s is a disease of basal ganglia in the midbrain

A

TRUE

  • Death of dopamine-producing neurons in substantia nigra of the basal ganglia
  • Disruption in dopamine-acetylcholine balance in basal ganglia
  • Onset is gradual and insidious
28
Q

what are the causes of Parkinson’s disease?

A

Cause is a combo of genetics and environmental factors

  • Drug or chemical induced (Reglan, haldol, lithium, Thorazine, amphetamines, Carbon monoxide, manganese, copper)
  • Hydrocephalus
  • Hypoxia
  • Infections
  • Stroke
  • Tumor
  • Repeated head trauma (destroyed part of brain that has dopamine)
29
Q

TEACHING POINT: what is the classic triad of PD?

A
  • Tremor, rigidity, bradykinesia
    • Gait disturbance
    • Progression
30
Q

what are the non-motor symptoms of parkinson’s disease?

A
  • Dementia (40% develop)
  • Depression
  • Anxiety
  • Apathy
  • Fatigue
  • Pain
  • Constipation
  • Impotence
  • Short-term memory impairment
  • Sleep problems
31
Q

what are the diagnostic tests for PD?

A
  • No specific tests!
  • Diagnosis based solely on history and clinical features
  • At least 2 of classic triad
  • Confirmation with positive response to Parkinson’s meds
  • Mood, dementia
  • Weight loss, drooling, pill-rolling TP
  • Incontinence, constipation
32
Q

what are the complications of PD?

A
  • Motor symptoms
  • Dysphagia
  • Malnutrition
  • Skin breakdown
  • Infections
  • Falls
  • Neurological, neuropsychiatric problems, severe dementia
33
Q

there are two types of medications used for parkinson’s disease. what do they do?

A

Type 1 - Improves the supply of dopamine

Type 2 - Blocks the effects of cholinergic neurons

34
Q

what are the type 1 meds for PD?

A
  • Dopamine precursors -
  • Levodopa with carbidopa (Sinemet)
  • Dopamine Receptor agonist - stimulates
  • Dopamine agonist – blocks reuptake
  • MAO inhibitors – block breakdown of dopamine
35
Q

what are the type 2 meds for PD?

A

• Anticholinergics - Cogentin

36
Q

what are the other meds for PD?

A
  • Antihistamines - used to manage tremors

* Antiviral agent - exact mechanism unknown

37
Q

what are the different parkinson’s surgeries?

A
  • Transplantation of fetal neural tissue into the basal ganglia
  • Ablation surgery
  • Deep brain stimulation
38
Q

it’s important for PD pts to maximize: ?

A
  • Neurologic function
  • Psychosocial well-being
  • Nutrition - assess for swallowing/ability to feed self TP
  • Safety
  • Independence in ADLs for as long as possible **TP - ambulating and sitting in chair
39
Q

those with PD may involve collaborative care, like: …

A
  • PT
  • Speech/language pathologist
  • Dietician
  • Social services
  • Home health
  • Family support
40
Q

what is myasthenia gravis?

A

Neuromuscular disorder of weakness (acetylcholine)
• Autoimmune disease
• 15% have thymic tumor, most have abnormal thymus
• Antibodies attack acetylcholine receptors
• Nerves can’t stimulate the muscular response

41
Q

what are the clinical manifestations for MG?

A

• Fluctuating weakness of skeletal muscles
- Due to ↓ ACh receptors at neuromuscular junction
- Exacerbation periods or progressive/variable symptoms
*** Rest improves symptoms
• ↓ Strength of facial muscles
• 90% eye movement problems
• Also:
• Swallowing
• Speaking
• Breathing

42
Q

what are the diagnostics used for MG?

A
  • Tensilon test –brief improvement of muscle strength
  • Electromygraphy (EMG) – shows muscle fatigue
  • Acetylcholine Receptor Antibody- 90% positive
43
Q

what are the complications for MG?

A
  • Myasthenic crisis
  • Muscle weakness that affects swallowing and breathing
  • Aspiration pneumonia
  • Respiratory insufficiency
  • Respiratory tract infection
44
Q

TEACHING POINT: It’s important to check for competence of muscles effecting breathing, swallowing → aspiration and respiratory tract infection

A

TRUE YAS I GET IT

45
Q

Is there a cure for MG? TP

A

no known cure

medications though! must be sure to take their meds on time TP

46
Q

what types of meds are given for MG?

A 
• Acetylcholinesterase drugs
- Tensilon, others
• Immune suppression
- Imuran
- CellCept
- Sandimmune
- Corticosteroids
47
Q

what are the other tx for myasthena gravis?

A
  • Thymectomy - Surgery to remove thymus

* Plasmapheresis -Removal of abnormal antibodies from the blood

48
Q

what is guillain-barre syndrome?

A

Ascending, symmetrical paralysis due to an
autoimmune attack on cranial and peripheral nerves
• Loss of myelin
• Edema, inflammation of nerve
• Distal to proximal paralysis
Danger of respiratory arrest

49
Q

what are the sxs of GBS?

A
  • Ascending, symmetrical weakness
  • May progress rapidly to ascending paralysis
  • Inability to execute voluntary movement
  • Diminished reflexes, dyskinesia, paresthesias
  • Diaphragm and intercostal function weakens
50
Q

what are the nursing interventions for GBS?

A
  • Assess and monitor respiratory status
  • BP, rate and rhythm; dysrhythmias
  • Support person psychologically
  • Emergent intubation may be life saving
51
Q

TEACHING POINT: it’s important to question what when it comes to GBS?

A

question: did they have respiratory/gastro infection lately?

52
Q

what are the diagnostics for GBS?

A 
History of viral, bacterial illness, trauma, surgery,
gastroenteritis, vaccination
• ABGs
• CSF
• EMG
• Nerve conduction velocity
• Pulmonary Function Test
• MRI of brain
53
Q

what are the complications for GBS?

A 
• Pneumonia
• Infection
• DVT/PE
• Pain Control
• Immobility
Excellent preventative and collaborative care needed to avoid complications!
54
Q

what is the tx for GBS?

A 
- Treat underling cause:
• Antibiotics
• Antivirals
• IVIG – immunoglobulin
• Plasmapheresis
- Protection of airway
• Mechanical ventilation
• VAP prevention
- Nutritional support
- ROM, physical therapy
- DVT prophylaxis
- Patient and family education

Nursing Semester 3 (29 decks)

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