Cyndi - Week 15 - Exam 7 Flashcards
what is multiple sclerosis?
Chronic, progressive, disseminated demyelination of nerve axons
- Most common of the demyelinating disorders
- Age usually 20-50, temperate climate, women 2-3 x men
what are the risk factors of MS?
- genetic
- viral/bacterial
- exposure to heavy metals
- *all cause inflammation → scarring/injury
T/F: MS is an autoimmune destruction of CNS myelin where ACTIVATED T cells cross into the BBB.
TRUE - and kill oligodendrocytes
what are the three stages of the pathophysiology of MS?
- chronic inflammation
- demyelination
- gliosis
what are the characteristics of the “chronic inflammation” in MS?
- slows transmission
- Nodes of Ranvier
- *inflammation in the Nodes of Ranvier → harder for info to get through
what are the characteristics of “demyelination” in MS?
- can regenerate
- oligodendrocytes → make myelin
what is the characteristic of “gliosis” in MS?
- sclerotic plagues
- *injured tissue
- hypertrophy of oligodendrocytes → gliosis → dead/not working
MS involves a gradual onset of vague symptoms, they include:
- motor
- sensory (debilitating fatigue)
- cerebral (ataxia, tremor)
- emotional
what are the common sxs of MS?
- weakness
- numbness
- tingling
- balance problems
- fatigue
- blurred vision
- vision problems
- cognitive impairment
- bladder problems
what is the most common/early sxs?
eye problems
- heavily covered in myelin → impairment, color perception, pain with eye movement
what are the different types of MS?
- intermittent (most common)
- chronic
- degenerative
TEACHING POINT: how does pregnancy affect MS?
- may improve, but worsen during postpartum period
what are the goals when it comes to MS?
Goals: maximize neuromuscular function and independence; manage pain and fatigue;
optimize health and avoid triggers, educate
what are the diagnostic tests used for MS?
- MRI of brain and spine
- Evoked potential
- Cerebrospinal fluid
- Oligoclonal bands – 90-95%
- Immunoglobulin G – 70-90%
TEACHING POINT: what are the 3 characteristics the patient must have for an MS diagnosis?
- At least 2 inflammatory demyelinating lesions in at least 2 different locations in the CNS
- Damage or attacks occurring at different times
- All other diagnoses ruled out
what are the complications of MS?
- Acute exacerbations
- Decreased mobility
- Respiratory tract infection
- Urinary tract infection
- Pressure ulcers
- Constipation
- Bladder control
- Depression
T/F: there is a cure for MS
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
what is the pt education in regards to MS?
- 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)
what are the 3 different types of meds given for MS?
- meds that modify the disease process
- meds that help an exacerbation
- meds that provide symptom relief
what are the meds that modify the disease process for MS?
- Immunomodulators (Interferon)
- Immunosuppressant
- Sphingosine 1-Phospate Receptor Modulator (↓ frequency of relapse)
- Monclonal Antibody (bind to neutrophil → delay crossing into CNS)
what are the meds that help an exacerbation?
- Steroids
- Adrenocorticotropic hormone (↓ edema/inflam at the site)
what are the meds that provide symptom relief?
- Cholinergics – (urecholine)
- Anticholinergics (ditropan)
- Muscle relaxers (valium, baclofen)
- Nerve conductor enhancers (ampyra)
- Antidepressants
- Others
TEACHING POINT: for a hypotonic bladder, what type of med would be used?
cholinergics
TEACHING POINT: for a HYPERactive bladder, what type of med would be used?
anticholinergics
what is parkinson’s disease?
Chronic progressive neurodegenerative
disease of dopamine receptors
what does dopamine do in regards to parkinson’s disease?
Neurotransmitter essential for extrapyramidal system
- Posture
- Support
- Voluntary movement
T/F parkinson’s is a disease of basal ganglia in the midbrain
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
what are the causes of Parkinson’s disease?
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)
TEACHING POINT: what is the classic triad of PD?
- Tremor, rigidity, bradykinesia
- Gait disturbance
- Progression
what are the non-motor symptoms of parkinson’s disease?
- Dementia (40% develop)
- Depression
- Anxiety
- Apathy
- Fatigue
- Pain
- Constipation
- Impotence
- Short-term memory impairment
- Sleep problems
what are the diagnostic tests for PD?
- 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
what are the complications of PD?
- Motor symptoms
- Dysphagia
- Malnutrition
- Skin breakdown
- Infections
- Falls
- Neurological, neuropsychiatric problems, severe dementia
there are two types of medications used for parkinson’s disease. what do they do?
Type 1 - Improves the supply of dopamine
Type 2 - Blocks the effects of cholinergic neurons
what are the type 1 meds for PD?
- Dopamine precursors -
- Levodopa with carbidopa (Sinemet)
- Dopamine Receptor agonist - stimulates
- Dopamine agonist – blocks reuptake
- MAO inhibitors – block breakdown of dopamine
what are the type 2 meds for PD?
• Anticholinergics - Cogentin
what are the other meds for PD?
- Antihistamines - used to manage tremors
* Antiviral agent - exact mechanism unknown
what are the different parkinson’s surgeries?
- Transplantation of fetal neural tissue into the basal ganglia
- Ablation surgery
- Deep brain stimulation
it’s important for PD pts to maximize: ?
- 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
those with PD may involve collaborative care, like: …
- PT
- Speech/language pathologist
- Dietician
- Social services
- Home health
- Family support
what is myasthenia gravis?
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
what are the clinical manifestations for MG?
• 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
what are the diagnostics used for MG?
- Tensilon test –brief improvement of muscle strength
- Electromygraphy (EMG) – shows muscle fatigue
- Acetylcholine Receptor Antibody- 90% positive
what are the complications for MG?
- Myasthenic crisis
- Muscle weakness that affects swallowing and breathing
- Aspiration pneumonia
- Respiratory insufficiency
- Respiratory tract infection
TEACHING POINT: It’s important to check for competence of muscles effecting breathing, swallowing → aspiration and respiratory tract infection
TRUE YAS I GET IT
Is there a cure for MG? TP
no known cure
medications though! must be sure to take their meds on time TP
what types of meds are given for MG?
• Acetylcholinesterase drugs - Tensilon, others • Immune suppression - Imuran - CellCept - Sandimmune - Corticosteroids
what are the other tx for myasthena gravis?
- Thymectomy - Surgery to remove thymus
* Plasmapheresis -Removal of abnormal antibodies from the blood
what is guillain-barre syndrome?
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
what are the sxs of GBS?
- Ascending, symmetrical weakness
- May progress rapidly to ascending paralysis
- Inability to execute voluntary movement
- Diminished reflexes, dyskinesia, paresthesias
- Diaphragm and intercostal function weakens
what are the nursing interventions for GBS?
- Assess and monitor respiratory status
- BP, rate and rhythm; dysrhythmias
- Support person psychologically
- Emergent intubation may be life saving
TEACHING POINT: it’s important to question what when it comes to GBS?
question: did they have respiratory/gastro infection lately?
what are the diagnostics for GBS?
History of viral, bacterial illness, trauma, surgery, gastroenteritis, vaccination • ABGs • CSF • EMG • Nerve conduction velocity • Pulmonary Function Test • MRI of brain
what are the complications for GBS?
• Pneumonia • Infection • DVT/PE • Pain Control • Immobility Excellent preventative and collaborative care needed to avoid complications!
what is the tx for GBS?
- 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
