Exam 2: Peripheral Nerve Problems Flashcards
1
Q
What is Bell’s palsy caused by ?
A
Inflammation of the 7th (facial) cranial nerve
2
Q
Bell’s palsy is characterized what ?
A
One-sided facial paralysis
- can happen very rapidly - Within a few hours
3
Q
Is the cause of Bell’s palsy unknown ?
A
Yes!
4
Q
With Bell’s palsy there is a possible link with what ?
A
Viral link (HSV)
5
Q
Bell’s Palsy is associated with what types of illness/ symptoms ?
A
Flu-like illness
6
Q
Bell’s palsy is Benign, with a full recovery happening when ?
A
3 to 6 months
7
Q
True or False: A small percentage of individuals with Bell’s palsy with have long-tern paralysis ?
A
True
8
Q
Bell’s palsy is characterized by what types of things ?
A
- Inability to wrinkle brow
- Drooping eyelid
- Inability to close eye
- Inability to puff cheeks, no muscle tone
- Drooping mouth
- Inability to smile or pucker lips
9
Q
What does the Tx include for pt’s with Bell’s palsy ?
A
- Prednisone
- Acyclovir (if HSV)
Other:
- Heat
- Gentle massage
- Prescribe exercises
- Electrical stimulation
10
Q
What is the Nursing Goal for pt’s with Bell’s palsy ?
A
- Free of injury
- Adequate nutrition
11
Q
What are Nursing interventions for Bell’s palsy ?
A
- Teach to prevent corneal irritation
- Gentle massage to face
- Chew on unaffected side of mouth
- Encourage verbalization of feelings
12
Q
Guillan-Barre Syndrome is defined as what ?
A
- Acute, rapidly progressing polyneuritis
13
Q
What is Guillan-Barre Syndrome characterized by ?
A
Progressive motor weakness, possible paralysis (ascending)
14
Q
Guillan-Barre Syndrome is immune mediated and commonly seen when ?
A
Following a viral infection, illness, or immunization (1-3wks)
15
Q
True or False: In individuals with Guillan-Barre Syndrome, recovery can take a year, and some may experience residual deficits or die from complications
A
True
16
Q
What does it mean when the diagnostic for Bell’s palsy says “One of exclusion” ?
A
Will first rule out other possibilities first such as tumor, stroke, etc.
- If that all comes back negative, then will have a Bell’s palsy diagnosis
17
Q
What are these Clinical Manifestations seen in ?
- Development of s/s 1-3 weeks after inffection
- Weakness of lower extremities occurring hours to days, and peaking at about 2 weeks
- Ascending weakness, paresthesia, paralysis
- Facial and extraocular movement weakness
- Dysphagia
- May involve cranial nerves
- Respiratory failure d/t the respiratory muscles being comprimised
- ANS dysfunction - hypotension, bradycardia
A
Guillan-Barre Syndrome
18
Q
What diagnostics are used for GBS ?
A
- Signs & Symptoms
- if CSF analysis is done, it will have extra protein in it
- EMG
- Brain MRI done to r/o MS (since they both have lower extremity weakness, etc)
19
Q
What does collaborative care involve for patients with GBS ?
A
- Supportive care (helping with mobility)
- Corticosteroids
- Plasmapheresis
(can spin off antibodies that were once working to fight of an infection, but are now destructing the myelin that covers nerves) - High dose immunoglobulin therapy
- Nutrition
(pt’s may have many GI complications)
(at risk for aspiration)
20
Q
In pt’s with GBS we want to maintain airway , what should be kept at the bedside ?
A
Trach set
21
Q
What is Nursing Management for GBS ?
A
- Monitor disease progression & muscle weakness
- Maintain airway, keep track at bedside
- Ventilator support as needed
- Emotional support (pt & family)
- Prevent complications of muscle weakness and immobility
- Prevent DVT
22
Q
In pt’s with GBS, what do we want to make sure they don’t develop ?
A
“Foot Drop” from loss of muscle function
(utilize foot flexion boots”
23
Q
As a pt with GBS recovers, the re-mylination occurs ________, and the neurological function will return from ____________ to _________ ?
A
- Slowly
- Proximal to distal
24
Q
GBS starts how & Resolves how ?
A
Starts: from the bottom up
Resolves: from the top down
25
Spinal cord injury is defined as what ?
Trauma or damage to the spinal cord
26
Spinal cord injuries occur primarily in who ?
Young men
27
_________ &_______ are present in the majority of accidental spinal cord injuries ?
ETOH and drugs
28
What are complications related to spinal cord injures ?
- Respiratory failure
- Autonomic dysreflexia
- Spinal shock
- Further cord damage
- Death
29
The prognosis for spinal cord injuries cannot be determined for how long ?
For up to 72 hours
30
What are the different levels where spinal cord injuries can occur ?
- Cervical
- Thoracic
- Lumbar
31
What are the most frequently involved vertebrae of the following
- Cervical:
- Thoracic:
- Lumbar:
Cervical: C5, C6, C7
Thoracic: T12
Lumbar: L1
* because there the most flexible areas of the spine
32
What is another name for Quadriplegia ?
Tetraplegia
33
What is Quadriplegia ?
Paralysis involving all 4 extremities
34
What is Paraplegia ?
Paralysis involving only the lower extremities
35
With Paraplegia spinal cord injuries generally occur where ?
Between T1 and L4
36
With Quadriplegia spinal cord injuries generally occur where /
Between C1 and C8
37
What type of spinal cod injury is defined as a _________ transection of the spinal cord; with symptoms depending on the extant & location of damage ?
Incomplete injury
blank line word = partial)
38
A C4 spinal cord injury will result in what ?
- Tetraplegia (Quadriplegia)
| - complete paralysis below the neck
39
A C6 spinal cord injury will result in what ?
Partial paralysis of the hands and arms as well as the lower body
40
A T6 spinal cord injury will result in what ?
- Paraplegia
| - Paralysis below the chest
41
A L1 spinal cord injury will result in what ?
- Paraplegia
| - Paralysis below the waist
42
True or False: You should always suspect a SCI when trauma occurs until it can be ruled out ?
True
43
True or False: With spinal cord trauma & suspected SCI (until ruled out), the pt should be immobilized on a spine backboard with the head in a neutral position to prevent an incomplete injury from becoming complete ?
True
44
When somebody comes in with trauma to the spinal cord/SCI, what should you assess/do ?
Assess respirations & maintain airway
45
True or False: With trauma to the spinal cord/SCI, you should prevent head flexion, rotation, or extension ?
True
46
In pts with spinal cord trauma/SCI how should you turn them ?
Log roll
- not part of body should be twisted/turned - cannot sit up
47
In the ED, patient with a cervical fracture should be placed in what immediately ?
rigid C-collar
48
If a pt. has an injury around C4, they may not be able to do what ?
Use the muscles of respiration effectively
- Monitor ABG's
- May need mechanical ventilation
49
If its with SCI are able to breath on their own, what do we want to encourage ?
C & DB
50
In terms of respiratory management/iinterventions, what do we want to monitor for in patients with SCI ?
Monitor for respiratory infection
51
What can occur with a C4 SCI ?
Paralysis of the intercostal & abdominal muscles
52
What nursing interventions do we want to monitor for during hospitalizations of pt's with SCI, to prevent complications ?
- Monitor for cardiac dysrhythmias
- Monitor for signs of hemorrhage or bleeding
- Monitor for signs of septic shock
- Monitor for signs of DVT (Measure calves & thighs)
- Antiembolism stockings
- Monitor orthostatic hypotension with respositioning
53
What are complications of Spinal Cord injures ? (3)
- Spinal shock
- Neurogenic shock
- Autonomic Hyperreflexia
54
__________________ may occur following an acute SCI ?
Spinal shock
55
What are complications of Spinal Cord injures ? (3)
- Spinal shock (loss of sensation)
- Neurogenic shock
- Autonomic Hyperreflexia
56
How long does spinal shock last ?
Days to weeks
- resolves with return of reflexes
57
Spinal shock is characterized by what (below level of injury) ?
- Decreased reflexes
- Loss of sensation
- Absent thermoregulation
- Flaccid paraysis (Lose and floppy limbs)
58
How long does spinal shock last ?
Days to weeks
- resolves spontaneously !
59
What is Neurogenic shock defined as ?
Loss of vasomotor tone d/t injury
| hemodynamic change
60
What is the 1st thing to return in patients with Spinal shock ?
Reflexes
61
With Neurogenic shock there is a loss of what ?
Sympathetic Nervous system innervation
62
With Neurogenic shock, the loss of sympathetic nervous system innervation causes what
- peripheral vasodilation
- venous pooling
- Decreased CO
63
Neurogenic shock usually occurs with what types of spinal cord injuries ?
Cervical or high thoracic injuries
64
Neurogenic shock is characterized by what ?
(change in vital signs)
- Hypotension
- Bradycardia
These pt's require
- IV fluids
- Vasopressors
65
Autonomic Hyperreflexia (Dysreflexia) can occur with what types of Science ?
with injuries T6 or higher
66
Autonomic Hyperreflexia (Dysreflexia) cannot occur until what ?
Until spinal shock has resolved
67
What is Autonomic Hyperreflexia (Dysreflexia) ?
A massive cardiovascular reaction mediated by the SNS
68
What do we see with Autonomic Hyperreflexia (Dysreflexia) ?
We see stimulation of sensory receptors below the level of the injury
69
What complication of a SCI is considered Life-threatening condition that requires an immediate resolution ?
Autonomic Hyperreflexia (Dysreflexia)
70
If Autonomic Hyperreflexia (Dysreflexia) is left uncorrected, what things can it lead to ?
- Status epilepticus
- Stroke
- MI
- Death
71
What is Autonomic Hyperreflexia (Dysreflexia) caused by ?
an irritant of some sort below the level of the injury
72
When you think of causes of Autonomic Hyperreflexia (Dysreflexia), think of what ?
Somethings happening below the level of the injury
Ex: - a full bladder (or something as simple as a kink in the Foley catheter tubing)
- Distended full bowel
- Hemorrhage
73
The signs and symptoms below are seen with which complication of SCI ?
- Sudden onset of an acute HA
- Extreme increase in BP (EX: over 300)/ or decrease in HR
- Flushed face & chest above level of injury & please below level of injury
- Sweating above level of injury
- Nasal congestion
- Feeling of apprehension
Autonomic Hyperreflexia (Dysreflexia)
74
What are immediate interventions for Autonomic Hyperreflexia (Dysreflexia) ?
- Raise to a sitting position
- Remove the noxious stimulus
- kinked urinary catheter
- fecal impaction
- tight clothes
- Call health care provider if actions do not relieve symptoms
75
What are measures to Decrease Autonomic Hyperreflexia (Dysreflexia) ?
- Promote regular bowel & bladder function
- Use local anesthetic to prevent hyperreflexia if manual rectal stimulation is used to promote bowel function
- Monitor urine output
- Medic alert bracelet indicating a Hx of and risk for Autonomic Hyperreflexia
