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Med Surg II > Exam 2: Peripheral Nerve Problems > Flashcards

Exam 2: Peripheral Nerve Problems Flashcards

1
Q

What is Bell’s palsy caused by ?

A

Inflammation of the 7th (facial) cranial nerve

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2
Q

Bell’s palsy is characterized what ?

A

One-sided facial paralysis

  • can happen very rapidly - Within a few hours
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3
Q

Is the cause of Bell’s palsy unknown ?

A

Yes!

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4
Q

With Bell’s palsy there is a possible link with what ?

A

Viral link (HSV)

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5
Q

Bell’s Palsy is associated with what types of illness/ symptoms ?

A

Flu-like illness

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6
Q

Bell’s palsy is Benign, with a full recovery happening when ?

A

3 to 6 months

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7
Q

True or False: A small percentage of individuals with Bell’s palsy with have long-tern paralysis ?

A

True

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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
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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
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10
Q

What is the Nursing Goal for pt’s with Bell’s palsy ?

A
  • Free of injury

- Adequate nutrition

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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
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12
Q

Guillan-Barre Syndrome is defined as what ?

A
  • Acute, rapidly progressing polyneuritis
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13
Q

What is Guillan-Barre Syndrome characterized by ?

A

Progressive motor weakness, possible paralysis (ascending)

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14
Q

Guillan-Barre Syndrome is immune mediated and commonly seen when ?

A

Following a viral infection, illness, or immunization (1-3wks)

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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

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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

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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

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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)
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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)
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20
Q

In pt’s with GBS we want to maintain airway , what should be kept at the bedside ?

A

Trach set

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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
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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”

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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

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24
Q

GBS starts how & Resolves how ?

A

Starts: from the bottom up
Resolves: from the top down

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25
Q

Spinal cord injury is defined as what ?

A

Trauma or damage to the spinal cord

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26
Q

Spinal cord injuries occur primarily in who ?

A

Young men

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27
Q

_________ &_______ are present in the majority of accidental spinal cord injuries ?

A

ETOH and drugs

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28
Q

What are complications related to spinal cord injures ?

A
  • Respiratory failure
  • Autonomic dysreflexia
  • Spinal shock
  • Further cord damage
  • Death
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29
Q

The prognosis for spinal cord injuries cannot be determined for how long ?

A

For up to 72 hours

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30
Q

What are the different levels where spinal cord injuries can occur ?

A
  • Cervical
  • Thoracic
  • Lumbar
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31
Q

What are the most frequently involved vertebrae of the following

  • Cervical:
  • Thoracic:
  • Lumbar:
A

Cervical: C5, C6, C7

Thoracic: T12

Lumbar: L1

  • because there the most flexible areas of the spine
32
Q

What is another name for Quadriplegia ?

A

Tetraplegia

33
Q

What is Quadriplegia ?

A

Paralysis involving all 4 extremities

34
Q

What is Paraplegia ?

A

Paralysis involving only the lower extremities

35
Q

With Paraplegia spinal cord injuries generally occur where ?

A

Between T1 and L4

36
Q

With Quadriplegia spinal cord injuries generally occur where /

A

Between C1 and C8

37
Q

What type of spinal cod injury is defined as a _________ transection of the spinal cord; with symptoms depending on the extant & location of damage ?

A

Incomplete injury

blank line word = partial)

38
Q

A C4 spinal cord injury will result in what ?

A
  • Tetraplegia (Quadriplegia)

- complete paralysis below the neck

39
Q

A C6 spinal cord injury will result in what ?

A

Partial paralysis of the hands and arms as well as the lower body

40
Q

A T6 spinal cord injury will result in what ?

A
  • Paraplegia

- Paralysis below the chest

41
Q

A L1 spinal cord injury will result in what ?

A
  • Paraplegia

- Paralysis below the waist

42
Q

True or False: You should always suspect a SCI when trauma occurs until it can be ruled out ?

A

True

43
Q

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 ?

A

True

44
Q

When somebody comes in with trauma to the spinal cord/SCI, what should you assess/do ?

A

Assess respirations & maintain airway

45
Q

True or False: With trauma to the spinal cord/SCI, you should prevent head flexion, rotation, or extension ?

A

True

46
Q

In pts with spinal cord trauma/SCI how should you turn them ?

A

Log roll

  • not part of body should be twisted/turned - cannot sit up
47
Q

In the ED, patient with a cervical fracture should be placed in what immediately ?

A

rigid C-collar

48
Q

If a pt. has an injury around C4, they may not be able to do what ?

A

Use the muscles of respiration effectively

  • Monitor ABG’s
  • May need mechanical ventilation
49
Q

If its with SCI are able to breath on their own, what do we want to encourage ?

A

C & DB

50
Q

In terms of respiratory management/iinterventions, what do we want to monitor for in patients with SCI ?

A

Monitor for respiratory infection

51
Q

What can occur with a C4 SCI ?

A

Paralysis of the intercostal & abdominal muscles

52
Q

What nursing interventions do we want to monitor for during hospitalizations of pt’s with SCI, to prevent complications ?

A
  • 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
Q

What are complications of Spinal Cord injures ? (3)

A
  • Spinal shock
  • Neurogenic shock
  • Autonomic Hyperreflexia
54
Q

__________________ may occur following an acute SCI ?

A

Spinal shock

55
Q

What are complications of Spinal Cord injures ? (3)

A
  • Spinal shock (loss of sensation)
  • Neurogenic shock
  • Autonomic Hyperreflexia
56
Q

How long does spinal shock last ?

A

Days to weeks

  • resolves with return of reflexes
57
Q

Spinal shock is characterized by what (below level of injury) ?

A
  • Decreased reflexes
  • Loss of sensation
  • Absent thermoregulation
  • Flaccid paraysis (Lose and floppy limbs)
58
Q

How long does spinal shock last ?

A

Days to weeks

  • resolves spontaneously !
59
Q

What is Neurogenic shock defined as ?

A

Loss of vasomotor tone d/t injury

hemodynamic change

60
Q

What is the 1st thing to return in patients with Spinal shock ?

A

Reflexes

61
Q

With Neurogenic shock there is a loss of what ?

A

Sympathetic Nervous system innervation

62
Q

With Neurogenic shock, the loss of sympathetic nervous system innervation causes what

A
  • peripheral vasodilation
  • venous pooling
  • Decreased CO
63
Q

Neurogenic shock usually occurs with what types of spinal cord injuries ?

A

Cervical or high thoracic injuries

64
Q

Neurogenic shock is characterized by what ?

A

(change in vital signs)

  • Hypotension
  • Bradycardia

These pt’s require

  • IV fluids
  • Vasopressors
65
Q

Autonomic Hyperreflexia (Dysreflexia) can occur with what types of Science ?

A

with injuries T6 or higher

66
Q

Autonomic Hyperreflexia (Dysreflexia) cannot occur until what ?

A

Until spinal shock has resolved

67
Q

What is Autonomic Hyperreflexia (Dysreflexia) ?

A

A massive cardiovascular reaction mediated by the SNS

68
Q

What do we see with Autonomic Hyperreflexia (Dysreflexia) ?

A

We see stimulation of sensory receptors below the level of the injury

69
Q

What complication of a SCI is considered Life-threatening condition that requires an immediate resolution ?

A

Autonomic Hyperreflexia (Dysreflexia)

70
Q

If Autonomic Hyperreflexia (Dysreflexia) is left uncorrected, what things can it lead to ?

A
  • Status epilepticus
  • Stroke
  • MI
  • Death
71
Q

What is Autonomic Hyperreflexia (Dysreflexia) caused by ?

A

an irritant of some sort below the level of the injury

72
Q

When you think of causes of Autonomic Hyperreflexia (Dysreflexia), think of what ?

A

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
Q

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
A

Autonomic Hyperreflexia (Dysreflexia)

74
Q

What are immediate interventions for Autonomic Hyperreflexia (Dysreflexia) ?

A
  • 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
Q

What are measures to Decrease Autonomic Hyperreflexia (Dysreflexia) ?

A
  • 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

Med Surg II (13 decks)

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