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ADULT HEALTH 1 > Exam 4- Peripheral Nervous System > Flashcards

Exam 4- Peripheral Nervous System Flashcards

1
Q

Guillain-Barre´ Syndrome

A
  • Acute onset
  • Monophasic immune-mediated disorder of the peripheral nervous system
  • Demyelination of peripheral nerves
  • Result of immune-mediated pathologic processes

-Symptoms:
Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction

-Incidence: 1-2 cases per 100,000

-Variants
Acute inflammatory demyelinating polyradicularneuropathy (AIDP) most common in the US

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2
Q

Guillain-Barre´ Syndrome: Etiology

A
  • Immune mediated response:IgG antibodies
  • Viral infections
  • Bacterial infection-have you been sick with any type of infection?
  • Vaccines
  • Lymphoma
  • Surgery
  • Trauma
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3
Q

GB Patho

A
  • Segmental demyelination process of the peripheral nerves
  • T cells migrate to the peripheral nerves: Edema & inflammation

-Macrophages:
Break down myelin
Inflammation
axonal damage

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4
Q

Stages of Guillain-Barre: Initial

A
  • 1-4 weeks

- onset til no new symptoms present

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5
Q

Stages of Guillain-Barre: Plateau

A
  • several days to 2 weeks

- no deterioration and no improvement

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6
Q

Stages of Guillain-Barre: Recovery

A
  • 4-6 months and up to 2 years
  • remyelination and return of muscle strength
  • Recovery much faster in young adults
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7
Q

GB Signs & symptoms

A

-Motor weakness, parathesias

-Cranial nerve dysfunction:
Oculomotor, facial, glossopharyngeal, vagal, spinal accessory, hypoglossal

-Autonomic dysfunction:
BP fluctuation
dysrhythmias

  • Motor loss:
  • Symmetric, bilateral, ascending(eventually have the inability to take a deep breath)*
  • Measure tidal volume, chest rise (RR) q4h*

-Respiratory function:
Inspiratory force, tidal volume

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8
Q

GB: Diagnosis

A

-CSF analysis:
Elevated CSF proteins with normal cell counts (wbc & rbc okay)

-Nerve conduction studies:
Electromyeography (EMG)
Nerve conduction velocity

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9
Q

GB: Management

A

-Plasmapheresis:
Exchanges occur ~ three to four treatments, 1 to 2 days apart
IV access in hospital
Need intubation

-Intravenous Immune globulin (IVIG):
Daily dose based on body weight for 5 consecutive days

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10
Q

Plasmapheresis

A
  • Removes circulating antibodies assumed to cause disease
  • Plasma selectively separated from whole blood; blood cells returned to patient without plasma
  • Plasma usually replaces itself, or patient is transfused with albumin
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11
Q

GB: Collaborative management

A

-Survey for complications
-Acute dysautonomia
-HR, BP
-Respiratory care
-Atelectasis, VAP,
pneumothorax, ARDS
-Skin & musculoskeletal - support
-Decubiti, ROM
-Gastrointestinal
-Ileus

  • Initiating rehab in the ICU
    • Early mobility
  • Nutritional support
    - enteral
  • Emotional support
    • Due to sudden paralysis
  • Patient education
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12
Q

GB: Plan of Care

A

-Diagnostic testing

-Priority nursing care
Respiratory care
Pain management
Communication and emotional (altenate methods, specialized call button) 
Nutritional
  • Involvement of family, other team members
  • Education
  • Medical treatments—plasmapheresis
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13
Q

Myasthenia Gravis

A
  • An acquired autoimmune disease characterized by muscle weakness
  • Caused by antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction
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14
Q

Types of MG

A

Ocular & Generalized

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15
Q

MG Risk factors

A
  • Coexisting autoimmune disorder

- Hyperplasia of the thymus gland

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16
Q

MG Triggers

A

Infection
Stress, fatigue
Pregnancy
Heat

17
Q

MG Symptoms

A 
Progressive muscle weakness
Diplopia
*Drooping eyelids, one or both (ptosis)*
Difficulty chewing and swallowing (dysphagia)
Respiratory dysfunction
Bowel & bladder dysfunction
*Fatigue*
18
Q

Tensilon Testing

A

-Baseline assessment of cranial muscle strength
Edrophonium (Tensilon) administered
Monitor eyelid
Give a small amount to assess tolerance

-Positive test:
Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes

-Nursing care:
Observe for facial fasciculations, cardiac arrhythmias
Observe for bradycardia, sweating, abdominal cramps
Atropine at bedside

19
Q

MG: Cholinesterase Inhibitor Drugs

A

-Anticholinesterase (antimyasthenics)
Enhance neuromuscular impulse transmission by preventing decrease of ACh by enzyme ChE
Improves muscle strength

-Pyridostigmine (Mestinon)
Administer with small amount of food-time it an hr before a meal so that they will have strength to eat the meal
Eat meal 45 to 60 minutes after med
Observe drug interactions
Magnesium, morphine, sedatives, neomycins

Medication given on a strict schedule

20
Q

MG: treatments

A

-Immunosuppressants Prednisone or Azathioprine (Imuran)
Given during periods of exacerbations
Monitor for infections

  • Plasmapheresis
  • Thymectomy=if it involves the thymus
21
Q

MG: Management

A

Respiratory support

Promoting self-care guidelines

Assisting with communication

Nutritional support

Eye protection

22
Q

Cholinergic crisis

A 
T-oo much ChE inhibitor drug
Increased weakness
Hypersalivation
Sweating
Increased bronchial secretions
N,V&D
Hypotension
  • Maintain respiratory function
  • Anticholinergic drugs withheld while on ventilator
  • Atropine
  • Supportive care
23
Q

Myasthenic Crisis

A
  • Not enough ChE inhibitor drug
  • Flare of sx, increased weakness
  • Hypertension
  • Increased HR, RR
  • Maintain respiratory function
  • Cholinesterase-inhibiting drugs withheld
  • Supportive w/other conditions that cause complications with the disease
24
Q

MG Health Teaching

A

-Factors in exacerbation—infection, stress, surgery, hard physical exercise, sedatives, enemas, strong cathartics

Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes

-Teach warning signs and importance of compliance

25
Q

Peripheral Nerve Trauma: Common causative agents

A
  • Vehicular or sports injury

- Wounds to peripheral nerves

26
Q

Peripheral Nerve Trauma

A
  • Degeneration/retraction of nerve distal to injury within 24 hr
  • Cold phase vs. warm phase
  • Perioperative and postoperative care
  • Rehabilitation through physiotherapy
27
Q

Restless Legs Syndrome (RLS)

A

-Leg paresthesias
Irresistible urge to move
Peripheral and central nerve damage in legs/spinal cord

28
Q

Restless Legs Syndrome (RLS): Management

A

Symptomatic
Nonmedical treatment
Drug therapy effective for some patients

29
Q

Trigeminal Neuralgia

A

Trigeminal or fifth cranial nerve

30
Q

TN Pain management

A 
-Nonsurgical management
Gabapentin 
-Surgical management	
Microvascular decompression
Radiofrequency thermal coagulation
Percutaneous balloon microcompression
31
Q

TN post-op care

A

Infection, intense pain, bleeding

32
Q

Facial Paralysis (Bell’s Palsy

A
  • Seventh cranial nerve
  • Interventions
    • Medical management
      • Prednisone, analgesics, acyclovir (if there is a viral etiology
      • Protection of eye
      • Nutrition – my have trouble swallowing
      • Massage, warm/moist heat, facial exercises

ADULT HEALTH 1 (4 decks)

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