Exam 4: Problems of the Peripheral Nervous System (7 questions)

Question 1

Guillain-Barre syndrome pathophysiology

Answer 1

• Segmental demyelination process of the peripheral nerves
• T cells migrate to the peripheral nerves
  Edema & inflammation
• Macrophages
  Break down myelin
  Inflammation
  axonal damage
• Temporary condition
• Acute onset
• Acute inflammatory demyelinating polyradicularneuropathy (AIDP) most common in the US

Question 2

Guillain-Barre syndrome etiology

Answer 2

• Immune mediated response
  IgG antibodies
• Viral infections
• Bacterial infection
• Vaccines
• Lymphoma
• Surgery
• Trauma

Question 3

Guillain-Barre syndrome stages

Answer 3

• Initial:
  1-4 weeks
  onset til no new symptoms present
• Plateau:
  several days to 2 weeks
  no deterioration and no improvement
• Recovery:
  4-6 months and up to 2 years
  remyelination and return of muscle strength

Question 4

Guillain-Barre syndrome symptoms

Answer 4

• Motor weakness, parathesias
• Cranial nerve dysfunction
  Oculomotor, facial, glossopharyngeal, vagal, spinal accessory, hypoglossal
• Autonomic dysfunction
  BP fluctuation
  dysrhythmias
• Motor loss
  Symmetric, bilateral, ascending
• Respiratory function
  Inspiratory force, tidal volume

Question 5

Guillain-Barre syndrome treatment

Answer 5

• Plasmapheresis
  Exchanges occur ~ three to four treatments, 1 to 2 days apart
• Intravenous Immune globulin (IVIG)
  Daily dose based on body weight for 5 consecutive days

Question 6

Plasmapheresis for Guillain-Barre syndrome

Answer 6

• 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

Question 7

Guillain-Barre syndrome nursing care/management

Answer 7

• Survey for complications
• Early mobility
• Enteral Nutrition
• Emotional support
• Patient education

Question 8

Myasthenia Gravis pathophysiology

Answer 8

• An acquired autoimmune disease characterized by muscle weakness
• Caused by antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction
• Types: Ocular & Generalized

Question 9

Myasthenia Gravis- Tensilon Testing

Answer 9

• Baseline assessment of cranial muscle strength

- Edrophonium (Tensilon) administered

Question 10

Myasthenia Gravis- Tensilon Testing: Positive test

Answer 10

Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes (look at eyelids)

Question 11

Myasthenia Gravis- Tensilon Testing: complications/nursing care`

Answer 11

• Observe for facial fasciculations, cardiac arrhythmias
• Observe for bradycardia, sweating, abdominal cramps
• Atropine at bedside

Question 12

Myasthenia Gravis- Cholinergic crisis

Answer 12

• Too much ChE inhibitor drug (Anticholinesterase (antimyasthenics)) and (Pyridostigmine (Mestinon))
• Increased weakness
• Hypersalivation
• Sweating
• Increased bronchial secretions
• N,V&D
• Hypotension

Question 13

Myasthenia Gravis- Cholinergic crisis: treatment

Answer 13

• Maintain respiratory function
• Anticholinergic drugs withheld while on ventilator
• Atropine

Question 14

Myasthenia Gravis- Myasthenia crisis

Answer 14

• Not enough ChE inhibitor drug
• Flare of sx, increased weakness
• Hypertension
• Increased HR, RR

Question 15

Myasthenia Gravis- Myasthenia crisis: treatment

Answer 15

• Maintain respiratory function

- Cholinesterase-inhibiting drugs withheld