Exam 7 (Neuro)

Question 1

Phases of Migraines

Answer 1

Phase One: (prodromal phase)
Aura develops over a period of several minutes and last no more than 1 hour
Pain may be preceded by visual disturbances, flashing lights, lines, spots, shimmering or zig- zag lights
Pain may be preceded by neurologic changes including numbness, tingling of lips, tongue

Second Phase:
Increase in intensity/nausea & vomiting
Pain usually begins in temple and increases in intensity

Third Phase:
Pain becomes dull

Question 2

Mild treatment of Migraines

Answer 2

Mild
simple analgesics - Tylenol
NSAIDS –decrease inflammation
Narcotic analgesics

Question 3

Severe treatment for migraines

Answer 3

1. Triptan Preparations (vasoconstiction)
   Imitrex
   Relapax
   Zomig
2. Ergotamine preparations
   Cafergot: do not give within 24 hrs of triptan medications
3. Isometheptene Combination
   Midrin (APAP, Isometheptene, dichloralphenazone)

Question 4

Drug therapy for Migraines

Answer 4

Drug Therapy
Beta blockers
Antidepressants
Calcium channel blockers
Depakote – promising new Tx
Topamax (low dose)

Question 5

Drugs that could trigger a migraine

Answer 5

Tagamet
Estrogens
Nitroglycerin
Nifedipine

Question 6

Cluster headaches

Answer 6

More common in men

Seasonal in nature

Headaches shorter duration

Vasoreactivity & neurogenic inflammation

Imaging studies suggest:
Overactive and enlarged Hypothalamus

Question 7

Symptoms of cluster headaches

Answer 7

Pain is unilateral deep and around eyes
Ipsilateral tearing of eyes
Rhinorrhea
Flushing/pallor of face
Pace, walks, rocks sit or stand during HA

Question 8

Treatment for cluster headaches

Answer 8

100% Oxygen via mask at 5 liters/min with client in sitting position x 15 minutes

Consistent sleep/wake cycle

Decrease precipitating factors

Question 9

Define epilepsy and seizures

Answer 9

Epilepsy: A chronic disorder characterized by recurrent, unprovoked seizure activity

Seizure: An abnormal, sudden, excessive discharge of electrical activity in the brain.

Question 10

Tonic clonic seizures

Answer 10

Lasts 2-5 minutes
Tonic phase -> stiffening or rigidity of muscles, particularly the arms and legs and immediate loss of consciousness
Clonic phase -> rhythmic jerking of all extremities

Question 11

Absence seizures

Answer 11

More common in children and tends to run in families
Blank staring
Returns to baseline immediately after seizure
May interfere with daily activities (work, school
Automatism

Question 12

Myoclonic seizures

Answer 12

Brief jerking or stiffening of the extremities, which occur singly or in groups
Lasts a few seconds

Question 13

Atonic seizures

Answer 13

Sudden loss of muscle tone, lasting for seconds followed by postictal (after seizure) confusion

Seizure may cause client to fall

Most resistant to drug therapy

Question 14

Partial seizures: simple

Answer 14

Client remains conscious
Reports aura (unusual sensation before occurrence)
Client may have unilateral movement of an extremity
Client may experience unusual sensations

Question 15

Partial seizures complex

Answer 15

Lose consciousness – black out for 1-3 minutes
Automatisms may occur- client is not aware of the behavior such as lip smacking, patting, picking at clothes
After seizure, client may experience amnesia
Area most affected is
temporal lobe

Question 16

Drugs used in seizure management

Answer 16

Dilantin
Ativan
Depakote
Klonopin

Question 17

Seizure precautions

Answer 17

Oxygen and suctioning equipment available
Insert saline lock
Raise side rails, lower bed
Never insert padded tongue blade after seizure begins
Turn client on side, turn head during tonic-clonic and complex partial seizures
Do not restrain the client

Question 18

What is status epilepticus?

Answer 18

Characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes. 
Causes:
Acute alcohol withdrawal
Head trauma
Cerebral edema
Metabolic disturbances

**Neurologic emergency – treat promptly and
aggressively

Question 19

Drug treatment for status epilepticus

Answer 19

Drug Treatment
IV Diazepam (Valium)
IV Lorazepam (Ativan) * drug of choice 
Diazepam gel (Diastat)
Phenytoin (Dilantin) * not compatible with many drugs or D5W….flush IV with normal saline

Question 20

Drug precautions

Answer 20

Be aware of Drug-Drug interactions
Do not give Coumadin with Dilantin
Be aware of Food-Drug interactions
Citrus fruits such as grapefruit can interfere with metabolism

Question 21

Viral meningitis

Answer 21

Inflammation of meninges and CSF
Infected through bloodstream following viral infection
Exudate does not form

Question 22

Bacterial Meningitis

Answer 22

Bacterial is a medical emergency

Infected through bloodstream following a bacterial infection: upper respiratory tract, sinuses or otitis media) or via direct route

Exudate forms which may further irritate spinal and cranial nerves

Meningococcal meningitis: can be epidemic in nature

Question 23

Encephalitis

Answer 23

Inflammation of the brain tissue

Usually viral in nature and preceded by a viral infection and transmitted to brain through bloodstream
Inflammation does not form exudate but causes degeneration of the neurons of the cortex
Demyelization of axons occurs and leads to hemorrhage, edema, necrosis and further can develop into compression of vessels and ICP

Question 24

Symptoms of meningitis and encephalitis

Answer 24

Clinical Manifestations:
Photophobia
Headache, nausea, vomiting & fever
Nuccal Rigidity, seizures and focal neurologic deficits may occur.

Question 25

Meningitis and encephalitis cont…

Answer 25

May lead to ICP – herniation of the brain – death
Stimulation of hypothalamus may lead to SIADH (water retention)
Septic emboli may result in gangrene, DIC, hemiparesis and death.

Question 26

Neurologic infection precautions

Answer 26

Administer medications and IV fluids
Strict I & O
HOB elevated 30 degrees
Reduce stimuli
Maintain isolation for meningitis

Question 27

What is huntingtons disease?

Answer 27

Hereditary disorder
Decrease in GABA and acetylcholine (excitatory)
No change in dopamine (inhibitory)
The shift in balance between dopamine and GABA leads to uninhibited motor activity

Question 28

Symptoms of huntingtons disease

Answer 28

Symptoms
Progressive mental status change leading to dementia

Choreiform movements (rapid, jerky) in limbs, trunk and facial muscles

No cure or treatment
Prevent transmission by not having children
Antipsychotic agents-to manage movements
Administer meds to treat depression etc
Collaborative care – speech therapy, dietician,PT/OT, SW

Question 29

Seizures

Answer 29

• Recognize that generalized seizures, such as the tonic-clonic seizure, involve both cerebral hemispheres. Partial seizures, also called focal or local seizures, usually involve only one hemisphere.

Question 30

Status epilepticus

Answer 30

• Status epilepticus is a medical emergency characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes.
• Causes of status epilepticus may include withdrawal from antiepileptic drugs, alcohol or other drugs, head trauma, infections, cerebral edema, and metabolic disturbances

Question 31

• Meningitis

Answer 31

• Meningitis is an inflammation of the meninges surrounding the brain and spinal cord.
• Bacterial and viral organisms are most often responsible for meningitis, although fungal meningitis and protozoal meningitis also occur.
• Viral meningitis is usually self-limiting and the patient has a complete recovery; but bacterial meningitis is potentially life-threatening.
• Increased intracranial pressure may occur as a result of blockage of the flow of CSF, change in cerebral blood flow, or thrombus formation.
• Analysis of the cerebrospinal fluid is used to diagnose meningitis.
• Patients who are older than 60 years of age, immunocompromised, or with signs of increased intracranial pressure (ICP) usually have a CT scan performed before the lumbar puncture.
• For patients with meningitis, carefully monitor neurologic status, including vital signs and neurovascular checks. Observe for signs and symptoms of increased intracranial pressure (ICP).

Question 32

Parkinson disease

Answer 32

• Parkinson disease, also referred to as paralysis agitans, is a progressive neurodegenerative disease, which most often is idiopathic in origin.
• It is a debilitating disease affecting motor ability and is characterized by four cardinal symptoms: tremor, rigidity, bradykinesia or akinesia, and postural instability

Question 33

Alzheimer’s disease

Answer 33

• Alzheimer’s disease is a chronic, progressive, degenerative disease accounting for 60% of the dementias occurring in people older than 65 years of age, eventually causing complete disorientation and total dependence on others for care.
• It is characterized by loss of memory, judgment, and visuospatial perception, and by a change in personality.
• The most important risk factors are age, female gender, and family history.
• Recall that familial Alzheimer’s disease has a genetic predisposition.

Question 34

• Huntington disease

Answer 34

• Huntington disease is a chronic, hereditary illness that is transmitted as an autosomal dominant trait at the time of conception. Refer patients with the disease for genetic counseling.
• The triad of dominant inheritance, choreiform movements or rapid, jerky movements, and dementia are hallmarks of the disease.
• There is no known cure or treatment, therefore genetic counseling is important.
• The first drug to be approved to decrease chorea associated with HD is tetrabenazine (Xenazine).

Question 35

The client has Parkinson disease (PD). Which nursing intervention best protects the client from injury?

Answer 35

Monitoring the client’s sleep patterns .
Clients with PD tend to not sleep well at night because of drug therapy and the disease itself. Some clients nap for short periods during the day and may not be aware that they have done so. This sleep misperception could put the client at risk for injury (e.g., falling asleep while driving).

Question 36

The client has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place?

Answer 36

Intravenous access
Suction equipment at the bedside
Siderails up

Question 37

The client with a migraine is lying in a darkened room with a wet cloth on the head after receiving analgesic drugs. What will the nurse do next?

Answer 37

Allow the client to remain undisturbed.

Question 38

Which is the most effective way for the college student to minimize the risk for bacterial meningitis?

Answer 38

Getting the meningitis polysaccharide vaccine

Question 39

The nurse is caring for the client with advanced Alzheimer’s disease. Which communication technique is best to use with this client?

Answer 39

Assuming that the client is not totally confused

Question 40

The client is admitted into the emergency department with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What does the nurse suspect may be occurring?

Answer 40

Classic migraine

Question 41

The female client with newly diagnosed migraine is being discharged with a prescription for sumatriptan (Imitrex). Which comment by the client indicates an understanding of the nurse’s discharge instructions?

Answer 41

I must report any chest pain right away.”

Question 42

The parents of a young child report that their child sometimes stares blankly into space for just a few seconds and then gets very tired. The nurse anticipates that the child will be assessed for which seizure disorder?

Answer 42

Absence seizures are more common in children and consist of brief (often just seconds) periods of loss of consciousness and blank staring, as though he or she is daydreaming.

Question 43

The nurse is administering the intake assessment for a newly admitted client with a history of seizures. The client suddenly begins to seize. What does the nurse do next?

Answer 43

Turning the client on the side during a generalized tonic-clonic or complex partial seizure is indicated because he or she may lose consciousness.

Question 44

The client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client?

Answer 44

The most important nursing intervention for clients with meningitis is the accurate monitoring and recording of their neurologic status, vital signs, and vascular assessment. The client’s neurologic status and vital signs should be assessed at least every 4 hours, or more often if clinically indicated. The priority for care is to monitor for early neurologic changes that may indicate increased intracranial pressure (ICP), such as decreased level of consciousness (LOC).

Question 45

The client is being discharged to home with progressing stage I Alzheimer’s disease. The family expresses concern to the nurse about caring for their parent. What is the priority for best continuity of care?

Answer 45

Assigning a case manager

Question 46

The spouse of the client with Alzheimer’s disease (AD) is listening to the hospice nurse explaining the client’s drug regimen. Which statement by the spouse indicates an understanding of the nurse’s instruction?

Answer 46

Cholinesterase inhibitors (e.g., donepezil) are approved for the symptomatic treatment of Alzheimer’s disease.

Question 47

The client has been diagnosed with Huntington disease. The nurse is teaching the client and her parents about the genetic aspects of the disease. Which statement made by the parents demonstrates a good understanding of the nurse’s teaching?

Answer 47

“If she has children, she’ll pass the gene on to her kids.”

Question 48

The nursing instructor asks the student nurse caring for a client with Alzheimer’s disease who has been prescribed donepezil (Aricept) how the drug works. Which response by the nursing student best explains the action of donepezil?

Answer 48

“It delays the destruction of acetylcholine by acetylcholinesterase.”

Question 49

The nurse has received report on a group of clients. Which client requires the nurse’s attention first?

Answer 49

Young adult who has experienced four tonic-clonic seizures within the past 30 minutes

Question 50

A client receiving sumatriptan (Imitrex) for migraine headaches is experiencing adverse effects after taking the drug. Which adverse effect is of greatest concern to the nurse?

Answer 50

Chest tightness
Triptan drugs are contraindicated in clients with coronary artery disease because they can cause arterial narrowing; the nurse should instruct the client to not take the medication until the nurse can talk with the prescribing health care provider.

Question 51

Which change in the cerebrospinal fluid (CSF) indicates to the nurse that the client may have bacterial meningitis?

Answer 51

Cloudy, turbid cerebrospinal fluid is a sign of bacterial meningitis. Clear fluid is a sign of viral meningitis.

Question 52

The nurse is reviewing the history of a client who has been prescribed topiramate (Topamax) for treatment of intractable partial seizures. The nurse plans to contact the health care provider if the client has which condition?

Answer 52

Bipolar disorder

Question 53

• Multiple sclerosis (MS) i

Answer 53

• Multiple sclerosis (MS) is a chronic autoimmune disease that affects the myelin sheath and conduction pathway of the central nervous system and is a leading cause of neurologic disability in young adults.
• This chronic disease is characterized by periods of remission and exacerbation of an inflammatory response that results in demyelinization.
• The four major types of MS include:
o Relapsing-remitting
o Primary progressive
o Secondary progressive
o Progressive-relapsing
• Since there is genetic predisposition, having a first-degree relative such as a parent or sibling with MS increases a person’s risk of developing the disease.

Question 54

Amyotrophic lateral sclerosis

Answer 54

• Amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, is an adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting, and spasticity eventually leading to paralysis.
• There is no known cure for ALS, but an interdisciplinary approach is used to develop an individualized treatment plan to maintain optimum functioning.
• Monitor respiratory status carefully in patients with amyotrophic lateral sclerosis. Patients experience respiratory failure in terminal stages of the disease. Consider their advance directives to assist in planning care

Question 55

The client is admitted with a spinal cord injury at the fifth thoracic vertebra secondary to a gunshot wound. Which nursing intervention is the priority for this client’s care?

Answer 55

Positioning the client to maximize ventilation potential

Question 56

To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the health care team is a nursing priority?

Answer 56

Respiratory therapy
Pneumonia, pulmonary emboli, and atelectasis have replaced kidney failure as the leading causes of death in clients with spinal cord injury. Respiratory therapy helps prevent complications such as these from arising.

Question 57

The client with amyotrophic lateral sclerosis (ALS) is degenerating rapidly and will soon need respiratory support. What will the nurse plan to review with this client?

Answer 57

Advance directive

Question 58

The client has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the client indicates understanding of the nurse’s instruction?

Answer 58

“I can go home the day of the procedure.”

Question 59

Which nursing intervention is best for preventing complications of immobility when caring for the client with spinal cord health problems?

Answer 59

Regular turning and repositioning

Question 60

A client with serve muscle spasticity has been prescribed tizanidine (Zanaflex, Sirdalud). The nurse plans to instruct the client about which adverse effect of tizanidine?

Answer 60

Tizanidine (Zanaflex, Sirdalud) is a centrally acting skeletal muscle relaxant, and drowsiness and sedation are common adverse effects.

Question 61

The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the health care provider will request which medication?

Answer 61

Hydralazine (Apresoline)
This client is experiencing autonomic dysreflexia, which is a neurologic medical emergency that causes severe hypertension and bradycardia. Hydralazine (Apresoline) is an antihypertensive drug used to treat autonomic dysreflexia.

Question 62

Guillain-Barré syndrome

Answer 62

• Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) that affects the peripheral nervous system, causing motor weakness and sensory abnormalities.
• Guillain-Barré syndrome, also called acute idiopathic polyneuritis and polyradiculoneuropathy, is an uncommon disorder affecting middle-aged men slightly more than women.
• Demyelination of the peripheral nerves occurs to varying degrees.
• This is an immune-mediated pathological process where the immune system starts to destroy the myelin sheath that surrounds the axons of the peripheral nerves or attacks the axons themselves.
• Symptoms typically begin in the legs and spread to the arms and upper body, referred to as an ascending paralysis.
• Recall that patients with GBS have ascending paralysis, sensory changes, cranial nerve involvement, and autonomic manifestations as a result of demyelination of neurons.
• Paralysis can increase in intensity until the muscles cannot be used and the patient is almost totally immobile, sometimes requiring mechanical ventilation.
• Three stages make up the acute course: the acute or initial period of 1 to 4 weeks beginning with the onset of the first symptoms and ending when no further deterioration occurs, the plateau period, and the recovery phase which coincides with remyelination and axonal regeneration.
• In general, it is self-limiting and the paralysis temporary, but patients may experience depression throughout the recovery period.

Question 63

Myasthenia gravis

Answer 63

• Myasthenia gravis (MG) is a chronic disease characterized by remissions and exacerbations of fatigue and weakness primarily in muscles innervated by the cranial nerves, as well as in skeletal and respiratory muscles.
• This autoimmune disease of the neuromuscular junction may take many forms—from mild disturbances of the ocular muscles to a rapidly developing, generalized weakness that may lead to death from respiratory failure
• Pharmacologic tests with the cholinesterase inhibitors edrophonium chloride (Tensilon) and neostigmine bromide (Prostigmin) helps to confirm diagnosis.

Question 64

The client with myasthenia gravis (MG) is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates correct understanding of the nurse’s instruction?

Answer 64

A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the client is experiencing crisis. The family member should call 911 for emergency assistance.

Question 65

The client arrives to the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease?

Answer 65

Myasthenia gravis (MG)

Question 66

The client is being evaluated for signs associated with myasthenia crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the client is experiencing a cholinergic crisis?

Answer 66

Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs.

Question 67

The client has returned to the unit after a thymectomy and is extubated. The client begins to report chest pain. What will the nurse do next?

Answer 67

The client’s chest pain is a symptom of a hemothorax or a pneumothorax and must be reported to the surgeon immediately.

Question 68

The nurse is caring for a client with Guillain-Barré syndrome (GBS) who is receiving immunoglobulin (IVIG). Which client finding warrants immediate evaluation?

Answer 68

Headache with stiff neck

This may be a sign of aseptic meningitis, a possible serious complication of IVIG therapy.

Question 69

The nurse admits a client with suspected myasthenia gravis (MG). The nurse anticipates that the physician will request which medication to aid in the diagnosis of MG?

Answer 69

Edrophonium chloride (Tensilon) 
Edrophonium chloride (Tensilon) is used most often for testing for MG because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors

Question 70

The nurse is reviewing the medication history of a client diagnosed with myasthenia gravis (MG) who has been prescribed a cholinesterase inhibitor (ChE). The nurse plans to contact the physician if the client is taking which medication?

Answer 70

Procainamide (Pronestyl) should be avoided because it may increase the client’s weakness.

Question 71

Interventions for Back Pain

Answer 71

Avoid opiod analgesics
Chronic pain – use antiepileptic such as Neurontin (gabapentin)
Heat/ice
Weight control
Diskectomy-spinal nerve lifted to
remove offending
portion of disk
Laminectomy – removal of one or more vertebral laminae plus the herniated nucleus pulposus

Question 72

Spinal cord injury

Answer 72

Initial injury
Hemorrhage – microscopic bleeding into gray matter
Edema – spreads along cord
Vasospasm

Question 73

True or false

Incomplete spinal cord injuries are more common than complete ones

Answer 73

True

Question 74

Most common causes of spinal cord injuries

Answer 74

Most common cause is from trauma:
MVA
Acts of violence
Falls
Sports

Most common vertebrae include:
Cervical 5,6 and 7
Thoracic 12
Lumbar 1

Question 75

Neurogenic shock

Answer 75

Neurogenic shock
May occur within the first 24 hours after injury

Characterized by hypotension and bradycardia

Associated with cervical spine injuries and caused by loss of autonomic function
Hemodynamic Instability

(Results from injury to the descending sympathetic pathways in the spinal cord (loss of vasomotor tone and sympathetic innervation to the heart.)

Question 76

Autonomic dysreflexia

Answer 76

Autonomic dysreflexia    (hyperreflexia)
Characterized by :
Severe hypertension
Bradycardia
Severe headache
Nasal stuffiness
Flushing

Caused by noxious stimuli
Reflex vasoconstriction leading to hypertensive crisis

Noxious stimuli: kinked foley, full bladder, hang nail, fecal impaction, pressure sore, ingrown toe nail (can all lead to seizures, stroke, death if not treated)

Question 77

What is autonomic dysreflexia caused by?

Answer 77

Caused by a massive sympathetic response to any noxious stimuli (full bladder, line insertions, fecal impaction), which results in bradycardia, hypertension, facial flushing , and headache. Immediate intervention is needed to prevent cerebral hemorrhage, seizures, and acute pulmonary edema. Treatment is aimed at relieving noxious stimuli. Prevention is key!!

Question 78

Definition of incomplete spinal cord injury?

Answer 78

Incomplete: Results in mixed loss of voluntary motor activity and sensation below the level of injury

Central Cord Syndrome
Loss of motor function in upper extremities

Question 79

Anterior cord syndrome

Answer 79

Anterior Cord Syndrome

Motor, pain and temp are lost below the injury

Touch, position, vibration are intact
Patient can FEEL toes but cannot MOVE them

Question 80

Brown-Sequard Syndrome

Answer 80

Brown-Sequard Syndrome

Motor function, proprioception and deep touch lost on same side as injury

Pain, temp and light touch are lost on opposite side

Question 81

Posterior Cord Syndrome

Answer 81

Posterior Cord Syndrome

Motor function is intact

Loss of touch, position, vibration below level of injury

( Patient can MOVE toes but cant FEEL them)

Question 82

Drug therapy for spinal cord injuries

Answer 82

Drug Therapy
Vasopressors
Methylprednisolone

Question 83

Rehabilitation

Answer 83

Neurogenic bladder- use valsalva maneuver and check post void residual, some need intermittent cath several times per day, some need indwelling catheter
Risk for renal complications (hydronephrosis, renal failure, kidney stones, UTI’s) These patients may not feel symptoms of infection (dysuria, urgency, back pain)
Bowel schedule- include stool softeners and high fiber diet, increased fluids
Digital stimulation ONLY if requested by healthcare provider- could cases vagal response (bradycardia, syncope)

Question 84

What is MS?

Answer 84

What is MS?
Chronic, progressive degenerative disease that affects the myelin sheath of the brain and spinal cord from viruses, allergies, or an autoimmune response.

MS stands for many scars
Most common demyelinating disease of the CNS
Gliosis means death of cell
Plaques of demyelination
Onset: 10-50 years with average age of 30

Question 85

Pathophisiology of MS?

Answer 85

Inflammatory response destroys myelin leading to axon dysfunction
Myelin sheaths of the spinal cord, brain and optic nerve are destroyed in patches, called plaques along the axon
Demyelination of nerve fibers slows and distorts conduction of nerve impulses or causes total absence of the impulse

Question 86

Symptoms of MS?

Answer 86

FATIGUE
Most common initial symptoms:
Sensory loss 37%
Optic neuritis 36%
Weakness 35%
Paraesthesias 24%
Diplopia 15%
Ataxia 11%
Vertigo 6%
Bladder dysfunction 4%

Question 87

Types of MS

Answer 87

Relapsing Remitting
Most common form of MS at time of initial diagnosis
Acute worsening with complete or partial recovery
85% most common
During relapse the person is free of disease

Secondary Progressive
Experience an initial period of relapsing-remitting disease
Followed by a steadily worsening disease course

Primary Progressive and Progressive Relapsing
Relatively rare

Question 88

Tests for clients with MS?

Answer 88

No single test can reliably diagnose MS

CSF shows elevated proteins, WBC cells and IgG bands due to the immune response

CT scan shows atrophy and white matter lesions

Oligoclonal bands are band of immunoglobulins that are seen when a patient’s blood plasma or CSF is analyzed
CSF sample and blood sample obtained at the same time to compare bands
Oligoclonal bands present in CSF, but not in blood serum, indicate central nervous system production of immunoglobulins
These bands are indicators in the diagnosis of MS
Approx 80-90% of all patients with MS have bands
Most consistent with diagnosis of MS
From two to five bands can be seen
Bands disappear from CSF as a person recovers from the neuro disease

Question 89

Pharmalogical measures for those with MS?

Answer 89

Corticosteroids – help decrease symptoms and induce remissions through anti-inflammatory effects
Solu-Medrol (Methylprednisolone drug of choice for acute exacerbations of MS)
1000 mg IV daily for 3 days high dose
followed by oral Prednisone (Orasone)

Novantrone (Mitoxantrone)
Given IV
Antineoplastic agent effective for MS
Agent can cause CHF and life threatening dysrhythmias

Tysabri (Natalizumab)
Humanized Monoclonal Antibody
Use for pts who don’t tolerate other MS drugs
IV piggyback 
No flu symptoms!

Question 90

What is ALS or Lou Gehrig’s Disease?

Answer 90

Most common progressive motor neuron disease of muscular atrophy
ALS is often called Lou Gehrig’s disease after Lou Gehrig, a hall-of-fame baseball player for the New York Yankees who was diagnosed with ALS in the 1930s. People in England and Australia call ALS motor neurone disease (MND). The French refer to it as maladie de Charcot, after the French doctor Jean-Martin Charcot, who first wrote about ALS in 1869.
spinal cord. Motor neurons are nerve cells that control muscle movement. Upper motor neurons send messages from the brain to the spinal cord, and lower motor neurons send messages from the spinal cord to the muscles. Motor neurons are an important part of the body’s neuromuscular system.
The neuromuscular system enables our bodies to move and is made up of the brain, many nerves, and muscles. Things that we do every day — like breathing, walking, running, lifting stuff, and even reaching for a glass of water — are all controlled by the neuromuscular system.
Here’s how the neuromuscular system works: If you want to make a fist, your brain first sends signals through upper motor neurons to the area in your spinal cord that controls your hand muscles. Then lower motor neurons in your spinal cord signal the muscles in your hand to move and make a fist.
Over time, Lou Gehrig’s disease causes these motor neurons in the brain and spinal cord to shrink and disappear, so that the muscles no longer receive signals to move. As a result, the muscles become smaller and weaker. Gradually the body becomes paralyzed, which means that the muscles no longer work.
However, someone with ALS, even at an advanced stage, can still see, hear, smell, and feel touch. The nerves that carry feelings of hot, cold, pain, pressure, or even being tickled, are not affected by Lou Gehrig’s disease. In some people with ALS, the parts of the brain that allow us to think, remember, and learn also are affected by the disease.

Question 91

Cause of death for ALS?

Answer 91

Progressive, debilitating, neuromuscular disorder
No cure
Degeneration of both upper (central nervous system) and lower motor neurons (central and peripheral nervous system)
Progressive wasting and atrophy of all voluntary muscles
Characterized by weakness, fasciculations, and hyperactive reflexes
Cause of death:
Respiratory insufficiency from weakness of muscles
Starvation from an inability to eat

Question 92

Incidence of ALS

Answer 92

Age of onset is between 40 and 70 yrs

More prevalent in men

Death occurs 2-5 years after the onset

Question 93

Cause of ALS

Answer 93

Causes
Unknown
May be related to increased levels of glutamate
10% have inherited form of the disease
Viral infection creates a disturbance in motor neurons
Autoimmune response

Question 94

Characteristics of ALS

Answer 94

Characteristics
Progressive loss of motor neurons in both the cerebral cortex and the spinal cord until flaccid quadriplegia occurs
Atrophy of the hands, forearms and legs
Impairment of the respiratory muscles distinguishes it from MS
Results in paralysis and death

Question 95

Gullian Barre syndrome

Answer 95

Pathophysiology
Immune system attacks ascending or descending peripheral nerves
Myelin sheath surrounding axons is destroyed
Myelin can regenerate in PNS
Motor, sensory and autonomic functions may be involved
Affects motor, sensory, autonomic nerves and spinal roots
Demyelination accompanied by edema and inflammation of peripheral nerves
Lymphocytes and macrophages are responsible for actually stripping the myelin between the Nodes of Ranvier – patchy
Remyelination occurs slowly – can take years

Question 96

What is the most common form of gullian barre syndrome?

Answer 96

Ascending GBS (most common)
Weakness, paresthesia in lower extremities
Weakness progresses upward to trunk, arms and/or cranial nerves
Motor deficit may range from mild paresis to total quadriplegia
Respiratory compromise
Cardiac dysrhythmias
Labile BP

Question 97

Descending GBS symptoms

Answer 97

Descending GBS
Weakness of facial muscles (cranial nerves)
Dysphagia
Ophthalmoplegia (paralysis or weakness of eye muscles)
Diplopia
Difficulty speaking
Respiratory compromise

Question 98

Diagnosing GBS

Answer 98

Diagnosis
Lumbar puncture – increase in CSF protein level without an increase in cell count is a distinguishing feature
Moderate leukocytosis early in illness
EMG – decreased motor nerve conduction
MRI/CT to rule out other causes

Question 99

Treatment of GBS

Answer 99

Prepare client for plasmaphoresis
Removes circulating antibodies that cause GBS
Plasma is separated from whole blood
Client receives 3 to 4 treatments 1-2 days apart
Can reduce recovery up to 50

Question 100

Myasthenia Gravis incidence

Answer 100

Incidence
0.5 cases per 100,000 people
Affects most people between 20 and 30 yrs old
Women are affected three times more than men
May be preceded by infection, emotional upset, pregnancy, or anesthesia

Question 101

Pathophysiology of MG?

Answer 101

Pathophysiology
Autoimmune disease of the neuromuscular junction
Affects cranial nerves, skeletal and respiratory muscles
Caused by an antibody attack on the acetylcholine receptors (AChR) in muscle end plate membranes
Overgrowth of thymus gland or thymoma
Characterized by remissions and exacerbations

Question 102

MG symptoms

Answer 102

Weakness and fatigue
Difficulty chewing
Dysphagia
Ptosis
Diplopia
Weak, hoarse voice
Difficulty breathing
Diminished breath sounds
Respiratory paralysis and failure

Question 103

Diagnosing MG

Answer 103

Diagnosis
AChR antibodies 
Thyroid function tests 
Chest CT
Tensilon testing – client shows improvement after administration
Inhibits breakdown of 
   Ach at postsynaptic 
	membrane
Antidote: Atropine 
EMG

Question 104

Myasthenia crisis

Answer 104

Myasthenia crisis
Acute exacerbation of the disease 
Caused by rapid progression of MG, inadequate medication, infection, stress, fatigue
Symptoms
Restless
Weakness
Dyspnea
Dysphagia

Question 105

Cholinergic crisis

Answer 105

Cholinergic crisis
Depolarization of motor end plates
Caused by overmedication with anticholinesterase drugs
Symptoms
Restlessness
Weakness
Dyspnea
Dysphagia
Nausea, vomiting, and diarrhea
Fasciculations