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N136 MCA II > Exam II > Flashcards

Exam II Flashcards

1
Q

Myasthenia Gravis patho

A

Autoimmune - acetylcholine receptors in muscle = nerve impulse not transmitted

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2
Q

Multiple Sclerosis patho

A

Autoimmune - mylein sheath (CNS so does not regenerate)

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3
Q

Guillian Barre patho

A

Autoimmune - myelin sheath destroyed (PNS so regenerates = recovery)

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4
Q

Amyotrophic Lateral Sclerosis patho

A

Autoimmune - muscle atrophy from loss of spinal cord nerves = scar tissue, motor neurons

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5
Q

Myasthenia Gravis S&S

A

Early - facial / occular, chewing and swallowing difficulty, diplopia - double vision, ptosis - drooping of eyelids
Late - limb weakness, general muscle weakness, respiratory impairment

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6
Q

Multiple Sclerosis S&S

A

Early - nystagmus - involuntary eye movement, fatigue, spasticity
Late - motor and sensory impairments in trunk and limbs, numbness and weakness
symptoms come and go, onset gradual / chronic

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7
Q

Guillian Barre S&S

A

Ascending - lower extremity paresthesia, paresis to quadreplegia with 50% respiratory compromise, does not affect LOC
Descending - eye, facial and jaw muscle weakness, diplopia, dysphagia
sudden onset, acute, 3 stages
acute phase - onset, ends when no further deterioration 1-4 weeks
plateau phase - little change, several days to 2 weeks
recovery phase - remyelination and axonal regeneration 4-6 months

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8
Q

Amyotrophic Lateral Sclerosis S&S

A

Early - fatigue, dysphagia & dysarthria - difficulty articulating, extremity weakness
Late - flacid quadreplegia, atrophy extremities, respiratory impairment
gradual onset - no cure

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9
Q

Myasthenia Gravis diagnostics

A

AChR antibodies, thyroid function tests, Tensilon Test, EMG - repetitive nerve stimulation, pattern of response, serum blood test - acetylcholine receptor antibody

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10
Q

Multiple Sclerosis diagnostics

A

lumbar puncture - detect oligoclonal bands, CSF, MRI - plaques in brain, nerve sheath demyelination, CT

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11
Q

Guillian Barre diagnostics

A

Lumbar puncture, Leukocytosis, EMG, MRI, CT

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12
Q

Amyotrophic Lateral Sclerosis diagnostics

A

Elevated CK, muscle biopsy

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13
Q

Myasthenia Gravis nursing priorities

A

Risk for ineffective breathing pattern, activity intolerance related to fatigue / muscle weakness, self care deficit, deficient knowledge

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14
Q

Multiple Sclerosis nursing priorities

A

fatigue, impaired physical mobility, urinary retention, constipation, disturbed sensory perception - visual, deficient knowledge

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15
Q

Guillian Barre nursing priorities

A

airway, cardiac, acute pain, impaired physical mobility, self care deficit, risk for aspiration

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16
Q

Amyotrophic Lateral Sclerosis nursing priorities

A

speech therapy, dietician, hospice, advance directives

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17
Q

Myasthenia Gravis interventions

A

anticholinesterase agents - donepezil (aricept), memantine (nameda), mestinon immunosuppressives - prednisone, chemo - imuran, cytotoxan, plasmapheresis - remove abnormal antibodies, thymectomy - remove thymus gland

18
Q

Multiple Sclerosis interventions

A

corticosteroids, antispasmodics/muscle relaxants - tizaninde, baclofen, adjuncts - parethesias biologic response modifiers, CNS stimulant - Ritalin for fatigue, anticholinergics - probanthine, ditropan, oxybutynin - reduce urinary frequency / urgency, side effects - thrombocytopenia, leukopenia, depression, injection site reactions

19
Q

Guillian Barre interventions

A

plasmaphoresis - infection, hypovolemia, low K and Ca, paresthesias temporarily - abnormal sensations

IV immunoglobulin - safer

20
Q

Amyotrophic Lateral Sclerosis interventions

A

rilutex - increases lifespan, meds to manage symptoms

21
Q

Head injury

A

ABCs, vitals and neuro, basal skull fracture - CSF drainage (otorrhea/rhinorrhea), head of bed - 20-30 degrees

22
Q

Increased ICP

A

Early sign - LOC, Late signs - Cushing’s triad - widening pulse pressure, decreased RR - cheyne stokes - deep irregular respirations, decreased PR - bradycardia, personality change, behavior change, diplopia

23
Q

Seizure

A

Aura, LOC, incontinence, positioning - safety and airway, oxygen and suction, monitor, record, and report, padded side rails

24
Q

GCS score

A

Motor 6
no move, extension, abnormal flexion, withdrawal, localizes, obeys commands

Verbal 5
no sound, incomprehensible, inappropriate, confused, oriented

Eye 4
no open eyes, opens eyes pain, voice, spontaneously

25
Q

Types of strokes

A

TIA - 10 min - 48 hr, temporary, no damage, warning for ischemic strokes

Ischemic - partial / complete occlusion
Thrombotic - thrombus, plaques already narrowed blood vessels
Embolic - sudden, clot dislodged, move elsewhere

Hemorrhagic - bleeding into brain, intracerebral / subarachnoid

26
Q

Treatment ischemic stroke

A

IV thrombolytics - tPA, early treatment, within 3 hours from onset, BP > 185/110, older than 18, break up clots
anticoags - heparin, lovenox, coumadin, prevent further clotting
antiplatelet - aspirin, prevent future stroke
antihypertensive - want to keep BP high, not too high
embolectomy - remove emboli

27
Q

Treatment hemorrhagic stroke

A

interventional radiology - coiling, small hole starts in femoral / radial artery
surgery
lower BP

28
Q

Symptoms of stroke FAST

A

Facial droop
Arm drift
Slurred speech
Time - when initial symptoms started

29
Q

Types of generalized seizures

A

generalized - distributed, loss of consciousness
absence seizures - brief periods of impaired consciousness without convulsions
myoclonic - brief jerky motor movements
clonic - rhythmic jerky movements, upper/lower extremities
tonic - sudden tonic extension/flexion of neck/head/trunk/extremities
tonic/clonic or grand mal - rhythmic clonic movements with prolonged postictal phase
atonic - loss of postural tone, falls injury
status epilepticus - seizure more than 5 min, multiple seizures, emergency, lorazepam

30
Q

Types of partial seizures

A

partial seizures
simple partial - sensory symptoms, motor symptoms, no loss of consciousness
complex partial - psychomotor seizure, temporal lobe, altered behavior, loses consciousness for a few seconds

31
Q

Seizure patho

A

sudden, transient, alteration of brain function, a lot of energy, disorderly discharge

32
Q

Stroke patho

A

loss of perfusion to brain - blockage - ischemic, or bleed - hemorrhagic

33
Q

Stroke on right side of brain

A

paralyzed left side, left sided neglect, spatial perceptual deficits, deny/minimize problems, rapid performance, short attention span, impulsive, safety problems, impaired judgement, impaired time concepts

34
Q

Stroke on left side of brain

A

paralyzed right side, impaired speech/language aphasias, impaired right/left discrimination, slow performance, cautious, aware of deficits, depression, anxiety, impaired comprehension related to language, math

35
Q

Autonomic dysreflexia

A

caused by lesion / injuries above T6, or distended bladder or impacted rectum, emergency

severe hypertension, bradycardia, severe headache, nasal stuffiness, flushing

  1. raise head of bed, high fowler’s
  2. loosen tight clothing
  3. check for bladder distension, noxious stimulus
  4. admin HTN meds
  5. document occurrence, treatment, response
36
Q

Cervical injuries

A

C2-C3 - fatal
C4 - respiratory difficulty, paralysis all 4 extremities
C5-C8 - movement in shoulder, decreased respiratory

37
Q

Thoracic injuries

A

loss of movement of chest, trunk, bowel, bladder, legs, leg paralysis

above T6 - autonomic dysreflexia

38
Q

Lumbar and sacral injuries

A

S2-S3 - micturition, bladder contract but not empty
above S2 - have erection, no ejaculation
S2-S4 - no erection, no ejaculation, damage sympathetic and parasympathetic response

loss of movement and sensation of lower extremities

39
Q

Antidote heparin

A

Protamine sulfate

40
Q

Antidote coumadin

A

Vitamin K

41
Q

Antidote tensilon

A

Atropine

N136 MCA II (2 decks)

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