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Kol- 410 Med Surg II > Guillane Barre / MG / TN > Flashcards

Guillane Barre / MG / TN Flashcards

1
Q

who is guillain barre? what makes her tick?

A
  • autoimmune
  • damage to myelin sheath
  • unknown cause with various triggers

most common triggers:
COVID
Respiratory Infection
GI infection
Zika Virus
Cytomegalovirus
Mycoplasma pneumonia
Campylobacter
Influenza virus
Epstein Barr virus (mono)
Hep A, B, C, E
HIV

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2
Q

how common is it that guillain barre is caused by surgery and vaccinations?

A

rare according to this lecture

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3
Q

3 phases of guillain barre

what happens during them? how long to they last

A
  1. progressive
    - Days to weeks
    - Peak at 1-2 weeks
  2. plateau
    - Weeks to months
    -No clinical change
  3. recovery
    - Months to years
    -Remyelination
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4
Q

which phase of guillain barre is longest?

A

recovery = months to years

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5
Q

which phase of guillain barre is longest?

A

recovery = months to years

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6
Q

which phase of guillain barre does remyelination occur?

A

recovery

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7
Q

GB is typically ascending or descending?

A

ascending (legs up to arms)

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8
Q

s/s of GB?

A
  • ascending weakness
  • unstead gait
  • tingling
  • pain
  • loss of DTR
  • facial droop/limited facial movement
  • dysphagia
  • dyarthria
  • difficulty chewing
  • loss of bowel and bladder control
  • tachycardia
  • hypo/hypertesnino
  • resp distress
  • paralysis
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9
Q

how long can sxs of GB last?

A

can linger for years

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10
Q

why get tachycardia and hypo or hypertensive with Gb?

A

vagus nerve

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11
Q

most common way sxs progress at start vs resolving for GB

A
  • Start = Symptoms ascend
  • Resolve= Symptoms descend
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12
Q

complications of GB?

A

MI, Resp distress

(ALS/ MS do not have MI complication)

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13
Q

diagnostics for GB

A

difficult early on…
- LP
- Electromyography
- Nerve Conduction Velocity (Nerve Conduction Study)

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14
Q

interventions for GB focused on…

A

managing sxs and decreasing duration

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15
Q

interventions for GB include…

A
  • Plasmapheresis
  • immunoglobulin therapy
  • pain meds
  • rehab
  • resp/vent support
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16
Q

how does plasmapheresis work?

A
  • separates blood into RBC, WBC, Plasma, and Platelets.
  • Removes antibodies
  • Whole blood is returned, plasma discarded and replaced with albumin.

how does this help guillain barre?

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17
Q

risk of what bowel and bladder stuff with GB?

A

Incontinent
Retention
Constipation

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18
Q

mobility risks with GB

A

falls
DVT

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19
Q

what is Myasthenia Gravis?

A
  • autoimmune
  • weakness and fatigue of volunatry muscles
  • antibodies mess up ACH muscle receptors = reduced nerve impulse/ no contraction
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20
Q

what is Myasthenia Gravis?

A
  • autoimmune
  • weakness and fatigue of volunatry muscles
  • antibodies mess up ACH muscle receptors = reduced nerve impulse/ no contraction
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21
Q

which class of My. gravis needs intubation?

A

class V

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22
Q

MG class IVa vs IVb

A
  • IVa Primarily affects limbs and axial muscles
  • IVb Primarily affects Oropharyngeal and respiratory muscles
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23
Q

this class of MG only causes ocular muscle weakness?

A

class I

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24
Q

class II vs Class III MG?

A

II = mild weakness in other muscle
III = moderate weakness in other muscles

+ both may have mild to severe ocular weakness

25
Q

class IIIb MG =

A

IIIb Affects Oropharyngeal and or respiratory muscles

26
Q

MG occurence

A
  • Women 20-30
  • Men 50-60
27
Q

s/s of MG

A

-progressive
- visual disturbance
>Double vision
>Eye muscle weakness, inability to move eyes
> Drooping eyelids

  • weakness
    >Weakness increases as muscle is used, symptoms improve with rest.
    >Arms, Legs, Neck
    >Dysarthria
    >Dysphagia
    >Difficulty with chewing
    >Respiratory difficulty
28
Q

how do activity and rest effect MG?

A

Weakness worsens with activity, Improves with rest.

29
Q

factors that worsen MG

A

Fatigue
Illness
Infection
Surgery
Stress
Pregnancy
Menstruation
Medications (see other card)

30
Q

meds that make MG worse

A

Beta blockers
Quinidine
Gluconate
Phenytoin
Anaesthetics
Some antibiotics

31
Q

complications of MG

A
  • Myasthenic Crisis
  • thymus gland tumor
  • increase risk of autoimmune disorders
  • hypo/hyper thyroidism
32
Q

what does the thymus do?

A

release thymosin hormone that will stimulate the maturation of T cells.

33
Q

is thymus tumor from MG super bad?

A

its pretty chill, usually benign

34
Q

how do we confirm a MG diagnosis?

A

cholinergic drug administration/ response

35
Q

what is an ice pack test for MG?

A

Place ice pack to eyes for 2 minutes, remove and check for eyelid droop improvement.

36
Q

what is a
Edrophonium Injection (Tensilon test) for MG?

A

Inject edrophonium to briefly relieve weakness
Blocks breakdown of acetylcholine.

37
Q

what blood tests do we do for MG?

A
  • Check for antibodies
  • Thyroid function
38
Q

MG interventions are focused on….

A

symtptom management

39
Q

1st line choice of med for MG?

A

Cholinesterase inhibitors

40
Q

what is Pyridostigmine used for?

A

Inhibit breakdown of acetylcholine
–> treat MG

41
Q

How should we give Pyridostigmine?

A

with food

42
Q

How should we give Pyridostigmine?

A

with food

43
Q

Pyridostigmine
may cause a cholinergic crisis. What does that look like?

A
  • Increased weakness
  • Excessive saliva
  • Sweating
  • Increased bronchial secretions
  • Nausea/Vomiting
  • Diarrhea
  • Constricted pupils
44
Q

other drugs to treat MG

A

Corticosteroids
Immunosuppressants
Plasmapheresis
IVIG
Monoclonal Antibodies

45
Q

Cholinergic versus Myasthenic Crisis

A

Cholinergic =
- Too MUCH cholinesterase inhibitor drugs
- Tensilon challenge test
= Decrease in muscle tone
-miosis
-treat with vent support/ atropine

Myasthenic Crisis=
- Too LITTLE cholinesterase inhibitor drugs
- Tensilon challenge test
= Improvement in muscle tone
-myandriasis
-treat with vent support/ neostigmine

46
Q

interventions for cholinergic crisis

A
  • atropine
  • intubation
  • monitor resp secretion (mucous plugs)
47
Q

what is trigminal neuralgia?

A

-sudden faical pain with spasms
- CN V
- Provoked by minimal stimulation of a trigger zone

48
Q

causes of TN? frequency?

A
  • Spontaneous
  • Facial Trauma
  • Dental Procedures
  • Vascular Compression
    –>Pressing into CN V
  • Familial
  • Occurs more often in women over 50
49
Q

s/s of TN

A
  • sharp/electric intermittent (seconds- minutes) facial pain
  • can affect the entire face!
50
Q

complications from TN

A

Psychosocial problems
- Depression
- Fear of pain
- Self harm

51
Q

triggers for TN

A

anything involving touching/moving your head

Talking
Smiling
Chewing
Brushing teeth
Washing face
Light touch
Putting on makeup
Shaving face
Kissing
Swallowing
Cool Breeze blowing on face
Head movement
Stress

52
Q

how do we diagnose TN? who usually identifies it?

A
  • no specific test
  • rule out other things with MRI
  • dentist
52
Q

how do we diagnose TN? who usually identifies it?

A
  • no specific test
  • rule out other things with MRI
  • dentist
53
Q

interventions for TN

A
  • pain meds
  • anticonvulsants
  • nerve block
  • surgery
54
Q

what kinds of pains meds to treat TN?

A
  • Baclofen
  • Gabapentin
  • Pregamblin
55
Q

why give anticonvulsants/epilecptics to TN? which ones do we use?

A

Slows electrical impulses
- Carbamazepine
- Lamotrigine

56
Q

interventions for TN are focused on…

A
  • avoiding triggers
  • pain managment
    —> no cure
56
Q

interventions for TN are focused on…

A
  • avoiding triggers
  • pain managment
    —> no cure

Kol- 410 Med Surg II (27 decks)

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