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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
class IIIb MG =
IIIb Affects Oropharyngeal and or respiratory muscles
26
MG occurence
- Women 20-30 - Men 50-60
27
s/s of MG
-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
how do activity and rest effect MG?
Weakness worsens with activity, Improves with rest.
29
factors that worsen MG
Fatigue Illness Infection Surgery Stress Pregnancy Menstruation Medications (see other card)
30
meds that make MG worse
Beta blockers Quinidine Gluconate Phenytoin Anaesthetics Some antibiotics
31
complications of MG
- Myasthenic Crisis - thymus gland tumor - increase risk of autoimmune disorders - hypo/hyper thyroidism
32
what does the thymus do?
release thymosin hormone that will stimulate the maturation of T cells.
33
is thymus tumor from MG super bad?
its pretty chill, usually benign
34
how do we confirm a MG diagnosis?
cholinergic drug administration/ response
35
what is an ice pack test for MG?
Place ice pack to eyes for 2 minutes, remove and check for eyelid droop improvement.
36
what is a Edrophonium Injection (Tensilon test) for MG?
Inject edrophonium to briefly relieve weakness Blocks breakdown of acetylcholine.
37
what blood tests do we do for MG?
- Check for antibodies - Thyroid function
38
MG interventions are focused on....
symtptom management
39
1st line choice of med for MG?
Cholinesterase inhibitors
40
what is Pyridostigmine used for?
Inhibit breakdown of acetylcholine --> treat MG
41
How should we give Pyridostigmine?
with food
42
How should we give Pyridostigmine?
with food
43
Pyridostigmine may cause a cholinergic crisis. What does that look like?
- Increased weakness - Excessive saliva - Sweating - Increased bronchial secretions - Nausea/Vomiting - Diarrhea - Constricted pupils
44
other drugs to treat MG
Corticosteroids Immunosuppressants Plasmapheresis IVIG Monoclonal Antibodies
45
Cholinergic versus Myasthenic Crisis
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
interventions for cholinergic crisis
- atropine - intubation - monitor resp secretion (mucous plugs)
47
what is trigminal neuralgia?
-sudden faical pain with spasms - CN V - Provoked by minimal stimulation of a trigger zone
48
causes of TN? frequency?
- Spontaneous - Facial Trauma - Dental Procedures - Vascular Compression -->Pressing into CN V - Familial - Occurs more often in women over 50
49
s/s of TN
- sharp/electric intermittent (seconds- minutes) facial pain - can affect the entire face!
50
complications from TN
Psychosocial problems - Depression - Fear of pain - Self harm
51
triggers for TN
anything involving touching/moving your head ## Footnote 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
how do we diagnose TN? who usually identifies it?
- no specific test - rule out other things with MRI - dentist
52
how do we diagnose TN? who usually identifies it?
- no specific test - rule out other things with MRI - dentist
53
interventions for TN
- pain meds - anticonvulsants - nerve block - surgery
54
what kinds of pains meds to treat TN?
- Baclofen - Gabapentin - Pregamblin
55
why give anticonvulsants/epilecptics to TN? which ones do we use?
Slows electrical impulses - Carbamazepine - Lamotrigine
56
interventions for TN are focused on...
- avoiding triggers - pain managment ---> no cure
56
interventions for TN are focused on...
- avoiding triggers - pain managment ---> no cure

Kol- 410 Med Surg II (27 decks)

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