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MedSurg > Lecture 9 - Neuro > Flashcards

Lecture 9 - Neuro Flashcards

1
Q

What is MS?

A

An autoimmune disease of the CNS - results the inflammatory demyelination of nerves in CNS, which disrupts nerve transition

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2
Q

What causes MS?

A

No exact cause known
–> Lifestyle, environmental, biological factors contribute

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3
Q

When is the typical onset of MS?

A

ages 20-50 (more specifically, 30-35)

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4
Q

Which gender is affected more by MS? What about geographic demographics?

A

Women (75%)
–> Canada, Northern USA, Northern and central Europe, Australia, New Zealand

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5
Q

What is the diagnostic process for MS?

A

Hx - S/S, family Hx

Neuro Assessment - Eyes and facial movement, reflexes, strength, sensation, coordination

MRI - Looking for abnormalities in brain and spinal cord

Lumbar Puncture/Spinal Tap - Examines fluid for increased levels of immunoglobulin and oligoclonal banding

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6
Q

What is clinically isolated syndrome?

A

Refers to an episode of neurological symptoms suggesting MS.
–> Often found using MRI to find evidence of abnormality in the brain and spinal cord

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7
Q

What is Relapsing-Remitting MS?

A

Characterized by unpredictable but clearly defined relapses during which new symptoms appear or existing ones get worse
–> Between relapse, recovery is complete or near complete to pre-relapse
–> Relapse lasts at least 48 hours and may g on for several months

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8
Q

What is a Pseudo-Relapse in MS?

A

When the body is fighting another infection or otherwise stressed and symptoms appear to mimic relapse (but relapse has not occurred)

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9
Q

What is the most common kind of MS?

A

RRMS
–> 85%

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10
Q

What is benign MS?

A

A subtype of RRMS
–> Remission after relapse is almost complete and there is only minimal disability after 10-15 cases
–> 10-15% of cases

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11
Q

What is aggressive/malignant MS?

A

Multiple relapses early in disease and rapid disability within 5 years of onset
–> Very rare

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12
Q

What scale is used to measure the progression of MS on life?

A

The Expanded Disability Status Scale (EDSS)

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13
Q

What are the symptoms of MS?

A

Invisible:
–> Fatigue, visual problems, paresthesia, cognitive impairment, bladder and bowel problems, pain, dizziness, depression and mood alterations, sexual dysfunction

Apparent:
–> Motor function changes (walking, weakness spasticity, tremor, drop foot), speech problems, lack of balance and coordination

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14
Q

What is the most common symptoms of MS?

A

Fatigue
–> 90% experience an overwhelming sense of tiredness, lack of energy, or feeling of exhaustion

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15
Q

What visual problems are seen in MS?

A

Optic Neuritis (most common)
–> Inflammation of optic nerve results in painful eye movements, blurring or graying of vision, or blindness in one eye

Nystagmus
–> Uncontrolled eye movement

Diplopia
–> Double vision caused by eye muscle weakness

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16
Q

Cognitive changes occur in what percent of people with MS?

A

50% have memory or recall problems
–> Person with MS may not be aware of this deficit even when its obvious to others

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17
Q

What are the three categories of medication for MS?

A
  1. Disease Modifying Therapies (DMTs)
  2. Relapse Management Medications (steroids)
  3. Symptom Management Medications
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18
Q

What is the purpose of disease-modifying therapies in MS?

A

Drugs that impact the underlying disease and target the inflammatory process in MS to
–> Reduce frequency and severity of relapses
–> Reduce number of lesions seen in MRI
–> Slow accumulation of disability

*available as injectable, oral, and infusion medication

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19
Q

What drugs are used for relapse management in MS?

A

High Dose Corticosteroids (usually 5 days)
–> Decreases severity and duration of relapse by reducing inflammation that occurs in CNS

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20
Q

What medications can be used for symptoms management of MS?

A

Drugs that help ease symptoms such as fatigue, bladder issues, spasticity, and pain
–> Immunomodulators
–> Antispasmodics
–> CNS stimulants
–> Anticholinergics
–> Antidepressants
–> Vit D

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21
Q

What non-pharmacological treatments can be used in MS?

A

Improve quality of Life
–> Exercise
–> Physio/OC
–> Rehabilitation
–> Massage
–> Stress Reduction Techniques

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22
Q

Recent research indicates that ___ is safe and beneficial for people with MS. It is now recognized as an important part of the overall care plan.

A

Physical activity

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23
Q

What are four important traits of stem cells?

A

Pluripotency
–> Can grow into different cell types

Self-Renewing

High Proliferation Potential

Transplantable

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24
Q

How did research into stem cell therapy begin for MS?

A

Research began when a pt with leukemia and MS had a stem cell transplant for leukemia and her MS improved

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25
Q

What is an autologous transplant?

A

Transplant of one’s own cells

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26
Q

What is an allogeneic transplant?

A

Transplantation of donor cells

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27
Q

What are seizures?

A

Uncontrolled, transient neuronal activity in the brain that interrupts normal function

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28
Q

What is the typical cause of seizure disorders by age?

A

First 6 Months
–> birth injury, congenital and metabolic disorders

2-20
–> Infection, trauma, genetic

20-30 years
–> Structural lesions (trauma, tumors, vascular disease)

After age of 50
–> cerebrovascular lesions and metastatic brain tumors

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29
Q

What is epilepsy? What age is it usually diagnosed by?

A

At least two spontaneous seizures in greater than 24 hours, caused by underlying chronic pathology
–> Most diagnosed by 18

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30
Q

What are the four phases of seizures?

A

Prodrome
–> signs or activities that precede the seizure

Aural
–> Sensory warning

Ictal
–> Full seizure

Postictal
–> Recovery

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31
Q

What are tonic-clonic seizures?

A

Characterized by loss of consciousness and memory of seizure. The body will stiffen for 10-20 seconds (tonic), and then extremities will jerk for 30-40 (clonic) seconds.
–> Cyanosis, salivation, cheek and tongue biting, and incontinence may accompany seizure.

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32
Q

What is status epilepticus?

A

A state of continuous seizure activity in which seizures occur in rapid succession and without return to consciousness between them.
–> Use of more energy than is available can result in permanent brain damage

Tonic-Clonic is most dangerous because can result is ventilatory insufficiency, hyperthermia, hypoxia, and dysrhythmias.

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33
Q

What diagnostic studies are doen for seizure disorders?

A

EEG
–> Only shows abnormalities
–> Some people without seizure disorders who abnormalities, and those with seizure disorders only show them when seizing

May also use CT, MRI for new-onset seizures to rule out abnormalities.

CBC, metabolic panel, liver and kidney studies, urinalysis

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34
Q

What should the nursing interventions be during a seizure?

A

Observe al details: lengths of seizure, preceding factors, data by phase.

Oxygenation
–> Airway patency, support head, turn onto side, o2 mask 6L
–> May require repositioning onto side, suctioning, or oxygen after seizure.

Assessment of level of understanding

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35
Q

What are the medication therapy goals with seizures?

A

Stabilization of the cell membrane and prevention of epileptic discharge
–> Monitor serum levels of medication

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36
Q

What can we give someone during status epilepticus to cease seizure activity?

A

IV benzodiazepines and anticonvulsants.

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37
Q

What are some seizure precautions?

A

Injury/Fall/Emergency Precautions
–> Pad side rails with flannel blankets
–> Ensure top rails are up
–> Ensure suction/O2 available
–> Bed at lowest position

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38
Q

What diet can be therapeutic for MS?

A

Diet high it Vit b12, C, D

Diet low in fat, with gluten-free, and lots of raw vegetables.

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39
Q

What patient teaching is necessary for MS?

A

Avoiding fatigue, extremes hot and cold, exposure to infections

Fiber for bowel regularity

Might need teaching of self-catheterization

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40
Q

What is Parkinson’s disease?

A

Disease of basal ganglia characterized by slowing down in the initiation and execution of movement
–> Increases muscle tone
–> Tremor as rest
–> Impaired gait

Unknown etiology

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41
Q

What is the etiology of Parkinsons?

A

Unknown etiology - Lewy bodies of unknown origin found in brain.

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42
Q

What are the classic manifestations of Parkinsons?

A

TRAP:
Tremor
Rigidity
Akinesia
Postural Instability

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43
Q

Akinesia of what kind is most prevalent in Parkinsons?

A

Akinesia is the absence of loss of voluntary muscle movement
–> Bradykinesia (slowness of movements) is especially evident in the loss of autonomic movements in Parkinsons

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44
Q

Other than TRAP, what other symptoms are seen in parksinsons?

A

–> Depression, anxiety, apathy
–> Fatigue, memory changed
–> pain
–> Sleep conditions, memory changes
–> Malnutrition, urinary retention, constipation, erectile dysfunction

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45
Q

What medications are used for Parkinsons?

A

Levodopa with Carbidopa (Sinimet)
–> Enhance release or supply of dopamine

Antiviral - unknown reason

Anticholinergics and antihistamines
–> Block effects of overactive cholinergic neurons in striatum

46
Q

What are lifestyle changes that can help with Parkinsons

A

Promoting physical exercise and wellbeing

Using elevated toilet seats, avoiding buttons or things that can be difficult with compromised fine motor skills, promotion of safety.

47
Q

What is Myasthenia Gravis? What does the disease process look like?

A

A chronic neuromuscular autoimmune disease caused by loss of ACH receptors necessary for muscles to contract
–> Ocular muscle weakness
–> Bulbar Muscle weakness
–> Skeletal muscle weakness

Some patients have short-term remissions and other have progressive involvement

48
Q

How do we diagnose myasthenia gravis?

A

Diagnosis is based on clinical presentation - muscle weakness with repetitive movement

Confirmed by testing response to anticholinesterase drug Tensilon*

*textbook says this test is not done in North America as it has become obsolete, but the slides say it is still performed.

49
Q

What surgical treatment is available for myasthenia gravis?

A

The thymus gland appears to enhance production of Ach receptor antibodies, so removing is results in improvement in most patients.

50
Q

What pharmacological interventions are used for myasthenia gravis?

A

Anticholinesterase agents such as pyridostigmine bromide, neostigmine bromide

Corticosteroids - prednisone

Immunosuppressive agents - azathioprine, cyclophosphamide

51
Q

How should those with myasthenia gravis change their eating and lifestyle habits?

A

Eating
–> Sit upright during and 1 hour after eating
–> Keep chin down when swallowing

Misc - coughing and deep breathing, suction at bedside.
Plan activities with rest periods and be aware the weakness will be greater at the end of the day.

52
Q

What are absence seizures? Who do they affect?

A

Loss of awareness without the body dropping or convulsing.
–> Almost only seen in children and disappear by adolescence

Atypical versions may also present with eye blinking or jerking of the lips –> may continue into adulthood

53
Q

What is a focal aware seizure?

A

Do not involve loss of consciousness and rarely last longer than 1 minute. May involve motor, sensory, or autonomic phenomena and are often focused in specific areas of the brain.
–> aka Jacksonian seizures

54
Q

Antiseizure medications control seizures in what percentage of those with seizure disorders?

A

70%

55
Q

What diagnostic tests are available for parkinsons?

A

No specific tests are available, diagnosis is based solely on history and clinical features.
–> Clinical diagnosis requires the presence of TRAP

56
Q

Parkinsonian tremor is usually one that occurs during…

A

rest.

57
Q

What kind of rigidity is seen in parkinsonism?

A

Resistance to passive motion and usually of jerky quality (cogwheel)

Sustained contraction results in soreness, achiness.

58
Q

What kinds of postural instability are seen in parkinsons?

A

Patients feeling as though they are unable to stop themselves from falling forward or backward.

Pull test - causes patient to fall backward

59
Q

What nutritional therapy can be helpful for those with parkinsons?

A

Malnutrition and constipation can result from poor nutrition
—> Appetizing and easy to chew and swallow foods
–> High fiber and fruit to reduce constipation

Six small meals a day can be less tiring the three large ones, account for ample time for eating. Food should be cut into bite-sized pieces.

Protein ingestion and B6 can impair levodopa absorption

60
Q

Which food items can impair levodopa absorption and should thus be limited with parkinsons?

A

Protein and B6

61
Q

How does myasthenia gravis present?

A

Chronic muscle fatigue, vision changes, droopy eyelids, weakness in extremities, impaired or slurred speech.

62
Q

What is a myasthenic crisis?

A

An acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, pregnancy, exposure to some medications, or beginning of treatment with corticosteroids.

Major complications are respiratory muscle weakness.

63
Q

What is a cardiovascular accident?

A

Loss of blood flow to brain results in cell death

64
Q

What are the two kinds of strokes and what is their prevalence?

A

Ischemic - 85%
Hemorrhagic - 15%

65
Q

What is an ischemic stroke?

A

When an embolus lodges in and occludes a cerebral artery.
–> Infarction + edema of the area supplied the the involved vessel

Sudden onset on symptoms

66
Q

What is hemorrhagic stroke?

A

Results from intracerebral bleeding and has sudden onset of symptoms.

67
Q

What are the symptoms of hemorrhagic stroke?

A

Neurological deficits, headache, N/V, decreased LoC, HTN

68
Q

What is the primary cause of hemorrhagic stroke? When do they usually occur?

A

HTN - 1° cause
–> Usually occur during periods of activity

69
Q

What are the non-modifiable risk factors for stroke?

A

Increased Age

More common in women

Ethnicity - Indigenous, African, South Asian heritage

Family + medical Hx

70
Q

What are the modifiable risk factors for stroke?

A

HTN, heart disease, diabetes, oral contraceptive use, physical inactivity, obesity

71
Q

What is a TIA? How long to they last?

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction of the brain.

Symptoms last less than an hour.

72
Q

How can we prevent stroke in those that have had TIAs?

A

Antiplatelet medication are usually chosen to prevent stroke for those that have had a TIA
–> ASA

Statins can also be used.

73
Q

What is aphasia?

A

Loss of understandings of and ability to communicate through language.

74
Q

What is dysarthria?

A

Inability to articulate words - causes slowed or slurred speech.

75
Q

Stroke can result in impairment of…

A

Mobility
Respiratory function
Swallowing + Gag reflex
Speech + communication
Elimination
Self-Care abilities

76
Q

The following symptoms are indicative of which sided brain damage?

Spatial-perceptual deficit, tends to deny or minimize problems, rapid performance with short attention span.
Compulsive with safety concerns, and impaired judgement and time concepts.

A

Right-sided brain damage
–> We also might see left sided hemiplegia and neglect.

77
Q

The following symptoms are indicative of which sided brain damage?

Slowed performance, overly cautious. Impaired right-left discrimination. Person will be aware of deficits and experience depression and anxiety
Impaired language and math comprehension.

A

Left-sided
–> Right-sided hemiplegia

78
Q

Which side of the brain is responsible for spatial and time awareness?

A

Right side

79
Q

Which side of the brain is responsible for right-left discrimination and language?

A

Left

80
Q

Assessment findings for a stroke include…

A

Altered LoC, weakness, paresthesia.

Visual or speech disturbances

Respiratory distress, changes in HR

Unequal pupils, headache.

81
Q

List the levels of GCS.

A

EYE OPENING
spontaneous - 4
to speech - 3
to pain - 2
none - 1

VERBAL RESPONSE
Ox3 - 5
Confused - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response - 1

MOTOR RESPONSE
Obeys commands - 6
localizes pain - 5
Withdrawal from pain - 4
Decorticate - 3
Decerebrate - 2
none - 1

82
Q

What is decorticate posturing?

A

Arms flexed towards the core

83
Q

What is decerebrate posturing?

A

Arms extended at sides.

84
Q

What is mild, moderate, and severe GCS?

A

Mild - 13-15 (15 is normal)
Moderate - 9-12
Severe - 3-8

85
Q

The purpose of diagnostic studies with a stroke is to determine what? How do we do this?

A

To confirm that it is a stroke and identify potential causes - CT scan primarily

86
Q

Why would we perform an MRI on someone we suspect stroke on?

A

To determine the extent of brain injury

87
Q

What are the goals for care during the acute phase of a stroke?

A
  1. Preserve life
  2. Prevent further brain damage
  3. Reduce disability
88
Q

What is the initial collaborative care for acute stroke?

A

ABCs always

  1. Obtain CT
  2. Perform baseline labs
  3. Position head on midline
  4. If no symptoms of shock occur, elevate the hob 30°
89
Q

What are priority nursing interventions with acute stroke?

A
  1. Airway patency
  2. Call the stroke team
  3. Remove dentures
  4. pulse oximetry + oxygenation
  5. IV Access w NS
  6. Maintain BP
  7. Seizure precautions
  8. Anticipate thrombolytic therapy for ischemic stroke
90
Q

HTN is common right after stroke. What is the goal BP when administering drugs to lower it?

A

SBP - 140
MAP >75

91
Q

Why is fluid and electrolyte balance so important following stroke?

A

Adequate hydration promotes perfusion and decreases further brain injury

92
Q

What are the ongoing monitoring priorities with stroke?

A

LoC, sensory function, PERRLA, O2 sats, cardiac rhythm

93
Q

How soon after ischemic stroke must tPA be administered?

A

within 3-4.5 hrs.

94
Q

Aspirin for ischemic stroke should be given how soon afterwards?

A

24-48 hours

95
Q

What surgical interventions are available for hemorrhagic stroke?

A

Immediate evacuation of aneurysm-induces hematomas (>3cm)

96
Q

What surgical interventions are available for ischemic stroke?

A

Mechanical Embolus Removal in Cerebral Ischemia (MERCI)

97
Q

How can we assess cerebellar function following stroke?

A

Asking pt to touch nose and nurse finger

98
Q

Management of the respiratory system is a nursing priority. What are the relevant risks for someone following stroke?

A

Risk for atelectasis, aspiration pneumonia, airway obstruction

May req endotracheal intubation and mechanical vent.

99
Q

What can prevent external hip rotation, hand contractures, and foot drop following stroke?

A

Trochanter rolls, hand cones, foot boards

Passive ROM is important

100
Q

Following a stroke, a person should only be rolled onto the weak or paralyzed side for how long?

A

30 mins at a time

101
Q

What is the most common GI issue post stroke? How can we prevent this?

A

Constipation
–> Treat with prophylactic fiber and stool softeners

Physical activity if possible

102
Q

Should you use indwelling catheters to help with incontinence post stroke?

A

No, risk of infection.

103
Q

Before a persons starts eating following a stroke, what should be assessed?

A

Swallowing, chewing, gag reflex, and risk of pocketing.

104
Q

What is homonymous hemianopsia?

A

Blindness in same half of visual field
–> Common following stroke

105
Q

Homonymous hemianopsia is common following stroke. What other visual changes are common?

A

Diplopia, ptosis, loss of corneal reflex

106
Q

What is ptosis?

A

Drooping eyelid

107
Q

What are the two kinds of ischemic stroke?

A

Thrombotic
–> Clot in BV d/t damage to vessel

Embolic
–> Clot formed elsewhere (usually heart) and lodges is BV in brain

108
Q

What are some risk factors for embolic stroke?

A

Valvular diseases and a-fib
–> Can cause clot formation

109
Q

What are the kinds of hemorrhagic stroke?

A

Intracerebral
–> Bleeding occurs directly into brain tissue itself

Subarachnoid
–> Bleeding in subarachnoid space between brain and skull

110
Q

What are aneurisms?

A

Weak spots in BV walls that balloon out and can rupture

111
Q

Which lab findings are expected with epilepsy?

A

Increased creatinine, BUN, and Liver function tests

Decreased BGL

MedSurg (13 decks)

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