Med surg exam Flashcards
Doctyl sodium sulfosuccinate ( colace)
Is a fecal softner
Polyethylene glycol and electrolytes
Is an osmotic agent.
Bisacodyl sodium (dulcolax)
Is a stimulant relaxant
Magnesium hydroxide ( milk of magnesia)
Is a Saline agent
What is MS, amyotrophic sclerosis ( ALS) and myasthenia gravis (MG)
They are neurological diseases that typically result in impaired and worsening function of voluntary muscles.
MS & ALS affect nerve cells in the brain and spinal cord.
MG affects the neuromuscular junction.
What is MS
It is an autoimmune disorder characterized by development of plague in the white matter of the CNS. This plague damages the myelin sheath and interferes with impulse transmission between the CNS and the body.
ALS
Is a disease of the upper and lower motor neurons characterized by muscle weakness progressing to muscle atrophy and eventually paralysis and death.
ALS does not Involve autonomic changes, sensory alterations, or cognitive changes.
What is MG
It is an autoimmune disorder characterized by antibody- mediated loss of acetylcholine receptors at the neuromuscular junction, interfering with communication between motor neurons and innervated muscles.
Crede manuever
Placing manual pressure on abdomen over the bladder to expel urine
What are medications used to treat MS
Azathioprine ( Imuran) and cyclosporine ( sandimmune)
Immunosuppressive agents are used to reduce the frequency of relapses.
Prednisone- corticosteroids are used to reduce inflammation in acute exacerbations.
Dantrolene ( Dantrium), tizanidine ( zanaflex) baclofen ( lioresal) and diazepam ( Valium)- antispasmodics are used to treat muscle spasticity
What med can be used in severe cases of MS
INTRATHECAL baclofen
Interferon beta ( Betaseron)
Immunomodulators are used to prevent or treat relapses
Carbamazepine ( tegretol)
Anticonvulsants are used for paresthesia
Docusate sodium ( colace)
Stool softener used for constipation
Propantheline
Anticholinergics used for bladder dysfunction
What exactly is ALS
It is a degenerative neurological disorder of the upper and lower motor neurons that results in deterioration and death of the motor neurons.this results in progressive paralysis and muscle wasting that eventually causes respiratory paralysis and death. Cognitive function is usually not affected.
What is the other name for ALS
Lou Gehrig’s disease… After the baseball player who died of this in 1941.
Death usually occurs due to respiratory failure within 3-5 yrs of the initial manifestations.
There is no cure
Risk factors for MS
20-40 years of age
Woman
Genetic
Environmental factors include smoking, lack of vitamin D exposure, and exposure to Epstein Barr virus.
Because MS, is an autoimmune disease, what factors triggers relapse
Viruses and infectious agents Cold climates Physical injury Emotional stress Pregnancy Fatigue Extreme temps Hot shower or bath
What are the risk factors for developing ALS
Men
40-70 years of age
What are objective findings of a person with ALS
Muscle weakness, usually begins in one part of the body Muscle atrophy Dysphagia Dysarthria Hyperreflexia of deep tendon reflexes
What are lab test to diagnose ALS
Increased creatine kinase ( CK-BB) level
What are diagnostic procedures to diagnosis ALS
Electromyogram ( EMG)- reduction in number of functioning motor units of peripheral nerves.
Muscle biopsy- reduction in number of motor units of peripheral nerves and atrophic muscle fibers.
What are medications used to treat ALS
Rilozole ( Rilutek) is a glutamate antagonist that can slow the deterioration of motor neurons by decreasing the release of glutamic acid. It must be taken early in the disease process and will add approx. 2-3 months of life to the clients lifespan.
Baclofen ( Lioresal), dantrolene sodium ( Dantrium), diazepam ( Valium)
Are antispasmodics used to decrease muscle spasticity
What are complications of ALS
Pneumonia can be caused by respiratory muscle weakness and paralysis ncontributing to ineffective airway exchange
Respiratory failure may necessitate mechanical ventilation.
What is MG
Myasthenia gravis is a Progressive autoimmune disease that produces severe muscular weakness.
It is characterized by periods of exacerbations and remission.
Muscle weakness improves with rest and worsens with increased activity
What are risk factors of MG
Coexisting autoimmune disorder
Frequently assoc with hyperplasia of the thymus gland
What are subjective symptoms of MG
Progressive muscle weakness Diplopia Difficulty chewing and swallowing Respiratory dysfunction Bowel and bladder dysfunction Poor posture Fatigue after exertion
What are objective physical findings of a person with MG
Impaired respiratory status Decreased swallowing ability Decreased muscle strength Incontinence Droopy eyelids
What are diagnostic tests performed to diagnose MG
Tensilon testing- baseline assessment of cranial muscle strength is done
Electromyography- shows the neuromuscular transmission characteristics of MG.
What is atropine the antidote for
Atropine is the antidote for edrophonium ( bradycardia, sweating, and abdominal cramps.)
What are medications used to treat MG
Anticholinesterase is the 1st line in therapy.
Pyridostigmine ( Mestinon) and neostigmine ( Prostigmin) are used to increase muscle strength. It inhibits the breakdown of acetylcholine and prolongs its effects.
Immunosuppressants- because MG is an autoimmune disease, immunosuppressants decrease the production of antibodies.
What is bile
Bile is used for the digestion of fats
It is produced in the liver and stored in the gallbladder
What are risk factors of SLE
Nephritis
Oral ulcers
Very fragile skin
Ulcers on skin
What are tests to determine SLE
Blood tests
S&s of cholecystitis
Feeling of fullness Cholesterol Pigment stones Dark urine Pale stool Jaundice Itchiness, warmth on skin RUQ PAIN RUQ PAIN. RUQ PAIN
What are risk factors of cholecystitis
Woman Oral contraceptives Estrogens or clofibrate Meds known to ^ biliary levels Cholesterol saturation Increased age GI DISEASE Diabetes Obesity/rapid wt. loss
What is treatment of cholecystitis
Decrease intake of fatty foods
What are diagnostics to diagnose cholecystitis
ERCP ABDOMINAL X RAY CHOLECYSTOGRAPHY BILIRUBIN LEVELS ULTRA SOUND ^ WBC ^ CHOLESTEROL LEVELS
What are s&s of crohns
Diarrhea Abdominal pain Anorexia Wt.loss Nutritional deficiencies
What is treatment for crohns
Sedatives Anti diarrheal Anti peristaltic meds Amino salicylates ( sulfalazine) Corticosteroids Immunosuppressants
What tests determines whether a person has crohns
Proctosigmoidoscopy Stool examination Barium study ^ WBC ^ ESR ^ CRP ⬇️ HCT ⬇️ HGB ⬇️ albumin
What are s&s of ulcerative colitis
10-20 stools LLQ PAIN LLQ PAIN LLQ PAIN Fever Vomiting Abdominal distention Hyperactive bowel sounds Hypocalcemia Rectal bleeding
What is treatment of ulcerative colitis
Steroids Immunosuppressants Anti inflammatory Surgical interventions Colon resection Colostomy/ illeostomy
What tests determine ulcerative colitis
Endoscopy
Colonoscopy
Barium enema
⬆️ WBC ⬆️ ESR ⬆️ CRP
⬇️ albumin ⬇️ HCT ⬇️ HGB
Where does the genetic predisposition of MS come from
It is indicated by the presence of a specific cluster ( halo type) of human leukocyte antigens on the cell wall.mits presence may increase susceptibility to factors such as viruses,mthat teigger that autoimmune response activated in MS.
What does the RR course of MS involve
Relapsing remitting…with each relapse recovery is usually complete; however, residual deficits may occur and accumulate mover time.
What does the primary progressive course of MS involve
Disabling symptoms steadily increase, with rare plateaus and temporary minor improvement.
What are signs and symptoms of MS
PAIN, most ppl with MS also take opioids.
Paresthesia, dysesthesias, and proprioception loss.
Muscle Spasticity- usually occurs in in the lower extremities and can include loss of abdominal reflexes.
Ataxia ( impaired coordination of movements) and tremor
Bladder, bowel and sexual dysfunction
What do secondary complications of MS include
Urinary tract infections Constipation Pressure ulcers Contracture deformities Dependent pedal edema Pneumonia Reactive depression And osteoporosis.
What is treatment for MS
Analgesics
Antiimmune therapy
Interferon beta 1a ( rebif) and interferon 1b ( Betaseron) are administered SC every other day.
Another preparation of interferon : avonex, is administered IM once a week
What are side effects of all interferon beta meds
Flulike symptoms that can be managed with acetaminophen and ibuprofen and resolve after a few months
Additional side effects include; potential liver damage
Fetal abnormalities and depression
What med is the key agent in treating acute relapse in the RR course of MS
IV methylprednisolone, they key agent in treating acute relapse in the RR course shortens the duration of relapse.it eceprts anti inflammatory effects by acting on T cells and cytokines, it is administered 1g IV daily for 3-5 days followed by an oral taper of prednisone. Side effects include mood swings, wt. gain, and electrolyte imbalances.
Mitoxantrone ( Novantrone)
Is used for MS.
It is administered by IV infusion every 3 months.
It can reduce the frequency of clinical relapses in patients with secondary progressive or worsening RR MS.
patients must be very closely monitored for side effects and there is a maximum life time dosage that can be used.
What are medications used for the specific symptoms of MS
Baclofen ( lioresal) {GABA agonist}- is used to treat muscle spasticity
Benzodiazepines- diazepam, tizanidine ( Zanaflex), and dantrolene ( Dantrium) may also be used to treat muscle spasticity
Meds used to treat ataxia include; beta blockers ( propranolol)
The anti seizure gabapentin ( Neurontin) and benzodiazepines ( clonazepam)
What may be used to acidify the urine making bacterial growth less likely
Vitamin C ( ascorbic acid)
