MG, GBS, Spinal Cord Injury Flashcards
Assessment findings for MG
Progressive muscle weakness that improves with rest
Pytosis or incomplete eye closeure
Decreased smell/taste
Poor posture
Causes of MG
Unclear
Antibodies to the ach receptor
Abnormal thymus gland
Tumor on thymus gland
Risk factors for MG
Hyperthyroidism
Genetics
Patho of MG
Nerve impulse not transmitted at neuromuscular junction d/t decreased number or effectiveness of Ach receptor
Patient problems for MG
Breathing pattern
Fatigue
Verbal communication
Impaired nutrition < BR
Risk for injury: corneal abrasion
Risk for aspiration
Assessment findings for GBS
Ascending motor weakness/paralysis
50% develop respiratory compromise
- 25% require intubation/mechanical ventilation
Some develop loss of bowel/bladder control
Decreased DTR
Pain
Tingling
Possible facial weakness
Difficulty speaking
Dysphagia
Diplopia
Causes of GBS
Not well-understood
Acute illness
Surgery
Trauma
Immunization several weeks prior to onset
Risk factors for GBS
Acute illness
Surgery
Trauma
Immunization several weeks prior
Patho for GBS
Immune system destroys myelin leading to dispersion of impulses and slow conduction or blocked conduction along nerve fiber
Nursing problems for GBS
Gas exchange / breathing pattern
Impaired physical mobility
Acute pain
Impaired verbal communication
Anxiety / fear/ powerlessness
Risk for aspiration
What symptoms should be reported immediately for a patient with GBS?
Dyspnea and confusion
Type of treatment needed for GBS
Supportive treatment because this disease is usually self-limiting
What should be included in healthcare teaching for a patient with GBS?
Always include a family member of significant other
What is tensilon testing used for?
Can be used to distinguish between a cholinergic crisis and a myasthenic crisis
Which symptom in a patient with MG should a nurse report to the physician immediately?
Why?
Inability to swallow
B/c risk for aspiration
Which parameters should a nurse use when planning activities for a pt with MG? Why?
Medication times
Because soon after med admin is when the pt will have the best motor function and less fatigue
Important info about MG drug therapy
Drugs containing morphine or sedatives can increase muscle weakness
What is the most life threatening complication of GBS?
Respiratory failure
What is the role of plasmapheresis in a pt with GBS?
Removes circulating antibodies thought to be responsibility for the problem
What is the antidote for Tensilon?
Atropine
What is the role of anti cholinesterase drugs in the treatment of MG? Name two
To relive symptoms
Mestinon
Reginol
*Two types of shock that occur with a spinal cord injury
- Spinal
- Neurogenic
*Two types of spinal cord injury and what they are
Complete = from area of injury down, with total permanent loss of function
Incomplete = mixed pattern of sensory and motor issues, can have sparing of function, depending on the location of the injury
Top 2 priority assessments for spinal cord injury
First, look at airway and ventilation (b/c pt could have paralysis of diaphragm/intercostal muscles which result in ineffective breathing patterns)
Second, worried about sympathetic nervous system:
Vasodilation (loss of sympathetic tone) causing decreased BP, HR, and venous return
*Immediate treatment for a pt with a spinal cord injury in the field (in order)
- Need to treat all unconscious pts like they have spinal cord injury
- Get backboard and transportation ASAP
1st: stabilize airway
2nd: stabilization of spinal cord using:
- tongs, surgery, or halo
3rd: Give corticosteroids (*Solumederol IV) within 8 hours to decrease inflammation
4th: put pt in kinetic bed
Two main patient problems in pt with spinal cord injury
Ineffective breathing pattern
Potential for ineffective airway clearance
*What is autonomic dysreflexia?
Emergency, most commonly occurring with lesion at T6 or above, AFTER resolution of spinal shock. Small aggravation causes exaggerated SNS response.
*What can cause autonomic dysreflexia?
Kinked catheter
Fecal impaction
Temperature extremes
**Symptoms of autonomic dysreflexia
HTN
HA
Bradycardia
Piloerection
Nasal congestion
Sweating
(All symptoms of fight response)
