MG, GBS, Spinal Cord Injury

Question 1

Assessment findings for MG

Answer 1

Progressive muscle weakness that improves with rest
Pytosis or incomplete eye closeure
Decreased smell/taste
Poor posture

Question 2

Causes of MG

Answer 2

Unclear
Antibodies to the ach receptor
Abnormal thymus gland
Tumor on thymus gland

Question 3

Risk factors for MG

Answer 3

Hyperthyroidism
Genetics

Question 4

Patho of MG

Answer 4

Nerve impulse not transmitted at neuromuscular junction d/t decreased number or effectiveness of Ach receptor

Question 5

Patient problems for MG

Answer 5

Breathing pattern
Fatigue
Verbal communication
Impaired nutrition < BR
Risk for injury: corneal abrasion
Risk for aspiration

Question 6

Assessment findings for GBS

Answer 6

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

Question 7

Causes of GBS

Answer 7

Not well-understood
Acute illness
Surgery
Trauma
Immunization several weeks prior to onset

Question 8

Risk factors for GBS

Answer 8

Acute illness
Surgery
Trauma
Immunization several weeks prior

Question 9

Patho for GBS

Answer 9

Immune system destroys myelin leading to dispersion of impulses and slow conduction or blocked conduction along nerve fiber

Question 10

Nursing problems for GBS

Answer 10

Gas exchange / breathing pattern
Impaired physical mobility
Acute pain
Impaired verbal communication
Anxiety / fear/ powerlessness
Risk for aspiration

Question 11

What symptoms should be reported immediately for a patient with GBS?

Answer 11

Dyspnea and confusion

Question 12

Type of treatment needed for GBS

Answer 12

Supportive treatment because this disease is usually self-limiting

Question 13

What should be included in healthcare teaching for a patient with GBS?

Answer 13

Always include a family member of significant other

Question 14

What is tensilon testing used for?

Answer 14

Can be used to distinguish between a cholinergic crisis and a myasthenic crisis

Question 15

Which symptom in a patient with MG should a nurse report to the physician immediately?
Why?

Answer 15

Inability to swallow
B/c risk for aspiration

Question 16

Which parameters should a nurse use when planning activities for a pt with MG? Why?

Answer 16

Medication times
Because soon after med admin is when the pt will have the best motor function and less fatigue

Question 17

Important info about MG drug therapy

Answer 17

Drugs containing morphine or sedatives can increase muscle weakness

Question 18

What is the most life threatening complication of GBS?

Answer 18

Respiratory failure

Question 19

What is the role of plasmapheresis in a pt with GBS?

Answer 19

Removes circulating antibodies thought to be responsibility for the problem

Question 20

What is the antidote for Tensilon?

Answer 20

Atropine

Question 21

What is the role of anti cholinesterase drugs in the treatment of MG? Name two

Answer 21

To relive symptoms

Mestinon
Reginol

Question 22

*Two types of shock that occur with a spinal cord injury

Answer 22

• Spinal
• Neurogenic

Question 23

*Two types of spinal cord injury and what they are

Answer 23

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

Question 24

Top 2 priority assessments for spinal cord injury

Answer 24

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

Question 25

*Immediate treatment for a pt with a spinal cord injury in the field (in order)

Answer 25

• 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

Question 26

Two main patient problems in pt with spinal cord injury

Answer 26

Ineffective breathing pattern
Potential for ineffective airway clearance

Question 27

*What is autonomic dysreflexia?

Answer 27

Emergency, most commonly occurring with lesion at T6 or above, AFTER resolution of spinal shock. Small aggravation causes exaggerated SNS response.

Question 28

*What can cause autonomic dysreflexia?

Answer 28

Kinked catheter
Fecal impaction
Temperature extremes

Question 29

**Symptoms of autonomic dysreflexia

Answer 29

HTN
HA
Bradycardia
Piloerection
Nasal congestion
Sweating

(All symptoms of fight response)