Module 10 Sensory/Skin Flashcards
Tx: Headaches
Test:Always start w/less invasive/strong med
•Aspirin
•Acetaminophen (Tylenol)
•NSAIDS
•Muscle relaxants
•Caffeine containing analgesics
•Antiseizure meds: topiramate (Topamax) (*dont D/C abruptly can cause seizures and kidney stones (drink water!!) . Takes 2-3 months to kick in.)
•Triptans (sumatriptan, Imitrex)
•B-Blockers (if Pt has low BP, don’t give!)
•Botox
Nursing management: Headaches
•stress coping strategies
•relaxation, exercise (yoga), socialization
•massages, moist hot packs
•avoid common triggers
Most important = tx pain, coping, avoid triggers by keeping a log to figure out what’s causing the headaches
What are the 5 degenerative disorders in this module?
•Multiple Sclerosis (MS)
•Parkinson’s disease
•myasthenia Gravis (MG)
•Amyotrophic lateral sclerosis (ALS)
•Huntington’s disease
MS overview
•Disseminated demyelination of nerve fibers (myelin sheaths) of brain & spinal cord
Exact cause is unknown, believed to be genetic, environmental exposure(extreme temps or infection)
Higher in women 30-35 age of onset. Can try to slow it down and manage symptoms & quality of life
Clinical manifestation: MS
test 1st symptoms often related to vision (blurred or double vision. Red/green distortion. Possible blindness in one eye)
•gradual: weeks-months
•extreme weakness/paralysis (worst case)
•numbness & tingling
•lhermitte’s sign (shock down extremities)
•other problems: speech impairment, hearing loss, tremors, nystagmus (involuntary eye movements), ataxia (coordination/imbalance)
Clinical signs cont. (MS)
•constipation(more common) / diarrhea
•spastic bladder OR flaccid bladder (may have to straight cath themselves)
•sexual problems (psychosocial, anxiety, decreased libido/sensation)
•cognitive issues (forgetful, reading comprehension)
•emotional changes
Dx studies (MS)
•No definite test for MS
•H&P play a big role
•MRI/CSF analysis (increased immunoglobulin)
•to be Dx, Pt must have evidence of :
-2 inflammatory demyelimating lesions in at least 2 areas of CNS
-damage or attack occurring at different times
-all other dx ruled out
Drug Therapy (MS) 58.13 1370 know for test
no cure, only management of Symptoms. Starting therapy early helps pt’s
•start w/ immunomodular drugs (B-interferons)
•immunosuppressants, monoclonal antibody, corticosteroids, anticholinergics, muscle relaxants, nerve conductor enhancers
Alternate Nursing management (MS)
•Surgery
•dorsal column electrical stimulation
•PT: exercise (decreases spasticity, coordination, retrains unaffected muscles to act for impaired ones, WATER EXERCISE* (both sides)
GOALS: maintain ADL’s, muscular functions. Each goal is dependent on Pt’s symptoms/problems
Patient/family teaching (MS)
•teach about triggers
•coping w/Walker wheel chair, home safety)
•good balance & exercise & rest, healthy diet.
•minimize caffeine (may be a trigger, if on test it says eliminate it’s wrong**)
•teach meds
•self- catheterization (if needed)
Parkinson’s overview
•chronic, progressive neurodegenerative disorder characterized by :
-bradykinesia (slow movement)
-rigidity (stiffness)
-tremor at rest
-gait changes (shuffling)
Parkinson’s etiology
Degeneration of dopamine-producing neurons in the substantia Nigra of midbrain
Not hereditary but thought that certain genetic risk could interplay w/environmental factors :
-exposure to well water
-high dairy
-pesticides
-industrial chemicals
-drug induced (street or meds)
-TBI
Clinical manifestations (Parkinson’s) Test*
TRAP:
T:remor (often 1st sign, may go
Unnoticed by others, worsens w/stress)
R:igidity (increased resistance to passive ROM, jerky quality -cogwheel-, slow movement)
A:kinesia (absence or loss of voluntary muscle movement -blinking, swinging arms, swallowing, expressions, drooling, shuffling)
P:ostural instability (unable to stop themselves from propulsion. Pull test. Can’t control movement may hurt spouse in sleep!)
May have speech problems
Dx studies (Parkinson’s)
There’s not one specific test for Parkinson’s.
-Diagnose off of pt’s hx and clincial features
-to diagnose it require the presence of TRAP & confirmation of PD (positive response to antiparkinsonian meds)
Drug therapy (Parkinson’s) *test
Primary : levopoda (effectiveness may decrease over time therefore may be used in combo with Other drugs)
Antiviral
Anticholinergic
MOA-B
Meds also give to tx dementia & depression
Surgical therapy (Parkinson’s)
For severe cases where meds aren’t working and motor skills decrease
-deep brain stimulation
-Ablation (destroy tissue that produces abnormal chemical or electrical impulses causing symptoms )
-transplantation (fetal neural tissue into basal ganglia, not as common)
Nursing management/teaching (Parkinson’s)
Pg. 1376
Nutrition: 6 small meals a day, cut it in small pieces and let them take their time eating, look for dysphasia, bradykinesia, aspiration, if on levapoda save all protein for dinner meal
•promote physical activity (constipation issues, PT, OT)
•caregiver teaching to help promote ADL’s
•teach depression & anxiety coping skills
Myasthenia Gravis (MG)
• an autoimmune disease at the neuromuscular junction, marked trifluctuating weakness of certain skeletal muscle groups
• weakness increases with use. It is suggested that the auto antibody production starts in the thymus because thymuc hyperplasia and tumor are common with MG.
Clinical manifestations (Myasthenia Gravis) Test
** Fluctuating weakness of skeletal muscles. 1st muscle involved is usually ocular. ***
• other muscles involved muscles used to chew, swallow, speak and breathe.
• no sensory or reflexes lost- muscle atrophy is rare
• 20% will stay in facial region. Not every patient will look the same or have the same symptoms.
Complications (MG)
• MG symptoms may be exacerbated by stress, trauma, weather extremes, beta-blockers, and antibiotics
• Myasthenic crisis: acute worsening of muscle weakness, especially in areas that affects swallowing or breathing, airway infections.
•may become a medical emergency (respiratory intubation supplies ready. Need RT to be there!)
Diagnostic studies (MG)
Can be confirmed w/diagnostic testing
-H&P
-EMG (single fiber EMG for confirming**) slow to respond shows muscle fatigue
-Tensilon test (injection)
-CT scan to evaluate thymus after Dx (tumor, hyperplasia)
Drug therapy (MG)
• anticholinesterase drugs most successful long term
• corticosteroids (alternating days-prednisone- long-term use= Cushing’s)
•immunosuppressants (azathioprine=imuran)
•plasmapheresis(short term improvement) & IV immunoglobulin G
