MS, MG, Guillain-Barre, cranial nerve and PNS disorders Flashcards
terminology
ataxia
impaired coordinationof movement during voluntary movement
terminology
diplopia
the awareness of two images of the same object occuring in one or both eyes
generally occurs with MG
terminology
dysphagia
difficulty swallowing
seen with parkinsons, MG, ALS, MS
terminology
dysphonia
voice impairment or altered voice production
nasallly tone
seen with MS and MG
terminology
neuropathy
general term indicating a disorder of the the nervous system
numbness, tingling, burning
terminology
ptosis
drooping of the eyelids
seen with MG
terminology
spasticity
muscular hypertonicity with increased resistance to stretch often associated with weakness, increased deep tendon reflexes, and diminished superficial reflexes
CNS related, jerky movements
name some infectious neurologic disorders
- meningitis
- brain abscesses
- encephalitis
- creutzfeldt-jakob disease
all of these lead to change in LOC
can use lumbar puncture, CT, MRI
describe meningitis
- inflammation os meninges
- originates through blood or invasive procedures
- clinical manifestations include HA, neck rigidity, phtotophobia, and rash
- diagnostic testing includes CT, lumbar puncture, C&S of CSF
describe brain absecesses
- frequent in immunocompromised/bacteria can cause
- clinical manifestations - HA (worse in AM), mental status changes
- diagnostics: CT/MRI, drainage of abscess
describe encephalitis
- inflammation of the brain tissue (increased ICP -> cushings triad)
- causes: viruses, arthropod vectors
- clinical manifestations: HA, fever, confusion, hallucinations, focal seizures
- diagnostics: EEG, CT, MRI, lumbar puncture, PCR (polymerase chain reaction)
describe creutzfeldt-jakob disease
- group of infectios disorders: mad cow disease (infected meat with prions, lie dormant)
- originates through blood or invasive procedures
- clinical manifestations: psychiatric symptoms, uncoordinated movements, memory loss
- diagnostics: brain biopsy, EEG, MRI, lumbar puncture
what is multiple sclerosis
- progressive demyelinating disease of the CNS
- impaired nerve impulses in spine and brain
the demyelenation of axons can affect the eyes, muscles, grasp, digestion, urinary spasms, neurogenic bladder, and speech
who is at a higher risk of multiple sclerosis
- peak age 25-35 years
- women twice as likely as men
- prevalent in colder climates
describe the cause of multiple sclerosis
exact cause is unknown but there are theories like:
- may be immunogenetic viral infection - epstein-barr virus
- HLA gene on chromosone 6
potential risk factors include:
- smoking
- lack of vitamin D
- epstein-barr virus
is multiple sclerosis predictable?
nope it is unpredictable in nature
- variable pathophysiology
- no two patients are alike in care needs
- demyelination disrupts nerve impulses
- plaques develop on demylinated axons
what are the four typical courses of multiple sclerosis
- relapsing remitting: most common, manifestations remit with little or no progression
- seondary progressive: gradual neurologic deterioration
- primary progressive: gradual continuous deterioration
- progressve relapsing: gradual deterioration with occasional superimposed relapses (never go back to baseline)
what are some clinical manifestations of multiple sclerosis
symptoms vary depending on location of the lesion
- main symptoms: fatigue, depression, weakness, paresthesia, ataxia, loss of balance, spasticity, pain
- visual disturbances: blurred vision, diplopia, loss of peripheral vision, scotoma (patchy blindness), total blindness
- bladder/bowel dysfunction: hesitancy, frequency, urgency, retention, and constipation
- sexual dysfunction
- dysarthria
- dysphagia
- mood changes
- cognitive impairment
what are some gerontologic considerations for multiple sclerosis
- high risk of med interactions
- monitor closely for toxicities d/t altered pharmacokinetics
- lots of meds are hard on the liver
describe the diagnosis of multiple sclerosis
- patient history: clinical presentation (partial diagnosis)
- imaging: presence of plaques on MRI
- lab findings: lumbar puncture to check CSF for presence of oligoclonal banding
- urodynamic studies: underling bladder dysfunction
- evoked potentials of optic pathways and auditory system: slowed never conduction
- neuropsychological testing: detects cognitive impairments
what is the goal of treatment for multiple sclerosis
slow progression of the disease, manage symptoms, and treat acute exacerbations
describe pharmacologic disease modifying therapies for relapsing-remitting MS
interferon Beta: suppress immune system
glatiramer: used speicifically for relapsing-remitting MS, works by stopping the body from damaging its own nerve cells
methylprednisolone: for exacerbations, watch glucose Q6, suppresses immune system
MS drugs
whats used for spasticity
- baclofen
- tizanidine
- dantrolene
- benzos
MS drugs
whats used for anxiety
benzodiazepines - diazepam
also used for spasticity
MS drugs
whats used for fatigue
amantadine
MS drugs
whats used for bladder issues
anticholinergics
tell em to piss and shit before giving this
what are some nonpharmacological treatments for MS
individualized care plan
- physical, functional, and emotional/social needs
- safety (increased risk for falls)
- mobility (ROM)
- bowel and bladder control
describe myasthenia gravis
Autoimmune disease affecting the myoneural junction characterized by varying degrees of weakness of voluntary muscles
- Antibodies directed at acetylcholine receptor sites impair transmission of impulses across the myoneural junction (80%)
- Resulting in less stimulation → Voluntary muscle weakness
- May have thymic hyperplasia or thymic tumor
when are the two peaks of onset for myasthenia gravis
- 20-30yrs for women
- after 50 for men
whats the hallmark symptom of myasthenia gravis
increased weakness with sustained muscle contraction that improves after periods of rest
what are the clinical manifestations of myasthenia gravis
- ocular manifestations are most common (80%): ptosis and diplopia
- weakness of muscles of face and throat: expressionless face, difficulty swallowing, difficulty chewing
- dysphonia: nasally voice
- may also affect extremities, trunk, neck, and breathing
- degree of weakness varies from local to generalized
- symptoms vary in type and degree
describe the diagnosis of myasthenia gravis
- history
- clinical presentation
- physical exam (cant maintain contraction)
- neurological exam
- diagnostic tests
what diagnostic tests are used in the diagnosis of myasthenia gravis
- anticholinesterase inhibitor test
- ice test (used for patienrs with asthma or cardiac conditions)
- blood tests (positive for acetylcholine receptor antibodies)
- nerve conduction tests
- EMG
- MRI to assess for enlarged thymus gland
describe anticholinesterase inhibitor test
- edrophonium (tensilon test) IV: improve 30 seconds after injection lasting 5 mins
- neostigmine for diagnostic purposes
atropine is antidote for both drugs
describe the treatment of myasthenia gravis
- pharmacological
- surgical
- others given with exacerbations: intravenous immune globulin, therapeutic plasma exchange
what pharmacological therapy is used for myasthenia gravis
- anticholinesterase agent: pyridostigmine (generally given 4x/day to help control weakness)
- immunosuppressive drugs: corticosteroids (reduce levels of serum Ach receptor antibodies, sx get worse b4 getting better)
- cytotoxic drugs: azathioprine (reduces receptor antibody levels; adverse effects are leukopenia and liver toxicity)
what surgical therapies may be used for myasthenia gravis
thymectomy
describe therapautic plasma exchange (aka plasmapheresis) for myasthenia gravis exacerbations
- done in specialty area
- central line used, pull blood out and take out plasma then give antibodies
- used daily for a couple weeks
what are some possible triggers of a myasthenia crisis
- resp infection
- med changes/sudden withdrawal of meds
- surgery
- pregnancy
- stress on the body
- spontaneously
what are some symptoms of myasthenia crisis
- severe generalized muscle weakness
- severe resp/cyanosis
- sudden rise in BP secondary to hypoxia
- increased HR
- absent cough and swallow reflexes
- increased secretions (salivation, diaphoresis, tearing)
- restlessness, dysarthria
- bowel/bladder incontinence
whats the treatment for myasthenia crisis
- increase meds
- may need mechanical vent
what is a cholinergic crisis
excess of acetylcholine (over medication)
what are some symptomgs of cholinergic crisis
- severe abd cramps
- bronchospasms
- N/V
- increased secretions
- increased weakness
- blurred vision
whats the treatment of cholinergic crisis
- discontinue all cholinergic meds until symptoms subside
- provide ventilation support
- atropine 1mg to reverse side effects of meds
will the majority of patients with myasthenia gravis live normal life expectancy?
yep
what is guillain-barre
acute inflammatory demyeleinating polyneuropathy affecting the peripheral nervous system
what are some causes of guillain-barre
- autoimmune response a viral infection
- often preceded by URI or GI infection (1-4wks)
- various potential viruses like campylobacter jejuni, cytomegalovirus, epstein barr, and others
what are some types of guillain-barre
- ascending (most common): starts at feet and works its way up
- purely motor
- descending
- miller fisher syndrome (rare)
- acute pan-automatic neuropathy
what are the characteristics of ascending weakness guillain-barre
- starts in lower extremities
- paresthesia - hands and feet
- pain
- hyporeflexia
- can involve paralysis up to and including resp system
what are the three phases of guillain-barre
- initial acute: 1-3wks after viral infection (be very aware)
- plateau: 2-4wks, stops progressing
- recovery occurs in a descending pattern (usually maximal recovery within 6mo (up to 2 yrs)
excellant prognosis, 70% make full recovery
whats included in the diagnosis of guillain-barre
- history: type of infection, resp status, recent weakness
- clinical presentation
- CSF examination (lumbar puncture)
- EMG (assess muscle response)
whats included in the medical treatment of guillain-barre
- considered a medical emergency
- focus of therapy is resp and supportive care
- therapeutic plasma exchange
whats included in nursing management of guillain-barre
- vitals
- resp assessments
- assess and manage swallowing
- intake and output (SIADH - retaining fluids)
- mobility (prevent contractures)
- pain (meds)
- preventing complications (monitor skin, VTE risk, EKG, pneumonia, and aspiration risk)
what cranial nerve does trigeminal neuralgia affect
V
describe trigeminal neuralgia
- affects cranial nerve V
- causes sudden pain in face and facial contraction
- use anticonvulsants to relieve pain -> calms nerves down
what cranial nerve does bells palsy affect
VII
describe bells palsy
- affects cranial nerve VII
- inflammation of the nerve and paralysis of facial muscle
- drooping face
- treat with steroids and check sugar
describe peripheral neuropathies
- numbness, tingling, burning in hands and feet
- both motor and sensory
- most common cause is diabetes
- untreated: atrophy, weakness, and decreased reflexes
describe mononeuropathy
- one nerve
- like carpal tunnel
