Myasthenia Gravis, Guillain Barre, MS, ALS

Question 1

Myasthenia gravis

Answer 1

Chronic autoimmune that causes weakness in skeletal muscles. Remissions and exacerbations.

Question 2

Myasthenia gravis s&s

Answer 2

***Muscle weakness that worsens after activity and gets better after rest
Drooling
Weakness in neck, face, arms and legs
Dysphagia
Dysarthia
Extraocular muscle involvement (strabismus, double vision)
Ptosis

Question 3

Patho of myasthenia gravis

Answer 3

Immune system builds up antibodies against ACH receptors making muscle contraction weak r/t enlarged thymus

Question 4

Treatment of myasthenia gravis

Answer 4

No cure

Anticholinesterase drugs, take 40-60 minutes before eating to reduce risk of choking

Thymectomy

Question 5

Myasthenic crisis

Answer 5

Severe muscle weakness, respiratory failure d/t not enough meds

Will IMPROVE with tensilon test

Question 6

Cholinergic crisis

Answer 6

Too many meds, leading to worn out muscle fibers

will GET WORSE with tensilon test

Administer atropine if symptoms get worse

Question 7

Nursing Management for myasthenia gravis

Answer 7

Respiratory status
Keep suction and crash cart close
Perform activies in the morning
Small bites of soft food

Question 8

Guillain-Barre synrdrome

Answer 8

Immune system attacks mylein sheath, sometimes related to previous infecions

Question 9

Guillain-Barre s&s

Answer 9

Paresthesia starting in lower extremities, moving upward and symmetrical
Can progress to paralysis over 2-3 weeks
Symptoms will start to subside after 2-3 weeks but takes years to regain normal functioning (rehab)

Question 10

Nursing Management of Guillain Barre

Answer 10

Monitor respirations
Eye drops if loss of sensation in face
Communicate with patient, this is likely temporary
Feeding tube
Can have severe pain despite paralysis
Possible intubation or trach

Question 11

MS

Answer 11

Relapsing-remitting most common. Attack on CNS, demyelination leads to lesions

Question 12

Symptoms of MS

Answer 12

Fatigue
Speech issues
Spasms
Paresthesia
Coordination issues
Nystagmus
Positive Romberg’s sign (falling with eyes closed)
Uthoff’s sign (s&s get worse with heat)

Question 13

Nursing interventions for MS

Answer 13

Safety!
Bowel/bladder (possible straight cath, easy access to bathroom)
Prevention of worsening symptoms (heat, stress, infection, and overexertion)
Swimming

Question 14

Lioresal (MS)

Answer 14

Muscle relaxant
se: dizziness, drowsiness, lethargy

Question 15

Diazepam (MS)

Answer 15

Muscle relaxant
se: dizziness, drowsiness, lethargy
Monitor: bp, pulse and rr

Question 16

Tizanidine (MS)

Answer 16

Anti spasticity
se: anxiety, depression, hypotension

Question 17

Corticosteroids (MS)

Answer 17

Decrease inflammation
se: decreased immune system, osteoporosis

Question 18

ALS

Answer 18

neurogenerative disease reflecting degeneration of motor neurons. More debiliatating that MS, can lead to death

Question 19

ALS s&s

Answer 19

Muscle cramps
Clumsiness
problems holding head up
Fatigue
Dysphagia d/t weak muscles

Question 20

ALS Nursing care

Answer 20

Imparied mobility, communication
High risk for aspiration–>HOB 90 degrees when eating, maybe enteral tube
Ineffective breathing d/t impaired muscles