neuro Flashcards
multiple sclerosis
CNS (brain and spinal cord)
chronic, autoimmune, degenerative
inflamed nerve
loss of myelin (protects the nerves)
increase in oligodendrocyte (cells that produce myelin)
patches of plaque in white matter of CNS
schwann cells destroyed
MS triggers
infection, trauma, pregnancy, fatigue, stress
RRMS (relapse remit) 85% start with this, exacerbations and remissions
PPMS (primary progressive) symptoms gradually worsen
SPMS (secondary progressive) 10-25 years of RRMS, no real recovery
PRMS (progressive relapsing), escalates severely, few remission periods
MS etiology and contributing factors
unknown, age 20-40, immune system malfunction, viral, genetics, environmental
high suicide rate
maintain normal family function
MS diagnosis
history, mcdonald criteria (2 episodes one month apart), neuro symptoms (blurred vision, muscle weakness)
MRI
evoked potential
MS clinical manifestations
visual blurring, diplopia, blindness, nystagmus, oscillopsia
intentional tremors, poor condition, numbness, spasm, sensitivity to heat, fatigue, lassitude (collapse), poor memory, judgment, and reasoning
MS nursing management
relieve symptoms, mobility (ROM exercises), bladder, high fiber diet
prevent overheating
wide-based gate walk
increase fluids to relieve constipation
void every 2 hrs to prevent UTI
kegel exercises
avoid laxatives
MS pharmacologics
anticholinergics
amantadine HCL
antidepressants
beta blockers
antihistamines
muscle relaxants (baclofen)- spasticity
immunoregulatory (avonex, beta-interferon, rebif, copaxone, etc)
myasthenia gravis
autoimmune neuromuscular disease
acetylcholine receptors depleted
weakness (hallmark symptom) in the presence of sustained contraction
relieved with rest
myasthenia gravis clinical manifestations
ocular-diplopia and ptosis (drooping eyelid)
facial- dysphagia, dysphonia, mastication
larynx- dysarthria, aspiration, dysphagia
limbs- unsteady gait
weak diaphragm
myasthenia gravis diagnosis
tensilon test or edrophonium chloride- blocks breakdown of acetylcholine, given 2mg of tensilon injected IV. if muscle tone increases, an additional 8mg is given
no response= pt given bromide injected IV
serum tests- antibodies to SCH receptors
electromyography (EMG)
chest x-ray (enlarged thymus gland)
myasthenia gravis complications
myasthenia crisis- under dose, increase anticholinesterase drugs
cholinergic crisis- overdose, decrease anticholinesterase drugs
myasthenia gravis drugs
anti-cholinesterase (bromides)
immunosuppressives (prednisone, cytoxan)
plasmapheresis (removed acetylcholine receptor antibodies)
thymectomy (thymus excision)
myasthenia gravis nursing management
medications at exact same time
given 30-60 min before meals
given before ADL’s
cut food into small bites, sit upright
main meal= when pt is least fatigued (AM over PM)
protect eyes (sunglasses)
wear medical alert bracelet
may need artificial tears
rest periods throughout the day
parkinsons disease
affects voluntary movement
chronic neurodegenerative disease, juvenile
idiopathic (unknown cause)
latrogenic (caused by drugs)
more men than women
destruction of cells in substantia nigra
DECREASED DOPAMINE
loss of control, coordination, and initiation of voluntary movement
post encephalitic parkinsonism
pt had encephalitis as a kid, developed parkinson’s symptoms as they aged
Parkinson’s cardinal signs
tremors (resting, micrographia, pill-rolling)
supination/pronation
bradykinesia
rigidity
resting tremors disappear with slow, purposeful movement
propulsive gait
festination (short, shuffling steps)
hypomimia
dysphagia
rigidity of chest wall
TRAP tremors rigidity akinesia postural instability
parkinsons teaching
high risk for falls, no rugs
firm chairs with arms
velcro/slip on shoes and clothes with buttons
rock back and forth to get up
eat sitting upright
wide based gait
raised toilet seat
parkinsons disease nursing care
give semi solid foods with thickeners for dysphagia
diet: pyridoxine, no alcohol, NOT high protein (should be evenly distributed)
refer to nutritionist
drug holiday: pt in quiet room with subdued lighting
physical therapist for movement
speech pathologist for swallowing
parkinsons diagnosis
presence of symptoms
trial of levodopa (consistent response to the drug rules out parkinson’s like syndrome)
pt may have to walk the length of the room to be observed for rigidity and resting tremors
parkinsons medical management
levodopa (hallmark treatment), benefits only last 5-10 years so this is the last treatment given
carbidopa (combination= sinimet), gets more levodopa to the brain
nonergot derivatives (requip, mirapex)
dopamine antagonist (parlodel, permax)
MAOIs (selegiline)
antiviral (amantadine)
COMT inhibitors
antidepressants, antihistamines
guillian barre
life threatening autoimmune syndrome
affects peripheral nervous system
clinical manifestations of guillian barre
rapid onset of pain
ascending pattern
paralysis (over a few hours, lasting 1-4 weeks), paresthesia
dyskinesia
loss of DTR
respiratory paralysis (late symptom)
vocal paralysis
bladder incontinence/incomplete emptying
constipation, dizzy, cramps, BP affected
nursing management guillian bare
ventilator, incentive spirometer, chest PT, suction to prevent aspiration, mobility, HOB15-30º. passive ROM, thigh high stockings, check bowel sounds, monitor gag reflex, TPN or G tube
refer to speech pathologist
patrial (focal) seizure
simple partial
no loss of consciousness
changes in site, hearing, smell, may involve 1 finger
aware of surroundings but cannot control
lasts 30 seconds
complex partial seizure
loss of consciousness
automatism (purposeless repetitive symptoms like lip smacking, picking at clothes, tapping)
blacks out
bizarre behavior
generalized seizure
involves the entire brain
tonic-clonic
absence seizure
myoclonic
atonic
tonic clonic preictal phase
aura- brief sensory experience that occurs a few seconds before seizures
ex. strange odor, mild depression, irritability
clonic phase
2-5 minutes
jerking of extremities
rhythmic shaking, muscle contractions, and relaxation
incontinence, may be foaming from the mouth
turn head to the side
postictal phase
deep sleeping (30 min to 4 hr)
disorientation (no memory of seizure)
confusion
weakness
headache
muscle ache
documentation is important!
absence seizure
brief loss of consciousness
vacant facial expression
rapid blinking
often disappears after puberty
myoclonic seizure
brief jerking of muscles
brief loss of consciousness
atonic seizure
loss of muscle tone
falls to the floor, briefly nods off
confused post ictal
must wear protective head gear
seizure diagnostic tests
history
EEG (within 24 hrs of seizure)
computer tomography
MRI
telemetry (brain activity monitor)
videotaping
pharmacological therapy/ seizure management
control, raise threshold, therapeutic blood level, monitor for allergies/toxicity, give meds at same time each day
switching meds: 1 med is tapered as the other is increased
phenytoin, carbamazepine, clonazepam, diazepam or lorazepam (IV), luminal (phenobarbital)
seizure patient teaching
phenytoin causes gingival hyperplasia, hirsutism, hypothermia, diplopia, BMS
avoid triggers
take meds on time and correct dose
avoid dangerous activities
wear protective headgear
lie down if experiencing aura
meticulous oral hygiene with phenytoin
wear medical alert bracelet
nursing care for seizures
assess for aura and triggers
establish/maintain airway
move objects, remain until consciousness returns
do not insert anything into mouth
turn head to the side
padded siderails on the bed
do not restrain or shout
call ambulance if seizure is longer than 10 minutes
oxygen/trach equipment at bedside
maintain saline lock for pt incase medication is needed
