Neuro Flashcards
Disease of the basal ganglia
Parkinson’s Disease
What is Parkinson’s characterized by?
Slowing down in the initiation and execution of movement, increased muscle tone, tremors at rest, and impaired postural reflexes
Who is Parkinson’s more common in?
Men older than 50
What is the pathology of Parkinson’s Disease?
Degeneration of dopamine-producing neurons in substantia nigra of the midbrain, disrupting the dopamine-acetylcholine balance in basal ganglia
What is dopamine essential for the normal functioning of?
Posture, support, and voluntary motion
When do the symptoms of Parkinson’s begin?
After 80% of the neurons in the substantia nigra are gone
What is the hallmark of Parkinson’s?
Cogwheel rigidity
What is the rigidity in Parkinson’s caused by?
Sustained muscle contractions
What are the nursing interventions for patients with Parkinson’s?
Fall risk, aspiration risk, nutrition risk
How is Parkinson’s diagnosed?
Solely on history and clinical features
What confirms a Parkinson’s diagnosis?
A positive response to anti-parkinsonian medications
What is the goal of drug therapy for Parkinson’s?
Enhance or release the supply of Dopamine and block the effects of overactive cholinergic neurons
Dopamine receptor antagonist that promotes the release of dopamine
Parlodel
In which patients is Parlodel used?
Patients who experience dyskinesias or orthostatic hypotension while receiving Sinemet
Precursor of dopamine the can cross the blood brain barrier and convert to dopamine in the basal ganglia
Levodopa with carbidopa
What does long term use of levodopa with carbidopa lead to?
dyskinesia
How should levodopa with carbidopa be used?
Before meals to increase absorption and transport across the blood brain barrier
Drug used to block specific enzymes that inactivate dopamine
MAO Inhibitor
What teachings should accompany MAO Inhibitors?
There are many food interactions that continue for 14 days after discontinuation
Why are anticholinergic drugs used to manage Parkinson’s?
They decrease the activity of acetylcholine
What does surgery to to treat Parkinson’s?
Decrease the increased neuronal activity produced by dopamine depletion
Which surgeries are used in the treatment of Parkinson’s?
Ablation and Deep Brain Stimulation
What are the nutritional concerns in patients with Parkinson’s?
Malnutrition, constipation, and aspiration
How should the nutritional concerns of Parkinson’s patients be addressed?
Food easy to chew, thicken, small frequent meals, and adequate roughage
What is the cause of Parkinson’s?
Possible genetic component, stress
What do Parkinson’s patients look like?
Hunched over, shuffled gait and pill rolling fingers
What sensory impairment do patients with Parkinson’s have?
Dry eyes do to excessive blinking
What do Parkinson’s patients usually die of?
Pneumonia due to aspiration and immobility
What are the five Fs of Neurodegenerative diseases?
Fatigue and immobility, fluctuations in function, frequent medication changes, fecal, and flow
Chronic demyelinating disease of the entire central nervous system caused by plaque, inflammation, edema and recovery of the nerve cells
Multiple Sclerosis
Where are people more likely to develop MS?
Not near the equator
Who is more likely to develop MS?
Young caucasian women
What causes MS?
Possible post-viral stimuli, possible genetic component, autoimmune disease
What is the biggest impediment to adjusting to the diagnosis of MS?
The uncertain course of the disease and the inability to plan for the future
How is MS diagnosed?
Rule out everything else, then look at an MRI for two areas of demyelination or two or more exacerbations
What are the signs of MS?
Paresthesias, double vision, tremors, nystagmus, schitomas, Lhermitte’s sign
Seeing floaters in eyes
Schitomas
Flexing neck causes shooting, electric like pain in the lower extremities
Lhermitte’s sign
What brings a patient with MS in initially?
Vision changes
What is the goal for the drug therapy of patients with MS?
Keep the disease in remission
What medications are used to treat MS?
IV and PO corticosteroids, Copaxone, and Baclofen
What is Baclofen used to treat in MS patients?
Spasticity
How are corticosteroids used in MS patients?
As a rescue treatment
How is Copaxone used for MS patients?
It is an immunomodulator used to reduce the frequency of relapses
What risk accompanies Copaxone and corticosteroids?
Risk for infection
What considerations need to be taken when using steroids?
Low K, bleeds, psuedodiabetes
Why are MS patients on antibiotics?
Frequent UTIs
What do MS patients have to be taught about urination habits?
Use the Crede method
What are the nursing interventions for patients with MS?
Impaired mobility, altered urinary elimination, risk for falls
What are the major problems for MS patients?
Motor balance and coordination
What are the sensory dysfunctions for patients with MS?
Loss of sensitivity or tingling, pins and needles, numbness
What is the worst kind of MS?
Primary Progressive
What is the main dysfunction of MS?
Urinary interruptions and muscle spasticity and weakness
When do tremors occur in patients with MS?
With activity
What causes a relapse of MS?
Stress to the body or mind
What are the side effects of Levidopa?
Makes the patient extremely sexual and tar dive dyskinesia
What is Requip used for in patients with Parkinson’s?
It mimics dopamine
What sensory dysfunction occurs with MS?
Loss of sensitivity, tingling, pins and needles and numbness in extremities
What is TENS?
Low does electricity used to treat MS
What is the nursing priority for patients with MS?
Prevent falls
What part of the nervous system does MS attack?
CNS
Destruction of the myelin sheath in peripheries caused by multiple immunizations or an autoimmune attack
Guillain Barre
Who does Guillain Barre affect?
Men and women over 55
What is the problem in Guillain Barre?
The lymphocytes are not making the distinction between self and non self cells
What part of the nervous system does Guillain Barre affect?
PNS
Where in the body does Guillain Barre start?
Starts at toes and works its way up
What sensory dysfunctions does Guillain Barre cause?
Paresthesia, blindness, and a blank stare
What is the major problem of Guillain Barre
Respiratory depression from paralysis of muscles
How is Guillain Barre treated?
Plasmapheresis and IV-IG
What are the side effects of IV-IG?
Chills, fever, myalgia, acute renal failure, and anaphylaxis
What can patients with Guillain Barre never be given?
Corticosteroids
What are the nursing interventions for patients with Guillain Barre?
Prepare to intubate, impaired mobility, ineffective airway clearance
What is the prognosis for Guillain Barre?
The disease should remit and go away within 2 years
Autoimmune disorder in which antibodies attack the acetylcholine receptors at neuromuscular junctions, impairing the transmission of impulses
Myasthenia Gravis
Who does MG affect?
Women younger than 40 and men older than 60
What can cause MG?
Thymus problems, stress
What are the motor dysfunctions in patients with MG?
Muscle fatigue and aches
What are the sensory dysfunctions for patients with MG?
Impaired facial expressions, paresthesia, impaired chewing and swallowing, decreased smell and tastes, dysphonia, and ptosis
What is the major problem for patients with MG?
Respiratory Failure
What is used to treat MG?
Immunosuppressants, thyroidectomy and anticholenergases
Name an anticholenergase drug
Mestinon
What teaching needs to accompany a MG diagnosis?
Teach family CPR and how to respond to respiratory distress
What causes a myasthenic crisis?
Too little acetylcholine
What happens to patients in a myasthenic crisis?
Increased heart rate, increased respirations, and elevation in blood pressure
What causes a cholenergic crisis?
Too much acetylcholine
What happens to patients in a cholenergic crisis?
Nausea, vomiting, diarrhea, pallor, twitching, and hypotension
What are the nursing interventions for patients with MG?
Keep the airway patent and keep the patient away from extremes in temperature
How is MG diagnosed?
Tensilon Test
What is a Tensilon Test?
Give the patient an injection of acetylcholine and see if their symptoms resolve
What are the four major symptoms of Parkinson’s?
Tremors, rigidity, bradykineisa, and postural imbalances
Where does the demyelination of neurons take place in patients with Guillain Barre?
At the Nodes of Ranvier
Which neuro patient is at risk for developing DVTs?
Guillain Barre
Which neuro patients have hyporeflexia?
Guillain Barre
What is the diagnostic tool for Guillain Barre?
Presence of protein in the CSF
What are the complications associated with plasmapheresis?
Infection, hypovolemia, hypokalemia, hypocalcemia, temporary paresthesia
How long can a patient be intubated before a trach is needed?
10-14 days
Which gland is involved in MG?
Thymus
What is the first symptom of MG?
Ptosis
How should Mestinon be given?
Eat 45 minutes to an hour after administration
Which MG crisis requires intubation?
Myasthenic
What do patients with Parkinson’s have to be closely monitored for?
Drug toxicity
