neurologic disorder 2 Flashcards

1
Q

Inflammation of brain tissue caused by virus

A

Encephalitis

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2
Q

Signs and symptoms Encephalitis

A

Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and restlessness commonly seen
Comatose or exhibit aphasia, hemiparesis, facial weakness, and other alterations in motor activity

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3
Q

Medical treatment Encephalitis

A

Enhance patient comfort and increase strength

Because seizure activity is a potential problem, take appropriate safety precautions

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4
Q

Nursing Care

Encephalitis

A

The nursing plan of care parallels that of the patient with meningitis

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5
Q

Although specific cause unknown, it is believed to be an autoimmune response to a viral infection
Patients often report some recent viral infection or vaccination

A

Guillain-Barré Syndrome

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6
Q

Initial phase s/s Guillain-Barré Syndrome

A

Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper extremities
Visual and hearing disturbances, difficulty chewing, and lack of facial expression
Mild paresthesias or anesthesia in feet and hands in a glove or stocking distribution pattern
Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention

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7
Q

Plateau phase s/s Guillain-Barré Syndrome

A

Remains essentially unchanged

No further neurologic deterioration, but no improvement either

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8
Q

Recovery phase s/s Guillain-Barré Syndrome

A

Remyelinization; muscle strength returns in a proximal-to-distal pattern (head to toes

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9
Q

medical diagnosis Guillain-Barré Syndrome

A

Characteristic onset and pattern of ascending motor involvement
Elevated protein level in the CSF
Nerve conduction velocity studies reveal slowed conduction speed in the involved nerves

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10
Q

medical treatment Guillain-Barré Syndrome

A

Preserve vital function, particularly respiration
Respiratory status is closely monitored and mechanical ventilation initiated if vital capacity falls to 15 mL/kg of body weight
Massive doses of corticosteroids prescribed to suppress the inflammatory process
Plasmapheresis

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11
Q

assessment of Guillain-Barré Syndrome

A

Health history describes the progression of symptoms
Note fears, coping strategies, and sources of support
Physical examination focuses on cranial nerve, motor, respiratory, and cardiovascular function

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12
Q

Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement

A

Parkinson’s Syndrome

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13
Q

Parkinson’s Syndrome s/s

A

Tremor, rigidity, and bradykinesia
Loss of dexterity and power in affected limbs, aching, monotone voice, handwriting changes, drooling, lack of facial expression, rhythmic head nodding, reduced blinking, and slumped posture
Depression common; dementia may develop

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14
Q

Medical diagnosis Parkinson’s Syndrome

A

From health history and physical examination

MRI to rule out other causes of the symptoms

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15
Q

Medical treatment Parkinson’s Syndrome

A

Control symptoms: physical therapy and drug therapy
Massage, heat, exercise, and gait retraining
Dopamine receptor agonists pramipexole (Mirapex) or ropinirole (Requip); L-dopa (L-dihydroxyphenylalanine); carbidopa/levodopa (Sinemet); anticholinergic drugs such as trihexyphenidyl (Artane) and benztropine (Cogentin)

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16
Q

assessment Parkinson’s Syndrome

A

Weakness, fatigue, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements
Note lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination

17
Q

Chronic, progressive degenerative disease
An autoimmune response that attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS

A

Multiple Sclerosis

18
Q

Chronic, progressive MS

A

progresses steadily

19
Q

Exacerbating-remitting MS

A

exacerbations and remissions

20
Q

Relapsing-progressive MS

A

less stable periods than exacerbating-remitting

21
Q

Stable MS

A

stable; no active disease for a year

22
Q

MS related to

A

Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated

23
Q

s/s of MS

A

Fatigue, weakness, and tingling in one or more extremities; visual disturbances; problems with coordination; bowel and bladder dysfunction; spasticity; and depression

24
Q

Medical diagnosis

for MS

A

Based on the physical examination and history of cyclic remission-exacerbation periods
Magnetic resonance imaging of the brain and spinal cord may reveal plaques characteristic of MS

25
Medical treatment for MS
Corticosteroids (ACTH, prednisone, methylprednisolone) Interferon  1b (Betaseron) and interferon 1a (Avonex) Glatiramer acetate (Copaxone) Immunosuppressants: mitoxantrone (Novantrone) Amantadine (Symmetrel) Urinary retention treated with cholinergics, such as bethanechol (Urecholine) or neostigmine (Prostigmine
26
assessment for MS
Onset and progression of symptoms, especially those that affect mobility, vision, eating, and elimination Range of motion and strength, gait abnormalities, tremors, and muscle spasms
27
a degenerative neurologic disease Virus suspected, but exact cause unknown Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms
Amyotrophic Lateral Sclerosis (ALS) | Also known as Lou Gehrig’s disease
28
s/s Amyotrophic Lateral Sclerosis (ALS)
Weakness of voluntary muscles of the upper extremities, particularly the hands Difficulty swallowing and speaking Eventually, respirations shallow; difficulty clearing airway of pulmonary secretions Death results from aspiration, respiratory infection, or respiratory failure
29
Medical diagnosis Amyotrophic Lateral Sclerosis (ALS)
History and physical examination findings | Electromyography
30
Medical treatment Amyotrophic Lateral Sclerosis (ALS)
Because no known cure or treatment, therapy is supportive; focuses on preventing complications and maintaining maximum function
31
Nursing Assessment Amyotrophic Lateral Sclerosis (ALS)
Dyspnea, dysphagia, muscle cramps, weakness, twitching, joint stiffness, muscle atrophy, abnormal reflexes and gait, and paralysis
32
Insufficient receptor sites at the junction of the motor nerve with the muscle With repeated stimulation, muscle becomes exhausted; eventually unable to contract at all If respiratory muscles involved, death from respiratory insufficiency or arrest possible May have an autoimmune basis
Myasthenia Gravis
33
s/s Myasthenia Gravis
Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking Partial improvements of strength with rest Dramatic improvement with the use of anticholinesterase drugs Ptosis and diplopia commonly seen
34
Medical diagnosis Myasthenia Gravis
``` Administering edrophonium (Tensilon) Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes ```
35
Medical treatment Myasthenia Gravis
``` Anticholinesterase drugs Neostigmine and pyridostigmine (Mestinon) Corticosteroids Cytotoxic therapies Thymectomy Plasmaphere ```
36
assessment of Myasthenia Gravis
Health history describes the onset of symptoms: muscle weakness, diplopia, dysphagia, slurred speech, breathing difficulties, and loss of balance