Neurological diseases

Question 1

What is multiple sclerosis?

Answer 1

–> loss of muscle control d/t autoimmune demyelination of CNS nerves
Key Dx: increased gamma globulins, brain plaque
Key S/Sx: muscle spasms, stiffness
Tx:
- cluster care and allow for rest. (balance rest and exercise)
- avoid triggers (4S: stress, sickness, sun and heat, smoking)
- IVIG
- cyclosporine

Question 2

What is myasthenia gravis?

Answer 2

autoimmune dz that attacks acetylcholine receptors
S/Sx: dry membranes, droopy eyes, constipation, decreased urine output, muscle weakness, visual disturbance, muscle cramps
Tx:
- cholinergic medications “-stigmine”

Question 3

What is myasthenic crisis?

Answer 3

–>
S/Sx: diaphragmatic weakness & respiratory arrest
Tx:
- airway protection: intubation tray, administration of cholinergic medications prior to meals, a diet of semi-soft foods

Question 4

Levodopa

Answer 4

• medication for Parkinson’s disease, prevents reuptake of dopamine
• SE: psychosis, orthostatic hypotension
• Toxicity S/Sx: dyskinesia (involuntary movements)
  CI: protein (inhibits absorption)
  OK to use with MAOIs (selegiline)

Question 5

Parkinson’s disease

Answer 5

low dopamine, high acetylcholine
Key S/Sx: shuffling gait, pill-rolling, tremors at rest, muscle weakness
Tx: Levodopa & Carbidopa
- maintain safe environment

Question 6

signs and symptoms of alzheimer’s

Answer 6

forgetfulness, disorientation from reality, memory loss

Question 7

Nursing considerations when caring for a patient with Alzheimer’s

Answer 7

MAINTAIN SAFETY
- no rugs, loose wires, etc
- lock all toxic chemicals, closets, etc
- lock all doors leading to the outside
- distract and redirect from reality

Question 8

Nursing considerations when caring for a patient with Parkinson’s disease

Answer 8

• do not perform all ADLs
• no rugs, loose wires, etc
• no protein diet if taking Levodopa

Question 9

What are the key signs and symptoms of Guillain-Barr Syndrome?

Answer 9

• inability to cough
• inability to lift the head or eyebrows
  = respiratory failure

Question 10

What is Guillain-Barr Syndrome

Answer 10

–> rapidly ascending paralysis

Question 11

Signs and symptoms of MS

Answer 11

• muscle spasms & stiffness
• burning sensation
• numbness & tingling
• ataxia
• urinary retention
• vision problems
• trouble concentrating
• hyperreflexia

Question 12

What are 4 common triggers of autoimmune diseases?

Answer 12

stress (exercise, injury, surgery)
sickness & sepsis
smoking
sun and heat (hot tubs, baths, saunas)

Question 13

What are common side effects of immunosuppressants such as cyclosporine and azathioprine?

Answer 13

bone marrow suppression = low WBC & platelets = increased risk of infection and bleeding
- monitor bleeding
- avoid crows
- use soft-bristled toothbrush and do not floss
Gingival hyperplasia

contraindications:
- grapefruit juice
- pregnancy

Question 14

What are common signs and symptoms of Parkinson’s disease?

Answer 14

shuffling gait
tremors at rest
pill rolling of fingers
jitteriness
start-stop movements
muscle weakness and rigidity
bradykinesia

Question 15

Your patient with Parkinson’s disease has red or brown-tinged saliva, sweat, and urine. What interventions should you take?

Answer 15

None. This is an expected side effect of Levodopa.

Question 16

Neostigmine

Answer 16

IND: cholinergic med –> myasthenia gravis & decrease secretions, low acetylcholine
SE: cholinergic crisis, visual disturbance
CI: asthma

Question 17

What are signs and symptoms of cholinergic crisis?

Answer 17

increase in pupil constriction, salivation, lacrimation, diaphoresis, diarrhea, N/V
Tx: Notify HCP when symptoms arise. Give anticholinergic medications ATROPINE; discontinue cholinergic medications.