Neurological disorders

Question 0

Name the cause of multiple sclerosis

Answer 0

The causes unknown But suggest that it is related to infectious, immunologic, and genetic factors

Question 1

Define multiple sclerosis

Answer 1

A chronic, progressive, degenerative disorder of the CNS characterized by demyelination of nerve fibers in the brain and spinal cord

Question 2

Name the characteristics of multiple sclerosis

Answer 2

Demyelinization and gliosis in the CNS, activation of the inflammatory response that leads to demyelinization of axons leading toImpairment of function, myelin can regenerate (remission) But if axons are destroyed permanent loss of function results

Question 3

Clinical manifestations of multiple sclerosis

Answer 3

Motor sensory cerebellar and emotional problems, weakness, paralysis of Men’s trunk or head, diplopia, scanning speech, spasticity of the muscles, numbness, tingling, blurred vision, vertigo, tinnitus, decreased hearing, neuropathic pain, fatigue, ataxia, dysarthria, dysphagia

Question 4

What is the relationship to multiple sclerosis and pregnancy

Answer 4

Women who become pregnant experience remission or an improvement but are at greater risk for exacerbation in the postpartum period.

Question 5

What is the average life expectancy after onset of multiple sclerosis

Answer 5

More than 25 years

Question 6

What aggravates/exacerbates multiple sclerosis

Answer 6

Physical and emotional trauma, fatigue, and infection

Question 7

Name the diagnostic studies for multiple sclerosis

Answer 7

No definitive diagnostic tests, based primarily on history and clinical manifestations and the presence of multiple lesions over time as measured by MRI.

Question 8

Collaborative care of multiple sclerosis

Answer 8

Care is aimed at treating the disease process and symptomatic relief. Steroids and immunomodulator drugs treat acute exacerbations

Question 9

Define Parkinson’s disease

Answer 9

A chronic, progressive neurodegenerative disorder characterized by bradykinesia, increased muscle tone, tremor at rest, and gait disturbance.

Question 10

What is the etiology of Parkinson’s disease

Answer 10

Genetic makeup, encephalitis is associated, chemical intoxication, carbon monoxide and manganese, Drug induced, hydrocephalus, hypoxia, infections, stroke, tumor, Huntington’s disease, trauma

Question 11

Clinical manifestations of Parkinson’s disease

Answer 11

Also known as the triad of PD. Tremor, first sign, aggravated by emotional stress or increased concentration, pill rolling.
Rigidity, second sign, increased resistance to passive motion, jerky quality.
Bradykinesia, Loss of automatic movements, blinking, swinging arms, swallowing of saliva, self-expression, postural adjustment, masked face, drooling, shuffling gait

Question 12

Complications of Parkinson’s disease

Answer 12

Depression, anxiety, apathy, fatigue, pain, constipation, impotence, short-term memory impairment, dementia, malnutrition or aspiration, pneumonia, UTI, skin breakdown, orthostatic hypotension, loss of postural reflexes, sleep disorders

Question 13

Diagnostic studies for Parkinson’s disease

Answer 13

No specific diagnostic test. When at least two of the three triads are present. Ultimate confirmation is a positive response to anti-Parkinson’s drugs.

Question 14

Collaborative care for Parkinson’s disease

Answer 14

Aimed at relieving the symptoms. Correcting an imbalance of neurotransmitters by enhancing the release or supply of dopamine, Sinemet.

Question 15

Surgical therapy for Parkinson’s disease

Answer 15

Deep brain stimulation - by electrode in the thalamus is adjustable and reversible, ablation - has been used but is replaced by deep brain stimulation, transplantation -Fetal neural tissue which provides dopamine producing cells

Question 16

Nutritional therapy for Parkinson’s disease

Answer 16

Food that’s easily chewed and swallowed. Roughage and fruit to avoid constipation. Six small meals per day.

Question 17

Define myasthenia gravis

Answer 17

In autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups

Question 18

Etiology of myasthenia gravis

Answer 18

Autoimmune process in which antibodies attack acetylcholine receptors preventing muscle contraction

Question 19

Clinical manifestations of myasthenia gravis

Answer 19

Fluctuating weakness of skeletal muscle, eyes, eyelids, chewing, swallowing, speaking, breathing, muscles are strongest in the morning but weak by end of the day

Question 20

What is a myasthenic crisis and what triggers one

Answer 20

It is an acute exacerbation of muscle weakness. Triggered by infection, surgery, emotional distress, drug overdose, inadequate drugs.

Question 21

Diagnostic studies for myasthenia gravis

Answer 21

Diagnosis is based on history and physical. If diagnosis still in doubt EMG or Tensilon test maybe used.

Question 22

Drug therapy for myasthenia gravis

Answer 22

Corticosteroids suppress the immune response, anticholinesterase drugs enhance the function of the neuromuscular junction

Question 23

Surgical therapy for myasthenia gravis

Answer 23

Removal of the finest gland - thymectomy

Question 24

Other therapies for myasthenia gravis

Answer 24

Plasmapheresis is a short-term improvement indicated for patients in crisis or preparation for surgery

Question 25

Define amyotrophic lateral sclerosis ALS

Answer 25

Hey where progressive neurologic disorder characterized by loss of motor neurons

Question 26

ALS (Lou Gehrig’s disease) life expectancy

Answer 26

Death within 2 to 6 years

Question 27

ALS etiology/pathophysiology

Answer 27

For unknown reasons, motor neurons in the brain stem and spinal cord gradually degenerate leading to weakness of upper extremities, dysarthria, dysphagia, muscle wasting and fasciculations, Pain, sleep disorders, spasticity, drooling, emotional lability, depression, constipation, esophageal reflux, devastating because patient remains cognitively intact while wasting away.

Question 28

Define Bell’s palsy

Answer 28

I disorder characterized by the inflammation of the facial nerve on one side

Question 29

Etiology of Bell’s palsy

Answer 29

Unknown cause, but activation of herpes simplex one may be involved because it causes inflammation, edema, ischemia, eventually demyelination, creating pain and alterations in motor and sensory function

Question 30

Clinical manifestations of Bell’s palsy

Answer 30

Herpes vesicles in or around the ear, fever, tinnitus, hearing deficit, flaccidity, drooping of the mouth, drooling, inability to close eyelid, inability to smile frown or whistle, loss of taste, decreased muscle movement, excessive tearing

Question 31

Bell’s palsy collaborative care

Answer 31

Moist heat, Tampa massage, electrical stimulation exercises, relief of symptoms, corticosteroids, acyclovir, Full recovery after six months in most patients

Question 32

Define Guillain-Barre syndrome

Answer 32

An acute rapidly progressing and potentially fatal form of polyneuritis characterized by ascending symmetric paralysis

Question 33

Etiology and pathophysiology of Guillain-Barre

Answer 33

Etiology is unknown. It is a loss of Mylan and edema and inflammation of the affected nerves. Distal to proximal and in recovery function returns proximal to distal. The syndrome is often preceded by viral infection, trauma, surgery, viral immunizations, or HIV.

Question 34

Clinical manifestations of Guillain-Barre

Answer 34

Symptoms develop 1 to 3 weeks after a upper respiratory or G.I. infection. Paresthesia, hypotonia, areflexia, deep sensitivity more effective, orthostatic hypotension, hypertension, abnormal vagal responses, Ballin bladder dysfunction, facial flushing, diaphoresis, pain is common, respiratory failure is a complication.

Question 35

Diagnostic studies for Guillain-Barre

Answer 35

Diagnosis is based on H&P, but CSF and EMG can be evaluated.

Question 36

Collaborative care of Guillain-Barre

Answer 36

Supportive care, ventilatory support, plasmapheresis, immunoglobulin, difficulty swallowing can lead to tube feedings or parenteral nutrition.

Question 37

Guillain-Barre prognosis

Answer 37

Residual problems and relapses are uncommon, complete recovery can be anticipated, generally a slow process that takes months or years if axonal degradation occurs

Question 38

Define fibromyalgia

Answer 38

Hey chronic disorder characterized by widespread nonarticular musculoskeletal pain and fatigue with multiple tender points

Question 39

Etiology and pathophysiology of fibromyalgia

Answer 39

A disorder involving neuroendocrine/neurotransmitter dysregulation causing pain amplification due to abnormal sensory processing in the CNS

Question 40

Clinical manifestations and complications of fibromyalgia

Answer 40

Widespread burning pain, tenderness at 11 or more of the 18 identified sites, difficulty concentrating, memory lapses, migraine, depression, anxiety, restless leg syndrome, Irritable bowel syndrome, constipation, diarrhea, abdominal pain, difficulty swallowing

Question 41

Diagnostic studies for fibromyalgia

Answer 41

Diagnosis is difficult to establish. It’s two criteria are met, pain experienced and 11 of 18 and history of widespread pain is noted at least three months. Muscle biopsy may show moth eaten appearance or fiber atrophy.

Question 42

Collaborative care for fibromyalgia

Answer 42

Treatment is symptomatic. Rest, Flexeril Elavil, reuptake inhibitors, Ultram, SSRI, OTC analgesics, Xanax, Ambien, Neurontin

Question 43

Nursing management for fibromyalgia syndrome

Answer 43

Massage, ultrasound, heat and cold packs, gentle stretching, yoga, tai chi, low impact aerobics, limiting sugar caffeine and alcohol, vitamin and mineral supplements, relaxation strategies