Neurological disorders Flashcards
Name the cause of multiple sclerosis
The causes unknown But suggest that it is related to infectious, immunologic, and genetic factors
Define multiple sclerosis
A chronic, progressive, degenerative disorder of the CNS characterized by demyelination of nerve fibers in the brain and spinal cord
Name the characteristics of multiple sclerosis
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
Clinical manifestations of multiple sclerosis
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
What is the relationship to multiple sclerosis and pregnancy
Women who become pregnant experience remission or an improvement but are at greater risk for exacerbation in the postpartum period.
What is the average life expectancy after onset of multiple sclerosis
More than 25 years
What aggravates/exacerbates multiple sclerosis
Physical and emotional trauma, fatigue, and infection
Name the diagnostic studies for multiple sclerosis
No definitive diagnostic tests, based primarily on history and clinical manifestations and the presence of multiple lesions over time as measured by MRI.
Collaborative care of multiple sclerosis
Care is aimed at treating the disease process and symptomatic relief. Steroids and immunomodulator drugs treat acute exacerbations
Define Parkinson’s disease
A chronic, progressive neurodegenerative disorder characterized by bradykinesia, increased muscle tone, tremor at rest, and gait disturbance.
What is the etiology of Parkinson’s disease
Genetic makeup, encephalitis is associated, chemical intoxication, carbon monoxide and manganese, Drug induced, hydrocephalus, hypoxia, infections, stroke, tumor, Huntington’s disease, trauma
Clinical manifestations of Parkinson’s disease
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
Complications of Parkinson’s disease
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
Diagnostic studies for Parkinson’s disease
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.
Collaborative care for Parkinson’s disease
Aimed at relieving the symptoms. Correcting an imbalance of neurotransmitters by enhancing the release or supply of dopamine, Sinemet.
Surgical therapy for Parkinson’s disease
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
Nutritional therapy for Parkinson’s disease
Food that’s easily chewed and swallowed. Roughage and fruit to avoid constipation. Six small meals per day.
Define myasthenia gravis
In autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups
Etiology of myasthenia gravis
Autoimmune process in which antibodies attack acetylcholine receptors preventing muscle contraction
Clinical manifestations of myasthenia gravis
Fluctuating weakness of skeletal muscle, eyes, eyelids, chewing, swallowing, speaking, breathing, muscles are strongest in the morning but weak by end of the day
What is a myasthenic crisis and what triggers one
It is an acute exacerbation of muscle weakness. Triggered by infection, surgery, emotional distress, drug overdose, inadequate drugs.
Diagnostic studies for myasthenia gravis
Diagnosis is based on history and physical. If diagnosis still in doubt EMG or Tensilon test maybe used.
Drug therapy for myasthenia gravis
Corticosteroids suppress the immune response, anticholinesterase drugs enhance the function of the neuromuscular junction
Surgical therapy for myasthenia gravis
Removal of the finest gland - thymectomy
Other therapies for myasthenia gravis
Plasmapheresis is a short-term improvement indicated for patients in crisis or preparation for surgery
Define amyotrophic lateral sclerosis ALS
Hey where progressive neurologic disorder characterized by loss of motor neurons
ALS (Lou Gehrig’s disease) life expectancy
Death within 2 to 6 years
ALS etiology/pathophysiology
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.
Define Bell’s palsy
I disorder characterized by the inflammation of the facial nerve on one side
Etiology of Bell’s palsy
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
Clinical manifestations of Bell’s palsy
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
Bell’s palsy collaborative care
Moist heat, Tampa massage, electrical stimulation exercises, relief of symptoms, corticosteroids, acyclovir, Full recovery after six months in most patients
Define Guillain-Barre syndrome
An acute rapidly progressing and potentially fatal form of polyneuritis characterized by ascending symmetric paralysis
Etiology and pathophysiology of Guillain-Barre
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.
Clinical manifestations of Guillain-Barre
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.
Diagnostic studies for Guillain-Barre
Diagnosis is based on H&P, but CSF and EMG can be evaluated.
Collaborative care of Guillain-Barre
Supportive care, ventilatory support, plasmapheresis, immunoglobulin, difficulty swallowing can lead to tube feedings or parenteral nutrition.
Guillain-Barre prognosis
Residual problems and relapses are uncommon, complete recovery can be anticipated, generally a slow process that takes months or years if axonal degradation occurs
Define fibromyalgia
Hey chronic disorder characterized by widespread nonarticular musculoskeletal pain and fatigue with multiple tender points
Etiology and pathophysiology of fibromyalgia
A disorder involving neuroendocrine/neurotransmitter dysregulation causing pain amplification due to abnormal sensory processing in the CNS
Clinical manifestations and complications of fibromyalgia
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
Diagnostic studies for fibromyalgia
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.
Collaborative care for fibromyalgia
Treatment is symptomatic. Rest, Flexeril Elavil, reuptake inhibitors, Ultram, SSRI, OTC analgesics, Xanax, Ambien, Neurontin
Nursing management for fibromyalgia syndrome
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
