Neurological Disorders - PNS

Question 1

Guillain-Barre Syndrome - Pathophysiology

acute idiopathic polyneuritis

Answer 1

• Acute autoimmune attack on peripheral nerve myelin
  > demyelination
  > ascending (Ground to Brain)
  > dyskinesia/paresthesia
  > flaccid paralysis & severe pain
  > resp impairment when reaches lvl diaphragm

Question 2

Guillain-Barre Syndrome - Triggers

Answer 2

• Viral infections (most common)
  > campylobacter jejuni 25-50%
  > H. influenza
  > Mycoplasma pneumonia
  > HIV
• Immunization
• Immune disorders
• Other stresses

Question 3

Guillain-Barre Syndrome - CMs

Answer 3

• Begins in lower extremities
  > muscle weakness
  > diminished reflexes (hypo-reflexia)
• Ascending paralysis
• Resp failure
• 2-4wk peak severity
  > longer = chronic inflamm demyelinating polyneuropathy

Question 4

Guillain-Barre Syndrome - Medical Treatment

Answer 4

• Diagnosis
  > CSF elevated protein
  > loss of nerve conduction
• Critical care needed
• Mechanical ventilation
• DVT/PE prophylaxis
• IVIG: dcr circulating antibodies by attacking myelin

Question 5

Guillain-Barre Syndrome - Nursing Diagnosis

Answer 5

• Ineffective breathing pattern
• Impaired gas exchange
• Impaired physical mobility
• Imbalanced nutrition
  > inability to swallow
• Impaired verbal communication
• Anxiety
• Fear

Question 6

Guillain-Barre Syndrome - Nursing Interventions

Answer 6

• Maintain resp func
• Enhancing phsyical mobility
• Providing adequate nutrition
• Improved communication
• Dcrd anxiety
• Monitoring for comps

Question 7

Myasethenia Gravis - Patho

Answer 7

• Autoimmune disorder affecting myoneural junction
  > Acetylcholine receptor sites impair transmission
  > dcrd receptor stimulation
  > muscle weakness escalates w/ continued activity
  > women greater than men
  > 75% thymus gland issue

Question 8

Myasthenia Gravis - CMs

Answer 8

• Diplopia/ptosis (80%)
• Face & throat muscle weakness
• Dysphonia
• Dysphagia
  > incr risk aspiration
• Generalized weakness
• Pure motor; no sensory involvement

Question 9

Myasthenia Gravis - Diagnostics

Answer 9

• Acetylcholinesterase inhibitor test
• Lab: acetylcholine antibodies
• Ice test
• Repetitive nerve stimulation

Question 10

Myasthenia Gravis - Medical Surgical Treatment

Answer 10

• Pharmacologic therapy: Pyridostigmine
  > incring concentration of available acetylcholine 4x/day
  > take 45-60 mins before meals
• Therapeutic plasma exchange
  > plasmapheresis
• Surgical management
  > thymectomy

Question 11

Myasthenia Gravis - Nursing Diagnosis

Answer 11

• Ineffective airway clearance
• Interrupted family process
• Fatigue
• Impaired phsyical mobility
• Imbalanced nutrition
• Impaired swallowing

Question 12

Myasthenia Gravis - Nursing Interventions

Answer 12

• Conserve energy
  > consistent routines
  > avoid excessive activity/stress
  > high envir’t temp
• Med prior to meals
  > prevent aspiration
• Tape eye closed/eye drops
  > prevent corneal damage