Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sophomore 2 Test 3 > Neuromuscular > Flashcards

Neuromuscular Flashcards

1
Q

Autoimmune Neurological Disorders

A
  1. Multiple Sclerosis
  2. Myasthenia gravis
  3. Guillain-Barre syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Multiple Sclerosis

A

A chronic, progressive immune-related disease involving demyelination of CNS

  • Typically relapsing and remitting
  • Peak age is 25-35; 2X more women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

S/Sx of Multiple Sclerosis

A
  1. Fatigue
  2. Depression
  3. Weakness
  4. Numbness
  5. Difficulty in coordination
  6. Loss of balance
  7. Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MS: Visual Disturbances

A
  1. Blurred vision
  2. Diplopia
  3. Patchy blindness (scotoma)
  4. Total blindness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MS: Bladder Dysfunction

A
  1. Urgency
  2. Frequency
  3. Incontinence
  4. Retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MS: Motor Dysfunction

A
  1. Weakness in limbs (esp. lower extremities)
  2. Ataxia
  3. Poor coordination/loss of balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MS: Abnormal Reflexes

A
  1. Hyperreflexia or absent
  2. Muscle spasticity (especially in lower legs)
  3. Tremor possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MS: Bowel Dysfunction

A
  1. Bowel incontinence (rare)

2. Constipation (common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MS: Sensory Dysfunction

A
  1. Decreased perception to pain, temp, and touch
  2. Numbness
  3. Pain
  4. Paresthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MS: Emotional/Mental Changes

A
  1. Depression
  2. Labile emotion
  3. Confusion
  4. Apathy
  5. Loss of memory
  6. Poor concentration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to treat the emotional/mental changes from MS

A

SSRI’s and/or other antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Drugs to treat the fatigue of MS

A
  1. Amantadine HCl
  2. Modafinil
    * * Heat and exercise makes fatigue worse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Medications for Relapsing-Remitting MS

A

Glatiramer acetate SQ daily (is not an interferon, has minimal side effects, but takes longer to show effectiveness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Medications for Secondary Progressive MS

A

Mitoxantrone is good for this type (monitor closely for cardiac toxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of MS

A
  1. Relapsing-Remitting
  2. Primary Progressive
  3. Secondary Progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Primary Progressive Course of MS can result in what?

A
  1. Quadriparesis
  2. Cognitive dysfunction
  3. Visual loss
  4. Brain stem syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Factors that trigger MS relapses

A
  1. Viruses and infections
  2. Cold climate
  3. Physical injury
  4. Emotional stress
  5. Pregnancy
  6. Fatigue
  7. Overexertion
  8. Temperature extremes
  9. Hot shower/bath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MS: Medical Management (maintenance)

A
  1. Interferon Beta-1a IM weekly
  2. Interferon Beta-1b SQ every other day
  3. Refib - SQ every other day
    * * Should be started as soon as possible
    * * Can cause them to have flu-like symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MS: Medical Management (relapse, inflammation)

A

Corticosteroids (reduce inflammation in acute exacerbation)

  • Methylprednisone (IV)
  • Prednisone (PO)
  • Dexamethasone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MS: Side Effects of Corticosteroids

A
  1. Mood swings
  2. Weight gain
  3. Watch electrolytes
    * * Avoid long-term use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Medical Management of MS muscle spasms

A

Muscle Relaxants

  1. Baclofen (** avoid stopping abruptly due to withdrawal symptoms)
  2. Diazepam
  3. Tizanidine
  4. Dantrolene
  5. Nerve blocks/surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Medical Management of MS fatigue/impairment of ADLs

A
  1. Amantidine
  2. Pemoline
  3. Modafinil
23
Q

Medical Management of MS ataxia

A
  1. Beta blockers (propanolol)

2. Antiseizure meds (gabapentin)

24
Q

Medical Management of MS bowel/bladder problems

A
  1. Oxybutynin helps with bladder spasms
  2. Nitrofurantoin
  3. Vitamin C acidifies urine, decrease bacterial growth
  4. Docusate sodium - stool softener used for constipation
25
Q

Myasthenia Gravis

A

Autoimmune disorder affecting the transmission of impulses from nerves to involuntary muscles

  • Acetylcholine receptor antibodies interfere with neuromuscular impulse transmission, producing severe muscle weakness
  • Acetylcholine is essential for proper neuromuscular function
  • Onset gradual
26
Q

Manifestations of Myasthenia Gravis

A
  • Initially, involves ocular muscles (diplopia, ptosis)
  • Bulbar weakness: weakness in the face and throat; impaired swallowing, issues with eyes
  • Laryngeal s/sx (dysphonia, choking, aspiration)
  • Generalized weakness (extremities and intercostal muscles; strength improves after rest)
27
Q

Myasthenia Gravis Diagnostics

A
  1. Acetylcholinesterase inhibitor test
  2. MRI (may see enlarged thymus gland)
  3. EMG (may confirm defect in neuromuscular transmission)
  4. Serum and AchR (acetylcholine receptor antibodies)
28
Q

Acetylcholinesterase Inhibitor Test

A

Edrophonium chloride
SE: bradycardia, sweating, cramping
** Have atropine on hand!!!!
** Edrophonium is given IV. 30 seconds after injected, the ptosis will disappear for at least 5 minutes

29
Q

Pharmacologic Therapy for Myasthenia Gravis Includes what?

A
  1. Anticholinesterase medication
  2. Immunosuppressive therapy
  3. IV immune globulin (IVIG)
  4. Plasmapheresis
30
Q

Surgical Plan for Myasthenia Gravis

A

Thymectomy

  • Partial or complete remission
  • ICU/temporary ventilator (post Thymectomy, monitor resp status closely, observe for signs of pneumo- or hemothorax)
  • Benefit may take up to 3 years (circulating T cells have long life span)
31
Q

Anticholinesterase Medication

A

For Myasthenia Gravis

    • pyrostigmine bromide (1st line of therapy)
    • Must give on schedule
32
Q

Immunosuppressive Therapy

A

For Myasthenia Gravis

    • If pyrostigmine bromide is ineffective
    • Corticosteroids (decreases immune response and decreases antibody production)
33
Q

Nursing Considerations for Myasthenia Gravis

A
  1. MUST avoid procaine (novocaine) at dentist
  2. Careful with abx, cardiac, anti-seizure meds, OTC meds
  3. MUST talk to HCP about medications to be taken
34
Q

IV Immune Globulin (IVIG) treatments

A

For Myasthenia Gravis

- Treats exacerbations, east to administer, involves the administration of pooled human gamma-globulin

35
Q

Plasmapheresis

A

For Myasthenia Gravis

  • Treats exacerbations
  • Temperature decreases circulating antibodies (75% improve, but lasts only a few weeks)
36
Q

Myasthenic Crisis

A
  • Result of disease exacerbation or a precipitating event
  • Severe generalized muscle weakness with respiratory bulbar weakness = mechanical ventilation
  • Patient may develop respiratory compromise and failure
  • Hypertension
37
Q

Assessment/Supportive Measures for Myasthenic Crisis

A
  1. Ensure airway/respiratory support (chest PT, postural drainage, suction, mechanical ventilation)
  2. ABGs, serum electrolytes, I/O, and daily weight
  3. If dysphagia, may have nasogastric feeding
  4. Avoid meds that cause CNS depression
  5. Maintain muscle function
  6. Establish system for communication
38
Q

Guillain-Barre Syndrome

A
  1. Autoimmune Syndrome
    • Acute attack on peripheral nerve myeline and cranial nerves secondary to antibodies produced
  2. Rapid Demyelination
    - Possible respiratory failure
    - Autonomic nervous system dysfunction
    - CV instability
39
Q

Guillain-Barre Syndrome: Manifestations

A
  1. Weakness and diminished reflexes of the lower extremities (usually ascending)
  2. May involve bulbar weakness, cranial nerve symptoms (swallowing, talking), tachy or brady, hyper or orthostatic hypotension, respiratory difficulty, etc.
  3. NO alteration in cognition of LOC
40
Q

Guillain-Barre Syndrome: Timeline

A
  • Initial period: 1 to 3 weeks onset of symptoms until neurological deterioration stops
  • Peak severity about 2 weeks after symptoms
  • Client may report weakness with no history of injury, virus with 1 to 3 weeks prior
  • Decreased/absent deep tendon reflexes
41
Q

Guillain-Barre Syndrome: Diagnosis

A
  • Recent viral infection
  • S/Sx (unique presentation: symmetric weakness, diminished reflexes, upward progression of motor weakness)
  • CSF: high protein (otherwise normal cells)
  • Vital capacity and negative inspiratory force is ASSESSED!!!
42
Q

Guillain-Barre Syndrome: Medical Management

A

Medical Emergency due to rapid progression

  1. ICU with continuous monitoring/respiratory support
  2. Prevent complications (possible elective intubation)
  3. Plasmapheresis/IVIG (with rapidly progressing paralysis, IVIG has fewer side effects)
43
Q

Guillain-Barre Syndrome: Nursing Management

A
  1. Maintain respiratory function (spirometer, HOB up, TCDB, chest PT, ventilation, suction, etc.)
  2. Monitor for autonomic dysfunction
  3. Maintain maximum mobility (support extremities, ROM, turn Q2h, padding/pressure relief, TEDs, anticoagulants)
  4. Adequate nutrition/fluid
  5. Means of communication; decrease fear/anxiety
44
Q

Guillain-Barre Syndrome: Potential Complications

A
  1. Respiratory failure
  2. Cardiac dysrrhythmias
  3. DVT
  4. PE
45
Q

Amyotrophic Lateral Sclerosis (ALS)

A
  • Degeneration/loss of motor neurons - these are the nerve cells that control muscles
  • As neurons die the muscle atrophy
  • Progressive, incapacitating and fatal; life expectancy 3-5 years
  • Death usually due to respiratory failure or aspiration
46
Q

Amyotrophic Lateral Sclerosis: Chief Symptoms

A
  1. Muscle fatigue
  2. Progressive muscle weakness
  3. Cramps
  4. Twitching
  5. Incoordination
    * * Weakness starts in the muscles supplied by the cranial nerves in 25% of patients
47
Q

Amyotrophic Lateral Sclerosis: Diagnosis

A
  1. Muscle biopsy

2. EMG with nerve conduction studies

48
Q

Amyotrophic Lateral Sclerosis: Nursing Management

A
  1. Maintain/improve function well-being, quality of life
  2. Treat s/sx, prevent complications (immobility, aspiration, respiratory problems [cough assist machines])
  3. Monitor nutrition
  4. Emotional support
49
Q

Amyotrophic Lateral Sclerosis: Medications

A
  1. Riluzole - glutamate antagonist (only FDA approved drug for ALS)
  2. Baclofen (for muscle spasms)
50
Q

Amyotrophic Lateral Sclerosis: End of Life Issues

A
  1. Pain
  2. Dyspnea
  3. Delirium
  4. PEG tube
    * * Discuss advanced directives and living wills
51
Q

Scleroderma

A
  • Is a complication of an autoimmune disorder affecting the skin, blood vessel walls, and internal organs
  • No specific test to diagnose
  • Two types: localized and systemic
  • Cause is unknown but thought to have an immunologic basis
52
Q

CREST Syndrome

A

Associated with Scleroderma

  • C: Calcinosis (abnormal deposition of calcium salts in tissues)
  • R: Raynaud’s (arteriolar vasoconstriction, results in coldness, pain, and pallor of the fingertips and toes)
  • E: Esophageal hardening (swallowing)
  • S: Sclerodactyly (induration of the skin of the fingers and toes)
  • T: Telangiectasia (vascular lesion formed by dilation of a group of small blood vessels)
53
Q

Scleroderma: Teaching Client Self-Care

A
  1. Explain disease and disease management (monitoring/prevention of complications)
  2. Medication teaching
  3. Pain management
  4. Joint protection - light exercise
  5. Self-care with assistive devices
  6. Exercise and relaxation
  7. Room temp

Sophomore 2 Test 3 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions