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Nursing 2 > Neuromuscular > Flashcards

Neuromuscular Flashcards

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1
Q

trauma involving central nervous system affects

A

brain and spinal cord

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2
Q

intracranial pressure increased by

A

bleeding and swelling

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3
Q

intracranial pressure can lead to

A

vasoconstriction, ischemia possibly CVA

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4
Q

CT vs MRI

A

CT (high speed X ray) always used first, MRI longer process so patient must be stable

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5
Q

brian injury or hypoxia/ischemia dangerous b/c

A

brain has inability to store oxygen and glucose

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6
Q

brain focused assessment:

A
  1. altered level of consciousness/LOC
  2. confusion
  3. abnormal pupils (change in response to light)
  4. sudden onset of neurologic deficits
  5. changes in VS
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7
Q

VS changes

A
  1. altered respiratory pattern
  2. widened pulse pressure
  3. bradycardia
  4. tachycardia
  5. hypothermia
  6. hyperthermia
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8
Q

altered LOC signs

A
  1. not oriented
  2. does not follow commands
  3. needs stimuli to achieve state of alertness
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9
Q

myelin definition

A

fat and protein that surrounds certain nerve fibers in the brain and spinal cord

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10
Q

demyelination causes

A

impaired transmission of nerve impulses

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11
Q

multiple sclerosis definition

A

chronic disease of CNS, degeneration and loss of myelin in brain, spinal cord and cerebrum.

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12
Q

progressive stage of MS

A

nerve impulses completely blocked

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13
Q

clinical manifestations of MS; motor

A
  1. weakness/fatigue
  2. paralysis
  3. diplopia / double vision
  4. spastic muscles
  5. ataxia
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14
Q

clinical manifestations of MS: sensory

A
  1. numbness/tingling
  2. vertigo
  3. tinnitus
  4. sporadic blindness
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15
Q

clinical manisfestations of MS: other

A
  1. chronic pain
  2. emotional instability
  3. bladder dysfunction
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16
Q

voluntary motor system; 2 types of neurons

A

upper motor neuron and lower motor neuron

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17
Q

upper motor neurons: pathway and location

A

descending motor pathways, located entirely within CNS

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18
Q

upper motor neurons: role

A

modulate activity of lower motor neurons

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19
Q

lower motor neurons: location

A

CNS and PNS

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20
Q

lower motor neurons: begin and end points

A

spinal cord to muscle

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21
Q

lower motor neurons: responsibility

A

all voluntary movement/muscle contraction

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22
Q

upper motor neuron lesions vs lower motor neuron lesions: weakness and tone

A

UMN lesions - weakness distal/below point of injury (T4 or above)
UMN lesions - spastic
LMN lesions - weakness at point of peripheral nerve root
LNM lesions - flaccid tone

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23
Q

multiple sclerosis MS cure?

A

no

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24
Q

ataxia is

A

impaired balance or coordination

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25
Q

MS and the immune system

A

the immune system degrades the protective protein coating of nerves

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26
Q

interferons: definition

A

treat MS, naturally made by body to control immune system

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27
Q

interferon beta medication goal for MS:

A

reduce exacerbations (ataxia, bladder problems, etc) and slow disease progression

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28
Q

interferon beta drugs: 2 types

A

beta - 1a (Avonex) intramuscular injection

beta - 1b (Betaseron) subq injection

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29
Q

interferon drug side effects

A

flu symptoms so administer at night

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30
Q

drug reduces the rate of relapse of RR in MS patients

A

glatiramer acetate (Copaxone)

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31
Q

Myasthenia Gravis definiton

A

autoimmune disorder affecting the neuromuscular junction

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32
Q

myasthenia gravis characteristics:

A

fatigue and varying degrees of weakness of voluntary muscles

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33
Q

acetylcholine ACh and muscle contraction

A

ACh attaches to nerves at neuromuscular junction and stimulates muscle contraction

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34
Q

myasthenia gravis and ACh

A

antibodies/immune system limit number of ACh receptor sites so voluntary muscle weakness, weaker muscle contractions

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35
Q

myasthenia gravis fluctuating muscle weakness intensifies

A

with physical activity/exercise

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36
Q

myasthenia gravis fluctuating muscle weakness improves with

A

rest

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37
Q

myasthenia gravis diagnostic tests: 2

A

acetylcholine/ACh test for ACh in serum

tensilon test - edrophonium IV given and muscle strength is assessed after IV

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38
Q

myasthenia gravis clinical manifestations

A

occular - ptosis (drooping eyelids), diplopia (double vision)

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39
Q

nursing management of MG

A

improve function and reduce antibodies

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40
Q

myasthenia gravis thymus and diaphragm

A

?

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41
Q

skeletal muscles control

A

eyes, facial expression, swallowing, breathing

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42
Q

skeletal muscles strength during day

A

strongest in morning, weaker afternoon, etc

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43
Q

myasthenia gravis first line medication

A

anticholinesterase inhibitors - Mestinon, inhibit breakdown of ACh so can bind at neuromuscular junction and enable muscle contraction

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44
Q

myasthenia gravis second line medication

A

immunosuppressants - reduce production of antibody

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45
Q

corticosteroids role in MG

A

suppress immune system / inflammation

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46
Q

surgery for MG

A

thymectomy - all or partial removal of Thymus

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47
Q

nursing management of MG

A

chronic disease, patient seen on outpatient basis, patient and family teaching, medication management, energy conservation, aspiration risk when eating

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48
Q

MG complications

A

Cholinergic Crisis - overmedication problem resulting in muscle weakness, respiratory impairment and excessive pulmonary secretions which can cause respiratory failure

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49
Q

MG complications

A

Myasthenic Crisis - undermedication or infection

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50
Q

myasthenic crisis priority

A

ventilation assistance, dysphagia, dysarthia

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51
Q

MG nursing assessment

A

respiratory rate, depth, oxygen saturation

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52
Q

Tensilon Test Myasthenic vs Cholinergic Crisis

A 
Myasthenic = Tensilon Test positive
Cholinergic = Tensilon Test negative
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53
Q

Guillain-Barre Syndrome definition

A

autoimmune attack on the peripheral nerve myelin

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54
Q

Guillain-Barre Syndrome results in

A

acute, rapid segmental demyeliation of peripheral nerves > paralysis of voluntary muscle movements

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55
Q

Guillain-Barre Syndrome autoimmune attack leads to

A

inflammatory demyelination

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56
Q

sensory neurons action

A

carry nerve signals from periphery to the Central Nervous System

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57
Q

motor neurons action

A

carry nerve signals from brain and spinal cord to outer parts of body - skin, muscles, glands

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58
Q

Parkinson Disease cause

A

injury or impairment of dopmine-producing cells of the substantia nigra in the basal ganglia region of brain

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59
Q

dopamine definition

A

neurotransmitter essential for normal functioning of extrapyramidal system /posture, support, involuntary movement

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60
Q

Parkinson TRAP

A

Tremor - occurs at rest
Rigidity of muscles - resistance to passive limb movement
Akinesia / Bradykinesia - lack of movement, slow to initiate movement = rising from sitting position to turning in bed
Postural disturbances - poor posture, head forward when walking = fall risk

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61
Q

PD primary medication

A

Dopaminergics aka Levodopa

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62
Q

Levodopa action

A

converts to dopamine in basal ganglia/mid-brain

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63
Q

Dopaminergics/Levodopa problems

A
  1. unpredictable - effective for first few years

2. wearing off effect - immobility is when off, effective when on

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64
Q

Deep Brain Stimulation is

A

high frequency electrical stimulation blocks tremors, patient awake

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65
Q

Parkinson nursing interventions

A
  1. hydration b/c orthostatic hypotension
  2. protein intake
  3. fiber intake - low dopamine levels > constipation
  4. easy to chew foods b/c skeletal muscle weakness
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66
Q

Parkinson head of bed HOB

A

full fowler’s

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67
Q

Parkinson risks

A
  1. fall
  2. aspiration b/c weak skeletal muscles
  3. OOB out of bed with assistance
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68
Q

leading cause of neuromuscular disease

A

trauma involving central nervous system

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69
Q

cervical spinal cord 4 aka

A

C4, fourth from the top of the spinal cord

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70
Q

C4 injury

A

at C4 point on the spine, ventilation dependent

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71
Q

spinal cord tracts: 2

A

ascending - sensory pathway

descending - pyramidal and extrapyramidal tracts

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72
Q

descending tracts notable feature

A

cross over medulla so L Hemisphere damage, right sided effects

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73
Q

pyramidal tract controls

A

voluntary movement

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74
Q

extrapyramidal tract controls

A

posture, involuntary/automatic movement

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75
Q

lesion aka

A

injury

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76
Q

unm lesions

A

spastic

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77
Q

without lower motor neurons muscles will not contract so tone will be

A

flaccid

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78
Q

hyperextension - mechanism of injury

A

head back, whiplash

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79
Q

hyperflexion - mechanism of injury

A

head down, chin into chest

80
Q

compression - mechanisim of injury

A

smashed together, compacted, usually spine, jump into pool

81
Q

penetrating - mechanism of injury

A

knife wound, gun shot

82
Q

steroid therapy med

A

methylprednisolone

83
Q

why treat spinal cord injuries with steroids?

A

reduce inflammation and swelling

84
Q

2 types of shock

A
  1. neurogenic shock

2. spinal shock

85
Q

neurogenic shock is

A

acute high level spinal injury above T6, affects nervous system, sympathetic nervous sys doesn’t work, no epi or norepi

86
Q

neurogenic shock location

A

upper part of spine T6 and above

87
Q

spinal shock is

A

loss of spinal reflex, no communication between upper motor neurons and lower motor neurons, injury anywhere on spine

88
Q

neurogenic shock VS

A

low BP, low HR b/c no sympathetic nervous response

89
Q

myelin regenerate? nerve?

A

myelin can regenerate, nerve can not

90
Q

RR aka

A

relapsing and recovery/remitting, disability increases over time, does not get better

91
Q

CT scan will show what for MS?

A

white lesions, demyelination, myelin is stripped away from nerve, myelin is white colored so lesion is the remaining white myelin surrounding the raw nerve which looks dark colored

92
Q

MS pain usually due to

A

spasticity

93
Q

Parkinson caused by

A

low dopamine

94
Q

dopamine deficiency manifestations

A

poor gait, poor posture

95
Q

PD confirmed when

A

2 out of 4 TRAP conditions

96
Q

paradoxical intoxication

A

symptoms get worse despite med administration

97
Q

Parkinson’s unpredictability

A

good days, bad days, some days meds work

98
Q

carbidopa/levadopa work by

A

replacing dopamine by crossing blood brain barrier

99
Q

dopamine - ACh relationship

A

inverse, low dopamine/PD means high level ACh

100
Q

treat high level ACh with

A

anticholinergics/benztropine

101
Q

myasthenia gravis and thymus gland

A

hyperplasia of thymus gland (large thymus)

102
Q

thymus and myasthenia

A

thymus produces antibodies that block ACh receptor sites so muscles can’t contract

103
Q

thymus diagnostic test

A

CT will show if enlarged

104
Q

Tensilon test positive result

A

admin Tensilon and muscle movement improve, dog can walk naturally again

105
Q

myasthenia gravis and diaphragm

A

muscles of diaphragm affected, chewing, swallowing, breathing (MGD, miller genuine draft)

106
Q

myasthenia gravis assess focus

A

respiratory, vital capacity (how deep can breathe), diaphragm which is a muscle

107
Q

anticholinesterase inhibitors

A

block enzyme that blocks ACh from binding

108
Q

anticholinergics vs anticholinesterase

A

anticholinergics block acetylcholine

anticholinesterase blocks enzyme that block ACh from binding

109
Q

myasthenia treatment

A

give anticholinesterase = pyridostigmine

110
Q

cholinergic crisis - MG

A

increased pulmonary secretions, overmedication of anticholinesterase which stops enzyme from blocking acetylcholine from binding, so ACh is binding but too much so muscles stimulated to point where the stop working

111
Q

ACh/acetylcholine action

A

neurotransmitter that sends signals for voluntary muscle contraction

112
Q

MS, PD, MG, ALS

A 
MS  = myelin damage
PD = low dopamine
MG = decreased ACh receptor sites
GB = myelinated neurons paralyzed
ALS = motor neuron degeneration in brain and spinal cord
113
Q

C4 injury and diaphragm

A

C4 injury results in loss of diaphragm function so ventilator needed for breathing

114
Q

Guillain-Barre primary risk

A

neuromuscular respiratory failure b/c can’t use diaphragm to breathe

115
Q

Guillain-Barre device to prevent respiratory failure

A

use incentive spirometer

116
Q

GB key symptom

A

symmetric weakness or paralysis of extremities (lower usually first), ascending paralysis

117
Q

GB diagnostic tests: 2

A
  1. Lumbar puncture - CSF (cere) will show elevated protein and normal WBC count
  2. EMG (electromyography) assess health of muscles and nerves that control them (motor neurons)
118
Q

GB nursing interventions goal

A

enhance physical mobility and prevent complications of immobility (DVT)

119
Q

Guillain-Barre typically begins with

A

viral infection

120
Q

Guillain-Barre stages

A

muscle weakness, diminished reflexes of lower extremities > hyporeflexia > tetraplegia/paralysis of all four extremities

121
Q

process that filters blood and removes antibodies from plasma portion of whole blood

A

plasmapheresis

122
Q

negative inspiratory force

A

handheld or electronic device can be attached to endotracheal tube, exhale and inhale

123
Q

ALS definition

A

degenerative disease loss of both upper and lower motor neurons in brain and spinal cord

124
Q

ALS impact of motor neuron death

A

muscle fibers served by the motor neurons atrophy

125
Q

ALS chief symptoms

A

fatigue and limb weakness

126
Q

ALS nerve signal impact

A

chemical and electrical messages exist in brain but dead motor neurons can’t transport signals to muscles

127
Q

ALS diagnosis

A

signs and symptoms

128
Q

ALS risks

A

dehydration, malnutrition, pneumonia

129
Q

ALS and cognition

A

cognition remains intact

130
Q

ALS most common cause of death

A

infection/ pneumonia

131
Q

proprioception is

A

awareness of the position and movement of the body

132
Q

neurogenic bladder definition

A

urinary incontinence due to lesion in the nervous system

133
Q

neurogenic bladder: 2 types

A
  1. reflex/spastic

2. flaccid

134
Q

neurogenic bladder: reflex/spastic cause

A

upper motor neuron lesion prevents impulses from travelling from spinal cord to voiding reflex arc/cortex

135
Q

neurogenic bladder: reflex/spastic voiding

A

done by reflex, no control by patient, incomplete emptying

136
Q

neurogenic bladder: flaccid cause

A

lower motor neuron lesion

137
Q

neurogenic bladder: flaccid effect

A

bladder continues to fill but no strong contraction

138
Q

neurogenic bladder: interventions

A

monitor I/O,

139
Q

neurogenic bladder: meds

A

spastic - anticholinergics - slow muscle movement

flaccid - cholinergic to stimulate muscles of bladder

140
Q

autonomic dysreflexia definition

A

upper spinal cord injury, can lead to severe hypertension, nerve signal inaccurate, ex: BP rises and brain says vasoconstricton making BP higher

141
Q

autonomic dysreflexia interventions

A
  1. sit up, HOB highest point

2. remove stimulus for spinal cord injury

142
Q

bowel management: 2 types

A
  1. reflex (UMN) incontinence w/o warning

2. flaccid (LMN) infrequent small stools

143
Q

bowel program definition

A

establishes a regular time to stimulate the bowels to cause a bowel movement

144
Q

upper motor neurons and the bowels

A

UMN usually T12 and above, spastic, muscle spasms, colon is tight

145
Q

digital stimulation goal

A

stimulate reflex to defecate

146
Q

MSGB memory aid

A

jack coraggio is a Green Bay fan; multiple sclerosis (CNS) and Guillain-Barre (PNS) both demyelination of neurons

147
Q

injury tone: UMN and LMN

A

Upper Motor Neuron injury will be spastic

Lower Motor Neuron injury will be flaccid

148
Q

flaccid muscle tone is

A

no muscle tone, can’t contract

149
Q

spastic muscle tone is

A

too much muscle tone

150
Q

MS-GB recovery

A

jack coraggio likes Green Bay
Multiple Sclerosis chronic
Guillain-Barre can recover

151
Q

Guillain-Barre symmetrical symptoms?

A

yes, facial weakness, bilateral pain (charlie horse), abesent reflexes (areflexia)

152
Q

Guillain-Barre treatment: 2

A

plasmaphersis and Immunoglobin therapy - high does IMG to stop immune sys attacking itself

153
Q

ALS and diagnostics

A

muscle biopsy to determine muscle quality and atrophy

154
Q

spinal shock symptoms

A

all spinal reflexes below injury shut down. flaccid paralysis. 7-10 days duration

155
Q

neurogenic bladder injury location

A

below sacral area (bladder is lower than sacrum)

156
Q

bladder if not functional then becomes

A

flaccid, bladder is a muscle, paralysis or no use then flaccid

157
Q

neurogenic bladder - flaccid symptom

A

brain can’t transmit message to bladder that it is full so overfill, urge incontinence, urine dribbles out

158
Q

flaccid bladder management

A

push or massage bladder to manually stimulate it

159
Q

PVR and bladder management

A

PVR = post void residual

160
Q

spastic bladder medications

A

anticholinergic to stop spasms

skeletal muscle relaxants = propantheline

161
Q

flaccid bladder medication

A

cholinergics/acetylcholine/ACh to produce muscle contractions = bethanechol

162
Q

autonomic dysreflexia definition

A

severe vasoconstriction below injury, HTN, low HR

163
Q

autonomic dysreflexia med

A

nitro paste for vasodilation, admin above injury

164
Q

spinal cord injury and sensation

A

no sensation below injury, can’t tell when to urinate, defecate

165
Q

flaccid muscles and bowel

A

no peristalsis > constipation

166
Q

paralytic ileus is

A

blockage of intestine due to paralysis

167
Q

PNS disorder affect LOC?

A

no

168
Q

PNS neuromuscular diseases

A

Guillaime-Barre and Myasthenia Gravis

169
Q

GB and MG peripheral nervous sys treatment

A

plasmapheresis

170
Q

MS a respiratory problem?

A

no

171
Q

infections: 2 types

A

respiratory and urinary

172
Q

spinal cord injury and body temp

A

unable to regulate it, no sweating or chills

173
Q

Parkinson’s test

A

passive ROM/cobwheel

174
Q

prevention of autonomic dysreflex

A

monitor bowels, check urinary drainage

175
Q

medic alert bracelet will not

A

prevent anything

176
Q

Guillaime-Barre assess for

A

deep tendon reflex b/c ascending paralysis, lose reflexes

177
Q

CSF should be

A

clear, check for infection

178
Q

impaired physical mobility due to paralysis turn patient

A

every 2 hours even when sleeping

179
Q

myasthenia gravis teach

A

abdominal thrust/Heimlich b/c choking risk

180
Q

skeletal muscles, type of muscle?

A

voluntary muscles

181
Q

motor neuron disorders and skeletal muscles

A

motor neurons affect skeletal muscle cells

182
Q

pyramidal system

A

system of voluntary movement, medulla located in area called the pyramids > pyramidal system

183
Q

normal motor function steps

A
  1. signals from brain to brain stem/medulla or spinal cord by upper motor neurons
  2. brain stem/mid brain or spinal cord to skeletal muscles by lower motor neurons
184
Q

upper motor neuron lesions signs

A
  1. no muscle atrophy
185
Q

lower motor neuron lesions signs

A
  1. muscle atrophy b/c neurons that control skeletal muscle movement not getting there
  2. flaccid paralysis, muscles don’t move so sag
  3. absent deep tendon reflex (patella, hit knee with hammer)
186
Q

spinal cord injury can lead to 2 types of shock:

A

neurogenic shock and spinal shock

187
Q

neurogenic shock symptoms

A

no sympathetic nervous sys activity > no epi, no norepi > bradycardia and no vasoconstriction so hypotension

188
Q

neurogenic shock interventions

A

fluids b/c low BP/hypotension

monitor breathing

189
Q

spinal shock symptoms

A

ex: compression > inflammation and bleeding > treat with methylprednisone > but blood so blood vessels constrict to stop bleeding > tissue hypoxia / ischemia

190
Q

MS and Guillaime-Barre autoimmune / demyelination process

A
  1. infection-fighting white blood cells and inflame the nerves
  2. inflammation strips away myelin sheath from nerves
191
Q

increase in BP, decrease in HR after spinal cord injury is symptom of

A

autonomic dysreflexia, risk hypertensive stroke

192
Q

autonomic dysreflexia causes

A

foley catheter, constipation

193
Q

PNS diseases GB and Myasthenia Gravis LOC?cerebral function?

A

no effect b/c PNS not CNS

194
Q

GB and assessment

A

deep tendon / knee reflexes

195
Q

GB vs MS

A

Guillaine-Barre full recovery, MS chronic

196
Q

MG teach

A

abdominal thrust b/c choke risk

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