Neuromuscular conditions Flashcards
disturbance in transmission of impulses at the post-synaptic Neuromuscular Junction (NMJ). What is this? What kind of disease is this?
- Myasthenia Gravis
* Autoimmune disorder
What does MG involve? (Receptors)
involves antibody-mediated disruption of Acetylcholine Receptors
MG is often associated with ____ and mostly occurs in ______.
- Thymus tumors
* Women in their 30’s
How can MG be fatal?
may be fatal due to respiratory complications e.g. aspiration pneumonia.
Subjective assessment for MG? 5 Ds
- extreme muscle fatigue
- Diplopia –double vision
- Dysphagia –difficulty swallowing/chewing
- Dysarthia- difficuly speaking
- Dyspnea
- Descending weakness
Objective assessments for MG include:
- Early sign?
- Mouth?
- Vision?
- Voice?
- Pitosis of eyelid (early sign)
- Myashenic smile - snarling
- Strabismus
- Voice weakness and articulation problem
(EOM)- visual axis alignment off, uni or bi
Strabismus
In MG Muscle strength decreases with______. This can cause things such as?
- Muscle strength decreases with use
* Can cause respiratory failure,bowel and bladder incontinence
What is a tensilon test and what is it used to determine?
- IV edrephonium given and muscle strength will improve for five minutes
- used to determine if cause is MG
Medication used for treatment of MG? 2 examples. What else can be used?
Anticholinesterases- Pyridostigmine, Neostigmine
*Immunosuppresants (Azothiaprine, prednisone).
Surgical treatment for MG? What can be done before this in crisis?
- Thymectomy - may cause remission in some
* Plasmapheresis
When may a client with MG Need a ventilator?
*with respiratory paresis unresponsive to drugs, it may be necessary for complete respiratory support
Onset - ____ and _____ general muscle weakness. What will the client have issues doing? What is this?
*Abrupt and severe muscle weakness, client will have issues speaking, swallowing, and maintaining respiration. Myasthenia gravis
3 causes of MG?
*UNDERmedicated, infection, and stress
2 nursing interventions for MG?
- Give edrephonium to see if there is improvement (positive tensilon test)
- Increase anticholenestrace drugs
Mnemonic for Cholenergic crisis for signs and symptoms.
- SLUDGE
- Salivation/sweating
- Lacrimation
- Urination
- Defication
- Gastrointestinal distress
- Emesis
What is the cause of cholenergic Crisis? How can this be tested for? What should the nurse do?
- Overmedicated with anticholenestrase drugs
- Tensilon test will be negative (muscle weakness will worsen after edrophonium is given
- Stop anticholenestrase drugs as prescribed by doctors order
what 3 things should be available bedside for MG client?
*Tracheostomy kit, endotracheal tube, suction
Medication for MG should be given on _____ _____. Know ________ drugs like. ____ ______ e.g. morphine
- Strict schedule
- Know contraindicated drugs
- Respiratory depressants such as morphine
In MG meals need to coincide with what? What is the onset and duration of Pyridostigmine?
- Drug action
* 30-35 minutes
Antidote for Anticholinesterase For: Edrophonium, Pyridostigmine, Neostigmine
*Atropine
5 priorities for MG in order
Breathing, Swallowing, Medication, Rest, Health Promotion
slowly progressive CNS disease demyelinated patches disseminated in the brain and spinal cord.
Multiple Sclerosis or demylinating disease
What kind of disease is MS? What is the cause?
Autoimmune
*Cause unknown (May be latent virus, immunologic abnormality, environmental factors - temperate climate zones)
Who is affected the most by MS? Ages?
- More women than men
* 20-40s
In MS client they may experience ______ in one or more limbs, trunk, one side of the face
Parasthesias
4 motor function abnormalities that may be seen with MS?
- Weakness/spasticity of extremity (s)
- Ataxia
- Slurred speech/dysarthia
- Intension tremor
5 visual disturbances occuring with MS?
*Diplopia
*Nystagmus
*Optic nerve pain
*DIm vision
Scotomas
5 moods/affects seen with MS?
- Depression
- Sudden weeping
- Forced laughter
- Euphoria
- Mania (late sign)
Sensory issues seen with MS?
- Blunting
- Parasthesias
- Vertigo
- Pain — electrical/burning
Diagnostics for MS include ____ that shows plaques and areas of demyelenation? Contrast enhances _____ can show ______?
- MRI
* CT scan shows lesions
What 3 things may be elevated in CSF of person with MS?
- IGG antibody
- Lymphocytes
- Protein
In ms am immunomodulator tHat may reduce relapse frequency.
Interferon B
2 central acting muscle relaxants for spasticity in MS.. What is another drug used for spasticity ?
- diazepam
- baclofen
- BOTOX
Drugs off-label use for MS? Whats an example?
*immunosuppresants - cyclophosphamide
IN MS what medication is used for urinary retention? Incontinence?
- Bethenachol
* Oxybutinin
Surgical procedures for MS?
tendon release to relieve spasticity
Nursing intervention for mobility for MS?
stretching and strengthening exercises
What do MS clients want to avoid? Why?
- heat- avoid heating pads, hot water bottles, hot baths, etc
- exacerbates
in MS clients encourage _____ to improve gait, use ______ gait.
- Encourage walking
* Use wide gait
Parkinsons is a ______progressive, degenerative _____disorder. Caused by? It is characterized by what four things?
- SLOWLY PROGRESSIVE CNS DISORDER
- Idiopathic
- Slow decreased movement
- Muscular rigidity
- Resting tremor
- Postural instability
parkinsons is most commonly seen in what gender? Race? Mean age of onset? what do 50-80% of parkinsons client eventually develop?
- Males
- Hispanic
- Mean onset age of 57
- Dementia
functionally related gray matter nuclei, embedded in the cerebrum, diencephalons and midbrain.
Basal Ganglia
Basal Ganglia disease is loss of______producing ____ ____ neurons in the Basal Ganglia
and involving the ____ ______ _____. Dopamine decrease is relative to _______.
- Dopamine
- Substantia Nigra
- Extra pyramidal system
- Acetylcholine
Effects of Parkinson disease
TRAP GAMES
- Tremor - NON-intentional tremor (Pin rolling tremor) in 70%,. Lessens w/ sleep and intentional movement
- Rigidity
- Akinesia - difficulty initiation movement or slow movement (bradykinesia)
- Posture - stooped
Gait - shuffling short steps, forward momentum may inadvertently quicken,
Autonomic symptoms - drooling, sweating, tearing incontinence
Mask like face - decreased eye blinking, lack of expression (Advanced sign)
Emotional - Depression, lability
Speech - monotonous, stuttering
What can be seen with parkinson client handwriting?
*Small writing - micrographic
Diagnosis of parkinsons is made by _____.
- Clinical symptoms
* No fda approved tests
Surgery can be performed to treat Parkinsons where there is a Transplantation of ________ nerve cells. Procedure that relieves rigidity? Procedure that relieves tremor?
- Dopamine producing
- Pallidotomy
- Thalamotomy
in parkinsons this relieves rigidity and contractures.
______ increases strength, balance, bowel function, bone strength.
- Physiotherapy
* Exercise
drug mechanism of parkinsons meds: mimic, increase, extend_______or block________.
- Dopamine
* Block acetylcholine.
carbidopa-levodopa is what kind of agent? Each part? What is a major side effect to monitor for?
- Dopaminergic agent
- Dopamine precursor and decarboxylase inhibtor
- orthostatic hypotension
Anticholinergics decrease what 3 parksinsons symptoms? 3 examples? What else can be used for its anitcholinergic effects?
- Ridigity, tremor, bradykinesia
- Benztropine, Trihexyphenidyl ,Procyclidine (Bring the pot)
- Antihistamine diphenhydrimine
4 Direct acting dopamine receptor agonists
- Bromocriptine
- Preoglide
- Pramipexole
- Ropinorole
Mnemonic - Put Parkinsons Right Back
An indirect acting dopamine receptor agonist/ MAO-B inhibitor. What should be avoided with this medication that can be fatal?
- Selegline
* Opioids especially meperidine
2 indirect acting Dopamine receptor agonists/Comt inhibitors
- Tolcapone
* Eentacapone
Antiviral drug used in parkinsons?
Amantadine
FDA approved anitpsychotic used in treatment for hallucinations in parkinsons?
Pimavanserin
Given for mild to moderate Dementia in parkinsons? Route? Class?
- Rivastigmine
- Patch
- Cholinestrase inhibitor
Two medications that can be used for off periods and how are they administered?
- Levodopa inhilation powder
* Apomorphine sublingual film
Parkinsons Medication Teaching
• Medication- take_____ as prescribed.
• Do not take______ without consulting the Primary Care Provider (PCP), pharmacist, neurologist.
• Levodopa take ______, but if ______take food shortly after taking med to decrease GI irritation (_______food may impair med effect, check with provider, pharmacist and dietitian on proper food/med consumption.).
• _______of sweat or urine may occur.
• Good oral hygiene: can use _____ or ______ for dry mouth (be careful of swallow issues).
- TAKE ON TIME
- OTCS/SUPPLEMENTS etc
- TAKE ON EMPTY STOMACH but if N/V take food shortly after. Protein may impair med
- DARKENING of sweat/urine may occur
- Sugarless gum or candy
Taking MAOI and Levodopa can cause what? example?
- Hypertensive crisis
* Phenelzine
Symptoms return before the next medication dose is due, this is the what? What can be done to help determine if this is happening?
- WEARING OFF PROBLEM
* SYMPTOM DIARY
What vitamin should be limited for parkinsons patients on levodopa because of interference with medication? What foods contain this?
- pyridoxine (B6)
* glandular meats, pork, lamb, veal, legumes, potatoes, oatmeal, wheat germ & bananas
What two herbs interfere with dopamine and may worsen PD symptoms?
- KAVA KAVA
* Rauwolfa
Meals for PD should be ____, _____, _____ and include what to help with constipation? What should be divided into small amounts?
- Small, frequent, easy to masticate
- Fiber and fluid
- Divide protein
If parkinsons client is having a freeze moment they should try what two things?
- Something to walk over
* Rocking back and forth
When traveling, a client w/ PD should sit where and why?
*aisle seat for toileting
Bells Palsy is a disorder of which cranial nerve
*7th or facial
Bells Palsy is defined as ____ onset of entire____ or ____. Inflammation, swelling, ischemia and compression of the facial nerve.
- Sudden onset
* Entire unilateral facial weakness or paralysis
Cause of BP? What may precede this? Recovery time? Medication treatment?
- Cause unknown
- Pain behind ear may precede facial weakness
- Usual full recovery in 3 to 4 months
- Cortticosteroids and analgesics
Assessment for BP
*complete paralysis of _____of face.
*Loss of taste of ______of tongue on effected side.
Loss of expression, displacement of _____ towards _____side,
Inability to close ______ on affected side.
Diminished _____reflex
Increased ______
- One side
- Anterior 2/3 of tongue on effected side
- Displacement of mouth towards unaffected side
- Eyelid
- Blink
- lacramation
Teach patients with BP what about eye care? What about eating?
- prevent corneal irritation - Artificial tears, eye shield, close eyes manually
- Small frequent meals on UNAFFECTED side
Trigeminal nuergalgia is a Disorder of the____cranial nerve (trigeminal) sensory root, excruciating____or ____ pain along branches of C.V nerve, lasting_____ to ____
Whos more at risk?
- 5th cranial nerve
- Excruciating knife-like/burning pain
- seconds to minutes
- Older women
What kind of medication is used to treat TN?
*Carbamazapine/ anitepileptics
What are trigger zones in TN
areas that if stimulated cause
Excruciating knife like pain. (e.g. chewing, drinking, teeth brushing, hair brushing, shaving, face washing etc.).
A surgical procedure for TN where nerve fibers are destroyed
rhizotomy
What 3 things should be taught about food/fluid for TN?
- Avoid too hot or too cold food
- Chew on unaffected side
- Prevent dehydration and malnutrition related to fear of pain from eating.
Guillian Barre is ______ polyneuritis, bilaterally _______, characterized by ______starting in _____extremities, usually within _____to ____hours. Mild sensory changes.
- Peripheral
- Bilaterally symmetrical
- Ascending paralysis
- Lower extremities
- 24 to 48 hours
3 percipitating factors for GB
- Gi infections
- Viral Infections
- Immunizations
Paralysis from GB may ascent to _____ and _____. What may be required?
- respiratory muscles and cranial nerves
* Mechanical ventilation
2 Autonomic dysfunctions from GB?
Autonomic dysfunction- Hypertension, tachycardia
Priority nursing intervention for GB? After that, in order
- Respiratory - Trach at bedside
* Aspiration, Autonomic dysfunction, mobility complications
