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Nursing 232 - EXAM 3 > Neuromuscular conditions > Flashcards

Neuromuscular conditions Flashcards

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1
Q

disturbance in transmission of impulses at the post-synaptic Neuromuscular Junction (NMJ). What is this? What kind of disease is this?

A
  • Myasthenia Gravis

* Autoimmune disorder

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2
Q

What does MG involve? (Receptors)

A

involves antibody-mediated disruption of Acetylcholine Receptors

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3
Q

MG is often associated with ____ and mostly occurs in ______.

A
  • Thymus tumors

* Women in their 30’s

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4
Q

How can MG be fatal?

A

may be fatal due to respiratory complications e.g. aspiration pneumonia.

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5
Q

Subjective assessment for MG? 5 Ds

A
  • extreme muscle fatigue
  • Diplopia –double vision
  • Dysphagia –difficulty swallowing/chewing
  • Dysarthia- difficuly speaking
  • Dyspnea
  • Descending weakness
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6
Q

Objective assessments for MG include:

  • Early sign?
  • Mouth?
  • Vision?
  • Voice?
A
  • Pitosis of eyelid (early sign)
  • Myashenic smile - snarling
  • Strabismus
  • Voice weakness and articulation problem
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7
Q

(EOM)- visual axis alignment off, uni or bi

A

Strabismus

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8
Q

In MG Muscle strength decreases with______. This can cause things such as?

A
  • Muscle strength decreases with use

* Can cause respiratory failure,bowel and bladder incontinence

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9
Q

What is a tensilon test and what is it used to determine?

A
  • IV edrephonium given and muscle strength will improve for five minutes
  • used to determine if cause is MG
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10
Q

Medication used for treatment of MG? 2 examples. What else can be used?

A

Anticholinesterases- Pyridostigmine, Neostigmine

*Immunosuppresants (Azothiaprine, prednisone).

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11
Q

Surgical treatment for MG? What can be done before this in crisis?

A
  • Thymectomy - may cause remission in some

* Plasmapheresis

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12
Q

When may a client with MG Need a ventilator?

A

*with respiratory paresis unresponsive to drugs, it may be necessary for complete respiratory support

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13
Q

Onset - ____ and _____ general muscle weakness. What will the client have issues doing? What is this?

A

*Abrupt and severe muscle weakness, client will have issues speaking, swallowing, and maintaining respiration. Myasthenia gravis

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14
Q

3 causes of MG?

A

*UNDERmedicated, infection, and stress

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15
Q

2 nursing interventions for MG?

A
  • Give edrephonium to see if there is improvement (positive tensilon test)
  • Increase anticholenestrace drugs
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16
Q

Mnemonic for Cholenergic crisis for signs and symptoms.

A
  • SLUDGE
  • Salivation/sweating
  • Lacrimation
  • Urination
  • Defication
  • Gastrointestinal distress
  • Emesis
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17
Q

What is the cause of cholenergic Crisis? How can this be tested for? What should the nurse do?

A
  • 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
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18
Q

what 3 things should be available bedside for MG client?

A

*Tracheostomy kit, endotracheal tube, suction

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19
Q

Medication for MG should be given on _____ _____. Know ________ drugs like. ____ ______ e.g. morphine

A
  • Strict schedule
  • Know contraindicated drugs
  • Respiratory depressants such as morphine
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20
Q

In MG meals need to coincide with what? What is the onset and duration of Pyridostigmine?

A
  • Drug action

* 30-35 minutes

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21
Q

Antidote for Anticholinesterase For: Edrophonium, Pyridostigmine, Neostigmine

A

*Atropine

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22
Q

5 priorities for MG in order

A

Breathing, Swallowing, Medication, Rest, Health Promotion

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23
Q

slowly progressive CNS disease demyelinated patches disseminated in the brain and spinal cord.

A

Multiple Sclerosis or demylinating disease

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24
Q

What kind of disease is MS? What is the cause?

A

Autoimmune

*Cause unknown (May be latent virus, immunologic abnormality, environmental factors - temperate climate zones)

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25
Q

Who is affected the most by MS? Ages?

A
  • More women than men

* 20-40s

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26
Q

In MS client they may experience ______ in one or more limbs, trunk, one side of the face

A

Parasthesias

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27
Q

4 motor function abnormalities that may be seen with MS?

A
  • Weakness/spasticity of extremity (s)
  • Ataxia
  • Slurred speech/dysarthia
  • Intension tremor
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28
Q

5 visual disturbances occuring with MS?

A

*Diplopia
*Nystagmus
*Optic nerve pain
*DIm vision
Scotomas

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29
Q

5 moods/affects seen with MS?

A
  • Depression
  • Sudden weeping
  • Forced laughter
  • Euphoria
  • Mania (late sign)
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30
Q

Sensory issues seen with MS?

A
  • Blunting
  • Parasthesias
  • Vertigo
  • Pain — electrical/burning
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31
Q

Diagnostics for MS include ____ that shows plaques and areas of demyelenation? Contrast enhances _____ can show ______?

A
  • MRI

* CT scan shows lesions

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32
Q

What 3 things may be elevated in CSF of person with MS?

A
  • IGG antibody
  • Lymphocytes
  • Protein
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33
Q

In ms am immunomodulator tHat may reduce relapse frequency.

A

Interferon B

34
Q

2 central acting muscle relaxants for spasticity in MS.. What is another drug used for spasticity ?

A
  • diazepam
  • baclofen
  • BOTOX
35
Q

Drugs off-label use for MS? Whats an example?

A

*immunosuppresants - cyclophosphamide

36
Q

IN MS what medication is used for urinary retention? Incontinence?

A
  • Bethenachol

* Oxybutinin

37
Q

Surgical procedures for MS?

A

tendon release to relieve spasticity

38
Q

Nursing intervention for mobility for MS?

A

stretching and strengthening exercises

39
Q

What do MS clients want to avoid? Why?

A
  • heat- avoid heating pads, hot water bottles, hot baths, etc
  • exacerbates
40
Q

in MS clients encourage _____ to improve gait, use ______ gait.

A
  • Encourage walking

* Use wide gait

41
Q

Parkinsons is a ______progressive, degenerative _____disorder. Caused by? It is characterized by what four things?

A
  • SLOWLY PROGRESSIVE CNS DISORDER
  • Idiopathic
  • Slow decreased movement
  • Muscular rigidity
  • Resting tremor
  • Postural instability
42
Q

parkinsons is most commonly seen in what gender? Race? Mean age of onset? what do 50-80% of parkinsons client eventually develop?

A
  • Males
  • Hispanic
  • Mean onset age of 57
  • Dementia
43
Q

functionally related gray matter nuclei, embedded in the cerebrum, diencephalons and midbrain.

A

Basal Ganglia

44
Q

Basal Ganglia disease is loss of______producing ____ ____ neurons in the Basal Ganglia
and involving the ____ ______ _____. Dopamine decrease is relative to _______.

A
  • Dopamine
  • Substantia Nigra
  • Extra pyramidal system
  • Acetylcholine
45
Q

Effects of Parkinson disease

A

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

46
Q

What can be seen with parkinson client handwriting?

A

*Small writing - micrographic

47
Q

Diagnosis of parkinsons is made by _____.

A
  • Clinical symptoms

* No fda approved tests

48
Q

Surgery can be performed to treat Parkinsons where there is a Transplantation of ________ nerve cells. Procedure that relieves rigidity? Procedure that relieves tremor?

A
  • Dopamine producing
  • Pallidotomy
  • Thalamotomy
49
Q

in parkinsons this relieves rigidity and contractures.

______ increases strength, balance, bowel function, bone strength.

A
  • Physiotherapy

* Exercise

50
Q

drug mechanism of parkinsons meds: mimic, increase, extend_______or block________.

A
  • Dopamine

* Block acetylcholine.

51
Q

carbidopa-levodopa is what kind of agent? Each part? What is a major side effect to monitor for?

A
  • Dopaminergic agent
  • Dopamine precursor and decarboxylase inhibtor
  • orthostatic hypotension
52
Q

Anticholinergics decrease what 3 parksinsons symptoms? 3 examples? What else can be used for its anitcholinergic effects?

A
  • Ridigity, tremor, bradykinesia
  • Benztropine, Trihexyphenidyl ,Procyclidine (Bring the pot)
  • Antihistamine diphenhydrimine
53
Q

4 Direct acting dopamine receptor agonists

A
  • Bromocriptine
  • Preoglide
  • Pramipexole
  • Ropinorole

Mnemonic - Put Parkinsons Right Back

54
Q

An indirect acting dopamine receptor agonist/ MAO-B inhibitor. What should be avoided with this medication that can be fatal?

A
  • Selegline

* Opioids especially meperidine

55
Q

2 indirect acting Dopamine receptor agonists/Comt inhibitors

A
  • Tolcapone

* Eentacapone

56
Q

Antiviral drug used in parkinsons?

A

Amantadine

57
Q

FDA approved anitpsychotic used in treatment for hallucinations in parkinsons?

A

Pimavanserin

58
Q

Given for mild to moderate Dementia in parkinsons? Route? Class?

A
  • Rivastigmine
  • Patch
  • Cholinestrase inhibitor
59
Q

Two medications that can be used for off periods and how are they administered?

A
  • Levodopa inhilation powder

* Apomorphine sublingual film

60
Q

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).

A
  • 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
61
Q

Taking MAOI and Levodopa can cause what? example?

A
  • Hypertensive crisis

* Phenelzine

62
Q

Symptoms return before the next medication dose is due, this is the what? What can be done to help determine if this is happening?

A
  • WEARING OFF PROBLEM

* SYMPTOM DIARY

63
Q

What vitamin should be limited for parkinsons patients on levodopa because of interference with medication? What foods contain this?

A
  • pyridoxine (B6)

* glandular meats, pork, lamb, veal, legumes, potatoes, oatmeal, wheat germ & bananas

64
Q

What two herbs interfere with dopamine and may worsen PD symptoms?

A
  • KAVA KAVA

* Rauwolfa

65
Q

Meals for PD should be ____, _____, _____ and include what to help with constipation? What should be divided into small amounts?

A
  • Small, frequent, easy to masticate
  • Fiber and fluid
  • Divide protein
66
Q

If parkinsons client is having a freeze moment they should try what two things?

A
  • Something to walk over

* Rocking back and forth

67
Q

When traveling, a client w/ PD should sit where and why?

A

*aisle seat for toileting

68
Q

Bells Palsy is a disorder of which cranial nerve

A

*7th or facial

69
Q

Bells Palsy is defined as ____ onset of entire____ or ____. Inflammation, swelling, ischemia and compression of the facial nerve.

A
  • Sudden onset

* Entire unilateral facial weakness or paralysis

70
Q

Cause of BP? What may precede this? Recovery time? Medication treatment?

A
  • Cause unknown
  • Pain behind ear may precede facial weakness
  • Usual full recovery in 3 to 4 months
  • Cortticosteroids and analgesics
71
Q

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 ______

A
  • One side
  • Anterior 2/3 of tongue on effected side
  • Displacement of mouth towards unaffected side
  • Eyelid
  • Blink
  • lacramation
72
Q

Teach patients with BP what about eye care? What about eating?

A
  • prevent corneal irritation - Artificial tears, eye shield, close eyes manually
  • Small frequent meals on UNAFFECTED side
73
Q

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?

A
  • 5th cranial nerve
  • Excruciating knife-like/burning pain
  • seconds to minutes
  • Older women
74
Q

What kind of medication is used to treat TN?

A

*Carbamazapine/ anitepileptics

75
Q

What are trigger zones in TN

A

areas that if stimulated cause
Excruciating knife like pain. (e.g. chewing, drinking, teeth brushing, hair brushing, shaving, face washing etc.).

76
Q

A surgical procedure for TN where nerve fibers are destroyed

A

rhizotomy

77
Q

What 3 things should be taught about food/fluid for TN?

A
  • Avoid too hot or too cold food
  • Chew on unaffected side
  • Prevent dehydration and malnutrition related to fear of pain from eating.
78
Q

Guillian Barre is ______ polyneuritis, bilaterally _______, characterized by ______starting in _____extremities, usually within _____to ____hours. Mild sensory changes.

A
  • Peripheral
  • Bilaterally symmetrical
  • Ascending paralysis
  • Lower extremities
  • 24 to 48 hours
79
Q

3 percipitating factors for GB

A
  • Gi infections
  • Viral Infections
  • Immunizations
80
Q

Paralysis from GB may ascent to _____ and _____. What may be required?

A
  • respiratory muscles and cranial nerves

* Mechanical ventilation

81
Q

2 Autonomic dysfunctions from GB?

A

Autonomic dysfunction- Hypertension, tachycardia

82
Q

Priority nursing intervention for GB? After that, in order

A
  • Respiratory - Trach at bedside

* Aspiration, Autonomic dysfunction, mobility complications

Nursing 232 - EXAM 3 (5 decks)

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