Neuromuscular Disease Flashcards
Neuromuscular Diseases (NMD
Primary muscle disease decreases the ability of a normal neural impulse to generate effective muscle contraction
Peripheral nerve disorders that cause respiratory muscle dysfunction may be caused by
🔹Inflammatory process
🔹Vascular disorders
🔹Metabolic disorders
NMD- Cardiopulmonary consequences may include
🔹Ventilatory insufficiency 🔹Central sleep apnea 🔹Aspiration PNA 🔹Atelectasis leading to hypoxemia 🔹Cor Pulmonale
Pathophysiology of NMD
❗Diaphragmatic paralysis most often diagnosed by PFT
🔹⬇ Decreased VC, FEV1, TLC
🔹Normal or ⬆ increased RV and diffusing capacity
🔹Positional changes suggest diaphragmatic weakness
▶seated to supine ->20% decline in FVE1 and VC
⬇ Decrease MIP and Mep
Pathophysiology of NMD
❗ Chief complaint
🔹Exertional dyspnea
🔹Fatigue
🔹 Orthopnea
Respiratory muscle weakness leads to
🔹Fatigue and respiratory failure, May meed MV
🔹Monitor MIP, VC and ABG’s
🔹ABG’s: ⬇ PaO2 ⬇ PaCO2, deterioration leads to ⬆PaCO2
🔹 Monitor all respiratory function / nocturnal oximetry
Pt with significant muscle weakness are at risk for
🔹 Mucous Plugging
🔹 PNA
🔹 Pulmonary edema
Muscle weakness leads to
🔹Respiratory insufficiency
🔹 Retained secretions
Other names for (GBS) Guillain-Barre Syndrome
🔹Landry-Guillain-Barre-Strhol syndrome 🔹Acute idiopathic polyneuritis 🔹Postinfectious polyneuritis 🔹Landry's paralysis 🔹Acute post-infectious polyneuropathy 🔹Acute Polyradiculitis 🔹Polyradiculoneurooathy
GBS is a
Autoimmune disorder of the peripheral nervous system
🔹 In which flaccid paralysis of skeletal muscles and loss of reflexes develop in a previously healthy individual.
Severe cases of GBS may result in
Ventilatory failure from diaphragmatic paralysis
Nerves with GBS demonstrate
🔹Demyelination
🔹Inflammation and edema (microscopically)
If GBS is not managed properly ventilatory failure form paralysis may result from
🔹Alveolar consolidation
🔹Atelectasis
GBS affects
Male and female equally
Grater incidence of GBS in people
🔹Over the age of 50
🔹50-60% more common in whites
GBS etiology
🔹Idiopathic
🔹Believed to be an immune disorder that causes inflammation and deterioration of the pt’s peripheral nervous system.
🔹Elevated antibodies (IgM) are found in serum blood test
GBS causative agent
🔹Campylobacterjejuni
🔹Cytomegalovirus
Other infections that have been implicated to GBS
🔹Mononucleosis
🔹Measles and Mumps
🔹Mycoplasm Pneumoniae
🔹Chlamydia psittaci
GBS diagnosis is based in
🔹Clinical history
🔹Abnormal (EMG) Electromyography
🔹 ⬆ Elevated protein levels on cerebral fluid
GBS Non-cardiopulmonary clinical manifistations
🔹Paresthesia or dysesthesias (tingling sensation and numbness in extremities). 🔹Pain in BACK, BUTTOCKS, and LEGS 🔹Progressive ascending paralysis 🔹Loss of deep tendon reflexes 🔹Difficulty swallowing
GBS recovery % of functional recovery
🔹Functional spontaneous recovery in about 90% of cases
GBS cardiopulmonary clinical manifestations
🔹Diminished breath sounds 🔹Crackles and Rhonchi 🔹 ⬇ Decreased flows ⬇Decreased Volumes 🔹Restrictive disorders 🔹CXR show ⬆ increased opacity
GBS Heart rhythms
🔹Tach and Bradycardia
GBS BP
🔹Hypotension
GBS are in danger of due to immobilization
🔹Thromboembolism
In GBS what has shown to decrease morbidity rates? And been proven to reduce antibody titers?
🔹Plasmapheresis
Immunoglobulin infusion
🔹Can block damaged antibodies
Corticosteroids are contraindicated in GBS because?
🔹They may prolong pt’s recovery time
What can RT’s do for GBS?
🔹O2
🔹CPT
🔹Hyperinflation
🔹MV
