Neuromuscular / Sensory Flashcards by Crystal Sanders

Spinal shock

Flaccid paralysis 
Vasodilation 
Hypotension 
Bradycardia 
Increased venous capacity 
Hypothermia 
All reflexes below level of injury are lost 
Can have urinary and fecal retention

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Complications following spinal cord injury

Infections 
DVT 
Orthostatic hypotension 
Skin breakdown 
Renal complications

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Autonomic dysreflexia (hyperreflexia)

Increased reflex actions 
Severe bradycardia (low as 30/bpm)
Hypertension (systolic high as 300/mmHg)
Severe HA
**Most commonly caused from distended bladder & severely constipated**

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Nursing management of SCI’s

Ensure patent airway
Maintain cardiovascular function
Move by log-rolling technique; use turning frames
Provide good skin care
Emotional support
Ensure adequate nutrition
Reduce aggravating factors that cause spasticity
Bladder and bowel training
Client and family education to cope with detailed care at home

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MS S&S

Muscle weakness
Tingling sensations 
Numbness
Visual problems/nystagmus/patchy blindness 
Urinary incontinence 
Fatigue 
Weakness
Spasticity of muscles 
Ataxia 
Sexual dysfunction 
Dysphagia; swallowing difficulties
Vertigo 
Cognitive impairment

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NI’s for MS patients

Well balanced diet 
High fiber 
Adequate fluids 
Good skin care
Regular exercise 
Daily rest periods 
Avoid hot baths and temperature extremes
Reduce stress

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Immune Modulators

Betaseron (interferon beta-1b) 
Avonex (interferon beta-1a) 
Adrenocorticotropic hormone (ACTH)

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Corticosteroids

Prednisone or Decadron

Azathioprine (Imuran)

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Immunosuppressive drugs

Cyclophosphamide (Cytoxan)
Valium, Baclofen
Pro-banthine: urecholine
Bactrim, Septra, and Macrodantin

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Myasthenia Gravis

“grave muscle weakness*
AUTOIMMUNE disease of the NEUROMUSCULAR JUNCTION
Unpredictable
Nerve impulses fail to pass at the myoneural junction
Causes muscular weakness

10-65 years of age

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Myasthenia Gravis S&S

Ptosis - drooping eyelid 
Diplopia 
Skeletal weakness; ataxia 
Dysarthria; dysphagia 
Weak vocal cords 
Voice sounds nasally 
Muscle weakness
Bowel and bladder incontinence

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NI’s for Myasthenia Gravis

Monitor for UR infections 
Suctioning PRN
Change daily patterns for activity 
Physical therapy ROM 
Must take medication at same time everyday

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Anticholinesterase drugs

Prositigmin

Mestinon

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Complications of Myasthenia Gravis

Aspiration 
Respiratory infection and failure 
Myasthenic crisis 
Cholinergic crisis 
SLUDGE 
-Salivating 
-Lacrimation (tearing) 
-Urination 
-Diarrhea 
-GI cramping 
-Emesis

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Amyotrophic Lateral Sclerosis (ALS)

“Lou Gherig’s Disease”
“Steven Hawkings”
Rare progressive DEGENERATIVE NEUROLOGICAL disease
Death results usually in 2-6 years
Motor neurons in brain stem and spinal cord gradually degenerate
Electrical and chemical messages originating in brain do not reach muscles to activate them
No cure

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Clinical Manifestations of ALS

Upper extremity weakness 
Dysarthria 
Dysphagia 
Muscle wasting & fasciculations 
Death from respiratory infection secondary to compromised respiratory function 
*Person usually remains mentally alert*

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Diagnostic Tests for ALS

Clinical symptoms
CSF analysis
EEG
NCV (nerve conduction velocity)

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Fasciculations

Involuntary muscle twitching

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NI’s for ALS

Baclofen & Valium
Rilutek
Multidisciplinary ALS teams; emotional support

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Huntington’s DIsease

Overactivity of dopamine pathways
Genetically transmitted
Onset 30-50 years old

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Clinical Manifestations of Huntington’s Disease

Abnormal or excessive involuntary movements ((chorea))
Ataxia to immobility
Gait deteriorates
Mental functions deteriorates
Death usually 10-30 years after onset of symptoms

NI’s of Huntington’s Disease

No cure; palliative 
Antipsychotics
Antidepressants (Xenazine [tetrabenazine])
Safe environment 
Emotional support 
High calorie diet (4,000-5,000)

Guillain-Barre Syndrome

Inflammation and demyelination of the PNS

Possibly viral or autoimmune reaction

Clinical Manifestations of Guillain-Barre Syndrome

Progressive symptoms
Ascending paralysis - usually starts in lower extremities and moves upward
May stop at any point
Muscle weakness
Paralysis
Tingling
Numbness
Respiratory failure if intercostal muscles are affected
May have difficulty swallowing, breathing, and speaking
Fluctuating BP

Cause of Guillain-Barre Syndrome

Unknown May be viral or autoimmune In 1980's people developed GB after swine flu vaccine

Tests for Guillain-Barre Syndrome

History of symptoms and recent infections CT scan Lumbar puncture - **increase in protein is a red flag** Nerve conduction velocity study

NI's for Guillain-Barre Syndrome

``` Plasmapheresis Immunoglobulin therapy Anticoagulants Analgesics Mechanical ventilation G tube Meticulous skin care ROM exercises ```

Encephalitis

``` Inflammation of brain tissue Similar to meningitis Caused by: viruses, bacteria, spirochetes, fungi, protozoa Serious sometimes fatal Mortality rate: 5-20% ```

Encephalitis caused by complications of:

``` Measles Chicken pox Mumps Outdoor job or hobby Associated with certain season (warmer) and certain geographic areas ```

Encephalitis MOT

Ticks | Mosquitoes

Clinical Manifestations of Encephalitis

``` Flu-like Maliase Fever HA Dizziness Nuchal rigidity N/V Ataxia Tremors Seizures Coma and maybe death *Major sign in infant: bulging of the soft spot (fontanels)* ```

Tests for Encephalitis

``` Symptoms ID'ed the virus Lab tests: Serologic test CSF cultures (spinal tap) MRI PET ```

NI's for Encephalitis

``` Hospitalization for strict observation Administering meds Supportive care Control fever Ensure adequate hydration and nutrition Monitor VS ```

Treatment for Encephalitis

Diuretics (Mannitol) | Corticosteroids (dexamethasone/decadron)

Treatment for Encephalitis caused by Herpes

Acyclovir (Zovira) | Vidarabine (Vira-A)

Poliomyelitis

"Polio" Acute viral infection involving the GI tract and occasionally the CNS Declined rapidly after licensure of inactivated polio vaccine 1955 and live polio vaccine in 1960 Most common in infants and children; young adults and older adults can contract it too

MOT of Polio

Fecal-oral transmission

Symptoms of Polio

``` Asymptomatic (most infectious) to symptomatic Mild Symptoms: Sore throat HA Malaise Upset stomach Low-grade fever May include acute flaccid paralysis of a single limb to quadriplegia (affects fewer than 1%) Respiratory failure Death ```

NI's for Polio

NO medication treatment Isolate Bed rest Pain-relievers May need assistance breathing - supplemental O2 or ventilator Provide proper positioning and ROM exercises

Prevention of Polio

Vaccine Limiting exposure/contact with infected secretions Hand washing

Post-Polio Syndrome (PPS)

Development of new symptoms in persons who have had polio | After period of stable physical symptomology of at least 15 years

Cardinal Symptoms of PPS

Weakness in previously affected or unaffected muscles | Fatigue with general reduction in stamina and pain in either joints or muscles or both

Less common symptoms of PPS

Muscle atrophy Respiratory dysfunction Swallowing dysfunction Cold intolerance

Management of PPS

``` Facilitating appropriate levels of exercise with concurrent energy conservation Education Lifestyle changes Tailored exercise programs Muscle strength & endurance Psychological Depression (monitor for) Life satisfaction ```

Spinal cord injury to C1-C3

Usually fatal | No independent respiratory function

Spinal cord injury to C4

Quadriplegic; paralyzed neck down | May be able to breathe independently

SCI to C5-C6

Quadriplegic with some arm and shoulder movement

SCI to C7-C8

Quadriplegic with some arm and hand movement

SCI to T1-T6

Paraplegic; some trunk movement, legs paralyzed

SCI to T7-T12

Paraplegic; good upper back and abdominal strength, May function well in wheelchair

SCI to L1-L4

Paraplegic; may learn to walk with crutches or braces