Neuropathy- Mahoney Flashcards
cross cultural communication… do you need an interpreter?
YES! this is under your license. you cannot afford to misunderstand the patient/have their be a biased family member translating or have the patient not understand you. have then return another time if interpreter not schedule.
HHS: Office of Minority Health. interpreters mandated for all recipients of federal funds. 24/7 available. not appropriate to use family members.
research evidence: physician errors were observed without proper use.
cross cultural communication… family connections?
it is not uncommon for wives to defer to husbands in decision making.
make sure to involve the family when it comes time to make decisions.
patient’s sometimes avoid eye contact.
Case study findings….
normal. .. except having a positive Rhomberg.
* also has “thin blood”- lack of platelets.
* apallesthesia- cannot sense vibrations
significance of apaalesthesia and peripheral neuropathy?
do this.
significance of a positive Rhomberg?
“A patient who has a problem with proprioception can still maintain balance by using vestibular function and vision. In the Romberg test, the standing patient is asked to close his or her eyes. A loss of balance is interpreted as a positive Romberg’s test.”
- detects inability to maintain steady posture.
- provider gives a shove and if cannot maintain balance = positive result. patient seen with excessive swaying while eyes are closed, but NOT while open.
causes of peripheral neuropathy?
do this
If the patient is unsteady while eyes are open…
three sensory systems provide input to the cerebellum to maintain truncal stability
- vision
- proprioception- position sense with receptors in joints
- vestibular sense- inner ear/CN8/connections to pons
all and all … eyes closed vs open.
with your eyes open, mild lesions in vestibular/proprioception systems can usually be compensated for- but NOT in cerebellum.
- eyes closed- visual input removed and instability is brought out.
- no matter if eyes open or closed, a more severe lesion would be detected with imbalance either way.
Kinds of peripheral neuropathies?
sensory, motor, autonomic nerve pathology alone, or in combination together.
when do we see neuropathies developing?
DM, AIDS, thyroid disease, alcoholism, Vitamin deficient, renal failure, cancer, chemotherapy, drugs, chemicals, toxins
labs that were checked and abnormal?
Hb: 9.2 ( n = 12-16)
RBC: 3.54 (n= 4.1-4.9)
hematocrit: 27 (n=37-42)
B12: less than 100 ( n>200)
What is the problem with deficiency of B12?
megoblastic anemia… B12 cofactor used to convert homocystein to methionine, which can be used for myeline sheaths0-without this nerve transmission is impaired. Also prevents cells from making DNA. ( RBC) lead to anemia since there is rapid turnover. cells are fewer, however they are larger. trapped in immature state due to inadequate # of divisions. also have more pigment ( hyperchromatic).
what is the bigger picture of b12 deficiency?
causes subacute combined degeneration of the spinal column. the posterior portion of the spinal column transmits vibration and positional sensation. laterally, it coordiante voluntary movement disorders and can cause stroke like symptoms.
What are some other systems/findings with deficiency of B12?
LDH and indirect bilirubin increase.
bone marrow = hyperplastic ( less RBC)
multisegmented nuetrophils due to diminished cell division
GI symptoms also common
how does someone become b12 deficient?
lack of instrinsic factor/transcobalamin transport
could have autoantibodies
atrophied gastric mucosa( in elderly)- less pepsin released preventing B12 release
often called food-cobalamin malabsorption
