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Med Surg 2 > neurosensory disorders > Flashcards

neurosensory disorders Flashcards

1
Q

MS

A
  • Chronic, progressive immune-mediated disease of the CNS.
  • Characterized by patches of demyelination in the brain and spinal cord.
  • Symptoms occur in relapse and remission pattern.
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2
Q

s/s of ms

A

vary in relation to location of lesion.
- Fatigue
- Visual disturbances
+ Nystagmus
+Blurred vision
+Diplopia
- Slurred speech
- Weakness of extremities
- Spastic bladder
- Emotional lability

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3
Q

ms cure and treatment

A
  • Currently there is no cure.
  • Treatment is aimed at relieving symptoms and decreasing severity of relapses.
  • Stress management may prevent exacerbations.
  • Promote independence and maintaining a active lifestyle.
  • Promote daily exercise with fall precautions.
  • Teach self- cath and self- injection techniques.
  • Teach injury prevention strategies.
    @ risk for falls and staged wounds
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4
Q

MS medications

A
  • immunosuppressants
  • muscle spasticity and tremors
  • meds for fatigue
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5
Q

immuno drugs for ms

A

to reduce frequency and duration of relapses:
- interferon beta-1a (Avonex). IM weekly
- interferon beta-1b ( Betaseron) sub q
- glatiramer acetate (Copazone) sub q daily

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6
Q

Muscle spasticity and tremors drugs for ms

A

baclofen (Lioresal)
gabapentin (Neurontin)
clonazepam (Klonopin)

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7
Q

drugs for fatigue ms

A

amantadine (Symmetrel)
modafinil (Provigil)

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8
Q

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect?

Hypoactive deep tendon reflexes
Ascending paralysis
Intention tremors
Increased lacirmation

A

3

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9
Q

Amyotrophic lateral sclerosis (ALS)

A

Progressive, invariably fatal neurological disease that attacks nerve cells (neurons) that control voluntary muscles; Lou Gehrig’s disease.
- risk for aspiration (airway priority)

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10
Q

als s/s

A
  • Twitching, cramping, muscle weakness
  • Fatigue
  • Slurred or nasal speech with difficulty forming words
  • Difficulty chewing and swallowing
  • Overactive deep tendon reflex
  • Eventual respiratory compromise, leading to respiratory failure, infection, or aspiration and eventually death
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11
Q

nursing interventions for ALS

A
  • Provide education, information, and support.
    Disease progression, advanced directives, aspiration risks
  • Implement aspiration precautions and alternate methods of communication if needed.
  • Support respiratory function.
  • Administer medications to prevent excessive salivation, pain, muscle cramps, constipation, and depression.
  • Referral to occupational, physical, and speech therapy.
  • Referral to home care and hospice when necessary.
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12
Q

Myasthenia Gravis

A
  • Autoimmune disorder in which antibodies are produced by the thymus glad that damage acetylcholine receptor sites.
  • This impairs transmission at the myoneural junction.
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13
Q

MG causes

A

voluntary muscle weakness that increases with activity, improves with rest, and is characterized by periods of exacerbation and remission.

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14
Q

MG early manifestations

A

involved ocular muscles leading to increased risk of aspiration.
- Diplopia
- Pitosis
- Dysphagia
- Dysphonia

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15
Q

MG progressive deterioration

A

Progressive deterioration, particularly the respiratory system and muscle wasting.

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16
Q

MG type of crisis

A

cholinergic
myasthenic

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17
Q

cholinergic MG

A

usually from overmedication
- Respiratory distress
- Increased GI motility
- Hypersecretion
- Hypotension

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18
Q

Myasthenic MG

A

may be caused by exacerbation trigger or inadequate medication.
- Respiratory distress
- Dysphagia
- Dysarthria
- Ptosis
- Diplopia
- Hypertension
- Increased muscle weakness

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19
Q

MG factors that contribute to exacerbations

A
  • Infections
  • Pregnancy
  • Stress (emotional, fatigue)
  • Increase in body temperature
  • Inconsistency with medication administration
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20
Q

MG nursing interventions

A
  • Maintain patent airway
    Prevent aspiration
    Keep suction and manual ventilation equipment at bedside
  • Plan activities to avoid fatigue
  • Provide small, frequent, high calorie meals
  • Administer medications on time
  • Provide eye care
    Artificial tears
  • Referral to speech therapy and the Myasthenia Gravis Foundation of America
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21
Q

MG medications

A

Anticholinesterase
immunosuppressants

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22
Q

anticholinesterase med MG

A

medications increase the amount of acetylcholine in the neuromuscular function.
- Pyridostigmine (Mestinon): first line therapy
- Atropine is the antidote

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23
Q

immunosuppressants meds MG

A

Steroids: prednisone
Cytotoxic medications: azathioprine (Imuran)

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24
Q

MG therapeutic measures

A

Thymectomy
- Excision of the thymus
- Intravenous immunoglobulin (IVIG): fluid that has imunotherapy
- Plasmapheresis: flushes bad cells than infuse with IVIG

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25
Q

The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is the nurse’s priority action?

Administer an acetaminophen suppository.
Notify the physician immediately.
Recheck vital signs in 1 hour.
Reschedule patient’s physical therapy.

A

2

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26
Q

GUILLAIN-BARRE SYNDROME

A

is a disorder of the nervous system that affects peripheral nerves and spinal nerve roots. It is also called infectious polyneuritis.
- irreversible

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27
Q

GBS caused by

A
  • The exact cause of Guillain-Barre syndrome is unknown.
  • Many patients give a history of a recent infection, especially of the upper respiratory tract.
  • There is also evidence of a connection with the Swine flu vaccination.
  • Diagnosis is made on the basis of the history and symptoms.
  • Lumbar puncture will reveal increased protein in the CSF.
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28
Q

what happens in gbs

A
  • Acute, autoimmune attack on the peripheral nerve and some cranial nerve myelin.
  • Usually preceded by an infection.
  • Usually presents with ascending weakness, which may progress to paralysis, leading to acute respiratory failure.
  • Recovery takes several months to 2 years.
  • Causes paresthesia and pain.
  • loose head to toe feeling and comes back toe to head
29
Q

GBS therapeutic measures

A
  • Respiratory support (patient may need mechanical ventilation).
  • Plasmapheresis
  • Intravenous immunoglobulin
30
Q

GBS nursing interventions

A
  • Assess respiratory status and provide respiratory support as indicated.
  • Monitor vital signs and ECAG.
  • Provide nutrition and prevent aspiration.
  • Prevent complications of immobility:
    +Pneumonia
    +DVT
    +UTI
    +Skin breakdown
31
Q

s/s of GBS

A
  • Motor weakness, especially in the extremities, is often the first symptom.
  • Weakness usually progresses (ascends), over a period of several hours to one week, to the upper areas of the body, where muscles of respiration may be affected.
  • Sensory disturbances, numbness, and tingling.
  • Cranial nerve involvement resulting in difficulty
    in chewing, talking,…
  • Diminished or absent deep tendon reflexes. Low grade fever.
32
Q

Plasmapheresis

A

A method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.

33
Q

IVIG

A
  • Immune globulin products from human plasma were first used in 1952 to treat immune deficiency.
  • Intravenous immunoglobulin (IVIG) contains the pooled immunoglobulin G (IgG) immunoglobulins from the plasma of approximately a thousand or more blood donors
  • Initially, immune globulin products were administered by intramuscular injection.
34
Q

laminectomy

A

A surgical procedure to removal portion of the vertebrae for the treatment of severe pain and disability from compression of spinal nerves, ruptured disk, or bony compression.

35
Q

Diskectomy

A

Surgical procedure to remove a herniated disk.

36
Q

spinal fusion

A

Surgical fusion of vertebral spinous process with bone graph.

37
Q

nursing implications for spinal fusion

A
  • Monitor vital signs.
  • Monitor dressing for spinal fluid, bleeding, or signs of infection.
  • Log roll the patient. Teach proper alignment to decrease stress on the spine.
  • Manage pain.
  • Refer to rehab if necessary.
38
Q

meningitis

A

inflammation of the meninges
- The severity of the disease is dependent upon the specific microorganism involved, the presence of other neurological disorders, the general health of the patient, the speed of diagnosis, and the initiation of treatment

39
Q

enciphilitis

A

viral and cant be treated just managed by brain resr

40
Q

cause of meningitis

A

Infectious microorganisms in the meninges via the bloodstream or through direct extension from an infected area (such as the middle ear or paranasal sinuses).
- Contaminated head injury.
- Infected shunt.
- Contaminated lumbar puncture.

41
Q

common microorganisms that cause meningitis

A

Meningococcus.
Streptococcus.
Staphylococcus.
Pneumococcus.

42
Q

how is meningitis diagnosed

A

by lumbar puncture
- no glucose in it

43
Q

s/s of meningitis

A
  • Elevated temperature.
  • Chills.
  • Headache (often severe).
  • Nausea, vomiting.
  • Nuchal rigidity (stiffness of the neck).
  • Photophobia.
  • Opisthotonos
  • Altered level of consciousness.
  • Multiple petechiae on the body.
  • bradinsky: flex neck and legs kick up
  • kernicks: unable to rise leg
44
Q

Opisthotonos

A

extreme hyperextension of the head and arching of the back due to irritation of the meninges

45
Q

Parkinson’s Disease

A
  • A progressive neurological disorder affecting the brain centers that are responsible for control of movement.
  • Primary degenerative changes of the basal ganglia and their connections prevent motor transmission of automatic movements (blinking, facial expressions, muscle tone).
46
Q

cause of parkinsons

A

Suspected causes include genetic factors, viruses, chemical toxicity, encephalitis, and cerebrovascular disease.

47
Q

parkinsons s/s

A
  • Bradykinesia, which usually becomes the most disabling symptom.
  • Tremor which tends to decrease or disappear on purposeful movements.
  • Rigidity, particularly of large joints.
  • Classic shuffling gait.
  • Muscle weakness which affects eating, chewing, swallowing, speaking, writing.
  • Mask-like facial expression with unblinking eyes.
  • Depression.
  • Dementia.
48
Q

treatment of parkinsons

A

Treatment is based on a combination of the following:
Drug therapy.
Physical therapy.
Rehabilitation techniques.
Patient and family education.

49
Q

encourage and instruct for parkinsons

A
  • Encourage patient to participate in physical therapy and an exercise program to improve coordination and dexterity.
  • Instruct patient in postural exercises and walking techniques to offset shuffling gait and tendency to lean forward.
  • Encourage warm baths and showers to help relax muscles and relieve spasms.
  • Instruct patient to establish a regular bowel routine with a high fiber diet and plenty of fluids. Constipation is a problem due to muscle weakness, lack of exercise, and drug effects.
50
Q

1st and 2nd level aproach to treat parkinsons disease

A
  1. The first approach attempts to increase the levels of dopamine in the brain and
  2. the second approach attempts to improve the symptoms of Parkinson’s disease by other means.
51
Q

Sinemet (Levodopa/Carbidopa) parkinsons disease

A

most commonly prescribed and most effective drug for controlling the symptoms of Parkinson’s disease, particularly bradykinesia and rigidity.

52
Q

nursing considerations for levodopa

A
  • It is generally recommended that patients take Sinemet on an empty stomach, at least 30 minutes before, or one hour after meals.
  • Has the least short-term side effects, it is associated with risks of long-term side effects, such as involuntary movements (dyskinesia).
  • Used on a long-term basis, levodopa may also cause restlessness, confusion, or abnormal movements.
53
Q

common medications to treat parkinsons

A
  • Dopamine Agonists.
  • Symmetrel.
  • Anticholinergics (Artane, Cogentin)
  • Eldepryl and Azilect.
  • Tasmar, Comtan (COMT Inhibitors)
54
Q

A nurse is providing teaching regarding a new prescription for carbidopa-levodopa for a client with Parkinson’s disease. Which of the following client statements indicates an understanding of the teaching?

a. “ I should expect a slight increase in my blood pressure while taking this medication”.
b. “I should take my medication with a high-protein food”
c. “I should expect my urine to be a darker color”
d. “ I will expect it to take up to a week for this medication to work”

A

c

55
Q

A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which action must you intervene?

a. The NA assists the patient to ambulate to the bathroom and back to bed.
b.The NA reminds the patient not to look at his feet when he is walking.
c. The NA performs the patient’s complete bath and oral care.
d. The NA sets up the patient’s tray and encourages patient to feed himself.

A

c.

56
Q

All of these nursing activities are included in the care plan for a 78-year-old man with Parkinson’s disease who has been referred to your home health agency. Which ones will you delegate to a nursing assistant (NA)?
Select all that apply:

a. Check for orthostatic changes in pulse and blood pressure.
b. Monitor for improvement in tremor after levodopa (L-dopa) is given.
c. Remind the patient to allow adequate time for meals.
d. Monitor for abnormal involuntary jerky movements of extremities.
e. Assist the patient with prescribed strengthening exercises.
f. Adapt the patient’s preferred activities to his level of function.

A

a,c,e,f,

57
Q

A nurse is teaching a client with Parkinson’s disease interventions for dealing with bradykinesia. Which information should the nurse include in the teaching session?
Select all that apply:

a. Rock back and forth to get going.
b. Maintain a wide—based gait when walking.
c. Pause between every word.
d. Use both hands to accomplish tasks.
e. Visualize your intended movement.

A

a,b,e,

58
Q

A nurse is caring for a client who displays signs of stage III Parkinson’s disease. Which of the following actions should the nurse include in the plan of care?

a. Recommend a community support group.
b. Integrate a daily exercise routine.
c. Provide a walker for ambulation.
d. Perform ADLs for the client.

A

c

59
Q

bell’s palsy

A
  • A cranial nerve disorder characterized by facial paralysis.
  • Peripheral involvement of the 7th cranial nerve (facial nerve) produces weakness or paralysis of the facial muscles.
60
Q

cause of bell palsy

A

unknown, but the majority of patient’s have experienced a viral upper respiratory infection 1 to 3 weeks prior to the onset of symptoms.

61
Q

complications of bells palsy

A

facial weakness, facial spasm with contracture, corneal ulceration, and blindness

62
Q

bell palsey s/s

A
  • Distortion of face.
  • Numbness of face and tongue.
  • Overflow of tears down the cheek from keratitis caused by drying of cornea and lack of blink reflex.
  • Decreased tear production that may predispose to infection.
  • Speech difficulty secondary to facial paralysis
  • recomend eye patch
63
Q

bell pasly nursing considerations

A
  • Instruct patient to wear a protective patch at night.
  • Instruct patient to wear protective glasses to further protect eye and decrease normal evaporation of moisture from eye.
  • Administer steroid therapy, as ordered.
    +May reduce inflammation and edema and restore normal blood circulation to the nerve.
  • Provide for pain relief with analgesics and local application of heat.
  • Facial massage may be prescribed to help maintain muscle tone.
  • Surgical intervention may be necessary.
  • Decompression of facial nerve.
    Surgical correction of eyelid deformities.
64
Q

meniere disease

A

Disorder of the inner ear that causes episodes in which the patient feels:
- As if they are spinning (vertigo)
- Have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing
- Ringing in the ear (tinnitus)
- Sometimes a feeling of fullness or pressure in your ear.
- In most cases, Meniere’s disease affects only one ear.

65
Q

menieres disease age range

A

Meniere’s disease can occur at any age, but it usually starts between the ages of 20 and 50.

66
Q

is menieres chronic or acute

A
  • a chronic condition, but various treatments can help relieve symptoms and minimize the long-term impact on the client.
  • Most people with Meniere’s disease don’t experience symptoms between episodes.
67
Q

cause of meniers disease

A
  • Viral infection.
  • Injury to the inner ear.
  • Arterial disease.
  • Thyroid hormone deficiency.
  • Oestrogen deficiency.
  • Pituitary or adrenal gland malfunction.
  • History of migraine.
  • Food allergy.
  • Diagnosis
68
Q

treatment of meniers disease (drug)

A
  • Treatment focuses on the control of symptoms.
  • Prochlorperazine and cinnarizine can be used to treat acute attacks of vertigo and nausea.
  • Betahistine and diuretics can reduce the frequency of attacks.
  • A range of drugs may be used prophylactically, different ones work for different people, so trial and error is usually necessary.
69
Q

treatment of meniers disease (procedure)

A
  • Vestibular nerve section can reduce vertigo by cutting the nerve from the balance organ.
  • In severe cases, labyrinthectomy may be performed, but normally if only one ear is affected and hearing loss is serious, as the procedure results in total deafness.
  • Physiotherapy may help to improve balance.

Med Surg 2 (35 decks)

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