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Patho Exam 4 > Parkinsons, Seizures, MS, MG > Flashcards

Parkinsons, Seizures, MS, MG Flashcards

1
Q

Parkinson’s Disease

A

PROGRESSIVE DEGENERATIVE DISORDER of the dopamine secreting neurons that control muscle movement

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2
Q

Forms of Parkinson’s Disease

A 
Idiopathic Parkinson's Disease (Primary)
Secondary Parkinsonism (caused by trauma, infection, tumor, atherosclerosis, toxins)
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3
Q

Primary Parkinson’s Causes

A

Idiopathic = etiology unknown

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4
Q

Secondary parkinson’s causes

A

trauma, infection, tumor, atherosclerosis, toxins

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5
Q

Dx of Parkinson’s

A

it’s CLINICAL = no lab tests for it
can do a CT or MRI to rule out other causes for the symptoms
15% dx <50; mainly dx in 60-70s

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6
Q

Parkinson’s Pathophysiology

A

Deficiency of dopamine and relative excess of acetylcholine at the synapse = rigidity, tremors, and bradykinesia (slow movement)

Dopamine deficiency prevent affected brain cells from performing their normal inhibitory functions in the CNS - dopamine (inhibitory) AcH (excitatory)

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7
Q

What does dopamine do

A

deep in basal ganglia and influences initiation, modulation, and completion of movement

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8
Q

What are the manifestations of Parkinson’s

A

Resting tremor
Bradykinesia
Rigidity
Postural dysfunction

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9
Q

Resting tremor

A

usually in hand and feet - can do “pill rolling” to help decrease the tremor
Disappears during sleep, and worse with stress/anxiety
Intermittent and progressively gets worse, but stops when they do things

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10
Q

Bradykinesia

A

generalized slowness of movement and failure of agnostic muscles to relax (loss of walking, swallowing, blinking etc)

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11
Q

Rigidity

A

involuntary contraction of striated muscles
Stiffness of limbs; resistance to ROM
ex. Lead pipe = jerky and whole thing is rigid
Cogwheel rigidity = gears of mvmt. and stiffness

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12
Q

Postural dysfunction

A

shuffling gait and balance problems
lose postural reflexes = falls or stooped posture = leaning to one side
festinating gain = short, accelerating steps until fall

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13
Q

Other manifestations of Parkinson’s

A

Fine motor deficits = micrographia (small, cramped handwriting)
Hypomimia = mask like faces
Freezing = stuck in place when trying to initiate a step
“En bloc” turn = turn entire body and hesitant doing so
Less blinking, drooling and dysphagia
ANS DYSFUNCTION - orthostatic hypotension, constipation, urinary retention

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14
Q

Parkinson’s Complications

A 
Injury from falls
Aspiration/difficulty swallowing
UTI
Pressure ulcers (b/c they have difficulty moving)
Dementia
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15
Q

Parkinson’s Tx

A

NO CURE AT THIS TIME
only goal is to relieve symptoms and maintain function

PT = PROM, walking, baths (loosens muscles) massages
Surgery
Drugs = dopaminergic, anticholinergetics

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16
Q

Parkinson’s Nursing Care

A

Education, and referral to support groups
Exercise program
Assess - chewing, swallow depression
Speech Therapy, Home Safety, Clothing Choices

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17
Q

Seizure Disorder (Epilepsy)

A

neurons are firing off extra/abnormal signals to the brain

typically highest in childhood and old age

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18
Q

Types of Epilepsy

A

Primary - idiopathic (born with it and don’t know why)

Secondary - structural changes or metabolic alterations = increased automacticity

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19
Q

Febrile seizures

A

typically in infants/increased temp to 103-104 and child has seizure; doesn’t mean that kid will have a seizure disorder…just deals with the fact that the neurological system is NOT fully developed.

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20
Q

Causes of Seizure Disorders

A 
Idiopathic
Anoxia (no O2)
PKU or TB
Hypoglycemia (metabolic disorders) or even low calcium or low sodium
CVA = stroke
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21
Q

Diagnostics of Seizure Disorders

A

Have to have 1 or more seizures
EEG - records electrical activity in brain to see if there is anything abnormal going on
CT or MRI to reveal STRUCTURAL brain abnormalities
Serum chemistries to evaluate metabolic units

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22
Q

In an EEG what indicates whether or not they had a seizure

A

high fast voltage spikes in all leads

No seizure = rounded spike waves

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23
Q

Pathology of Seizure disorders

A

Epileptogenic (means seizure forming) neurons in the brain depolarize or become hyper excitable = fires more readily when stimulated
Resting membrane potential is less negative or inhibitory connections are missing = lower threshold
Epilpetogenic fires and spreads the current to surrounding tissues = 1 side of brain (partial) or full brain (generalized)
INCREASE IN METABOLIC DEMAND FOR O2

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24
Q

If the metabolic demand for O2 is not met in a seizure what could happen

A

brain damage

If they inhibitory neurons cannot fire enough to cause the excitatory neurons to stop it could result in status epilepticus (w/o tx anoxia is FATAL)

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25
Q

Manifestations of seizure disorders

A 
RECURRENT SEIZURES
Aura (prodrome) - type of sign that the pt feels indicating a seizure is coming (see/smell something)
Postictal State (after seizure) = slow return to consciousness, combative/lethargic, confusion, headache, fatigue)
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26
Q

Partial Seizures

A

arise from a local areal and cause focal symptoms

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27
Q

Simple Partial (jacksonian) Seizure

A

beings in a specific area and DOES NOT ALTER CONSCIOUSNESS
Sx = flashing lights, smells, auditory hallucinations
ANS Sx = sweating pupil dilation
Psychic Sx = dream states, anger, fear

28
Q

Complex Partial Seizure

A

ALTERS CONSCIOUSNESS generally lasts 1-3 minutes and pt may follow simple commands
Amnesia for events that occur during and immediately after the seizure

29
Q

Generalized Seizures

A

affect the entire brain and can be convulsive or non-convulsive

30
Q

Absence (petit mal) seizure

A

brief change in LOC and lasts 1-10 sec

31
Q

Myoclonic seizure

A

bilateral; brief involuntary muscular jerks of the body and extremities
Consciousness usually NOT affected

32
Q

Generalized tonic-clonic (grand-mal)

A

MOST COMMON; about 2-5 min

typically begins with a loud cry= loss of consciousness = body falls = body spasms (TONIC) and then relaxes (CLONIC)

33
Q

Atonic

A

loss of postural tone, and temporary loss of consciousness (drop attacks)

34
Q

Status epilepticus

A

THIS IS A MEDICAL EMERGENCY
It’s a continuous seizure state and can happen in all types
Most life threatening is the generalized tonic clonic status epilepticus

Will see respiratory distress= hypoxia/anoxia

35
Q

What are some reasons Status epilepticus might occur

A

Abrupt withdrawal of anticonvulsant medications
Acute head trauma
Hypoxic/Metabolic encephalopathy

36
Q

Ungeneralized seizure

A

seizures that do not fit characteristics of partial or generalized seizure or status epilepticus

37
Q

Complications of Seizure Disorders

A

Hypoxic brain damage/Mental Retardation
Depression and Anxiety
Social Isolation

38
Q

Tx of Seizure Disorders

A

1 identify type of seizure/ NOTE TIME AND ACTIVITY

Reverse the cause of disorder
Drugs/pharmacologic
Surgery
Vagal nerve stimulators = reduce frequency of seizures in some patients
Counseling

39
Q

Seizure disorder Nursing Care

A 
Cushion head and loosen any ties or buttons near neck to (protect from injury)
Turn on size
Maintain airway (nothing in mouth)
Lood for ID (and DON'T HOLD PERSON DOWN)
Apply O2 and monitor response
40
Q

What do Nurses want to to for their pts after a seizure

A

Administer aniconvulsants per oder
Monitor the therapeutic effects of meds
Education about precipitating factors

41
Q

Multiple Sclerosis (MS)

A

DEMYELINATION of the white matter of the brain and spinal cord
damage to nerve fibers and their targets
Characterized by exacerbations and remissions

42
Q

MS facts

A

major cause of chronic disability in young adults
usually sx by btwn 20-40 yrs
Female > Male
White> non white
NORTH urbane areas (especially if you live there for the 1st 15 years of your life
Higher Socioeconomic status more prone

43
Q

MS syndromes

A

Corticospinal
Brain Stem
Cerebellar
Cerebral

**SOME FOLKES WILL HAVE ELEMENTS OF ALL OF THESE

44
Q

Corticospinal MS Syndrome

A

symmetric muscular weakness and stiffness, spastic paralysis, bowel/bladder incontinence

45
Q

Brain Stem MS Syndrome

A

dysfunction of CN III - XII = opthalmoplegia, nystagmus, dysarthria, facial and muscle weakness and paresthesias

46
Q

Cerebellar MS Syndrom

A

affects your ability to move = spastic gait, ataxia, inanition tremors, hypotonia

47
Q

Cerebral MS Syndromes

A

optic neuritis, impaired vision, intellectual and emotional deterioration

48
Q

Types of MS

A

Relapsing - remitting
Primary progressive
Secondary progressive
Progressive relapsing

49
Q

Relapsing - Remitting MS

A

90%
clear relapses with full/partial recovery and lasting disability
Disease does NOT worse between attacks

50
Q

Primary progressive

A

10%

Steady progression from the onset with minor recovery

51
Q

Secondary Progressive

A

Begins with clear relapses and recovery and lasting disability steadily progressive and worsens between attacks

52
Q

Progressive Relapsing

A

Steadily progressive from the onset, but has clear acute attacks

53
Q

Causes of MS

A

Unknown but auto immune = antibodies destroy neurons in the CNS

Slow acting/late viral infection stimulates autoimmune response
Environmental and genetic factors
Trauma, toxins, nutritional deficiencies

54
Q

MS Pathology

A

sporadic patches of axon demeylination and nerve fiber loss occurs throughout the CNS = neurologic dysfunction
**Presence or absence of axons is what determines how sick they are not just the loss of patches

Peripheral nerves are unaffected
SLOW NEURAL IMPULSES
Swelling and edema causes further injury to neurons and development of scar tissue plaques on myelin

55
Q

Dx of MS

A 
Evidence of 2 or more neurologic attacks
MRI (multifocal white lesions)
EEG abnormalities
LP (normal CSF protein but and increased CSF IgG
CSF electrophoresis
EPs = slowed nerve impulses
56
Q

Manifestations of MS

A

DEPENDS ON EXTENT AND LOCATION OF MYELIN DESTRUCTION

FATIGUE = most debilitating symptom
Ocular disturbances = diplopia (double vision), nystagmus, scotoma (lack of center vision)
Pins and needles/electrical sensations
weakness, wobbly gain, paralysis
incontince, frequent/urgent peeing

Stress and Heat can precipitate exacerbations

57
Q

MS complications

A 
Secondary
injuries from falls
UTI
Pressurer ulcers
Pneumonia
Insomnia

Tertiary
Depression, Loss of support, Financial probe (unemployment)

58
Q

MS Tx

A

treat exacerbations and treat s/s

aggressive immunosupressant drugs at start of disease
antivirals may slow progression
SQ immune substance to decrease exacerbations
Innovative Therapies

59
Q

MS Nursing Care

A 
Drugs
Symptom management
PT
Educations
Nutrition
Safety
60
Q

Myasthenia Gravis

A

“grave muscular weakness”

autoimmune disorder of transmission at the neuromuscular junction (Acetylcholine receptors destroyed, altered/not enough receptors d/t abnormal T- cell function)

61
Q

Manifestations of MG

A 
Drooping eyelid (ptosis)
Weakness in arms and legs
difficulty breathing, chewing,swallowing
Blurred/double vision
Slurred speech
Chronic muscle fatigue
62
Q

More MG manifestations

A

can progress from ocular to generalized weakness
Extremity weakness usually greater in proximal parts rather than distal
Symptoms usually at their quietest in the morning, and grow worse with effort throughout the day.

63
Q

Myasthenia Crisis

A

Affects respiratory system and may require ventilatory support and close airway management

64
Q

DX of MG

A

Hx of and Physical Exam
Anticholinesterase test
Nerve and muscle stimulation studies
Testing for acetylcholine receptor antibodies

65
Q

Anticholinesterase test

A

administer an short acting acetylcholinesterase inhibitor IV to decrease the breakdown of Ach

If MG there will be a dramatic improvement in muscle function

66
Q

Tx of MG

A 
Anti-cholinesterase drugs
Immunosuppressants
Corticosteroids
Plasmapheresis - to removed antibodies from circulation
Thymectomy (removal of the thymus)

Patho Exam 4 (7 decks)

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