Peripheral Nerves Flashcards
Monophasic immune-mediated disorder of the peripheral nervous system
Demyelination of peripheral nerves
Result of immune-mediated pathologic processes
Guillain-Barre´ Syndrome
What is the onset?
acute
What are symptoms of Guillain-Barre´ Syndrome?
Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction
Variants of Guillain-Barre’ syndrome
Acute inflammatory demyelinating polyradicularneuropathy (AIDP) (most common in the US)
Causes of Guillain-Barre’ syndrome
Immune mediated response (IgG antibodies) Viral infections Bacterial infection Vaccines Lymphoma Surgery Trauma
(Patho) What happen when T cells migrate to the peripheral nerves
edema and inflammation
(Patho) What happens to marcophages
break down myelin, inflammation, axonal damage
Stages of Guillian-Barre’
Initial, plateau, recovery
What is the initial stage
1-4 weeks
onset til no new symptoms present
What is the plateau stage
several days to 2 weeks
no deterioration and no improvement
What is the recovery stage
4-6 months and up to 2 years
remyelination and return of muscle strength
What are signs and symptoms of Guillian-Barre’
Motor weakness, paresthesias (pins & needles sensation), cranial nerve dysfunction, autonomic dysfunction, motor loss, respiratory dysfunction
Cranial nerve dysfunction
lll Oculomotor, Vll facial, Xl glossopharyngeal, X vagal, Xl spinal accessory, Xll hypoglossal
Autonomic dysfunction
BP fluctuation, dysrhythmias
Motor loss
symmetric. bilateral, ascending
Respiratory function
inspiratory force, tidal volume
How to diagnosis GB
CSF analysis (Elevated CSF proteins with normal cell counts)
Nerve conduction studies (Electromyeography (EMG)
Nerve conduction velocity)
Management for GB
Plasmapheresis (Exchanges occur ~ three to four treatments, 1 to 2 days apart)
Intravenous Immune globulin (IVIG)
(Daily dose based on body weight for 5 consecutive days)
Removes circulating antibodies assumed to cause disease
Plasma selectively separated from whole blood; blood cells returned to patient without plasma
Plasma usually replaces itself, or patient is transfused with albumin
Plasmapheresis
Collaborative management of GB
Acute dysautonomia (HR, BP) Respiratory care (Atelectasis, VAP, pneumothorax, ARDS) Skin & musculoskeletal support (Decubiti/ulcer, ROM) Gastrointestinal (Ileus) Initiating rehab in the ICU (Early mobility) Nutritional support (enteral) Emotional support Patient education
Priority nursing care of GB
Respiratory care
Pain management
Communication and emotional
Nutritional
Plan of care of GB
diagnostic testing, involvement of family and team members, education, medical treatment=plasmapheresis
An acquired autoimmune disease characterized by muscle weakness
Myasthenia Gravis
What causes Myasthenia Gravis
antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction
Types of Myasthenia Gravis
Ocular and generalized
Risk factors for MG
Coexisting autoimmune disorder
Hyperplasia of the thymus gland
Triggers of MG
Infection
Stress, fatigue
Pregnancy
Heat
Symptoms of MG
Progressive muscle weakness Diplopia Drooping eyelids, one or both (ptosis) Difficulty chewing and swallowing (dysphagia) Respiratory dysfunction Bowel & bladder dysfunction Fatigue
Baseline assessment of cranial muscle strength
Tensilon Testing
What is administered in a Tensilon test
Edrophonium
Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes
Positive test
Nursing care of Tensilon test
Observe for facial fasciculations, cardiac arrhythmias
Observe for bradycardia, sweating, abdominal cramps
Atropine at bedside
MG: Cholinesterase Inhibitor Drugs
Anticholinesterase (antimyasthenics)
(Enhance neuromuscular impulse transmission by preventing decrease of ACh by enzyme ChE
Improves muscle strength)
Pyridostigmine (Mestinon)
(Administer with small amount of food
Eat meal 45 to 60 minutes after med
Observe drug interactions-Magnesium, morphine, sedatives, neomycins)
How are MG medications given
on a strict schedule
MG treatments
Immunosuppressants (Prednisone or Azathioprine (Imuran) Given during periods of exacerbations Monitor for infections) Plasmapheresis Thymectomy
Management of MG
Respiratory support Promoting self-care guidelines Assisting with communication Nutritional support Eye protection
Crisis associated with MG
Cholinergic and Myasthenic
What is Cholinergic crisis
Too much ChE inhibitor drug Increased weakness Hypersalivation Sweating Increased bronchial secretions N,V&D Hypotension
How to treat cholinergic crisis
Maintain respiratory function
Anticholinergic drugs withheld while on ventilator
Atropine
What is Myastenic crisis
Not enough ChE inhibitor drug
Flare of sx, increased weakness
Hypertension
Increased HR, RR
Hw to treat myathenic crisis
Maintain respiratory function
Cholinesterase-inhibiting drugs withheld
Health teaching of MG
Factors in exacerbation—infection, stress, surgery, hard physical exercise, sedatives, enemas, strong cathartics
Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes
Teach warning signs and importance of compliance
Degeneration/retraction of nerve distal to injury within 24 hr
Peripheral Nerve Trauma
Common causative agents of Peripheral Nerve Trauma
Vehicular or sports injury
Wounds to peripheral nerves
Nerves most commonly affected by trauma
radial, median, ulnar, femoral, deep peroneal, sciatic, common peroneal, superficial peroneal
Leg paresthesias
(Irresistible urge to move
Peripheral and central nerve damage in legs/spinal cord)
Restless leg syndrome
Management of RLS
Symptomatic
Nonmedical treatment
Drug therapy effective for some patients
3 divisions of trigeminal nerve (V)
ophthalmic, maxillary, mandibular
Pain management of Trigeminal Neuralgia
Surgical management
Microvascular decompression
Radiofrequency thermal coagulation
Percutaneous balloon microcompression
What cranial nerve does Bell’s palsy affect
Vll- Facial Paralysis
Interventions for Facial Paralysis
Medical management (Prednisone, analgesics, acyclovir)
Protection of eye
Nutrition
Massage, warm/moist heat, facial exercises
