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Adult Health l > Peripheral Nerves > Flashcards

Peripheral Nerves Flashcards

1
Q

Monophasic immune-mediated disorder of the peripheral nervous system
Demyelination of peripheral nerves
Result of immune-mediated pathologic processes

A

Guillain-Barre´ Syndrome

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2
Q

What is the onset?

A

acute

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3
Q

What are symptoms of Guillain-Barre´ Syndrome?

A

Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction

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4
Q

Variants of Guillain-Barre’ syndrome

A

Acute inflammatory demyelinating polyradicularneuropathy (AIDP) (most common in the US)

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5
Q

Causes of Guillain-Barre’ syndrome

A 
Immune mediated response (IgG antibodies)
Viral infections
Bacterial infection
Vaccines
Lymphoma
Surgery
Trauma
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6
Q

(Patho) What happen when T cells migrate to the peripheral nerves

A

edema and inflammation

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7
Q

(Patho) What happens to marcophages

A

break down myelin, inflammation, axonal damage

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8
Q

Stages of Guillian-Barre’

A

Initial, plateau, recovery

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9
Q

What is the initial stage

A

1-4 weeks

onset til no new symptoms present

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10
Q

What is the plateau stage

A

several days to 2 weeks

no deterioration and no improvement

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11
Q

What is the recovery stage

A

4-6 months and up to 2 years

remyelination and return of muscle strength

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12
Q

What are signs and symptoms of Guillian-Barre’

A

Motor weakness, paresthesias (pins & needles sensation), cranial nerve dysfunction, autonomic dysfunction, motor loss, respiratory dysfunction

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13
Q

Cranial nerve dysfunction

A

lll Oculomotor, Vll facial, Xl glossopharyngeal, X vagal, Xl spinal accessory, Xll hypoglossal

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14
Q

Autonomic dysfunction

A

BP fluctuation, dysrhythmias

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15
Q

Motor loss

A

symmetric. bilateral, ascending

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16
Q

Respiratory function

A

inspiratory force, tidal volume

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17
Q

How to diagnosis GB

A

CSF analysis (Elevated CSF proteins with normal cell counts)
Nerve conduction studies (Electromyeography (EMG)
Nerve conduction velocity)

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18
Q

Management for GB

A

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)

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19
Q

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

A

Plasmapheresis

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20
Q

Collaborative management of GB

A 
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
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21
Q

Priority nursing care of GB

A

Respiratory care
Pain management
Communication and emotional
Nutritional

22
Q

Plan of care of GB

A

diagnostic testing, involvement of family and team members, education, medical treatment=plasmapheresis

23
Q

An acquired autoimmune disease characterized by muscle weakness

A

Myasthenia Gravis

24
Q

What causes Myasthenia Gravis

A

antibodies that interfere with the transmission of acetylcholine at the neruromuscular junction

25
Q

Types of Myasthenia Gravis

A

Ocular and generalized

26
Q

Risk factors for MG

A

Coexisting autoimmune disorder

Hyperplasia of the thymus gland

27
Q

Triggers of MG

A

Infection
Stress, fatigue
Pregnancy
Heat

28
Q

Symptoms of MG

A 
Progressive muscle weakness
Diplopia
Drooping eyelids, one or both (ptosis)
Difficulty chewing and swallowing (dysphagia)
Respiratory dysfunction
Bowel & bladder dysfunction
Fatigue
29
Q

Baseline assessment of cranial muscle strength

A

Tensilon Testing

30
Q

What is administered in a Tensilon test

A

Edrophonium

31
Q

Onset of muscle tone improvement within 30 to 60 sec after injection of Tensilon (for most patients); lasts 4 to 5 minutes

A

Positive test

32
Q

Nursing care of Tensilon test

A

Observe for facial fasciculations, cardiac arrhythmias
Observe for bradycardia, sweating, abdominal cramps
Atropine at bedside

33
Q

MG: Cholinesterase Inhibitor Drugs

A

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)

34
Q

How are MG medications given

A

on a strict schedule

35
Q

MG treatments

A 
Immunosuppressants
(Prednisone or Azathioprine (Imuran)
Given during periods of exacerbations
Monitor for infections)
Plasmapheresis
Thymectomy
36
Q

Management of MG

A 
Respiratory support
Promoting self-care guidelines
Assisting with communication
Nutritional support
Eye protection
37
Q

Crisis associated with MG

A

Cholinergic and Myasthenic

38
Q

What is Cholinergic crisis

A 
Too much ChE inhibitor drug
Increased weakness
Hypersalivation
Sweating
Increased bronchial secretions
N,V&D
Hypotension
39
Q

How to treat cholinergic crisis

A

Maintain respiratory function
Anticholinergic drugs withheld while on ventilator
Atropine

40
Q

What is Myastenic crisis

A

Not enough ChE inhibitor drug
Flare of sx, increased weakness
Hypertension
Increased HR, RR

41
Q

Hw to treat myathenic crisis

A

Maintain respiratory function

Cholinesterase-inhibiting drugs withheld

42
Q

Health teaching of MG

A

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

43
Q

Degeneration/retraction of nerve distal to injury within 24 hr

A

Peripheral Nerve Trauma

44
Q

Common causative agents of Peripheral Nerve Trauma

A

Vehicular or sports injury

Wounds to peripheral nerves

45
Q

Nerves most commonly affected by trauma

A

radial, median, ulnar, femoral, deep peroneal, sciatic, common peroneal, superficial peroneal

46
Q

Leg paresthesias
(Irresistible urge to move
Peripheral and central nerve damage in legs/spinal cord)

A

Restless leg syndrome

47
Q

Management of RLS

A

Symptomatic
Nonmedical treatment
Drug therapy effective for some patients

48
Q

3 divisions of trigeminal nerve (V)

A

ophthalmic, maxillary, mandibular

49
Q

Pain management of Trigeminal Neuralgia

A

Surgical management
Microvascular decompression
Radiofrequency thermal coagulation
Percutaneous balloon microcompression

50
Q

What cranial nerve does Bell’s palsy affect

A

Vll- Facial Paralysis

51
Q

Interventions for Facial Paralysis

A

Medical management (Prednisone, analgesics, acyclovir)
Protection of eye
Nutrition
Massage, warm/moist heat, facial exercises

Adult Health l (9 decks)

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