T3 - Probs of PNS (Josh) Flashcards
Guillian Barre is a problem of the —
PNS
Guillian Barre is caused by what?
demylenation of peripheral nerves which leads to disruption of sensory and motor pathways
Etiology of Guillian Barre
Immune mediated response (IgG antibodies)
Viral Infections
Bacterial Infections
Vaccines
Lymphoma
Surgery
Trauma
Patho of Guillian Barre
T cells migrate to peripheral nerves
Macrophages break down myelin
Inflammation can cause axonal damage (mostly temporary)
What are the stages of Guillian Barre?
Initial (1-4 wks)
Plateau (several days to 2 yrs)
Recovery (4-6 mths up to 2 yrs)
S/S of Guillian Barre
Initial muscle weakness and pain
ASCENDING paralysis
Autonomic dysfunction
Motor weakness
Cranial nerve dysfunction
Resp dysfunction
Guillian Barre:
What is the Ascending paralysis?
symmetric, bilateral, ascending motor loss
Guillian Barre:
What is the Autonomic Dysfunction caused by GB?
BP fluctuations
Dysrhythmias
Guilliian Barre:
Which cranial nerves are typically affected?
III: Occulomotor
VII: Facial
IX: Glossopharyngeal
X: Vagus
XI: Accessory
XII: Hypoglossal
Guillian Barre:
What happens to respiratory function?
changes in Tidal Volume
Treatment plan of Guililan Barre:
Plasmapheresis
Intravenous Immune Globulin (IVIG)
Guillian Barre:
What is Plasmapheresis?
removes circulating antibodies assumed to cause the disease
Plasma is selectively separated from whole blood
Plasma usually replaces itself or is transfused with albumin
Guillian Barre:
What is the treatment regimen if the use IVIG?
daily dose based on body weight for 5 consecutive days
Nursing care for Guillian Barre.
Treat the symptoms
Monitor for complications
Early Mobility
Enteral Feedings
Guillian Barre:
What are the cardio complications?
Acute Dysautonomia (HR, BP)
Guillian Barre:
What are the things we need to monitor for with respiratory care?
Atelectasis
VAP
Pneumothorax
ARDS
Guillian Barre:
What are the GI complications we need to monitor for?
decreased motility (paralytic ileus)
- **give Reglin
- **listen to bowel sounds
- **keep up with BMs
— — is an autoimmune disease characterized by muscle weakness.
Myasthenia Gravia
What is Myasthenia Gravis caused by?
antibodies interfere with the transmission of ACh at the neuromuscular junction
What are the different types of Myasthenia Gravis?
Occular
Generalized
What is Tensilon Testing?
baseline assessment of cranial muscle strength
**tested with Myasthenia Gravis
What is a positive Tensilon Test?
onset of muscle tone improvement within 30-60 secs after Tensilon injection
***lasts 4-5 mins
Tensilon Test:
Nursing care
Observe for:
- facial fasciculations
- cardiac arrhythmias
- bradycardia
- sweating
- abdominal pain
Tensilon Test:
What drug do we need to have at bedside when doing the test?
Atropine
Myasthenia Gravis:
Why could you have a Cholinergic Crisis?
too much cholinisterase inhibitor drug (overmedication)
**remember that MG is a problem with too little ACh so cholinsterase inhibitors are used to treat
Myasthenia Gravis:
What are s/s of Cholinergic Crisis?
Increased weakness
Hypersalivation
Sweating
Increased Bronchial secretions
N/V/D
Hypotension
Myasthenia Gravis:
What is the treatment for Cholinergic Crisis?
Maintain resp function
Withhold anticholinergic drugs while on vent
Atropine
Myasthenia Gravis:
What is a Myasthenia Crisis?
too little cholinisterase inhibitor drug (undermedication)
Myasthenia Gravis:
S/S of Myasthenia Crisis?
Flare of MG symptoms
Increased weakness
HTN
Increased HR
Myasthenia Gravis:
Treatment for Myasthenia Crisis?
Maintain resp function
Withold cholinisterase inhibiting drugs
Myasthenia Gravis:
How does Tensilon work?
inhibits the breakdown of ACh, making it available for use at the neuromuscular junction
S/S of Myasthenia Gravis
Progressive muscle weakness
Diplopia
Difficulty chewing/swallowing
Resp dysfunction
Bowel/Bladder dysfunction
Poor posture
Fatigue after exertion
Myasthenia Gravis clients will have decreased muscle strenght, especially of which part of body?
face, eyes, and proximal portion of major muscle groups
Myasthenia Gravis:
With cholinisterase inhibitors, what should we teach client?
Take with food (for GI s/e)
Eat within 45 mins of taking med to increase chewing strength and reduce risk of aspiration
Take med at same time each day
***Use cautiously with clients who have asthma or cardiac dysrhythmias
— — is facial paralysis associated with cranial nerve VII.
Bell’s Palsy
S/S of Bell’s Palsy
Droop in one half of face
Forehead doesn’t wrinkle (stroke victims can wrinkle)
Can’t raise eyelid
Treatment for Bell’s Palsy
Medical mgmt (prednison, analgesics, acyclovir)
Protect eye
Nutrition
Massage, warm/moist heat, facial exercises
– – is characterized by severe pain that can be triggered by chewing or brushing teeth.
Trigemenal Neuralgia
With Trigeminal Neuralgia, what type of pain do they fee?
severe, sudden spurt of pain with twitches in face
Medication mgmt of Trigeminal Neuralgia
Carbamazepine
Amitryptiline (TCA)
Surgical mgmt of Trigeminal Neuralgia
Microvascular decompression
Radiofrequency Thermal Coagulation
Percutaneous Balloon Microcompression
***goal of each is to take pressure off of the Trigeminal Nerve
Myasthenia Gravis:
What improves muscle weakness?
What worsens it?
rest
activity
Myasthenia Gravis:
Which type of crisis causes muscle twitching so severe that you lose resp function and need a mechanical vent?
Cholinergic Crisis
Myasthenia Gravis:
Hypermotility (abdominal cramps) are a s/e of which crisis?
Cholinergic Crisis
Myasthenia Gravis:
What affect does Tensilon have on Cholinergic Crisis?
What affect does it have on Myasthenia Crisis?
worsens findings
temporarily decreases findings
Cholinergic Crisis:
Why have Atropine available?
it is an anticholinergic
Myasthenia Gravis:
Which type of crisis (Cholinergic or Myasthenia) will lead to Mechanical Ventilation?
BOTH
When are Bell’s Palsy symptoms most severe?
after 48 hrs
Myasthenia Gravis:
What are exacerbating factors?
Infection
Stress
Surgery
Hard physical exercise
Sedatives
Enemas
OVERHEATING (no sunbathing)
Myasthenia Gravis:
What type of schedule do the meds need to be given on?
Strict schedule
What is the classic presentation of Myasthenia Gravis?
muscle weakness that increases when patient is fatigued
When you think Myasthenia Gravis, think — —
When you think Guillian Barre, think — —
muscle weakness
ascending paralysis
Myasthenia Gravis:
What should we teach about Pyridostigmine?
take with small amount of food
eat within 45-60 mins after taking
GBS:
What should we ask about a client who presents with Guillian Barre?
have they had any respiratory virus in past 2 weeks
GBS:
What usually triggers Guillian Barre?
respiratory or GI viral infection
***sometimes, surgery and vaccination can also trigger
