Test #4 Flashcards
What does ALS stand for
Amyotrophic lateral sclerosis
What is ALS
- Progressive loss of motor neurons in the cerebral cortex and spinal cord, which causes muscle atrophy
- Causes firmness in tissues = sclerosis
Breakdown the ALS name
Amyotrophic (muscles wasting away) lateral (happens symmetrically) sclerosis (leads to firmness of the tissues)
Is cognition affected in ALS
No - they are still there (think of steven hawking)
What is the most common complication of ALS
Respiratory (lose muscles to swallow and cough, etc)
Is there a genetic form of ALS
Yes, but most people don’t have the genetic form (autosomal dominant pattern of inheritance) (they might have a genetic predisposition though)
What are risk factors for developing ALS 9
- Smoking
- Exposure
- Severe stress
- Head trauma (football players, etc)
- Living in the western pacific islands
- Persistent physical exhaustion
- Viral infections
- MIs
- Malnutrition
Who is more at risk for ALS
Higher incidence in men, but after menopause, both men and women incidence is equal
What is an early symptom of ALS that people usually write off
- *Asymmetrical painless weakness in one limb (not loss of sensation - will eventually turn into symmetrical bilateral weakness, but typically starts in one part of the body first)
- Dominant arm more commonly affected
What are other common early symptoms of ALS
- Tripping/loss of balance
- Weight loss
- Speech problems
- Difficulty chewing/swallowing
- *Drooling
- Tongue tremors
- Breathing difficulties
- Choking
- Crying spells or periods of inappropriate laughter (caused by bulbar palsy)
- *Vesiculations (muscle twitching)
- Secretions in lungs
- Poor/absent gag reflex
What do we use to help monitor a pt’s ALS progression
The ALS Functional Rating Scale (the higher the number the better, a decrease in number indicates further decline)
How do we diagnosis ALS
- Through an electromyography (EMG)
- Muscle biopsy
- Cerebrospinal fluid analysis
- Pulmonary function tests
- Computed tomography scan
- MRI
- Genetic testing
- HIV testing (to rule out)
- Lyme disease (to rule out)
When do we see the typical onset of ALS? What if we see it earlier?
Typically ALS is seen around 65. If earlier, it is most likely the genetic form.
Are there any tx options for ALS?
Not really - tx is limited. There is riluzole, which can be given to help slow progression.
Go over vent management
What are some nursing interventions for ALS
- Keep upright for 30 min after a meal
- Chest physiotherapy
- IS
- Encourage periods of rest prior to eating
What is Guillain-Barre Syndrome (GBS)? What can it lead to?
- Acute autoimmune response that occurs a few days or weeks after a viral or bacterial infection, where demyelinating polyradiculoneuropathy (AIDP) occurs
- Can lead to paralysis and respiratory failure
What are most GBS patients on
Vents
What is happening in GBS
Immune response, usually from IgG immunoglobulins (antibodies formed from bacteria or virus), after a bacterial or viral infection
Is GBS permanent
No, re-myelination can occur, which can help your body regain functions
Symptoms of GBS
- Lower extremity weakness progresses to flaccidity (usually within hours or days) (starts as ascending)
- Motor loss is symmetrical
- Weakness will continue up and threaten respiratory muscles
- Pain, increasing at night
- Orthostatic hypotension or hypertension
- Abnormal vagal responses like bradycardia, or heart block
- Disfunction with bladder and bowel
- Facial flushing
- Diaphoresis
- Weak or absent reflexes
What is the main feature of GBS
Ascending, rapidly progressing, symmetrical weakness of the limbs
What is the most common cause of death for someone with GBS
Respiratory arrest
How do we diagnosis GBS
- Symptoms
- Cerebral spinal fluid (elevated protein, but normal cell count)
- Nerve conduction studies (will show decreased conduction)