TOPIC 11 - neuro part 1

Question 1

bells palsy

Answer 1

acute peripheral facial paresis of unknown cause. as the most common facial nerve disorder

characterized by inflammation of the facial nerve (cn vii) on one side of the face in the absence of any other disease such as a stroke

Question 2

theories of causes of bells palsy

Answer 2

acute demyelination similar to guillain barre disease

reactivated herpes

other infection

Question 3

hallmark signs of bell palsy

Answer 3

inability to close the eyelid, with an upward movement of the eyeball when closure is attempted, is a inability to smile, frown, or whistle
unilateral loss of taste is common
decreased muscle movement may alter chewing ability.
pain behind the ear

Question 4

onset of bells palsy

Answer 4

onset is sudden with a rapid onset of unilateral facial weakness that can occur in a few hours.

Question 5

complications of bells palsy

Answer 5

psychologic withdrawal - changes in appearance
malnutrition
dehydration
mucous membrane trauma
corneal abrasions
muscle stretching
facial spasms
contractures

Question 6

interventions for pain related to bells palsy

Answer 6

analgesics
hot packs for herpetic lesions

Question 7

interventions for hypersensitivity to heat and cold related to bells palsy

Answer 7

protect face

Question 8

interventions for risk for aspiration related to bells palsy

Answer 8

Teach to chew on the unaffected side
Avoid trapping food
Good oral hygiene

Question 9

interventions for risk for cornea damage related to bells palsy

Answer 9

Teach to cover the eye with a protective shield at night.
Apply eye ointment to keep eyelids closed duringsleep.

Question 10

interventions for muscle tone change related to bells palsy

Answer 10

Show patient how to perform facial massage with gentle
upward motion several times daily when the patient can tolerate the massage.
Demonstrate facialexercises, such as wrinkling the forehead,
blowing out the cheeks, and whistling, in an effort to prevent muscle atrophy.

Question 11

interventions for diet and nutrition related to bells palsy

Answer 11

Instruct patient to chew on the unaffected side of hismouth.
Eliminate hot fluids and foods.
Give frequent mouth care, being particularly careful to remove residues of food that collects between the cheeks and gums.

Question 12

what is myasthenia gravis and how is is causes

Answer 12

autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups.

antibodies attack acetylcholine (ach) receptors, resulting in a decreased number of ach receptor (achr) sites at the neuromuscular junction. this prevents ach molecules from attaching and stimulating muscle contraction.

Question 13

which neurotransmitter is related to myasthenia gravis

Answer 13

ACH

Question 14

assessment of myasthenia gravis

Answer 14

fluctuating weakness of skeletal muscle
the muscles most often involved are those used for moving the eyes and eyelids, chewing, swallowing, speaking, and breathing
eyelid muscles or extraocular muscles are involved. facial mobility and expression can be impaired
the patient may have difficulty chewing and swallowing food. speech is affected, and the voice often fades after a long conversation.

Question 15

acute exacerbation of muscle weakness related to myasthenic crisis is triggered by

Answer 15

infection
surgery
emotional distress
drug overdose
inadequate drugs

Question 16

major complications with myasthenic crisis

Answer 16

muscle weakness in areas that affect swallowing and breathing = aspiration, resp insufficiency, resp tract infection

Question 17

drug therapy for MG

Answer 17

anticholinesterase agents
corticosteroids
immunosuppressive agents

Question 18

what is removed in surgery for MG

Answer 18

thymus gland

Question 19

other therapies for MG

Answer 19

plasmapheresis
iv immunoglobulin g

Question 20

interventions for MG

Answer 20

balanced diet that is easily chewed and shallowed (semi-solid foods)
scheduling doses of drugs so that peak action is reached at mealtime may make eating less difficult.
arrange diversional activities that require little physical effort and match the patient’s interests.
help the patient plan activities of daily living to avoid fatigue.

Question 21

multiple sclerosis

Answer 21

chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord.

Question 22

possible precipitating factors of multiple sclerosis

Answer 22

infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy, and a poor state of health, type 1 diabetes, thyroid problems, IBS

Question 23

what is the patho of multiple sclerosis

Answer 23

The activated t cells in the systemic circulation migrate to the cns, disrupting the blood-brain barrier. this is likely the initial event in the development of ms. subsequent antigen-antibody reaction within the cns activates the inflammatory response and leads to the demyelination of axons.

Question 24

manifestations of multiple sclerosis

Answer 24

Onset of the disease is often insidious and gradual
Chronic, progressive deterioration in some patients
Remissions and exacerbations in others
Overall trend is progressive deterioration in neurologic function

Question 25

assessment of multiple sclerosis

Answer 25

severe fatigue
tremors
bladder and bowel dysfunction
c/o pain in low thoracic area or abdominal region.
decrease peripheral sensation (pain, temperature, touch)
emotional instability
speech impediments
cognitive functions
spasticity of muscles
visual disturbances
dizziness
hearing loss
dysphagia

Question 26

interprofessional management of multipole sclerosis

Answer 26

no cure - supportive therapy
energy conservation
maintain adequate fluid intake 2000 ml/day
provide bowel and bladder training
encourage activity independence
regulate temperatures on water heaters, baths, and heating pads
home safety (rugs, cords, etc.)
drug therapy

Question 27

disease modifying drugs immunomodulators for multiple sclerosis

Answer 27

glatiramer acetate (copaxone)

Question 28

education for glatiramer acetate

Answer 28

inj-site: hives, rash, irritation, severe pain, flushing, chest pain
allergic reaction: itching, trouble breathing, chest pain, dizziness, sweating
do not change dosing or stop taking product without hcp advice

Question 29

interventions for multiple sclerosis

Answer 29

Help patient identify triggers and develop ways to avoid them or minimize their effects
Reassure patient during diagnostic phase
Assist patient in dealing with anxiety and grief caused by diagnosis
During acute exacerbation, prevent major complications of immobility
Focus teaching on building general resistance to illness

Question 30

interventions for multiple sclerosis

Answer 30

Help patient identify triggers and develop ways to avoid them or minimize their effects
Reassure patient during diagnostic phase
Assist patient in dealing with anxiety and grief caused by diagnosis
During acute exacerbation, prevent major complications of immobility
Focus teaching on building general resistance to illness

Question 31

parkinsons disease

Answer 31

chronic, progressive neurodegenerative disorder characterized by slowness in the initiation and execution of movement

Question 32

symptoms of parkinsons disease

Answer 32

increased muscle tone (rigidity), tremor at rest, and gait disturbance.

Question 33

manifestations of parkinsons

Answer 33

tremor
rigidity
bradykinesia, hypokinesia or akinesia
postural instability
depression
dementia
sleep disturbances
difficulty smelling

Question 34

complications related to parkinsons

Answer 34

Dysphagia may result in malnutrition or aspiration
General debilitation may lead to pneumonia, UTIs, and skin breakdown
Orthostatic hypotension

Question 35

TRAP parkinsons mnemonic

Answer 35

T – tremors at rest
R – cogwheel rigidity of limbs and movement
A – akinesia or bradykinesia, slowing of movements
P – postural instability, clumsy, shuffling gait

Question 36

surgical therapy for parkinsons

Answer 36

dbs – deep brain stimulation
ablation – destruction
transplantation

Question 37

antiparkinsonian drug therapy effects

Answer 37

aimed at correcting imbalances of neurotransmitters within the cns
enhance or release supply of da
antagonize or block the effects of overactive cholinergic neurons in the striatum

Question 38

primary treatment of parkinsons

Answer 38

levodopa carbidopa

Question 39

signs of dyskinesia

Answer 39

report any uncontrolled movement of face, eyelids, mouth, tongue, arms, hands, or legs
mental changes
Palpitations
severe nausea and vomiting
difficulty urinating

Question 40

ablation surgery

Answer 40

locating, targeting, and destroying an area of the brain affected by PD.
The goal is to destroy tissue that produces abnormal chemical or electrical impulses leading to tremors or other symptoms.

Question 41

what is targeted in ablation surgery

Answer 41

Typical targets of ablation are the thalamus (thalamotomy), globus pallidus (pallidotomy), and subthalamic nucleus (subthalamic nucleotomy).

Question 42

nutritional therapy for parkinsons

Answer 42

malnutrition and constipation can be serious consequences
patients with dysphagia and bradykinesia need food that is easily chewed and swallowed
adequate fiber
eating more numerous small meals is less exhausting than eating fewer large meals each day
provide ample time to avoid frustration
levodopa can be impaired by protein and vitamin b6 ingestion