Unit 18 Neuromuscular Flashcards
Ascending Tracts - Sensory Pathways
6 tracts- perception of touch, pressure,
vibration, proprioception, pain, temperature
Begin in the spinal cord and end in the brain
Carry sensory input to higher levels of CNS
Descending Tract - Motor Pathways
- Pyramidal tract
Voluntary movement - Extrapyramidal
Automatic movement, posture
Upper Motor Neurons
(UMN
– Entirely within the CNS
– Initiates voluntary movement
Lower Motor Neurons (LMN)
Lower Motor Neurons (LMN)
– Directly innervate skeletal muscle
– Essential for muscle contraction
– Part of PNS
UMN Lesions
Weakness: Distal to Injury
Tone: Spastic
LMN Lesions
Weakness: Specific to Peripheral Nerve root
Tone: Flaccid
Complete Spinal Cord Injury
Loss of all sensory, proprioception, and voluntary motor activity
Incomplete Spinal Cord Injury
Part of the Spinal Cord is Intact
Spinal Cord Mechanisms of Injury
Hyperextension Hyperflexion Compression Flexion-rotation Penetrating
Neurogenic Shock
Loss of vasomotor tone and impairment of autonomic function
Sx: Hypotension, bradycardia, warm and dry skin
Spinal Shock
Loss of spinal reflexes –> Flaccid paralysis
Multiple Sclerosis
A chronic disease of the CNS
characterized by degeneration & loss of
myelin in the brain, spinal cord, & cerebrum.
Early Stages: Nerve damage minimal.
Progressive: Nerve impulses are completely blocked.
MS Clinical Manifestations (Motor)
Weakness – Paralysis – Diplopia – Spasticity of muscles – Scanning speech – Fatigue
MS Clinical Manifestations (Sensory)
– Numbness & tingling – Patchy blindness – Vertigo – Tinnitus
MS Clinical Manifestations (Cerebellar)
Ataxia
Nystagmus
Dysarthria
Dysphagia
MS Clinical Manifestations (Other)
Bladder dysfunction Sexual dysfunction Emotional instability (anger, depression, euphoria)
MS Pharma
Biological Response Modifiers: Interferons (beta-1a, beta-1b) Synthetic Immunomodulator (glatiramer acetate) Steroids (methylprednisone, prednisone) Immunosuppressants Antispasmodics : baclofen
Parkinsons Disease
Def: Injury or impairment of dopamineproducing
cells of the substantia nigra in
the mid-brain
Dopamine: a neurotransmitter that is essential for normal functioning of extrapyramidal system (control of posture, support, & automatic movement
Key Features of Parkinsons (TRAP)
Tremor
Rigidity
Akinesia/Bradykinesia
Postural Disturbances
Parkinsons Pharma
Dopaminergics:
carbidopa/levadopa
Problems: Unpredictable, wears off. Paradoxical intoxication
Dopamine agonists: bromocriptine
Catechol O-methyltransferase COMT inhibitors:
entacapone
MAO-B inhibitors: rasagiline
Anticholinergics: benzotropine
Deep Brain Stimulation (MS)
A permanent stimulating lead placed in
brain & connected to an impulse generator
that’s implanted in chest
Controlled by radio frequency transmissions
from a computer
DBS helps interrupt “short-circuits” in brain
Myasthenia Gravis
Def: a disease of the neuromuscular
junction char. by fluctuating weakness
of certain skeletal muscles
Patho: An autoimmune process that
results in a decreased # of ACh receptor sites at the neuromuscular
junction –> therefore, prevents Ach molecules from
attaching & causing muscle contraction
MG Diagnostics
History and S/S “Look to the ceiling” test
Tensilon test (edrophonium)
Blood test: Acetylcholine Receptor antibodies (AChR)
EMG Studies
CT scan for overgrown thymus
MG S/S
Fatigability of skeletal Muscles, esp those involved in: Moving eyes and eyelids Chewing/Swallowing Speaking Breathing
MG Pharma and Mgmt
Anticholesterase inhibitors: pyridostigmine bromide
Corticosteroids: prednisone
Immunosuppressants
Plasmapheresis
Thymus gland removal
Myasthenic Crisis
Due to undermedication or commonly, infection. Will + tensilon test
S/S: Increased BP, Pulse, RR
Severe resp. distress.
Bowel and bladder incont.
Cholinergic Crisis
Due to excessive meds
Will test neg. tensilon test
S/S: abdom Cramps
Diarrhea
Inc. Pulmonary secretions and bronchial spasms
Amyotrophic Lateral Sclerosis ALS
Degeneration of motor neurons in brain
& spinal cord for unknown reasons
Electrical & chemical messages
originate in brain but the dead motor neurons cannot produce or transport
vital signals to muscles
Clinical Manifestations of ALS
Weakness Dysarthria Dysphagia Muscle wasting Spastic muscles Eventually - flaccid paralysis ** Cognitive - stays intact
Guillain Barre Syndrome (Infectious Polyneuritis)
Def: A paralysis affecting the myelinated neurons of the PNS
Segmental demyelination
Affects motor neurons more than sensory neurons
Thought to be a cell mediated immunologic reaction
GB Dx
Clinical S/S Lumbar puncture EMG FVC Negative Inspiratory Force NIF
GB 3 stages
1. Initial Period usually 1 - 3 weeks 2. Plateau Period several days to 2 weeks 3. Recovery Phase 4-6 months, may be up to 2 years
Clinical Variations of GB
Ascending- starts from feet goes up
Descending - starts in head goes down
Clinical Manifestations of GB
Fatigue while talking Facial weakness Cranial nerve involvement Paresthesias Pain resembling a “charlie horse” Difficulty walking Motor weakness (flaccid paralysis) Respiratory compromise/failure
GB Tx
Plasmapheresis
Whole blood is removed from body-> RBC’s & WBC’s are separated from plasma & returned to body without plasma. Body will reproduce plasma
High dose immunoglobulin therapy
Neuro Pyschosocial Nsg Dxs
Anxiety Coping, Ineffective Grieving, Dysfunctional Altered body image/Self Concept Sexuality
Neurogenic Bladder (Reflex/Spastic)
- Impulses cannot travel from lower spinal cord to cortex because of
UMN lesion - Reflex arc is intact
- Result Uncontrolled expulsion of urine without complete emptying
Neurogenic Bladder (Flaccid)
- Message that bladder is full gets to brain but bladder cannot interpret the message so it remains flaccid.
- Damage to reflex arc
- Loss of sensation of bladder fullness,
result overfill & distention
Spastic bladder Mgmt
- Trigger reflex
- Catheterization (PVR)
- Meds
Flaccid bladder mgmt
- Valsalva maneuver
- Crede
- Catheterization (PVR)
- Meds
Spastic Bladder Meds
- Anticholinergics: propantheline
Oxybutynin - Skeletal Muscle relaxants:
baclofen
Flaccid bladder meds
- Cholinergics : bethanechol
Bladder problems w/ neuro
Urinary calculi
Urinary Retention
Autonomic Dysreflexia
Autonomic Dysreflexia
Full bladder or stimulus from bowel –> Afferent stimulus –> Massive sympathetic response –> Widespread vasoconstriction – > HTN – > Baroreceptors in BVs detect HTN crisis - signal brain –> HR slowed –> Descending inhibitory signals blocked at site of spinal cord injury (T6 or above)
AD assess and intervene
Assess: HTN HA or blurred vision Diaphoresis/Vasocilation above injury level Bradycardia
Intervention: HOB High as possible Remove stimulus (bowel/bladder)
Bowel Mgmt w. Neuro
Reflex (UMN) - Incontinence w/o warning
Flaccind (LMN) infrequent small stools
Tx: Consistent time Suppository program High residue foods High fluid intake Stood softener
UMN Lesion -> Digital stimulation
LMN Lesion -» Manual removal
Impaired mobility problems
Skin integrity- decubiti Thrombophlebitis Osteoporosis Muscle atrophy Contractures Fatigue Alteration in coordination, gait, posture Pain
Pain from Neuro
Disruption of nerve endings
Spasms/fatigue
Inflammation
Pain Mgmt-
Physical Therapy
Pharma Support
Surgical Intervention
Neuro Pain Pharma Teraphy
Muscle relaxants Anti inflammatory Non narcotic Analgesics Nerve blocks Epidurals
Safety Nsg Dx Neuro
Risk for Infection
Altered Sensory Perception
Inability to Regulate body temp
Prone to Hazards - drug therapy
Neuro drug therapy
Anthcholinergics: benztropine
Dopaminergics: carbi/levadopa
CS: Prednisone
Cholinergics: Pyridostigmine bromide
Oxygen Nsg Dx Neuro
Alteration in resp. patterns
Decrese in Circ to extremities
Orthostatic Hypotension
Increase Workload on Heart
Nutrition Nsg Dx Neuro
Paralysis of mouth/tongue Difficulty chewing Dysphagia Anorexia Osteoporosis
diplopia
double vision
ptosis
upper eyelid droop
extrapyramidal
r/t motor nerves descending from the cortex and spine that are not part of the pyramidal system
intention tremor
a trembling of a part of the body when attempting a precise movement, associated especially with disease of the cerebellum.
