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NUR123 > Unit 18 Neuromuscular > Flashcards

Unit 18 Neuromuscular Flashcards

1
Q

Ascending Tracts - Sensory Pathways

A

 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

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2
Q

Descending Tract - Motor Pathways

A
  1. Pyramidal tract
    Voluntary movement
  2. Extrapyramidal
    Automatic movement, posture
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3
Q

Upper Motor Neurons

(UMN

A

– Entirely within the CNS

– Initiates voluntary movement

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4
Q

 Lower Motor Neurons (LMN)

A

 Lower Motor Neurons (LMN)
– Directly innervate skeletal muscle
– Essential for muscle contraction
– Part of PNS

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5
Q

UMN Lesions

A

Weakness: Distal to Injury
Tone: Spastic

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6
Q

LMN Lesions

A

Weakness: Specific to Peripheral Nerve root
Tone: Flaccid

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7
Q

Complete Spinal Cord Injury

A

Loss of all sensory, proprioception, and voluntary motor activity

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8
Q

Incomplete Spinal Cord Injury

A

Part of the Spinal Cord is Intact

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9
Q

Spinal Cord Mechanisms of Injury

A 
 Hyperextension
 Hyperflexion
 Compression
 Flexion-rotation
 Penetrating
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10
Q

Neurogenic Shock

A

Loss of vasomotor tone and impairment of autonomic function

Sx: Hypotension, bradycardia, warm and dry skin

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11
Q

Spinal Shock

A

Loss of spinal reflexes –> Flaccid paralysis

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12
Q

Multiple Sclerosis

A

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.

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13
Q

MS Clinical Manifestations (Motor)

A 
Weakness
– Paralysis
– Diplopia
– Spasticity of
muscles
– Scanning speech
– Fatigue
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14
Q

MS Clinical Manifestations (Sensory)

A 
– Numbness &
tingling
– Patchy blindness
– Vertigo
– Tinnitus
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15
Q

MS Clinical Manifestations (Cerebellar)

A

Ataxia
Nystagmus
Dysarthria
Dysphagia

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16
Q

MS Clinical Manifestations (Other)

A 
Bladder dysfunction
Sexual dysfunction
Emotional instability (anger, depression, euphoria)
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17
Q

MS Pharma

A 
Biological Response Modifiers:
  Interferons (beta-1a, beta-1b)
   Synthetic Immunomodulator
   (glatiramer acetate)
Steroids (methylprednisone, prednisone)
Immunosuppressants
Antispasmodics : baclofen
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18
Q

Parkinsons Disease

A

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
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19
Q

Key Features of Parkinsons (TRAP)

A

Tremor
Rigidity
Akinesia/Bradykinesia
Postural Disturbances

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20
Q

Parkinsons Pharma

A

Dopaminergics:
carbidopa/levadopa
Problems: Unpredictable, wears off. Paradoxical intoxication

Dopamine agonists: bromocriptine

Catechol O-methyltransferase COMT inhibitors:
entacapone

MAO-B inhibitors: rasagiline

Anticholinergics: benzotropine

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21
Q

Deep Brain Stimulation (MS)

A

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

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22
Q

Myasthenia Gravis

A

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

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23
Q

MG Diagnostics

A

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

24
Q

MG S/S

A 
Fatigability of skeletal Muscles, esp those involved in: 
Moving eyes and eyelids
Chewing/Swallowing
Speaking
Breathing
25
Q

MG Pharma and Mgmt

A

Anticholesterase inhibitors: pyridostigmine bromide

Corticosteroids: prednisone

Immunosuppressants

Plasmapheresis

Thymus gland removal

26
Q

Myasthenic Crisis

A

Due to undermedication or commonly, infection. Will + tensilon test

S/S: Increased BP, Pulse, RR
Severe resp. distress.
Bowel and bladder incont.

27
Q

Cholinergic Crisis

A

Due to excessive meds
Will test neg. tensilon test

S/S: abdom Cramps
Diarrhea
Inc. Pulmonary secretions and bronchial spasms

28
Q

Amyotrophic Lateral Sclerosis ALS

A

 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

29
Q

Clinical Manifestations of ALS

A 
 Weakness
 Dysarthria
 Dysphagia
 Muscle wasting
 Spastic muscles
 Eventually - flaccid paralysis
** Cognitive - stays intact
30
Q

Guillain Barre Syndrome (Infectious Polyneuritis)

A

 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

31
Q

GB Dx

A 
Clinical S/S
Lumbar puncture
EMG
FVC
Negative Inspiratory Force NIF
32
Q

GB 3 stages

A 
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
33
Q

Clinical Variations of GB

A

Ascending- starts from feet goes up

Descending - starts in head goes down

34
Q

Clinical Manifestations of GB

A 
 Fatigue while talking
 Facial weakness
 Cranial nerve involvement
 Paresthesias
 Pain resembling a “charlie horse”
 Difficulty walking
 Motor weakness (flaccid paralysis)
 Respiratory compromise/failure
35
Q

GB Tx

A

 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

36
Q

Neuro Pyschosocial Nsg Dxs

A 
 Anxiety
 Coping, Ineffective
 Grieving, Dysfunctional
 Altered body image/Self Concept
 Sexuality
37
Q

Neurogenic Bladder (Reflex/Spastic)

A
  1. Impulses cannot travel from lower spinal cord to cortex because of
    UMN lesion
  2. Reflex arc is intact
  3. Result Uncontrolled expulsion of urine without complete emptying
38
Q

Neurogenic Bladder (Flaccid)

A
  1. Message that bladder is full gets to brain but bladder cannot interpret the message so it remains flaccid.
  2. Damage to reflex arc
  3. Loss of sensation of bladder fullness,
    result  overfill & distention
39
Q

Spastic bladder Mgmt

A
  1. Trigger reflex
  2. Catheterization (PVR)
  3. Meds
40
Q

Flaccid bladder mgmt

A
  1. Valsalva maneuver
  2. Crede
  3. Catheterization (PVR)
  4. Meds
41
Q

Spastic Bladder Meds

A
  1. Anticholinergics: propantheline
    Oxybutynin
  2. Skeletal Muscle relaxants:
    baclofen
42
Q

Flaccid bladder meds

A
  1. Cholinergics : bethanechol
43
Q

Bladder problems w/ neuro

A

Urinary calculi
Urinary Retention
Autonomic Dysreflexia

44
Q

Autonomic Dysreflexia

A

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)

45
Q

AD assess and intervene

A 
Assess:
HTN
HA or blurred vision
Diaphoresis/Vasocilation above injury level
Bradycardia
Intervention: HOB High as possible
Remove stimulus (bowel/bladder)
46
Q

Bowel Mgmt w. Neuro

A

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

47
Q

Impaired mobility problems

A 
Skin integrity- decubiti
Thrombophlebitis
Osteoporosis
Muscle atrophy
Contractures
Fatigue
Alteration in coordination, gait, posture
Pain
48
Q

Pain from Neuro

A

Disruption of nerve endings
Spasms/fatigue
Inflammation

Pain Mgmt-
Physical Therapy
Pharma Support
Surgical Intervention

49
Q

Neuro Pain Pharma Teraphy

A 
Muscle relaxants
Anti inflammatory
Non narcotic Analgesics
Nerve blocks
Epidurals
50
Q

Safety Nsg Dx Neuro

A

Risk for Infection
Altered Sensory Perception
Inability to Regulate body temp
Prone to Hazards - drug therapy

51
Q

Neuro drug therapy

A

Anthcholinergics: benztropine
Dopaminergics: carbi/levadopa
CS: Prednisone
Cholinergics: Pyridostigmine bromide

52
Q

Oxygen Nsg Dx Neuro

A

Alteration in resp. patterns
Decrese in Circ to extremities
Orthostatic Hypotension
Increase Workload on Heart

53
Q

Nutrition Nsg Dx Neuro

A 
Paralysis of mouth/tongue
Difficulty chewing
Dysphagia
Anorexia
Osteoporosis
54
Q

diplopia

A

double vision

55
Q

ptosis

A

upper eyelid droop

56
Q

extrapyramidal

A

r/t motor nerves descending from the cortex and spine that are not part of the pyramidal system

57
Q

intention tremor

A

a trembling of a part of the body when attempting a precise movement, associated especially with disease of the cerebellum.

NUR123 (6 decks)

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