w6 notes Flashcards
Dx of seizure
- accurate and comprehensive description of seizure
- health hx
- EEG (Electroencephalogram)
- ideally w/in 24 hours of seizure
- only helpful if abnormal
- CBC, serum chemistries, LFTs, kidney function tests, urinalysis – to r/o metabolic disorders
- CT or MRI – to r/o structural lesions
Dx of seizure
- accurate and comprehensive description of seizure
- health hx
- EEG (Electroencephalogram)
- ideally w/in 24 hours of seizure
- only helpful if abnormal
- CBC, serum chemistries, LFTs, kidney function tests, urinalysis – to r/o metabolic disorders
- CT or MRI – to r/o structural lesions
Problem =
- not enough dopamine
- too much acetylcholine
PD
Nerve conduction tests – measures speed of conduction through a nerve
- repetitive nerve stimulation (RNS) studies – MG dx
- single fiber electromyogram/EMG – MG dx
Electrophysiological studies
4 phases of seizure
1. __________ phase – sensations or behavior changes that precede a seizure by hours – days
2. _________phase – sensory warning that a seizure is about to happen
3. _______phase – first symptom through the end of seizure activity
4. _______ phase – recovery period after the seizure
4 phases of seizure
1. prodromal phase – sensations or behavior changes that precede a seizure by hours – days
2. aural phase – sensory warning that a seizure is about to happen
3. ictal phase – first symptom through the end of seizure activity
4. post ictal phase – recovery period after the seizure
- combined ultrasound and pulsed doppler technology
- for stroke patients
- non-invasive
- procedure:
- Probe placed over carotid artery
- Slowly moved along course of common carotid artery
- Frequency of U/S corresponds to blood velocity
- Increased velocity can indicate stenosis
Carotid artery duplex scan
Types of seizures: both sides of brain or one hemisphere of brain?
Generalized onset seizure
Focal onset seizure
Generalized onset seizure (both sides of brain)
Focal onset seizure (one hemisphere of brain)
MG Problem = reduction of _________ receptors
acetylcholine
- chronic
- progressive
- insidious
- neurodegenerative
Parkinsons disease
memorization cue
BGPD
basal ganglia
Parkinsons disease
Treatment of MS
Drug therapy
- highly ____________
Drug therapy goal
- modify disease process
- Treat acute relapses
- manage _____
Non drug therapy:
- PT and OT
- strengthening exercises
- adapting ADLs
- mobility assistance
- counseling
Treatment of MS
Drug therapy
- highly individualized
Drug therapy goal
- modify disease process
- Treat acute relapses
- manage s/s
Non drug therapy:
- PT and OT
- strengthening exercises
- adapting ADLs
- mobility assistance
- counseling
PD Cardinal features (motor system disorders)
(early)
1.
2.
3.
(later)
4.
tremor
muscle rigidity
bradykinesia
postural instability
which type of seziure?
- stiffen 10-20 secs
- jerking 30-40 secs
- Loss of consciousness, falls to ground
- salivation
- Diaphoresis
- Tongue biting
- incontinence
- post-ictal – may sleep for hours
- no memory of experience
generalized seizures
(both sides of brain)
tonic clonic seizure
- tonic = stiffen 10-20 secs
- clonic – jerking 30-40 secs
MG Presenting s/s
ocular symptoms:
2 main thing with the eyes?
Bulbar symptoms:
- __________ – _______ speech
- ________ – difficulty swallowing
- fatigable ________
__________ limb weakness
Presenting s/s
ocular symptoms:
1. - Ptosis – droopy eyelids r/t weak muscles
- Fluctuates
- May be unilateral, bilateral, or switch eyes
2. - diplopia – double vision, initially sensed as blurred vision
Bulbar symptoms:
- dysarthria – garbled speech
- dysphagia – difficulty swallowing
- fatigable chewing
Proximal limb weakness
MS Diagnosis requires evidence of ONE of the following:
- 2 or more episodes of ___________
- Must be separated by 1 month
- Must last more than 24 hours
- Must have subsequent/following recovery - clinical history
- Must have clearly defined _________ and ________
- Can be with or without complete recovery
- Must be followed by a ____________ of s/s over 6 months or more - slow and stepwise __________ of s/s
- Must be over 5 months or more
- 2 or more episodes of exacerbation
- Must be separated by 1 month
- Must last more than 24 hours
- Must have subsequent/following recovery - clinical history
- Must have clearly defined exacerbations and remissions
- Can be with or without complete recovery
- Must be followed by a progression of s/s over 6 months or more - slow and stepwise progression of s/s
- Must be over 5 months or more
Types of seizures
- ___________ onset seizure - both sides of brain
- tonic clonic seizure
- absence seizure
-_________ onset seizure – one hemisphere of brain
- with retained awareness
- without retained (impaired) awareness
Generalized
Focal
seizures non-surgical treatment:
- antiepileptic drugs
- start with one and titrate, add another if needed
- older drugs (ex: _________) have narrow therapeutic index
- Need ______ level monitoring
- Teach to avoid abrupt _______– may precipitate seizure
- Adherence to drug therapy is important
- Classic s/e of phenytoin = __________
non-surgical treatment
1. antiepileptic drugs
- start with one and titrate, add another if needed
- older drugs (ex: phenytoin) have narrow therapeutic index
- Need serum drug level monitoring
- Teach to avoid abrupt withdrawal – may precipitate seizure
- Adherence to drug therapy is important
- Classes s/e of phenytoin = gingival hyperplasia
PD _______ tremor
MS _______ tremor
resting - noticed when not engaged in activity
action - noticed when engaged in activity
Treatment of ALS
- cure?
- drug therapy = ________
- Only FDA approved ALS drug
- Extends survival time
- no cure
- drug therapy = riluzole
seizure: Surgical treatment
1 - Surgical resection of affected area
2 - _____ nerve stimulation
- “pacemaker of the brain” is placed under skin on chest wall and wire runs to _____ nerve in neck
- Prevents seizures by sending regular, mild pulses to the brain via the ______ nerve
Surgical treatment
- Surgical resection of affected area
- vagal nerve stimulation
- “pacemaker of the brain” is placed under skin on chest wall and wire runs to vagus nerve in neck
- Prevents seizures by sending regular, mild pulses to the brain via the vagus nerve
PD
1. motor s/s (trb + falls)
2. Non-motor and neuropsychiatric clinical features:
- _______ dysfunction and dementia
- psychoses and ________
- ______ disorders
- ________ (smell) dysfunction
- sleep __________
- ________ nervous system dysfunction
- BP issue?
- Constipation or diarrhea?
- ___________ (swallowing)
- Diaphoresis
- Urinary difficulties
- Sexual dysfunction
- pain /sensory disorders – face, abdomen, genitals, joints
- ___________ - slow, monotonous, slurred speech
- micrographia – progressive ___________ of hand writing
- cognitive dysfunction and dementia
- psychoses and hallucinations
- mood disorders
- olfactory (smell) dysfunction
- sleep disturbances
- autonomic nervous system dysfunction (maintains normal bodily functions)
- Orthostasis (orthostatic hypotension)
- Constipation
- Dysphagia (swallowing)
- Diaphoresis
- Urinary difficulties
- Sexual dysfunction
- pain /sensory disorders – face, abdomen, genitals, joints
- dysarthria - slow, monotonous, slurred speech
- micrographia – progressive shrinking of hand writing
- chronic
- inflammatory
- autoimmune
- remissions and exacerbations
- potentially disabling – brain and spinal cord
- pace of progression is highly variable and there are many atypical forms
- causes demyelination (of myelin sheath) and axonal injury (no nerve conduction)
Multiple sclerosis
memorization cue
multiple sclerosis
myelin sheath
“M.S. M.S.”
s/s MS
- ________ issues in limbs and face
- _____ loss, nystagmus, diplopia
- motor issues
- gait issues
- balance issues
- lhemitte sign – electric shock sensations running down back or limbs when neck is flexed
- vertigo
- bladder or bowel issues
- limb ataxia (lack of coordination)
- cognitive problems (cog fog)
- spasticity - stiffness
- _________ tremors
- _________ loss or tinnitus
- sexual dysfunction
- depression
- fatigue
- _______intolerance
- sensory issues in limbs and face
- visual loss or nystagmus
- motor issues
- diplopia
- gait issues
- balance issues
- lhemitte sign – electric shock sensations running down back or limbs when neck is flexed
- vertigo
- bladder or bowel issues
- limb ataxia (lack of coordination)
- cognitive problems (cog fog)
- spasticity - stiffness
- intention tremors - worsens when trying to perform a voluntary movement or action
- hearing loss or tinnitus
- sexual dysfunction
- depression
- fatigue
- heat intolerance
which type of seizure
- eyes open
- loss of consciousness or changes in awareness (feel like dreaming)
- make movements that seem purposeful but can’t interact with observer
- safety – may walk into traffic, or take off clothes
- lasts 1-2 mins
- tired and confused after
Focal onset seizure
(one hemisphere of brain)
without retained (impaired) awareness
- measures brains electrical activity
- used to assess presence and types of seizures
- non invasive and painless
- procedure:
- Withhold stimulants for 8 hours
- Clean scalp
- Apply electrodes – 16-25 metal electrodes
- Done bedside or EEG lab
- Lasts 20-40 mins
Electroencephalogram (EEG)
Screening and dx of MG
- medical history and focused neurological exam
- gait, posture, coordination, balance - _________
- test of choice to support clinical dx
- can reveal MS lesions - ____________
- measures nerve sensations and electrical senses sent to brain in response to stimuli
- can use visual or electrical stimuli - Lumbar puncture/spinal tap
- to check CSF for ____creased WBCs or protein
Screening and dx of MG
medical history and focused neurological exam
- gait, posture, coordination, balance
MRI
- test of choice to support clinical dx
- can reveal MS lesions
Evoked potential test
- measures nerve sensations and electrical senses sent to brain in response to stimuli
- can use visual or electrical stimuli
Lumbar puncture/spinal tap
- to check CSF for increased WBCs or protein
which type of seizure
- no loss of consciousness
- lasts < 1 min
- unusual sensations
- joy
- anger
- sad
- nausea
- hear, smell, taste, see things that are not real
Focal onset seizure
(one hemisphere of brain)
with retained awareness
which neuro dx test?
- obtains fluid and measurements of CSF
Lumbar puncture AKA Spinal tap
!!grave muscle weakness in head area!!
- acquired
- autoimmune
- progressive
- muscle weakness!!
- remissions and exacerbations!!
- exacerbations/flares r/t emotional stress, pregnancy, illness, heat
- disease peaks within 2 years
Myasthenia gravis
memorization cue
A.R.M.G
acetylcholine receptors (low)
myasthenia gravis
- Levodopa
- Dopamine agonists
- Anticholinergics
treat ?
PD
2 neurodegenerative diseases (progressive degeneration and death of neurons in the brain or peripheral nervous system)
no cure
- which has cognitive dysfunction and motor disorders?
- which does pt remain cognitively intact while their body wastes away?
PD
ALS
- PD
- ALS
Lumbar puncture AKA Spinal tap = obtains fluid and measurements of CSF
- pre-procedure:
- Pt education
- Empty ______
- Position –
- Tilt table – allows control of ________
- ________ form - post-procedure:
- Position –
- Monitor if ______ occurs
- Treat mild spinal h/a with ________ (including opioids)
- Treat severe spinal h/a with _______ and IV caffeine
- pre-procedure:
- Pt education
- Empty bladder
- Position – lateral recumbent/fetal position
- Tilt table – allows control of CSF moving up/down body
- Consent form - post-procedure:
- Position – maybe lay flat for 1 hour
- Monitor if spinal h/a occurs
- Treat mild spinal h/a with bed rest and analgesics (including opioids)
- Treat severe spinal h/a with epidural blood patch (autologous blood injected into dura from periphery) and IV caffeine
- assess nerve innervation
- used with ALS and myasthenia gravis diagnoses
- slight discomfort with needle insertion
Electromyography (EMG)
PD
Problem =
- not enough ________
- too much _______
Problem =
- not enough dopamine
- too much acetylcholine
PD drugs
1. Levodopa
- most effective drug for ______ PD, especially ___________
- few or lots of side effects?
- what is the associated phenomenon? effective for how long?
- __________ agonists – monotherapy or combination
- Anticholinergics – monotherapy
- Levodopa
- most effective drug for symptomatic PD, especially bradykinesia
- Lots of side effects
- - On-off phenomenon -
Only effective for a certain amount of time, so eventually it will stop working – within several years of starting levodopa, motor fluctuations may develop - Dopamine agonists – monotherapy or combination
- Anticholinergics – monotherapy
_____ may require Short term treatment
why?
- used until other meds take effect
- prior to surgery
- myasthenic crisis
- intravenous immunoglobulin (IVIG)
- an injection of nonspecific antibody (immunoglobulin)
- dials down the immune system’s production of its own ___________ - _________ (plasma exchange)
- IV line used to remove antibodies from plasma = decreases symptoms
- 6 exchanges over 2 weeks with weekly/monthly follow ups prn
MG
- intravenous immunoglobulin (IVIG)
- an injection of nonspecific antibody (immunoglobulin)
- dials down the immune system’s production of its own antibodies - plasmapheresis (plasma exchange)
- IV line used to remove antibodies from plasma = decreases symptoms
- 6 exchanges over 2 weeks with weekly/monthly follow ups prn
Care of PD
- allow extra ______ to respond to questions and ADL’s
- collab with ____ – ADL’s
- listen
- meds – admin ______ and monitor for s/e
- implement interventions to prevent complications of immobility
- Constipation
- Contractures
- Skin breakdown
- collab with ____ – encourage physical exercise
- collab with SLP
- Dysphagia – swallowing
- _________ – weak voice
- collab with dietician
- Balanced diet
- _______ calorie
- ______ fiber
- _______ fluid
- Bite size pieces
- Small frequent meals
- assess for depression and anxiety
- assess for insomnia and sleeplessness
- if pt freezes while walking
- Consciously think about ________
- Drop ________ and step over them
- _____ from side to side
- Lift ______ when stepping
- Take one step _____ward and 2 steps ______ward
- remove rugs and other tripping hazards at home
- assess care giver burden
- support groups
Care of PD
- allow extra time to respond to questions and ADL’s
- collab with OT – ADL’s
- listen
- meds – admin prompt and monitor for s/e
- implement interventions to prevent complications of immobility
- Constipation
- Contractures
- Skin breakdown
- collab with PT – encourage physical exercise
- collab with SLP
- Dysphagia – swallowing
- Hypophonia – weak voice
- collab with dietician
- Balanced diet
- High calorie
- High fiber
- High fluid
- Bite size pieces
- Small frequent meals
- assess for depression and anxiety
- assess for insomnia and sleeplessness
- if pt freezes while walking
- Consciously think about stepping over imaginary/real lines on floor
- Drop rice kernels and step over them
- Rock from side to side
- Lift toes when stepping
- Take one step backwards and 2 steps forward
- remove rugs and other tripping hazards at home
- assess care giver burden
- support groups
__________ crisis = not enough acetylcholinesterase inhibitors AKA “anticholinesterase meds”
___________ crisis = too much acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Myasthenic crisis = not enough acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Cholinergic crisis = too much acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Drug therapy for ________
- acetylcholinesterase inhibitors AKA “anticholinesterase meds” = Pyridostigmine bromide, neostigmine
- immunotherapeutic/ immunosuppressants = Prednisone (corticosteroid), azathioprine, cyclosporine
MG
2 types of MG
1. _________ myasthenia gravis:
- most common
- typically originates as this type
- effects face, neck, jaw
2. ________ myasthenia gravis:
- may progress into this type
- effects face, throat, limbs, and respiratory system.
MG Severity varies
- mild motor neuron disturbances 2ndary to respiratory failure/muscle weakness
ocular
Generalized
Treatment of MG
Drug therapy
_________ inhibitors AKA “___________ meds”
- Pyridostigmine bromide, neostigmine
- 1st line
- Relief in mins
- Day to day variation in dosing depending on changing symptoms
immunotherapeutic/ immuno________
- Prednisone (corticosteroid), azathioprine, cyclosporine
Treatment of MG
Drug therapy
- acetylcholinesterase inhibitors AKA “anticholinesterase meds”
- Pyridostigmine bromide, neostigmine
- 1st line
- Relief in mins
- Day to day variation in dosing depending on changing symptoms
- immunotherapeutic/
immunosuppressants - Prednisone (corticosteroid), azathioprine, cyclosporine
PD treatment: surgery
Deep _______ stimulation (DBS)
- electrodes are surgically placed in the brain and connected to a neurostimulator in the _______ (pacemaker device)
- most common surgical treatment for _________ PD
- adjusted to control ________
- irreversible procedure?
treatment: surgery
Deep brain stimulation (DBS)
- electrodes are surgically placed in the brain and connected to a neurostimulator in the chest (pacemaker device)
- most common surgical treatment for advanced PD
- adjusted to control symptoms
- reversible procedure
Problem = reduction of acetylcholine receptors
MG
Care: seizures
- if pt is at risk for seizure – needs ______ access
- wear medic alert ID
- patient education of psychosocial ramifications
- May suffer from loss of independence, employment, insurance, ability to drive, self esteem
- support
Care: seizures
- if pt is at risk for seizure – needs IV access
- wear medic alert ID
- patient education of psychosocial ramifications
- May suffer from loss of independence, employment, insurance, ability to drive, self esteem
- support
- MS dx
- detection electrodes are placed on scalp, neck and back
- 3 types of evoked potential:
- Visual – sits before a screen in which checkerboard pattern is displayed, MS dx
- Auditory – patient hears a series of clicks in each ear
- Sensory evoked – short electrical impulses are administered to an arm or leg
- responses to the stimulation are recorded
Evoked potential test
PD drug: levodopa
On-off phenomenon
- rapid swings or fluctuations that happen with ______ term levodopa admin
- on or off? = medication is working well, mobile
- on or off? = medication’s effects have worn off and PD symptoms (trb) return, immobile
- initially – med starts wearing off at ___________-
- eventually – “off period” becomes more ___________
care:
- ________ inter-dose intervals
- Controlled release meds
- Avoid high ________ meals
On-off phenomenon
- rapid swings or fluctuations that happen with long term levodopa admin
- on = medication is working well, mobile
- off = medication’s effects have worn off and PD symptoms (trb) return, immobile
- initially – med starts wearing off at the end of the dosing interval
- eventually – “off period” becomes more unpredictable
- care:
- Reduce/shorten inter-dose intervals
- Controlled release meds
- Avoid high protein meals
medical emergency seizure: Status epilepticus
life-threatening condition characterized by _______ or ________ seizures without regaining consciousness in between
- medical emergency = prolonged seizure > 5 mins and/or repeated seizures over course of 30 mins
- notify rapid response team, then to ICU for monitoring if not resolved
- _______ #1
- drug therapy = IV _________ (benzo), 1st line
- seizures lasting > 10 mins can cause __________
Status epilepticus - life-threatening condition characterized by prolonged or recurrent seizures without regaining consciousness in between
- medical emergency = prolonged seizure > 5 mins and/or repeated seizures over course of 30 mins
- notify rapid response team, then to ICU for monitoring if not resolved
- airway #1
- drug therapy = IV lorazepam or diazepam (benzo), 1st line
- seizures lasting > 10 mins can cause death
Seizure disorder/epilepsy
T/F - transient, uncontrolled electrical discharge of neurons in the brain that interrupt normal function
T/F - may accompany other disorders
T/F - “seizure disorder” = the seizures stop when the underlying problem is corrected
Seizure disorder/epilepsy
T - transient, uncontrolled electrical discharge of neurons in the brain that interrupt normal function
T - may accompany other disorders
F - if the seizures stop when the underlying problem is corrected = not “seizure disorder”
- chronic
- progressive
- insidious
- neurodegenerative
2. - acquired
- autoimmune
- progressive (disease peaks within 2 years)
- remissions and exacerbations
3. - chronic
- inflammatory
- autoimmune
- remissions and exacerbations
4. - relentlessly progressive
- neurodegenerative
5. - acute
- (auto)immune mediated polyneuritis
- progressive
PD
MG
MS
Amyotrophic lateral sclerosis (ALS)
GB
Dx of MG
1. bedside tests
- easy to perform and are sensitive to MG, but may result in ___________
- use only with pt with _______ – improvement can be seen
Bed side test:
A). tensilon/edrophonium test
- tensilon = _________ inhibitor
- onset 30-45 secs
- duration 5-10 mins
- route IV
- watch eyelids, ptosis will ________ if pt has MG
B). Bed side test: ice pack test
- based on principle of improving neuromuscular transmission at lower muscle temperatures
- surgical glove of ice on lid x 2 mins
- remove ice and immediately assess ptosis
- ptosis will _______ if pt has MG
- serologic tests for autoantibodies
(b/c MG is ________)
- ____________ antibodies
- muscle specific tyramine kinase antibodies - nerve conduction tests (EMG/Electromyography)
- assess nerve innervation
- slight discomfort with _______ insertion
- bedside tests
- easy to perform and are sensitive to MG, but may result in false positive
- use only with pt with ptosis – improvement can be seen
Bed side test: tensilon/edrophonium test
- tensilon = acetylcholinesterase inhibitor
- onset 30-45 secs
- duration 5-10 mins
- route IV
- watch eyelids, ptosis will improve if pt has MG
Bed side test: ice pack test
- based on principle of improving neuromuscular transmission at lower muscle temperatures
- surgical glove of ice on lid x 2 mins
- remove ice and immediately assess ptosis
- ptosis will improve if pt has MG - serologic tests for autoantibodies
(b/c MG is autoimmune)
- acetylcholine receptor (AChR) antibodies
- muscle specific tyramine kinase antibodies - nerve conduction tests (EMG/Electromyography)
- assess nerve innervation
- slight discomfort with needle insertion
Types of seizures: Generalized onset seizure (both sides of brain) VS Focal onset seizure (one hemisphere of brain)
- tonic clonic seizure
- with retained awareness
- absence seizure
- without retained (impaired) awareness
G - tonic clonic seizure
F - with retained awareness
G - absence seizure
F - without retained (impaired) awareness
are all seizures medical emergencies?
When is seizure a medical emergency? (2)
whats it called
no
When it lasts > 5 mins or is back to back
Status epilepticus - life-threatening condition characterized by prolonged or recurrent seizures without regaining consciousness in between
Care of MG
- recognize ________ – infection, trauma, stress, change in environment
- rest
- Exercise
- ________ – ex: swimming
- improves strength, muscle, balance, coordination, depression
- environmental control
- avoid extreme ______ – r/t fatigue
- ______ environment is best – A/C, tepid or cool baths
- nutrition – balanced diet, keep immune system strong
- maintain ADLs
Care of MG
- recognize triggers – infection, trauma, stress, change in environment
- rest
- Exercise
- aerobic – ex: swimming
- improves strength, muscle, balance, coordination, depression
- environmental control
- avoid extreme heat – r/t fatigue
- cool environment is best – A/C, tepid or cool baths
- nutrition – balanced diet, keep immune system strong
- maintain ADLs
Xray of spinal cord after injection of contrast medium into the subarachnoid space for imaging purposed
- herniated disc dx
Myelogram
Evoked potential test (Visual) – sits before a screen in which checkerboard pattern is displayed
- _____ dx
Electrophysiological studies
Nerve conduction tests – measures speed of conduction through a nerve
- repetitive nerve stimulation (RNS) studies – ____ dx
Electromyography (EMG) - assess nerve innervation
- used with ____ and _____ dx
MS
MG
ALS and myasthenia gravis
s/s ALS
- symptoms initially spread w/in segment of onset and then to other regions in a predictable pattern
- asymmetric or symmetric? limb weakness!!
- UE = _____ weakness or shoulder girdle muscles
- LE = _______ or weakness
- fatigue
- Dysarthria/dysphagia
- muscle atrophy and spasticity (stiff)
- fasciculations/twitching of face or tongue
- respiratory muscle weakness (life threatening)
- pt remains cognitively intact while their body wastes away
s/s ALS
- symptoms initially spread w/in segment of onset and then to other regions in a predictable pattern
- asymmetric limb weakness!!
- UE = hand weakness or shoulder girdle muscles
- LE = foot drop (foot dorsiflexion) or weakness
- fatigue
- Dysarthria/dysphagia
- muscle atrophy and spasticity (stiff)
- fasciculations/twitching of face or tongue
- respiratory muscle weakness (life threatening)
- pt remains cognitively intact while their body wastes away
EEG = what organ is the focus?
EKG = what organ is the focus?
EMG = what organ is the focus?
EEG = brain
EKG = heart
EMG = nerve
Myasthenic crisis = _________ acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Cholinergic crisis = _________ acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Myasthenic crisis = not enough acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Cholinergic crisis = too much acetylcholinesterase inhibitors AKA “anticholinesterase meds”
Surgical treatment of _____
Thymectomy – removal of thymus gland (in mediastinum)
- thymus enhances acetylcholine receptor antibodies
- done in early dx (within 2 years of onset of s/s)
MG
Care of MG
- usually requires hospital admin with respiratory tract infection or acute myasthenic crisis
- focus of care on neurologic deficits and ADL’s
- diet – balanced, ______ to chew, semi-solids
- schedule meds so peak action is during _________
- diversional activities that require minimal exertion
- teach
- What causes flares
- Med regimen and s/e
- Complications of MG
- Complications of therapy – crisis conditions
- Support groups
Care of MG
- hospital admin with respiratory tract infection or acute myasthenic crisis
- focus of care on neurologic deficits and ADL’s
- diet – balanced, easy to chew, semi-solids
- schedule meds so peak action is during mealtime
- diversional activities that require minimal exertion
- teach
- What causes flares
- Med regimen and s/e
- Complications of MG
- Complications of therapy – crisis conditions
- Support groups
- relentlessly progressive
- no cure
- neurodegenerative - progressive degeneration and death of neurons in the brain or peripheral nervous system
- causes muscle weakness, disability and death (usually w/in 5 years of dx)
Amyotrophic lateral sclerosis (ALS)
transient, uncontrolled electrical discharge of neurons in the brain that interrupt normal function
Seizure disorder/epilepsy
Dx of PD
- specific dx tests?
- based on history and _______
- at least 2 signs of _______ present
- ultimate confirmation = _______ response to ___________
- cure?
Dx of PD
- no specific dx tests
- based on history and clinical features
- at least 2 signs of classic triad present (trb)
- ultimate confirmation = positive response to antiparkinsonian drugs
- no cure
First aid DURING a seizure
1. - ABCs
- patent airway
- suction/breathing assistance when?
2. - safety
- pad bed rails
- _______ objects into mouth
- ________ restrain movements – unless patient is in danger
- stay with pt until _______
- turn _________ if possible w/out forcing it
3. - monitor
- vitals
- LOC
- O2
- EMV/GCS
- Pupil size and reactivity
- Time – onset and duration
- Accurate documentation
- Cyanosis – seen in tonic-clonic self limiting
- rest and support
First aid DURING a seizure
- ABCs
- patent airway
- suction/breathing assistance after seizure prn
- safety
- pad bed rails
- do not force objects into mouth
- do not restrain movements – unless patient is in danger
- stay with pt until seizure ends
- turn head to side if possible w/out forcing it
- monitor
- vitals
- LOC
- O2
- EMV/GCS
- Pupil size and reactivity
- Time – onset and duration
- Accurate documentation
- Cyanosis – seen in tonic-clonic self limiting
- rest and support
- for patients with intractable seizures
- for diagnostic and pinpointing seizure activity and origin
- combines video and continuous EEG recordings of seizure activity
Epilepsy monitoring units
which type of seizure
- rare after adolescence
- brief staring spell that resembles day dreaming
- lats < 10 secs
- unresponsive when spoken to during seizure
generalized seizures
(both sides of brain)
absence seizure
Dx of MG
Depends on if ocular or generalized
1. bedside tests
- ______ test
- ______ test
2. serologic tests for _________
3. ________ conduction tests (EMG)
- bedside tests
- tensilon/edrophonium test
- ice pack test - serologic tests for autoantibodies
- nerve conduction tests (EMG)
PD Cardinal features (motor system disorders)
(early)
1. tremor
- _____ rolling
- _____ tremor
- considered the least debilitating of cardinal symptoms b/c the tremor ___creases with purposeful activity
- may initially be unnoticeable to others
- starts ____laterally
- muscle rigidity
- increased resistance to _______
- jerky quality – “cog-wheel”
- starts ____laterally - bradykinesia
- generalized _______ in movement
- major cause of disability in PD pts
- most difficult s/s for them to describe
- weakness
- incoordination
- tired
- ___creased ability to initiate voluntary movement
- _____, _____ gait
- _______ facial expression - postural instability
- trouble with _____ and _______
- ____ward tilt posture
- occurs early or later in disease process?
- tremor
- pill rolling
- rest tremor – noticed when not engaged in activity
- (essential tremors and multiple sclerosis tremors are action tremors)
- considered the least debilitating of cardinal symptoms b/c is decreases with purposeful activity
- may initially be unnoticeable to others
- starts unilaterally, spreads contralaterally in several years - muscle rigidity
- increased resistance to passive ROM
- jerky quality – “cog-wheel”
- starts unilaterally and then spreads contralaterally - bradykinesia
- generalized slowness in movement
- major cause of disability in PD pts
- most difficult s/s for them to describe
- weakness
- incoordination
- tired
- decreased ability to initiate voluntary movement
- short shuffling gait
- blank facial expression
(later) - postural instability
- trouble with balance and falls
- forward tilt posture
- occurs later in disease process
s/s of myasthenic crisis, cholinergic crisis, or both?
- n/v/d
- apprehension
- increased VS
- absence of cough/swallow reflex
- abdominal cramps
- restlessness
- dyspnea
- worsening of symptoms with tensilon test
- bowel/bladder incontinence
- dysphagia
- generalized weakness
- respiratory failure
- flaccid paralysis
- improvement of symptoms with tensilon test
- hypersecretions – saliva, swear, tears
C - n/v/d
B - apprehension
M - increased VS
M - absence of cough/swallow reflex
C - abdominal cramps
B - restlessness
B - dyspnea
C - worsening of symptoms with tensilon test
M - bowel/bladder incontinence
B - dysphagia
B - generalized weakness
B - respiratory failure
C - flaccid paralysis
M - improvement of symptoms with tensilon test
C - hypersecretions – saliva, swear, tears
Treatment of PD
- goal of drugs = relieve symptoms or cure disease?
- drug therapy goal = correcting neurotransmitter imbalance by either ___creasing dopamine or __creasing effect of cholinergic neurons (acetylcholine)
- no cure
- goal = relieve symptoms
- drug therapy goal = correcting neurotransmitter imbalance by either increasing dopamine or antagonizing (stop) effect of cholinergic neurons (acetylcholine)
s/s unique to ________ crisis
- increased VS
- bowel/bladder incontinence
- absence of cough/swallow reflex
- improvement of symptoms with tensilon test
s/s unique to ________ crisis
- flaccid paralysis
- hypersecretions – saliva, swear, tears
- n/v/d
- abdominal cramps
- worsening of symptoms with tensilon test
myasthenic
cholinergic
Care of ALS
- exercise
- To reduce spasticity
- PT consult
- support cognitive function
- SLP consult – facilitate communication
- diet?
- pain assessment – r/t muscle weakness
- risk for injury precautions
- diversional activity
- support grieving
Care of ALS
- exercise
- To reduce spasticity
- PT consult
- support cognitive function
- SLP consult – facilitate communication
- maintain NPO – aspiration
- pain assessment – r/t muscle weakness
- risk for injury precautions
- diversional activity
- support grieving
- type of nuclear medicine procedure
- small amount of radioactive substance is used – radiotracer
- evaluates metabolism of an organ – usually brain or heart
- evaluates physiology of an organ (where as other scans evaluate anatomy of organ)
PET scan (positron emission tomography)
