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MedSurg 2 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is a type 3 hypersensitivity?

A

the bases for many auto immune disease. The immune system is trying to get rid of the complex that has deposited itself in tissues.

AKA particular reaction where antigens and antibodies come together and deposit themselves in tissue.

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2
Q

What is an example of type 3 hypersensitivity?

A

Rhematoid arthritis.

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3
Q

What does multiple sclerosis do to the nerve fibers that affect the body?

A

demylentation of the nerve fibers

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4
Q

Since MS affects the nerve fibers, what symptoms will the individual experience regarding mobility?

A
  1. Scissors gait
  2. move slow
  3. Movements aren’t coordinated
  4. scanning speech
  5. dysarthria
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5
Q

Does multiple sclerosis affect men or women more?

A

women

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6
Q

What age group does MS typically onset at?

A

20-50 years of age

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7
Q

Is multiple;e sclerosis hereditary?

A

yes

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8
Q

What are some sensory problems associated with multiple sclerosis?

A
  1. Visual disturbances
  2. Decreased hearing, tinnitus
  3. Paresthesia
  4. Chronic neuropathic pain
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9
Q

What are some cerebellar problems of MS?

A
  1. Nystagmus
  2. Dysphagia
  3. Ataxia
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10
Q

Do people with MS have bowel and bladder problems?

A

yes, constipation and spastic or flaccid bladder.

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11
Q

What is the main diagnostic exam for MS?

A

MRI

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12
Q

What does an MRI of the brain for MS show?

A

2 inflammatory lesions where there in broken Schwann cells and intact shyann cells

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13
Q

Is there a cure for MS?

A

naurrrr

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14
Q

What is the main tx exacerbations for MS?

A

corticosteroids

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15
Q

Which corticosteroid aka immunosuppressant is started first for someone experiencing an exacerbation of MS?

A

methylprednisolone

IV steroid, short acting

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16
Q

how does methylprednisolone? How does it work? What is the brand name?

A

immunosuppressant/corticosteroid

it quickly decreases inflammation

Solumedrol

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17
Q

Once methylprednisolone gotten the inflammation under control which medication is given to get the patient into remission?

A

Dexamethasone

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18
Q

Can someone with multiple sclerosis experience ringing in the ears? what is that called?

A

yes, tinnitus

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19
Q

What is ataxia? Can someone with MS get it?

A

yes. scissors gait. impaired balance or coordination

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20
Q

What is nystagmus?

A

take someones eyes all the way to an end point and there is subtle shaking of the eyes

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21
Q

What are the cerebellar problems of MS?

A
  1. Nysagmus
  2. Dysphagia
  3. Ataxia
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22
Q

What are the sensory problems of MS?

A
  1. visual disturbances
  2. Decreased hearing, tinnitus
  3. Paresthesia
  4. Chronic neuropathic pain
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23
Q

What are the motor problems for someone with MS?

A
  1. spasticity, and or weakness
  2. scanning speech, dysarthria
  3. intentional tremors
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24
Q

What are some cognitive manifestations that someone may have MS?

A

difficulty with short term memory, attention, information processing, planning, and word finding

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25
Q

In an MRI of someone who has MS, what will be shown in the MRI?

A

Sclerotic plaques

*evidence of at least 2 inflammatory demylinating lesions in at least 2 different CNS locations

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26
Q

How often can damage occur in someones brain for MS?

A

Damage or an attack can occur at different types but at least 1 month apart

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27
Q

When giving an immunosuppressant, what should you educate the patient about?

A
  1. watch for opportunistic infections such as thrush
  2. Demineralizes bone
  3. Weight gain
  4. Insomnia
    Give in AM with food
  5. raises blood glucose
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28
Q

What is an example of a immunomodulator to tx MS?

A

Glatiramer acetate

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29
Q

What are examples of antispasmodics to tx MS?

A
  1. Baclofen
  2. Dantrolene
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30
Q

What is baclofen?

A

Muscle relaxant, helps with muscle spasms, great med to help control

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31
Q

Why would you give dantrolene instead of baclofen?

A

FAST acting for someone who is veryyyyy contracted. its quick acting relaxation

also used to reverse reactions of malignant hyperthermia

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32
Q

What anti seizure medications are given to tx MS?

A
  1. Carbamazepine
  2. Gabapentin
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33
Q

Why is Gabapentin effective for MS?

A

Helps tx a lot of symptoms that come with MS?

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34
Q

IN DANTROLENE, WHAT IS THE FIRST SIGN WE LOOK FOR?

A

Hepatic dysfunction, scleral jaundice

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35
Q

What are some anticholinergics to tx MS?

A
  1. Oxynutynin
  2. Tolteridone
  3. Propantheline
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36
Q

What are some laxatives that are used to tx people with MS?

A

stool softeners and bulk forming

  1. Docusate sodium
  2. Psyllium
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37
Q

When someone is taking a bulk forming laxative, what should we teach them to do?

A

drink alotttaaaa wattaaaaaa

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38
Q

What are some antidepressants we would tx someone with MS?

A
  1. Amitriptylline
  2. Sertraline
  3. Fluoxetine
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39
Q

How does oxybutynin work?

A

its an anticholinergic, causes detrusor muscle to relax

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40
Q

Why would we give someone a phosphodiesterase inhibitor? What is a example of that med?

A

sildenafil

txs sexual dysfunction

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41
Q

What do we NOT mix sildenafil with? Why?

A

NEVER mix with nitro! It can bottom out their blood pressure

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42
Q

What are some medication examples of adamantanes and CNS stimulants used to tx MS?

A
  1. Amantadine
  2. Methylphenidate
  3. Modanifil
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43
Q

What is methylphenidate used for to tx MS?

A

used to help focus

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44
Q

Why is modanifil prescribed to MS patients?

A

increases alertness

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45
Q

What is an example off a K+ channel blocker to tx MS?

A

Dalfampridine

46
Q

If someone is taking Dalfampridine, what should we watch out for?

A

CARDIAC DYSRYTHMMIAS

47
Q

What are some nursing interventions for someone who has MS?

A
  1. Promote independence, rest. activity
  2. Encourage fiber
  3. Prevent injury and avoid stressors
48
Q

What is PD? what happens pathophysiologically?

A

Parkinson’s disease

degeneration-producing neurons in the basal ganglia and depletion of dopamine

49
Q

Is PD more common in men or women?

A

men

50
Q

What is the exact cause of PD?

A

exact cause is unknown

51
Q

In an an MRI for someone with PD, what is usually shown in it?

A

shows breakdown of substantia nigra

52
Q

How does dopamine play in role in movement?

A

Dopamine helps the cerebellum coordinate movement

53
Q

what are the clinical manifestations of PD?

A
  1. Bradykinesia
  2. Resting tremor
  3. Postural and gait disturbances
  4. expressionless, fixed gaze; masklike
  5. drooling and slurred speech
  6. depression
54
Q

What is the infamous TRIAD that allows us to help dx PD?

A
  1. Rigidity
  2. Bradykinesia
  3. tremors at rest

must have two of the three to be dx

55
Q

What does the lack
of movement for people with PD cause?

A

bowel and bladder problems

56
Q

what are some neuromotor symptoms for someone with PD?

A

Depression
pain
fatigue
anxiety
constipation
sleep problems

57
Q

is dementia prominent in those with PD?

A

YUPPPP 70% of those with PD have dementia

58
Q

What are some complications of PD?

A
  1. dysphagia
  2. general debilitation
  3. orthostatic hypotension
59
Q

Are there any specific tests for PD?

A

naurrrr

60
Q

Is Thera a cure for PD?

A

naurrrr

61
Q

what are the different drug therapies for PD?

A
  1. Dopaminergic agent
  2. Dopamine agonist
  3. MAO-B inhibitors
  4. COMT inhibitors
  5. Anticholinergic
  6. Antihistamine
  7. Antiviral
  8. Antidepressant
  9. Anticholinesterase inhibitor
62
Q

what is the first line tx for PD?

A
  1. dopiminergic agents

levodopa and carbidopa

63
Q

why do we see psychosis in patients who are receiving medications that provide more dopamine?

A

too much dopamine causes psychosis

64
Q

what are some examples of MAO-B inhibitors for PD?

A
  1. Rasagiline
  2. Selegiline
65
Q

What are some examples of dopamine agonists for PD?

A
  1. Bromocriptine
  2. Apomorphine
66
Q

What are some examples of COMT inhibitors?

A
  1. Entacapone
  2. Tolcapone
67
Q

What is an example of an anticholinergic used to tx PD?

A

benztropine

68
Q

what is an example of an antihistamine used to tx PD?

A

Diphendydramine

69
Q

what is an example of an antiviral used to tx PD?

A

Amantadine

70
Q

What is an example of an antidepressant used to tx PD?

A

Amitriptyline

71
Q

What is an example of an anti cholinesterase inhibitor used to tx PD?

A

Donezepil

72
Q

why would donepezil be given to someone with PD?

A

used to help tx the side effects ts of other meds so its given to help with the bowel and bladder problems when using an anticholinergic.

73
Q

What is ALS?

A

Amyotrophic Lateral Sclerosis

AKA Lou Gehrig’s disease

74
Q

Describe ALS.

A

Happens FAST!

slowed movement almost to the point of paralysis which ultimately leads to muscle wasting

75
Q

What are some Typical symptoms of ALS?

A
  1. Dysarthria
  2. Dyspahgia
  3. Muscle weakness
76
Q

What are other clinical manifestations of ALS besides the typical symptoms?

A
  1. Fasciculations
  2. Cramping
  3. Overactive deep tendon reflex
  4. Fatigue
  5. Depression and anxiety
  6. Drooling, difficulty learning the airway, eventual respiratory compromise
77
Q

Why is aspiration pneumonia commonly seen in those with ALS?

A

Drooling and difficulty clearing the airway

78
Q

Is there a specific diagnostic test for ALS?

A

naurrrr

79
Q

What diagnostic tests would be used to determine ALS?

A
  1. Electromyography (EMG)
  2. Muscle biopsy
  3. Pulmonary function tests
80
Q

Is there a cure for ALS?

A

nope

81
Q

What are the different options of drug therapy for ALS?

A

RILUTEK: to slow down disease progression

82
Q

How does rilutek work for ALS?

A

keeps nerves from overfiring, slows down glutamate

83
Q

As a nurse, if our patient is taking rilutek for ALS what are some nursing interventions?

A
  1. take on empty stomach
  2. monitor liver enzymes
84
Q

What can rilutek cause? What do we monitor for?

A

it can cause hepatic dysfunction so monitor for scleral jaundice

85
Q

What are some nursing interventions for someone who has ALS?

A
  1. Ventilatory support
  2. Nutritional support
  3. Prevention of complications
  4. pain management
  5. Psychosocial support and community referrals
86
Q

What damages the acetylcholine receptor in myasthenia gravis?

A

antibodies

87
Q

what is myasthenia gravis characterized by?

A

muscle weakness

88
Q

what are some clinical manifestations of myasthenia gravis?

A
  1. Increased with activity and improved rest
  2. ocular palsy, ptosis, diplopia
  3. Dysphonia
  4. Dysphagia
  5. loss of bowel and bladder control
  6. Fatigue
  7. Muscle wasting
  8. Progressive deterioration, particularly the respiratory system
89
Q

If someone has Masthenia gravis, what will typically be done to help their respiratory system?

A

intubate!!!

90
Q

What are the different types of crisis for myasthenia gravis?

A
  1. Myasthenic gravis
  2. Cholinergic crisis
91
Q

What are some manifestations of a myasthenic crisis with myasthenia gravis?

A
  1. Undermedication
  2. Respiratory distress
  3. Hypertension
  4. Ptosis, diplopia
  5. Dysarthria, dysphagia
  6. Symptoms improve during tension test
92
Q

what are manifestations of a cholinergic crisis with myasthenia gravis?

A
  1. Overmedication
  2. Respiratory distress
  3. Hypotension
  4. Increased GI motility
  5. Hypersecretion
  6. Symptoms worsen or do not improve during tension test
93
Q

If someone is overmedicated with MG, how will the patient appear?

A

Sedated heavily and drooling

94
Q

What are the diagnostic studies for MG?

A
  1. Edrophonium chloride (Tensilon)
  2. Serum Ach receptor antibodies
  3. Electromyography (EMG)
  4. MRI of the thymus gland
95
Q

What is there antidote for the tension test?

A

atropine (anticholinergic)

96
Q

What are the two drug therapy classless used for MG?

A
  1. Anticholinesterase
  2. Immunosuppressants
97
Q

What are the two different anti cholinesterase medications used for MG?

A
  1. Pyridostigmine
  2. Atropine
98
Q

what are the two different immunosuppressants for MG?

A
  1. Corticosteroid
  2. Azathioprine
99
Q

What other therapies are available for MG?

A
  1. Thymectomy
  2. Intravenous immunoglobulin
  3. Plasmapharesis
100
Q

Nursing interventions for MG?

A
  1. Maintain patent airway
  2. Offer small, frequent, high calorie meals***
  3. Provide eye care
  4. Plan activities salty in the day
101
Q

What is Guillain-Barre syndrome characterized by?

A

KEYYYYYY: ascending paralysis

102
Q

What are most cases preceded by with GBS?

A

Preceded by an infection (respiratory or gastrointestinal).

103
Q

What does ascending weakness progress to in GBS?

A

progresses to paralysis and leading to acute respiratory failure

104
Q

What will you need to do to sustain life for someone with GBS?

A

will need to intubate to sustain life

105
Q

What are clinical manifestations of GBS?

A
  1. Ascending weakness progressing to paralysis and leading to acute respiratory failure
  2. hyporeflexia
  3. Loss of bowel and bladder control
106
Q

What sensory manifestations will someone have with GBS?

A
  1. Paresthesia and pain
107
Q

What cranial nerve manifestations will someone have with GBS?

A

Diplopia
Dysarthria
Dysphagia

108
Q

What autonomic manifestations will someone have with GBS?

A

Bradycardia
Labile BP
Dysrythmia (tachy/SVT)

109
Q

What are some diagnostic studies for GBS?

A
  1. Clinical signs such as parathesia and ascending weakness
  2. Cerebrospinal fluid study
  3. EMG and nerve conduction velocity test
  4. evoked potentials
  5. MRI brain to rule out multiple sclerosis
110
Q

What is important to know about the flu vaccine in relation to GBS?

A

the flu vaccine does not cause GBS but it can reactivate if you have a hx of it.

111
Q

What are the collaborative care options for GBS?

A

IVIG
Plasmapheresis

112
Q

What are the nursing interventions for someone GBS?

A
  1. Ventilatory support
  2. Nutritional support
  3. Prevention of complications of immobility
  4. Pain management
  5. Psychosocial support and community resources

MedSurg 2 (5 decks)

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