Week 1 - Neuro Disorders & Eyes

Question 1

what is M.S. ?

Answer 1

an autoimmune disease that causes progressive demyelination of oligodendrocytes in the CNS

*affects nerve impulses
no cure
*muscle SPASM & STIFFNESS

Question 2

MS risk factors

Answer 2

WOMEN (20-40) > men
family history
vitamin D deficiency

Question 3

M.S. s/s

Answer 3

*muscle spasticity

*altered vision - scotoma & diplopia

*Urinary retention (urinary/bowel problems)

*loss of cognitive function / coordination

*sexual dysfunction

Question 4

diagnosing MS

Answer 4

2 lesions on MRI

CSF lumbar puncture

multiple flare ups > 1 month a part

Question 5

MS drug classes

Answer 5

1. Immunosuppressants = corticosteroids
2. antispasmodics
3. anti-seizures
4. anticholinergics
5. laxatives
6. K channel blockers
7. Immunomodulators

Question 6

corticosteroids used for M.S.

Answer 6

1. methylprednisolone (solumedrol) *IV PUSH
2. dexamethasone (decradon) *IV INFUSION
3. prednisone = PO

Question 7

antispasmodics used for M.S.

Answer 7

*dantrolene - assess for liver injury & sclera jaundice

*baclofen - do not stop abruptly

adv effect = dizziness

Question 8

laxatives used for M.S.

Answer 8

docusate sodium = mush not push

psyllium = bulk forming (increase water

Question 9

anticholinergics used for MS & consideration

Answer 9

*Oxybutynin = helps w bladder control

• Propantheline
• Tolterodine

dries everything – offer HARD CANDY

Question 10

K+ channel blocker used for MS and what it does

Answer 10

Dalfampridine

*makes AP last longer but has increased risk for seizures & hyperkalemia

Question 11

nursing interventions for MS patients

Answer 11

*speech pathologist

monitor visual acuity
avoid stress
increase sleep / rest
avoid sun exposure

Question 12

Uhthoff’s sign

Answer 12

worsening vision/neuro function for 24hrs following exposure to heat

MS patients

Question 13

triad to diagnose parkinson’s
disease

Answer 13

1. tremors at rest
2. bradykinesia
3. muscle rigidity

Question 14

what is Parkinson’s Disease & who gets it more?

Answer 14

degeneration/depletion of dopamine and excess secretion of acetylcholine

*MEN (40-70)

Question 15

s/s of Parkinson’s

Answer 15

constipation
drooling
dysarthria (slurred speech)
insomnia
lack of facial expression
PILL THUMB ROLLING
posture / gait disturbance

Question 16

parkinson’s complications

Answer 16

*orthostatic hypotension
aspiration pneumonia
altered cognition

Question 17

5 types of meds for parkinsons

Answer 17

1. levodopa / carbidopa = produce dopamine
2. BenzTropine = anticholinergic
3. Apomorphine & Bromocriptine = stimulate dopamine
4. MAOi’s = Selegiline & Rasagiline
5. entacaPONE & tolcaPONE = prevent dopamine breakdown

Question 18

levodopa / carbidopa considerations

Answer 18

can lower blood pressure
*orthostatic hypotension

avoid protein w levodopa

Question 19

benztropine considerations

Answer 19

*anticholinergic

treats tremors
DRIES EVERYTHING - can cause blurry vision

Question 20

Bromocriptine & Apomorphine considerations

Answer 20

stimulate dopamine

adv effects = gi disturbances
n/v

• watch for psychosis

Question 21

MAOi considerations

Answer 21

*selegiline & Rasagiline

avoid tyramine = wine & deli meats

Question 22

entacaPONE & tolcaPONE considerations

Answer 22

derease breakdown of levodopa

dark urine = normal
assess for diarrhea

Question 23

5 stages of parkinson’s

Answer 23

Stage 1 = unilateral shaking of one limb

stage 2 = bilateral limb movement & shuffling gait

stage 3 = postural instability & slow physical movement *walker

stage 4 = decreased tremors, akinesia & rigidity

stage 5 = dependent & dementia

Question 24

Nursing care considerations for parkinson’s disease

Answer 24

bite-size food
cold fluids
puree diet
safe environment
thickener to liquids
weigh weekly

Question 25

ALS

Answer 25

body > mind
ALL MUSCLES STOP

• MEN (40 to 70)

Question 26

s/s of ALS

Answer 26

constipation
cramping
dysarthria
dysphagia
fasiculations
muscle weakness
ronchi lung sounds

*respiratory arrest

Question 27

ALS med (1) & considerations

Answer 27

*Rilutek = blocks inflammatory mediators

EMPTY stomach

assess for SCLERAL jaundice (increased risk for hepatic injury)

Question 28

diagnosing ALS consists of

Answer 28

EMG

muscle biopsy (shows damage of junctions)

Pulmonary Function Test (#’s similar to asthma & COPD)

Question 29

ventilator considerations

Answer 29

2 weeks MAX
oral hygiene