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M6 13-005
Exam 15: Alzheimer's Disease & Myasthenia Gravis (MG)
| Term | Definition |
|---|---|
| Alzheimer's disease | degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning |
| Alzheimer's Disease: Elevated homocysteine levels | increased risk |
| Alzheimer's Disease: Changes in the brain include | Plaques in the cortex and neurofibrillary tangles. Decrease in brain size. |
| Nursing Management with Alzheimer's | Directed toward supporting patient and family |
| Maintain adequate nutrition with Alzheimer's by | Finger food Frequent feedings with high nutritional value 2000mLs of fluid per day |
| Anti-Alzheimer's Agents act by inhibiting | acetylcholinesterase It increases the amount of acethylcholine in the CNS. |
| Anti-Alzheimer's Agents: Cholinesterase inhibitor agents used to treat mild to moderate | donepezil (Aricept) galantamine (Reminy) rivastigmine (Exelon) tacrine (Cognex) |
| Memantine (Namenda): for Alzheimer's Disease | First drug approved to treat moderate to severe AD Classified as aN-methyl-D-aspartate receptor antagonist |
| Tacrine | hepatic disease. Contraindicated in Anti-Alzheimer's Agents |
| Anti-Alzheimer's Agents: Side Effects | CNS: Headache, Seizures. Resp: bronchospasm. GI: Nausea, Vomiting, Diarrhea Weight loss. GI: Bleeding. GU: urinary tract obstruction. |
| Myasthenia Gravis (MG) | neuromuscular disorder characterized by severe weakness of one or more groups of skeletal muscles. Believed to be an autoimmune disease with lower motor neuron characteristics. |
| Myasthenia Gravis (MG): Pathophysiology | blocking of synaptic transmission at myoneural junction, results in muscle weakness |
| Myasthenia Gravis (MG) is thought to be | triggered by antibodies that attack acetylcholine receptor sites at the neuromuscular junction and interfere with impulse transmission to the muscles. |
| Myasthenia Gravis (MG): ocular S&S | Ptosis (eyelid drooping). Diplopia (double vision). 15% of cases remain confined to the eye muscles. |
| Myasthenia Gravis (MG): Clinical Manifestations | May initially have ptosis and /or diplopia. Skeletal weakness. Dysarthria. Dysphagia. Vocal cords weaken and the voice can sound nasal. |
| As Myasthenia Gravis (MG) progresses | Trunk and lower limbs are affected: Difficulty with walking and sustained sitting -Inability to breath -May need mechanical ventilation - Bowel and bladder sphincter weakness |
| With Myasthenia Gravis (MG) respiratory infections, emotional tension and menstruation | may initiate excerbation |
| Myasthenia Gravis (MG): Subjective data | Patient’s understanding of the disease Complaints of weakness, double vision Difficulty in chewing or swallowing Presence of any bowel or bladder incontinence |
| Myasthenia Gravis (MG): Objective Data | Muscle weakness on neurological testing Nasal-sounding speech Voice often fades after a long conversation Breath sounds diminish Ptosis of the eyelids Weight loss if dysphagia |
| Myasthenia Gravis (MG): Diagnostic Tests | Look upward for 2-3 mins (look for Ptosis). Electromyography. IV anticholinesterase (Tension or Neostimine). |
| Myasthenia Gravis (MG): Medical Managment | Anticholinesterase drugs -Corticosteroids as adjunct therapy -Immunosupressive drugs. Plasmapheresis Thymectomy -Immune globulin -May require intubation |
| Myasthenia Gravis (MG): Patient Education | Medications -What to take vs. what to avoid Upper respiratory infection Eating positions Avoid crowds in flu and cold season Activities and rest periods Medical alert bracelet |
| Myasthenia Gravis (MG): Cholinergic Agents | Inhibits the action of acetylcholinesterase, preventing the breakdown of acetylcholine. neostigmine (Prostigmin). pyridostigmine bromide (Mestinon) |
| Myasthenia Gravis (MG): Cholinergic Agents (Therapeutic effect) | increase muscle strength Used to reverse nondepolarizing neuromuscular blocking agents. |
| Cholinergic Agents Effects | Miosis. Increased intestinal and skeletal muscle tone. Bronchial and ureteral constriction. Bradycardia. Increased salivation. Lacrimation. Sweating . |
| Cholinergic Agents: Side Effects | CNS: seizures, dizziness, weakness EENT: lacrimation, miosis Resp: bronchospasm, excessive secretions CV: bradycardia, hypotension GI: abdominal cramps, diarrhea, excessive salivation, nausea, vomiting Derm: sweating, rashes. |
| Antidote to Cholinergic agents | Atropine |
| Pyridostigmine may be administered | 30 min before meals if difficulty chewing |
| Taking dose Cholinergic Agent late may result | Myasthenic crisis ( life-threatening condition that occurs when the muscles that control breathing become too weak to do their jobs) |
| Taking dose Cholinergic Agent early may result in | cholinergic crisis (the muscles stop responding to the bombardment of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms) |
| Amyotrophic Lateral Slerosis (ALS) aka Lou Gerhig's Disease | degeneration of the motor neurons of the spinal cord and brain stem result in muscle weakness and wasting |
| ALS primary symptoms | Weakness of the upper extremities Dysarthria, Dysphagia Muscle wasting and fasciculations |
| With ALS death usually results from | Respiratory infection |
| ALS Medical Management | Riluzole (Rilutek):Helps to protect motor neuron damaged by the disease Adds 3 months or more to a patient’s life if given early |
| Huntington's Disease | A genetically transmitted disorder that affects both genders. Onset between 35-45 years of age. |
| Huntington's Disease: Etiology/ Pathophys | Involves the basal ganglia and the extrapyramidal motor system. -Overactivity of the dopamine pathway. -The net effect is an excess of dopamine, which leads to symptoms that are the opposite of Parkinsonism. |
| Chorea | Abnormal, excessive involuntary movements |
| Huntington's Disease: Clinical Manifestion | Chorea. Writhing, twisting movements of face, limbs, and body. Movements get worse as disease progresses. Speech, chewing and swallowing are affected. Gait deteriorates unable to ambulate. Mental functions deteriorate. |
| Huntington's Disease: Dx | Based on family history Based on clinical symptoms Detection of the characteristic DNA pattern from blood samples |
| Huntington's Disease: Medical Management | Antipsychotics Antidepressants Antichoreas |
| Huntington's Disease: Nursing Management | Prevent malnutrition -High caloric intake to maintain body -Up to 4000-5000 calories per day |
Created by:
jtzuetrong
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