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Chapter 10
Unit 2: Nursing care of clients with neurosensory disorders
| Question | Answer |
|---|---|
| Multiple Sclerosis, Amyotrophic Lateral Sclerosis, & Myasthenia Gravis (Pg. 100) | Neuro diseases that typically result in impaired & worsening function of voluntary muscles |
| Multiple Sclerosis: Define | Autoimmune disorder characterized by development of plaque in the white matter of the CNS -Plaque damages the myelin sheath & interferes w impulse transmission between the CNS & the body |
| What is MS marked by? r&r | Relapsing & remitting (common courses) -Overtime client may progress to quadriplegia |
| Is there a known cure to MS? | No & it's chronic |
| Risk factors: Age, gender, family | 20-40 yrs old onset, 2x likely in women -Family hx |
| What can trigger relapses? (Autoimmune disease) | Viruses/infectious agents, cold, physical injury, emotional stress, pregnancy, fatigue, overexertion, temperature extremes, hot shower/bath. |
| S/s of MS (Pg. 101) -Fatigue, pain, vision | Fatigue (lower extremities), pain/paresthesia, diplopia, changes in peripheral vision |
| What is diplopia and paresthesia? | Diplopia: double vision Paresthesia: tingling sensation "pins & needles" |
| S/s of MS con't (Pg. 101) -What is uhthoff's sign? -Hearing, mouth | -Temporary worsening of vision & other neuro functions just after exertion or situation where they are exposed to heat -Tinnitus, vertigo, decreased hearing acuity -dysphagia, dysarthria |
| What is tinnitus? | Ringing or buzzing in the ears |
| What is dysarthria? for MS | Slurred & nasal speech |
| S/s of MS con't -muscles, bowels/bladder | Muscle spasms, ataxia, nystagmus, constipation/incontinence, areflexia, sexual dysfunction |
| What is ataxia? | Loss of full control of bodily movements |
| What is nystagmus? | Rapid involuntary movement of the eyes |
| What is areflexia? | Absence of reflexes |
| MS lab tests? | CSF analysis ^ protein level & slight ^ WBC |
| Dx procedures for MS? | MRI reveals plaques of the brain & spine |
| MS meds: -Azathioprine (Imuran) & Cyclosporine (Sadimmune) & s/e | Immunosuppresive agents; to reduce frequency of relapses -htn, kidney dysnfunction (s/e) |
| MS meds: -Prednisone (Deltasone) & s/e | Corticosteroid; reduce inflx in acute exacerbations -^ risk of infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, personality changes |
| MS meds: -Dantrolene (Dantrium), Tizanidine (Zanaflex), Baclofen (Lioresal), & Diazepam (Valium) -s/e | Antispasmodics; tx muscle spasticity -^ weakness, liver damage, jaundice |
| MS meds: -Interferon beta (Betaseron) | Immunomodulators; prevent/tx relapses |
| MS meds: -Carbamazepine (Tegretol) | Anticonvulsants; tx paresthesia |
| MS meds: -Docusate sodium (Colace) | Stool softners; constipation |
| MS meds: -Propantheline (Pro-Banthine) | Anticholinergics; bladder dysfunction |
| MS meds: -Primidone (Mysoline) & Clonazepam (Klonopin) | Beta-blockers used for tremors |
| Amyotrophic Lateral Sclerosis: (Pg. 103) Define & what does this cause | Degenerative neuro disorder of the upper & lower motor neurons = death & deterioration of the motor neurons -Progressive paralysis & muscle wasting that eventually causes respiratory paralysis & death |
| Does ALS usually affect cognitive function? | Cognitive function not usually affected |
| ALS is also known as: | Lou Gehrig's disease |
| How does death usually occur? and when? ALS | D/t respiratory failure, within 3-5 years |
| Is there a cure for ALS? | No & the cause is unknown |
| Risk factors for ALS? gender, ages | More men than women, 40-70 onset |
| S/s of ALS? | Fatigue, twitching/cramping muscles, muscle weakness, muscle atrophy, dysphagia, dysarthria, hyperreflexia of DTR |
| Lab tests for ALS? | Increased CK-BB level; creatine kinase |
| Dx procedures for ALS? | -Electromyogram (EMG): reduction in # of functioning motor neurons of peripheral nerves -Muscle biopsy: reduction in # of motor units of peripheral nerves & atrophic muscle fibers |
| Nursing care w ALS? (Pg. 103) -airway, HOB, speech, intake, nutrition | Maintain patent airway; suction/intubate, ABGs, o2, bpap, vent, etc. -HOB 45, TCDB q2h, IS, chest physiotherapy -Communication method -Swallow reflex, oral intake.. thicken liquids -Enteral nutrition when you can't swallow |
| Meds for ALS: Riluzole (Rilutek) | Glutamate antagonist; can slow the deterioration of motor neurons by decreasing the release of glutamic acid. -Can add 2-3 months of lifespan, take early in disease |
| S/e of Rilutek: | Hepatotoxic (monitor LFTs) Dizzy, vertigo, somnolence |
| Educating on Rilutek: -Avoid, take, store | Avoid alcohol Take med at evenly spaced intervals (q12h ex) Store away from bright light |
| Meds for ALS: Baclofen (Lioresal), Dantrolene sodium (Dantrium), Diazepam (Valium) | Antispasmodics are used to decrease muscle spasticity |
| Complications of ALS: -Think airway | Pneumonia & respiratory failure |
| Myasthenia Gravis: (Pg. 105) | Progressive autoimmune disease; produces muscular weakness. -Periods of exacerbation & remission |
| MG, muscle weakness improves with ___ & worsens with ____ | Rest, increased activity |
| What causes MG? | Antibodies that interfere w the transmission of acetylcholine at the neuromuscular junction |
| Risks to MG: -Causes | Coexisting autoimmune disorder, hyperplasia of the thymus gland |
| Risks to MG: -Triggers | Infection, stress, fatigue, pregnancy, ^ in body temperature |
| S/s of MG: | Progressive muscle weakness, diplopia, dysphagia & chewing, respiratory dysfunction, bowel/bladder issues (incontinence), poor posture |
| For MG where is the decreased muscle strength usually seen? | Face, eyes & proximal portion of major muscle groups -drooping eyelids |
| Dx testing for MG: | Tensilon testing: baseline assessment of cranial nerve strength is done & Edrophonium (Tensilon) is administered -Positive test; marked improvement in muscle strength that lasts approximately 5 minutes |
| What does Tensilon do? MG | Inhibits the breakdown of acetylcholine |
| Complications of the Tensilon test? | Fasciculations around the yes & face, cardiac arrhythmias |
| What is the antidote for Tensilon? | Atropine |
| Another dx test for MG? | Electromyography: shows the neuromuscular transmission characteristics of MG |
| Nursing care for MG? (Pg. 106) basics, types of meals, eyes, ID | Airway, rest, swallowing precautions -Small, frequent, high-calorie meals -eye drops day & night if client can't close eyes, might need to tape eyes shut at night to prevent damage to the cornea -med ID band |
| First line therapy for MG? | Anticholinesterase agents -Usually given 4x a day |
| Client education for anti cholinesterase agents? | Hx of asthma, cardiac dysrhythmias (be careful) -Take w food, eat within 45 mins of taking the med to strengthen chewing & reduce the risk for aspiration, maintain therapeutic levels |
| Meds for MG: Pyridostigmine (Mestinon) & Neostigmine (Prostigmin) | Used to increase muscle strength in the symptomatic tx of MG -Inhibits breakdown of acetylcholine and prolongs its effects -Careful w asthma, seizures, cvd |
| Meds for MG: Prednisone (Deltasone) & Azathioprine (Imuran) | Immunosuppressants given during exacerbations when Mestinon is not effective -they decrease the production of antibodies -prednisone (corticosteroid) is the 1st med of choice |
| S/e of immunosuppressants: | Monitor for infection, taper off slowly |
| Therapeutic procedures for MG: | Plasmapheresis: removes circulating antibodies from the plasma -VS, wt, labs before -lasts 2-5 hrs |
| Plasmapheresis intraprocedure nursing care: -Assess for | Dizziness & hypotension -Maintain shunt patency (usually 1 in each upper extremity) |
| Post procedure for plasmapheresis: | Apply a pressure dressing, monitor for infection, labs, monitor for hypokalemia,volemia,calcemia |
| Surgical interventions for MG: | Thyectomy- removal of thymus gland; attain better control & complete remission |
| How long until you can see the results of a thyectomy? | Months to years d/t the life of circulating T cells |
| Nursing action postop thyectomy? -Airway | Client may have had a chest tube or intubated -TCDB q2hr -Pneumo/hemothorax (observe for s/s) |
| Complications of MG: | Myasthenic crisis & cholinergic crisis |
| What is myasthenic crisis? S/S pg. 108 | Occurs when client is experiencing a stressor that causes an exacerbation of MG; i.e.. infection -Or taken too little cholinesterase inhibitor |
| What is cholinergic crisis? S/S pg. 108 | Occurs when the client has taken too much cholinesterase inhibitor |
Created by:
mary.scott260!
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