Prepu

A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an I.V. injection of a medication. What is the medication the nurse tells the client he'll receive during this test?

Edrophonium (Tensilon)

Pathophysiology of encephalitis

a local necrotizing hemorrhage that becomes more generalized, followed by edema.

Secondary complications with Guillain-Barre Syndrome

autonomic dysfunction, DVT, pulmonary embolism, urinary retention

What is the direction of Guillain-Barre Syndrome (proximal to distal or distal to proximal)?

begins in distal legs, moves up slowly. Patient may recover, then they will get worse and progress further up.

The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform? a) Avoid swimming and any weight-bearing activity. b) Exercise following a circuit training regimen. c) Apply warm packs to the affected area. d) Relax in a hot bath.

c) Apply warm packs to the affected area.

The diagnosis of multiple sclerosis is based on which of the following tests? a) Cerebrospinal fluid (CSF) electrophoresis b) Evoked potential studies c) Magnetic resonance imaging (MRI) d) Neuropsychological testing

c) Magnetic resonance imaging (MRI) The diagnosis of MS is based on the presence of multiple plaques in the CNS observed with MRI.

The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder began? a) Muscle spasms b) Shortness of breath c) Sensitivity to bright light d) Drooping eyelids

d) Drooping eyelids

What are primary complications of MS?

fatigue, depression, weakness, numbness, spacticity, pain, loss of balance, and difficulty in coordination

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following?

"Have you experienced any viral infections in the last month?"

What does a positive Kerning's sign look like?

- when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended.

What does a positive Brudzinski sign look like?

- when the patient's neck is flexed (after ruling out cervical trauma) flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity.

Common nursing interventions

Activity w/ rest, bowel/bladder voiding schedule and training schedule, swallowing instructions, reduce risk of aspiration, memory aides, structured environment, minimize stress, support of coping

When do you start antibiotics in bacterial meningitis?

Adults: after results of lumbar puncture come back Children: IMMEDIATELY - don't wait for lumbar puncture results

Chest Tube Management of the Chest Tube Chart 21-21

Chest Tube Management on Patient Chart 21-21 -auscultate lung sounds and assess for rate, rhythm, and depth -monitor oxygenation with pulse oximetry -monitor ECG for rate and rhythm changes -assess cap refill, skin color, and status of the surgical dressing -encourage and assist patient to turn, cough and take deep breaths. -verify that all connection tubes are patent and connected securely -assess that the water seal is intact when using a wet suction system, ans assess the regulator dial in dry suction systems -monitor characteristics of drainage, including color, amount and consistency -assess for significant increases and decreases in drainage output -note fluctuations in the water seal chamber for wet suction systems and the air leak indicator in dry suction systems -keep system below the patients chest level -assess suction control chamber for bubbling in wet suction systems -keep suction at prescribed level -maintain appropriate fluid in water seal in wet suction systems -keep air vent open when suction is off

Who is more affected by Herpes Simplex Virus -1 and Herpes Simplex Virus - 2

HSV -1 typically affects children and adults HSV -2 typically affects neonates who acquire form mother who has active infection at time of delivery

Manifestations of meningitis

Headache, high fever - initially Neck immobility, Disorientation and memory impairment - can be early sign Positive Kerning's sign Positive Brudzinski sign Photophobia

What is the most common cause of acute encephalitis?

Herpes simplex virus (HSV)

What are common nursing diagnoses for patients with MS?

Impaired physical mobility, risk of injury, impaired bowel and bladder function.

The diagnosis of multiple sclerosis is based on which of the following tests?

MRI

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord?

MS

Which of the following is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?

MS

myasthenia crisis vs. cholinergic crisis. Cause and symptoms

Myasthenia crisis: Results form disease exacerbation or precipitating event - most commonly a respiratory infection Symptoms include severe generalized muscle weakness and respiratory bulbar weakness Patient may develop respiratory compromise and failure Cholinergic Crisis: Results from over medication with cholinesterase inhibitors Symptoms include severe muscle weakness with respiratory bulbar weakness Patient may develop respiratory compromise and failure **main point: these look the same in the patient**

What are the medical management techniques for meningitis?

Prevention - vaccination Treatment - early administration of IV antibiotics (bacterial) dexamethasone (reduce inflammation) Treatment of dehydration, shock, seizure - as needed

What are the main bacteria that cause meningitis?

Streptococcus pneumoniae and Neisseria meningitidis.

What are secondary complications of MS?

UTI, constipation, pressure ulcers, contracture deformaties, pedal edema, pneumonia, osteoporosis.

What are other causes of encephalitis?

West Nile Virus (mosquitoes) and fungal infections (mostly in immunocompromised)

The nurse is preparing to provide care for a patient diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what? a) A lower motor neuron lesion b) Genetic dysfunction c) Decreased conduction of impulses in an upper motor neuron lesion d) Upper and lower motor neuron lesions

a) A lower motor neuron lesion

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? a) Diplopia and ptosis b) Numbness c) Patchy blindness d) Loss of proprioception

a) Diplopia and ptosis

A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? a) Help the client perform range-of-motion (ROM) exercises every 8 hours. b) Use pressure-relieving devices when the client is in bed or in a wheelchair. c) Change body position every 2 hours. d) Use a footboard and trochanter rolls.

a) Help the client perform range-of-motion (ROM) exercises every 8 hours.

Which of the following diseases is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia? a) Huntington disease b) Creutzfeldt-Jakob disease c) Multiple sclerosis d) Parkinson's disease

a) Huntington disease

A patient diagnosed with multiple sclerosis (MS) has ataxia. Which of the following medications could be used to treat this clinical manifestation? a) Neurontin b) Baclofen c) Valium d) Dantrium

a) Neurontin Ataxia is a chronic problem most resistant to treatment. Medications used to treat ataxia include beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), and benzodiazepines (Klonopin).

A nurse is caring for a client with multiple sclerosis. Client education about the disease process includes which of the following explanations about the cause of the disorder? a) The immune system recognizes one's own tissues as "foreign." b) Excess cytokines cause tissue damage. c) The immune system recognizes one's own tissues as "self." d) Regulatory mechanisms fail to halt the immune response.

a) The immune system recognizes one's own tissues as "foreign."

A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? a) Vision changes b) Flaccid muscles c) Tremors at rest d) Absent deep tendon reflexes

a) Vision changes

Pathophysiology of myasthenia gravis

autoimmune disorder affecting the mineral junction. Antibodies directed at acetylcholine at the mineral junction impair transmission of impulses.

Which of the following is the most common clinical manifestation of multiple sclerosis? a) Ataxia b) Fatigue c) Pain d) Spasticity

b) Fatigue

Which of the following is the first-line therapy for myasthenia gravis (MG)? a) Deltasone (Prednisone) b) Pyridostigmine bromide (Mestinon) c) Lioresal (Baclofen) d) Azathioprine (Imuran)

b) Pyridostigmine bromide (Mestinon) (Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction)

A client with multiple sclerosis is being seen by a neuroophthalmologist for her routine eye exam. The nurse explains to the client that during the examination, she will be asked to fix her gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when she can see the object. The nurse further explains that the test being performed is called a ________. a) retinal angiography b) perimetry test c) slit-lamp examination d) color vision test

b) perimetry test

The nursing instructor is teaching the senior nursing class about neuromuscular disorders. When talking about Multiple Sclerosis (MS) what diagnostic finding would the instructor list as being confirmatory of a diagnosis of MS? a) An elevated acetylcholine receptor antibody titer b) Episodes of muscle fasciculations c) Oligoclonal bands d) IV administration of edrophonium

c) Oligoclonal bands

The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest? a) Taking a hot bath at least once daily b) Increasing the dose of muscle relaxants c) Resting in an air-conditioned room whenever possible d) Avoiding naps during the day

c) Resting in an air-conditioned room whenever possible

Guillain-Barre Syndrome pathophysiology

cell-mediated and humoral immune attack on peripheral nerve myelin proteins that causes inflammatory demyelination. The best-accepted theory of cause is molecular mimicry, in which an infectious organism contains an amino acid that mimics the peripheral nerve myelin protein.

What is the medical management of Myasthenia graves?

cholinesterase inhibitor, plasmapheresis, thymectomy

A nurse is explaining treatment options to a patient diagnosed with an immune dysfunction. Which of the following statements made by the patient accurately reflects the teaching about current stem cell research? a) "Stem cell transplantation has been discontinued based on concerns about safety, efficacy, resource allocation, and human cloning." b) "Currently stem cell transplantation has only been performed in the laboratory, but future research with embryonic stem cell transplants for humans with immune dysfunction has been promising." c) "Stem cell clinical trials have only been attempted in patients with acquired immune deficiencies but plans are underway to begin human cloning using embryonic stem cells." d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."

d) "Stem cell transplantation has been carried out in humans with certain types of immune dysfunction and clinical trials using stem cells are underway in patients with a variety of disorders having an autoimmune component."

A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? a) "You'll continue to experience progressive muscle weakness and sensory deficits." b) "You'll need to take edrophonium (Tensilon) to treat the disease." c) "The disease is a disorder of motor and sensory dysfunction." d) "This disease doesn't cause sensory impairment."

d) "This disease doesn't cause sensory impairment."

The nurse is caring for a client hospitalized with a severe exacerbation of myasthenia gravis. When administering medications to this client, what is a priority nursing action? a) Assess client's reaction to new medication schedule. b) Document medication given and dose. c) Give client plenty of fluids with medications. d) Administer medications at exact intervals ordered.

d) Administer medications at exact intervals ordered.

The nurse is caring for a patient with myasthenia gravis. The nurse generates a plan of care for the patient based on which of the following types of hypersensitivity reaction? a) Immune complex b) Delayed c) Anaphylactic d) Cytotoxic

d) Cytotoxic

Which of the following is considered a central nervous system (CNS) disorder? a) Myasthenia gravis b) Guillain-Barré c) Bell's palsy d) Multiple sclerosis

d) Multiple sclerosis

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? a) Huntington disease b) Parkinson's disease c) Creutzfeldt-Jakob disease d) Multiple sclerosis (MS)

d) Multiple sclerosis (MS)

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? a) Padded tongue blade b) Nasal cannula and oxygen c) Sphygmomanometer d) Suction machine with catheters

d) Suction machine with catheters

A patient has a diagnosis of multiple sclerosis. The nurse is aware that neuromuscular disorders such as multiple sclerosis may lead to a decreased vital capacity. What does vital capacity measure? a) The volume of air inhaled and exhaled with each breath b) The volume of air in the lungs after a maximal inspiration c) The maximal volume of air inhaled after normal expiration d) The maximal volume of air exhaled from the point of maximal inspiration

d) The maximal volume of air exhaled from the point of maximal inspiration

Interventions in patients with Guillain-Barre Syndrome

enhancing physical mobility to prevent DVT, administer IV nutrition, assess swallowing and gag reflex, develop plan for communication, decrease fear and anxiety

What is the pathophysiology of multiple sclerosis?

immune-mediated, progressive demylenation of neurons in the CNS. Demylenation results in impaired transmission of nerve impulses.

What is ataxia?

impaired coordination of movements, and tremor. Loss of the control connections between the cortex and the basal ganglia

Diagnosis in Guillain-Barre Syndrome

ineffective breathing, impaired gas exchange, impaired mobility, imbalanced nutrition, impaired communication, fear, anxiety

Meningitis

inflammation of the meninges, which cover and protect the brain and spinal cord. The three main causes of meningitis are bacterial, viral, and fungal.

clinical manifestations of HSV

initially - fever, headache, confusion, hallucinations. focal seizures and hemiparesis - indicates the area of cerebral inflammation and necrosis

What are initial and progressive symptoms of myasthenia gravis?

initially - ocular muscles (diplopia and ptosis) progressive - same as above with difficulty swallowing, respiratory difficulty, and weakness of voice.

What are common nursing interventions for meningitis?

instituting infection control precautions until 24 hours after initiation of antibiotic (oral and nasal discharge is considered infectious) assisting with pain management assisting with getting rest implementing interventions to treat the elevated temperature encouraging patient to stay hydrated close monitoring of neurologic function seizure precautions I/O, serum electrolytes, urine volume, specific gravity, osmolality

medications for MS

interferon beta-1a and interferon beta-1b. with methylprednisolone

Diagnosis of meningitis

lumbar puncture

What is required in management of pt with Myasthenia Gravis?

patient education - signs and symptoms of crises (myasthenia and cholinergic) Ensuing adequate ventilation, intubation and mechanical ventilation Assessment of supportive measures - - ensure airway - ABG's, electrolytes, I&O, daily weights - ensure ability to swallow - avoid sedatives and tranquilizers - energy manifestations - help with ocular manifestations

Do patient's recover from Guillain-Barre Syndrome?

recovery rates vary, but most patients recover completely.

Assessment emphasis in Guillain-Barre Syndrome

resp - vital capacity, respiratory failure Cardio - dysrythmias, DVT Social - coping ability

Manifestations of Guillain-Barre Syndrome

weakness, paralysis, parestheis, pain, diminished reflexes, bulbar weakness. - All symptoms start in lower extremities and progress upward

A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need to accomplish the following. Choose all that apply. a) Validate family functioning b) Validate individual self-worth c) Die without comfort d) Ignore threats to identity e) Alleviate and manage symptoms

• Alleviate and manage symptoms • Validate family functioning • Validate individual self-worth

A client with multiple sclerosis is learning to perform intermittent self-catherizations of the urinary bladder. The nurse obtains the following equipment for teaching. Select all that apply. a) Syringe with sterile water b) Forceps c) Foley bag d) 16-French catheters e) Anatomically correct model

• Anatomically correct model • 16-French catheters

Which of the following are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. a) Aphasia b) Numbness c) Fatigue d) Spasticity e) Depression f) Pain

• Numbness • Pain • Spasticity • Fatigue • Depression