Final: Neuro Problems 1
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?"
A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?
"The paralysis caused by this disease is temporary."
Myasthenia Gravis
"grave muscle weakness" women > men 14/100,000
MG nursing care
1. AIRWAYS (breathing pattern & clearence help) 2. assess swallow reflex 3. watch for dysphagia 4. fall risk
nursing care for GB
1. respiratory 2. VS 3. suctioning 4. enteral feeeding 5. dysphagua (aspiration precautions)
parkinson's
160/100,000 age 70's men > women
Myasthenia gravis occurs when antibodies attack which receptor sites?
Ach
Which nursing intervention is the priority for a client in myasthenic crisis?
Assessing respiratory effort
MG pathophysiology
Increase in Ach antibodies causing a breakdown in communication between nerves and muscles
The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis?
Muscle weakness and hyporeflexia of the lower extremities
Guillain Barre Syndrome
Progressive loss of peripheral nerve function Fatal Men 1.5x> women 0.4-0.7/100,000
The nurse is performing an initial assessment on a client who is admitted to rule out myasthenia gravis. Which of the following findings would the nurse expect to observe?
Ptosis and diplopia
A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient?
Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.
Which of the following tests confirms the diagnosis of myasthenia gravis (MG)?
Tensilon test
s&s of huntingtons
abnormal excessive voluntary movement (chorea), speech intact, swallow and chewing difficult, intellect deterioration
MG treatment
anticholinesterase & steroids removal of thymus
ALS (amyotrophic lateral sclerosis)
autoimmunity, hereditary, or excess level of glutamate men 2x> women death within 2-6 years
stage 5
bed rest or wheelchair
parkinsons patho
destruction of nerve cells in basal gangia because of neurotransmitter imbalances, virus, CVA, trauma causing dopamine deficiency and degeneration of muscular function
Bell's Palsy
disruption of CN 7 causing peripheral facial paralysis 20/100,000 20-65 yrs old
stage 4
fully developed - severely disabled can walk and stand but very impaired
huntingtons patho
genetic autosomal dominant disorder causing by the lack of neurotransmitters Ach and GABA creating excess dopamine (opposite of parkinsons)
huntingotn's
hereditary (off spring of someone with hungtingon's has a 50% chance of getting it) men = women 1/10,000 death 10-20 yrs after 1st sx
stage 3
impaired reflexes, unsteadines
tx
levodopa or other forms of dopamine (side effects include dyskinesia
GB pathophysiology
loss of myelin on peripheral nerves and increase in nerve swelling due to inflammation and edema because of a virus, trauma, immunizations, and HIV
bradykinesia
masked face, shuffle gait, drool
s&s of parkinsons
mild pain large joint stiffness or rigidity depression (intellect intact) pill rolling tremors bradykinesia incontinence, slow speech etc
cholingergic complications
over medication of anti-cholinestrase - muscles stop responding to Ach sx: sweat, muscle weakness, inability to swallow, inceased salvation
MG motor s&s
progressive weakness improved with rest degeneration of voluntary movements (eye movement, chewing, swallowing, speaking, breathing) ptosis incontinence respiratory compromise
ALS patho
rare progressive neurological disease causing loss of motor neurons
parkinsons nursing dx
self care deficit impaired physical mobility impaired physical communication
nursing care for parkinsons
1. fall risk 2. chewing/ feeding help (high nutrient diet) 3. activity 4. calm environment - self esteem help 5. medication teaching
nursing care for bells palsy
1. pain 2. protect eye 3. nutrition 4. body image help
nursing care for ALS
1. pt cognitively intact - communicate 2. aspiration risk and help 3. pain 4. fall risk
stage 2
bilateral involvement without balance impair
bells palsy s&s
herpes vesicles around ear pain paralysis inability to close eye tearing decrease salivation chewing & taste difficulties
complications of GB
mortality due to respiratory compromise (PE or arrest)
MG sensory s&s
muscle aches parethesia loss of smell and taste
GB motor s&s
muscle weakness flaccid paralysis loss of bowel and bladder respiratory compromise
complications
myasthenic and cholinergic
Ach
needed to stimulated muscle contraction
The most common cause of cholinergic crisis includes which of the following?
overmedication
care
palliative (anti-psychotics) control sx
GB sensory s&s
paresthesias, numbness and tingling, pain, cramping, dysrythmias, focal weakness, dysphagia, hypotension
leading cause of death in ALS
pneumonia
nursing diagnosis for MG and GB
risk for injury (d/t muscle weakness) ineffective breathing pattern ineffective airway clearence (dysphagia, suctioning need) impaired physical mobility altered sensory perceptions
myasthenic complications
under med of anti-cholinestrase sx: arrythmias, respiratory distress, increased secretions, paralysis
stage 1
unilateral involvement, little no no neurological changes
ALS s&s
weakness, dysarthria (slow or slurred speach), muscle wasting, respiratory problems