N406: Unit 3- Exam 1
Interferon beta-1b
- Betaseron - disease modifying agent - reduce incidence of relapse and slow physical disability
Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis?
- Ineffective airway clearance
Bromocriptine (Parlodel)
- antiparkinson agent - dopamine D2 receptor agonists - relief of rigidity and tremor in parkinsonism
Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter?
- dopamine
Which nursing intervention is the priority for a client in myasthenic crisis?
Assessing respiratory effort
A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder?
Trigeminal neuralgia
A patient is undergoing a Tensilon test to diagnose myasthenia gravis. Which of the following medications should be available to control the side effects of Tensilon? a. Lidocaine b. Atropine c. Mestinon d. Copaxone
b. Atropine
Nurse Coral is assessing a client with Parkinson's disease. The nurse recognizes bradykinesia when the client exhibits: a. intentional tremor b. paralysis of limbs c. muscle spasm d. lack of spontaneous movement
d. lack of spontaneous movement
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?"
The nurse is assessing a client with sudden bilateral lower extremity weakness and dyskinesia. The client reports accompanying numbness and tingling episodes. Which question will the nurse ask the client to help determine the reason for the client's symptoms?
"Have you had a recent illness?"
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education?
"I will stretch daily as directed by the physical therapist."
A client asks the nurse to explain the development of Parkinson disease (PD). Which response will the nurse provide the client?
"It is caused by low levels of dopamine that are not available to counteract the effects of acetylcholine."
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."
A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate?
"You sound a bit overwhelmed. Tell me more about what's happening."
The most common cause of cholinergic crisis includes which of the following?
- overmedication
Baclofen (Lioresal)
- skeletal muscle relaxant (centrally acting) - anti-spasticity agents - tx of reversible spasticity due to MS - bowel and bladder function may be improved
Symptoms of Parkinson's Disease
- tremors at rest - muscle rigidity (may produce muscle pain, expressionless, mask-like face, difficulty chewing) - bradykinesia (slow movement) - cognitive impairment (mood swings; ie dementia) - postural instability (falls, poor balance, stooped posture, difficulty walking, slow shuffling gait)
What happens to a person who has ALS?
- unable to function - inability to use muscles to breathe - they do not lose ability to taste, hear, touch, see, or feel - as this dx progresses muscles become weaker and weaker until they are paralyzed - ventilatory support will eventually be needed as breathing muscles are affected and paralyzed - swallowing, dehydration, and malnutrition can become problems, along with aspirating secretions, food, or liquid into the lungs - ONLY affects the motor neurons
Modafinil (Provigil)
- used off-label in MS to treat fatigue and sleepiness
Glasgow Coma Scale
- used to measure LOC - three parts: eye opening response, verbal response, and motor response - normal response is 15 - a score of 7 or less is comatose - score of 6 indicates the client is in a state of coma
What triggers Guillain-Barré syndrome?
- viral illness - vaccination - surgery - acute illness
Who is most affected by multiple sclerosis?
- women who are aged 20-40 years old
During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do?
Administer atropine to control the side effects of edrophonium
_____________ syndrome is an autoimmune attack on myelin, a complex substance that covers nerves.
Guillain Barre
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?
Help the client perform range-of-motion (ROM) exercises every 8 hours
The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning?
Increased pulse rate, adventitious breath sounds
Which of the following are disease-modifying agents used in the treatment of multiple sclerosis (MS)? Select all that apply
Interferon beta-1a (Rebif) Interferon beta-1b (Betaseron) Interferon beta-1a (Avonex) Glatiramer acetate (Copaxone)
The diagnosis of multiple sclerosis is based on which test?
MRI
Most patients diagnosed with _____________ ______________ have a relapsing-remitting course.
Multiple Sclerosis
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
One of the most common features of ______________ disease is bradykinesia.
Parkinson's
Which of the following is the first-line therapy for myasthenia gravis (MG)?
Pyridostigmine bromide (Mestinon)
A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has?
Relapsing-remitting (RR)
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?
Suction machine with catheters
The highest incidence of brain tumors in adults occurs in the fifth to seventh decades of life: T or F
True
The initial manifestation of myasthenia gravis in most patients involves the ocular muscles. T or F
True
While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: a. lead pipe rigidity b. cogwheel rigidity c. pronate rigidity d. flexor rigidity
b. cogwheel rigidity
Which of the following is NOT a cardinal sign of Parkinson's disease? a. tremor b. dementia c. bradykinesia d. rigidity
b. dementia
Thalamotomy and pallidotomy are successful ablative procedures used to relieve symptoms of Parkinson disease. T or F?
false
A _____________ is the most common type of intracerebral brain neoplasm.
glioma
The pharmacologic agent _____________, which is converted to dopamine in the basal ganglia, is the most effective agent, and the mainstay of treatment, for Parkinson disease.
levodopa
Parkinson disease is associated with decreased levels of dopamine resulting from degeneration of these storage cells in the substantia nigra in the basal ganglia region of the brain. T or F?
true
Glial cells and myelinated axons are the components of which of the following?
white matter
Which of the following promotes dopamine release by an unknown mechanism?
- Amantadine - an interesting medication because it has activity as an anti parkinsonian medication, as well as an antiviral medication - it increases dopamine release by a poorly understood mechanism and also has anticholinergic action
Regarding the autonomic nervous system, which of the following best describes how the effects of the sympathetic and parasympathetic nervous system relate to one another?
- Antagonistic Effects of Sympathetic and Parasympathetic Nervous Systems
What drug should be given to reverse any complications of a Tensilon test?
- Atropine
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem?
- Amyotrophic lateral sclerosis (Lou gehrigs disease)
Thymectomy
- a surgical procedure in which the thymus gland, an immune organ, is removed - can reduce patient's need for medication and reduce the severity of MG regardless of age, sex, severity, or length of sickness, or thymic masses
Uhtoff's sign
- a transient worsening of neurological symptoms when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs.
Myasthenia gravis occurs when antibodies attack which receptor sites?
- acetylcholine
Diet/Nutrition for Myasthenia Gravis
- eat small meals and snacks 5-6 times a day - avoid using low fat or diet products when possible - avoid eating lemons or tonic water - eat warm rather than hot food - runny or puree diet needed when swallowing is difficult - alternate sips of liquid to avoid food from sticking - AVOID eating chewy or dry crumbly foods
How is Myasthenia Gravis diagnosed?
- edrophonium test (TENSILON) - special blood test - administered very briefly - injection that is given breaks down acetylcholine and may result in a sudden improvement in muscle strength which is an indication of this disease - test is positive is there is an improvement in the muscle strength - blood analysis, repetitive nerve stimulation, single-fiber electromyography (EMG), or imaging scans can also be used
Signs and Symptoms of Multiple Sclerosis
- emotionally and cognitive: Lhermittee's sign and Romberg's sign - Vision: nystagmus and double vision - elimination: urgency, hesitancy - ***symptoms can get worse due to heat called Uhthoffs sign (ex: heat from weather, exercise, etc.)
Nursing care for Guillain-Barre syndrome
- maintain patent airway - monitor for cardiac dysrhythmias and BP - HOB elevated - seizure precautions, ascending paralysis - assess gag, corneal, and swallow reflexes - cough and deep breath q2h - spirometry - monitor VS - pain management - foley cath - look at Albumin levels; use a high energy high protein diet
Cholinergic Crisis
- results from overmedication - muscle twitching results in respiratory muscle weakness and mechanical ventilation - cholingergic symptoms include hypersecretions and hypermotility - hypotension - tensilon has no positive effect on symptoms - symptoms improve with anticholinergic medications - signs and symptoms: weakness with difficulty swallowing, chewing, speaking, abdominal cramps, diarrhea, sweating, increased saliva and secretions - tx: discontinue all cholinergic drugs until effects decrease, provide vent support, Atropine 1 mg IV
Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells?
- Parkinson's Disease
Nystagmus
- involuntary rapid eye movements
A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to:
- rest in an air-conditioned room.
ALS Medications
- riluzole (Rilutek): only med that is approved for use in treating ALS - used for its neuroprotective effect in the early stages of the dx - take one hour before or 2 hours after meals and avoid caffeine - causes dizziness, drowsiness, nausea, headache, lung function decrease, liver dysfunction, and numbness - extends survival and/or time to invasive breathing assistance - works by decreasing body's levels of glutamate (an amino acid that affects nerves that send messages from your brain to your muscles)
Which drug should be available to counteract the effect of edrophonium chloride?
- Atropine
Which of the following is an acronym or mnemonic associated with Parkinson's Drugs?
- BALSA acronym - Commonly used Parkinson's drugs can be remembered by the acronym BALSA: Bromocriptine, Amantadine, Levodopa, Selegiline, Antimuscarinics.
Which of the following is a potent dopamine agonist?
- Bromocriptine - an ergot alkaloid - a potent dopamine agonist, and increases its availability in Parkinson's disease - also effects serotonergic, alpha adrenergic and glutamate receptors
Medications/Treatment for Myasthenia Gravis
- Immunosuppressive therapy: Prednisone or Azathioprine; works by reducing the activity of the body's immune system, thus decreasing the number of antibodies in the bloodstream that interfere with communication between the nerves and muscles - Acetylcholinesterase Inhibitors: first line of therapy: - Neostigmine bromide (Pyridostigmine) - decrease muscle weakness - Edrophonium chloride (Tensilon)
Which of the following is a dopamine isomer?
- Levodopa - commonly administered with carbidopa - L-Dopa is protected from breakdown by carbidopa in the gut and periphery and readily passes through the blood-brain barrier to increase central dopamine bioavailability
Nursing Implementation for MS
- Reassure patient during diagnostic phase. - Assist patient in dealing with anxiety and grief caused by diagnosis -Identify triggers, develop ways to avoid them or minimize their effects -Prevent major complications of immobility -Avoid fatigue, extremes of hot and cold, exposure to infection -Balance exercise and rest
Interferon beta-1a
- Rebif and Avonex - disease modifying agents - for relapsing forms of MS, including relapsing-remitting disease - reduce incidence of relapse (neurologic dysfunction) and slow physical disability - first line treatment - can cause increased chance of infections
Regarding the autonomic nervous system, which of the following is true about postganglionic neurons?
- Sympathetic Postganglionic Neurons Release Norepinephrine
Which of the following tests confirms the diagnosis of myasthenia gravis (MG)?
- Tensilon test
Guillain-Barre Syndrome
- acute inflammatory disease - usually preceded by a viral infection (URI or GI) 1-4 weeks (Ex: flu) or vaccines - degeneration of the myelin sheath of peripheral nerves - immune system attacks PERIPHERAL NERVE CELL MYELIN PROTEINS (rarely involves brain) - spares the SCHWANN CELLS which produce myelin; this causes remyelenization and recovers the affected person
Medication Tips and Tricks for MG
- administer with small amount of food to avoid GI upset and eat within 45 minutes - MUST be administered on time and SAME time each day
What are the signs and symptoms of Myasthenia Gravis?
- affects any of the muscles that you control voluntarily - symptoms progress over time, usually reach their worst within a few years after onset - worsening muscle weakness with repeat activity - early signs and symptoms include diplopia and ptosis - diplopia: double vision - ptosis: when the upper eyelid droops over the eye - weakness of facial muscles - voice impairment (dysphonia) - difficulty speaking (dysarthria) - generalized weakness - fatigue - problems chewing and swallowing (aspiration and dysphagia) - progressive weakness of diaphragm (resp distress)
Which of the following is most likely indicated in patients with severe Guillain-Barre Syndrome the longer it goes on?
- aggressive airway management - Priorities involve continuous assessment and preparation for respiratory emergencies. Considerations include frequent assessments, management of secretions with suctioning if needed, keeping intubation equipment at the bedside, and considering the need for mechanical ventilation
What class of drugs can be used in the treatment of Parkinson's disease?
- antimuscarinics - drugs, such as benztropine, block muscarinic receptors to curb cholinergic neuron activity - this class of drugs works to alleviate tremor and rigidity associated with Parkinson's, but does not work well at treating bradykinesia
(mitoxantrone) Novantrone
- antineoplastics - for secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (MS) - suppresses the activity of T cells, B cells, and macrophages that are thought to lead the attack on the myelin sheath - make sure you do a good assessment (esp cardiac and monitoring for leukopenia) - get baseline of left ventricular function - < 50% of ejection fraction DO NOT give this drug (may cause cardiotoxicity)
Levodopa/Carbidopa
- antiparkinson agent/dopamine agonists - Sinemet - combined meds to treat abnormal movements (dyskinesias) - increases dopamine levels - crosses the blood brain barrier - side effects: can cause peptic ulcers or asthma, GI distress, hypotension, dyskinesias, urinary retention (urine can get dark) - take these meds on an empty stomach, can take up to 3 weeks to be effective - if you stop taking this med abruptly, you need to be hospitalized because it can cause impaired movement - most clients within 5-10 years of taking this develop a response to this medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements, bradykinesia, micrographia, and dysphonia - the patient should avoid foods and supplements high in vitamin B6 because it decreases the effectiveness of this medication.
Amantadine
- antiviral agent - used in combination with levodopa therapy - known to aid in reducing dyskinesia
Which of the following clinical features is MOST COMMONLY seen in Guillain-Barre Syndrome?
- ascending paralysis - Demyelination causes eventual full body paralysis in a characteristic ascending fashion starting in the lower limbs and traveling upward to the trunk and upper limbs. Typically involuntary muscles like the diaphragm are affected later in the disorder. It is important to remember that patients have no cognitive decline or decreased level of consciousness
Parkinson's Disease Nursing Interventions
- assess/monitor patient - mobility: progressive daily exercise - nutrition/hydration: weight loss is common, teach swallowing sequence - speech: encourage to speak slowly - promote pt commuication - provide safe environment - administer prescribed meds
What is multiple sclerosis?
- autoimmune disease - life long disease with no cure - the body attacks and destroys the fatty tissue called myelin sheath that insulates an axon/nerve - if damage is severe it can also destroy the nerve/axon itself
Myasethenia Gravis
- autoimmune disorder where antibodies destroy the acetylcholine receptor leading to a decrease in neuromuscular transmission - motor disorder - affects myoneural junction - no single cause - abnormal thymus tissue found in most patients - virus infections have been found in some causes - effects women in their 20s-30s; more common in women - effects me in their 50s-60s
How is Parkinson's diagnosed?
- based on symptoms and ruling out other disorders that produce similar symptoms - must have 2 or more of the primary symptoms, one of which is a resting tremor or bradykinesia - often dx is made after observing that symptoms have developed and become established over a period of time
Parkinson's Disease
- cause unknown- progressively debilitating disease that affects gross motor function - degeneration of the nerves that control voluntary movement - occurs in the part of the brain called SUBSTANTIA NIGRA
Myasthenic Crisis
- caused by under medication or precipitated by an infection - respiratory muscle weakness can cause mechanical ventilation - myasthenic symptoms cause weakness, incontinence, fatigue - hypertension - temporary improvement of symptoms with Tensilon - s/s: increased BP and HR, severe resp distress/cyanosis, absent cough and swallow reflex - tx: increase dose of cholinergic drugs, intubation and mechanical ventilation (resp complications are common because of ineffective coughing)
What causes ALS / "Lou Gehrig's disease"?
- causes are unknown - can be due to HIGH GLUTAMATE levels - Glutamate is a chemical messenger found in the brain - high levels of glutamate can be found in ALS patient's spinal cord - autoimmune response: self attacks self
A neurologic deficit is best defined as a deficit of the:
- central and peripheral nervous systems with decreased, impaired, or absent functioning
Which of the following body organs or body parts is most likely associated with Central Nervous System and responsible for movement and balance?
- cerebellum
Which best describes the pathophysiology of Parkinson's disease?
- decreased dopamine - the substantia nigra in the brain degenerates and fails to secrete sufficient levels of dopamine - these low levels of dopamine prevent normal transmission signals to the thalamus as well as the motor cortex. The mechanism of basal ganglia dysfunction or disruption is complex and eventual failure of compensatory mechanisms are often why symptoms worsen with disease progression
Pathophysiology of Parkinson's Disease
- degeneration of dopamine-producing nerve cells in the brain, specifically in the substantia nigra - this is where neurons communicate with other neurons in the brain using a neurotransmitter called dopamine - when these dopamine neurons die, signaling between neurons is severely hampered causing loss of controlled movement
Signs and Symptoms of ALS
- difficulty lifting the front part of the foot and toes (foot drop) - weakness in the ankles and feet - tripping over small things - hand weakness and clumsiness - dropping things often - trouble using the hands for simple things such as washing, dressing, and buttoning clothes - abnormal fatigue of the legs and/or arms - muscle cramps and twitching - "thick" or slurred speech and difficult projecting the voice - uncontrollable periods of laughing or crying - dysarthria - dysphagia
Which of the following clinical features is typically seen in patients with Guillain-Barre syndrome?
- difficulty speaking - Involvement of cranial nerve VII the facial nerve often causes difficulty speaking or dysarthria - Ensure to get a proper history of the progression of symptoms to understand progression of symptoms to rule out a stroke
During an eye exam, which of the following findings is most likely to be seen in Guillain-Barre syndrome?
- diplopia - Involvement of cranial nerves may cause double vision in patients due to paralysis of the muscles which have motor control of the eyes, called ophthalmoplegia. Pupillary constriction and dilation are not usually affected
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?
- diplopia and ptosis
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following?
- dyskinesia
Regarding the autonomic nervous system, which of the following best describes the physiological response of the sympathetic nervous system?
- fight or flight - response to perceived threats enables humans to either fight off the threat or run away quickly. Blood flow increases to the heart and skeletal muscle, while blood flow decreases to the GI tract and kidneys. Additionally, breathing and heart rates increase to meet oxygen demands of physical stress, and pupils dilate to maintain clear vision
Which of the following is involved in motor functions, reasoning, memory, and several higher order functions.?
- frontal lobe - located at the front of the brain and is involved in motor functions, reasoning, memory, and several higher order functions
Copaxone
- glatiramer acetate - disease modifying agents - for relapsing forms of MS - decreases incidence of relapses
Unmyelinated axons are the components of which of the following?
- grey matter
Parkinson's disease nursing diagnosis
- impaired physical mobility related to muscle rigidity and weakness - self care deficit related to tremor and motor disturbance - risk for falls - risk for imbalanced nutrition: less than body requirements related to tremor, slowness in eating, difficult in chewing and swallowing
Nursing Diagnoses for MS
- impaired physical mobility related to weakness, muscle paresis, and spasticity - risk for injury related to sensory, visual, and motor impairment - altered urinary and bowel elimination related to SC dysfunction - altered thought processes related to cerebral dysfunction - impaired physical mobility - dressing/grooming self-care deficit - impaired urinary elimination pattern
Anticholinergics with Parkinson's dx
- improve tremors and stiffness - most effective in controlling tremors - causes impairment and constipation - example: benztropine Mesylate
Biochemically, Parkinson's disease is characterized by what?
- increased acetylcholine - because as dopamine decreases, there is an imbalance of neurotransmitters required for motor control - there is not a gross excess of acetylcholine, but rather an imbalance, leading to a higher acetylcholine in comparison to dopamine
Selegiline
- increases dopaminergic activity and slows the progression of the disease - increased response to levodopa/dopamine therapy in Parkinson's disease
What are the nursing diagnoses for Myasthenia Gravis?
- ineffective breathing pattern related to respiratory muscle weakness - impaired physical mobility due to muscle weakness - risk for aspiration - self care deficit
Exacerbation Trigger Factors
- infection - stress - fatigue - cathartics (laxatives) - heat (sauna, hot tubs, sunbathing)
Lhermitte's sign
- intense burst of pain like an electric shock that runs down your back into your arms and legs when you move your neck - bending your neck so that your head moves down with your chin moving towards your chest
Which of the following vital sign changes is most likely to be seen in patients with Guillain-Barre syndrome?
- labile blood pressure - If patients have cranial nerve involvement, they may present with episodes of hypertension, as well as episodes of hypotension - These must be managed independently
How is Guillian-Barre Syndrome diagnosed?
- lumbar puncture (LP): cerebrospinal fluid with ELEVATED PROTEIN level
Nursing Interventions for Myasthenia Gravis
- maintain patent airway - assess swallowing to prevent aspiration - keep appropriate equipment available at the bedsides: oxygen, suction, ambu bag, endotracheal intubation - promote energy conservation measures - consult PT for medical equipment needs (walkers, wheelchairs) - avoid exposure to heat and cold - provide eye care - consult OT for assistive devices to facilitate ADLs - consult with speech and language therapist if weakening facial muscles impact communication - monitor I+O, serum albumin, and daily weights - immunosuppressants: Prednisone - cholinesterase inhibitors: pyridostigmine
Which of the following is the lower half section of the brain-stem and is responsible for autonomic functions?
- medulla oblongata - lower half section of the brain-stem and is responsible for autonomic functions and systems, such as respiration, cardiac center, and bulbar reflexes including vomiting, swallowing, coughing and sneezing
Prognosis for GBS
- most people recover from even the most severe cases of GBS with minimal residual symptoms
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord?
- multiple sclerosis
A client is receiving baclofen for management of symptoms associated with multiple sclerosis. To evaluate the effectiveness of this medication, what does the nurse assess?
- muscle spasms
Collaborative Care for MS
- nutritional therapy includes megavitamins and diets consisting of low-fat, gluten-free food, and raw vegetables - high protein diet with supplementary vitamins is often prescribed
Which of the following groups of people are most commonly associated with Parkinson's disease?
- older adults - This disease is most common in older patients and is the third most common neurological disorder in the US - It has an average age of onset of 60 years of age.
Regarding the autonomic nervous system, which of the following sub-systems primarily uses the vagus nerve for innervation and functions to stimulate excretory and digestive organs?
- parasympathetic nervous system - involves stimulating excretory and digestive organs and has antagonistic effects to the sympathetic nervous system. Innervation occurs primarily via the vagus nerve.
What are the S&S of Guillain-Barre Syndrome?
- paresthesias - ascending weakness in legs that progresses to paralysis - hyporeflexia of the lower extremities and pain - severe bradycardia
Which of the following neurological symptoms is most commonly seen in Guillain-Barre Syndrome?
- paresthesias (pins and needles) - Patients often present with a sudden onset of weakness with or without paresthesias, which are a burning prickling feeling like pins and needles. This also characteristically occurs in an ascending fashion in the disorder
Which of the following Lobes integrates sensory information and determines spatial sense and navigation?
- parietal lobe
Which of the following are most likely signs or symptoms of Parkinson's disease?
- pill-rolling, mask like face, shuffling gait, resting tremor, cogwheel rigidity, bradykinesia, cognitive decline
Treatment for Guillian-Barre Syndrome
- plasmapheresis to decrease circulating antibodies - EKG monitoring for autonomic dysfunction - immunoglobulin therapy (Sandoglobulin) - immunoglobulin and plasmapharesis most effective within 2 weeks - hormonal therapy and physical therapy to increase muscle flexibility and strength
What is located between the midbrain and the medulla oblongata?
- pons - a portion of the hindbrain that bridges the medulla oblongata and cerebral cortex. It coordinates arousal, autonomic functions, sensory information and sleep.
Romberg's Sign
- present when a patient is able to stand with feet together and eyes open, but sways or falls with eyes closed - used in an exam of neurological function for balance
Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig's Disease)
- progressively neurodegenerative disease, which causes death to upper motor neurons located in the cerebral cortex (brain), as well as peripheral lower motor neurons, originating in the spinal cord - death of motor neurons causes the brain to lose the ability to produce and control motor muscle movements - as this progresses the patient becomes paralyzed and eventually dies - occurs in ages 40-70 more in men
What is the most common form of multiple sclerosis?
- relapsing-remitting form - patients have relapses of MS and periods of stability in between relapses
What is the biggest issue with Guillain Barre Syndroe?
- respiratory failure from intercostal and diaphragmatic muscle paralysis - rapid progression
What is the most common cause of death for people with ALS?
- respiratory failure since breathing muscles are affected and paralyzed - will need vent support
Regarding the autonomic nervous system, which of the following best describes the physiological response of the parasympathetic nervous system?
- rest and digest - stimulates organs that help the body eat and relax. Blood flow to digestive and excretory organs increases, while blood flow to the heart and skeletal muscle decreases. Ventilation and heart rates decreases
How is ALS diagnosed?
- series of diagnostic tests - to help confirm ALS an EMG (electromyography) is ordered to detect abnormal electrical activity of the involved muscles - must show widespread anterior horn cell destruction with fibrillations, positive waves, Fasciculations (muscle twitches), and chronic changes in the neuronic motor units
What is the hallmark sign of ALS?
- slow progressive muscle weakness - atrophy in distal muscles and 1 upper extremity
amantadine (Symmetrel)
- sometimes effective in relieving fatigue in multiple sclerosis
The Central Nervous System's route of communication with the body is through which of the following?
- spinal cord
What are early signs of Parkinson's Disease?
- stiffness - rigidity - tremors of 1 or both hands - pill rolling movements
When conducting the Glasgow Coma Scale on a patient, which of the following are characteristics in the LOC (level of consciousness) assessment?
- stuporous: conscious but sleep-like state associated with little or no activity; only responsiveness is in reaction to pain - comatose: no response to stimuli, cannot be aroused; no gag reflex or pupil response to light - delirious: disoriented, restless, clear deficit in attention; possible incidence of hallucinations and delusions - obtunded: decreased alertness, slowed motor responses; sleepiness - conscious: normal, attentive; oriented to self, place, and mind - confused: impaired, or slowed thinking; disoriented - somnolent: excessive drowsiness; little response to external stimuli
Parkinsonian Crisis
- sudden or inadvertent withdrawal of anti-PK drugs or emotional trauma - patients experiencing severe exacerbation of tremor, rigidity and bradykinesia, along with acute anxiety, sweating, and tachycardia - interventions: respiratory and cardiac support, subdued lighting, mild barbituates, anti PK drugs
Regarding the autonomic nervous system, which of these sub-systems dominates against perceived threats?
- sympathetic nervous system - constantly active to maintain homeostasis in the body, but has a very specific response mechanism against perceived threats
Which of the following lobes has functions which include auditory perception, memory, speech, emotional responses, visual perception, and language skills including writing?
- temporal lobe
Plasmapheresis
- the plasma compartment of the blood is exchanged with substitute plasma to ensure that the immune system does not attack the body's own tissues - myasthenia gravis and guillian-barre can be treated with this - plasma is disregarded and the RBCs are given back to the pt along with albumin, NS, and lytes - purpose is to remove the plasma proteins causing MG
Parkinson's disease treatment
- there is no cure - treatment centers on relieving symptoms using meds, surgery, or surgically implanted device that lessens tremors
Severe GBS: Medical Emergency
- total paralysis - potentially dangerous fluctuation in pulse and BP - 25% unable to breathe without respiratory assistance - muscles for eye movement, speaking, chewing, and swallowing also become weak or paralyzed
Corticosteroids for MS
- treat acute exacerbations by reducing edema and inflammation at the site of demyelination
How to care for a patient with MS
- treatment for constipation: high-fiber diet, bulk laxatives, stool softeners, increase fluids to > 2000 cc/day - keep environment cool: no hot baths, plan activities at peak energy level: use amantadine (Symmetrel) and modafinil (Provigil) - require assistance with ADLs - fear of loss of independence and fear of disability