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