Exam 15: Alzheimer's Disease & Myasthenia Gravis (MG)
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
---|---|---|---|---|---|
Alzheimer's disease | degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning
🗑
|
||||
Alzheimer's Disease: Elevated homocysteine levels | increased risk
🗑
|
||||
Alzheimer's Disease: Changes in the brain include | Plaques in the cortex and neurofibrillary tangles.
Decrease in brain size.
🗑
|
||||
Nursing Management with Alzheimer's | Directed toward supporting patient and family
🗑
|
||||
Maintain adequate nutrition with Alzheimer's by | Finger food
Frequent feedings with high nutritional value
2000mLs of fluid per day
🗑
|
||||
Anti-Alzheimer's Agents act by inhibiting | acetylcholinesterase
It increases the amount of acethylcholine in the CNS.
🗑
|
||||
Anti-Alzheimer's Agents: Cholinesterase inhibitor agents used to treat mild to moderate | donepezil (Aricept)
galantamine (Reminy)
rivastigmine (Exelon)
tacrine (Cognex)
🗑
|
||||
Memantine (Namenda): for Alzheimer's Disease | First drug approved to treat moderate to severe AD
Classified as aN-methyl-D-aspartate receptor antagonist
🗑
|
||||
Tacrine | hepatic disease.
Contraindicated in Anti-Alzheimer's Agents
🗑
|
||||
Anti-Alzheimer's Agents: Side Effects | CNS: Headache, Seizures.
Resp: bronchospasm.
GI: Nausea, Vomiting, Diarrhea Weight loss.
GI: Bleeding.
GU: urinary tract obstruction.
🗑
|
||||
Myasthenia Gravis (MG) | neuromuscular disorder characterized by severe weakness of one or more groups of skeletal muscles. Believed to be an autoimmune disease with lower motor neuron characteristics.
🗑
|
||||
Myasthenia Gravis (MG): Pathophysiology | blocking of synaptic transmission at myoneural junction, results in muscle weakness
🗑
|
||||
Myasthenia Gravis (MG) is thought to be | triggered by antibodies that attack acetylcholine receptor sites at the neuromuscular junction and interfere with impulse transmission to the muscles.
🗑
|
||||
Myasthenia Gravis (MG): ocular S&S | Ptosis (eyelid drooping).
Diplopia (double vision).
15% of cases remain confined to the eye muscles.
🗑
|
||||
Myasthenia Gravis (MG): Clinical Manifestations | May initially have ptosis and /or diplopia.
Skeletal weakness.
Dysarthria.
Dysphagia.
Vocal cords weaken and the voice can sound nasal.
🗑
|
||||
As Myasthenia Gravis (MG) progresses | Trunk and lower limbs are affected:
Difficulty with walking and sustained sitting
-Inability to breath
-May need mechanical ventilation
- Bowel and bladder sphincter weakness
🗑
|
||||
With Myasthenia Gravis (MG) respiratory infections, emotional tension and menstruation | may initiate excerbation
🗑
|
||||
Myasthenia Gravis (MG): Subjective data | Patient’s understanding of the disease
Complaints of weakness, double vision
Difficulty in chewing or swallowing
Presence of any bowel or bladder incontinence
🗑
|
||||
Myasthenia Gravis (MG): Objective Data | Muscle weakness on neurological testing
Nasal-sounding speech
Voice often fades after a long conversation
Breath sounds diminish
Ptosis of the eyelids
Weight loss if dysphagia
🗑
|
||||
Myasthenia Gravis (MG): Diagnostic Tests | Look upward for 2-3 mins (look for Ptosis).
Electromyography.
IV anticholinesterase (Tension or Neostimine).
🗑
|
||||
Myasthenia Gravis (MG): Medical Managment | Anticholinesterase drugs
-Corticosteroids as adjunct therapy
-Immunosupressive drugs.
Plasmapheresis
Thymectomy
-Immune globulin
-May require intubation
🗑
|
||||
Myasthenia Gravis (MG): Patient Education | Medications
-What to take vs. what to avoid
Upper respiratory infection
Eating positions
Avoid crowds in flu and cold season
Activities and rest periods
Medical alert bracelet
🗑
|
||||
Myasthenia Gravis (MG): Cholinergic Agents | Inhibits the action of acetylcholinesterase, preventing the breakdown of acetylcholine.
neostigmine (Prostigmin).
pyridostigmine bromide (Mestinon)
🗑
|
||||
Myasthenia Gravis (MG): Cholinergic Agents (Therapeutic effect) | increase muscle strength
Used to reverse nondepolarizing neuromuscular blocking agents.
🗑
|
||||
Cholinergic Agents Effects | Miosis.
Increased intestinal and skeletal muscle tone.
Bronchial and ureteral constriction.
Bradycardia.
Increased salivation.
Lacrimation.
Sweating .
🗑
|
||||
Cholinergic Agents: Side Effects | CNS: seizures, dizziness, weakness
EENT: lacrimation, miosis
Resp: bronchospasm, excessive secretions
CV: bradycardia, hypotension
GI: abdominal cramps, diarrhea, excessive salivation, nausea, vomiting
Derm: sweating, rashes.
🗑
|
||||
Antidote to Cholinergic agents | Atropine
🗑
|
||||
Pyridostigmine may be administered | 30 min before meals if difficulty chewing
🗑
|
||||
Taking dose Cholinergic Agent late may result | Myasthenic crisis ( life-threatening condition that occurs when the muscles that control breathing become too weak to do their jobs)
🗑
|
||||
Taking dose Cholinergic Agent early may result in | cholinergic crisis (the muscles stop responding to the bombardment of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms)
🗑
|
||||
Amyotrophic Lateral Slerosis (ALS) aka Lou Gerhig's Disease | degeneration of the motor neurons of the spinal cord and brain stem
result in muscle weakness and wasting
🗑
|
||||
ALS primary symptoms | Weakness of the upper extremities
Dysarthria, Dysphagia
Muscle wasting and fasciculations
🗑
|
||||
With ALS death usually results from | Respiratory infection
🗑
|
||||
ALS Medical Management | Riluzole (Rilutek):Helps to protect motor neuron damaged by the disease
Adds 3 months or more to a patient’s life if given early
🗑
|
||||
Huntington's Disease | A genetically transmitted disorder that affects both genders. Onset between 35-45 years of age.
🗑
|
||||
Huntington's Disease: Etiology/ Pathophys | Involves the basal ganglia and the extrapyramidal motor system.
-Overactivity of the dopamine pathway.
-The net effect is an excess of dopamine, which leads to symptoms that are the opposite of Parkinsonism.
🗑
|
||||
Chorea | Abnormal, excessive involuntary movements
🗑
|
||||
Huntington's Disease: Clinical Manifestion | Chorea.
Writhing, twisting movements of face, limbs, and body.
Movements get worse as disease progresses.
Speech, chewing and swallowing are affected.
Gait deteriorates unable to ambulate.
Mental functions deteriorate.
🗑
|
||||
Huntington's Disease: Dx | Based on family history
Based on clinical symptoms
Detection of the characteristic DNA pattern from blood samples
🗑
|
||||
Huntington's Disease: Medical Management | Antipsychotics
Antidepressants
Antichoreas
🗑
|
||||
Huntington's Disease: Nursing Management | Prevent malnutrition
-High caloric intake to maintain body
-Up to 4000-5000 calories per day
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
jtzuetrong
Popular Medical sets