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NSG 210 Ch. 64
Mgmt of Pt w/ Neurologic Inf, Autoimmune Dis, Neuropathies
Question | Answer |
---|---|
Impaired coordination of mvmts is defined as | ataxia |
diplopia is | double vision |
dyskinesia is defined as | impaired ability to execute voluntary mvmts |
Difficulty swallowing is termed | dysphagia |
voice impairment or altered voice is | dyphonia |
paresthesia is | sensation of numbness/tingling |
________ is an inflammation of the lining around the brain and spinal cord caused by bacteria or viruses. | Meningitis |
septic meningitis is caused by? aseptic meningitis is caused by? | bacteria virus or secondary to brain abscess, lymphoma, leukemia Lyme Disease can lead to it |
Meningitis has s/s of | stiff/painful neck, + Kernig's sign, + Brudzinski's sign, photophobia, rash in some types, disorientation, memory impairment, seizures |
What are the key diagnostic tests for Meningitis | Bacterial culture and gram stain of CSF usually done by lumbar puncture(LP) |
Who is at risk for meningitis? | college students in dorms |
what is a + Kernig's sign? + Brudzinski's sign? | ker: Pt lying with thigh flexed on abd, leg cannot be fully extended Brud: when neck flexed, knees/hips flex |
In tx of meningitis, what two things are administered with one being an adjunct to the first. | Antibiotics like vancomycin, Cipro, Rocephin and adjunct is Dexamethasone(Decadron)- watch for stress ulcer for GI bleed |
Brain Abscess s/s? Medical Mgmt? Nsg Mgmt? | s/s: HA(worse in morn), V, seizures, focal weakness, confusion, irritability Med: needle biopsy, antibiotics, antiseizures Nsg: neuro assess, pt safety |
what is most common cause of acute encephalitis? Name two types | Herpes Simplex Virus (HSV) HSV1- children/adults HSV2 - neonates |
HSV Encephalitis s/s? Med Mgmt? Nsg Mgmt? | fever, HA, confusion, change in behavior Acyclovir(Zovirax)ganciclovir(Cytovene limit noise, avoid opiates, seizures |
Viral Encephalitis s/s? Med mgmt? nsg mgmt? | caused by mosquito, s/s: fluish, ICP manage seizures prevent injury(falls, seizures) |
Fungal Encephalitis s/s? Med mgmt? nsg mgmt? | meningitis s/s amphotericin B Give diphenhydramine(Benadryl) and acetaminophen 30 min prior |
Transmissable Spongiform encephalopathy refers to what disease? Med mgmt? | Creutzfeldt-Jakob palliative |
Name the three autoimmune nervous system disorders | multiple sclerosis, myasthenia gravis, Guillain-Barre |
In MS what is causing the impaired transmission of nerve impulses on the central nervous system, spinal cord and brain stem? | Plaques on demyelinated axons |
MS s/s? what cranial nerve disease is common in MS? | fatigue, depression, numbness, weak, diplopia, pain, sexual, relational issues, ataxia 5th Cranial Nerve Disease(Trigeminal Neuralgia) |
Disease modifying drugs to help reduce freq of relapse in MS are the "ABCs" | interferon beta 1a: Rebif, Avonex interferon beta 1b: Betaseron Copaxone....all subq |
What IV med is given q 3mos to reduce relapse in MS? | Mitoxantrone(Novantrone) |
Again to treat spasicity is what drug? Fatigue is treated with what drugs? Ataxia is treated with? | Spas: Baclofen, valium, dantrium fat: amantadine, pemoline atax: Inderal(BB), benzos |
What is impaired and not working in Myasthenia Gravis? | weak voluntary muscles r/t receptor sites for acetylcholine being attacked by immune system. |
Myasthenia Gravis s/s? | s/s from top down "Myacetyl gravity" ocular weakness, swallowing probs,voice impairment |
Diagnostic tests for Myasthenia Gravis | Tensilon(anticholinesterase) test IV to see if too much cholinergic or not enuf, same s/s. Tensilon prevents breakdown of acetylcholine so it's available for the neuro jx. If pt gets better than it's MG |
MG pts often have thymus tumors so what tx would help this? | thymectomy. The thymus is the place where the acetylcholine receptor antibodies are produced |
What tx is used in MG to eliminate the acetylcholine receptor antibodies? | plasmaphoresis |
What is key nsg mgmt with MG | give anticholinesterase meds on time to prevent swallowing or even resp muscle weakness exacerbations |
Guillain-Barre is an autoimmune attack on what? | peripheral nerve myelin |
what is affected in GB? | ascending weakness with dyskinesia, hyporeflexia, paresthesias usually from an event like a viral infection |
s/s of GB? | muscle weakness and diminished reflexes of lower extrimities. Does not affect LOC |
How is MG dx? | symmetric weakness, diminished reflexes, upward progression of motor weakness, recent viral infection |
Med mgmt for Guillain barre? | mechanical ventilation plasmaphoresis IVIG...both decr antibody levels No vaccinations with a virus in them, like flu, can trigger exacerbation |
What are nsg mgmt intv? | resp failure, so maintain resp fx, enhance physical mobility, adequate nutrition, decr fear/anxiety, cardiac dysrhythmias, DVT |
Which cranial nerve is affected by trigeminal neuralgia? | 5th |
What is key distinguishing factor in trigeminal neuralgia? | unilateral pain shooting/stabbing in cheek and jaw area, and ends as abruptly as starts and cause mouth twitching, sudden closing of the eye, thus name Tic Douloureux |
What is medical mgmt for trigeminal neuralgia? | antiseizure meds: tegretal, neurontin, baclofen(chill out nerve endings). Surgery can be option |
The 7th cranial nerve is the | facial nerve |
the 7th cranial nerve, when inflammed unilaterally, causes facial paralysis/weakness known as | Bells' Palsy |
What is medical mgmt for Bells Palsy? Nsg Mgmt? | prednisone for inflammation Nsg mgmt: Reassure pt not stroke, help excercises to strengthen facial muscles(blow, massage, whistling) |
Peripheral nerves transmit motor impulses (to, from) brain and relay sensory impulses (to, from) brain? | motor from brain, sensory to brain |