neuro 171-2

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neuro 171-2
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2012-03-29 10:25:51
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neuro 171-2
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  1. What 3 things are in the brain stem?
    • midbrain
    • pons
    • medulla
  2. What does the midbrain do?
    • allows 2 hemishperes of brain to communicate
    • motor cordination
  3. What does the pons do?
    • bridges motor and sensory pathways
    • respitory center
  4. what does the medulla do?
    • relay station for heartrate, repitory rate, blood pressure
    • sneezing, swelling, vomiting coughing
  5. What does the cerebellum do?
    • cordinates smooth muscle movement
    • cordinates posture, equllibrium test and muscle tone
    • (test this for DUI)
  6. Where is the spinal cord?
    below the foreman magum
  7. What are the 2 pathways of the spinal cord?
    • ascending track (afferent)- carries sensory info to the brain
    • desending track (efferent)- carries motor response to the muscles
  8. What is a myelogram?
    • xray of spinal cord with dye in the csf
    • looks for lesions, tumors, infection, herniated disc
  9. What is the nurses role for a myelogram?
    • know patients allergies
    • increase fluid intake
    • NPO four 4 hours prior to procedure
    • bed rest after procedure (3-24 hours)
    • lay flat or 30 degrees per MD orders
    • monitor injection site for csf leakage
  10. How many carnial nerves do we have?
    12 pair or 24
  11. What carinal nerves are motor nerves?
    • III- occulomotor
    • IV- trochlear
    • V- trigeminal (both)
    • VI- abduucens
    • VII- facial(both)
    • IX- glossophayngeal (both)
    • X-vagus (both)
    • XI- accesory
    • XII- hypoglassal
  12. What carianl nerves are sensory nerves?
    • I- olfactory
    • II- optic
    • V- trigeminal (both)
    • VI- abducens
    • VII- facial (both)
    • VIII- auditory
    • IX- glossopharyngeal (both)
    • X- vagus (both)
  13. How do you test Carinal nerve I- olfactory?
    (sensory)
    Have patient smell something through each nostril
  14. How do you test cranial nerve II- optic?
    (sensory)
    • have patient read snellen chart
    • test each eye separate and then together
    • If patient wheres glasses have them keep them on
  15. How do you test carnial never III occulomotor (motor), IV trochlear (motor), VI abduncens (motor)
    follow fingers, field of gaze
  16. How do you test carinal nerve V trigeminal (sensory and motor)?
    • Only tested on unconcious patient
    • cotton swab or something shar on cheek
  17. How do we test crainail nerve VII facial (sensory and motor)
    • smile
    • taste
    • puff out cheeks


    **bells palsey
  18. What is bells palsy?
    paralysis of nerve 7, ussally only on one side of the face, etilogy unknown

    Looks like CVA
  19. How to test nerve VIII acoustic (sensory)?
    • can patient hear?
    • wernikies tells them what they hear
  20. How to test carinail never IX glossopharyngeal (motor and sensory), X vagus
    check gag reflux, can they swallow
  21. How do we test nerve XII accessory?
    shoulder shruggs
  22. How to test nerve XII hypoglossal?
    stick tongue out, smile
  23. How do we asses neuro subjective data?
    • History of present illness
    • pain, seizure, dizziness, vertigo, visual changes, weakness, abnormal sensations, mental status, posture, movement,
    • med history, medications, bowel /bladder function
  24. How do we collect objective data for a neuro assessment?
    • general observation of cliet
    • mental status
    • function of cranial nerves
    • motor functions (grips and pulls)
    • movement cordination
    • sensory functions (sharp/dull)
    • relex function
  25. How to do a bedside neuro check?
    assess LOC

    • respiratory function
    • motor function
    • vital signs
    • pain
    • vomiting not associated with nausea (IICP)
    • glascow coma scale
  26. What is abnormal posturing?
    • Flaccid- over all non movement
    • Flexor (decorticate) pulling of extermities inward
    • Extensor (decerebrate)- posturing of extremities outward
  27. What is intercranial pressure?
    • hydrostatic forrce measured in the CSF
    • Normal 0-15 mmHG
  28. what three things attribute to ICP?
    • brain tissue
    • blood
    • csf
  29. What is increased intercranial pressure?
    • Pressure of CSF over 15 mmHG
    • ***Life threatening
  30. What kind of things can cause IICP?
    • vacular injury
    • cerebral infections
    • head injury
    • lesions
    • deep brain stimulation
    • brain surgery
    • liver or kidney failure
  31. Why do we want to keep clients with IICP PaCo2 low?
    Co2 vasodilates vessles in the brain, which increases blood flow / pressure
  32. What are early signs of IICP?
    • nausea vomiting
    • altered LOC
    • headache
    • unilateral pupillary changes
    • impaired use of crainal nerves 3,4,6 cant follow gaze
  33. What are late signs of IICP?
    • bilateral pupillary change
    • unconcious
    • cushing triad
  34. Whta is cushings triad?
    • A late sign of IICP,
    • systolic hypertension
    • bradycardia
    • altered respirations (because brain stem is being compressed)
  35. What are some nursing Dx for IICP?
    • Ineffective tissue perfusion
    • decreased intercranial adaptive capacity
    • risk for disuse synrome
  36. What does a nurse do for IICP?
    • assess LOC
    • elevate head of bed ( to allow fluid to drain)
    • prevent flexion of hips, neck
    • monitor vital signs
    • maintain body temp
    • prevent shivering
    • decrease stimuli
    • monitor electrolytes
    • fluid restrictions
    • avoid straining (give stool softners, cough suppressants)
  37. What medications can help with IICP?
    • Osmotic duiretics
    • corticosteriods
    • barbituates
    • anticonvulsants
  38. Why and what kind of osmotic diuretic would you use for IICP?
    Mannitol (osmitrol)- it pulls the fluid into the vascular
  39. Why and what kind of corticosteriod would you use for IICP?
    Dexamethasone (decadron) to decrease inflammation
  40. Why and what kind of barbituate would you use for IICP?
    • Pentobarbital ( Nembutal)
    • it will allow the brain to rest
  41. Why and what kind of anticonvulsant would you use for IICP?
    Phenytoin (Dilantin) as a preventitive for seizures because IICP puts patient at high risk for seizures
  42. Why would you not give a patient with IICP hypotonic fluids?
    Hypotonic fluids pull fluids into the vessels causeing more sweeling of the cells increasing edema and risk for stroke.
  43. What are the three types of CVA (stroke)?
    • Thrombotic
    • embolic
    • Hemorragic
  44. What is a thrombotic stroke?
    • ussally a plaque (fatty deposit) causing a blockage
    • ***** most common
  45. What is an embolic stroke?
    • when a clot reaches an artery that is to narrow to pass through causing an obstruction
    • can be caused by a-fib, cardiomyopathy
  46. What is a hemorragic stroke?
    • *****least common*****
    • a burst in a blood vessel allowing blood to seep into blood tissues
    • worst headache of your life
  47. How do we rule out a hemorragic stroke?
    • CT of the brain with out contrast.
    • contrast resembles blood, andr should not be used.
  48. What wil a CT look like for the first 24 hours of a patient with out a hemorragic stroke?
    normal
  49. Can a DVT cause a stroke?
    NO, dvt do not go to brain they go to the lungs. Afib can cause a clot that gets to brain
  50. What are s/s of left sided CVA?
    • right sided weakness, hemiplegia
    • impaired rt/left discrimination
    • impaired speech (broccas)
    • aware of deficiets
    • cautious slow preformance
    • anxiety
    • depression (patient understands what is wrong)
    • inpaired launguage and math comprehension
  51. What are s/s of righ sided CVA?
    • act like a teenager
    • impulsive
    • left sided weakness, hemiplegia
    • left side neglect
    • spatial deficits
    • deny problems
    • short attention span
    • impaired judgement
  52. What is sensory aphasia?
    • Receptive
    • Wernikies area damaged
    • trouble understanding words, can't comprehend
  53. What is motor aphasia?
    • Expressive
    • Damage to broccas area
    • can not form words, patient knows what is wrong but can not say it.
  54. What is mixed aphasia?
    • A deficit of expressive and receptive aphasia
    • cannot form words or comprehend
  55. What is a TIA?
    • temporary interuption of blood flow to the brain
    • impending sroke (warning sign)
    • tempory loss of vision
    • vertigo
    • confusion
    • all symptoms resolved with in 24 hours
  56. What are some nursing dx for TIA and CVA?
    • ineffective tissue perfusion
    • ineffective airway clearence
    • impaired physical mobility
    • impaired verbal communication
    • inability to swallow
    • low self esteem
    • unilateral neglect
  57. What does a nurse do for a CVA or TIA during an acute phase?
    • Maintain airway
    • monitor vital signs
    • keep blood pressure up to maintain cerebral perfusion
    • suction
    • Monito ICP
    • position side lying or low fowlers so patient does not choke on saliva
    • assess LOC
    • calm enviroment
    • monitor bowel and bladder function
    • IV fluids
    • monitor I/O
    • monitor electrolytes
    • give meds as ordered
  58. What would a nurse do during the post acute phase of a CVA or TIA?
    • turn and position Q2 hours
    • eye, mouth and skin care
    • passive range of motion
    • TED hose, SCD
    • test gag reflex
    • diet control (thickened liquids, puree)
  59. What would a nurse do during chronic phase of CVA or TIA?
    • monitor for neglect syndrome (show patient all sides)
    • PT, OT, ST
    • increase fluids, fiber
    • provide bowel care of choice
    • allow patient to express feelings
    • promote independance
    • offer assistive devices to help with ADL
    • encourage ROM, deep breathing exercises
  60. What are some drugs used for CVA?
    • tPA
    • Anticoagulants (warfarin, heparin)
    • Platelet inhibitors (aspirin, plavix)
  61. What is the protocal for tPA?
    • R/O hemorragic stroke
    • must be given with in 3 hours of onset of symptoms
    • plus what ever else hospital protocol is
  62. What is the action of tPA?
    goes in and finds clot and makes it break up
  63. What is a seizure?
    abnormal sudden excessive dicharge of electrical activity with in the brain

    interruption of normal brain function
  64. What are causes of seizures?
    • idiopatic
    • genetic
    • trama
    • tumors
    • circulatory/ metabolic disorders
    • toxcity
    • infections
    • electrolyte imbalance
    • liver failure
  65. What are the two types of seziures?
    • generalized (loss of conciousness) both sides of brain effected
    • partial (altered level of conciousness) one side of brain effected
  66. What is a tonic clonic seizure?
    • "grand mal"
    • generalized seizure
    • effects both sides of the brain
    • most commonly associated with epilepsy
    • TONIC= stiff like a bridge
    • CLONIC= jerking
  67. How do we assess a patient with history of siezures?
    • History
    • type
    • occurances before during and after
    • aura
    • loss of motor skills or bowel / bladder
    • loss of conciousness
    • postical state
  68. What does a nurse do during a seizure?
    • stay with patient
    • think safety (put patient in laying postion
    • record start and end time
    • have suction available
    • maintain airway
    • give O2
    • turn patient on side
    • loosen constrictive clothing
    • pad rails
    • evaluate respiratory status
    • administer medications
    • document
    • stay calm
    • provide privacy
  69. Why do we push valium and ativan during an active seizure?
    • depresses CNS
    • worried about patients safety
    • will decrease anxiety
  70. What is the reversal agent for a benzodiazepine?
    Romazecon
  71. What type of medications would you push during a active seizure?
    • CNS depressants
    • valuim
    • ativan
    • benzodiazopines
  72. What is an anticonvulsant?
    • used to depress abnormal neuronal discharges and prevent the spread of sezuires to adjacent neurons
    • (prevent seizures, not eliminating the cause)
    • classified as CNS depressants ( like a dimmer switch)
  73. What is the principal drug therapy for anticonvulsants?
    • single drug based on patients age, weight, type and frequency of seizure
    • increase dosage to reach theraputic range or until toxic side effects are noted
    • may need to be combined with other drugs
  74. What are some types of anticonvulsants?
    • Hydations
    • barbituates
    • valproates
    • bensodiazepines
  75. What is phenytonin (Dilantin)?
    • anticonvulasant (hydantoins)
    • Prevents partial and geneeralized seizures
    • can also be used as a antidysrhytmic
    • can be given IV, or PO
  76. How does phenytonin (dilantin) work?
    • binds to sodium channels suppressing sodium influx
    • prolongs the channel inactivation preventing nerve from firing
  77. What kind of fluid can you mix phenytonin (dilantin) with?
    • Can ONLY be mixed with normal saline
    • warm to room tempature to dissolve perceptitate
  78. What are side effects of phenytoin (dilantin)?
    • headache
    • diplopia
    • dizziness
    • low bp
    • nausea
    • discolored urine (pink, red, brown)
  79. What are adverse effects for phenytoin (dilantin)?
    • Ginigval hyperplasia (promote good oral care)
    • thrombocytopenia
    • bone marrow surpression
    • luekopenia
    • steven johnson syndrome
  80. What is steven johnson syndrome?
    • vare rear disease
    • flu like symptoms
    • rash
    • progesses to bright red skin that sloughs off like a burn patient
  81. What is theraputic phenytoin (dilantin) level?
    10-20
  82. Whta do nurses need to know about phenytoin (dilantin)?
    • also used to treat dysrythemias
    • decreases effectiveness of birth control
    • can cross blood brain barrier
    • cna cross into breast milk
    • can increase blood glucose levels
    • protien binding - can effect treatments for other disoders that require protien binding medicines like coumidin
    • monitor CBC, platelets, liver renal function
  83. What to teach patients taking phenytoin (dilantin)?
    • may cause drowiness
    • where id braclet
    • take at same time daily
    • avoid alcohol
    • maintain good oral hygiene
    • monitor blood glucose
    • will effect birthcontrol
  84. What is Phenobarbital (Luminal)?
    • barbituate
    • to prevent tonic-clonic and partial seizures, status epilepticus
    • CNS depressant
  85. what is the action of Phenobarbital (Luminal)?
    enhances the activities of GABA, which is an inhibitory neurotransmitter
  86. what is the theraputic range for phenobarbitol (luminal)?
    15-40 mcg/ ml
  87. What are the side effects of phenobarbitol (luminal)?
    • sedation
    • ataxia
    • dizziness
    • mood changes
    • hypotension
    • respiratory depression
  88. What is carbamazipine (tegretol)?
    • Iminostilbene - CNS depressant
    • decreases synaptic transmission in the CNS by effecting the sodium channels in neurons
  89. What is the theraputic range for carbamazipine (tegretol)?
    5-12 mcg/ml
  90. What are the theraputic uses of carbamazepine (tegretol)?
    • refactory seizures
    • tonic clonic seizures
    • bipolar disease
    • trigeminal neuralgia
    • neurological pain
  91. What MUST a patient avoud when using carbamazepine (tegretol)?
    DO NOT TAKE WITH GRAPEFRUIT JUICE

    can be toxic
  92. What is Levetiracetam (Keppra)?
    CNS depressant -- pyrrolidine
  93. What is the theraputic use for Levetiracetam (Keppra)?
    • complex partial and tonic clonic sezures
    • adjunctive and monotheroy
    • prevents propagation of sezuire activity (spreading to other neurons)
  94. What is meningitis?
    inflammation of the arachniod and pia mater of the brain and spinal cord

    ****medical emergency****
  95. What are the two types of meningitis?
    Bacterial and viral
  96. What is bacterial meningitis?
    • infection in the meningies
    • 100% mortailty rate if untreated
    • needs to be on antibiotics
    • Protien levels high in CSF, and glucose low beacuse bacteria feeds on glucose
  97. What is viral meningitis?
    • self limiting infection because virus does not continually reproduce
    • full recovery expected
    • glucose in CSF is with in normal limits
  98. What are signs and symptoms of meningitis?
    • nuchal ridigity
    • high fever
    • headache
    • photophobia
    • lethargy
    • rash (50% of patients)
    • disorientation
    • memory loss
    • IICP
    • seizures
    • Positive kernigs and brudzinkis sign
  99. What is a brudzinkies sign?
    postive results would be when patient is lying flat on his back and neck is pulled forward. Patient will react by puling legs up to relieves pain and pressure on the spine meninges
  100. What is a kernigs sign?
    positive results would be back pain and resistance to straightening when a leg is pulled up
  101. What test is performed to diagnosis and type meningitis?
    Lumbar puncture
  102. What is a lumbar puncture?
    A test where csk is removed from the spinal column via needle. It is removed in the lumbar region of the spine.
  103. What is the nurses role in a lumbar puncture?
    • postion patient in lateral recumbant (sidelying like a fetus)
    • reassure patient
    • hold patient still
    • label tubes and take to lab (do not use tube system)
    • post procedure have patient lay on back, bedrest
    • neuro assessment q3-6 hours
    • monitor for leakage
  104. What is encephalitis?
    inflammation of the brain
  105. What causes encephalitis?
    • meningitis
    • herpes simplex virus
    • west nile virus
  106. what are clinical manifestations of encephalitis?
    • cold sores
    • insect bites
    • infectious disease
    • travel
    • headache
    • nausea/ vomiting
    • altered LOC
    • IICP
    • neuro deficits
  107. What are some nursing diagnosis for menengitis/ encephalitis?
    • ineffective tissue perfusion
    • acute pain
    • hyperthermia
  108. What are nurisng interventions for menengitis?
    • neuro assessment
    • VS
    • assess for s/s of IICP
    • seizure precautions
    • isolation for bacterial
    • elevate HOB
    • quiet enviroment
    • keep lights dim
  109. What is myasthenia gravis?
    • an autoimmune disorder
    • antibodies attack acetycholine receptors
    • les stimulation of muscle contraction
    • causes deficient Ach transmission at the myoneural junction
    • prevents voluntary muscle and fine motor movements
  110. What muscles are most affected with myasthenia gravis?
    • eyelids (ptosis-droopy eyelid)
    • chewing
    • swallowing
    • speaking
    • breathing
  111. What are clinicla manifestations of myasthenia gravis?
    • fluctuating weakness of the skeletal muscles
    • ussally strongest after rest in am
  112. What are nursing diagnosis for myasthenia gravis?
    • impaired breathing
    • ineffective airway clearence
    • impaired verbal communication
    • imbalanced nutrition: less than required
    • Disturbed sensory perception
    • activity intolerence
    • disturbed body image
  113. What do nurses do for myasthenai gravis?
    • monitor respiratory status (have suction readily available)
    • monitor speech
    • monitor swallowing ability
    • administer anticholinesterase medications as ordered per patients schedule
    • educate patient on disease and to avoid stress, infection, and OTc medications
  114. What is a myasthenia crisis?
    • patient does not have enough anticholinesterase medication on board
    • patient is drooling, fatigue, weak, SOB
  115. What is treatment for myasthenia crisis?
    Give more meds- anticholnesterase meds
  116. What is a cholinergic crisis?
    • patient has to much anticholinergic medication on board
    • patient is drooling fatique, weak, sob
  117. What is the treatment for cholinergic crisis?
    give atropine
  118. Since myasthenia crisis and cholinergis crisis look the same how do we test to decide which one it is?
    Tensolin test
  119. What is the name for tensolon test medication?
    Edrophonium chloride (tensilon)
  120. what is a tensolin test?
    • it is a fast acting drug that shows if a patient has to LITTLE or to MUCH anticholinesterase on board
    • when given the medication if the patient has to LITTLE patient will get better withing 30-60 seconds
    • when patient has to MUCH patient will get worse.
    • This is a fast acting drug and only stays in the body for a few minutes
  121. What do medications to treat myasthenia gravis do?
    • Anticholinesterase
    • it inhibits the cholinesterase enzyme so ach is available to activate cholinergic receptors and promote muscle contraction
  122. What type of medication is Pryridostigine Bromide (mestinon)?
    • anticholnesterase drug
    • used to prevent distruction of acetocholine
    • will increase SLUD, and decrease HR, and BP
  123. When do we give Pryidostigmine Bromide (mestinon) to a patient with myasthenia gravis?
    • Given every 3-6 hours on patients schedule
    • helps promote breathing, swallowing, chewing
    • increases activity
  124. What does a nurse need to know when giving Pryriostigmine Bromide (mentinon)?
    • medication needs to be given on time per patients schedule
    • instruct patient to eat 45-60 minutes after medication
    • wear med alert bracelet
    • lifelong therapy
    • can be given up to 8 times per day
  125. What is Amyotrophic Lateral Sclerosis (ALS)?
    • Progressive neurologic disease
    • degenerates spinal MOTOR neurons
    • aka- lou Gehrigs disease
    • progresses from upper motor neurons to lower motor neurons
    • no known cure
    • can effect respiratory muscles
    • life expectancy 5 years
  126. What test can be done to determine if tremors are caused by Parkinson's disease?
    DAT scan
  127. What is parkinson's disease?
    • degenerative disease
    • depletion of dopimine or degeneration of dopamine neurons
  128. What are the four cardinal signs of Parkinson's disease?
    • Tremors- at rest
    • Rigidity
    • Bradykinesia (slow movement)
    • Posture instability
  129. What are clinical manifestations of Parkinson's disease?
    • Tremors- at rest
    • Rigidity
    • Bradykinesia (slow movement)
    • Posture instability
    • and pill rolling, fresing, mood swings, dementia, impaired memory, anxiety, shuffling gait, masked face, micrographia (really thin handwriting), hypophonia (monotone, low speech volume), slow thinking, akathisia (restlessness)
  130. What are some autonomic effects of parkinson's disease?
    drenching sweats, SOB, ORTHOstatic hypotension, sexual dysfunction, really oily skin (seborrhea)
  131. What are antiparkinsonian medications?
    • Dopaminergic agents
    • anticholiergic agents
    • dopamine agonist
    • Mao-B inhibitors
    • COMT inhibitors
  132. What are some nursing diagnosis for Parkinson's disease?
    • Impaired physical mobility
    • Impaired verbal communication
    • Deficient diversiona; activity
    • Imbalanced nutrition ; less than required
  133. What are some nursing interventions for parkinson's disease?
    • assess neuro status
    • assess ability to swallow / gag reflex
    • Encourage high fiber, calorie and protien diet with small frequent meals
    • 2-3 liters of fluid daily
    • do not rush patient
  134. What is Carbidopa / Levadopa (sinemet) used for?
    It is used to increase dopimine in the brain. Both medications are given together because dopimine can not cross the blood brain barrier.

    • This medication is used in Parkinson's patients
    • This medication is classified as a dopaminiergic agent
    • This medication reduces tremors and rigidity
  135. What are the side effects of Carbidopa/ Levodopa (sinemet)?
    • anorexia
    • nausea and vomiting
  136. What are the adversse reactions of Carbidopa/ Levodopa (sinemet)?
    • involuntary movement (dyskinesia)
    • orthostatic hypotension
    • urinary retention
  137. What are nursing interventions for a patients on Carbidopa/ Levodopa (sinemet)?
    • monitor VS
    • assess for s/s of orthostatic hypotension
    • educate patient on low protien diet
    • administer on patients schedule
    • do not stop meds
    • urine may be dark
    • limit vitamin B6
  138. What is Benztropine Mesylate (Cogentin)?
    • anticholinergic agent
    • used with adjunctant treatment for parkinson
    • decreases Ach
    • reduces rigidity
  139. What do we need to teach a patient taking Benztropine Mesylate (Cogentin) for Parkinson's?
    • This is an anti slud medication
    • will exerience dry mouth, constipation
    • educate patient on how to treat anti-SLUD problems
  140. What is multiple sclerosis?
    chronic, progressive degenerative disorder of the CNS

    has an unknown etilology, believe to be caused by a virus (antigen)
  141. Who is more likely to develop Multiple sclerosis?
    • white people
    • ages 20-50
    • women
    • northern europe decent
  142. What part of the brain is affected by MS?
    • mainly white matter because mylination is destroyed, but also grey matter
    • when matter is injured unreversable lesions develop
  143. How is MS diagnosed?
    • Time and Space
    • time = disease that occurs more than once
    • space= specific # of lesions on the brain (atleast 2)
  144. What are the 4 levels of MS?
    • RRMS
    • SPMS
    • PPMS
    • PRMS
  145. What is RRMS?
    • most prevalant type of MS
    • relaping and remitting
    • (times when you can move and then you recover, later you have another attack)
  146. What is SPMS?
    A decrease in relaspes with increased progression of MS
  147. What is PPMS?
    a slow and steady decline in a patient with MS
  148. What is PRMS?
    a steady progression of MS, patient has no remission period
  149. What are signs and symptoms of MS?
    • fatigue
    • ataxia/vertigo
    • tremors (more common in lower extremities)
    • parasthesias
    • emotional changes
    • blurred vision / diplopia
  150. What are some nursing diagnosis for MS?
    • impaired physical mobility
    • sexual dysfunction
    • impaired elimanation pattern
    • interrupter family processes
  151. What are treatment for MS?
    • immunomodulators
    • corticosteriods

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