AMS1

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alyn217
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165238
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AMS1
Updated:
2012-08-13 23:02:32
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AMS1T4 Chronic neuro disorders
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Chronic Neurological disorders
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  1. Basic info about MS
    • Pathology
    • autoreactive t-cells-->attack cns-->antigen/antibody rxn-->^inflamatory response-->demylenation of axons-->plaque formation replaces myleon sheath-->sclerois/inablity of axon to conduct elecrtrical impulse.
  2. aggrivating factors in ms
    • undue ratigue or exertion
    • overheating
    • infection
    • hot baths
    • fever
    • emotional stress
    • preggers. need to discuss with primary care to weigh options before deciding to become preggers.
  3. SnSs of MS
    • weakenss of LE's
    • parasthesia
    • loss of vision
    • poor coordination
    • bowel or bladder dysfunciton
    • seizures
    • emotional lability
    • sexual dysfucntnion
    • Uhtoff's sign?
  4. Know slide #5 
    Test
  5. Diagnostics for MS and collaborative care
    • H/P
    • MRI
    • CM?
  6. Parkingosn's
    • affects basal ganglia, specifically dopamine production in substantia nigra-->^ muscle rigidity-->v skeletal muscle activity
    • SnSs
    • tremor at rest
    • bradykinesia/akinesia (slow movement/frozen movement)
    • loss of postural respones
    • mask-like face
    • excessive drooling
    • slow speech
    • ans manifestations, ie excessive and uncontrolled sweating, sebaceous secretions, salivation, constipation, urinary incontincence, lacrimation
    • demenetia
    • depression
  7. Rx for parkinson's
    • sinement (levodopa, carbidopa)
    • levodopa: precursor to dopamine
    • carbidopa: inhibits enzyme that breads down levodopa
  8. Diagnostics/collaborative care of parkinson's
    • H/P
    • presence of classic triad, ie tremor, muscle regidity, bradykinesea/akinesea.
    • positive response to antiparkinsonian rx
    • Intervension:
    • Rx
    • Nutrition
    • Surgery
  9. Nursing Intervensions
    • Promote physical exercise
    • well-balanced diet, massive effort for movement-->^ caloric needs. 
    • pt/ot consultations
    • monitor for levodopa OD
    • assess ADLs 
    • appropriate referrals for equipment
    • supportive care
  10. Myasthenia gravis
    • progressive autoimmune diesease producing severe muscluar weakness due to antibodies destroying AChl receptors.
    • Women 20-40 most ast risk
  11. SnSs of Myasthenia gravis
    • skeletal muscle weakness
    • fatigue
    • weakness of eye closure
    • ptosis
    • dysphagia
    • dysarthria
    • mask-face
    • bobble head
    • respiratory distress
  12. Management of Myasthenia gravis
    • diagnostics:
    • h/p
    • emg
    • tensilon test: Rx given to keep Ach in synapse longer. if pt responds positively, then + myasthenia gravis
    • ana titer: checks for presence of antibodies for ACh. 
    • Rx:
    • anticholinesterase drugs
    • corticosteroids (antiinflamatory)
    • immunosupptressants (slows progression of disease)
  13. Nursing care of Myasthenia gravis
    • aspiration risk?
    • respiratory status, ie MG crisis. treated with mestinon
    • cholinergic crisis, ie drooling, constricted pupils, PNS symptoms. get worse with tinselon. Treated with atropine.

    • Dysphagia?
    • Nutrition/fluid status
    • TCDB
    • Semi-Fowler's position
    • Thickened liquids
    • Teaching
    • Referal to MG Foundation
  14. Amyotrophic Lateral Sclerosis
    Lue Gerig's disease
    • Degenerative progressive disorder with loss/death of motor neurons within brain and spinal cord
    • dead motor neurons do not transmit impusles to motor neurons
    • cognition is intact
    • leads to death from diagnosis in 2-6 years
    • men more at risk than women.
  15. ALS pathophys and SnSs
    Test
    • Unknown etiology, no cure.
    • weakness of upper extremities
    • dysarthria
    • dysphagia (have suction ready at bedside)
    • weakness in legs
    • respiratory nfxn/failure (late stage)
    • Rx:
    • Riluzole: only Rx available. decreases glutameat and slows progression.
  16. Huntington's disease
    • genetic autosomal dominant degenerative neurologic disease.
    • 50% chance to pass to offspring.
  17. Pathophys of Huntington's
    • destruction of neurons in the basal ganglia and extrapyramidal tracts-->v ACh and GABA-->^ Dopamine.
    • ^Dopamine-->SnSs opposite that of Parkinson's, ie exadurated writhing and uncontrolable movement of face and limbs. 
  18. SnSs
    • Chorea (diskinesiea)
    • emotional disturbances
    • mental deterioration
    • intellectual
  19. Rx for Huntingtons
    • terabenazine
    • haldol, diazepam, other anti-deressants/psychotics
    • Nursing management:
    • communication
    • nutrition
    • emotional support
    • injury prevention
    • ethtical dilemma, ie genetic testing and procreation. 
    • need~5000 calories/day diet to suppor dyskinesia.
  20. Guillain-Barre syndrome
    • ascending polyneuropathic paralysis
    • inflammatory disease, unknown etiology
    • loss of transmission of nerve impulses to periphery
    • diagnotsics
    • --presentation, LP, EMG.
  21. SnSs of guillain -barre
    • 1-3 weeks post uri/gi nfxn
    • ascending bilat weakness
    • pain-->narcotics. pain is neuropathic.
    • respiratory failure, uti, immobility.
  22. Collaborative care for GB
    • supportive care, steroids, may need to be intubated, npo, vented.
    • plasmapheresis
    • IV immunoglobulin
    • nutrition
    • 89-95% recovery rate
  23. Assessment of pt w/GB
    • neuro checks
    • lung sounds
    • airway
    • pain
    • bowel/bladder fnxn
    • immobility-->dvt, skin breakdown, PNA

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