chronic neuro problems 2

Question 1

multiple sclerosis (MS)

Answer 1

• chronic, progressive, degenerative dx of the CNS

- demyelination of nerve fibers of the brain and spinal cord occurs

Question 2

population affected by MS

Answer 2

• ages 20-50

- women affected more than men

Question 3

cause of MS

Answer 3

• infectious
• immunologic
• genetic

Question 4

s/s of MS

Answer 4

• motor s/s
• sensory (tingling)
• Lhermitte’s sign
• lack of coordination
• depression
• constipation
• spastic or flaccid bladder
• lack of concentration and memory
• ED, decreased libido

Question 5

Lhermitte’s sign

Answer 5

when neck is flexed, electric shock felt

Question 6

diagnostic studies for MS

Answer 6

• H/P
• CSF analysis: increased IgG
• MRI: to look for scar tissue and demyelination

Question 7

drug tx for MS

Answer 7

• prednisone
• betaseron (immunomodulator)
• imuran (immunosuppressants)
• lioresal (muscle relaxant)
• ritalin
• oxybutynin
• ampyra (nerve conduction enhancer)

Question 8

nursing interventions for MS

Answer 8

• help pt ID triggers
• prevent major complications of immobility
• good balance of exercise and rest
• adeqaute intake of fiber
• avoiding the hazards of immobility
• self catherization
• avoid fatigue, extreme heat or cold, exposure to infection

Question 9

Parkinson’s disease (PD)

Answer 9

• chronic, progressive neurodegenerative disorder
• bradykinesia
• muscle rigidity
• tremors at rest
• gait disturbance

Question 10

s/s of PD

Answer 10

• onset is gradual and insidious

- classic triad: tremors, rigidity, bradykinesia

Question 11

complications of PD

Answer 11

• nonmotor and motor symptoms
• dementia and neuropsychiatric problems
• dysphagia
• general debilitation may lead to pneumonia, UTIs, and skin breakdown
• orthostatic hypotension, falls/injury

Question 12

diagnosing PD

Answer 12

• no specific tests
• firm dx made when 2/3 s/s seen of classic triad
• ultimate confirmation is positive response to antiparkinsons drugs

Question 13

drug tx of PD

Answer 13

• sinemet (levodopa with carbidopa)
• parlodel
• artane
• cogentin
• benadryl
• symmetrel
• eldepryl

Question 14

other tx for PD

Answer 14

• deep brain stimulation
• food easy to chew and swallow
• adeqaute roughage
• bite size pieces
• small meals
• limit protein and vitamin B6

Question 15

myasthenia gravis (MG)

Answer 15

-autoimmune dx of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups

Question 16

s/s of MG

Answer 16

• fluctuating weakness of skeletal muscles
• eyes, eyelids, chewing, swallowing, speaking, breathing
• peek’s sign: eyes don’t close completely
• impaired speech
• facial mobility and expression

Question 17

diagnostic studies for MG

Answer 17

• H/P, neuro exam
• EMG
• tensilon

Question 18

myasthenia crisis

Answer 18

• an acute exacerbation of muscle weakness
• aspiration
• respiratory insufficiency
• respiratory tract infection

Question 19

cholinergic crisis

Answer 19

• OD of anticholinestrase drug
• muscle twitching
• sweating
• excessive salivation
• constricted pupils

Question 20

drug tx of MG

Answer 20

• mestinon
• prednisone: to suppress immune system
• immunosuppressants: imuran, sandimmune

Question 21

surgery for MG

Answer 21

thymectomy

Question 22

other tx for MG

Answer 22

• plasmapheresis

- IV IgG

Question 23

plasmapheresis

Answer 23

• replacement of antibodies, since antibodies are attacking you
• usually done in crisis situation