DNM

Cards (32)

  • Which disorders affect both motor and sensory nerves?
    Parkinson's, Multiple Sclerosis and Guillain-Barre
  • Which disorders affect just motor nerves?
    ALS and Myasthenia gravis
  • What are the primary symptoms of Parkinson's disease?
    T - Tremors 
     
    R – Rigidity of muscles 
     
    A - Akinesia/Bradykinesia   
     
    P – Postural instability  
  • Which conditions do exacerbations and crisis occur?
    Parkinson's, Multiple Sclerosis and Myasthenia Gravis
  • What are the primary symptoms of multiple sclerosis?
    • mental status changes: attention deficit, memory loss
    • patchy blindness
    • physical and mental fatigue
    • Muscle weakness
    • paraesthesia
    • bladder/bowel dysfunction
    • loss of balance
    • muscle tremors
  • What are symptoms of ALS?
    Spinal Sx
    • limb weakness
    • muscle twitching/spasicity
    • ASSYMETRIC muscle weakness progressing to paralysis
    • Respiratory muscle weakness
    Bulbar Sx:
    • dysarthria
    • dysphagia
    • atrophy of tongue
  • What are symptoms of myasthenia gravis?
    Bulbar Sx:
    • dysarthria
    • dysphagia
    • limited facial expressions
    Other Sx:
    • dilopia
    • drooping of eyelids (ptosis)
    • weakness in extremities
    • weakness in chest muscles
  • What are the symptoms of Guillain Barre syndrome?
    • symmetrical muscle weakness
    • can affect respiratory
    • paresthesia
    • neuropath
    • CNS facial/vagus nerve affected
  • What are the priority nursing diagnoses for Parkinson's disease?
    Falls Prevention, altered nutrition, risk for aspiration, communication
  • What is plasmapheresis?

    separation of plasma from blood cells; cells returned to body, plasma is discarded
  • Which of the DNM conditions can use plasmapheresis as a form of treatment?
    Guillain-Barré syndrome, Multiple sclerosis, myasthenia gravis
  • What are the major adverse effects of plasmapheresis?
    hypovolemia, hypokalemia, hypocalcemia
  • How often is plasmapheresis done?
    done daily and tapered to monthly
  • What are some primary nursing actions for the care of a client undergoing plasmapheresis?
    • hold meds until after the procedure
    • Monitor for hypotension = freq VS
    • Assess for bleeding
    • Monitor signs of electrolyte imbalance
  • How does electrolyte imbalance occur during the treatment of plasmapheresis?
    • Electrolytes become diluted w/ replacement fluid  
    • Hypocalcemia d/t citrate used during procedure that binds w/ CA 
    • Monitor for numbness, tingling, muscle cramps, arrhythmias  
    • Urticaria also observed  
  • What two medications are used in multiple sclerosis?
    Glatiramer (Copaxone), Fingolimid
  • What are the medications used for myasthenia gravis?
    Acetylcholinesterase inhibitors, immunosuppressants, corticosteroids.
  • What is Pyridostigmine ?
    • A: acetylcholinesterase inhibitor – prevents cholinesterase from inactivating acetylcholine  
    • S: GI Sx [cramps, diarrhea], drooling, bradycardia, muscle twitching 
  • What are some nursing care and teaching to be given with a client on Pyridostigmine?
    • Given PO, IV, IM, SQ; dose varies according to pt need 
    • Administer meds 1 hr AC (30min onset so that muscle strength to eat and decrease aspiration risk & inc absorption of food  
    • Hold med for HR < 60 
    • Monitor respiratory status  
    • Encourage pt to keep symptom diary  
    • Does w/ caution in those w/ asthma d/t bronchoconstriction 
    • Atropine = antidote  
  • What is Edrophonium (Tensilon)?
    • P: increase available Ach at myoneural junction by preventing breakdown; used a dx test for MG 
    • A: acetylcholinesterase inhibitor  
    • S: bronchospasm, arrhythmias, sweating, cramping  
  • What are some nursing care considerations for the administration of edrophonium (tensilon)?

    • Administer 2 mg of edrophonium IV; if no adverse rx give the remaining 8 mg within 5 min
    • If there is improved muscle strength lasting ~ 10 min, the test is positive to MG 
    • Pt on cardiac monitor & emergency airway equipment available 
    • Airway @ risk d/t respiratory muscle weakness
    • Monitor d/t bradycardia/asystole/VF
    • Have deliberator/pacer available 
  • What is the primary tx med for Parkinson's?
    Levodopa/carbidopa 
  • What is levodopa and cardipoda?
    Levodopa: medication for Parkinson's disease. Carbidopa: medication used with levodopa to treat Parkinson's disease.
    • P: primary tx for PD 
    • A: metabolic precursor of dopamine combined with carbidopa to cross BBB to restore dopamine lvls in the brain  
    • S: dyskinesias [abnormal involuntary movement ~ head bobbing, lip-smacking/grimacing], orthostatic hypotension, arrhythmias, N/V, constipation; many food & drug interactions  
  • What are some nursing care considerations for the patient on levodopa/carbidopa?
    • Safety precautions ~ unsteady gait w/ orthostasis increases fall risk; contraindicated in glaucoma 
    • Observe for sudden loss of effectiveness 
    • Medication teaching 
    • Take on time; don’t skip or stop suddenly or will have a PD crisis 
    • Has short half-life 
    • If NPO will see worsening of PD Sx w/in 24H 
    • Need low protein diet 
    • Many drug-drug interactions
  • What are common triggers for myasthenia crisis?
    infection, stress, temperature extremes, medications 
  • What are symptoms of a myasthenic crisis?
    respiratory distress, difficulty swallowing, muscle weakness  
  • What are the treatments for myasthenic crisis?
    Plasmapheresis and IV immunglobulin daily x5
  • How does IV immunoglobulin work compared to plasmapheresis?
    • IV immunoglobulin daily x 5 days  
    • Slower to work but quicker and easier than plasmapheresis  
    • P: suppresses T cell function 
    • S: same as transfusion rxn  
  • What does a cholinergic crisis in myasthenia gravis mean?
    Cholinergic Crisis (med overdose
    • Sx: respiratory distress, drooling, muscle twitching, GI Sx [cramping, diarrhea], bradycardia  
    • Sx occur 3060 min after taking meds 
    • Antidote is atropine 
  • What are your priority nursing problems for parkinson's disease?
    Falls prevention, Altered Nutrition, Communication, Aspiration Risk
  • What is your main focus for interventions for ALS?
    maintaining quality of life
  • What do all of the degenerative neuromuscular diseases have in common?
    muscle weakness, risk for aspiration, no cure, and progressive