med surg Neuro Flashcards

Terms Definitions
Guillain-Barre Syndrome: Promoting Communication
*Collaborate w/Speech Pathologist
*Develop communication system(blink for yes or no; pad for writing requests)
(due to weakened muscles for speech production)
What is a Herniated Disk?
*Lumbar Puncture: CSF
(increased CSF protein w/o an increase in cell count; lymphocyte count is normal)

*High protein levels occur after 1 to 2 weeks of illness, reaching peak at 4 to 6 weeks.
*(other tests
*Other Tests
1.)Electrophysiologic Studies-EPS- show demyelinating neuropathy.(testing results do not always accurately correspond with level of neuropathy)
2.)MRI/CT used to rule out other causes.
Guillain-Barre' Syndrome: Plasmapharesis
*Start PE for nonambulatory adult pt. who seek treatment w/in 4wks of onset of symptoms AND for ambulatory pts seen w/in 2 weeks of onset of symptoms.
Treatment: Pt usually receives 3-4 tx, 1 to 2 days apart.
Nursing Intervention:
Check for shunt patency, assess for bruits q2-4h, Keeping double bulldog clamps at bedside, observing puncture site for bleeding or ecchymosis. To treat paresthesias, add calcium gluconate or chloride to exchange fluids as ordered.
*Give ATROPINE in case of bradycardia
Medication treatment for Trigeminal Neuralgia?
Narcotic analgesics.
Anticonvulsants to reduce pain: Dilantin, tegretol, trileptal.
Baclofen- with anticonvulsants.
Proper dental care.
Types of closed Spinal Cord Injuries? (3)
What is another name for Spinal Shock?
Causes of Multiple Sclerosis (MS)?
Cause is unknown.
Probably autoimmune.
Genetic tendency, but not inherited.
Possibly viral, but not infectious.
Diagnosing Trigeminal Neuralgia?
Patient history.
Dental exam to r/o tooth problems.
MRI, CT to r/o other disorders.
How long does Spinal Shock (areflexia) last?
1-6 weeks.
Guillain-Barre' Syndrome: Drug Therapy
Drug Therapy for Guillain-Barre Syndrome
*Plasmapharesis or immunoglobulin(IVIG)-do not combine.
Why? PE removes circulating antibodies thought to be responsible for GBS.
*DO NOT USE CORTICOSTEROIDS unless necessary to treat other conditions.
GUILLAIN-BARRE' SYNDROME: Mgmt of Respiratory Status/Airway
Respiratory Status/Airway Mgmt: GBS

*Elevate HOB to 45 deg or higher depending on patient needs.
*Place patient on side, to prevent aspiration, log roll of cervical aspiration suspected.
*Monitor for signs of respiratory distress(dyspnea, lack/diminished breath sounds, air hunger, adventitious breath sounds, dec. O2 sat, cyanosis.
*Monitor patient's ability to cough and swallow
*Assess cognitive status, esp. elderly, a decline indicates hypoxia.
*Chest phys by RT
*Frequent position changes w/ breathing exercises(cough/deep breathe) to prevent atelectasis /pneumonia
*Keep ET kit at bedside
Treating Multiple Sclerosis (MS)?
Treatment is symptomatic & supportive.
Meds: Acute exacerbations- Steroids (IV then PO)
Clinical manifestations of Trigeminal Neuralgia?
Pain- mild to excruciating:
Sudden, burning, electrical shock-like, jolting, piercing, lightning-like, shooting, jabbing, like having wires in your face.
Usually comes & goes but may be persistant.
Usually leaves as quickly as it begins.
Usually one side of face (both sides possible).
Facial twitching and tearing.
Diagnosing Multiple Sclerosis (MS)?
History & physical exam
No specific test: Tests done to r/o other diseases. Or to collect bits & pieces to confirm.
EMG to evaluate neuromuscular function.
CT, MRI visualizes plaques.
EEG may be slow.
LP: Increased IGG, protein & WBC.
Diagnosing Bell's Palsy?
Based on history & physical exam.
CT, MRI, to r/o CVA, tumor.
EMG to determine extent & severity of damage.
What are vertebrae disks?
Disks that form cushion between vertebrae bodies.
Tough, fiberous material within a capsule.
Guillain-Barre' Syndrome: Pain Mgmt
*Pain is often worse at night
(paresthesias, hyperperesthesia, deep muscle aches, and muscle stiffness)
*Opiates effective for pain mgmt.
*PCA pump or continuous IV drip will be used.
*Also Gabapentin or tricyclic antidepressants
(Older patients due not get tricyclic antidep. cause urinary retention/blurred vision)
*Use nonpharm methods as well(massage, ice, imagery, hypnosis)
What is Bell's Palsy?
A temporary weakness or paralysis of the muscles that control expression on one side of the face.
Results from damage to the facial nerve (7th).
First priority with a Spinal Cord injury?
Immobilization of the spine.
Diagnosing a Spinal Cord Injury?
History and physical exam.
X-ray of spine.
Clinical manifestation of Herniated Disk?
Vary depending on level of injury.
Pain, weakness, paralysis, numbness, tingling radiating down arm or leg over distribution of nerve root.
Pain increases with straining, coughing & lifting because disk bulges more r/t increased CSF pressure in spinal column.
Eventually walking & sitting becomes difficult.
Loss of bowel & bladder control.
Guillain-Barre' Syndrome: Symptoms
*ASCENDING symmetric muscle weakness--flaccid paralysis
*Decreased or absent DTRs
*Respiratory compromise
*Loss of bowel sounds
*Facial Weakness
GBS is self limiting and paralysis is temporary!!!
How does Multiple Sclerosis affect nerve function?
Demyelination of nerves results in scarring & plaque formation, which causes poor nerve transmission.
Visual changes r/t Multiple Sclerosis (MS)?
Due to lesions on occipital lobe.
Nystagmus (involuntary movement of eyeball)
Diplopia (double vision)
Blurred vision
Blindness eventually
Herniated disks usually occur where?
Usually affects the cervical or lumbar disks.
Injury involved in a Subluxation Spinal Cord Injury?
Partial or incomplete dislocation of one vertebrae over another.
Spinal cord injury may or may not occur.
What is Autonomic Dysreflexia (hyperreflexia)?
Occurs with injury above T6 after spinal shock phase is over.
Stimuli --> massive sympathetic reflexive discharge from autonomic system --> catecholamine released --> vasoconstriction.
Clinical manifestations of Multiple Sclerosis (MS)?
Many & varied according to site of lesions- lesions scattered thoughout entire CNS
Repeated exacerbations result in increased scarring, therefore increased severity of s/s & increased residual deficits.
Biological response modifiers for Multiple Sclerosis (MS)?
Used to reduce severity & frequency of exacerbations.
ABC's of MS- use one:
Changes to hearing & speech r/t Multiple Sclerosis (MS)?
Decreased hearing & tinnitus r/t lesions in temporal lobe.
Speech is slurred & hesitant r/t muscle weakness & frontal lobe lesion.
Goals of treatment for Herniated Disk?
Rest & immobilization of spine to allow soft tissues time to heal.
Decrease inflammation of soft tissue & nerve roots.
Who is more prone to Trigeminal Neuralgia?
Females > Males
Usually after 50 yrs old.
How does a Compression Spinal Cord Injury occur?
Axial loading:  Fall from a height- landing on feet, buttocks or top of head- vertebrae explode or burst.
How does a Hyperextension Spinal Cord Injury usually occur?
Whiplash- mild form without injury to vertebrae or spinal cord from a rear end collision.
Fall and hit chin (ie falling on a slip and slide).
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