NUR 202 - EXAM 3/EXAM QUESTIONS AND ACCURATE ANSWERS

NUR 202 - EXAM 3/EXAM QUESTIONS
AND ACCURATE ANSWERS
Parkinson'suDiseaseu-uans-
Auslowuprogressiveuneurologicalumovementudisorder;u*idiopathicuisutheumostucom
monuform*;ucharacterizedubyu*decreasedulevelsuofudopamine*uanduincreaseduexc
itatoryuneurotransmittersuleadingutouanuimbalanceuthatu*affectsuvoluntaryumoveme
nt*

*Theumajorityuofudamageuisudoneupriorutousymptoms*

CardinaluSymptomsuofuParkinson'suDiseaseu-uans--uTremor
-uRigidity
-uBradykinesia
-uPosturaluInstability

ClinicaluManifestationsuofuParkinson'suDiseaseu-uans--
u*Slow,uunilateralurestingutremor*upresentuatuDX,udisappearsuwithupurposefulumo
vementu(pill-rollingusouslowurhythmicumovementuofuhead)
-uRigidityu(shoulderupain)
-uAutonomicusisu(constipation,uurinaryuretention)
-uPsychiatricuchangesu(AH/VH,udementiauinu70%)
-uDysphagia
-uVisionuchanges
-uShuffled,ushort-steppedugait

DiagnosisuofuParkinson'suDiseaseu-uans-
Baseduonuhistoryuandu*presenceuofu2uofutheu4ucardinalusymptoms*

Patientuwillulikelyubeuunableutourecalluwhenusymptomsustarted

Diagnosisuconfirmeduwithuaupositiveulevodopautrial

MedicaluManagementuofuParkinson'suDiseaseu-uans-
*Noutreatmentupreventsutheuprogressionuofutheudisease*ugoaluisutoucontrolusymp
tomsuandumaintainufunctionaluindependence

-u*Pharmacological:*uanti-viralu&uanti-parkinsonianumedications
-u*DeepuBrainuStimulation:*utoublockuantiucholineurigidurelease
-u*SurgicaluManagement:*utemporaryufixuforusevereutremor/rigidityuorulevodopa-
inducedudyskinesia

,Parkinson'suDisease:uNursinguInterventionsu-uans--uRegularuexercise
-uWalkinguprograms
-uPosturaluexercise
-uWarmubaths
-uEnhanceuself-care
-uImproveubowelueliminationu(decreaseduuseuofulaxatives,uboweluschedule)
-uDailyuweights
-uNutritional/mealusupplementsu(Ensure)
-uMonitoruAlbuminulevel
-uEncourageuuseuofuassistiveudevicesuforufeeding,uwalking,utoileting
-uSpeechutherapy
-uSupportucopinguabilitiesu(r/tudepression/withdrawal)
-uInvolveuhomeu&ucommunityubasedusupports
-uPromoteuindependence

MultipleuSclerosisu-uans-Auprogressiveuimmune-
relatedu*demyelination*udiseaseuofutheuCNSucharacterizedubyurelapsinguanduremi
ttingucyclesuofusymptoms;unewusymptomsuoftenuexacerbateuoldusxs

Causeuremainsuunknown

ClinicaluManifestationsuofuMS:uRelapsinguCourseu-uans-AKAuRemittinguCourse

*85%*

-uRecoveryuisuusuallyucomplete
-uResidualudeficitsumayuoccuruanduaccumulate

ClinicaluManifestationsuofuMS:uPrimaryuProgressiveuCourseu-uans-*15%*

-uDisablingusymptomsusteadilyuincreaseuwithurateuplateaus
-
uMayuresultuinuquadrauparesis,ucognitiveudysfunction,uvisualuloss,u&ubrainustemu
syndromes

ClinicaluManifestationsuofuMS:uProgressiveuRelapsinguCourseu-uans-*5%*

-uContinuousudisablinguprogressionubetweenuexacerbations

GerontologicuConsiderationsur/tuMSu-uans--uShorterulifeuexpectancyubyu5-7uyears
-uAlterationsuinumedicationuabsorption,udistribution,umetabolismu&uexcretion
-uAdverseu&utoxicueffectsuofumedications
-uOsteoporosis
-uDecreasedumobility

MedicaluManagementuofuMSu-uans-*NoucureuofuMS*

,Goaluofutreatment:
-uDelayuprogressionuofutheudisease
-uManageuchronicusymptoms
-uTreatuacuteuexacerbation

PharmacologicuTherapyuforuMSu-uans--uInterferonuβ-1auanduinterferonuβ-1bu
-uGlatirameruacetateu(Copaxone)uSC
-uMitoxantroneu(Novantrone)uIV
-uNatalizumabuIV
-uMethylprednisoloneuIV
-u*Baclofen*u(mostucommon/meduofuchoiceuforuspasticity)

NursinguDiagnosesur/tuMSu-uans--uImpaireduphysicalumobility
-uRiskuforuinjury
-uImpairedubowelu&ubladderufunction
-uImpaireduverbalucommunication
-uDisturbeduthoughtuprocess
-uIneffectiveucoping
-uImpaireduhomeumaintenance
-uPotentialusexualudysfunction

Guillian-BarreuSyndromeu(GBS)u-uans-
Autoimmuneud/ouwithuacuteuattackuofuperipheralunerveumyelin.u
u
*Rapiduinflammatoryudemyelination*uofutheumayuproduceurespiratoryufailureu&uaut
onomicunervoususystemudysfunctionuwithuCVuinstability

GBS:uClinicaluManifestationsu-uans-Symptomsuareuvariable

-u*Weakness*
-uParalysisu(tetraplegia)
-uParasthesias
-uPain
-u*Diminisheduoruabsentureflexes*u(startsuwithuloweruextremities,umovesuup)
-uBulbaruweakness
-uCranialunerveusymptoms
-uTachycardiauoruBradycardia
-uHTNuoruhypotensionu

*Oftenuprogressionuofusymptomsuforu2uweeks,ufollowedubyuplateauuforu2-
4uweeks,uthenurecovery*

Miller-FisheruVariantuofuGBSu-uans-
Includesuparalysisuofutheuocularumuscles,uataxia,uanduareflexia.

, GBS:uDiagnosticuFindingsu-uans--
uAscendingusymmetricuweaknessuwithudiminishedureflexes
-uHistoryuofuviraluoruotheruillness
-u↑uproteinulevelsuinuCSFuwithunou↑uofuotherucells
-u*SerumuIgGuantibodiesutouGQIb*u-utherapyuofuchoice,uusefuluforutheuMiller-
Fisheruvariant

GBS:uMedicaluManagementu-uans--
uRequiresuintensiveucareumanagementuwithucontinuousumonitoringu&urespiratoryu
supportu*prepareuforuintubation*
-uPlasmapharesisu&uIVIGutoureduceucirculatinguantibodies

GBS:uNursinguAssessmentu-uans--uOngoinguassessment/earlyudetectionuofulife-
threateningucomplicationsuofurespiratoryufailure,ucardiacudysrhythmias,uanduDVT
-uResp.ufunctionuanduIS
-uMonitoruforu∆uinuvitalucapacityu&unegativeuinspiratoryuforce
-uAssessuVSufrequentlyuorucontinuously
-uContinueuECGumonitoring

*Paralyticuileumuisuaupotentialucomplication*

GBS:uNursinguDiagnosesu-uans--uIneffectiveubreathingupattern
-uImpairedugasuexchange
-uImpaireduphysicalumobility
-uImbalancedunutrition
-uImpaireduverbalucommunication
-uFear
-uAnxiety

GBS:uNursinguInterventionsu-uans--
u*Enhanceuphysicalumobilityu&upreventionuofuDVT/PE*
-uSupportulimbs
-uPreventuaspirationu(suctionuatubedside)
-uPlanuforucommunication
-uDecreasingufearuanduanxiety

MyastheniauGravisu-uans-
Autoimmuneudisorderuaffectingutheumyoneuralujunctionucharacterizedubyu*varyingu
degreesuofuweaknessuofutheuvoluntaryumuscles*

*Motorud/ouwithunoueffectuonusensation*

MG:uClinicaluManifestationsu-uans-*Fluctuatinguskeletalumuscleuweakness*
-uOcular:uinvolvesueyelidsuanduEOM
-uGeneralized:uOcularuanduotherumuscles
-u*BulbaruSymptoms:ufaceu&uthroatumuscleuweakness*