CNS + PNS (ms exam 2) with 100% correct answers 2024

neuro changes associated w aging - answer-slower processing time, change in sleep pattern, change in perception of pain (may not be able to rate pain), change in sensory perception of touch, alterations in balance and coordination. cognitive decline is often cause by drug interaction or toxicity, or inadequate oxygen supply to the brain. acute mental status change is often a key early sign of an infection. neuro assessment - answer-cranial nerves- include cranial never III ocolomoter (PERRLA) motor function- hand strength (grips), limb strength upper and lower limbs against resistance, DTR activity- babinski sensory function- pain and temp, pan perception, touch and 2 point discrimination cerebellar function- walk across room and turn, heel to toe, tip toe- romberg sign romberg sign - answer-sway with eyes closed, problem with prioception amyotrophic lateral sclerosis (ALS) - answer-chronic disease with unknown cause leading to progressive muscle weakness, leads to paralysis of respiratory muscles. affects men women, ^ risk w each decade of life life expectancy 3-5 years after diagnosis s/s of ALS - answer-dysarthria, dysphagia, fatigue, muscle weakness, muscle atrophy, stiff clumsy gait, twitching of face and tongue interventions for als - answer-riluzole/rilutek slows disease, but does not cure palliative care for symptom management interdiscplinary supportive and pscyhosocial care multiple sclerosis - answer-chronic disease r/t immune mediate demyelination and nerve injury; genetic and infectious factors may contribute degenerative disease that attacks the CNS (WBCs attack neurons, affect fatty tissue (myeline) around the nerve fibers in brain/spinal cord) progression is individualized. normal life expectancy w treatment. 4 types relapsing remitting MS - answer-most common + classic. symptoms resolve in weeks to months, will return to baseline before exacerbations primary progressive MS - answer-steady gradual progression, no remission. most commonly seen in older individuals 40-60 secondary progressive MS - answer-half of relapsing remitting patients develop this type. start having a steady progressive decline progressive relapsing MS - answer-relapses w partial recovery, but never return to baseline aggravating factors for MS - answer-fatigue, stress, overexertion, hot shower or bath, temp extremes MS c/m - answer-early: visual disturbances, difficulty with mobility, altered sensation most disabling: overwhelming fatigue muscle weakness, spasticity, intention tremor dysphagia, dysarthria, numbness, tingling, bladder/bowel dysfunction, sexual dysfunction, psychosocial impact diagnostic tests for MS - answer-no single definitive test, based on collective results- very frustrating for most people MRI: presences of plaques in brain and spinal cord: most definitive CSF analysis: ^ protein and IgG bands often present management goals for MS - answer-modify disease effects on immune system prevent exacerbations manage symptoms improve function maintain quality of life must avoid crowds and exposure to those with infections- report s.s of infection to HCP drugs for managing acute exacerbations or onset for MS - answer-corticosteroids to decrease inflammation- teach patient to avoid abruptly stopping med, monitor b/p, fluid retention, mood swings, ^ infection risk cyclophosphamide- synergistic with corticosteroid- together help decrease inflammation disease-modifying drugs for MS - answer-immunodilators- (injected- interferon beta: decreases episodes + slows disability. teach pt how to inject + rotate sites, first dose under medical supervision due to anaphalyctic shock). oral- causes facial flushing, GI disturbances, monitor liver test, ^ infection risk natalizumab- given IV, under medical supervision- anaphylactic shock HIGH risk- for progressive multifocal leukoencephalopathy (usually reserved for severe exacerbations) MS aggravating factors to avoid - answer-rigorous activity, stress, fatigue, overexertion, extreme temps + humidity, hot bath or shower, clutter and trip hazards in hospital and home. social isolation alleviating factors for MS - answer-collaborate with PT + OT for exercise programs ROM exercises, strength training, stretching use assistive devices collaborate with SLP for slurred speech and difficulty swallowing patch eye for double vision- alternate the eye patch 3-4 times/day back pain causes - answer-can be acute or chronic muscle strain or spasms, ligament sprain, disc degeneration, herniated nucleus pulposus, spinal stenosis, tumors, diminished blood supply, vertebral fracture contributing factors to back pain - answer-acute injury-fall, MVC,heavy lifting, repetitive flexion, extension and/or rotation of the spine. obesity and or smoking, osteoporosis. congenital spinal conditions (scoliosis) low back pain s/s - answer-spinal nerve(s) affected produces CMs HNP common at L4-L5 pain radiates down leg may include the foot motor (spasms), sensory (pain, numbness, tingling) spinal cord compression: leg weakness, bowel and bladder incontinent or retention cervical neck pain s/s - answer-spinal nerve(s) affected produces CMs HNP common at C5-C6 pain radiating down shoulder and arm motor (headache, spasms), sensory (pain, numbness, tingling) spinal cord compression: arm weakness, impaired grip back pain prevention - answer-use ergonomic concepts to adapt workplace to fit your workplace and home needs assess situation before lifting to determine needs (get help+ use assistive devices), use good posture when sitting, standing, and walking (avoid prolonged lying down, sitting, and standing), walk or swim frequently or strengthen back. keep weight within 10% of ideal body weight. ensure adequate calcium + vitamin D intake non surgical mgmt for acute and sub acute pain - answer-may include massage, spinal manipulation, heat, acupuncture NSAIDS if above methods unsuccessful williams position, soft neck collar limit bed rest, prolonged sitting, and standing when improving: PT for stretch, flexion, and extension exercises chronic back pain non surgical mgmt - answer-NSAIDs not relieving pain: tramadol recommnded OTC topical creams, gels, sprays (temp cold or warmth), transcutaneous electrical nerve stimulator (TENS), surgically implanted pump intrathecal (spinal) infusion: Ziconotide precautions- if hallucinations or delusions occur, stop med and notify HCP complications of laminectomy for low back pain - answer-acute urinary retention paralytic ileus watch dressings over surgical sites/infection if spinal cord stimulators - answer-neurovascular checks- sensory/motor checks of legs (if lumbar), arms (if cervical) complication of spine surgeries: CSFleak - answer-check surgical dressing and linens. bulging at incision site, clear drainage and/or halo sign, client often c/o sudden headache, place flat in supine position complication of spine surges: hematoma + bleeding - answer-bulging at incision site check any drains (hemovac, jackson pratt) report 250 mL/8 hrs from drains persistent or progressive radiculopathy (nerve root pain)- complications of spinal surgery - answer-report pain unresponsive to opioids + pain mgmt techniques document location and client subjective descriptions of pain n/v checks, sensory/motor checks of legs (lumbar), arms (if cervical) complications of cervical spine surgeries - answer-first priority: assess airway, breathing, circulation second priority: nv checks, sensory/motor checks of shoulders, grips bilaterally - vital signs, i + o, acute urinary retention complications: edema can place pressure on trachea can cause partial airway obstruction, esophageal, laryngeal (hoarseness), and vertebral artery injury home care mgmt for sugeries - answer-conventional open- activities restricted for several weeks- driving, lifting 5 lbs, no pushing or pulling, off work about 6 weeks if non strenuous job, 3-6 months if job is physically strenuous MIS procedure- resume usually activity in few days to 3 weeks both- encourage walking post op. continue weight loss and smoking cessation leave steri strips in place until they fall off, redressing per MD preference gullain-barre syndrome - answer-acute inflammatory polyradiculopathy, result of altered immunity. antibodies attack the axons and/or myelin of peripheral nerve axons. most cases immunologic response to infection: common bacterial- campylobacter jejune gastroenteritis, viral: CMV, flu, epstein barr, zika precipitating event 1-3 weeks before onset of euro symptoms assessment findings of gullain-barre syndrome - answer-abrupt onset muscle weakness, pain, parathesia. loss of DTRs in legs and arms. ascending flaccid motor paralysis without muscle atrophy "ground to brain" more on GBS - answer-acute phase- 1-4 weeks: onset of symptoms, ends when no further deterioration plateau period: several days to 2 weeks recover phase- 4-6 months, sometimes up to 2 years . usually self limiting and temporary, a few have permanent near deficits GBS problems - answer-potential for respiratory distress or failure r/t thoracic muscle weakness potential for cv failure secondary to cardiac dysrhythmias, bradycardia, and hypotension interventions for GBS - answer-plasmapheresis- removes circulating antibodies, plasma is removed from whole blood. whole blood returned to client. initiated within days; 3-4 treatments, 1-2 days apart. numerous potential complications. may have a shunt- assess (feel for thrill,auscultate for but), observe for bleeding and bruising. IV immunoglobulin (IVIG)- as effective, readily available. side effects: minor: flu like major: anaphylaxis, AKI GBS inteventions - answer-focused respiratory assessment: keep suction and intubation equipment at bedside. manage the airway- promote airway patency. elevate HOB at least 45 degrees. aspiration precautions. SLP eval. cardiac monitor- risk for dysrhythmias- report asap myathensia gravis (MG) - answer-acquired, progressive autoimmune disorder characterized by muscle weakness; remissions and eacerbations. increased risk if patient or fam history of autoimmune disorder. pathology of MG - answer-antibodies against acetylcholine receptor sites resulting in reduced impulses at the neuromuscular junction: nerve impulses do not result in muscle contraction. distortion of acetylcholine receptors relationship to overgrowth 75% of the thymus or tumors 10% of thymus 2 types of MG - answer-ocular and generalized- based on symptoms and and muscle groups affected any ocular weakness (typically least severe) need for intubation (can be severe) MG s/s - answer-fatigue and proximal muscle weakness that improves with rest ptosis, ocular palsies and diplopia facial expression and dysphagia poor posture, weak shoulders + thighs severe: respiratory compromise, loss of bowel and bladder, muscle aches MG diagnostics - answer-repititive nerve stimulation- best with generalized MG single fiber electromyography (SFEMG)- sensitive for generalized and ocular MG edtrophonium (tensilon) test: helps improve muscle strength in just a sec. risk for v fib and cardiac arrest. atropine: antidote for tensilon. if MG- improvement in muscle strength, tone within 30-60 seconds lasting 4-5 minutes if cholinergic crisis: no improvement MG medications - answer-anticholinesterase (mestinon, prostigmin): allow ^ ACh in neuromuscular junction immunosupressants: prednisone, cyclosporine, imuran plasmapheresis or IVG, thymectomy. take meds on time for therapeutic blood levels. taken 45-60 minutes before activities, plan meals and activities after meds, plan periods of rest, keep a secure supply in an easily accessed location myasthenic crisis - answer-medical emergency: risk for resp failure r/t under medication, missed doses, surgery, stress, or infection be alert for sudden and severe motor weakness AEB sudden inability to swallow, cough, speak, or maintain patent airway and resp distress tachycardia, tachypnea, hypertension, dysphagia. hold drugs for 2 days (b/c ^ secretions and initially ineffective in crisis) and restart slowly cholinergic crisis - answer-medical emergency (rare)- risk for respiratory failure r/t overdosage of anti cholinesterase medication- overstimulation at neuromuscular junction: muscles stop responding (flaccid paralysis) hypersecretion: salivation, lacrimation, diaphoresis bradycardia, bronchospasm, abdominal cramps, blurred vision, facial muscle twitching, pallor, hypotension treatment of cholinergic crisis - answer-hold anti cholinesterase meds administer antidote: atropine 1 mg IV support airway clearance + respirations MG surgery - answer-thymectomy (transcervical) for those without a thymoma- VATS approach thymectomy (sternal split) for those with thymoma monitor for complications: chest pain, SOA, dec chest wall expansion, dec breath sounds, changes in LOC, hypotension, tachycardia, if develop- start o2, elevate HOB 45 degree, and call HCP or a rapid q MG- community care - answer-teach family how to use a manual resuscitation bag, suction equipment, and oxygen- arrange to have above supplies at home teaching needs to avoid complications- take meds on time, keep med + water at BS, set time. wear medic alert bracelet. similar to MS- avoid heat, crowds, plan activities + rest periods, cut food in small pieces, small meals nutrition protect eyes- ocular MG - answer-avoid corneal abrasion- artificial tears during day, lubricant to eyes at night and patch diplopia- cover eyes w patch for 2-3 hours at a time, one eye at a time (while awake) restless leg syndrome - answer-leg paresthesia associated w persistent urge to move legs, symptoms worse at night high incidence: DM II, CKD, Fe deficiency, Parkinsons, peripheral neuropathy. treat underlying cause- avoid caffeine, ETOH, smoking, lose weight, get exercise. relief strategies: walking, stretching, moderate exercise, warm bath medications for restless leg syndrome - answer-dopamine agonist: pramipexole, ropinrole antiepileptics: gabapentin, melatonin for insomnia last resort: opioids benzodiazepines trigeminal neuralgia or tic douloureux - answer-chronic pain syndrome with exacerbations and remissions cranial nerve V (trigeminal)- excessive firing of irritated fibers. 50 years old, women men excruciating facial pain: unilateral, sudden and intense, seconds to minutes priority: pain mgmt triggers for trigeminal neuralgia - answer-light touch, dental procedure, washing face, chewing, changes in facial expression, trauma and infection of teeth, jaw or ear meds for trigeminal neuralgia - answer-1st choice: carbamazepine, gabapentin, pregablin, baclofin- decrease afferent impulses to nerve surgery for trigeminal nerualgia - answer-percutaenous stereotactic rhizotomy- entire nerve is not destroyed. preserves facial touch, but insensitive to pain avoid rubbing affected eye, avoid chewing food on affected side can use ice pack on affected side to control pain- can be at risk for altered nutrition- avoid hot food + liquids, need to inspect affected side of mouth bells palsy - answer-acute unilateral facial paralysis- inflammation of these nerve cranial VII- pain behind ear or one face. flaccidity on affected side paralysis 2-5 days. r/t reactivated herpes simplex virus- 1 80% have full recovery in weeks 2 months provide psychosocial support bells palsy interventions - answer-corticosteroids daily for one week analgesics antivirals- acyclovir- for 7-10 days (since associated with herpes) moist heat, gentle massage risk for eye injury- artificial tears, patch eye or tape shut at bed time nursing implications for changes in nervous system related to aging - answer-provide sufficient time for older adult to respond, reinforce teaching by reputation, remind patient to change position frequently, instruct patient to move slowly when changing positions, monitor carefully for infection, provide usual bedtime routines lumbar puncture action alert - answer-it is very important that the patient not move during a lumbar puncture. if the patient is restless or cannot cooperate two people may need to assist. prepping patient for lumbar puncture - answer-position patient in fetal side lying position prevention of musculoskeletal injuries - answer-do not twist your back during movement, avoid shoulder stooping, do not walk or stand in high heeled shoes for prolonger periods spinal cord stimulators QSEN - answer-for patients who have a spinal cord stimulator implanted in the epidural space- assess near status below the level of insertion frequently- if any changes occur- document + report to surgeon immediately MS qsen - answer-large genome studies have identify familial patterns for MS- first degree relative ^ risk substantially gender health MS qsen - answer-MS affects women 2-3x more often than men, suggesting a possible hormonal role in disease development. drug alert qsen- for lower back pain - answer-zicontide can be given with opioid analgesics but should not be given to patients w severe mental health/behavioral health problems because it can cause psychosis- if symptoms such as hallucinations and delusions occur, teach patients to stop the drug ASAP and notify HCP action alert QSEN - answer-if a shunt is used for plasmapheresis, be sure to: check shunt patency by assessing the presence of bruit of thrill every 2-4 hours. keep double bull dog clamps at beside. observe the access site for bleeding or eccomyosis. improving nutrition in patients who have MG - answer-assess patients gag reflex and ability to chew and swallow. provide frequent oral hygiene as needed. cut food into small bites. provide high calorie snacks or supplements. keep HOB elevated.