A&E II final exam with correct answers
Bell's Palsy - CORRECT ANSWERS ✔✔Peripheral Facial Nerve Paralysis (CNVII)
-Benign, unilateral
-cause unknown
-Flaccidity of affected side of face w/dropping of mouth
-recovery within a few weeks or months. Small number have long term facial
paralysis
Bell's palsy Clinical manifestations - CORRECT ANSWERS ✔✔-increased pain
-inability to close eys
-tearing
-flattening of naso-labial fold
-loss of taste
-dropping of mouth
-fever
-tinnitus
-pain behind the ear on affected side
Bell's Palsy Diagnosis - CORRECT ANSWERS ✔✔-by elimination
-electromyography
Bell's palsy meds - CORRECT ANSWERS ✔✔-prednison
-zovirax
,Bell's Palsy Nursing Interventions: - CORRECT ANSWERS ✔✔-pain meds
(acetaminophen)
-moist heat
-protect face
-nutrition (chew on unaffected side, oral hygiene)
-dark glasses
-eye patch
-artificial tears
Trigeminal neuralgia - CORRECT ANSWERS ✔✔Compression of the Trigeminal
nerve (CNV)
-involving maxillary and mandibular brances (ophthalmic usually spared)
-chronic pain syndrome
-unknown etiology
--nerve compression, herpes simplex, jaw and teeth infection
Trigeminal neuralgia Clinical manifestations - CORRECT ANSWERS ✔✔-abrupt
onset of excruciating facial pain
-burning, knife-like, electric shock-like
--effected areas: lips, gums, cheeks, forehead, or side of nose
-intense twitching, grimacing, blinking, eye tearing
-attacks are brief, 2-3 seconds, unilaterally
-course is unpredictable and cyclical
-precipitating stimuli: chewing, brushing teeth, hot or cold air, touch or tickle
,-poor nutrition and hygiene, withdrawal, excessive sleep
Trigeminal neuraligia Dx and MEdication - CORRECT ANSWERS ✔✔-hx of pain
-MRI, CT scan, Lumbar puncture to rule out other problems
-complete neurological assessment
-anti seizure meds: phenytoin, carbamazepine (stabilize the neuronal membrane)
Trigeminal neuralgia interventions - CORRECT ANSWERS ✔✔-surgical: to relieve
pain-injection of glycerol into trigeminal nerve roots
-environmental management: room temperature, draft free
-pt's perform own facial care, hygiene, oral care
-limit talking during acute periods
-assess nutritional status
gullian-barre syndrome etiology and pathophysiology - CORRECT ANSWERS ✔✔-
rare
-cause unknown-cell mediated immune reaction to peripheral nerves (autoimmune)
-preceded by viral infection, trauma, surgery, viral immunization
-destruction of myelin, edema/inflammation of nerves (PSN)
-muscle degeneration and atrophy
-2/3 of people with GBS had diarrhea or respiratory illness several weeks before
symptoms
-infection w/ campylobacter jejuni
, GBS clinical manifestations - CORRECT ANSWERS ✔✔-ascending muscle
weakness, flaccid paralysis, symmetric (distal muscles more affected)
-respiratory compromise/paralysis and infection
-loss of bowel and bladder functioning
-sensory paresthesia/paralysis
-cranial nerves-dysphagia, diplopia, facial weakness, autonomic nervous system
dysfunction
-labile BP, orthostatic hypotension, arrhythmias
GBS dx and tx - CORRECT ANSWERS ✔✔-DX: Spinal tap, EMG, brain MRI
-TX:
-supportive care-airway management, commplication of immobility
--frequent respiratory assessment
--chest PT, sputum cultures
--prevent paralytic ileus, DVT, PE
--prevent UTI
-plasmapheresis (plasma exchange): removal of plasma containing components
(auto-antibodies, antigen antibody complexes)
-immunoglobulin (IV Ig): monitor for fevers, chills, myalgia
Multiple sclerosis - CORRECT ANSWERS ✔✔-chronic auto immune disease
affecting myelin sheath and conductive pathway of CNS
-exact cause is unknown
-one of the leading causes of neurological disability in young adults
-disease usually affects young to middle aged adults
Bell's Palsy - CORRECT ANSWERS ✔✔Peripheral Facial Nerve Paralysis (CNVII)
-Benign, unilateral
-cause unknown
-Flaccidity of affected side of face w/dropping of mouth
-recovery within a few weeks or months. Small number have long term facial
paralysis
Bell's palsy Clinical manifestations - CORRECT ANSWERS ✔✔-increased pain
-inability to close eys
-tearing
-flattening of naso-labial fold
-loss of taste
-dropping of mouth
-fever
-tinnitus
-pain behind the ear on affected side
Bell's Palsy Diagnosis - CORRECT ANSWERS ✔✔-by elimination
-electromyography
Bell's palsy meds - CORRECT ANSWERS ✔✔-prednison
-zovirax
,Bell's Palsy Nursing Interventions: - CORRECT ANSWERS ✔✔-pain meds
(acetaminophen)
-moist heat
-protect face
-nutrition (chew on unaffected side, oral hygiene)
-dark glasses
-eye patch
-artificial tears
Trigeminal neuralgia - CORRECT ANSWERS ✔✔Compression of the Trigeminal
nerve (CNV)
-involving maxillary and mandibular brances (ophthalmic usually spared)
-chronic pain syndrome
-unknown etiology
--nerve compression, herpes simplex, jaw and teeth infection
Trigeminal neuralgia Clinical manifestations - CORRECT ANSWERS ✔✔-abrupt
onset of excruciating facial pain
-burning, knife-like, electric shock-like
--effected areas: lips, gums, cheeks, forehead, or side of nose
-intense twitching, grimacing, blinking, eye tearing
-attacks are brief, 2-3 seconds, unilaterally
-course is unpredictable and cyclical
-precipitating stimuli: chewing, brushing teeth, hot or cold air, touch or tickle
,-poor nutrition and hygiene, withdrawal, excessive sleep
Trigeminal neuraligia Dx and MEdication - CORRECT ANSWERS ✔✔-hx of pain
-MRI, CT scan, Lumbar puncture to rule out other problems
-complete neurological assessment
-anti seizure meds: phenytoin, carbamazepine (stabilize the neuronal membrane)
Trigeminal neuralgia interventions - CORRECT ANSWERS ✔✔-surgical: to relieve
pain-injection of glycerol into trigeminal nerve roots
-environmental management: room temperature, draft free
-pt's perform own facial care, hygiene, oral care
-limit talking during acute periods
-assess nutritional status
gullian-barre syndrome etiology and pathophysiology - CORRECT ANSWERS ✔✔-
rare
-cause unknown-cell mediated immune reaction to peripheral nerves (autoimmune)
-preceded by viral infection, trauma, surgery, viral immunization
-destruction of myelin, edema/inflammation of nerves (PSN)
-muscle degeneration and atrophy
-2/3 of people with GBS had diarrhea or respiratory illness several weeks before
symptoms
-infection w/ campylobacter jejuni
, GBS clinical manifestations - CORRECT ANSWERS ✔✔-ascending muscle
weakness, flaccid paralysis, symmetric (distal muscles more affected)
-respiratory compromise/paralysis and infection
-loss of bowel and bladder functioning
-sensory paresthesia/paralysis
-cranial nerves-dysphagia, diplopia, facial weakness, autonomic nervous system
dysfunction
-labile BP, orthostatic hypotension, arrhythmias
GBS dx and tx - CORRECT ANSWERS ✔✔-DX: Spinal tap, EMG, brain MRI
-TX:
-supportive care-airway management, commplication of immobility
--frequent respiratory assessment
--chest PT, sputum cultures
--prevent paralytic ileus, DVT, PE
--prevent UTI
-plasmapheresis (plasma exchange): removal of plasma containing components
(auto-antibodies, antigen antibody complexes)
-immunoglobulin (IV Ig): monitor for fevers, chills, myalgia
Multiple sclerosis - CORRECT ANSWERS ✔✔-chronic auto immune disease
affecting myelin sheath and conductive pathway of CNS
-exact cause is unknown
-one of the leading causes of neurological disability in young adults
-disease usually affects young to middle aged adults
