Join our Nursing Review Community! Subscribe below. Its Free!

Join NurseReview.Org Community!

Get Connected With Other Nurses All Over The World! Its Free!! Enter your email to receive the Nursing Board Exam NLE Quick Result!


         Nursing Board Exam Result Subscribers PRC December NLE Quick Results Subscription

NurseReview.Org helps nurses all over the world keep in touch with each other. We provide an interactive environment where nurses can share their experience, ask questions regarding issues, provide assistance, etc.

If you want to be informed through email regarding NLE RESULTS, Nursing News, Retrogression Updates, New Nursing Board Exam Question & Answer, Latest Updates Regarding Nclex, please subscribe to us by filling in your email address above.

NOTE: You email address will be kept private and will not be distributed to spammers.
com/albums/dd234/jben501/philippinenurses/need_help_nursing.jpg" border="0" width="400" height="400" />

Tuesday, September 18, 2007

Peripheral Neurological Disorders & Central Nervous Center

If you're new here, you may want to subscribe to our RSS feed. One advantage of subscribing to RSS feeds is that you don't have to constantly re-visit this site to check for updates within specific sections you might be interested in because your browser or Feed reader will do this for you automatically on a regular basis plus you can even get email notification. Thank you so much. Enjoy!

Peripheral Neurological Disorders & Central Nervous Center Slideshow Transcript

Slide 1: Peripheral Neurological Disorders MG, GB

Slide 2: Common Nursing Diagnoses(there are more…) Mobility, Impaired Physical  Self Care Deficit  Disturbed Self Esteem  Fatigue  Respiratory Function, risk for impaired  Risk for Injury  Pain 

Slide 3: Myasthenia Gravis: “grave muscle weakness” Affects about one of every 7,500  people, all ethnic groups affected Onset usually between age 20 to 40 for  women. Later age of onset tends to include more men.

Slide 4: Pathophysiology Autoimmune response: decreases the number  of available acetylcholine receptors at the nerve to muscle junction. Antibodies bind to the receptor sites, render them useless. Without Ach receptors there is muscle weakness. Frequently goes with Thymus abnormalities 

Slide 5: Symptoms of MG: gradual onset common Weakness in muscles needed to talk,  chew, swallow. Ptosis  Drooling  Later, limb weakness, respiratory  muscle weakness

Slide 6: High Risk Nursing Care Issues Choking and/or aspiration during eating  and drinking Insufficient breathing effort due to  muscle weakness leads to respiratory crisis Falling 

Slide 7: Diagnosis of Myasthenia Gravis H & P: for signs and symptoms of muscle  weakness, patterns MRI or CT of Thymus  Labwork: look for increased antibody levels in  blood Tensilon Test. Tensilon is a short acting  anticholinesterase inhibitor. Give to patient, if see dramatic but short lived improvement in symptoms, + for MG. When physician is doing test, have atropine available.

Slide 8: Myasthenic Crisis Patient with MG can present with a severe  bout of symptoms, especially respiratory— may present like anxiety. Prevention involves taking care re  precipitants: menses, pregnancy (read in Lewis), stress, infection, over-exertion. Since overmedication can also cause  problems (cholinergic crisis), differentiate carefully.

Slide 9: Treatment with Medication Anticholinesterase drugs: inhibit the  destruction of acetylcholine and thus make more acetlycholine available at receptor sites. Two common ones are Prostigmin  (neostigmine) and Mestinon (pyridostigmine). Best taken about an hour prior to meals.  Also use prednisone (decrease inflammatory  response), other immunosuppressants, plasmapheresis, thymectomy

Slide 10: Guillain-Barre’ Syndrome Acute inflammatory process with  varying degrees of motor weakness and paralysis Immune system destroys the myelin  sheath – affects cranial, motor, and sensory neurons

Slide 11: Epidemiology 0.4-1.7 cases per 100,000  Affects all races and ages, but more  often seen among those over 45 and Caucasian

Slide 12: Symptoms of GB Flaccid paralysis with absent reflexes  Respiratory weakness/failure  Pain and paresthesias  Facial weakness with double vision and  trouble speaking

Slide 13: Respiratory Care

Slide 14: Medications

Slide 15: Other nursing care issues

Slide 19: Unit 8 CNS Problems: Read about Headaches and treatment  Read about Huntingtons Disease and  treatment Read about different types of Seizures  In this unit we will discuss Parkinson  Disease, Alzheimer’s Disease, MS, and SCI in class

Slide 20: Multiple Sclerosis: “Many areas of patchy destruction” About 250,000 to 300,000 people with  MS in the USA. More common among those living in the North, Caucasian descent. Typical onset is in young and middle  adult years.

Slide 21: Destruction of Myelin Sheath

Slide 22: MS Symptoms: Early and Later Early: Nystagmus, diplopia, blurry vision, mild  weakness, poor sensation, paresthesias. Pattern is quite variable, which makes diagnosis difficult Middle/Later: More serious weakness of  limbs, and can include paralysis, spasticity, ataxia. Numbness/tingling worsened. Continued eye, ear problems. Bowel and Bladder function may be affected  Emotionally difficult disease, Labile mood. 

Slide 23: Diagnosis of MS is Difficult No definitive test for MS  H & P remains central  MRI – look for plaques on neurons  Evoked potential study  CSF analysis, labwork 

Slide 24: Medical Treatment of MS: medication therapy Bethanecol  Glucocorticoids  Immunosuppressants  Skeletal muscle relaxants, eg Baclofen  and Dantrolene

Slide 25: MS: Multiple Nursing Care Issues Help the client avoid triggers to  exacerbation and to moderate activity level Later, immobility becomes a real issue,  and the complications of immobility require vigilant care Read your text re care plan. 

Slide 26: Assessment of seizure activity Observe, time and document carefully  Body movements, character, type  progression, include eye movements Loss of consciousness, incontinence  Precipitating factors you note  Post seizure (ictal) response. Confusion,  sleepiness common.

Slide 27: Issues in Seizure Precautions Tongue blade is outdated  Suction equipment nearby, IV or hep. lock if  risk is high for venous access Padding on bedrails/Observe client often  Avoid precipitants  Notify MD of new seizure, injury, unrelenting  seizure activity If client seizes, move objects away, side lying  if possible, loosen tight clothing, ease to floor or bed if possible

Slide 28: Status Epilepticus Defined as seizure over 4 minutes or in rapid  succession Life threatening due to brain damage mainly  Response involves ABC’s, IV administration  of anticonvulsants in a particular order. Usually valium first, if no response, dilantin and later a third drug are used. NG to control vomitus possibly. Review Anticonvulsant drugs discussed earlier 

Slide 29: Parkinson’s Disease: Triad 1. Tremor: hands, feet, steady rate,  resting, “pill rolling” 2. Rigidity: stiffening up, cogwheeling  3. Bradykinesia: less movement inc.  trunk, masklike face, moving “en bloc” and festinating gait (shuffling with accelerations)

Slide 30: More Parkinson’s Symptoms Decreased volume and variability of  voice Micrographia  Depression 50%  Dementia 10-40%  Psychosis 10%  Chronic, progressive disease 

Slide 31: Pathophysiology Pathway for disposing of flawed  proteins (Uch-Ll) is disturbed, leading to neuron death in substantia nigra. There is less dopamine available, symptoms don’t occur until about 80% destroyed. Gene on chromosome 4 is implicated in  the disease

Slide 32: Nursing Care of PD FASE: avoid fatigue, anxiety,  stimulation, and exertion Multiple care issues: injury prevention,  self care, nutrition, dysphagia, activity and rest, mobility, communication deficit, despair/grief, altered thought process, and knowledge deficit

Slide 33: Surgical Treatment of PD Pallidotomy: globus pallidus (which is  overactive in PD) is partly ablated—SE is occasional speech impairment Electronic Stimulator placement: Small  wire is set into brain and has a device placed in chest wall that can be stimulated to control increased tremors

Slide 34: Meds for Parkinson’s D. Levodopa—the precursor to dopamine  This drug chemically reverses the effect of  PD, enhances amt. of dopamine SE: nausea, hypotension, agitation and  hallucinations After several years, efficacy may decline  Don’t take with B-6 or if you have narrow  angle glaucoma

Slide 35: Sinemet: levodopa and carbidopa Adding carbidopa to levodopa allows  smaller dose of levodopa and fewer side effects Carbidopa prevents the breakdown of  levodopa When taking: have LFTs, RFTs, CBC  Many meds reverse the effect:  antipsychotics, dilantin, reserpine

Slide 36: Selegiline: Eldepryl MAOB inhibitor: decreases the  degradation of dopamine (note similarity to MAOIs) Careful use: many serious interactions  (opiods, SSRI’s, TCA’s) Limit tyramine rich foods in diet (You  will need to get familiar with list)

Slide 37: Other meds in PD Tasmar Mirapex   TCA’s Requip   Antihistamines For test know   sinemet, eldepryl Symmetrel  and be aware of Parlodel  others Pergolide 

Slide 38: Dementia: Basic Definitions Progressive deterioration in intellectual  functioning – MEMORY, LEARNING, and JUDGEMENT Onset insidious, chronic, and may be a  primary disorder

Slide 39: Types of Dementias-some Alzheimers DAT—see pathophys.  Picks; prominent emotional disinhibition  Huntington’s Chorea: inherited,  choreiform movement plus confusion Infarct Dementias  Korsakoffs slow starvation of brain  tissue ass. W/ alcoholism HIV encephalopathy 

Slide 40: Pathophysiology of DAT

Slide 41: Progression of Alzheimer’s Stage I: mild—forgetful. Short term memory loss,  aware of problem, depression common Stage II: moderate—confused. Progressive memory  deficits, Instrumental ADL’s decline, Cover with confabulation, denial Stage III: Severe—ambulatory dementia. Thinking and  communicating decrease, all ADLs decrease, depression resolves, person not aware of deficits Stage IV: Late. Loss of basic human abilities, identity  of self and family gone, physical deterioration

Slide 42: Treatment of Alzheimers Recent advances—correlation with head  trauma, disuse, large families 3 genes cause over production of alpha  beta Some possible protective factors-  vitamin E, antiinflammatory drugs, estrogen supp. Med: Tacrine/Cognex 

Slide 43: Nursing Diagnosis (some) Confusion, acute and chronic  Caregiver role strain  Memory, impaired  Wandering 

Slide 44: Spinal Cord Injury Epidemiology About 10-12,000 new cases per year, has  stayed stable over past 20 years. 80% male/20% female; 60% are young adult  males Currently about ¼ million paralyzed  individuals in the US Most frequent causes: MVA, gunshot (17%),  falls, diving, skiing, contact sport 50% paraplegia; 50% quadriplegia 

Slide 45: Pathophysiology Injury leads to:  lactate and chemical release causing vasospasm edema, hemorrhage All within a closed space: decreased circulation (decreased O2/glucose), build up of lactic acid

Slide 46: More Patho By limiting compression and edema, cell  death is minimized This can affect the level of injury.  Even a small gain in level of injury, can  mean the preservation of function of a group of muscles that can directly affect rehabilitation

Slide 47: Shock in SC Injury: acute period Spinal Shock Neurogenic shock   Flaccid paralysis  High level of injury  No bowel or bladder  hypotension, no persp. tone bradycardia No reflex activity  peripheral vasodilation Poikelothermia  NSG: dopamine, atropine, NSG: keep temp WNL,  MAST boots, tilt table, foley catheter, IV fluids, gradual position change Skin care, positioning, bowel regimen (suppositories)

Slide 48: When Spinal and Neurogenic shock subsides Typically see improvement in shock  symptoms after 1-6 weeks. Note: see spasticity, spastic bladder  Stabilization of VS.  A small percentage of clients continue  to have “flaccid” paralysis

Slide 49: Some treatment issues in acute period Time is important. Medical   CNS tissue does not management with survive for long. methylprednisone, Stabilization of spine mannitol, meds to  on site stabilize BP Techniques for CPR  Surgical  –jaw thrust decompression and Transfer to neuro  fixation/stabilization center asap

Slide 50: Nursing Issues: Acute period Spinal / Neurogenic shock  Altered respiratory function  Prevent DVT, skin breakdown and other  complications of immobility Body alignment  Post op infection risk 

Slide 51: Levels of Spinal Cord Innervation C-4 to C-6 Phrenic Nerve: diaphragm  function Upper Limbs C-7, C-8  T-1 to T-6 Intercostal muscles  T-1to L-4 Sympathetic outflow (HR,  bronchiole dilation, temp control) Bowel and Bladder at lowest level 

Slide 52: Autonomic Dysreflexia (also called hyperreflexia) Excess reflex arc stimulation, which fails to be  modified by messages from the brain, leads to a crisis. Sky high BP with bradycardia, headache,  sweating, blurred vision Can result in a CVA  NSG: raise HOB, Monitor VS, give  antihypertensive if needed, eliminate source of excess reflex activity such as kinked catheter, full bowel, etc.

Slide 53: More Notes about Nursing Issues: Enduring Problems Depression and suicide are common  About ¼ patients have chronic pain and  spasticity (antispasmodics) About 1/10 patients have decubiti  Altered respiratory function at higher  levels of injury is a continued concern- aspiration, atelectasis

Slide 54: Nursing Care Concerns Triple logroll technique to maintain  body alignment Skeletal/halo traction and care: pin  care, skin care under brace, proper fit Read in text re level of injury and  related ability and rehab potential

Article copyright - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.


Philippine Nurses in Action

Search for Nursing Jobs Abroad!

Quick Nursing Facts:

NLE Results December 2011 Results

December 2011 Nursing Board Exam Successful Examinees for the December NLE 2011

Nursing Board Exam July 2010 NLE PRC

July 2011 Nursing Board Exam Successful Examinee PRC

List of Successful Examinees for Nursing Licensure Examination July 2011 Conducted by the PRC

We are one of the few websites to post results right after the Philippine Regulatory Board have release the list of successful examinees

Results for July 2011 NLE Board Exam

July 2011 NLE Nursing Licensure Examination Results List Of Passers

Recommended Books

Filipino Nurse Tag Rolls

NursingReview.Org Disclaimer

© 2008-2009 NurseReview.Org This site contains links to other Web sites. The owner of this blog has no control over the content or privacy practices of those sites. The information provided here is for general information purpose only. Comments are moderated. If in any case the owner approves a comment, it should not be taken as an endorsement of that comment. The owner doesn't claim full ownership of all photos or articles posted on this site. If the respective copyright owners wish for their photos or articles to be taken down, feel free to e-mail me and it will be taken down immediately.