MEDICAL SURGICAL

Overview of the Structures & Functions of Nervous System

Central NS PNS ANS
Brain & spinal cord 31 spinal & cranial sympathetic NS
Parasypathatic NS
Somatic NS
C- 8
T- 12
L- 5
S- 5
C- 1
ANS (or adrenergic of parasympatholitic response)
SNS involved in fight or aggression response Effects of SNS (anti-cholinergic/adrenergic)
1. Dilate pupil 1 to aware of surroundings
Release of norepinephrine (adrenaline 1 cathecolamine) - medriasis
Adrenal medulla (potent vasoconstrictor) 2. Dry mouth
Increases body activities VS = Increase 3. BP & HR= increased
Except GIT 1 decrease GITmotility bronchioles dilated to take more oxygen
4. RR increased
* Why GIT is not increased = GIT is not important! 5. Constipation & urinary retention
Increase blood flow to skeletal muscles, brain & heart.
I. Adrenergic Agents 1 Epinephrine (adrenaline)
SE: SNS effect
II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in 埋lol.)
- Blocks release of norepinephrine.
- Decrease body activities except GIT (diarrhea)
Ex. Propanolol, Metopanolol
SE:
B 1 broncho spasm (bronchoconstriction)
E 1 elicits a decrease in myocardial contraction
T 1 treats HPN
A 1 AV conduction slows down
Given to angina & MI 1 beta-blockers to rest heart
Anti HPN agents:
1. Beta blockers (-lol)
2. Ace inhibitors (-pril) ex ENALAPRIL, CAPTOPRIL
3. Calcium antagonist
ex CALCIBLOC or NEFEDIPINE
Peripheral nervous system: cholinergic/ vagal or sympatholitic response Effect of PNS: (cholinergic)
- Involved in fly or withdrawal response 1. Meiosis 1 contraction of pupils
- Release of acetylcholine (ACTH) 2. Increase salivation
- Decrease all bodily activities except GIT (diarrhea) 3. BP & HR decreased
4. RR decrease 1 broncho
constriction
I Cholinergic agents 5. Diarrhea 1 increased GI motility
ex 1. Mestinon 6. Urinary frequency
Antidote 1 anti cholinergic agents Atropine Sulfate 1 S/E 1 SNS
S/E- of anti-hpn drugs:
1. orthostatic hpn
2. transient headache & dizziness.
-Mgt. Rise slowly. Assist in ambulation.
CNS (brain & spinal cord)
I. Cells 1 A. neurons
Properties and characteristics
a. Excitability 1 ability of neuron to be affected in external environment.
b. Conductivity 1 ability of neuron to transmit a wave of excitation from one cell to another
c. Permanent cells 2 once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes)
Regenerative capacity
A. Labile 2 once destroyed cant regenerate
- Epidermal cells, GIT cells, resp (lung cells). GUT
B. Stable 2 capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver,
kidney cells
C. Permanent cells 2 retina, brain, heart, osteocytes can.t regenerate.
3.) Neuroglia 2 attached to neurons. Supports neurons. Where brain tumors are found.
Types:
1. Astrocyte
2. Oligodendria
Astrocytoma 2 90 2 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte.
Astrocyte 2 maintains integrity of blood brain barrier (BBB).
BBB 2 semi permeable / selective
-Toxic substance that destroys astrocyte & destroy BBB.
Toxins that can pass in BBB:
1. Ammonia-liver cirrhosis.
2. 2. Carbon Monoxide 2 seizure & parkinsons.
3. 3. Bilirubin- jaundice, hepatitis, kernicterus/hyperbilirubenia.
4. 4. Ketones –DM.
OLIGODENDRIA 2 Produces myelin sheath 2 wraps around a neuron 2 acts as insulator facilitates rapid
nerve
impulse transmission.
No myelin sheath 2 degenerates neurons
Damage to myelin sheath 2 demyellenating disorders
DEMYELLENATING DSE
1.)ALZHEIMER’S DISEASE2 atrophy of brain tissue due to a deficiency of acetylcholine.
S&Sx:
A 2 amnesia 2 loss of memory
A 2 apraxia 2 unable to determine function & purpose of object
A 2 agnosia 2 unable to recognize familiar object
A 2 aphasia –
- Expressive 2 brocca.s aphasia 2 unable to speak
- Receptive 2 wernickes aphasia 2 unable to understand spoken words
Common to Alzheimer 2 receptive aphasia
Drug of choice 2 ARICEPT (taken at bedtime) & COGNEX.
Mgt: Supportive & palliative.
Microglia 2 stationary cells, engulfs bacteria, engulfs cellular debris.
II. Compositions of Cord & Spinal cord
80% - brain mass
10% - CSF
10% - blood
MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will
increase ICP.
Normal ICP: 0-15mmHg
Brain mass
1. Cerebrum 2 largest - Connects R & L cerebral hemisphere
- Corpus collusum
Rt cerebral hemisphere, Lt cerebral hemisphere
Function:
1. Sensory
2. Motor
3. Integrative
Lobes
1.) Frontal
a. Controls motor activity
b. Controls personality development
c. Where primitive reflexes are inhibited
d. Site of development of sense of umor
e. Brocca.s area 3 speech center
Damage - expressive aphasia
2.) Temporal –
a. Hearing
b. Short term memory
c. Wernickes area 3 gen interpretative or knowing Gnostic area
Damage 3 receptive aphasia
3.) Parietal lobe 3 appreciation & discrimation of sensory imp
- Pain, touch, pressure, heat & cold
4.) Occipital - vision
5.) Insula/island of reil/ Central lobe- controls visceral fx
Function: - activities of internal organ
6.) Rhinencephalon/ Limbec
- Smell, libido, long-term memory
Basal Ganglia 3 areas of gray matte located deep within a cerebral hemisphere
- Extra pyramidal tract
- Releases dopamine-
- Controls gross voluntary unit
Decrease dopamine 3 (Parkinson.s) pin rolling of extremities & Huntington.s Dse.
Decrease acetylcholine 3 Myasthenia Gravis & Alzheimer.s
Increased neurotransmitter = psychiatric disorder Increase dopamine 3 schizo
Increase acetylcholine 3 bipolar
MID BRAIN 3 relay station for sight & hearing
Controls size & reaction of pupil 2 3 3 mm
Controls hearing acuity
CN 3 3 4
Isocoria 3 normal size (equal)
Anisocoria 3 uneven size 3 damage to mid brain
PERRLA 3 normal reaction
DIENCEPHALON- between brain
Thalamus 3 acts as a relay station for sensation
Hypothalamus 3 (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center,
emotional responses, controls pituitary function.
BRAIN STEM- a. Pons 3 or pneumotaxic center 3 controls respiration
Cranial 5 3 8 CNS
MEDULLA OBLONGATA- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus
Vasomotor center, spinal decussation termination, CN 9, 10, 11, 12
CEREBELLUM 3 lesser brain
- Controls posture, gait, balance, equilibrium
Cerebellar Tests:
a.) R 3 Romberg.s test- needs 2 RNs to assist
- Normal anatomical position 5 3 10 min
(+) Romberg.s test 3 (+) ataxia or unsteady gait or drunken like movement with loss of balance.
b.) Finger to nose test –
(+) To FTNT 3 dymetria 3 inability to stop a movement at a desired point
c.) Alternate pronation & supination
Palm up & down . (+) To alternate pronation & supination or damage to cerebellum 3 dymentrium
Composition of brain - based on Monroe Kellie Hypothesis
- Skull is a closed container. Any alteration in 1 of 3 intracranial components = increase in ICP
Normal ICP 3 0 3 15 mmHg
Foramen Magnum
C1 3 atlas
C2 3 axis
(+) Projectile vomiting = increase ICP
Observe for 24 - 48 hrs
CSF 4 cushions the brain, shock absorber
Obstruction of flow of CSF = increase ICP
Hydrocephalus 4 posteriorly due to closure of posterior fontanel
CVA 4 partial/ total obstruction of blood supply
INCREASED ICP 4 increase ICP is due to increase in 1 of the Intra Cranial components.
Predisposing factors:
1.) Head injury
2.) Tumor
3.) Localized abscess
4.) Hemorrhage (stroke)
5.) Cerebral edema
6.) Hydrocephalus
7.) Inflammatory conditions - Meningitis, encephalitis
B. S&Sx change in VS = always late symptoms
Earliest Sx:
a.) Change or decrease LOC 4 Restlessness to confusion Wide pulse pressure: Increased ICP
- Disorientation to lethargy Narrow pp: Cardiac disorder, shock
- Stupor to coma
Late sign 4 change in V/S
1. BP increase (systolic increase, diastole- same)
2. Widening pulse pressure
Normal adult BP 120/80 120 4 80 = 40 (normal pulse pressure)
Increase ICP = BP 140/80 = 140 4 80= 60 PP (wide)
3. RR is decreased (Cheyne-Stokes = bet period of apnea or hyperpnea with periods of apnea)
4. Temp increase
Increased ICP: Increase BP Shock 4 decrease BP –
Decrease HR Increase HR CUSHINGS EFFECT
Decrease RR Increase RR
Increase Temp Decrease temp
b.) Headache
Projectile vomiting
Papilledima (edema of optic disk 4 outer surface of retina)
Decorticate (abnormal flexion) = Damage to cortico spinal tract /
Decerebrate (abnormal extension) = Damage to upper brain stem-pons/
c.) Uncal herniation 4 unilateral dilation of pupil. (Bilateral dilation of pupil 4 tentorial herniation.)
d.) Possible seizure.
Nursing priority:
1.) Maintain patent a/w & adequate ventilation
a. Prevention of hypoxia 4 (decrease tissue oxygenation) & hypercarbia (increase in CO2
retention).
Hypoxia 4 cerebral edema - increase ICP
Hypoxia 4 inadequate tissue oxygenation
Late symptoms of hypoxia 4 B 4 bradycardia
E 4 extreme restlessness
D 4 dyspnea
C 4 cyanosis
Early symptoms 4 R 4 restlessness
A 4 agitation
T 4 tachycardia
Increase CO2 retention/ hypercarbia 4 cerebral vasodilatation = increase ICP
Most powerful respiratory stimulant increase in CO2
Hyperventilate decrease CO2 4 excrete CO2
Respiratory Distress Syndrome (RDS) 4 decrease Oxygen
Suctioning 4 10-15 seconds, max 15 seconds. Suction upon removal of suction cap.
Ambu bag 5 pump upon inspiration
c. Assist in mechanical ventilation
1. Maintain patent a/w
2. Monitor VS & I&O
3. Elevate head of bed 30 5 45 degrees angle neck in neutral position unless contra indicated to
promote venous drainage
4. Limit fluid intake 1,200 5 1,500 ml/day
(FORCE FLUID means:Increase fluid intake/day 5 2,000 5 3,000 ml/day)- not
for inc ICP.
5. Prevent complications of immobility
6. Prevent increase ICP by:
a. Maintain quiet & comfy environment
b. Avoid use of restraints 5 lead to fractures
c. Siderails up
d. Instruct patient to avoid the ff:
-Valsalva maneuver or bearing down, avoid straining of stool
(give laxatives/ stool softener Dulcolax/ Duphalac)
- Excessive cough 5 antitussive
Dextrometorpham
-Excessive vomiting 5 anti emetic (Plasil 5 Phil only)/ Phenergan
- Lifting of heavy objects
- Bending & stooping
e. Avoid clustering of nursing activities
7. Administer meds as ordered:
1.) Osmotic diuretic 5 Mannitol./Osmitrol promotes cerebral diuresis by decompressing brain
tissue
Nursing considerations: Mannitol
1. Monitor BP 5 SE of hypotension
2. Monitor I&O every hr. report if < 30cc out put
3. Administer via side drip
4. Regulate fast drip 5 to prevent formation of crystals or
precipitate
2.) Loop diuretic - Lasix (Furosemide)
Nursing Mgt: Lasix
Same as Mannitol except
- Lasix is given via IV push (expect urine after 10-15mins) should
be in the morning. If given at 7am. Pt will urinate at 7:15
Immediate effect of Lasix within 15 minutes. Max effect 5 6 hrs due
(7am 5 1pm)
S/E of Lasix
Hypokalemia (normal K-3.5 5 5.5 meg/L)
S&Sx
1. Weakness & fatigue
2. Constipation
3. (+) 填5 wave in ECG tracing
Nursing Mgt:
1.) Administer K supplements 5 ex Kalium Durule, K chloride
Potassium Rich food:
ABC.s of K
Vegetables Fruits
A - asparagus A 5 apple
B 5 broccoli (highest) B 5 banana 5 green
C 5 carrots C 5 cantalope/ melon
O 5 orange (highest) –for digitalis
toxicity also.
Vit A 5 squash, carrots yellow vegetables & fruits, spinach, chesa
Iron 6 raisins,
Food appropriate for toddler 6 spaghetti! Not milk 6 increase bronchial
secretions
Don.t give grapes 6 may choke
S/E of Lasix:
1.) Hypokalemia
2.) Hypocalcemia (Normal level Ca = 8.5 6 11mg/100ml) or Tetany:
S&Sx
weakness
Paresthesia
(+) Trousseau sign 6 pathognomonic 6 or carpopedal spasm. Put bp cuff on
arm=hand spasm.
(+) Chevostek.s sign
Arrhythmia
Laryngospasm
Administer 6 Ca gluconate 6 IV slowly
Ca gluconate toxicity: Sx 6 seizure 6 administer Mg SO4
Mg SO4 toxcicity6 administer Ca gluconate
B 6 BP decrease
U 6 urine output decrease
R 6 RR decrease
P 6 patellar reflexes absent
3.) Hyponatremia 6 Normal Na level = 135 6 145 meg/L
S/Sx 6 Hypotension
Signs of Dehydration: dry skin, poor skin turgor, gen body
malaise.
Early signs 6 Adult: thirst and agitation / Child: tachycardia
Mgt: force fluid
Administer isotonic fluid sol
4.) Hyperglycemia 6 increase blood sugar level
P 6 polyuria
P 6 polyphagia
P 6 polydipsia
Nsg Mgt:
a. Monitor FBS (N=80 6 120 mg/dl)
5.) Hyperurecemia 6 increase serum uric acid. Tophi- urate crystals in joint.
Gouty arthritis kidney stones- renal colic (pain)
Cool moist skin
Sx joint pain & swelling usually at great toe.
Nsg Mgt of Gouty Arthritis
a.) Cheese (not sardines, anchovies, organ meat)
(Not good if pt taking MAO)
b.) Force fluid
c.) Administer meds 6 Allopurinol/ Zyloprim 6 inhibits synthesis of uric acid 6 drug of
choice for gout
Colchicene 6 excretes uric acid. Acute gout drug of choice.
Kidney stones 6 renal colic (pain). Cool moist skin
Mgt:
1.) Force fluid
2.) Meds 6 narcotic analgesic
Morphine SO4
SE of Morphine SO4 toxicity
Respiratory depression (check RR 1st)
Antidote for morphine SO4 toxicity –Narcan (NALOXONE)
Naloxone toxicity 6 tremors
Increase ICP meds:
3.) Corticosteroids - Dexamethsone 7 decrease cerebral edema (Decadrone)
4.) Mild analgesic 7 codeine SO4. For headache.
5.) Anti consultants 7 Dilantin (Phenytoin)
Question: Increase ICP what is the immediate nsg action?
a. Administer Mannitol as ordered
b. Elevate head 30 7 45 degrees
c. Restrict fluid
d. Avoid use of restraints
Nsg Priority 7 ABC & safety
Pt suffering from epiglotitis. What is nsg priority?
a. Administer steroids 7 least priority
b. Assist in ET 7 temp, a/w
c. Assist in tracheotomy 7 permanent (Answer)
d. Apply warm moist pack? Least priority
Rationale: Wont need to pass larynx due to larynx is inflamed. ET can.t pass. Need tracheostomy only-
Magic 2’s of drug monitoring
Drug N range Toxicity Classification Indication
D 7 digoxin .5 7 1.5 meq/L 2 cardiac glycosides CHF
L - lithium .6 7 1.2 meq/L 2 antimanic bipolar
A 7 aminophylline 10 7 19 mg/100ml 20 bronchodilator COPD
D 7 Dilantin 10 -19 mg/100 ml 20 anticonvulsant seizures
A 7 acetaminophen 10 7 30 mg/100ml 200 narcotic analgesic osteoarthritis
Digitalis 7 increase cardiac contraction = increase CO
Nursing Mgt
1. Check PR, HR (if HR below 60bpm, don.t giveDigoxin)
Digitalis toxicity 7 antidote - Digivine
a. Anorexia -initial sx.
b. n/v GIT
c. Diarrhea
d. Confusion
e. Photophobia
f. Changes in color perception 7 yellow spots
(Ok to give to pts with renal failure. Digoxin is metabolized in liver not in kidney.)
L – lithium (lithane) decrease levels of norepinephrine, serotonine, acetylcholine
Antimanic agent
Lithium toxicity
S/Sx -
a.) Anorexia
b.) n/s
c.) Diarrhea
d.) Dehydration 7 force fluid, maintain Na intake 4 7 10g daily
e.) Hypothyroidism
(CRETINISM7 the only endocrine disorder that can lead to mental retardation)
A – aminophyline (theophylline) – dilates bronchioles.
Take bp before giving aminophylline.
S/Sx : Aminophylline toxicity:
1. Tachycardia
2. Hyperactivity 7 restlessness, agitation, tremors
Question: Avoid giving food with Aminophylline
a. Cheese/butter7 food rich in tyramine, avoided only if pt is given MAOI
b. Beer/ wine -
c. Hot chocolate & tea 7 caffeine 7 CNS stimulant tachycardia
d. Organ meat/ box cereals 7 anti parkinsonian
MAOI 7 antidepressant
m AR plan
n AR dil can lead to CVA or hypertensive crisis
p AR nate
3 8 4 weeks - before MAOI will take effect
Anti Parkinsonian agents 8 Vit B6 Pyridoxine reverses effect of Levodopa
D – dilatin (Phenytoin) 8 anti convulsant/seizure
Nursing Mgt:
1. Mixed with plain NSS or .9 NaCl to prevent formation of crystals or precipitate
- Do sandwich method
- Give NSS then Dilantin, then NSS!
2. Instruct the pt to avoid alcohol 8 bec alcohol + dilantin can lead to severe CNS depression
Dilantin toxicity:
S/Sx:
G 8 gingival hyperplasia 8 swollen gums
i. Oral hygiene 8 soft toothbrush
ii. Massage gums
H 8 hairy tongue
A - ataxia
N 8 nystagmus 8 abnormal movement of eyeballs
A 8 acetaminophen/ Tylenol 8 non-opoid analgesic & antipyretic 8 febrile pts
Acetaminophen toxicity :
1. Hepato toxicity
2. Monitor liver enzymes
SGPT (ALT) 8 Serum Glutamic Piruvate Tyranase
SGOT- Serum Glutamic Acetate Tyranase
3. Monitor BUN (10 8 20)
Crea (.8-1)
Acetaminophen toxicity can lead to hypoglycemia
T 8 tremors, Tachycardia
I 8 irritability
R 8 restlessness
E 8 extreme fatigue
D 8 depression (nightmares) , Diaphoresis
Antidote for acetaminophen toxicity 8 Acetylcesteine = causes outporing of secretions. Suction.
Prepare suctioning apparatus.
Question: The following are symptoms of hypoglycemia except:
a. Nightmares
b. Extreme thirst 8 hyperglycemia symptoms
c. Weakness d. Diaphoresis
PARKINSONS DSE (parkinsonism) - chronic, progressive disease of CNS char by degeneration of
dopamine
producing cells in substancia nigra at mid brain & basal ganglia
- Palliative, Supportive
Function of dopamine: controls gross voluntary motors.
Predisposing Factors:
1. Poisoning (lead & carbon monoxide). Antidote for lead = Calcium EDTA
2. Hypoxia
3. Arteriosclerosis
4. Encephalitis
High doses of the ff:
a. Reserpine (serpasil) anti HPN, SE 8 1.) depression - suicidal 2.) breast cancer
b. Methyldopa (aldomet) - promote safety
c. Haloperidol (Haldol)- anti psychotic
d. Phenothiazide - anti psychotic
SE of anti psychotic drugs 8 Extra Pyramidal Symptom
Over meds of anti psychotic drugs 8 neuroleptic malignant syndrome char by tremors (severe)
S/Sx: Parkinsonism –
1. Pill rolling tremors of extremities 8 early sign
2. Bradykinesia 9 slow movement
3. Over fatigue
4. Rigidity (cogwheel type)
a. Stooped posture
b. Shuffling 9 most common
c. Propulsive gait
5. Mask like facial expression with decrease blinking eyes
6. Monotone speech
7. Difficulty rising from sitting position
8. Mood labilety 9 always depressed 9 suicide
Nsg priority: Promote safety
9. Increase salivation 9 drooling type
10. Autonomic signs:
- Increase sweating
- Increase lacrimation
- Seborrhea (increase sebaceous gland)
- Constipation
- Decrease sexual activity
Nsg Mgt
1.) Anti parkinsonian agents
- Levodopa (L-Dopa), Carbidopa (Sinemet), Amantadine Hcl (Symmetrel)
Mechanism of action
Increase levels of dopa 9 relieving tremors & bradykinesia
S/E of anti parkinsonian
- Anorexia
- n/v
- Confusion
- Orthostatic hypotension
- Hallucination
- Arrhythmia
Contraindication:
1. Narrow angled closure glaucoma
2. Pt taking MAOI (Parnate, Marplan, Nardil)
Nsg Mgt when giving anti-parkinsonian
1. Take with meals 9 to decrease GIT irritation
2. Inform pt 9 urine/ stool may be darkened
3. Instruct pt- don.t take food Vit B6 (Pyridoxine) cereals, organ meats, green leafy veg
- Cause B6 reverses therapeutic effects of levodopa
Give INH (Isoniazide-Isonicotene acid hydrazide.) SE-Peripheral neuritis.
2.) Anti cholinergic agents 9 relieves tremors
Artane mech 9 inhibits acetylcholine
Cogentin action , S/E - SNS
3.) Antihistamine 9 Diphenhydramine Hcl (Benadryl) 9 take at bedtime
S/E: adult9 drowsiness,9 avoid driving & operating heavy equipt. Take at bedtime.
Child 9 hyperactivity CNS excitement for kids.
4.) Dopamine agonist
Bromotriptine Hcl (Parlodel) 9 respiratory depression. Monitor RR.
Nsg Mgt 9 Parkinson
1.) Maintain siderails
2.) Prevent complications of immobility
- Turn pt every 2h
Turn pt every 1 h 9 elderly
3.) Assist in passive ROM exercises to prevent contractures
4.) Maintain good nutrition
CHON 9 in am
CHON 9 in pm 9 to induce sleep 9 due Tryptopan 9 Amino Acid
5.) Increase fluid in take, high fiber diet to prevent constipation
6.) Assist in surgery 10 Sterotaxic Thalamotomy
Complications in sterotaxic thalmotomy- 1.) Subarachnoid hemorrhage 2.) aneurism 3.)
encephalitis
MULTIPLE SCLEROSIS (MS)
Chronic intermittent disorder of CNS 10 white patches of demyelenation in brain & spinal cord.
- Remission & exacerbation
- Common 10 women, 15 10 35 yo cause 10 unknown
Predisposing factor:
1. Slow growing virus
2. Autoimmune 10 (supportive & palliative treatment only)
Normal Resident Antibodies:
Ig G 10 can pass placenta 10 passive immunity. Short acting.
Ig A 10 body secretions 10 saliva, tears, colostrums, sweat
Ig M 10 acute inflammation
Ig E 10 allergic reactions
IgD 10 chronic inflammation
S & Sx of MS: (everything down)
1. Visual disturbances
a. Blurring of vision
b. Diplopia/ double vision
c. Scotomas (blind spots) 10 initial sx
2. Impaired sensation to touch, pain, pressure, heat, cold
a. Numbness
b. Tingling
c. Paresthesia
3. Mood swings 10 euphoria (sense of elation )
4. Impaired motor function:
a. Weakness
b. Spasiticity 俣 tigas”
c. Paralysis –major problem
5. Impaired cerebellar function
Triad Sx of MS
I 10 intentional tremors
N 10 nystagmus 10 abnormal rotation of eyes Charcots triad
A 10 Ataxia
S - scanning speech
6. Urinary retention or incontinence
7. Constipation
8. Decrease sexual ability
Dx 10 MS
1. CSF analysis thru lumbar puncture
- Reveals increase CHON & IgG
2. MRI 10 reveals site & extent of demyelination
3. Lhermitte.s response is (+). Introduce electricity at the back. Theres spasm & paralysis at spinal cord.
Nsg Mgt MS
- Supportive mgt
1.) Meds
a. Acute exacerbation
ACTH 10 adenocorticotopic
Steroids 10 to reduce edema at the site of demyelination to prevent paralysis
Spinal Cord Injury
Administer drug to prevent paralysis due to edema
a. Give ACTH 10 steroids
b. Baclopen (Lioresol) or Dantrolene Na (Dantrene)
To decrease muscle spasticity
c. Interferone 11 to alter immune response
d. Immunosuppresants
2. Maintain siderails
3. Assist passive ROMexercises 11 promote proper body alignment
4. Prevent complications of immobility
5. Encourage fluid intake & increase fiber diet 11 to prevent constipation
6. Provide catheterization die urinary retention
7. Give diuretics
Urinary incontinence 11 give Prophantheline bromide (probanthene)
Antispasmodic anti cholinergic
8. Give stress reducing activity. Deep breathing exercises, biofeedback, yoga techniques.
9. Provide acid-ash diet 11 to acidify urine & prevent bacteria multiplication
Grape, Cranberry, Orange juice, Vit C
MYASTHENIA GRAVIS (MG) 11 disturbance in transmission of impulses from nerve to muscle cell at
neuro
muscular
junction.
Common in Women, 20 11 40 yo, unknown cause or idiopathic
Autoimmune 11 release of cholenesterase 11 enzyme
Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine
Descending muscle weakness
(Ascending muscle weakness 11 Guillain Barre Syndrome)
Nsg priority:
1) a/w
2) aspiration
3) immobility
S/ Sx:
1.) Ptosis 11 drooping of upper lid ( initial sign)
Check Palpebral fissure 11 opening of upper & lower lids = to know if (+) of MG.
2.) Diplopia 11 double vision
3.) Mask like facial expression
4.) Dysphagia 11 risk for aspiration!
5.) Weakening of laryngeal muscles 11 hoarseness of voice
6.) Resp muscle weakness 11 lead respiratory arrest. Prepare at bedside tracheostomy set
7.) Extreme muscle weakness during activity especially in the morning.
Dx test
1. Tensilon test (Edrophonium Hcl) 11 temporarily strengthens muscles for 5 11 10 mins. Short term-
cholinergic. PNS effect.
Nsg Mgt
1. Maintain patent a/w & adequate vent by:
a.) Assist in mechanical vent 11 attach to ventilator
b.) Monitor pulmonary function test. Decrease vital lung capacity.
2. Monitor VS, I&O neuro check, muscle strength or motor grading scale (4/5, 5/5, etc)
3. Siderails
4. Prevent complications of immobility. Adult-every 2 hrs. Elderly- every 1 hr.
5. NGT feeding
Administer meds –
a.) Cholinergics or anticholinesterase agents
Mestinon (Pyridostigmine)
Neostignine (prostigmin) 11 Long term
- Increase acetylcholine
s/e 11 PNS
b.) Corticosteroids 11 to suppress immune resp
Decadron (dexamethasone)
Monitor for 2 types of Crisis:
Myastinic crisis Cholinergic crisis
A cause 12 1. Under medication
2. Stress
3. Infection
B S&Sx 1. Unable to see 12 Ptosis & diplopia
2. Dysphagia- unable to swallow.
3. Unable to breath
C Mgt 12 adm cholinergic agents
Cause: 1 over meds
S/Sx - PNS
Mgt. adm anti-cholinergic
- Atropine SO4
- SNS 12 dry mouth
7. Assist in surgical proc 12 thymectomy. Removal of thymus gland. Thymus secretes auto immune
antibody.
8. Assist in plasmaparesis 12 filter blood
9. Prevent complication 12 respiratory arrest
Prepare tracheostomy set at bedside.