neuro/ neuromuscular dysfunction

Guillain-Barre syndrome (GBS)

acute peripheral motor weakness, paralysis occurs ~10 days after nonspecific viral/ bacterial illness, muscle function returns 2 days - 2weeks after symptom onset for most patients

• initial: muscle tenderness, paresthesia, muscle weakness

• paralysis that rapidly ascends from lower extremities, flaccid paralysis, loss of reflexes, breathing difficulties, urinary incontinence or retention, constipation

s/s of GBS

supportive care: ventilation, steroids, IVIG, heparin, gabapentin, analgesics

management of GBS

Duchenne muscular dystrophy (DMD)

x-linked disease defined by progressive weakness, muscle wasting, and contractures, relentless progression until death from respiratory or cardiac failure

waddling gait, frequent falls, Gower sign, lordosis, enlarged muscles from fatty infiltration, profound muscular atrophy, cardiomegaly, ambulation impossible by age 12

s/s of DMD

maintain function as long as possible, ROM, ADLs, bracing

management of DMD

spina bifida occulta

type of spina bifida that’s not visible externally

spina bifida cystica

type of spina bifida that’s visible with external sac-like protrusion

urine dribbling or overflow incontinence, poor anal sphincter tone, orthopedic deformities

s/s of spina bifida

latex allergy

what type of allergy are patients with spina bifida most likely to get?

surgery, maintain GU and bowel function

management of spina bifida

increased ICP, fever, hypothermia, altered LOC, feeding changes, muscle joint pain, nuchal rigidity

s/s of bacterial meningitis

lumbar puncture and CT, abx for 7-10 days

management of bacterial meningitis

hydrocephalus

imbalance in production and absorption of CSF, accumulation of CSF causes dilated ventricles which compresses brain

ventriculoperitoneal shunt

treats hydrocephalus by providing drainage of CSF from ventricles to peritoneum

watch for signs of increased ICP, abdominal distention, constipation, and infection

nursing considerations for VP shunt

epilepsy seizure disorder

excessive nerve cell activity in brain that causes two or more unprovoked seizures

simple partial seizure

type of seizure that only involves a motor or sensory phenomena, ex. twitching or strange taste

complex partial seizure

type of seizure that involves altered LOC, ex. person is dazed or confused

seizure precautions, maintain patent airway, neuro checks, meds, eliminate triggers

management of epilepsy

diazepam, phenytoin, valproic acid, phenobarbital, keppra

meds for epilepsy

status epilepticus

seizure lasting more than 30 minutes

diazepam

treatment of status epilepticus

frequent neuro assessment, bed rest with HOB elevated and head midline, seizure precautions, pain management, limit stimulation, IVF

management of head injuries