NCMB316 Finals

What is the primary demographic affected by Parkinson's Disease?

Usually occurs in the older population, with symptoms appearing during the 5th decade of life, and some diagnosed as early as age 30.

How does Parkinson's Disease affect gender distribution?

It affects men more frequently than women.

What are some potential causes of Parkinson's Disease?

The cause is unknown but can be postencephalitic, toxic, arteriosclerotic, traumatic, or drug-induced (e.g., reserpine, methyldopa, haloperidol, phenothiazine).

What diagnostic tests are used for Parkinson's Disease?

Diagnostic tests are not particularly helpful; PET scans are used only for evaluating levodopa uptake, and diagnosis is primarily clinical based on patient history and the presence of 2 of the 3 cardinal symptoms.

What are the cardinal symptoms of Parkinson's Disease?

Tremor, rigidity, and bradykinesia.

What type of tremor is commonly associated with Parkinson's Disease?

Resting tremor, often described as 'pill-rolling'.

What is bradykinesia?

Bradykinesia refers to slowness of movement.

What are some common physical signs of Parkinson's Disease?

Stooped posture, shuffling gait, difficulty rising from a sitting position, and a masklike face with decreased blinking.

What are some emotional and autonomic symptoms of Parkinson's Disease?

Emotional lability, depression, excessive sweating, constipation, seborrhea, decreased sexual capacity, and increased salivation.

What is the pathophysiology of Parkinson's Disease?

It involves degeneration of dopamine-producing neurons in the substantia nigra, leading to depletion of dopamine and degeneration of the basal ganglia.

What is the primary medication used to treat Parkinson's Disease?

Levodopa (Dopar, Larodopa).

What are the effects of Levodopa in Parkinson's Disease treatment?

It increases dopamine levels in the brain and relieves tremor, rigidity, and bradykinesia.

What are some side effects of Levodopa?

Anorexia, nausea, vomiting, postural hypotension, mental changes (confusion, agitation, hallucinations), insomnia, renal damage, cardiac arrhythmias, and dyskinesias.

What dietary restrictions should be considered when administering Levodopa?

Avoid multiple vitamin preparations containing vitamin B6 and foods high in vitamin B6 (e.g., tuna, pork, dried beans, salmon), as well as tyramine-rich foods (e.g., cheese, yogurt, coffee, raisins, sausage, red wine, beer) to prevent hypertensive crisis.

What is the role of Carbidopa in Parkinson's Disease treatment?

Carbidopa prevents the breakdown of dopamine in the periphery and causes fewer side effects.

What is Amantadine used for in the context of Parkinson's Disease?

Amantadine (Symmetrel) is an antiviral that can help manage symptoms.

What is the definition of Multiple Sclerosis (MS)?

A disease characterized by relapsing-remitting episodes, affecting 85% of cases.

What is the significance of the basal ganglia in Parkinson's Disease?

The basal ganglia are a collection of nuclei involved in the coordination of movement, and their degeneration leads to the symptoms of Parkinson's Disease.

What is a common gait characteristic of individuals with Parkinson's Disease?

Shuffling, propulsive gait.

What is the typical progression of symptoms in Multiple Sclerosis?

Relapses develop over 1-2 weeks and resolve over 4-8 months, returning to baseline.

What are the common nursing interventions for a patient with Parkinson's Disease?

Administer medications as ordered and monitor for side effects.

What percentage of patients may develop secondary progressive MS within 10 years?

50%

What percentage of patients may develop secondary progressive MS within 25 years?

90%

What is the prevalence of Progressive-relapsing MS (PRMS) among MS cases?

5% of cases

What is the primary use of anticholinergic medications in MS treatment?

To relieve rigidity, tremor, and bradykinesia in early/mild cases.

Name two anticholinergic medications used in MS treatment.

Benztropine mesylate (Cogentin) and procyclidine (Kemadrin).

What is the mechanism of action of anticholinergic medications?

They inhibit the action of acetylcholine.

What are common side effects of anticholinergic medications?

Dry mouth, blurred vision, constipation, urinary retention.

What is the role of dopamine agonists like Bromocriptine mesylate (Parlodel) in MS treatment?

They stimulate the release of dopamine in the substantia nigra.

What characterizes Primary Progressive MS (PPMS)?

Onset between 40 and 60 years of age, steady neurologic deterioration without remission.

What characterizes Secondary Progressive MS (SPMS)?

Begins with a relapsing-remitting course that later becomes steadily progressive.

What diagnostic tests are used for MS?

CSF studies (increased protein and IgG), EEG (abnormal), CT scan (increased density of white matter), MRI (shows areas of demyelination).

What are the first symptoms of MS?

Visual disturbances such as blurred vision, scotomas, and diplopia.

What are some common symptoms of MS related to sensation?

Impaired sensation including touch, pain, temperature, numbness, and tingling.

What nursing interventions promote mobility in MS patients?

Muscle-stretching and strengthening exercises, walking exercises, and assistive devices.

What medications are administered for acute exacerbations of MS?

Corticosteroids such as ACTH (IV) and prednisone.

What is the pathophysiology of MS?

Sensitized T cells remain in the CNS, promoting infiltration of damaging agents and leading to inflammation that destroys myelin.

What demographic is most affected by MS?

Typically young adults aged 20-40, with a higher prevalence in women.

What environmental factors are associated with MS?

More frequent in cool or temperate climates.

What are some interventions to improve communication abilities in MS patients?

Practice reading aloud, listen to their own voice, and enunciate each syllable clearly.

What dietary modifications can assist MS patients?

Cut food into bite-sized pieces, provide small frequent feedings, and allow sufficient time for meals.

What are the effects of tricyclic antidepressants in MS treatment?

They are given to treat depression.

What precautions should be taken to prevent injury in MS patients?

Test bath water temperature, avoid heating pads, inspect body parts frequently for injury.

What is the unknown cause of MS thought to possibly be?

A slow-growing virus or possibly of autoimmune origin.

What is the primary treatment for removing antibodies in Myasthenia Gravis?

Plasmapheresis (plasma exchange) is used to remove damaging antibodies from the blood.

What are the characteristic assessment findings in a patient with Myasthenia Gravis?

Ptosis, diplopia, dysphagia, extreme muscle weakness that increases with activity and decreases with rest, masklike facial expression, weak voice, and hoarseness.

What diagnostic test provides spontaneous relief of symptoms in Myasthenia Gravis?

The Tensilon test, which involves IV injection of Tensilon, provides relief that lasts 5-10 minutes.

What does plasmapheresis involve?

Plasmapheresis involves removing the liquid portion of blood (plasma), separating it from blood cells, and returning the blood cells to the body.

What is Myasthenia Gravis?

A neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction, causing extreme muscle weakness.

What age group is most affected by Myasthenia Gravis?

It most commonly affects women aged 15-35 and men over 40.

What is the suspected cause of Myasthenia Gravis?

It is thought to be an autoimmune disorder where antibodies destroy acetylcholine receptor sites at the neuromuscular junction.

Which muscles are primarily affected by Myasthenia Gravis?

Voluntary muscles, especially those innervated by cranial nerves.

What are the first noticeable symptoms of Myasthenia Gravis?

Weakness of the eye muscles, difficulty swallowing, or slurred speech.

What are the types of anticholinesterase drugs used in Myasthenia Gravis?

Neostigmine bromide (Prostigmin), pyridostigmine bromide (Mestinon), and edrophonium chloride (Tensilon).

What is the action of anticholinesterase drugs?

They block the action of cholinesterase and increase levels of acetylcholine at the neuromuscular junction.

What are some side effects of anticholinesterase drugs?

Excessive salivation, sweating, abdominal cramps, nausea, vomiting, diarrhea, and muscle twitching (fasciculations).

What corticosteroid is commonly used in Myasthenia Gravis?

Prednisone is used if other drugs are not effective.

What nursing interventions should be taken when administering anticholinesterase drugs?

Administer drugs as ordered, give them on time, with milk and crackers to decrease GI upset, and monitor muscle strength and vital capacity.

How should mealtimes be managed for a patient with Myasthenia Gravis?

Mealtimes should coincide with peak drug effects, medications should be given 30 minutes before meals, and a mechanical soft diet should be provided.

What should be monitored frequently in a patient with Myasthenia Gravis?

Respiratory status, including rate, depth, vital capacity, and the ability to deep breathe and cough.

What is a thymectomy?

A surgical procedure to remove the thymus gland, which may be performed in patients with Myasthenia Gravis.

What should be kept nearby during mealtimes for patients with swallowing difficulties?

Emergency airway and suction equipment.

What are signs of myasthenic or cholinergic crisis to observe for?

Signs include increased muscle weakness, respiratory distress, and excessive salivation.

What is the role of plasmapheresis in Myasthenia Gravis treatment?

It is believed to rid plasma of antibodies that contribute to the immune attack on nerves.

What are the initial assessment findings in Guillain-Barré Syndrome (GBS)?

Mild sensory changes, clumsiness, progressive motor weakness in more than one limb, cranial nerve involvement (dysphagia), ventilatory insufficiency, and absence of deep tendon reflexes.

What diagnostic tests are used for Guillain-Barré Syndrome?

CSF studies showing increased protein and EMG indicating slowed nerve conduction.

What is the medical management for Guillain-Barré Syndrome?

Considered a medical emergency, managed in ICU, may require mechanical ventilation, plasmapheresis, continuous ECG monitoring, propranolol for tachycardia, and atropine for bradycardia.

What nursing interventions are important for a patient with Guillain-Barré Syndrome?

Maintain adequate ventilation, check muscle groups every 2 hours, assess cranial nerve function, monitor vital signs, administer corticosteroids and antiarrhythmic agents, prevent complications of immobility, and promote comfort and nutrition.

What are fasciculations in the context of neurological disorders?

Fasciculations are small, local, involuntary muscle contractions visible under the skin.

What is the prognosis for patients with Guillain-Barré Syndrome?

Death usually occurs due to infection, respiratory failure, or aspiration, generally about 3 years after onset; few patients survive longer.

What is the primary treatment for swallowing difficulties in patients with Amyotrophic Lateral Sclerosis (ALS)?

Check the gag reflex before feeding, start with pureed foods, and assess the need for nasogastric tube feedings.

What medications are used in the management of Amyotrophic Lateral Sclerosis (ALS)?

Riluzole (glutamate antagonist), Baclofen/Diazepam (for spasticity), and Quinine (to relieve muscle cramps).

What is the pathophysiology of Amyotrophic Lateral Sclerosis (ALS)?

Loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem, leading to muscle atrophy and degeneration in both upper and lower neuron systems.

What are the common nursing interventions for patients with ALS?

Provide measures for muscle weakness and dysphagia, promote adequate ventilation, prevent complications of immobility, encourage diversional activities, and provide support to the client and family.

What is the leading theory regarding the cause of Amyotrophic Lateral Sclerosis (ALS)?

Overexcitation of nerve cells by the neurotransmitter glutamate leading to cell injury and neuronal degeneration.

What are the symptoms of respiratory insufficiency in patients with ALS?

Weakness starting in the muscles supplied by cranial nerves, leading to difficulty talking, swallowing, and ultimately breathing.

What is the typical age of onset for Amyotrophic Lateral Sclerosis (ALS)?

Usually occurs in the 5th or 6th decade of life.

What is the role of mechanical ventilation in the management of ALS?

It is used if hypoventilation develops due to respiratory muscle weakness.

What are the complications associated with immobility in neurological disorders?

Pressure ulcers, muscle atrophy, deep vein thrombosis, and pneumonia.

What is the significance of monitoring vital signs in patients with Guillain-Barré Syndrome?

To observe for signs of autonomic dysfunction such as hypertension, hypotension, tachycardia, and arrhythmias.

What is the role of corticosteroids in the treatment of Guillain-Barré Syndrome?

To suppress the immune reaction as ordered.

What are the signs of cranial nerve involvement in Guillain-Barré Syndrome?

Dysphagia and difficulty handling secretions.

What is the expected outcome for patients with ALS regarding independence?

Promoting independence for as long as possible is a key nursing goal.

What nursing intervention can help promote comfort in patients with sensory changes?

Provide comfort measures tailored to the patient's sensory experiences.

What is the role of physical therapy in the management of ALS?

To provide rehabilitation and support for maintaining function and independence.

What are the potential long-term nutritional support options for patients with ALS?

Cervical esophagostomy or gastrostomy to prevent aspiration and provide long-term nutrition.

What is the significance of continuous ECG monitoring in Guillain-Barré Syndrome?

To detect alterations in heart rate and rhythm due to autonomic dysfunction.

What is Huntington's Disease (HD)?

A chronic, progressive, hereditary disease of the nervous system that results in slow progressive involuntary choreiform movement and dementia.

At what age does Huntington's Disease typically onset?

Between the ages of 35 and 45 years, though 10% of patients are children.

How is Huntington's Disease inherited?

It is transmitted as an autosomal dominant genetic disorder, giving each child of a parent with HD a 50% risk of inheriting the illness.

What are the primary diagnostic tests for Huntington's Disease?

Diagnosis is based on signs and symptoms; no specific clinical or lab tests exist. EMG may indicate reduced functioning motor units, and MRI may show high signal intensity in the corticospinal tracts.

What is the pathophysiology of Huntington's Disease?

1) Premature death of cells in the striatum (caudate & putamen), 2) loss of cells in the cortex, 3) loss of cells in the cerebellum, 4) destruction of cells results in lack of GABA & AcH, leading to brisk, jerky, purposeless movements.

What neurotransmitters are affected in Huntington's Disease?

GABA and AcH (acetylcholine) levels decrease.

What are two main symptoms of Huntington's Disease?

1) Progressive mental status changes leading to dementia, 2) Choreiform movements in limbs, trunk, and facial muscles.

What are some emotional disturbances associated with Huntington's Disease?

Fits of anger, suicidal depression, impaired judgment, hallucinations, delusions, and paranoid thinking.

What are the three stages of Huntington's Disease?

1) Onset of neurologic or psychological symptoms, 2) Increasing dependence on others for care, 3) Loss of independent functions.

What are common complications leading to death in Huntington's Disease?

Choking, falls, infection, pneumonia, or heart failure, generally occurring 10-20 years after onset.

What medications are used to treat Huntington's Disease?

1) Phenothiazine (blocks dopamine receptors), 2) Reserpine (depletes presynaptic dopamine), 3) Tetrabenazine (reduces dopaminergic transmission).

What nursing interventions are important for patients with Huntington's Disease?

Frequent assessment of motor signs, interacting creatively with the patient, and understanding how the patient expresses needs.

What is the purpose of a bone scan?

To evaluate damage to bones, detect cancer that has spread to bones, and monitor conditions affecting bones.