Ice Bucket Challenge
How to diagnose? name 2 ways
MRI, clinical manifestations, lumbar puncture (if they have atypical symptoms), blood/urine sample (creatinine kinase elevated), electromyography
Name 3 labs that may indicate liver issues if they are out of whack
What is important to keep in mind when dealing with malnutrition?
Keep your bias separate. People with malnutrition can be skinny, obese, or seem like a healthy weight.
How do you diagnose MS?
Process of elimination
methods include
-MRI
-Lumbar puncture (IGG bands)
-EMG
-Evoked potentials (measures speed of nerves and how fast brain responds to visuals/sounds)
Baclofen and Tizanidine are often used to treat ALS, (MS too apparently) what do they do?
They reduce muscle spasticity
2 Risk factors of developing?
smoking/toxins
extreme exercise/overexertion
genetics
(note: caused by gene mutation)
Why is ammonia dangerous to the brain/can cause confusion?
It can cross the blood brain barrier
What do you do if the patient is having an absorption issue?
You gotta bypass
Name two med classes that help treat MS
-corticosteroids
-immunosuppressants
-immunomodulators SQ
What is most important med to treat ALS? What is its main goal?
Riluzole - goal is to slow down progression
What kind of diet and what kind of exercise is appropriate for a person with ALS?
exercise - low impact
What is the cure to encephalopathy (brain swelling caused by ammonia)
Lactolose (it pulls ammonia into intestinal tract)
Alb- 3.4-5.4g/dL
Total pro- 6-8g/dL
Name 4 s/s of MS
1. sudden weakness
2. tremors
3. unsteady gait
4. constipation
5. depression
6.sudden mood changes
7. vision issues
8. fatigue
9. bladder dysfunction
Oxybutynin vs Bethanechol
Which is used for overactive bladder and which is used for bladder retention?
What is especially important to know when caring for an ALS patient having a crisis?
Advanced directive status
Why do esophageal varices form?
They typically form when blood flow to the liver is blocked. This is usually due to the scar tissue on the liver from cirrhosis or liver failure. (Side note: the blood then backs up into the portal vein causing portal hypertension)
What line do you put TPN through?
Central line ONLY
2. What gender does MS affect mainly?
3. Is it born, borne, or maybe both?
1. 20-50
2. female
3. Potentially both. Genetics, environmental factors (smoking, physical injury), or unknown infection
Methotrexate is an immunosuppressant which can be used in MS treatment, what does it do?
It prevents lymphocytes from reaching the CNS (they will attack it causing more scars/inflammation if they reach it)
When does ALS become deadly?
When the muscles that control breathing atrophy too far
What is the name of the procedure done to remove ascites?
Paracentesis (notes- gonna need informed consent and have patient empty bladder beforehand)
What do you do if your TPN bag runs out early?
Infuse dextrose to keep blood sugar up
Explain patho of MS
autoimmune system attacks own nervous system. Chronic inflammation from attacks lead to scarring on CNS and demyelination
What is fingolimod?
It is an MS specific drug - phosphate receptor modulator