Multiple Sclerosis
Pathophysiology for MS
•Inflammatory disorder causing damage to myelin in brain and spinal cord
Demyelination of neurons in C N S
Destruction of axons impairs ability of nerves to conduct electrical impulses
List 2 Possible complications for peripheral IVs
List 2 interventions
Infiltration, Extravasion, phlebitis, infection
Stop the infusion immediately.
Remove the IV catheter.
Notify the healthcare provider.
Restart the IV in another extremity.
4 factors for possible causes of Alzheimers
Genetic factors (10% of cases)
Chronic inflammation, excess free radicals
Environmental factors
Immunologic factors
Nutritional factors
Viruses
Complication of Alteplase
Bleeding
5 Signs and Symptoms of Parksinson
Tremors
Muscle rigidity
Bradykinesia (difficulty chewing, swallowing, speaking)
Postural instability
Affective flattening
Possible causes of MS
Genetic or microbial factors like Climate (colder regions)
Microscopic pathogens
Describe of drawing blood from a central line
clean port for 30 seconds. Waste 10, draw amount of blood needed, and flush with 10-20ml of NS
May have a protective function in reducing neuronal calcium overload
What is Memantine (Namenda), N-methyl-D-aspartate (NMDA) receptor antagonist
Alteplase 3 Indication
Indications:
To treat acute myocardial infarction, deep vein thrombosis.
To treat cerebrovascular accident, pulmonary embolism, arterial thrombosis
To clear I V catheters
Indications of Pharmacology for Parkinson Disease
Increase the amount of dopamine and reduce the amount of acetylcholine.
Slow down the progression of disease and prolong more independence
List 5 signs and symptoms of MS
•Fatigue
•Heat sensitivity
•Neuropathic pain; spasticity
•Impaired cognitive ability
•Disruption of balance and coordination
•Visual impairment; slurred speech
•Sexual dysfunction
•Bowel and bladder symptoms
•Dizziness; vertigo
what is the treatment for hemolytic reaction
Stop transfusion, supportive measures, bolus large amount of NS/LR or albumin, give diuretics,
Describe the possible related cause of Alzheimer's Disease and pathophysiology and purpose of drug therapy
•Cause of most dementia unknown; associated with cerebral atrophy
Structural changes cause loss in number and function of neurons
Symptoms result from progressive damage to neurons in hippocampus (learning and memory). Requires acetylcholine as neurotransmitter
•No cure. Intensify effect of acetylcholine at cholinergic receptor
List 2 contradictions for alteplase
Alteplase is contraindicated in active internal bleeding, history of stroke or head injury within the past 3 months, recent trauma or surgery, severe uncontrolled H T N, intracranial neoplasm, or arteriovenous malformation.
List 5 interventions that can promote Parkinson Safety
Encourage the patient to consciously lift the feet when walking rather than shuffle.
Remove throw rugs and other obstacles from frequently used walking paths.
Allow additional time for position changes and ambulation.
Encourage the patient to rock from side to side before initiating movement when experiencing freezing.
Encourage the use of handrails and assistive devices when indicated.
Teach the patient to change positions slowly because orthostatic hypotension may occur.
Thickening liquids if swallowing is a problem
First line of Drug therapy for MS and indication
Interferon beta
reduce severity of symptoms; decrease lesions
Interventions needed for possible infected central line
Call the doctor
Insert a new peripheral IV
Draw blood cultures
Removed the CVAD
Culture the tip
Give Antibiotics and acetaminophen for fever
Education for Donepezil Therapy
Give medication prior to bedtime.
Medication is most effective when given on a regular schedule
Monitor for bradycardia, hypotension, asthma, hyperthyroidism, or active peptic ulcer disease, Severe nausea and vomiting
Medication that Used to promote the formation of clots
Aminocaproic Acid (Amicar)
Used in early stages of PD therapy and side effects
What is benztropine (Cogentin), Anticholinergic Agents?
typical anticholinergic side effects such as dry mouth, constipation, and tachycardia. Adverse general effects include sedation, drowsiness, dizziness, restlessness, irritability, nervousness, and insomnia.
What is the disease modifying drugs used for treatment of relapse-remitting M S and secondary-progressive M S
Interferon Beta
Complications of multiple unit blood transfusion
If patient overdoses, antidote is atropine
What is donepezil (Aricept), Cholinesterase Inhibitors?
List 5 Patient Education for Alteplase
Report a sudden severe headache immediately.
Report blood in the urine or stool.
Avoid unnecessary invasive procedures after receiving the medication
Avoid using razors
Report unusual bruising or bleeding.
Use soft toothbrushes
Notify the nurse immediately if vomiting blood occurs.
Limit physical activity that can result bleeding
List a Dopaminergic Agent
with mechanism of action
Indication
List 2 side effects
Contraindications/ Interactions
Education
Levodopa-Carbidopa-entacapine (stalevo)
•increases biosynthesis of dopamine within nerve terminals
to restore dopamine function or stimulate dopamine receptors within the brain. restores the neurotransmitter dopamine in extrapyramidal areas of the brain, thus relieving some Parkinson symptoms, especially tremor, bradykinesia, gait, and muscle rigidity.
uncontrolled and purposeless movements, involuntary movement, loss of appetite, nausea, vomiting, need to monitor weight
narrow-angle glaucoma, MAOI, Haldol, Methyldopa, antihypertensives, anticonvulsants, and antacids can lead to toxicity
•Abrupt withdrawal of the drug can result in Parkinson-like symptoms or N M S.