Parkinson's Disease
What is Parkinson's Disease?
What is a progressive neurodegenerative disease that is one of the most common neurological disorders of older adults.
What is Huntington's Disease/ Huntington's Chorea?
What is a hereditary disorder that causes progressive mental status changes and choreiform movements (rapid, jerky movements).
What is the definition for Multiple Sclerosis?
What is a chronic autoimmune disease that affects the myelin sheath and conduction pathway of the CNS.
What is the believed cause of Guillain-Barre Syndrome?
What is: it is triggered by an acute illness, trauma, immunization, or surgery in the recent past. Typically, from a respiratory or GI illness.
What is the treatment for Huntington's Diseae?
There is no treatment for Huntington's Disease, but there are two main medications/classes of medications to aid in symptom management!
1) Tetrabenazine (Xenazine) helps decrease chorea!
2) Psychotropic agents to manage movement abnormalities, control agitation, hallucinations, and psychotic delusions!
How is Parkinson's Disease diagnosed?
At what stage of Huntington's Disease does the patient lose all independent function?
What is Stage III
How is MS diagnosed in patients?
What is: diagnosis can be difficult due to the similarities of other neurological disorders. A thorough history as well as assessing for the presence of vision, mobility, and sensory changes can all indicate MS in a patient!
What is the key factor or feature of Guillain-Barre Syndrome?
What is ascending symptoms; weakness and paralysis begin in the legs and spread to the arms and upper body. This may lead to the need for mechanical ventilation.
What two medication classes are administered to patients with myasthenia gravis?
What is:
1) Anticholinesterases: first-line treatment by preventing the decrease of acetylcholine. Increases the response of muscles to nerve impulses and improves muscle strength.
2) Immunosuppressants: corticosteroids and chemotherapeutic agents to produce remission and to control/improve symptoms.
Name three different characteristics that can be present in patients with Parkinson's Disease?
Each additional characteristics named after the first three are 100 additional points!
What are:
Mask-like faces, difficulty chewing or swallowing, stooped fixed posture, slow shuffling gait, pill-rolling movement of the hands, tremors, muscle rigidity, akinesia, dysarthria (slurred speech), echolalia, hypophonia. Autonomic dysfunction (orthostatic hypotension, excessive perspiration, or flushing).
How is Huntington's Disease diagnosed?
Huntington's disease is diagnosed based upon three different criteria:
1) Presence of dominant inheritance (family history)
2) Choreoathetosis (neuromuscular symptoms)
3) The presence of dementia
Name three psychosocial changes that can occur after the diagnosis of MS has been made?
1) Apathy, emotional lability, and/or depression
2) With diagnosis, the patient is typically anxious
3) Assess for the impact of disease on the patient (incontinence, fatigue, and sexual dysfunction)
4) Withdrawal from society/friends/family/community.
How is the diagnosis of Guillain-Barre Syndrome made?
What is: there is no single clinical or laboratory finding that can confirm GBS.
A lumbar puncture may show increased protein in cerebrospinal fluid. Diagnosis should be based on history and symptoms.
You have a patient with Parkinson's who is experiencing drug toxicity. Name the three different ways to overcome and correct drug toxicity!
What is:
1) Reduce the dosage of the medication
2) Change the drug/ frequency of drug administration
3) Have the patient go on a "drug holiday"
What are the four primary symptoms of Parkinson's Disease?
1) Tremors
2) Rigidity
3) Bradykinesia/Akinesia
4) Postural Instability
What is:
1) GABA
2) Glutamate
These neurotransmitters lead to brisk, jerky, and purposeless movements that primarily affect the hands, face, tongue, and legs.
What are four of the most common manifestations of MS, you must state all four for points!
What is:
1) Motor ability: increased fatigue and stiffness of extremities, unsteady gait.
2) Visual changes: blurred vision, diplopia, decreased visual acuity, changes in peripheral vision, and nystagmus.
3) Sensory changes: hypalgesia (diminished pain sensation), paresthesia, facial pain, decreased temp. perception.
4) Cognitive changes: memory loss, impaired judgement, decreased ability to solve problems/perform calculations
What is the priority nursing diagnosis for a patient with Guillain-Barre Syndrome?
What is: Ineffective airway clearance/impaired gas exchange/ineffective breathing pattern. AIRWAY due to the increasing paralysis -may require a mechanical ventilator as the disease progresses.
How is a cholinergic crisis and a myasthenia crisis differentiated?
What is the tensilon test! Both of these crises are similar however, treatment varies significantly!
For a myasthenia gravis crisis: the tensilon produces a temporary improvement, indicating that the patient needs an increase in medication; while for a cholinergic crisis, the tensilon will provide no improvement! Both crises may require ventilatory support!
You have a 75 year-old male patient with Parkinson's disease who is prescribed Cogentin (an anticholinergic drug). Why may you as a nurse question this drug being prescribed?
Anticholinergic medications such as Cogentin and Artane can be used in patients with Parkinson's disease who are experiencing severe tremors and rigidity. Anticholinergic medications are part of the BEER'S Criteria, however, and should be monitored as they can cause acute confusion, urinary retention, constipation, dry mouth, and or blurred vision! (Safety concerns?)
What is the average age of onset for patients with Huntington's disease?
What is the age of onset is usually between 30-50 in patients.
These patients will commonly die from pneumonia, heart failure, or other immobility-related complications.
Name why each of the following medications may be prescribed to a patient with MS. All medications must be correctly identified!
1) Avonex
2) Baclofen (Lioresal)
3) Methotrexate
1) Avonex: an immunomodulator that can modify the course of the disease as well as has antiviral effects!
2) Baclofen: used for muscle spasticity
3) Methotrexate: immunosuppressant (same as for rheumatoid arthritis) used to stabilize the disease process and decrease inflammation. Educate on avoiding alcohol and pregnancy with this medication as it is a chemotherapy agent.
What is the treatment of choice for a patient with Guillain-Barre Syndrome?
What is the treatment of choice for patients with GBS is plasmapheresis?
Plasmapheresis removes the circulating antibodies from a patient's blood!
You have a patient that has been diagnosed with MS, why you should you educate them on avoiding hot showers and baths?
Patients with MS often experience heat intolerance that can lead to a worsening of symptoms!
Known as the Uhthoff phenomenon, and fun fact was used as a diagnostic test for MS in the 1950's!