Guillain Barre
What is the priority nursing intervention for a patient with GBS?
Ventilatory support / breathing?
A hallmark feature of tetanus is?
What is muscle rigidity and spasms
This is a hallmark feature of Bell's palsy.
Trigeminal neuralgia most commonly affects these 2 lower sensory branches of cranial nerve V
What is maxillary and mandibular
A patient with ascending paralysis develops a weak cough and difficulty swallowing. Despite an oxygen saturation of 96%, the patient's vital capacity has decreased to 14 mL/kg. The nurse recognizes the need to prepare for this potentially lifesaving intervention.
What is endotracheal intubation and mechanical ventilation?
GBS is the result of a ____ or ____ infection of the GI or upper respiratory system
viral or bacterial
Why is mechanical ventilation a priority in patient's with tetanus?
What is laryngospasm and administration of neuromuscular blocking agents
Oral Steroids should be started within this number of days to improve chances of a full recovery.
What is 3 days?
Patients frequently describe the classic pain quality of trigeminal neuralgia using these 2 common descriptors.
What is electric shock and stabbing/shooting
A patient with generalized tetanus develops severe muscle spasms and respiratory distress after being exposed to bright lights and loud noises. In addition to obtaining emergency airway assistance and administering prescribed medications, the nurse should immediately make this environmental modification.
What is reducing environmental stimulation by providing a quiet, dimly lit room?
Name one early symptom of GBS
parasthesia [numbness or tingling] or hypotonia [reduced muscle tone]
An HCP would administer a tetanus booster for a patient with an open wound if they have not had a booster in _____ years
What is 5 years
Prognosis for Bell's Palsy is good, with most patients making a full recovery within this time frame.
What is 3-6 months
These drugs may reduce pain by stabilizing the neuronal membrane an blocking nerve finding?
What is antiseizure drugs.
A patient presents with unilateral facial drooping, loss of taste, and an inability to close one eye. Although the facial weakness is concerning, the nurse recognizes that protecting this structure from drying and injury is a priority.
What is the cornea (or eye)
If a patient with GBS does not have a gag reflux, what interventions may be used to ensure adequate calorie intake?
Enteral (EN) or Parenteral (PN) nutrition
A nurse is caring for a patient who is experiencing severe muscle spasms. A _____ room would be therapeutic for the patient?
What is a quiet room low in stimuli
Patients should protect their face from the cold because extreme sensitivity to pain or touch, known as this, may occur.
What is hyperesthesia?
If corneal reflex us impaired, nurse should implement these 2 interventions?
What is eye shields and artifical eye drops.
A patient with trigeminal neuralgia reports that facial pain has improved after beginning carbamazepine and plans to stop taking the medication. The nurse recognizes that this teaching point is essential to prevent recurrence of severe pain.
What is taking carbamazepine consistently as prescribed and not discontinuing it without consulting the healthcare provider?
What is the treatment used for a patient with GBS?
Immunomodulating treatments
A patient presents witha puncture wound from a rusty nail. An appropriate primary treatment for the patient is?
What is TIG (tetanus immune globulin)
While there is no exact cause for Bell's Palsy, the reactivation of this is one suggested theory contributed to the cause of this disorder
reactivation of Herpes (simplex and zoster)
Name 3 triggering factors?
What is air flow, facial contact and facial movements.
Four patients require nursing attention: one with Bell's palsy and an unprotected eye, one with trigeminal neuralgia and severe facial pain, one with tetanus and stable intermittent stiffness, and one with Guillain-Barré syndrome whose vital capacity has fallen from 22 to 15 mL/kg over four hours. This is the patient the nurse must assess first.
Who is the patient with Guillain-Barré syndrome and rapidly declining respiratory function?