Guillain-Barré and Myasthenia Gravis Overview

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Questions and Answers

What symptom is NOT typically associated with Guillain-Barré syndrome?

Severe fever (correct)

Upward progression of motor weakness

Symmetric weakness

Diminished reflexes

Which laboratory test finding is characteristic of Guillain-Barré syndrome?

Elevated protein levels in CSF with normal cell count (correct)

Elevated creatinine levels in serum

Increased white blood cell count in CSF

Decreased glucose levels in CSF

What is a critical aspect of medical management for a patient with Guillain-Barré syndrome?

Assessment of respiratory function and muscle strength (correct)

Monitoring for signs of neurological improvement only

Supportive care only

Immediate discharge planning

Which treatment option is used to directly affect the peripheral nerve myelin antibody level in Guillain-Barré syndrome?

Plasmapheresis and IVIG Signup and view all the answers

During which phase of Guillain-Barré syndrome is ongoing assessment for disease progression emphasized?

Acute phase Signup and view all the answers

What is the primary characteristic of a myasthenic crisis?

Severe generalized muscle weakness Signup and view all the answers

Which treatment option is not typically used for exacerbations of myasthenia gravis?

Antihistamines Signup and view all the answers

What is the purpose of plasmapheresis in the treatment of myasthenia gravis?

To temporarily reduce circulating antibodies Signup and view all the answers

Which surgical procedure can lead to clinical improvement in myasthenia gravis patients?

Thymectomy Signup and view all the answers

During outpatient care for myasthenia gravis, which of the following strategies is emphasized for medication management?

Delay in medication can lead to complications Signup and view all the answers

What common precipitating event can lead to a myasthenic crisis?

Respiratory infection Signup and view all the answers

Which symptoms might indicate a cholinergic crisis in a patient with myasthenia gravis?

Excessive salivation and sweating Signup and view all the answers

What is an important nursing care strategy regarding nutrition in patients with myasthenia gravis?

Meals coinciding with the peak effects of medication Signup and view all the answers

What is a potential life-threatening complication associated with rapidly progressive weakness?

Cardiac dysrhythmias Signup and view all the answers

Which condition is linked to an inability to swallow in patients with rapidly progressive weakness?

Imbalanced nutrition Signup and view all the answers

Which intervention directly addresses respiratory function in patients with impending respiratory failure?

Maintaining effective respirations Signup and view all the answers

How does paralysis affect a patient's verbal communication?

Leads to cranial nerve dysfunction Signup and view all the answers

What nursing intervention can help decrease a patient's fear and anxiety related to loss of control?

Providing reassurance and support Signup and view all the answers

Which of the following is an indicator of recovery in a patient with impaired verbal communication?

Demonstration of effective articulation Signup and view all the answers

What is a common complication that can occur alongside deep vein thrombosis in these patients?

Pulmonary embolism Signup and view all the answers

Which nursing outcome is associated with providing adequate nutrition to a patient with swallowing difficulties?

Improved energy levels Signup and view all the answers

What is the initial manifestation of myasthenia gravis in the majority of patients?

Weakness in ocular muscles Signup and view all the answers

Which symptom is often associated with weakness of the facial muscles in myasthenia gravis?

Bland facial expression Signup and view all the answers

What does the Tensilon test involve in diagnosing myasthenia gravis?

Administration of a fast-acting acetylcholinesterase inhibitor Signup and view all the answers

What is one of the risks associated with laryngeal involvement in myasthenia gravis?

Choking and aspiration Signup and view all the answers

Which of the following is used as a diagnostic test for myasthenia gravis alongside the Tensilon test?

Ice test Signup and view all the answers

What is the first line of pharmacologic therapy for myasthenia gravis?

Pyridostigmine bromide Signup and view all the answers

Which of the following statements about myasthenia gravis is true?

It has no effect on coordination. Signup and view all the answers

What is the goal of medical management for patients with myasthenia gravis?

Improve function and remove antibodies Signup and view all the answers

What is a common goal for patients with myasthenia gravis?

Promotion of speech and swallowing mechanisms Signup and view all the answers

Which of the following best describes myasthenia gravis?

An autoimmune disorder affecting muscle strength Signup and view all the answers

How does myasthenia gravis primarily affect muscle function?

By reducing the number of available receptors for stimulation Signup and view all the answers

What type of activities is encouraged for patients with myasthenia gravis?

Promoting physical activity within limits Signup and view all the answers

What is the primary cause of muscle weakness in patients with myasthenia gravis?

Antibodies blocking acetylcholine receptors Signup and view all the answers

What is a significant structural abnormality found in 75% of individuals with myasthenia gravis?

Thymic hyperplasia or tumor Signup and view all the answers

Which symptom is commonly not associated with myasthenia gravis?

Heightened muscle response to stimulation Signup and view all the answers

What should be included in the nursing interventions for a patient with myasthenia gravis?

Minimizing spasticity and contractures Signup and view all the answers

What is the most common form of dementia?

Alzheimer’s Disease Signup and view all the answers

Which of the following is NOT a risk factor for Alzheimer's Disease?

Regular exercise Signup and view all the answers

What are neurofibrillary tangles associated with?

Communication failure between neurons Signup and view all the answers

How often does someone in the US develop Alzheimer's Disease?

Every 66 seconds Signup and view all the answers

Which symptom is NOT commonly associated with severe stages of Alzheimer's Disease?

Hallucinations Signup and view all the answers

What typically begins to accumulate in the brains of individuals with Alzheimer's Disease?

Beta-amyloid plaques Signup and view all the answers

Which statement is true regarding Alzheimer's Disease?

It causes progressive memory loss. Signup and view all the answers

What brain region is most affected in Alzheimer's Disease?

Cerebral cortex Signup and view all the answers

Study Notes

Neurological Autoimmune Disorders

Course: NURS3101 - Care of the Adult Population
Course location: University of Belize
Faculty: MS. Michelle Cox Hoare
Number of weeks: 13
Duration: 125 minutes

Learning Objectives

Define Multiple Sclerosis (MS)
Describe the pathophysiology of MS and Myasthenia Gravis
Describe the clinical manifestations of MS and Myasthenia Gravis
Define Parkinson's and Alzheimer's disease
Describe the pathophysiology of Parkinson's and Alzheimer's disease
Describe medical and nursing management of neurological disorders (MS, Myasthenia Gravis, Guillain-Barré Syndrome, Parkinson's and Alzheimer's disease)
Apply the nursing process in the management of patients with these diseases

What is Multiple Sclerosis (MS)?

Autoimmune condition where the immune system attacks the body's own tissues
Progressive demyelinating disease of the CNS
Demyelination is the destruction of myelin, impairing nerve impulse transmission
Cause is not definitively known but factors include genetics, immunology, and environment
No genetic transmission
Environmental risk factors include smoking, lack of vitamin D, and exposure to Epstein-Barr virus

MS Pathophysiology

T cells enter the brain via disruption of the blood-brain barrier
T cells recognize myelin as foreign and attack it triggering an inflammatory process.
Inflammatory processes release cytokines and antibodies, stimulating macrophages to attack myelin.
B cells produce antibodies that mark the myelin for engulfment by macrophages
Macrophages engulf the myelin and oligodendrocytes
Without oligodendrocytes, there is no remyelination in the axons.
Immune attacks are intermittent and regulatory T cells are activated following each attack to control further immune cell activation.
Upon early attack, myelin repairs the axons, however, repeated attacks lead to irreversible damage.

Clinical Manifestations of MS

Difficulty walking, speech problems (Dysarthria), blurry vision, balance problems, numbness or tingling, muscle stiffness or spasms
Other common symptoms are fatigue, cognitive impairment, bladder or bowel problems

Assessment and Diagnostic Findings of MS

Diagnosis based on the presence of multiple plaques in the CNS observed with Magnetic Resonance Imaging (MRI)
Spinal tap (Lumbar puncture) to detect high levels of antibodies in cerebrospinal fluid (CSF)
Visual evoked potential to assess visual stimulus response
Neuropsychological testing to assess cognitive impairment

Medical Management of MS

Management strategies aim at speeding recovery from attacks, slowing disease progression and managing symptoms
Medications: Immunomodulators, Corticosteroids (dexamethasone, methylprednisolone), immunosuppressants (methotrexate)
Disease-modifying therapies
Symptom management for specific complications

Nursing Process for MS

Assess function at rest and when fatigued, including weakness, spasticity, visual impairment, incontinence, and swallowing/speech difficulties; how disease has affected lifestyle
Nursing Diagnoses: Impaired bed, physical mobility, risk for injury, impaired urinary and bowel elimination, impaired verbal communication, chronic confusion, ineffective individual coping

Planning and Goals for MS

Goals include promotion of physical mobility, injury avoidance, achievement of bladder and bowel continence, promotion of speech and swallowing, improvement of cognitive function, development of coping skills, home maintenance, and adaptation to sexual dysfunction

Nursing Interventions for MS

Promoting physical activity and exercise
Minimizing spasticity and contractures
Rest and proper nutrition

Myasthenia Gravis

Autoimmune neuromuscular disorder affecting the myoneural junction
Characterized by variable degrees of voluntary muscle weakness
Primarily affecting the muscles of the eyes, face, and mouth

Myasthenia Gravis Pathophysiology

Acetylcholine (ACh) attaches to the receptor sites on the motor end plate stimulating muscle contraction
Antibodies directed at the ACh receptor sites impair impulse transmission across the myoneural junction
Fewer ACh receptors become available, leading to muscle weakness that worsens with continued activity.
Thymic abnormalities, including hyperplasia or tumors, are common in patients with MG.

Myasthenia Gravis Clinical Manifestations

Initial manifestation in 80% of patients involves ocular muscles (diplopia, ptosis - drooping eyelids)
Weakness of facial and throat muscles (bulbar), generalized weakness
Laryngeal involvement (dysphonia - voice impairment, dysphagia - difficulty swallowing), risk of choking and aspiration
Generalized weakness affecting extremities and intercostal muscles causing decreased vital capacity and respiratory failure

Myasthenia Gravis Assessment and Diagnostic Findings

Physical examination, Tensilon test (edrophonium chloride), ice test
Tensilon test- IV administration of edrophonium chloride, a fast acting acetylcholinesterase inhibitor, a temporary improvement in muscle strength is indicative of MG.
Ice test- ice pack over eyes for one minute, temporary reversal of diplopia and ptosis, indicative of MG.
MRI assessment of the thymus gland.

Myasthenia Gravis Medical Management

Improve function, reduce, and remove circulating antibodies
Therapeutic modalities include anticholinesterase medications (pyridostigmine bromide), immunosuppressive therapy, plasmapheresis, and thymectomy.

Myasthenia Gravis Complications

Myasthenic crisis, an exacerbation of the disease characterized by severe generalized muscle weakness, jaw and tongue weakness, inability to swallow, difficulty with respirations as a result of respiratory and bulbar weakness.
Crisis results from disease exacerbation or a precipitating event (infection, stress, medication changes, surgery).

Myasthenia Gravis Nursing Management

Outpatient self-care: medication management, energy conservation, strategies for ocular manifestations, and complication prevention.
Emphasize consequences of delaying medication, signs and symptoms of myasthenic and cholinergic crisis
During mealtime, administer anticholinesterase medication to coincide with peak effects to minimize aspiration risk.
Impaired vision from ptosis (drooping eyelid) or double vision management. Instill artificial tears, tape eyes as necessary.

Guillain-Barré Syndrome

Autoimmune attack on the peripheral nerve myelin, resulting in acute, rapidly progressive ascending weakness
Often follows a viral infection, usually with a few weeks delay

Guillain-Barré Syndrome Pathophysiology

Demyelination of peripheral nerves causing weakness, hyporeflexia, and paresthesia.
Damage to axons needs time to recover, a process that can take months or years to complete completely.
Infectious organism's amino acid mimics peripheral nerve myelin protein, and immune system mistakenly targets and destroys peripheral nerve myelin.

Guillain-Barré Syndrome Clinical Manifestations

Muscle weakness and diminished reflexes of the lower extremities, sometimes ascending to tetraplegia.
Respiratory failure due to neuromuscular weakness of the diaphragm and intercostal muscles
Sensory symptoms like dysesthesia (pain, numbness) in the hands and feet
Cranial nerve demyelination may result in blindness or difficulty with swallowing or autonomic dysfunction

Guillain-Barré Syndrome Assessment and Diagnostic Findings

Symmetric weakness, diminished reflexes, and upward progression of motor weakness
History of viral illness in few weeks preceding symptoms.
Assessment of vital capacity, negative inspiratory force
CSF analysis shows elevated protein levels without lymphocytic pleocytosis.

Guillain-Barré Syndrome Medical Management

Intensive care unit monitoring and management of respiratory failure.
Respiratory therapy, mechanical ventilation, chest physiotherapy for secretion removal.
Plasmapheresis and IVIG to target peripheral nerve myelin antibody level.

Guillain-Barré Syndrome Nursing Management

Monitor for impending respiratory failure, cardiac dysrhythmias, venous thromboembolism (VTE).
Maintain effective respirations, physical and mobility support, nutrition support, communication, and address patient fears by providing holistic care.

Parkinson's Disease

Progressive neurologic disorder affecting movement, leading to disability.
Fourth most common neurodegenerative disease

Parkinson's Disease Pathophysiology

Degeneration of dopamine storage cells in the substantia nigra.
Reduces dopamine levels in the corpus striatum
Imbalance of acetylcholine (excitatory) and dopamine (inhibitory) in striatal neurons impairs motor control and refinement

Parkinson's Disease Clinical Manifestations

Tremor (resting tremor, usually unilateral), rigidity, bradykinesia, and postural instability
Difficulty with voluntary movements and postural reflexes

Parkinson's Disease Assessment and Diagnostic Findings

Diagnosis is clinical. Symptoms include at least two of the cardinal manifestations: tremors, rigidity, bradykinesia, postural instability
No specific tests to diagnose PD
MRI to rule out other conditions

Parkinson's Disease Medical Management

Treatment is directed toward controlling symptoms and maintaining functional independence
Pharmacologic management is mainstay: antiparkinsonian medications to increase striatal dopaminergic activity, reduce excitatory cholinergic activity, or affect other neurotransmitters.

Parkinson's Disease Nursing Management

Assess how the disease affects ADLs and functional abilities: mobility, feeding, communication.
Assess cranial nerves, cerebellar function, and motor function.
Observe gait and activities
Assess speech clarity, space perception, depression, family supports and access to social services.

Alzheimer's Disease

Chronic, irreversible brain disease, a type of dementia.
Most common form of dementia

Alzheimer's Disease Pathophysiology

Degeneration of brain neurons, especially in the cerebral cortex.
Accumulation of neurofibrillary tangles and amyloid plaques.
Affects communication among neurons, resulting in memory loss, impaired thinking, disorientation, and personality changes.

Alzheimer's Disease Clinical Manifestations

Memory loss, disorientation, impaired thinking, and personality changes
Begins gradually, but progressively worsens.

Alzheimer's Disease Risk Factors

Age
Family history, genetic predisposition
Metabolic syndrome (diabetes, high blood pressure, high cholesterol), obesity
Smoking

Alzheimer's Disease Assessment and Diagnostic Findings

Diagnosis is clinical, based on symptoms and ruling out other causes with patient history and physical exam
No definitive tests
Stages may vary

Alzheimer's Disease Medical Management

Medications may improve some symptoms but cannot cure or stop progression.
Treatment is directed at managing symptoms and supporting functional independence.

Alzheimer's Disease Nursing Management

Focus on maintaining client health, promote mental and social activities, physical activity, and nutrition support.
Assess patient's current ADLs and functional problems, communication, memory, gait and balance, safety considerations (medication and cognitive impairments), family support.
Non-pharmacological strategies include: communication and interaction strategies, therapeutic activities, environmental modifications to optimize safety and well-being.

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