April 23, 2016, Up date

STUDY GUIDE FOR

MODULES 5 & 8

1. Understand and know how to evaluate a patients level of consciousness using the
Glasgow Coma Scale. Know at what level comatose is determine
Glasgow Coma Scale- a quick practical and standardized system for assessing the
LOC.
Three areas assessed; Pts ability to:
1). speak
2). Obey Commands
3). Open the eyes when a verbal or painful stimulus (sternal rub) is applied
Three indicators of response are evaluated:
1). Opening of the eyes
2). Best verbal response
3). Best motor response
Specific behaviors observed as responses to the testing stimulus are given numeric values.
As a Nurse, your responsibility is to elicit the best response on each of the scales.
The higher the scores the higher the level of brain function range from 3-15
Comatose is determined at a level 8 or below.
2. Know the primary responsibilities of the nurse caring for a client with a seizure disorder.

When a Seizure occurs:

Observe and record details of event
Note all aspects
What event preceded the seizure?
When did the Seizure occur?
How long did each phase last?
Prodromal- Remission stage- before any S&S of seizure
Aural- Subjective to pt, Phase in sensory warning
Ictal- Full Seizure
Postictal- Phase after seizure, rest and recovery
What occurred during each phase?
Both subjective (aural stage) and objective data are important
Note the exact onset (which body part was affected first and how)
Course and nature of seizure activity (loss of consciousness, tongue biting, automatism,
stiffening, jerking, total lack of muscle tone)
The body parts involved and their sequence of involvement
Autonomic signs such as:
Dilated pupils
Excessive salivation
Altered breathing
Cyanosis
Flushing diaphoresis
Incontinence
Postictal period assessment should include:
LOC
VS
Pupil size and position
Memory loss
Muscle soreness
Speech disorder (aphasia, dysarthria)
Weakness or paralysis
Sleep period
And duration of each sign and symptom
3. Know and fully understand all aspects of the administration of Dilantin (esp IV)
including teaching, and what possible adverse reactions (signs/symptoms in the pt.),
might occur when toxic levels are administered. Know the therapeutic acceptable ranges.

Dilantin (Phenytoin
Sodium- IV)
Anticonvulsant
Therapeutic Dosing:
10-15 mg/kg loading
dose followed by oral
or iv maintenance
dose q6-8 hours.
Should not exceed
50mg/min
Check levels Dilantin
levels before admin
Check liver and
renal fx prior to
admin

Adverse effects:
Venous irritation, pain, and
thrombophlebitis.
Extravasation can cause
tissue necrosis
Teaching:
Instructs to take meds as
directed each day at the same
time, may cause drowsiness
or dizziness
Caution to avoid driving
Caution to avoid alcohol and
CNS depression meds
Instruct that behavioral
changes skin rash, fever, sore
throat, mouth ulcers, easy
bruising, petechial, unusual
bleeding, abd pain, chills,
pale stools, dark urine,
jaundice, severe n&v, or
drowsiness, slurred speech,
unsteady gait, swollen glands
and persistent h/a should be
reported. Report any
worsening depression of
anxiety or thoughts of suicide
occur.
Folic Acid Absorption

Mild to mod toxicityN&V, nystagmus,

ataxia, mild CNS
depression
Severe Toxicity:
severe CNS
depression, coma,
rarely respiratory
depression. Rapid
infusion over
50mg/min can cause
hypotension,
bradycardia, AV
conduction delays,
and ventricular
dysrhythmias which
may be fatal.
Nursing: Monitor
serum phenytoin
levels routinely,
therapeutic levels are
10-20 mcg/ml
Teach oral care
Oral hygiene before and
after meals
Daily and regular dental
care to prevent gingiva
hyperplasia and hirsutism
(overgrowth of hair)

4. Be able to identify the clinical manifestations of a specific seizure type when given
specific client signs and symptoms. *** PLEASE review under Generalized Seizures
Myoclonic, simple focal, complex focal, and typical absence. Please study/review the
seizure power point.

SEIZURE DISORDERS AND EPILEPSY

A seizure is a paroxysmal, uncontrolled electrical discharge of neurons in the brain
that interrupts normal function. Seizures are often symptoms of an underlying
illness.
Epilepsy is a condition in which a person has spontaneously recurring seizures
caused by a chronic underlying condition.

Seizures are divided into two major classes: generalized and focal.
Generalized seizures
involve both sides of the brain and are characterized by bilateral synchronous
epileptic discharges in the brain. Because the entire brain is affected at the onset of
the seizures, there is no warning or aura.

Tonic-clonic seizure
Loss of consciousness and falling to the ground if the patient is
upright
Followed by stiffening of the body (tonic phase) for 10 to 20 seconds
Subsequent jerking of the extremities (clonic phase) for another 30 to
40 seconds.
S/S
Cyanosis
excessive salivation
Tongue or cheek biting may occur.
Postictal Phase
muscle soreness, fatigue
Patient may sleep for hours.
May not feel normal for hours to days
No memory of seizure
Typical Absence (petit mal) seizures
Usually occurs only in children and rarely beyond adolescence
May cease as the child matures or develop into another type
Can be precipitated by flashing lights and hyperventilation
S/S
daydreaming.
Lasts only a few seconds
Often goes unnoticed
May occur up to 100 times/day if untreated
Atypical absence seizure
staring spell with other manifestations
S/S

Brief warnings
Peculiar behavior during seizure
Confusion after

Atonic Seizures
Tonic episode or paroxysmal loss of muscle tone.
S/S

Begins suddenly and person falls

Consciousness usually returns by time person hits ground.
Can resume normal activity immediately
Great risk for head injury

Tonic seizures
o Involve sudden onset of maintained increased tone in the extensor muscles
o Patients often fall.
Clonic seizures
o Begin with loss of consciousness and sudden loss of muscle tone
o Followed by limb jerking
Focal seizures (partial)
are caused by focal irritations. They have unilateral manifestations that arise from
localized brain involvement.
Simple focal seizures
No loss of consciousness and rarely last longer than 1 minute.
S/S
Person experiences unusual feelings or sensations that can take many
forms.
Sudden and unexplainable feelings of joy, anger, sadness, or nausea
May hear, smell, taste, see, or feel things that are not real
Complex focal seizures
Person has a change or loss of consciousness.
Produces a dreamlike experience
S/S
Display strange behavior
Lip smacking
Automatisms repetitive movements that may not be appropriate
Does not remember an activity started before and continued during
seizure
Usually last just a few seconds

Status epilepticus is a state of continuous seizure activity or a condition in

which seizures recur in rapid succession without return to consciousness between
seizures. It is the most serious complication of epilepsy and is a neurologic
emergency.
Most seizures do not require emergency medical care because they are self-limiting
and rarely cause bodily injury. However, if status epilepticus occurs, if significant
bodily harm occurs, or if the event is a first-time seizure, medical care should be
sought immediately.
Seizure disorders are primarily treated with antiseizure drugs. The goal of therapy
is preventing seizures.

Magnetoencephalography in conjunction with EEG

o Greater sensitivity for detecting small magnetic fields generated by neuronal
activity
CBC, serum chemistries, liver and kidney function, UA to rule out metabolic
disorders
MRI, CT, PET
Primary drugs for treatment of generalized tonic-clonic and focal seizures
Phenytoin (Dilantin)
Divalproex (Depakote)
Carbamazepine (Tegretol)
Phenobarbital (Luminal)
Primidone (Mysoline)
(Carbamazepine, phenobarbital, and primidone negatively affect cognitive function.
Drug interactions with carbamazepine, phenytoin, phenobarbital)
Primary drugs used to treat absence and myoclonic seizures
Ethosuzimide (Zarontin)
Divalproex (Depakote)
Clonazapam (Klonopin)
Antiseizure drugs should not be discontinued abruptly as this can precipitate seizures.
Common side effects involve
the CNS and include diplopia, drowsiness, ataxia, and mental slowing.

Drugs must be taken regularly and continuously, often for a lifetime. Teach the
patient the importance of following the specific drug regimen and what to do if a
dose is missed.
A significant number of patients whose epilepsy cannot be controlled with drug
therapy are candidates for surgical intervention to remove the epileptic focus or
prevent spread of epileptic activity in the brain.
During the seizure, it is important to maintain a patent airway and observe and
record details of the event.

Acute Intervention
Observe, treat, and document seizure.
Maintain patent airway, support head, turn to side, loosen constrictive
clothing, ease to floor.
Do not restrain patient or place any objects in their mouth.
May require positioning, suctioning, or oxygen after seizure
MAOI: monoamine oxidase inhibitor. Contradicted with Tegretol

5. Understand all the nursing implications involved with the procedure laparoscopic
Nissen Fundoplication.
(GERD and HAITAL HERNIA)
MOST COMMON IN WOMEN OVER 40
Postop care:
GAG REFLEX (TURN TO LEFT SIDE)/ PREVENTION OF
ASPIRATION
Prevention of respiratory complications- PATENT AIRWAY/ DO NOT
WANT TO HEAR ABSENT BREATH SOUNDS
Maintenance of F &E balance
Prevention of infection
Prevention of N&V
Pain control
Assess
o Resp rate, and rhythm,
o Pulse rate and rhythm
o Signs of Pneumothorax (dyspnea, chest pain, cyanosis)
When peristalsis returns, only fluids are given initially
o Measure I&O
o Solids are added gradually with the goal of a regular diet
Teach
o Deep breath to fully expand the lungs
o Teach to avoid foods that are gas forming to prevent gastric distention
o Teach to chew food thoroughly
Notify MD if heartburn or regurgitation continues.

6. Know the common drugs used to treat peptic ulcers and what their therapeutic effect
should be as well as any specific nursing implications as it relates to side effects,
administration times, and interactions with other medications.

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is a condition characterized by erosion of the GI mucosa from
the digestive action of hydrochloric acid and pepsin.
PUD is classified as acute (SUPERFICIAL) or chronic (FOR MONTHS), and as gastric
or duodenal. Gastric and duodenal ulcers are different in their etiology and incidence.
The organism H. pylori is found in the majority of patients with PUD. Alcohol, nicotine,
stress, and drugs such as aspirin and NSAIDs play a role in gastric ulcer development.
Taking a careful patient history can assist in differentiating between gastric and duodenal
ulcers. Pattern and timing of pain in relation to food intake differs between the two.
The three major complications of chronic PUD are hemorrhage, perforation, and gastric
outlet obstruction.
Endoscopy is the most commonly used procedure for diagnosis of PUD lesions. Tests are
also used to test for the presence of H. pylori infection.
Treatment of PUD includes adequate rest, dietary modifications, drug therapy,
elimination of smoking, and long-term follow-up care. The aim is to decrease gastric
acidity, enhance mucosal defense mechanisms, and minimize the harmful effects on the
mucosa.
Aspirin and nonselective NSAIDs may be discontinued or the doses reduced. When their
use must be continued, coadministration with a proton pump inhibitor (PPI), histamine2
(H2) receptor blockers, or misoprostol (Cytotec) should be considered.
The drugs most commonly used to treat PUD are proton pump inhibitors (PPIs) and H2 receptor blockers.
Antibiotics are used to eradicate H. pylori infection.
If perforation occurs, the immediate focus of patient management is to stop the spillage
of gastric or duodenal contents into the peritoneal cavity and restore blood volume.
In gastric outlet obstruction, the aim is to decompress the stomach, correct any existing
fluid and electrolyte imbalances, and improve the patients general state of health.
Overall goals for the patient with PUD include compliance with the prescribed
therapeutic regimen, reduction or absence of discomfort, no signs of GI complications,
healing of the ulcer, and appropriate lifestyle changes to prevent recurrence.
You play an important role in identifying patients at risk for PUD. Patients with identified
PUD have specific needs regarding preventing recurrence and complications that require
detailed patient and caregiver teaching.
Surgical procedures for PUD include partial gastrectomy, vagotomy, and/or pyloroplasty.
o Long-term postoperative complications from PUD surgery may include (1)
dumping syndrome, (2) postprandial hypoglycemia, and (3) bile reflux gastritis.
Nursing care for the patient who underwent PUD surgery is similar of that to the
postoperative care of the patient who underwent an abdominal laparotomy

Hypercalcemia, kidney stones,

decreases absorption of
tetracycline, phenytoin and
iron salts, Increases Digitalis
effects. Use cautiously with
renal and cardiac patient

PPIs: Long term use or high doses may increase the risk of fractures of hip wrist and
spine. Also increased risk of C-Diff in hospitalized pts. Long term use is also associated
with PNA.
7. Be able to identify a specific type of ulcer (duodenal, gastric) given a clients signs &
symptoms.

8. Understand and know the pathophysiology/etiology of Cholecystitis & Cholelithiasis:

and, what happens when the common bile duct is obstructed as far as absorption of certain
minerals/vitamins (fat-soluble vitamins). What possible signs & symptoms might the
pt. exhibit with a deficiency in any of these vitamins.

Cholelithiasis
Stones in the Gall Bladder

Cholecystitis
Inflammation of the gallbladder

Stones may be lodges in the neck of

the gall bladder or the cystic duct.

Develops when the balance that keeps

cholesterol, bile salts, and calcium in
Manifestations of cholecystitis vary
solution is altered and precipitation
from indigestion to moderate to severe
occurs.
pain, fever, and jaundice
May produce severe symptoms or
none at all, depending on whether the
Initial symptoms of acute cholecystitis
stones are stationary or mobile and
include indigestion and pain and
whether obstruction is present
tenderness in the right upper quadrant.
Ultrasonography is commonly used to
diagnose gallstones
Treatment
Treatment is mainly supportive and
o Laparoscopic cholecystectomy is
symptomatic, focusing on control of
the treatment of choice for
pain, control of possible infection with
symptomatic Cholelithiasis.
antibiotics, and maintenance of fluid
o Medical dissolution therapy is
and electrolyte balance.
recommended for patients with
small radiolucent stones who are
mildly symptomatic and are poor
surgical risks.
Most Common drug therapy:
o Analgesics
o Anticholinergics (antispasmotics)
Atropine- relax smooth muscle and decrease ductal tone to pass stones
o Fat-Soluble Vitamins
o And Bile salts: - to facilitate digestions and vitamin absorption
o Morphine may be used initially for pain.
o NSAID (ketorolac (Toradol))
o Cholestyramine_(resin that binds bile salts in the intestines) powder form
mixed with milk or juice- relive pruritus in the skin
Side effects: N&V, diarrhea, constipation and skin reaction.

Acute or chronic
Usually associated with Cholelithiasis
or biliary sludge (a mixture of
cholesterol crystals and calcium salts).

9. Understand and be able to identify the nutritional recommendations for such disorders as
GERD, Hiatus Hernia, Peptic Ulcer, and Cholecystitis. **Most importantly, review
Inguinal Hernia and the nursing care of the patient postoperatively (Lewis, pg. 996997).
GERD
Low Fat Diet, eat small frequent meals,
avoid alcohol and smoking and
caffeine, Do not lie down for 2-3 hours
after eating, avoid eating 3 hours
before bedtime. Sleep with head
elevated, AVOID chocolate,
peppermint, tomatoes, fatty foods,
coffee and tea ( decreases LED
pressure) Lso avoid milk especially at
qhs ( increases gastric acid secretions)
Avoid constricting garments
Hiatus Hernia- herniation of the portion Low Fat Diet, eat small frequent meals,
of the stomach into the esophagus
avoid alcohol and smoking and
through an opening or hiatus, in the
caffeine, Do not lie down for 2-3 hours
diaphragm.
after eating, avoid eating 3 hours
before bedtime. Sleep with head
elevated, AVOID chocolate,
peppermint, tomatoes, fatty foods,
coffee and tea ( decreases LED
pressure) Lso avoid milk especially at
qhs ( increases gastric acid secretions)
Avoid constricting garments. Avoid
lifting and straining
Peptic Ulcer
Avoid irritants such as caffeine,
eliminate alcohol. Avoid hot and spicy
foods, pepper, carbonated drinks and
broth (meat extract)
Cholecystitis
Eat small frequent meals with some fat
at watch meal to promote gallbladder
emptying. Decrease obesity, reduce
calories, low in sat fats (butter,
shortening, lard) high in fiber and
calcium. Rapid weight loss call for
stones. Eat nutritive meals and avoid
excessive fat intake
Inguinal Hernia- most common type of hernia and occurs at the point of weakness
in the abdominal wall where the spermatic cord (men) and round ligament (in
women) emerges.

More common in men

Surgery is the treatment of choice for hernias.
If the hernia becomes strangulated, the patient will experience severe pain and
symptoms of a bowel obstruction, such as vomiting, cramping abdominal pain,
and distention.

Nursing care:
After herniorrhaphy, strangulated hernias are resected or may need a temp
colostomy
Pt may have difficulty voiding
o Must monitor I&O
o Assess for distended bladder
o Assess for scrotal edema (painful complication)
Scrotal support with ice bag
o Encourage deep breathing but not coughing
o Teach pts to splint their incision and keep mouth pen when coughing or
sneezing.
o Restrict heavy lifting for 6-8 weeks

10. Know the therapeutic ranges for common neurological drugs such as Dilantin, aspirin,
and Depakote. What signs/symptoms might you observe in a patient who has reached
toxic levels of these specific drugs?

Meds

S/S adverse
reactions

Toxic levels

Dilantin (Phenytoin

Venous irritation, pain, and

thrombophlebitis.
Extravasation can cause tissue
necrosis

Mild to mod toxicity-N&V,

nystagmus, ataxia, mild CNS
depression
Severe Toxicity: severe CNS
depression, coma, rarely
respiratory depression. Rapid
infusion over 50mg/min can
cause hypotension,
bradycardia, AV conduction
delays, and ventricular
dysrhythmias which may be
fatal.

Sodium- IV) Anticonvulsant

Dosing: 10-15 mg/kg loading
dose followed by oral or iv
maintenance dose q6-8 hours.
Should not exceed 50mg/min
Check levels Dilantin levels
before admin
Check liver and renal fx
prior to admin

Teach oral care

Oral hygiene before and
after meals
Daily and regular dental
care to prevent gingiva
hyperplasia and hirsutism

(overgrowth of hair)

ASA (aspirin) Antiplatelet

GI Upset, and tinnitus

Dosing: 160-325 mg orally

within 48hours of event
(Secondary prophylaxis) 75 to
100 mg Orally daily

Severe Toxicity: Metabolic

acidosis, hyperpnea,
diaphoresis, fever, altered
mental status, seizures, coma,
cerebral edema and death.

Should not ingest greater

than 150mg/kg or 6.5 g of
aspirin.

Depakote (Valproate
sodium)
Therapeutic dose: 10-15
mg/kg/day titrate as needed.
MAX Dose: 60 mg/kg/day

Mild to moderate Toxicity: GI

upset, tinnitus, tachypnea, and
respiratory alkalosis.

At risk of developing
hepatotoxicity during the first
6 months of treatment
especially if sued with other
anticonvulsants

Mild Toxicity: >200mg/kg

risk of CNS depression,
Mod: >400 mg/kg risk of
multiogran system toxicities
Severe: >750 mg/kg
potentially lethal

11. Know all of the care and appropriate interventions involved in caring for a patient
With ALS, myasthenia gravis, Parkinsons disease, multiple sclerosis, and Guillen Barre.

ALS (LOU GARRETS DISEASE)

DIAGNOSIS: difficult to diagnose median is 3 years of life after diagnosis.
1. Signs of degeneration of spinal cord and nerve stem
2. Brain
3. Spread to other regions
4. Absence of evidence
R/O any other possible disease.
Electromyogram, nerve signal test for pattern for ALS
MRI, herniated discs or spinal cord tumors to r/o ALS
Spinal Tap, r/o disease
TREATMENT
Priority slow down disease process
RILOTEK P.O take without food fasting, teach no cure to increase life span by
several months. Decreased ventilation support and monitor liver function test.
Sings of neutropenia (febrile, infx, cardio and resp changes)
Other meds Baclofen
Antidepressants,
Phenytoin.

CARE:
PT/OT/Speech therapy to maximize function
(want to provide with some kind of diversional activities)
Nutrition -Reducing risk of aspiration, weight loss
Must inform that even though body is deteriorating, Brain fx (cognitive) is in
tact
Facilitating communication
Decrease pain to muscle aches
Companionship
Fall risk
Emotional support/ counseling, psychosocial
Artificial methods in ventilation
Advanced directives.

Myasthenia Gravis (1473)

Autoimmune disease of the neuromuscular junction, antibodies attack acetylcholine receptors,
results sin decreases numbers of Ach receptors
DIAGNOSIS: no definitive tests
H&P
Fatigability with upward gaze (eyes almost closed)
Muscle weakness- improve after rest
o EMG, (electromyography)
o Single fiber EMG
o Tesnsilon test- reveals improved muscle contractility after injection
(endrophonium chloride) used to help confirm diagnosis (what are the clues
to diagnose disease)
o Atropine is the antidote
Solid dx requires
Serology: Acetylcholine receptor Antibodies (along with combination with
other tests)
Chest X-ray
CT

S/S:
o Specific muscle weakness
o Eye problems dropping, (ptosis)
o Double vision (diplopia)
o Face and throat muscle alterations
o Altered speech
o Dysphagia
o Limited facial expressions
o Neck and limb muscles alterations, difficult to hold head up
o Sensory loss
TREATMENT:
No cure

Can resolve spontaneously

Therapy
Drug therapy
Anticholinesterase
Corticosteroids
Immunosuppressant- destroying antibodies
Surgical therapy:
Thymectomy- thymus tumor removal
Other therapies
Plasmapheresis- exchange plasma (short term therapy)
CARE:
Dont take meds on empty stomach
Take meds before food (45 minutes to help ease feeding)
Take meds
O2, suction, equipment
Infection precautions
Apply lubricants to protect eyes,
Wear medical identifications for public safety

MS (MULTIPLE SCLEROSIS)
MULTIPLE MANY PART, SCLEROSIS (HARDENING) MANY PARTS OF CNS
STIFFENED
ON SET 20-50 WOMEN, UNKNOWN CAUSE. (INFX, SMOKING, PHYSICAL
INJURY)
AUTOIMMUNE TISSUE DISEASE
DEMYELINATION- DESTRUCTIONO F MYELIN SHEATHS.
S/S
DIFFER FROM PATIENT TO PT
NUMBNESS AND WEAKNESS IN ONE OR MORE LIMBS IN ONE SIDE OF THE
BODY
PARTIAL OR COMPLETE VISION LOSS, PAIN DURING EYE MOVEMENT
TINGLING OR PAIN
ELECTRIC SHOCK
SLURRED SPEECH
FATIGUE- BALANCE BETWEEN REST AND ACTIVITY- PACE ACTIVITY.
DIZZINESS
GI BOWEL AND BLADDER FX
DIAGNOSIS:
NO DIFINITIVE DX TEST
HX, CLINICAL MANIFESTATION
DX TESTS
XRAY 1ST

MRI
CSF- IMMUNOGLOBULIN G
EVIDENDCE OF DEMIYELINATION
TREATMENT: NO CURE
IMMUNO MODULATORS
SEE HAND OUT
CARE:
PT
WATER EXERCISE
SURGERY
PT TEACHING,
BUILDING RESISITANC ETO ILLNESES
TRIGGER FOR MS INFECTIONS OF ANY KIND
HIGH FIBER
SELF CATH
MINIMIZE CAFFEINE
TEACH RESOURCES, EMOTIONAL SUPPORT

PARKINSONS DISEASEDEGENARATION OF DOPAMINE. 80% OF NEURONS LOSS WE CAN SEE PD, CAUSES
CHEMICALS, DRUG INDUCED
DIAGNOSIS:
UNKONWN CAUSE, NO SPECIFIC DIAGNSOTIC TESTS
NUERO EXAM
DX WHEN 2OUT 3
POSITIVE RESPOSE TO MED TREAMENT
SIGNIFICANT IMPORVEMENT
25% OF DX ARE INCORRECTS
S/S:
SLOW DECREASE, ONSET GRADUAL AND INSIDIOUS. PROGRESS UNTIL NO
DOPAMINE
DROOL
DRCREASED SWALLONG
DECRESED BLINKING
SHUFFLING GAIN
LATE SIGNS
DEPRESSION ANXIETY FATIGUE, PAIN SHIRT TERM EMMORY LOSS, SLEEP
DISTURBANCES
THREE MUST HAVES
1. TREMOR-PILL ROLL LIKE TREMOR
2. RIGIDITY- STUCK WHEN TRYING TO WALK
3. BRADYKINISEA- DIFFICULTY INITIATING MOVEMENTS
TREATMENT:

o MEDICATION SENNAMET (LEVADOPA, CARVADOPA), AVOID VIT B6

&PROTEINS
o AFTER 3 YEARS OF DRUG THERAPY, SX PROGRESS AND WORSEN
o NUTRITIONAL THERAPY
o SURGICAL TREATMENTo DEEP BRAIN STIMULATION, ABLATION, TRANSPLANTAION FETAL
NEURO TISSUE
o LOSS OF APPETITE
o DYSPHAGIA
CARE:

DIET- CONSTIPATION AND WEIGHT LOSS, ANTIOXIDES, VEG, HIGH

FIBER,
FOOD SMALL PIECES,EASY TO SWALLOW,
EXERCISE- RELEASE OF DOPAMINE
EAT PROTEIN AND NIGHT
SAFETY
SPEECH THERAPY

INCREASED incidence of Gillian-Barre increased after influenza vaccinations in the 1976-1977

12.
Please review the drug Gentamycin, especially side effects,
acceptable therapeutic and toxic blood levels & any associated lab
data for this drug.

Gentamyacin:
Side effects:
Ataxia, vertigo, ototoxicity, nephrotoxicity, diarrhea
N&V, hypomagnesemia, muscle paralysis, apnea,
hypersensitivity
Acceptable therapeutic and toxic blood levels should not
exceed 10 mcg/ml for peak, trough should not exceed
2mcg/ml
Therapeutic dose: 1-2mg/kg q8h up to 6mg/kg/day in 3 divided
doses.
Associated labs- renal function, ua, specific gravity, BUN,
creatinine, peak and though
13. Please review and understand the test that can confirm the
diagnosis of
Myasthenia Gravis.
Tests to confirm diagnosis

no definitive tests
H&P
Fatigability with upward gaze (eyes almost closed)
Muscle weakness- improve after rest
o EMG, (electromyography)
o Single fiber EMG
o Tesnsilon testo a diagnostic technique for verifying the signs of myasthenia gravis by testing
the power of skeletal muscles before and after injection of edrophonium
hydrochloride.
o reveals improved muscle contractility after injection (endrophonium
chloride) used to help confirm diagnosis (what are the clues to diagnose
disease)
o In myasthenia gravis, there are too few receptors for acetylcholine on the
muscle. The acetylcholine is broken down before it can fully stimulate this
reduced number of receptors, and, as a result, the muscle is weak. By
blocking the action of acetylcholinesterase, Tensilon prolongs the muscle
stimulation, and temporarily improves strength. Increased strength following
an injection of Tensilon strongly suggests a dignosis of MG. The Tensilon test
is most effective when easily observed weakness is present, and is less useful
for vague or fluctuating complaints.
o Atropine is the antidote
Solid dx requires
Serology: Acetylcholine receptor Antibodies (along with combination
with other tests)
Chest X-ray
CT