Term
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Definition
Immune mediated inflammatory disease that attacks the axons in the CNS destroying myelin
-results in slow, blocked or loss of transmission of nerve impulses
-more common in women
-temperate climates
-onset between 20-40, peaks at 30
-more common in African Americans |
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Term
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Definition
| exacerbation with full recovery |
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Term
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Definition
| progression from onset with no relapse |
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Term
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Definition
| Begins as relapsing-remitting followed by steady worsening with or with out exacerbation |
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Term
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Definition
| Progression from onset with exacerbation |
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Term
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Definition
gradual onset, may not be diagnosed immediately
-location of demyelination determine deficit
-may have progressive deterioration or
exacerbation and relapses
-sensory lost
-blurred/double vision
-Fatigue
-stiffness w/ muscle cramps
-Cognitive impairment
-Pain
-heat intolerance
-Mood alteration |
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Term
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Definition
clinical manifestations are severe and last more than 24 hrs.
-usually separated by at least 1 month |
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Term
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Definition
| periods of time when manifestations are not obvious |
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Term
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Definition
R/t MS
-short episodes of symptoms lasting from seconds to minutes often caused by increased temp or serum calcium levels
-S/S: paresthesias (abnormal sensations), dysarthria (decreased ability to articulate speech), Ataxia (inability to move), tonic head turning (involuntary spasm) |
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Term
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Definition
increased body temp
physical or emotional trauma
fatigue
infection
climate change
immunization
delivery of baby |
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Term
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Definition
H&P, must have 2 of the following:
-2 or more exacerbations seperated by 1 month lasting more than 24 hrs, with recovery
-HX of repeated exacerbation and remissions for 6+ months
-slowly increasing symptoms for at least 6 months
MRI: most definitive if a lesion is found |
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Term
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Definition
Purpose: maintain optimal level of function, maintain remission, control exacerbation
Includes physical and occupational therapy
--maintain independence, muscle strength and mange spasms
meds. slow the progression of disease, decrease frequency of attacks and treat symptoms |
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Term
| Treating Exacerbation of MS |
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Definition
Corticosteriods (methylprednisone)-decreases inflammation
Plasma Exchange |
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Term
| Disease Modifying Therapy for MS |
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Definition
(not for secondary progressive)
Interferon beta: Avonex, betaseron, rebif-increase immune effects
Fingolimod: Gilenya
Glatiramer acetate: copaxine - stimulates myelin protein
Mitoxantrone: novantrone
Matalizumb: tysabri- indicated as monotherapy |
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Term
| Immunosuppressants for MS |
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Definition
Azathioprine: Imutran
cyclophophamide: cytoxan
methotrexate (chemodrug) |
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Term
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Definition
| Urecholine-for urinary retention |
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Term
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Definition
| Ditropan-for bladder spasticity |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
-for spasticity/deformities
Intrathecal (baclofen) pump for spasms
Deep brain stimulation for uncontrollable tremors
Jejunostomy tube placement
rhizotomy |
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Term
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Definition
Degenerative joint disease
affects younger men and older women
Risk factors: age, obesity, hx of repetitive joint stress, sedentary lifestyle, possible genetic factor |
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Term
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Definition
Cartilage soaks up the synovial fluid, joints become dry and rough and painful because they don't have fluid movement
-cartilage is lost and bone is exposed |
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Term
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Definition
more common than secondary
-affects weight bearing joints: knees, hips, lower back but also neck and fingers
-Obesity and family hx are main factors |
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Term
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Definition
occurs as a result of unknown risk factors like:
trauma
Injury
Inflammation
neurological disorders
congenital deformities
hematologic disorders |
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Term
| Symptoms of Osteoarthritis |
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Definition
pain-typically with movement, relieved with rest
joint stiffness and aching
joint deformities
numbness/tingling
joint enlargement
COOL on palpitation
Limited ROM
grating or crepitus movements
--symptoms are UNILATERAL |
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Term
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Definition
bony enlargements of distal joints, may be painful, redness or swelling
Osteoarthritis |
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Term
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Definition
bony enlargement of proximal joints
Osteoarthritis |
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Term
| Diagnosis of Osteoarthritis |
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Definition
H&P
X-rays
Synovial fluid biopsy |
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Term
| Nonpharmacological TX of Osteoarthritis |
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Definition
ROM exercises with rest periods
Heat/Ice
Use of Assistive Devices
Weight Loss |
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Term
| Pharmacological TX of Osteoarthritis |
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Definition
1. Acetaminophen
2. NSAIDS
3. COX-2 Inhibitors: celebrex (possible cardio issues)
4. Trolamine salicylates (aspercreme, topical)
5. Capsaicin (capsin, topical)
6. Intra-articular injections: Hyaluronic acid and steriods for localized, short term use mostly for inflammation
7. Natural Products: glucasamine, chondroitin |
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Term
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Definition
Autoimmune disease; progressive, systemic, inflammatory disease
-destruction of synovial fluid and cartilage
-periods of exacerbation and remission
-most common in wrists, hands, elbows, shoulders, knees and ankles --BILATERALLY
-most common in women |
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Term
| Deformities specific to RA |
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Definition
Boutonniere deformity:PIP is exteneded, DIP is flexed
Swan Neck: PIP is hyper extended, DIP is flexed
Ulnar deviation
Rheumatoid nodules |
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Term
| Systemic manifestations of RA |
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Definition
Increased risk for
CVD
Infection
Pulmonary disease
GI bleed
cancer:lung and lymphoma
osteoporosis |
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Term
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Definition
early morning stiffness
fatigue, weakness, anorexia, low grade fever
pain in joints at rest and with movement
swelling and WARMTH in joints
wrist involvement is UNIVERSAL |
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Term
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Definition
Immune system attacks moisture producing glands
--eyes, mouth |
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Term
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Definition
In advanced RA
Enlarged Spleen and decreased WBCs |
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Term
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Definition
nerve damage related to swelling
-skin lesions |
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Term
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Definition
Bone scans: detect changes in bone
X-Ray: bone erosion, cartilage destruction, subluxation
Synovial Fluid aspiration: increased WBCs, and Rheumatoid factor present |
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Term
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Definition
NSAIDS, corticosteroids
Disease modifying antirheumatic drugs: (Rheumatrex)chemotherapeutic-interfere with cell growth
Methotrexate: stops disease progression -chemotherapeutic drug
Biological Response Modifiers: inhibit tumor necrosis factor and inflammation |
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Term
| Nonpharmacological TX of RA |
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Definition
Apheresis: filter plasma to remove antibodies
Surgical Intervention:remove synovial membrane
Alternative therapies |
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Term
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Definition
| a variety of disorders that influence blood flow to the brain resulting in neurological deficits from ischemia and necrosis |
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Term
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Definition
HTN
CVD
DM
Hyperlipidemia (high cholesterol)
Smoking/Substance abuse
sickle cell disease
Hormone replacement therapy, estrogen, etc.
Obesity
--living in the stroke belt : Southeastern USA |
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Term
| Transient Ischemic Attack |
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Definition
Warning sign for stroke!(1/3 will have CVA later)
-r/t blockage from microemboli
-Often lasts 1-2 hrs, clears up in 24hrs
S/s depend on location of clot: weakness or numbness of extremity
speech and visual difficulties
confusion |
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Term
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Definition
result from decreased blood flow related to arterial occlusion
~80% of all strokes
2 subtypes: thrombotic and embolic |
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Term
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Definition
bleeding into brain tissue, subarachnoid space or ventricles
~20% of all strokes
2 Subtypes: Intracerebral and subarachnoid |
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Term
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Definition
ischemic
caused by formation of clot in a large artery that splits
-narrowing of vessel as clot size increases, progressing to occlusion of cerebral vessel
-result of atherosclerosis
ONSET: progressive as clot forms, often during rest/sleep--worsens in 1-2 days
--maximum deficit occurs ~3 days when stroke "completes"
Prognosis: depends on amount of deprived brain tissue and collateral circulation |
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Term
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Definition
Ischemic--2nd most common
-originate in left chambers of the heart where plaque and thrombus break off and occlude smaller vessels
ONSET: very sudden, when awake may have a headache
Prognosis: r/t tissue deprived
-no time for collateral circulation
-increased risk for hemorrhage
--emboli may be absorbed |
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Term
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Definition
Hemorrhagic stroke
-caused by bleeding from rupture of cerebral blood vessels
-more common in elderly
-most often fatal
--Most common cause HTN, also brain tumor, trauma, thrombolytic drugs and rupture aneurysm
Blood in an enclosed area leads to: increased ICP, ischemia, infarction |
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Term
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Definition
Hemorrhagic stroke
Onset: RAPID, with no warning often during activity
-more common in young people
-S/S: initial HA, N/V, unilateral weakness of extremities, loss of consciousness, seizures
Prognosis: pressure on brain tissue from increased ICP can cause coma and death |
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Term
| Common symptoms of Stroke |
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Definition
weakness of the face, arm or leg
numbness of one side of the face or body
Visual loss
Speech deficit
Sudden severe headache
Balance difficulties |
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Term
| Sensoriperceptional Complications of Stroke |
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Definition
Deficits in:
visual
hearing
smell
balance
taste
proprioception
perception of vibration, warmth, cold, pressure
Improper perception of self spatially--neglect affected side |
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Term
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Definition
loss of 1/2 of visual field in one or both eyes
(homonymous hemianopia is same for both eyes) |
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Term
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Definition
| inability to recognize familiar subjects |
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Term
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Definition
| Inability to perform motor pattern with sufficient strength |
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Term
| Cognitive/behavioral complications of Stroke |
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Definition
Emotional: exaggerated, unpredictable emotions
laugh/cry inappropriately
loss of self control
decreased stress tolerance
Intellectual:
memory loss
decreased attention span
poor judgement |
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Term
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Definition
more cautious
more problems with memory/language/speech |
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Term
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Definition
more impulsive
move quickly |
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Term
| Communication disorders R/t Stroke |
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Definition
| Impaired motor function, speech, language, memory, reasoning, emotion |
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Term
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Definition
| paralysis of 1/2 the body |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| increased muscle tone, w/ some weakness |
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Term
| Diagnostic study of Stroke |
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Definition
H&P
NIH stroke scale
Serial CT scan
MRI |
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Term
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Definition
| Drug therapy: low dose aspirin, anticoagulants (coumadin), Platelet inhibitors (plavix) |
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Term
| Surgical Intervention for Stroke |
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Definition
Carotid endarterectomy: removes plaque on vessels occluded 70-99%
Carotid angioplasty: balloon opens stenosed arteries (risk for emboli)
Artery Bipass |
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Term
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Definition
Stroke Recognition
F: face, ask pt. to smile, does one side droop?
A: arms, raise both arms, does one drift downward?
S: speech, ask person to repeat a simple sentence, do they slur their words or have trouble repeating
T: time, if the pt. shows any of these symptoms time is very important |
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Term
| Acute Care of Stroke pts. |
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Definition
maintain airway: artificial airway, vent., pulse ox
monitor neuro status frequently
Interrupt ischemic cascade: decrease blood viscosity to promote blood flow to the area
-tPA: tissue plasminogen activator, dissolves clots within 3 hrs of formation
--MUST be done within 3 hrs of onset of symptoms
maintain fluid.electrolyte balance
Surgery
Rehabilitation: 12-24 hrs. physical, emotional, occupational therapy |
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Term
| Symptoms of Dysphagia/Aspiration |
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Definition
coughing during meals
hoarse voice after meals
gurgling sounds in throat
drooling
upper respiratory infection
pneumonia |
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Term
| Symptoms of aspiration Pneumonia |
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Definition
elevated Resp. Rate
fever, cough, chills
Pleuritic chest pain
Crackles
Delirium,increased confusion or falls |
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Term
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Definition
single episode of uncontrolled electrical discharge of neurons in the brain the interrupts normal function
-more common in very young and very old, genetic link |
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Term
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Definition
spontaneously recurring seizures that interrupt normal function and is a chronic underlying problem
2 or more seizures |
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Term
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Definition
| imbalance of excitability of neurons with out proper inhibition--exceeds seizure threshold |
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Term
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Definition
repetitive electrical charge from epileptic focus causes permanent changes in neuron excitability
(seizures bring on more seizures)
neurons become more sensitive
--need consistent medication |
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Term
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Definition
| Begin in a specific hemisphere |
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Term
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Definition
remains conscious, lasts less than one minute
-Affects depend on area of the brain affected: often recurrent muscle contractions of face, opposite hand or finger
-jacksonian march: muscle twitching that moves up the body
May have abnormal sensation or hallucination
-Deja vu, fear, anger
-tachycardia, flushed, hypotension/hypertension |
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Term
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Definition
lasts greater than 1 minute, impaired consciousness
-may engage in repetitive, nonpurposeful activity
-may have an aura
-often experience post-ictal confusion and amnesia |
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Term
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Definition
| repetitive, nonpurposeful behaviors |
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Term
| Absence seizures (petit mal) |
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Definition
most common in children
-brief loss of consciousness
-staring spell (5-10 seconds), unresponsive, cessation of normal motor function
-may have automatisms too
-can occur several hundred times a day if untreated |
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Term
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Definition
affects the entire brain at onset of the seizure
-ALWAYS have loss of consciousness (seconds to minutes)
Tonic/Clonic (Grand Mal): may experience cyanosis, incontinence, slaivation, bite cheeck/tongue
--Risk for Injury
lasts 60-90 seconds |
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Term
| Tonic/Clonic Seizure Phases |
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Definition
Tonic phase: sudden loss of consciousness, falls to ground, rigid/extended muscles and jerking, apneic, pupils fixed, lasts 15 seconds.
Clonic phase: stiff and relax, hyperventilation, foam at the mouth
Post-ictal phase: fatigued, relaxed, may sleep for several hours, head ache, no memory of seizure |
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Term
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Definition
sense of uneasiness
abnormal smell--possibly burning rubber
abnormal vision--blurry, halos, bright light
abnormal sound or sensation |
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Term
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Definition
Seizures occurring in rapid succession
-Short periods of calm
-seizures are intense and persistent
-muscle contractions interfere with respiration
-can cause permanent brain damage
Tonic/Clonic status epilepticus is most dangerous: can cause hyperthermia, hypoglycemia, hypoxemia, arrythmias, systemic acidosis
--CAN be FATAL, Call 911 |
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Term
| Immediate Intervention for Status Epilepticus |
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Definition
Establish/maintain airway
Ativan or Valium IVP
50% dextrose IV
Start Dilantin
-time seizure |
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Term
| Complications of seizures |
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Definition
physical injury: trauma, head injury, burns, drowning, MVA
psychosocial: embarrassment, discrimination, transportation |
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Term
| Diagnostic Study of Seizures |
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Definition
History and description of seizure
-EEG
CBC
Liver/kidney effects
Blood glucose-rule out metabolic issue
CT/MRI-rule out brain lesion
Lumbar puncture-rule out CNS infection |
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Term
| Pharmacological TX of Seizures |
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Definition
can be controlled NOT cured by medications
-Dilantin
-Ativan
-Lamictal
--watch for resp. depression with IVP
may do trial with drawl if seizure free for 3 years
work by stabilizing nerve cell membranes and decreasing the spread of epileptic discharge |
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Term
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Definition
-Resection of epieltogenic tissue (focal point) if drug therapy is ineffective-may reduce or halt seizures
Vagal nerve Stimulation: may reduce the number and intensity of seizures in some pts. |
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Term
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Definition
Don't usually require emergency care unless it is the first seizure or STATUS epilepticus
Priority: maintain airway, turn on side if able, stay with pt., record data pertaining to seizure (time), prevent client injury |
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