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Compilation of Ms Notes

Compilation of Ms Notes

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48
MEDICAL-SURGICAL NURSINGAUTONOMIC NERVOUS SYSTEMSympathetic Nervous System(ADRENERGIC)Parasympathetic Nervous System(CHOLINERGIC, VAGAL, SYMPATHOLYTIC)-
Involved in fight or aggression response.- Release of Norepinephrine (cathecolamines)from
adrenal glands
and causes
vasoconstriction.
- Increase all bodily activity except GIT
EFFECTS OF SNS
- Dilation of pupils(
mydriasis
) in order to be aware.- Dry mouth (thickened saliva).- Increase BP and Heart Rate.- Bronchodilation, Increase RR- Constipation.- Urinary Retention.- Increase blood supply to
brain
,
heart
and
skeletalmuscles
.- SNS
I. Adrenergic Agents
- Give
Epinephrine.Signs and Symptoms:
- SNS
Contraindication:
- Contraindicated to patients suffering from COPD(Broncholitis, Bronchoectasis, Emphysema, Asthma).
II. Beta-adrenergic Blocking Agents
- Also called
Beta-blockers
.- All ending with “
lol
-
Propranolol
,
Atenelol
,
Metoprolol
.
 
Effects of Beta-blockers
B
 – roncho spasm
E
– licits a decrease in myocardial contraction.
T
– reats hypertension.
A
– V conduction slows down.
Should be given to patients with
AnginaPectoris
,
Myocardial Infarction
,
Hypertension
.
ANTI- HYPERTENSIVE AGENTS
1. Beta-blockers – “lol”2. Ace Inhibitors – Angiotensin, “pril” (Captopril,Enalapril)3. Calcium Antagonist – Nifedipine (Calcibloc)
In chronic cases of arrhythmia give
Lidocaine
(
Xylocaine
)
-
Involved in fight or withdrawal response.- Release of Acetylcholine.- Decreases all bodily activities except GIT.
EFFECTS OF PNS
- Constriction of pupils (
meiosis
).- Increase salivation.- Decrease BP and Heart Rate.- Bronchoconstriction, Decrease RR.- Diarrhea- Urinary frequency.
I. Cholinergic Agents
-
Mestinon
,
Neostigmine
.
Side Effects
- PNS
II. Anti-cholinergic Agents-
To counter cholinergic agents.- Atropine Sulfate
Side Effects
- SNS
2. Carbon Monoxide and Lead Poisoning
Can lead to
Parkinson’s Disease.
Epilepsy
Treat with
ANTIDOTE
:
Calcium EDTA.3. Type 1 DM (IDDM)
Causes diabetic ketoacidosis.
And increases breakdown of fats.
And free fatty acids
Resulting to
cholesterol
and (+) to
Ketones
(CNS depressant).
Resulting to acetone breath odor/fruity odor.
KUSSMAUL’S respiration,
a rapid shallow respiration.
Which may lead to diabetic coma.
4. Hepatitis
Signs of jaundice (icteric sclerae).
Caused by bilirubin (yellow pigment)
5. Bilirubin
Increase bilirubin in brain (
Kernicterus
).
Causing irreversible brain damage.
Compilation of MS Notes|Karl Gerald C. Manalili, UASN 2010
 
48
DEMYELINATING DISORDERS1.
ALZHEIMER’S DISEASE
Atrophy of brain tissues.
Sign and Symptoms
4 A’s of Alzheimer 
a.
Amnesia
– loss of memory.b.
Agnosia
 – no recognition of inanimate objects.c.
Apraxia
 – no recognition of objects function.d.
Aphasia
 – no speech (nodding).
*Expressive aphasia
“motor speech center”
Broca’s Aphasia
*Receptive aphasia
inability to understand spoken words.
Wernicke’s Aphasia
General Knowing Gnostic Area or General Interpretative Area.
DRUG OF CHOICE: ARICEPT (
taken at bedtime
) and COGNEX.2. MULTIPLE SCLEROSIS
Chronic intermittent disorder of CNS characterized by white patches of demyelination in brain andspinal cord.
Characterized by remission and exacerbation.
Women ages 15-35 are prone
Unknown Cause
Slow growing virus
Autoimmune disorders
Pernicious anemia
Myasthenia gravis
Lupus
Hypothyroidism
Signs and Symptoms1. Visual disturbances
blurring of vision (primary)
diplopia (double vision)
scotomas
(blind spots)
2. Impaired sensation
to touch, pain, pressure, heat and cold.
tingling sensation
paresthesia
numbness
3. Mood swings
euphoria (sense of well being)
4. Impaired motor function
weakness
spasticity
paralysis
5. Impaired cerebral function
scanning speech
TRIAD SIGNS OF MS
 
Ataxia
(Unsteady gait,
(+) Romberg’s test
)
Compilation of MS Notes|Karl Gerald C. Manalili, UASN 2010
 
CHARCOTSTRIAD
IAN
 
48
Intentional tremors
 
Nystagmus6. Urinary retention/incontinence7. Constipation8. Decrease sexual capacityDIAGNOSTIC PROCEDURE
CSF analysis (increase in
IgG
and
Protein
).
MRI (reveals site and extent of demyelination).
(+)
Lhermitte’s sign
a continuous and increase contraction of spinal column.
NURSING MANAGEMENT1.
Administer medications as ordereda.
ACTH (Adreno Corticotropic Hormone)/ Steroids
for acute exacerbation to reduce edema at siteof demyelination to prevent paralysis.b.
Baclofen (Dioresal)/ Dantrolene Sodium (Dantrene)
 – muscle relaxants.c.
Interferons
 – alter immune response.d.
Immunosupresants2.
Maintain side rails to prevent injury related to falls.
3.
Institute stress management techniques.a.
Deep breathing exercises
b.
 Yoga4.
Increase fluid intake and increase fiber to prevent constipation.
5.
Catheterization to prevent retention.a.
Diuretics
b.
Bethanicol Chloride (Urecholine)Nursing Management
Only given subcutaneous.
Monitor side effects bronchospasm and wheezing.
Monitor breath sounds 1 hour after subcutaneous administration.c.
For Urinary IncontinenceAnti spasmodic agent
a.
Prophantheline Bromide (Promanthene)
Acid ash diet like cranberry juice, plums, prunes, pineapple, vitamin C and orange.
To acidify urine and prevent bacterial multiplication.
 
COMMON CAUSE OF UTIFemale
short urethra (3-5 cm, 1-1 ½ inches)
poor perineal hygiene
vaginal environment is moist
Nursing Management
avoid bubble bath (can alter Ph of vagina).
avoid use of tissue papers
avoid using talcum powder and perfume.
Male
Urethra (20 cm, 8 inches)
urinate after intercourse
motor 
for vision
NEURO TRANSMITTERDECREASEINCREASEAcethylcholineMyasthenia GravisBi-polar DisordeDopamineParkinsons DiseaseSchizophreniaNEUROLOGIC DISORDERSNursing Management
Compilation of MS Notes|Karl Gerald C. Manalili, UASN 2010

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