Pathopysiology

• auto immune disorder
• causing damaged to myelin sheath  of peripheral nerves
• damaged myelin sheath results in faulty sending of signals between nerves and muscles
• prognosis 4 weeks to one year

• tingling/numbness in limbs
• muscle weakness in limbs
• unsteadiness
• stinging 
• paralysis (loss of motor function)
• sensory loss
• pain
• hypotension
• bradycardia

• close monitoring of pt respiration
• if severe may requires ICU and ventilation 
• ensure pt treament is effective in reduciong pain
• assess pt mobility and limbs
• does pt need a wheelchair?

• IV immunoglobulin (antibodies)
• rehabilitation after treatment to regain functions that was lost, assists with ADL

• auto immune disease of CNS
• affecting the brain, spine, optic nerves
• degeneration of CNS myelin sheath and loss of axon

• muscle weakness in the extremities
• difficulty with coordination and balance
• numbness
• speech impediments
• tremors
• dizziness
• fatigue
• pain

• assess the girth, muscle strength, weakness and coordination
• encourage ambulation with observance of proper gait and assistance
• physiotherapy and counselling referal
• ensure all personal belonging are within reach

• Corticosteroids are mainly used to reduce the inflammation that spikes during a relapse
• beta interferon slows down the progression of physical disability
• copaxone- myelin basic protein
• antibody

a progressive disorder that characterized by muscle rigidity, absence of movement and involuntary tremors.

Cell in the substantia nigra becomes impaired or died resulting in low levels of dopamine neurotransmitter in the brain causing symptoms of PD

• rigidity
• shuffling gait
• difficulty initiating voluntary movement
• postural changes
• brandykinesia
• akinesia
• hand tremors

• review pt diet regime, should consist of low protein, high fibers and vitamins
• assess pt gait
• ensure pt has suitable footwear

• Levodopa crosses BBB, converted to dopamine, high levels of dopamine assist movement
• Carbidopa doesn't cross BBB, it prevent the breakdown of levodopa prior to reaching the BBB. Lower dose of levodopa in the BBB reduces the risk side effects

Produce dopamine and controls movements

Reduction of dopamine in the  corpus striatum interrupts the balance between inhibitory dopamine and excitatory acetylcholine, preventing affected brain cells from performing normal function with CNS therefore causing parkinson's symptoms

absence of movement

slowness in performing movement

Festinating gait/ parkinsonian gait

Levodopa passes into the blood brain barrier and is converted to dopamine, therefore increases concentration of dopamine in the brain. Increased levels of dopaimine improves nerve conduction an assist with movement

Carbidopa does not cross the blood brain barrier, instead it prevents the breakdown of Levadopa before reaching the BBB, this allows lower doses of levadopa to be used and decreases the risk of side effects

• nausea
• vomiting
• confusion
• glaucoma
• dyskinesia 
• alkinesia
• hallucinations

Antiviral, antiparkinsonian agent

Stimulates natural dopamine rather than replacing it.  It mimics the signal from dopamine lost in Parkinson't disease

• Tricyclic antidepressant
• blocks reuptake of norepinephrine and serotonin into nerve endings
• best taken before bedtime
• side effect- sleepiness, dry mouth, increased appetite, confusion, constipation

Chemical messager in the brain works with acetylcholine to transmit messages from the brain to body especially important in coordinate movement (motor function), regulates sleep, behavior, reward, pleasure, memory, attention

abrupt and unpredictable changes in mobility when taking levodopa

• 0n- able to move
• off- immobile

can switch in a brief period of time

• Type 1 hypersensitivity allergic reaction to a normal stimulus
• IgE bind to mast cells and basophil
• Mast cell release histamine and heparin
• Vasodilation of smooth muscle occur due to release of histamine and heparin
• contraction last up to one hour

• hives
• respiratory distress
• systemic shock
• vasodilation
• vascular collapse
• wheezing

• ensure pt is not taking beta blockers as it reduces the efficiency of adrenaline
• ensure right dosage of adrenaline is given according to age
• if attack is less severe lie flat and raise legs
• if difficulty breathing have pt sit upright
• remove stimulus if appropriate
• do not induce vomiting
• d

• give adrenaline immediately to prevent and relieves laryngeal oedema and circulatory collapse 
• provide bronchodilator and reduces the release of histamine and other mediators
• O₂, IV access, fluid replacement, antihistamines, hydrocortisone

a neurological progressive disorder of cognitive and behaviour impairment

Plaques develop and commonly occur in the hippocampus and other areas of cerebra cortex causing neuro destruction and loss of brain tissue. Lack of acetylcholine in the brain results in symptoms of alzheimer

• memory loss
• confusion
• increased anxiety 
• wondering 
• mood and personality changes

• a daily report of pt behaviour should be documented
• ensure pt have anxiety med for PRN
• assess pt mental status 
• encourage sufficient food and
• adequate nutrition
• inspect pt’s skin for evidence of trauma, injury
• ensure the environment is safe and suitable for pt

• Cholinesterase inhibitors help with the cognitive symptoms of Alzheimer's. They work by preventing the breakdown of a chemical messenger in the brain called acetylcholine, which is important for learning, memory, and attention
• Donepezil(Aricept) is approved to treat mild, moderate, and severe Alzheimer's
• Rivastigmine (Exelon) and Galantamine (Razadyne) are approved to treat mild to moderate Alzheimer's

A neurological disorder due to lack of thiamine (vitamin b1) due to excessive alcohol consumption over prolonged period

Thiamine  plays a role in metabolizing glucose to produce energy for the brain. An absence of thiamine therefore results in an inadequate supply of energy to the brain, particularly the hypothalamus (which regulates body temperature, growth and appetite and has a role in emotional response

Result from reduced blood flow through one of the coronary arteries. This causes myocardial ischemic and necrosis of cells. Reduced blood flow is caused by occlusion from atherosclerosis, thrombosis, platelet aggregation, or coronary spasm.

• fatigue
• pallor
• perspiration
• hyperthermia
• angina
• SOB
• severe pain
• hypotension
• tachycardia

Due to the plaque blockage and necrosis of cell, the heart ability to pump blood is reduced therefore causing the heart to beat faster as it tries to pump blood to the rest of the body resulting in increased heart rate and increased cardiac output.

Major risk for stroke

Ventricular tachycardia is a fast heart rhythm that starts in the ventricles

absence contractions of the heart

Ventricular fibrillation is an abnormally irregular heart rhythm caused by rapid, uncoordinated fluttering contractions of the ventricles

• Pain assessment
• Baseline vital signs
• ECG scan

beta blockers because it reduces heart rate and cardiac output. It works by preventing stimulation of the sympathetic nervous system by inhibiting the action of catecholamines (norepinephrine and epinephrine) at beta-adrenergic receptors.

• beta adrenergic blocker or beta₁ blocker
• used to treat heart problem including angina and hypertension
• Prevent stimulation of the sympathetic nervous system by inhibiting the action of catecholamines at beta-adrenergic receptors

• Check apical/ radial pulse before administration
• warn pt against abrupt discontinuation of treatment
• inform pt about early signs of heart failure and instruct them to seek medical help asap

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle.

• A recent head injury
• Bleeding problems
• Bleeding ulcers
• Pregnancy
• Surgery
• Taken blood thinning medications such as CoumadinTrauma
• Uncontrolled high blood pressure

• Monitor patient respiratory rates
• Look out for signs of side effects
• ensure medication is taken as prescribed

Plasminogen activator (tPA)

thrombolytic drugs include

• Needs to be given within 12 hoursof symptom onset
• Alteplase
• reteplase
• streptokinase

Tenecteplase should be given asap within sixe hours of symptom onset

Covert pasminogen to plasmin, which dissovles  plasma protein

NSAID, oral anticoagulants, heparin, and antiplatelets increased risk of bleeding

Aminocaproic acid inhibits streptokinase and can be used to revreser it fibrinolytic effects

A subtle, progressive decline in memory and cognitive function caused by a series of strokes.

Strokes occurs when blood supply to the brain is blocked by blood clot in the artery or when the artery burst. When this happens, brain cells are deprived of oxygen and die, causing damage to the cortex of the brain that is associated with learning, memory and language functioning

• memory loss
• depression
• confusion
• loss of social skills
• agitation
• tremors
• weakness or altered sensation in the limbs and face
• loss of bladder and bowel control
• hallucination
• delusions
• slur speech
• inappropriate laughing or crying
• balance problem

Vascular dementia affects the cortex of the brain which is responsible for learning memory and language. When the cortex of the brain is damaged, due to lack of blood supply, it can affect a person's thinking process, memory and other cognitive functioning

A condition resulting in accumulation of fluid in the interstitial space due to the blockage of the lymphatic channels, may be due to infection, tumor or surgically removed. It mostly affects the arms and legs.

• swelling of the limbs
• weight gain
• feeling of tightness or fullness in the limbs
• aching, pain
• weakness in affected limb

• avoid tight clothing
• maintain health weight, BMI below 26
• avoid food high in salt
• Maintain skin integrity
• elevate limb when possible
• regular exercise

• Collect and transport tissue fluids from the intercellular spaces in all the tissues of the body, back to the veins in the blood system
• Returns plasma proteins to the bloodstream
• New lymphocytes are manufactured in the lymph nodes
• assist the body to build up an effective immunity to infectious diseases
• lymph nodes play an important role in the defence mechanism of the body. They filter out micro-organisms and foreign substances
• it transports large molecular compounds (enzymes & hormones) from their manufactured sites to the bloodstream

A chronic disorder of the airways that involves a complex interaction of airway obstruction, bronchial hyper-responsiveness and inflammation

exposure to allergens and irritants can trigger an asthma attack. During an asthma attack, muscles surrounding the bronchial tubes tighten (bronchospasm), narrowing the air passage and interrupting the normal flow of air into and out of the lungs. Airflow is further interrupted by an increased in mucus secretion, forming mucus plugs, and swelling of the bronchial tubes.

• wheezing
• tightness in chest
• difficulty breathing
• cough
• SOB

Beta 2 receptors mediate bronchodiation

Primarily located in smooth muscles of bronchioles, blood vessels and uterus

work by relaxing bronchial smooth muscles, stabilizing mast cell membranes and inhibiting mast cell mediators

1. Shake the puffer well, remove cap and place the inhaler outlet into the end of the spacer.

2. Place the spacer mouthpiece between the lips and breathe out through the mouthpiece. Depress the inhaler canister once.

3. Take a slow, deep breath in. Remove the spacer and hold your breath for approximately 10 seconds. If you are unable to hold your breath, breathe in and out slowly through the spacer for 4 breaths. Both techniques are effective.

The purpose of the spacer chamber is to hold the medication released from the Meter Dose Inhaler so that a child has the time to more effectively inhale the medication.

• Spacer should be cleaned once a month in hot soapy water to prevent build up of medicine residue
• spacer should be replaced every 6-12 months check with your prescriber
• ensure no one else uses your spacer
• Keep out of reach of children
• Use spacer as described on label or as directed by prescriber

• hold peak flow upright
• make sure line is at "0"
• Big breath in
• place into meter into mouth- seal lips around it completely
• Big breath out- quick and hard as possible
• record best of 3

Small device that convert a drug from a solution into an aerosol form by means of a compressor/compressed gas source

• Works by a flow of gas passing through a very small hole (Venturi)
• rapid expansion of air causes a negative pressure that sucks the nebulised fluid up the feeding tube system to be inhaled
• approx 12% of solution reaches the lungs
• therefore doses are higher than aerosol inhaler

• Check expiry date of drug
• Sit upright position
• place compressor near pt and plug into mains
• assemble the nebuliser
• connect tubing and compressor
• pour prescribe solution into chamber
• close lid and turn on compressor, mist should appears
• assist pt to apply mask/ mouth piece
• tell pt to breath through mouth an avoid talking
• tap on nebuliser every few minutes to avoid condensation
• once misting has stop, which of device and remove mask/mouthpiece
• wash and dry nebuliser chamber and store away
• offer pt a drink
• document that nebuliser has been administered as per protocols
• hands hygiene

Respiratory condition that involves inflammation of the bronchial tubes, resulting in excessive secretions of mucus and tissue swelling causing narrowing bronchial tubes, making it progressively more difficult to breath. Commonly affects children under 2 years of age

In most cases, the cause is a virus and antibiotics will not help.

• *inflammation of bronchi
• *coughing
• *production of sputum
• *SOB
• *Wheezing
• *fever/chills
• *chest pain
• *Blocked/runny nose
• *fatigue