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Med Surg Final 3

hernias, MS, MG, ALS, GBS

What is Myasthenia Gravis (MG)? An autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups; caused by antibodies attacking atetylcholine (ACh) receptor = decreased # of Ach receptor sites at the neuromuscular junction.
What are the S/S of MG? Fluctuating weakness of skeletal muscle (need rest); the muscles often involved are those for moving the eyes & eyelids, chewing, swallowing, speaking, & breathing; pt may have short-term remissions or severe, progressive involvement
When are MG pts the strongest? In the morning
What is myasthenic crisis? An acute exacerbation of muscle weakness triggered by infection, surgery, emotional distress, drug overdose, or inadequate drugs **complication is putting pt into resp distress**
What would be some good nursing diagnoses for a pt with MG? Ineffective breathing pattern, Ineffective airway clearance, Impaired verbal communication, Imbalanced nutrition, Disturbed sensory perception (visual), Activity intolerance, Disturbed body image (pg 1513)
What does the Tensilon test in a pt with MG reveal? Improved muscle contractibility after IV injection of the anticholinesterase agent endrophonium chloride (Tensilon); aids in dx of cholinergic crisis, which occurs when there is too much cholinesterase inhibition
What does the drug Neostigmine do? Facilitates myoneural junction impulse transmission by inhibiting acetylcholine destruction by cholinesterase; symptomatic control of MG
What is multiple sclerosis (MS)? A chronic, progressive, degenerative, disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain & spinal cord; disease of the young ; **white matter**
What are the S/S of MS? weakness or paralysis; diplopia; spasticity, numbness; tingling; scotomas; blurred vision; vertigo; tinnitus; decreased hearing; chronic neuropathic pain; nystagmus; ataxia; dysarthria; dysphagia; bowel & bladder problems; fatigue; short-term memory loss
What are some nursing dx for MS? Impaired physical mobility, Impaired urinary elimination, Interrupted family processes, & Ineffective self-health management (pg 1505-1506 in Nursing Care Plan 59-3)
What are the overall goals of the pt with MS? 1.Maximize neuromuscular function 2. Maintain independence of daily living for as long as possible 3. Manage disabling fatigue 4. Optimize psychosocial well-being 5. Adjust to the illness 6. Reduce factors that precipitate exacerbations
What should you teach the pt with MS to avoid? Exposure to cold climates, fatigue, extremes of heat and cold, hazards of immobility (pressure ulcers, contractures, etc.), malnutrition, & exposure to infection
What is a major problem in a pt with MS? Bladder control
What is one of the biggest challenges with the dx of MS? Emotional adjustments
What type of drug therapies are involved with an MS pt? Adrenocorticotropic hormone (ACTH), methylprednisolone, prednisone, Immunomodulators (Betaseron, Avonex, Rebif, Copaxone, Tyasbri), Immunosuppressants (Imuran, Cytoxan, Novantrone), Cholinergics, Anticholinergics, Muscle Relaxants (pg 1503 on Table 59-15)
What are some surgical therapies for an MS pt? Thalamotomy (unmanageable tremor); Neurectomy, rhizotomy, cordotomy (unmanageable spasticity)
What type of diet would a pt with MS be on? Low-fat, gluten-free foods, & raw veggies along with multivitamin supplements
What is Amyotrophic Lateral Sclerosis (ALS)? A rare progressive neurological disorder characterized by loss of motor neurons; usually leads to death within 2-6 yrs after dx; AKA Lou Gehrig’s Disease
What are the typical symptoms of ALS? Weakness of the upper & lower extremities, dysarthria, dysphagia, muscle wasting & fasciculations occur, pain, sleep disorders, spasticity, drooling, emotional lability, depression, constipation, & esophageal reflux
Why does death usually result from ALS? Resp infection secondary to compromised resp function **the pt remains cognitively intact while wasting away**
What is Guillan-Barre’ Syndrome (GBS)? An acute rapidly progressing, & potentially fatal form of polyneuritis; it is characterized by ascending symmetric paralysis that usually affects cranial nerves & the peripheral nervous system
What are some nursing dx for a GBS pt? Impaired spontaneous ventilation, Risk for aspiration, Acute pain, Impaired verbal communication, Fear, Self-care deficits (pg 1543 under Nursing Diagnoses)
Reducible hernia Easily return to abd cavity
Irreducible/Incarcerated hernia Cannot be placed back into abd cavity
Inguinal hernia Most common; @ the point of weakness in the abd wall where spermatic cord in M & round ligament in F emerge; indirect-protrusion escapes through inguinal ring & follows cord/ligament & direct-protrusion escapes through post inguinal wall; weight lifting
Femoral hernia Occurs when there is a protrusion through the femoral ring into the femoral canal; becomes strangulated easily; occurs more often in women
Umbilical hernia Occurs when the rectus muscle is weak (as w/ obesity) or the umbilical opening fails to close after birth
Ventral or Incisional hernias Due to weakness of abd wall at site of previous incision; occur mostly in obese pt who has had multiple surgical procedures in the same area
What are measures of hernia prevention? Don’t strain your muscles, maintain a healthy weight, get plenty of fiber, quit smoking, don’t rely on truss for support, be careful when lifting heavy objects
Created by: Ariel H