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M6 13-005

Exam 15: Alzheimer's Disease & Myasthenia Gravis (MG)

Alzheimer's disease degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning
Alzheimer's Disease: Elevated homocysteine levels increased risk
Alzheimer's Disease: Changes in the brain include Plaques in the cortex and neurofibrillary tangles. Decrease in brain size.
Nursing Management with Alzheimer's Directed toward supporting patient and family
Maintain adequate nutrition with Alzheimer's by Finger food Frequent feedings with high nutritional value 2000mLs of fluid per day
Anti-Alzheimer's Agents act by inhibiting acetylcholinesterase It increases the amount of acethylcholine in the CNS.
Anti-Alzheimer's Agents: Cholinesterase inhibitor agents used to treat mild to moderate donepezil (Aricept) galantamine (Reminy) rivastigmine (Exelon) tacrine (Cognex)
Memantine (Namenda): for Alzheimer's Disease First drug approved to treat moderate to severe AD Classified as aN-methyl-D-aspartate receptor antagonist
Tacrine hepatic disease. Contraindicated in Anti-Alzheimer's Agents
Anti-Alzheimer's Agents: Side Effects CNS: Headache, Seizures. Resp: bronchospasm.  GI: Nausea, Vomiting, Diarrhea Weight loss. GI: Bleeding. GU: urinary tract obstruction.
Myasthenia Gravis (MG) neuromuscular disorder characterized by severe weakness of one or more groups of skeletal muscles. Believed to be an autoimmune disease with lower motor neuron characteristics.
Myasthenia Gravis (MG): Pathophysiology blocking of synaptic transmission at myoneural junction, results in muscle weakness
Myasthenia Gravis (MG) is thought to be triggered by antibodies that attack acetylcholine receptor sites at the neuromuscular junction and interfere with impulse transmission to the muscles.
Myasthenia Gravis (MG): ocular S&S Ptosis (eyelid drooping). Diplopia (double vision). 15% of cases remain confined to the eye muscles.
Myasthenia Gravis (MG): Clinical Manifestations May initially have ptosis and /or diplopia. Skeletal weakness. Dysarthria. Dysphagia. Vocal cords weaken and the voice can sound nasal.
As Myasthenia Gravis (MG) progresses Trunk and lower limbs are affected: Difficulty with walking and sustained sitting -Inability to breath -May need mechanical ventilation - Bowel and bladder sphincter weakness
With Myasthenia Gravis (MG) respiratory infections, emotional tension and menstruation may initiate excerbation
Myasthenia Gravis (MG): Subjective data Patient’s understanding of the disease Complaints of weakness, double vision Difficulty in chewing or swallowing Presence of any bowel or bladder incontinence
Myasthenia Gravis (MG): Objective Data Muscle weakness on neurological testing Nasal-sounding speech Voice often fades after a long conversation Breath sounds diminish Ptosis of the eyelids Weight loss if dysphagia
Myasthenia Gravis (MG): Diagnostic Tests Look upward for 2-3 mins (look for Ptosis). Electromyography. IV anticholinesterase (Tension or Neostimine).
Myasthenia Gravis (MG): Medical Managment Anticholinesterase drugs -Corticosteroids as adjunct therapy -Immunosupressive drugs. Plasmapheresis Thymectomy -Immune globulin -May require intubation
Myasthenia Gravis (MG): Patient Education Medications -What to take vs. what to avoid Upper respiratory infection Eating positions Avoid crowds in flu and cold season Activities and rest periods Medical alert bracelet
Myasthenia Gravis (MG): Cholinergic Agents Inhibits the action of acetylcholinesterase, preventing the breakdown of acetylcholine. neostigmine (Prostigmin). pyridostigmine bromide (Mestinon)
Myasthenia Gravis (MG): Cholinergic Agents (Therapeutic effect) increase muscle strength Used to reverse nondepolarizing neuromuscular blocking agents.
Cholinergic Agents Effects Miosis. Increased intestinal and skeletal muscle tone. Bronchial and ureteral constriction. Bradycardia. Increased salivation. Lacrimation. Sweating .
Cholinergic Agents: Side Effects CNS: seizures, dizziness, weakness EENT: lacrimation, miosis Resp: bronchospasm, excessive secretions CV: bradycardia, hypotension GI: abdominal cramps, diarrhea, excessive salivation, nausea, vomiting Derm: sweating, rashes.
Antidote to Cholinergic agents Atropine
Pyridostigmine may be administered 30 min before meals if difficulty chewing
Taking dose Cholinergic Agent late may result Myasthenic crisis ( life-threatening condition that occurs when the muscles that control breathing become too weak to do their jobs)
Taking dose Cholinergic Agent early may result in cholinergic crisis (the muscles stop responding to the bombardment of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms)
Amyotrophic Lateral Slerosis (ALS) aka Lou Gerhig's Disease degeneration of the motor neurons of the spinal cord and brain stem result in muscle weakness and wasting
ALS primary symptoms Weakness of the upper extremities Dysarthria, Dysphagia Muscle wasting and fasciculations  
With ALS death usually results from Respiratory infection
ALS Medical Management Riluzole (Rilutek):Helps to protect motor neuron damaged by the disease Adds 3 months or more to a patient’s life if given early
Huntington's Disease A genetically transmitted disorder that affects both genders. Onset between 35-45 years of age.
Huntington's Disease: Etiology/ Pathophys Involves the basal ganglia and the extrapyramidal motor system. -Overactivity of the dopamine pathway. -The net effect is an excess of dopamine, which leads to symptoms that are the opposite of Parkinsonism.
Chorea Abnormal, excessive involuntary movements
Huntington's Disease: Clinical Manifestion Chorea. Writhing, twisting movements of face, limbs, and body. Movements get worse as disease progresses. Speech, chewing and swallowing are affected. Gait deteriorates unable to ambulate. Mental functions deteriorate.
Huntington's Disease: Dx Based on family history Based on clinical symptoms  Detection of the characteristic DNA pattern from blood samples
Huntington's Disease: Medical Management Antipsychotics Antidepressants Antichoreas
Huntington's Disease: Nursing Management Prevent malnutrition -High caloric intake to maintain body -Up to 4000-5000 calories per day
Created by: jtzuetrong



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