Question | Answer |
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 |