Exam 15: Alzheimer's Disease & Myasthenia Gravis (MG)
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| Alzheimer's disease | degenerative disorder that affects the cells of the brain and causes impaired intellectual functioning
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| Alzheimer's Disease: Elevated homocysteine levels | increased risk
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| Alzheimer's Disease: Changes in the brain include | Plaques in the cortex and neurofibrillary tangles.
Decrease in brain size.
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| Nursing Management with Alzheimer's | Directed toward supporting patient and family
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| Maintain adequate nutrition with Alzheimer's by | Finger food
Frequent feedings with high nutritional value
2000mLs of fluid per day
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| Anti-Alzheimer's Agents act by inhibiting | acetylcholinesterase
It increases the amount of acethylcholine in the CNS.
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| Anti-Alzheimer's Agents: Cholinesterase inhibitor agents used to treat mild to moderate | donepezil (Aricept)
galantamine (Reminy)
rivastigmine (Exelon)
tacrine (Cognex)
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| Memantine (Namenda): for Alzheimer's Disease | First drug approved to treat moderate to severe AD
Classified as aN-methyl-D-aspartate receptor antagonist
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| Tacrine | hepatic disease.
Contraindicated in Anti-Alzheimer's Agents
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| Anti-Alzheimer's Agents: Side Effects | CNS: Headache, Seizures.
Resp: bronchospasm.
GI: Nausea, Vomiting, Diarrhea Weight loss.
GI: Bleeding.
GU: urinary tract obstruction.
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| 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.
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| Myasthenia Gravis (MG): Pathophysiology | blocking of synaptic transmission at myoneural junction, results in muscle weakness
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| 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.
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| Myasthenia Gravis (MG): ocular S&S | Ptosis (eyelid drooping).
Diplopia (double vision).
15% of cases remain confined to the eye muscles.
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| 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.
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| 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
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| With Myasthenia Gravis (MG) respiratory infections, emotional tension and menstruation | may initiate excerbation
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| 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
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| 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
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| Myasthenia Gravis (MG): Diagnostic Tests | Look upward for 2-3 mins (look for Ptosis).
Electromyography.
IV anticholinesterase (Tension or Neostimine).
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| Myasthenia Gravis (MG): Medical Managment | Anticholinesterase drugs
-Corticosteroids as adjunct therapy
-Immunosupressive drugs.
Plasmapheresis
Thymectomy
-Immune globulin
-May require intubation
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| 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
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| Myasthenia Gravis (MG): Cholinergic Agents | Inhibits the action of acetylcholinesterase, preventing the breakdown of acetylcholine.
neostigmine (Prostigmin).
pyridostigmine bromide (Mestinon)
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| Myasthenia Gravis (MG): Cholinergic Agents (Therapeutic effect) | increase muscle strength
Used to reverse nondepolarizing neuromuscular blocking agents.
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| Cholinergic Agents Effects | Miosis.
Increased intestinal and skeletal muscle tone.
Bronchial and ureteral constriction.
Bradycardia.
Increased salivation.
Lacrimation.
Sweating .
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| 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.
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| Antidote to Cholinergic agents | Atropine
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| Pyridostigmine may be administered | 30 min before meals if difficulty chewing
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| 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)
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| 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)
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| 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
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| ALS primary symptoms | Weakness of the upper extremities
Dysarthria, Dysphagia
Muscle wasting and fasciculations
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| With ALS death usually results from | Respiratory infection
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| 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
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| Huntington's Disease | A genetically transmitted disorder that affects both genders. Onset between 35-45 years of age.
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| 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.
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| Chorea | Abnormal, excessive involuntary movements
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| 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.
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| Huntington's Disease: Dx | Based on family history
Based on clinical symptoms
Detection of the characteristic DNA pattern from blood samples
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| Huntington's Disease: Medical Management | Antipsychotics
Antidepressants
Antichoreas
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| Huntington's Disease: Nursing Management | Prevent malnutrition
-High caloric intake to maintain body
-Up to 4000-5000 calories per day
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