Complex Health Study Guide Exam 3.docx - Complex Health Study Guide Exam 3 Care of the Patient with Complex Nervous System Problems Peripheral Nervous

Complex Health Study Guide Exam 3.docx - Complex Health...

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Complex Health Study Guide Exam 3 Care of the Patient with Complex Nervous System Problems Peripheral Nervous System Problems- everything outside of the brain and spinal cord - Mysthenia Gravis o Pathophysiology- disorder of thymus gland characterized by fatigue of muscles acquired diseases- not directly inherited greater in women than men 2/3 of people of ocular type and others have a generalized type o Clinical manifestations Rapid onset fatigue- sudden and not often not recognized in ED symptoms of other diseases Increased weakness Ocular signs- initial sign diplopia, unstable gait, SOB, difficulty swallowing Facial weakness Dysarthria Respiratory Compromise Weight loss o Laboratory and Diagnostics History and physical examination Labs Serum protein electrophoresis Testing for AChR (acetylcholine) receptors- abnormally high levels Diagnostic Tests Repetitive Nerve Stimulation Tensilon Testing –inject medication into the patient and immediately the eyes open up
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o SE: bradycardia atropine at the bed side o short acting drug CXR/CT scan- to evaluate for thymoma o Medical Inteventions Surgical Thymectomy o Transcervical approach o Sternal split Preoperative Care o Routine o Meds – Pyridostigmine (Mestinon – anticholinesterase inhibitor) Post operative care o Monitor for respiratory compromise o Observe for signs of pneumothorax o Chest tube care (sternal approach) Pharmacological Anti-cholinesterase Inhibitor o Pyridostigmine bromide (Mestinon) o Preventing decrease of Ach by the enzyme Che o Increases the response of muscles to nerve impulses and improves muscle strength o Give 45min to 1 hour prior to meals Immunosuppressant's IV immune glogluin (IVIG) Plasmaphoresis- exchanging your plasma o Nursing Management Respiratory support May require intubation and mechanical ventilation Suctioning Monitor for signs of respiratory infection Nutritional support Promoting mobility Monitor for skin breakdown Turn and reposition frequently Promoting self-care guidelines Assisting with communication Eye protection Eye drops Taping eyelids as needed o Emergency Crisis Myasthenic crisis: an exacerbation of the myasthenic symptoms caused by undermedication with anticholinesterases severe and generalized weakness and respiratory failure intubation Cholinergic crisis: an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs Rare have atropine on hand (brady and respiratory distress) o Dishcarge Teaching Factors in exacerbation include infection, stress, surgery, hard physical exercise, sedatives, enemas, and strong cathartics. Avoid overheating, crowds, overeating, erratic changes in sleeping habits, or emotional extremes.
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Teach warning signs.
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