Nerve cells that control muscle are destroyed leads to atrophy The signal can

Nerve cells that control muscle are destroyed leads

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Nerve cells that control muscle are destroyed  leads to atrophy The signal can not reach muscle to activate them Clinical Manifestations Muscle weakness (involuntary twitching) Impaired speech Decrease ability to chew, swallow Difficulty breathing Excessive drooling Depression Spasticity Respiratory infection  death
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Diagnosis CSF analysis (protein) Muscle biopsy (r/o muscle disease) Electromyography (nerve damage) Treatment Riluzole (Rilutek) – Glutamate agonist Slows neuron destruction (adds 2-3mths of life) Nursing intervention Monitor liver function (LFT’s) No alcohol Administered evenly spaced For spasticity: Baclofen Dantrolene (dantrium) Diazepam (valium)
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Myasthenia Gravis Sporadic, progressive descending muscle weakness Abnormal fatigue of voluntary skeletal muscles Increase with exercise and repeated movements Affects women age 20-30, men age 70-80 Unknown etiology Autoimmune Thymus gland disorder Blood cell + thymus antibodies destroy neuroreceptors
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Myasthenia Gravis
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What is happening in Myasthenia Graves? Acetylcholine (chemical neurotransmitter) stimulated by nerve impulse attach to receptor sites and depolarize muscle fiber MG – antibodies attach to receptor site and destroy Ach receptor site – decrease muscle contraction Muscle Affected: Face Lips Tongue Neck Throat Eventually: muscle fibers degenerate (head ,neck, truck, limbs) Respiratory  life threatening
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Clinical Manifestations Extreme muscle weakness Fatigue Ptosis (drooping eye) Diplopia (double vision) Difficulty chewing/swallowing Sleepy, mask like expression Drooping jaw Bobbing head Upper extremity weakness Respiratory involvement  hypoventilation  decrease tidal volume
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Myasthenia Gravis Crisis Myasthenia Crisis Exacerbation or under-medicated Respiratory distress Hypoxia Tachycardia Decease gag reflex Visual changes Cholinergic Crisis usually from over medicated Symptoms worsen Tensilon Test Anticholinesterase (inhibits the break down of Ach) Nursing Intervention – atropine at bedside Nursing Intervention Airway!!! – suction and O2 at bedside Energy conservation Sit up while eating thicken fluids Lubricate eyes Medical ID
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Myasthenia Gravis Treatment & Medications Anticholinesterase 1 st line therapy Inhibits breakdown of acetylcholine Pyridostigmine (Mestinon) Neostigmine (prostigmine) Nursing Intervention Give at specific time  level increase within 1hr  improve weakness Give food within 45mins of taking medication  increase strength  decrease risk for aspiration May cause GI upset Check therapuetic levels (think cholinergic crisis)
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MG Treatment & Medications Immunosuppressant's During exacerbations Decrease the production of antibodies 1 st – Prednisone 2 nd – Azathioprine (Imuran) Nursing Intervention Taper off slowly Increase risk for infection GI bleeding Hypernatremia and increase fluid retention Hypokalemia Increase glucose Hypocalcaemia  prone to fractures
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