Myasthenia gravis: case study, Summaries of Medicine

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J. Martin, F. D. Carmona,

Myasthenia gravis: case

study

Myasthenia Gravis: The client has a 3-month history with complaints of fatigue, exhaustion, and multiple episodes of choking because she did not have the strength to chew the food. The healthcare provider (HCP) was unable to diagnose the problem and told the client to rest and eat soft foods that did not require chewing. The client’s husband notices that her left eye is drooping, and she tells him she is experiencing double vision. After another choking episode, he brings his wife back to the HCP, who now thinks she may have myasthenia gravis. The HCP administers an edrophonium chloride test to help confirm the diagnosis of myasthenia gravis (MG).

1. Which response to the test indicates that she has myasthenia gravis (MG)? a. No significant change in client’s neurovascular assessment b. Reduced amplitude of electrical stimulation in her muscle c. Anti-acetylcholine receptor antibodies present in the blood d. A noticeably marked improvement in her muscle strength She is diagnosed with myasthenia gravis. Her husband tells the nurse he does not understand how MG will affect his wife. 2. How should the nurse respond? a. An increased number of acetylcholine receptor sites cause muscle weakness b. A virulent virus destroys the covering of junctions between nerves and muscles c. A chronic neuromuscular disorder that will eventually cause paralysis in the extremities d. The body is not able to transmit nerve impulses, which results in muscle weakness The HCP leaves the room and the nurse continues to discuss the diagnosis and treatment of MG with the client and her husband. 3. Which statement by the client is correct? a. I will only take medications when I feel bad b. I can take my medications at any time of the day c. When I am fatigued I will rest d. I am training for a marathon. I will return to my regimen when I am discharged. The HCP prescribes the anticholinesterase pyridostigmine for her. She asks the nurse hwo the medication therapy will help her. 4. How should the nurse respond about the expected outcome of pyridostigmine therapy? (Select all that apply) a. Increases ability to independently perform ADL

10. Which further data indicates to the nurse that the client is experiencing a cholinergic crisis? a. The circulating acetylcholine receptor antibodies test is positive b. The symptoms improve when a cholinesterase inhibitor is administered c. The blood pressure and pulse increase after a blood transfusion d. The Tensilon test does not show improvement in muscle strength It is determined that the client is exerpiecing a cholinergic crisis, possibly due to an overdose of anticholinesterase medication. 11. In planning care for the client the nurses should identify which nursing diagnosis as a priority? a. Impaired swallowing b. Chronic pain c. Impaired skin integrity d. Ineffective airway clearance The HCP admits the client to the medical unit for observation and writes admitting prescriptions. 12. Which action should the nurse implement first? a. Administer IV atropine b. Prepare to place the client on a ventilator c. Determine the reason for the overdose d. Notify the admissions office The client is admitted to the medical unit in stable condition. Her mother-in-law sitting in the waiting room crying. The nurse offers support. The mother-in-law shares with the nurse that the client’s husband doesn’t know what is going to happen to him and the children if the client doesn’t get better. She is scared that her daughter-in-law is going to die. 13. What is the best response by the nurse? a. I think you should have your son talk to the HCP b. A local MG support group may be helpful c. Would you like me to contact another family member? d. This must be very scary; I will sit with you and we can talk for a while Later, the nurse notices the client is sitting up in bed coughing and exhibiting difficulty breathing. 14. Which action should the nurse take? a. Call the charge nurse b. Offer the client a sip of water c. Assess the client’s respiratory rate and O2 sat

d. Notify the HCP regarding client status A week later, the client and her husband arrive 35 minutes late for their appointment.

15. Which action should the nurse take when they arrive? a. Allow the client and her husband to see the HCP During the office appointment, the HCP discusses a thymectomy, which is a surgical procedure that may cure MG. After the HCP leaeves the office, the client’s husbamd returns to the nruse and says “I am not sure what the HCP was saying. How would this surgery cure my wife’s disease?” 16. How should the nurse respond? a. "There is a gland that is usually inactive after puberty that sometimes continues to produce antibodies. Removing it sometimes cures myasthenia gravis." It is decided that the surgery is the best option. The client is admitted to the hospital. Prior to the surgery, plasmapheresis is performed to remove antiacetylcholine receptor antibodies so the client will have improved muscle strength to be in the best physical condition prior to the surgery. 17. Which intervention should the nurse implement prior to the plasmapheresis? a. Assess the complete blood cell and platelet count 18. Which part of the assessment indicates to the nurse that Shiri is experiencing a complication from this procedure? (Select all) Nurse notifies surgeone of low calcium level. The client receives calcium via IV push, and the calcium level is now normal. Her condition stabilizes and she is schedule for surgery the next morning. She is taken to surgery the next morning where a thoracotomy with a sternal split procedure is performe to remove thymus gland. Upon her return to the unit following surgery, she has an anterior midsternal chest tube attached to a closed-chest drainage system. 19. Which intervention should the nurse implement? a. Monitor for fluctuation or tidaling in the water-seal compartment The nurse is encouraging the client to cough and deep-breathe. The client tells the nurse it hurts a great deal when she coughs and takes deep breaths. 20. Which intervention should the nurse implement? a. Positive Chvostek’s and Trousseau’s b. Elevation of temperature occurs