Use both your pharmacology (Lehne)and adult health nursing (Lewis) textbooks for this—this will help you understand what myasthenia is and how to treat it. The Lewis text covers it on pages1393-1395 and complements what our pharm textbook covers. References and in-text citations required. Points per question in parentheses at the end of each question. (11 total points available)
J.B. is a 58-year-old retired postal worker who has been on the neurology unit for several days receiving plasmapheresis every other day for myasthenia gravis (MG). About a year ago, J.B. started experiencing difficulty chewing and swallowing, diplopia, and slurring of speech, at which time he was placed on physostigmine. Before this admission, he had been relatively stable. His medical history includes hypertension controlled with metoprolol (Lopressor) and glaucoma treated with timolol ophthalmic preparation. Recently, J.B. was diagnosed with a sinus infection and treated with ciprofloxacin (Cipro). On admission, J.B. was unable to bear any weight or take fluids through a straw. There have been periods of exacerbation and remission since admission.
Vital signs include T 101.8 degrees, HR 108, RR 24, BP 170/68
Please answer the following questions:
1) What is myasthenia gravis and what are the usual presenting symptoms (2 points)?
2) Knowing the usual presenting symptoms, what are the essential assessments for this patient with myasthenia gravis (2 points)?
3) J.B.’s wife is wondering what caused the worsening of J.B.’s symptoms at this time. What are the possible causes of the worsening of the patient’s symptoms? Again, the adult health textbook is a good resource for this question in particular) (1 point)
4) How is myasthenia gravis diagnosed (1 point)?
5) Explain how each of the following is used to treat myasthenia gravis (2 points–1 for each part).
What is plasmapharesis and why is it being used in this patient?
What is physostigmine and how does it work to treat myasthenia gravis? Why is it used and not the prototype neostigmine?
6) What emergency medication should be on hand for this patient and why (1 point)? (I am looking for an antidote to too much cholinesterase inhibitor—again, its in the book!
7) Explain the difference between myasthenic crisis and cholinergic crisis. How could the health care provider determine the difference (2 points)?
Sample Solution
