Professional Documents
Culture Documents
A. Myasthenia gravis
Predisposing Factors: -most commonly affects young adult women (under 40) and older men (over 60)
Clinical Management: -Pyridostigmine (Mestinon) is the usual first line treatment for MG.
-Prednisone and Cyclosporine A are used for long-term immunosuppression
when further benefit is needed and relatively rapid onset of benefit is desired.
Prednisone is the most effective treatment for ocular MG.
-Azathioprine provides long-term immunosuppression with relatively few side
effects. However, it has a long latency before benefit begins, and some patients
do not improve at all.
-Mycophenolate mofetil may be a useful substitute for azathioprine with fewer
side effects and a shorter latency of action. More experience is required.
-Plasma exchange (PE) and Human immune globulin are used when MG
patients have life-threatening signs such as respiratory insufficiency or dysphagia
and a very rapid response to treatment is desired. PE is preferred.
-Thymectomy is performed for long-term benefit in patients age
d 8 to 55 with generalized MG.
Nursing Mgt: - Encourage the patient to keep a 24-hour fatigue/activity log for at
least 1 week.
- assist the patient to develop a schedule for daily activity and rest.
- refer the patient to an occupational therapist
- Monitor the patient’s nutritional intake for adequate energy sources
and metabolic requirements.
Prognosis: -The outlook for most patients with myasthenia gravis is bright: they will have
significant improvement of their muscle weakness and they can expect to lead
normal or nearly normal lives. In a few cases, the severe weakness of
myasthenia gravis may cause a crisis (respiratory failure), which requires
immediate emergency medical care. In some cases, however, symptoms may
worsen even with vigorous treatment, leading to generalized weakness and
disability. myasthenia gravis rarely causes early death except from myasthenic
crisis.
Possible Nursing Dx: -Activity Intolerance related to muscle weakness and fatigability,
-Constipation related to inadequate fluid intake and low fiber diet
-Disturbed sensory (visual) perception related to ptosis
-Fear related to anticipation of disease
-Compromised family coping related to overwhelming
- Risk for aspiration related to impaired swallowing
- Risk for falls related to visual difficulties and impaired physical
mobility
-Risk for peripheral neurovascular dysfunction related to vascular
effects
B. Upper Gastrointestinal Bleeding
Clinical Management: -Proton pump inhibitors (PPIs), which reduce gastric acid production and
accelerate healing of certain gastric, duodenal and esophageal sources of
hemorrhage.
-Octreotide is a somatostatin analog believed to shunt blood away from the
splanchnic circulation.
-Terlipressin is a vasopressin analog
-Antibiotics are prescribed in upper GI bleeds
Prognosis: - self-limiting in more than 80% of cases: the body is able to stop the bleeding on
its own. Patients who continue to bleed or who have symptoms of a sudden loss
of a large amount of blood usually are hospitalized and often are admitted to an
intensive care unit.
Etiologic agent: -Invasion (pituitary tumors, CNS tumors, carotid aneurysm), Infarction
(postpartum necrosis, pituitary apoplexy),
- Infiltration (sarcoidosis, hemochromatosis), Injury (head trauma, child abuse),
-Immunologic (lymphocytic, hypophysitis), Iatrogenic (surgery, radiation, therapy)
- Infectious (mycoses, tuberculosis, syphilis)
-Idiopathic (familial)
-Isolated (deficiency of an anterior pituitary hormone such as growth hormone,
LH, ESH, thyroid-stimulating hormone)
Clinical Management: - Treatment is essentially by replacing the hormones that the pituitary gland fails
to produce. Hormones like corticosteroids, thyroid hormones and estrogens
- Treatment involves estrogen and progesterone hormone replacement therapy,
which must be taken for the rest of your life. Thyroid and adrenal hormones also
must be taken.
Possible Nursing Dx: -fluid volume deficit related to excessive vascular loss
-altered tissue perfusion related to hypovolemia
-mild anxiety related to situational crisis
-risk for infection related to traumatized tissue
-risk for pain related to tissue trauma
-knowledge deficit related to unfamiliar resources
1. Explain the pathophysiology of a decreasing clotting factor of a patient with
dengue hemorrhagic fever
Dengue virus infection induces transient immune aberrant activation of CD4/CD8 ratio inversion and cytokine
overproduction, and infection of endothelial cells and hepatocytes causes apoptosis and dysfunction of these
cells. The coagulation and fibrinolysis systems are also activated after dengue virus infection. We propose a
new hypothesis for the immunopathogenesis for dengue virus infection. The aberrant immune responses not
only impair the immune response to clear the virus, but also result in overproduction of cytokines that affect
monocytes, endothelial cells, and hepatocytes. Platelets are destroyed by crossreactive anti-platelet
autoantibodies. Dengue-virus-induced vasculopathy and coagulopathy must be involved in the pathogenesis
of hemorrhage, and the unbalance between coagulation and fibrinolysis activation increases the likelihood of
severe hemorrhage in DHF/DSS. Hemostasis is maintained unless the dysregulation of coagulation and
fibrinolysis persists. The overproduced IL-6 might play a crucial role in the enhanced production of anti-
platelet or anti-endothelial cell autoantibodies, elevated levels of tPA, as well as a deficiency in coagulation.
Capillary leakage is triggered by the dengue virus itself or by antibodies to its antigens. This
immunopathogenesis of DHF/DSS can account for specific characteristics of clinical, pathologic, and
epidemiological observations in dengue virus infection.
Determine the length of time care in the home of the geriatric person is going to be needed. For example,
an elderly person may only need short term care if he is recovering from an illness or accident; in cases
where there is chronic illness or disability, long term care may be required.
Convene a family meeting with the senior in order to plan and prepare for care at home. Gain input from
everyone in terms of how the needs of the elderly person will be met. In some cases a primary care giver
will be selected from the family with the others acting in a supporting role. The family may also need to
decide if a full or part-time nurse or aide will be needed.
Gather important information from the geriatric patient to facilitate situations in which the data may be
needed. Keep a log with the patient's social security number, health insurance information, list of
medications, names and phone numbers of physicians and pharmacies.
Keep a record of all doctor and therapy visits. Log the date of each visit, what was accomplished, any
new prescriptions and follow-up appointment information. Keep all x-rays and test results in this record as
well.
Set up the house to facilitate geriatric care. Depending on the situation you may need to install a
wheelchair ramp, a hospital bed, oxygen tanks or bathroom safety products such as a shower chair. Ask
medical professionals for recommendations to what might be needed.
Gain knowledge regarding all the geriatric person's health problems so you can give them the best care
possible. This information can be helpful in letting you know what to expect with certain conditions, and it
can clue you in to current research and new medications which may be available.
Take a look at financial resources. Determine what funds the elderly person has available for medical
care and what the family in general can contribute. You may need to seek out financial help from
community resources. Schedule an appointment with your local social service office to find out what is
available.
Communicate extensively with the geriatric patient. It is common for caregivers to forget the patient has
her own opinions and ideas. This can happen due to the focus on meeting physical needs. Remember
that the senior's mental and emotional health is essential to her well being.