Myasthenia Gravis case study PDF

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Case study on myasthenia gravis from evolve HESI practice...

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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

b. c. d. e.

Increases tear production for adequate moisture in eyes Reduces gastric acid production to aid digestion of food Eliminates muscle pain to enhance client’s ability to sleep Prevents breakdown of acetylcholine, a natural substance, in the body

5. Which instruction about taking pyridostigmine should the nurse include in the plan of care? a. Take the medication 30 minutes prior to meals b. Do not eat before taking medication c. Sprinkle medication on your food d. Schedule daily at bedtime only 6. Which statement(s) indicates to the nurse that the client understands the medication teaching? Select all that apply. a. “When I am nauseated, I should not take my medication.” b. “If I miss a dose of my medication, I should double up on the next dose” c. “I must carry an identification card while on my medication regimen” d. “I need to have my serum blood levels checked monthly” e. “I need to try to take the medication on time” 7. Which intervention should the nurse direct toward the client’s husband? a. Demonstrate how to perform abdominal thrusts correctly b. Enroll the family in basic CPR training c. Teach importance of keeping the temperature at the house about 76 F d. Move the bed downstairs so the client will be able to rest as much as possible 8. Which statement by the client indicates she understands the client teaching provided by the nurse? a. “I can never get pregnant since I have MG” b. “I will avoid anyone that has a respiratory infection” c. “Relaxing in my hot tub daily will help my muscle rigidity” d. “I must decrease my fluid intake to 1000 mL of water a day” 9. Which referral to a member of the interdisciplinary team should the nurse make for the client? a. Respiratory therapist b. Recreational therapist c. Vocational therapist d. Speech therapist One month after the office visit, the client is admitted to the ED with a sudden exacerbation of motor weakness, diaphoresis, blurred vision, and diarrhea.

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) a. Positive Chvostek’s and Trousseau’s b. Elevation of temperature occurs 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. Demonstrate how to splint the incision when coughing The client’s tubes are removed. Two days later she is sitting on the side of the bed and sates that she is hungry. The HCP advances her diet from full liquids to a regular diet. 21. As the client is completing her meal request form, the nurse considers the client’s Hindu culture and anticipates that she will select which meal? a. Broccoli rice casserole, roll, and water The client progresses without complications and is transferred to the surgical unit. The nruse overhears the female UAP telling the client “You should chew your food thoroughly before swallowing” 22. Which action should the nurse implement? a. Praise the UAP for making this statement while the client is eating While walking down the hallway to begin client rounds, the charge nurse glances into the client’s room and observes the primary nurse in the room. The charge nurse notices that the primary nurse asks the client her name and then immediately administers a medication. 23. Which action should the nurse take? a. Review the need for two form of identification with the nurse at the medication cart The client continues to improve and is being discharged from hospital after 5 days. 24. Which action should the nurse implement? a. Continue reviewing the discharge instructions with the client 25. Which statement indicates the client understands the instructions provided by the nurse? a. "I will call my healthcare provider if I have a temperature of 100.0F or higher." 26. Which statement indicates to the nurse that the medication teaching has been effective? a. "If I have any weakness or choking episodes I will call my healthcare provider." b....