Case study myasthenia gravis patient

Please answer the questions in the case study below Although myasthenia gravis is uncommon, it can produce some dangerous symptoms and is an excellent disease process to help us understand the actions of Acetylcholine (ACH) in the body. This is material that will be on the test. Please use both your Lehne pharmacology and your Lewis Adult Health Nursing textbooks as your primary resource. Remember, the test questions come from our textbooks and not wikipedia, WebMD, or Mayo clinic!

Myasthenia Gravis Case Study

Please 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. (15 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:

What is myasthenia gravis and what are the usual presenting symptoms (2 points)?

Knowing the usual presenting symptoms, what are the essential assessments for this patient with myasthenia gravis (2 points)?

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? (often students question if we can talk about causes with patients—it is called teaching. If we know something will affect a patient’s health, we owe it to the patient to teach them what to do and what to avoid. Again, the adult health textbook is a good resource for this question in particular) (2 points)