Practicum Experience: Journal Entry
After completing this week’s Practicum Experience, reflect on a patient with a known history of a1. musculoskeletal disorder.2. Describe the patient’s personal and3. medical history, 4.drug therapy and treatments, and5. follow-up care. If you did not evaluate a patient with this background during the last 9 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.
This needs to be on the title page Student
Female gymnastics teacher
Known to have…
Inconsistent muscle weakness in her face
Gotten worse over the past three months
Tired jaw while chewing
Difficult swallowing
Diplopia (“double vision”) usually after reading for a few minutes
Difficult time spotting students during acrobatic moves, at work, due to upper arm weakness
Myasthenia Gravis
Weakness and fatigue of voluntary muscles
No known cure
Known treatments help relieve signs and symptoms such as:
Weakness of arms or legs
Double vision
Drooping eyelids
Difficulties with speech, chewing, swallowing, and breathing
Causes of myasthenia gravis
Caused by…
Breakdown in communication between nerves and muscles
Causes immune system to produce antibodies that block or destroy many muscles receptors
Fewer receptors leads to muscles receiving fewer nerve signals
Reasons why this disease causes difficulty when chewing and double vision
Muscle weakness leads to fatigue in skeletal muscles
The fatigue makes it harder for masseters, temporalis muscles, and pterygoid muscles (chewing muscles) to chew
Myasthenia gravis affects voluntary muscles that control eye and eyelid movement
Weakness of the eye muscles lead to drooping of the eyelids, which affects vision
Anti-acetylcholine receptor antibodies’ interference with skeletal muscle activity
Anti-AChR weakens muscles
Antibody can lead to a loss of muscle AChR
Effects of repetitive nerve stimulation and its result in decreased amplitude of the muscle contractions
The destruction of ACh receptors makes skeletal muscle less responsive to nerve stimulation –> premature fatigue
With fewer ACh receptors available to bind to ACh, the skeletal muscle’s cell membrane potentials have a more difficult time reaching the threshold potential and initiating contraction
This causes the normal degree of fatigue during repetitive nerve stimulation to be increased in an individual with myasthenia gravis
Anticholinesterase drugs act on improving skeletal muscle function
Anticholinesterase drugs help enhance communication between muscles and nerves and improve muscle contraction
Do not completely cure myasthenia gravis
Intake of these medications for too long can cause serious side effects such as…
Bone thinning
Diabetes
Infertility
Decreased white blood cell counts
These medications should not be used with proper medical guidance
Reason for why nausea, abdominal cramps, diarrhea, and excessive salivation are all side effects of the anticholinesterase drug
Side effects usually occur when there is a muscarinic overdose
Not recommended for a long period of time
Although the atropine does reduce or mask the symptoms it will not prevent the possibility of the patient going into cholinergic crisiss
Cholinergic crisis= caused by the inactivity of the AChE enzyme (drug overwork)
The benefits of corticosteroid prednisone
Prednisone is a synthetic drug
Resembles natural hormones made by the cortex of human adrenal glands
Steroids like this suppress the immune system which prevents abnormal antibodies from being made
Known to be the most effective treatment for myasthenia gravis
Reason why Jill must undergo plasmapheresis when her symptoms become especially severe
During this treatment…
Blood plasma is taken out of the body and treated
Plasma is then put back into the body
It is key for Jill to undergo this treatment because it removes the antibodies from her blood circulation
Reason why Jill’s doctor advises her that she is at increased risk for respiratory failure
The disease is known to weaken and cause fatigue in voluntary muscles
This includes the diaphragm and intercostal muscles, which are both a part of the respiratory tract
If these muscles seize to work it can cause the respiratory tract to fail
http://www.mayoclinic.com/health/myasthenia-gravis/DS00375
http://www.mayoclinic.com/health/myasthenia-gravis/DS00375/DSECTION=causes
http://www.beverlyhillsneurology.com/myastheniagravis-symptoms.html
http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm#222043153
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC490626/
http://wiki.answers.com/Q/Why_does_repetitive_nerve_stimulation_result_in_decreased_amplitude_of_the_muscle_contraction
http://www.drweil.com/drw/u/ART03138/Myasthenia-Gravis.html
http://www.rxlist.com/enlon-drug/patient-images-side-effects.htm
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0f56facf-1f0a-4ba5-876d-757b114dfa45#nlm34084-4
http://www.myasthenia.org.au/html/treatments.htm
