Question

Read the following article:

Moore, A.S. & Shepard, L.H. (2014). Myasthenia gravis vs. guillain-barré syndrome what’s the difference? (Links to an external site.)Links to an external site. Nursing Made Incredibly Easy! 12 (4). 21-30.
Initial Discussion Post:

Select one (1) of the following Nursing Diagnoses:

Impaired Spontaneous Ventilation
Impaired Swallowing
Care Giver Role Strain
Address the following:

Is the nursing diagnoses that you selected appropriate for the patient with a diagnosis of myasthenia gravis, Guillain-Barre syndrome or both? Explain your answer.
Provide an outcome for the nursing diagnosis that you selected making sure that is specific to the needs of the patient with myasthenia gravis or Guillain-Barre syndrome.
Identify two (2) interventions that will help your patient with myasthenia gravis or Guillain-Barre syndrome reach the outcome for the nursing diagnosis.

Answer 1

Answer)

MG is an acquired autoimmune disease. The autoantibody attack, which takes place on the acetylcholine (ACh) receptors of the myoneural junction, impairs transmissions of nerve impulses, causing weakness of the voluntary skeletal muscles. The disease's course varies from remissions, when no activity occurs, to pe- riods of flare-ups known as exacerbations. The disease isn't considered hereditary, although genetic abnormalities have been linked to it.

MG include an overgrowth of the thymus gland, as well as hyperthyroidism, which may lead the primary care provider to pre- scribe diagnostic imaging such as a chest X-ray or computed tomography. Because the antibodies (immune proteins) that are believed to target the Ach receptors are produced in the thymus gland, the pri- mary care provider may opt to remove it (thymectomy). MG can develop at any age and is seen in both men and women. In women, MG occurs more often in those younger than age 40, but in men it's more likely to occur later in life. MG is a chronic condition with- out any known cure, but with proper man- agement, patients can achieve a good quality of life. A concern for women who are pregnant is that the infant may be born with MG Comparing MG and GBS MG (descending type) GBS (ascending type)

Trigger - Unknown - Often follows viral infections, such as herpes simplex, AIDS, or mononucleosis - After surgery - Severe illness Incidence - Twenty per 100,000 individuals affected - Onset most common in women in their 20s and 30s; men in their 50s and 60s - Men more commonly affected - Unrelated to ethnicity - One or two per 100,000 individuals affected - Incidence increases with advancing age - Men and women equally affected - Unrelated to ethnicity Diagnostic testing - Edrophonium test - No specific test - Diagnosis is based on medical history and presenting signs and symptoms of increasing muscle weakness and decreased breathing Basic pathophysiology - Target: Neuromuscular junction - Autoimmune attack on the ACh receptors that block nerve impulses to the skeletal muscles - Target: Myelin sheath surrounding axons of peripheral nerves - Cell-mediated autoimmune reaction directed at peripheral nerves, interrupting nerve signals Course of progression - Chronic - Signs and symptoms begin proximally and progress downward - Progressive condition - Acute (early hours after trigger) - Rapidly progressive weakness begins in the lower extremities and progresses upward - Spontaneous recovery occurs in 4 months up to 2 years Source: Adapted from Tucker KL. Myasthenia gravis and Guillain-Barré syndrome.

MG, which is caused by the mother's abnormal antibodies enter- ing the neonate's bloodstream. When this occurs, the infant presents with muscle weakness of the upper extremities and facial muscles, which puts him or her at risk for aspirating while feeding. The abnormal anti- bodies are typically cleared within 2 months, relieving the infant from symptoms. Recognizing signs and symptoms Although the onset of MG is typically slow, certain conditions, such as infection or preg- nancy, can lead to a rapid onset. The initial assessment finding for MG is generalized weakness that gets worse with activity and progresses over time. The weakness is associ- ated with the specific muscles involved, which usually include the facial and laryn- geal muscles, all extremities, and intercostal muscles. Often, you'll find that early involvement affects the levator palpebrae, which are the muscles of the eyes and the eyelids. Specific signs and symptoms include pto- sis (drooping eyelids) and diplopia (dou- ble vision). The patient will appear to have little to no facial expression and, because the 50 laryngeal muscles are involved, he or she will have dysphagia (difficulty swallowing) and dysphonia (impairment of the voice). These patients won't com- plain of associated pain, but they may report muscle achiness. Diagnostic tests can help When the medical diagnosis of MG is being confirmed, you can anticipate that the primary care provider will order an edrophonium test, which includes I.V. Comparing assessments and interventions for MG and GBS MG GBS Assessment findings (signs and symptoms) - Weakness of the arms and legs that improves with rest - Oculomotor disturbances - Difficulty chewing, swallowing, speaking - Reflexes intact - Tingling in the legs - Weakness is widespread, including the respiratory muscles, and isn't improved with rest - Almost total paralysis - Difficulty swallowing - Difficulty breathing - Respiratory failure - Reflexes often absent Interventions - Plasmapheresis - IVIG - Thymectomy (removal of the thymus gland) Precautions - Aspiration precautions - Falls precautions Medications - Anticholinesterase drugs: pyridostigmine bromide, neostigmine, and ambenonium chloride - Immunosuppressant drugs: prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and cyclophosphamide - Plasmapheresis - IVIG - Mechanical ventilation