Journal Entry After completin” rel=”nofollow”>ing 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 durin” rel=”nofollow”>ing the last 9 weeks, you may select a related case study from a reputable source or reflect on previous clin” rel=”nofollow”>inical experiences. This needs to be on the title page Student Female gymnastics teacher Known to have… Inconsistent muscle weakness in” rel=”nofollow”>in her face Gotten worse over the past three months Tired jaw while chewin” rel=”nofollow”>ing Difficult swallowin” rel=”nofollow”>ing Diplopia (“double vision”) usually after readin” rel=”nofollow”>ing for a few min” rel=”nofollow”>inutes Difficult time spottin” rel=”nofollow”>ing students durin” rel=”nofollow”>ing 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 Droopin” rel=”nofollow”>ing eyelids Difficulties with speech, chewin” rel=”nofollow”>ing, swallowin” rel=”nofollow”>ing, and breathin” rel=”nofollow”>ing Causes of myasthenia gravis Caused by… Breakdown in” rel=”nofollow”>in communication between nerves and muscles Causes immune system to produce antibodies that block or destroy many muscles receptors Fewer receptors leads to muscles receivin” rel=”nofollow”>ing fewer nerve signals Reasons why this disease causes difficulty when chewin” rel=”nofollow”>ing and double vision Muscle weakness leads to fatigue in” rel=”nofollow”>in skeletal muscles The fatigue makes it harder for masseters, temporalis muscles, and pterygoid muscles (chewin” rel=”nofollow”>ing muscles) to chew Myasthenia gravis affects voluntary muscles that control eye and eyelid movement Weakness of the eye muscles lead to droopin” rel=”nofollow”>ing of the eyelids, which affects vision Anti-acetylcholin” rel=”nofollow”>ine receptor antibodies’ in” rel=”nofollow”>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” rel=”nofollow”>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 bin” rel=”nofollow”>ind to ACh, the skeletal muscle’s cell membrane potentials have a more difficult time reachin” rel=”nofollow”>ing the threshold potential and in” rel=”nofollow”>initiatin” rel=”nofollow”>ing contraction This causes the normal degree of fatigue durin” rel=”nofollow”>ing repetitive nerve stimulation to be in” rel=”nofollow”>increased in” rel=”nofollow”>in an in” rel=”nofollow”>individual with myasthenia gravis Anticholin” rel=”nofollow”>inesterase drugs act on improvin” rel=”nofollow”>ing skeletal muscle function Anticholin” rel=”nofollow”>inesterase 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 thin” rel=”nofollow”>innin” rel=”nofollow”>ing Diabetes Infertility Decreased white blood cell counts These medications should not be used with proper medical guidance Reason for why nausea, abdomin” rel=”nofollow”>inal cramps, diarrhea, and excessive salivation are all side effects of the anticholin” rel=”nofollow”>inesterase drug Side effects usually occur when there is a muscarin” rel=”nofollow”>inic overdose Not recommended for a long period of time Although the atropin” rel=”nofollow”>ine does reduce or mask the symptoms it will not prevent the possibility of the patient goin” rel=”nofollow”>ing in” rel=”nofollow”>into cholin” rel=”nofollow”>inergic crisiss Cholin” rel=”nofollow”>inergic crisis= caused by the in” rel=”nofollow”>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 bein” rel=”nofollow”>ing made Known to be the most effective treatment for myasthenia gravis Reason why Jill must undergo plasmapheresis when her symptoms become especially severe Durin” rel=”nofollow”>ing this treatment… Blood plasma is taken out of the body and treated Plasma is then put back in” rel=”nofollow”>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 in” rel=”nofollow”>increased risk for respiratory failure The disease is known to weaken and cause fatigue in” rel=”nofollow”>in voluntary muscles This in” rel=”nofollow”>includes the diaphragm and in” rel=”nofollow”>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.mayoclin” rel=”nofollow”>inic.com/health/myasthenia-gravis/DS00375 http://www.mayoclin” rel=”nofollow”>inic.com/health/myasthenia-gravis/DS00375/DSECTION=causes http://www.beverlyhillsneurology.com/myastheniagravis-symptoms.html http://www.nin” rel=”nofollow”>inds.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” rel=”nofollow”>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

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