Neurologic Disorder-Case Study Scenario: Ruth Roman Is a 74-year-old retired soc
ID: 211525 • Letter: N
Question
Neurologic Disorder-Case Study
Scenario:
Ruth Roman Is a 74-year-old retired social worker who has been on your floor for several days receiving
q.o.d. plasmapheresis for myasthenia gravis (MG). She has a PMH (past medical history) of type 2 DM
for 3 years and low back pain secondary to spinal stenosis. She received 2 steroid injections into her
spine for pain 2 to 3 weeks before her admission, which was followed by progressive, symmetric,
weakness in her lower extremities proximal > distal; R foot numbness; poor eye-hand coordination; and
significant hand weakness. On admission, Ruth was unable to bear any weight or take fluids through a
straw. There have been periods of exacerbation and remission since admission.
1. You are visiting with Ruth’s grandson who tells you he is just starting medical school and he would
like to know more about MG so that he can discuss it with his grandmother. What do you tell him?
2. He asks you to explain how plasmapheresis works. How would you explain this treatment?
3. He asks what drugs are used to treat MG. You explain although neostigmine (prostigmin) and
pyridostigminbe (Mestinin) are often used in combination, drug regimens and doses are highly
individualized. Identify the appropriate drug classification and explain the action of these two drugs to
Ruth’s grandson.
4. Ruth told her grandson that after taking her morning medications, she often experienced nausea,
heartburn, slight SOB, sweating, and she felt her heart beating rapidly. What can you tell him about
this?
5. Describe a myasthenic crisis.
6. List six nursing problem statements that would be appropriate for Ruth
7. List five factors that could predispose Ruth to an exacerbation of her illness.
8. Ruth Asks you what the doctors meant when they were talking about some kind of a challenge test.
You realize they must have been discussing the possibility of performing an edrophonium (Tensilon)
challenge. What is a Tensilon challenge, and what information will it yield?
9. What are aminoglycosides, and why are they contraindicated in patients with MG?
10. Ruth’s grandson wants to know when she’ll be able to go home. How do you respond?
11. What supportive measures can you suggest to Ruth’s grandson that he can undertake or arrange on
behalf of his grandmother?
Explanation / Answer
1). Myasthenia gravis is an autoimmune disease caused by the production of antibodies against acetylcholine receptors. This causes muscle weakness throughout the body. Weak pharyngeal and facial muscles cause difficulty in chewing and swallowing that sometimes causes aspiration of food. A drooping eyelid is an ocular symptom of myasthenia gravis. Failure of respiratory muscles may cause respiratory failure and death.
As the disease progresses, the myasthenic crisis develops. It is characterized by extreme muscle weakness, which results in quadriplegia, respiratory insufficiency and shortness of breath. The risk of respiratory arrest increases with myasthenic crisis.
The treatment includes using the cholinesterase inhibitors, which can delay the hydrolysis of acetylcholine. Some of the exercises are also usually included as a part of the treatment.