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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

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