Chapter 21 Agents Used in Musculoskeletal · PDF filecrisis and myasthenic crisis could lead...
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midnight, she was reassured that her pyridostigmine bromide can be given by injection. Natasia knows that both cholinergic crisis and myasthenic crisis could lead to muscle weakness and respiratory depression. Postoperatively, Natasia develops respiratory failure and needs to be maintained on a ventilator. She is frightened and is reassured by the health care provider, who decides to test for cholinergic crisis. The probable reason for the respiratory failure was that Natasia received atracurium besylate for muscle relaxation during surgery. She is placed on pyridostigmine bromide 100 mg 4 hourly. NURSING CARE PLAN A Client with Myasthenia Gravis Taking Pyridostigmine Bromide (Mestinon) Natasia Johnson, age 33, is admitted to the hospital and scheduled for thymectomy. Natasia has had a diagnosis of myasthenia gravis and has been on pyridostigmine bromide (Mestinon) 100 mg 4 hourly for the last year. In doing Natasia’s preoperative teaching, it is apparent that she understands her condition well and is aware of her medication routine. When Natasia is told she will be on nothing by mouth after Chapter 21 Agents Used in Musculoskeletal Disorders ASSESSMENT NURSING DIAGNOSIS PLANNING/GOALS IMPLEMENTATION EVALUATION Breathing patterns Impaired gas exchange related to muscle weakness of chest wall. Client will maintain adequate gas exchange. Arterial blood gases will be within normal range. Monitor oxygenation with arterial blood gases. Suction to maintain airway. Observe ventilator for correct settings and function. Schedule breathing exercises for shortly after medication is administered. Client has good oxygenation. Skin is warm and dry and no cyanosis is present. ABGs are within normal limits. Activity Activity intolerance related to fatigue and muscle weakness. Client will turn self in bed on day of surgery without shortness of breath or increase in heart rate. Turn client frequently. Permit client to assist as muscle strength is available. Encourage client to remember that as medication works, strength will return. Client maintains activity level within capabilities as evidenced by normal vital signs with activity. Mobility Impaired physical mobility related to weakness of skeletal muscles. Client sits in chair for 30 minutes with assistance on second post-operative day. Client walks to door and back with assistance on third postoperative day. Have client sit in chair twice on second postoperative day. Assist as necessary. Schedule ambulation for period when muscle strength is greatest. Ambulate client with assistance twice on postoperative day. Client sat in chair for 15 minutes twice on second postoperative day. Required assistance getting in and out of chair. No shortness of breath or increase in heart rate. Client ambulated to door and back twice with assistance on third postoperative day. No shortness of breath, but heart rate increased 30 beats/min. Communication Impaired verbal communication related to muscle weakness and tracheal intubation. Client uses alternative forms of communication while on ventilator. Plan communication for client on ventilator. ‘Yes’ and ‘No’ questions are good. Read lips. Have client write, if she has adequate muscle strength. Client communicates needs with eye movements and hand signals while on ventilator. Injury Risk for injury related to muscle weakness. Client will not experience injury during hospitalisation. Observe client closely for changes in muscle strength that might lead to falls or other types of injury. Assess client for risk of falls. Provide assistance for ambulation. Implement strategies for preventing falls. Client has no injuries during hospitalisation. CONTINUED
Transcript of Chapter 21 Agents Used in Musculoskeletal · PDF filecrisis and myasthenic crisis could lead...
midnight, she was reassured that her pyridostigmine bromide can be given by injection. Natasia knows that both cholinergic crisis and myasthenic crisis could lead to muscle weakness and respiratory depression. Postoperatively, Natasia develops respiratory failure and needs to be maintained on a ventilator. She is frightened and is reassured by the health care provider, who decides to test for cholinergic crisis. The probable reason for the respiratory failure was that Natasia received atracurium besylate for muscle relaxation during surgery. She is placed on pyridostigmine bromide 100 mg 4 hourly.
NursiNg Care PlaNA Client with Myasthenia Gravis Taking Pyridostigmine Bromide (Mestinon) Natasia Johnson, age 33, is admitted to the hospital and scheduled for thymectomy. Natasia has had a diagnosis of myasthenia gravis and has been on pyridostigmine bromide (Mestinon) 100 mg 4 hourly for the last year. In doing Natasia’s preoperative teaching, it is apparent that she understands her condition well and is aware of her medication routine. When Natasia is told she will be on nothing by mouth after
Chapter 21 Agents Used in Musculoskeletal Disorders
Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion
Breathing patterns Impaired gas exchange related to muscle weakness of chest wall.
Client will maintain adequate gas exchange. Arterial blood gases will be within normal range.
Monitor oxygenation with arterial blood gases. Suction to maintain airway. Observe ventilator for correct settings and function. Schedule breathing exercises for shortly after medication is administered.
Client has good oxygenation. Skin is warm and dry and no cyanosis is present. ABGs are within normal limits.
Activity Activity intolerance related to fatigue and muscle weakness.
Client will turn self in bed on day of surgery without shortness of breath or increase in heart rate.
Turn client frequently. Permit client to assist as muscle strength is available. Encourage client to remember that as medication works, strength will return.
Client maintains activity level within capabilities as evidenced by normal vital signs with activity.
Mobility Impaired physical mobility related to weakness of skeletal muscles.
Client sits in chair for 30 minutes with assistance on second post-operative day. Client walks to door and back with assistance on third postoperative day.
Have client sit in chair twice on second postoperative day. Assist as necessary. Schedule ambulation for period when muscle strength is greatest. Ambulate client with assistance twice on postoperative day.
Client sat in chair for 15 minutes twice on second postoperative day. Required assistance getting in and out of chair. No shortness of breath or increase in heart rate. Client ambulated to door and back twice with assistance on third postoperative day. No shortness of breath, but heart rate increased 30 beats/min.
Communication Impaired verbal communication related to muscle weakness and tracheal intubation.
Client uses alternative forms of communication while on ventilator.
Plan communication for client on ventilator. ‘Yes’ and ‘No’ questions are good. Read lips. Have client write, if she has adequate muscle strength.
Client communicates needs with eye movements and hand signals while on ventilator.
Injury Risk for injury related to muscle weakness.
Client will not experience injury during hospitalisation.
Observe client closely for changes in muscle strength that might lead to falls or other types of injury. Assess client for risk of falls. Provide assistance for ambulation. Implement strategies for preventing falls.
Client has no injuries during hospitalisation.
CONTINUED
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Assessment nursing diAgnosis PlAnning/goAls imPlementAtion evAluAtion
Fearfulness, need for information
Powerlessness related to inability to control symptoms.
After extubation, client verbalises fears and explores ways to achieve some control over her personal situation.
Give psychological support. Reassure client that the crisis will pass. Explain all actions and procedures. Keep client informed about medication schedule. Encourage involvement in decision making.
After extubation, client verbalises fear of never getting off machine and identifies three ways to achieve some control over the situation.
Signs of myasthenic crisis
Risk for altered health maintenance related to not recognising symptoms of disease.
Prior to discharge, client lists signs of myasthenic crisis to report to health care provider.
Client teaching after crisis passes should include reporting: dysphagia, dysarthria, eyelid ptosis, diplopia, tachycardia.
Prior to discharge client identifies signs of myasthenic crisis and reports them to health care provider.
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