Editing Medical-Surgical Nursing (section)

=== Neuromuscular and Degenerative Disorders ===

Myasthenia gravis is an autoimmune attack on acetylcholine receptors, producing descending weakness that worsens with activity and improves with rest, ptosis, diplopia, difficulty chewing and swallowing, and respiratory muscle weakness. Myasthenic crisis is undermedication or a trigger causing severe weakness and respiratory failure; cholinergic crisis is overmedication with anticholinesterase drugs and adds salivation, lacrimation, diarrhea, and muscle fasciculations. Both threaten the airway, so respiratory support is the immediate priority in either case.

Guillain-Barre syndrome produces ascending symmetric weakness and paralysis, often after a viral or gastrointestinal illness. The nursing priority is serial monitoring of respiratory status, particularly vital capacity and negative inspiratory force, because ascending paralysis can reach the diaphragm. Recovery is usually descending and gradual.

Multiple sclerosis is demyelination in the central nervous system producing variable fatigue, visual disturbance, weakness, spasticity, paresthesia, and bladder dysfunction with relapses and remissions. Teach avoidance of heat, which temporarily worsens symptoms, along with energy conservation and fall prevention.

Parkinson disease results from dopamine deficiency in the basal ganglia and produces resting tremor, cogwheel rigidity, bradykinesia, a shuffling festinating gait, masked facies, and postural instability. Teach the patient to consciously lift the feet, to use a wide stance, to allow extra time, and to eat soft, high-calorie foods safely.