MS / ALS / MS / GBS PART #3

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to a. perform physically demanding activities in the morning. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception.

ANS: A Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy should be discontinued. There is no decrease in sensation with MG, and muscle atrophy does not occur because muscles are used during part of the day.

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should: a. attempt to institute bowel-training activities. b. provide the client with small, frequent feedings. c. obtain an order for intermittent catheterization. d. orient the client to his or her surroundings frequently.

B The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

The nurse is educating the family of a patient in the late stages of amyotrophic lateral sclerosis (ALS). What teaching point is most important for the nurse to include? a. The patient's ability to move the upper limbs may be affected. b. The patient's cognitive and mental capacity will most likely remain intact throughout the disease progression. c. The patient's breathing should not be affected by the disease. d. The patient's ability to swallow will remain intact.

B Whereas the ability to move the upper limbs will likely be affected by the disease, it is important for families to remember that the patient's cognitive and mental capacity stays intact as the motor activity rapidly declines. Breathing and swallowing are often significantly affected by ALS.

A 30-year-old was diagnosed with amyotrophic lateral sclerosis (ALS). Which statement by the client would indicate a need for more teaching from the nurse? A) "I will have progressive muscle weakness." B) "I will lose strength in my arms." C) "My children are at greater risk to develop this disease." D) "I need to remain active for as long as possible."

C Feedback: There is no known cause for ALS, and no reason to suspect genetic inheritance. ALS usually begins with muscle weakness of the arms and progresses. The client is encouraged to remain active for as long as possible to prevent respiratory complications.

The early manifestations of amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are somewhat similar. What clinical feature of ALS distinguishes it from MS? A. Dysarthria B. Dysphagia C. Muscle weakness D. Impairment of respiratory muscles

D In ALS, there is progressive muscle atrophy until a flaccid quadriplegia develops. Eventually, there is involvement of the respiratory muscles, which leads to respiratory compromise.

The client is being evaluated to rule out ALS. Which signs/symptoms would the nurse note to confirm the diagnosis? a. Muscle atrophy and flaccidity b. Fatigue and malnutrition c. Slurred speech and dysphagia d. Weakness and paralysis

ANS: D ALS results from the degeneration and demyelination of motor neurons in the spinal cord, which results in paralysis and weakness of the muscles

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). What is the nurse's primary focus of care? 1. Respiratory support as the muscles of breathing fail, and managing secretions due to the inability to swallow and communicate 2. Providing gastrostomy feedings as soon as possible to build up muscle mass when motor functions return 3. Pain management and active range-of-motion (ROM) exercises 4. Administering immunosuppressants

Answer 1. Respiratory support as the muscles of breathing fail, and managing secretions due to the inability to swallow and communicate

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: a. Getting too little exercise b. Taking excess medication c. Omitting doses of medication d. Increasing intake of fatty foods

Answer C. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myasthenic crisis.

Which nursing intervention is aimed at reducing muscle weakness in the client with myas-thenia gravis? A. Therapeutic massage B. Assisting the client with ADLs C. Providing pressure-reducing devices D. Repositioning the client every 2 hours

B The hallmark of myasthenia gravis is muscle weakness that increases with fatigue. The nurse provides assistance with ADLs to prevent fatigue. The nurse also collaborates with the physical therapist in teaching the client energy conservation techniques.

The client with ALS is admitted to the medical unit with shortness of breath, dyspnea, and respiratory complications. Which intervention should the nurse implement first? a. Elevate the head of the bed 30 degrees. b. Administer oxygen via nasal cannula. c. Assess the client's lung sounds. d. Obtain a pulse oximeter reading.

ANS: B Oxygen should be given immediately to help alleviate the difficulty breathing. Remember that oxygenation is a priority.

A client who is recently diagnosed with amyotrophic lateral sclerosis (ALS) is to be discharged home. The nurse should teach the family to: 1. monitor the client's urine output at home. 2. check the client's level of consciousness frequently. 3. check bony prominences and reposition the client every 2 hours. 4. serve the client a high red meat diet.

Answer: 3 1. It is not necessary to monitor the client's urine output, but the family is encouraged to provide good hydration. 2. Clients with ALS maintain their mental acuity. 3. The client is usually bedridden, and should be turned every 2 hours and monitored for breakdown on bony prominences. 4. Clients with ALS lose their ability to swallow, and could aspirate on pieces of meat.

The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority? A) Prepare the patient for intubation. He is about to go into a myasthenic crisis. B) Perform teaching on medication side effects C) Assess for signs of infection D) Further assess for other thymectomy complications

C. Although the GI symptoms is a common side effect of medicaitons, it is important to follow up on the high temperature and assess for sings of infection. An infection can often exacerbate a Myasthenic crisis and should be carefully monitored for. There is no evidence that this person is about to have a myasthenic crisis and intubation should only be done if the patient is experiencing respiratory failure. There is no evidence that this patient has had a thymectomy.

The client diagnosed with MG is admitted to the emergency department with a sudden exacerbation of motor weakness. Which assessment data indicate the client is experiencing a myasthenic crisis? 1. The serum assay of circulating acetylcholine receptor antibodies is increased. 2. The client's symptoms improve when administering on a cholinesterase inhibitor. 3. The client's blood pressure, pulse, and respirations improve after intravenous (IV) fluid. 4. The Tensilon test does not show improvement in the client's muscle strength.

Correct answer 2: This assessment datum indicates a myasthenic crisis that is due to undermedication, missed doses of medication, or developing an infection. Serum assays are useful in diagnosing the disease, not in identifying a crisis. Vital signs do not differentiate the type of crisis. No improvement after Tensilon indicates a cholinergic crisis, not a myasthenic crisis.

The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). The nurse plans care based on which understanding of the patient's prognosis? 1. The disease progresses slowly and is fatal. 2. The disease will progress over many years but the patient's quality of life will be good. 3. The disease progresses rapidly but can be halted by drug therapy. 4. The disease will progress slowly and can be controlled by medication.

1 correct answer Rationale 1: The disease is slowly progressive and fatal and is characterized by weakness and wasting of muscles under voluntary control.Rationale 2: Quality of life is profoundly affected by this disorder. Rationale 3: Riluzole (Rilutek) is available to treat the disease, but it does not halt it. Death usually occurs due to respiratory failure. Rationale 4: The disease is slowly progressive and cannot be controlled by medication.

A thymectomy accomplished via a median sternotomy approach is performed in a client with a diagnosis of myasthenia gravis. The nurse develops a postoperative plan of care for the client that should include which intervention? 1. Monitor the chest tube drainage. 2. Restrict visitors for 24 hours postoperatively. 3. Maintain intravenous infusion of lactated Ringer's solution. 4. Avoid administering pain medication to prevent respiratory depression.

1. Monitor the chest tube drainage. Rationale: A thymectomy may be used for management of clients with myasthenia gravis. The procedure is performed through a median sternotomy or a transcervical approach. Postoperatively the client will have a chest tube in the mediastinum. Lactated intravenous solutions usually are avoided because they can increase weakness. Pain medication is administered as needed, but the client is monitored closely for respiratory depression. There is no reason to restrict visitors.

The nurse is discussing the future with a client recently diagnosed with amyotrophic lateral sclerosis (ALS). When the client asks about the possibility of continuing to work at his family's construction business, the nurse responses: 1. "Work as long at your job as you feel capable of keeping up with the demands it makes on you.". 2. "This is a progressively debilitating disease; you need to think of ways to conserve your energy, not expend it.". 3. "Can you do work that is less strenuous?" 4. "Is there a way that you can switch over to the office side of the business?"

1. "Work as long at your job as you feel capable of keeping up with the demands it makes on you.". Rationale: People with ALS do maintain careers and interests. They are encouraged to remain active for as long as possible. While it is important to minimize stress and conserve energy, it is not necessary to alter one's life dramatically until the symptoms of the disease demand it.

After the male client receives a diagnosis of amyotrophic lateral sclerosis (ALS), he expresses sadness and states he does not know what to do next. Which is the most effective response by the nurse to facilitate communication? 1. Ask the client what he finds comforting in his life. 2. Reassure the client his family will take care of him. 3. Refer the client to a church for spiritual counseling. 4. Tell the client hospice care is available immediately.

1. ALS is a progressive, degenerative neurological disease with no cure and, because of the grim diagnosis, the client expresses confusion and lacks a clear direction. To reduce anxiety enhance coping skills, and facilitate communication, the nurse provides a calm atmosphere by redirecting the client to identify comforting things. The nurse uses the comfort measures hoping they will reduce tension so the client can process information and make decisions.

The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis. The nurse determines that the client is using the information most effectively if the client reports which action? 1. Drinking a total of 1000 mL/day 2. Giving herself an enema every morning before breakfast 3. Taking stool softeners daily and a glycerin suppository once a week 4. Initiating a bowel movement every other day, 45 minutes after the largest meal of the day

4. Initiating a bowel movement every other day, 45 minutes after the largest meal of the day Rationale: To manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate the bowel program on an every-other-day basis. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.

The nurse is teaching the client with MS about the use of corticosteroids for treatment. Which of the following statements, if made by the patient indicates correct understanding? A) I should watch for side effects such as euphoria and insomnia while taking this medication B) This medication will need to be administered for at least 2 weeks before I begin to see improvements in my condition C) The corticosteroids will reduce my chances of relapsing in the future D) I could see flu-like symptoms while taking this medication

A. Some side effects of corticosteroid use include euphoria, mood changes, and insomnia. This medication should only be used for short periods of time (3-5 days) and is often tapered off. This medication is for use in shortening the duration of a relapse, not preventing relapse. Flu-like medications are often seen in Interferon beta-1a or 1b medications (Betaseron, avonex) which are used to for long-term treatment of MS.

The client with end-stage ALS requires a gastrostomy tube feeding. Which finding would require the nurse to hold a bolus tube feeding? a. A residual of 125 mL. b. The abdomen is soft. c. Three episodes of diarrhea. d. The potassium level is 3.4 mEq/L.

ANS: A A residual (aspirated gastric contents) of greater than 50 to 100 mL indicates that the tube feeding is not being digested and that the feeding should be held.

. A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a. Assist with active range of motion. b. Observe for agitation and paranoia. c. Give muscle relaxants as needed to reduce spasms. d. Use simple words and phrases to explain procedures.

ANS: A ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help to maintain strength as long as possible. Psychotic symptoms such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.

The client is in the terminal stage of ALS. Which intervention should the nurse implement? a. Perform passive ROM every two (2) hours. b. Maintain a negative nitrogen balance. c. Encourage a low-protein, soft-mechanical diet. d. Turn the client and have him cough and deep breathe every shift.

ANS: A Contractures can develop within a week because extensor muscles are weaker than flexor muscles. If the client cannot perform ROM exercises, then the nurse must do it for him - passive ROM.

The client is diagnosed with ALS. Which client problem would be most appropriate for this client? a. Disuse syndrome b. Altered body image c. Fluid and electrolyte imbalance d. Alteration in pain

ANS: A Disuse syndrome is associated with complications of bedrest. Clients with ALS cannot move and reposition themselves, and they frequently have altered nutritional and hydration status.

A 28-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "Symptoms of MS are likely to become worse during pregnancy." d. "MS is associated with a slightly increased risk for congenital defects."

ANS: A During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.

The nurse is assisting with care of a resident diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment findings does the nurse anticipate? (Select all that apply.) a. Progressive weakness b. Pill-rolling tremor c. Ascending paralysis d. Hemiparesis e. Decreased coordination of extremities f. Bradykinesia

ANS: A, E Primary symptoms of ALS include progressive muscle weakness and decreased coordination of arms, legs, and trunk. Atrophy of muscles and twitching (fasciculations) also occur. Pill-rolling tremor and bradykinesia are symptoms of Parkinson's disease. Ascending symptoms occur in Guillain-Barré syndrome. Paralysis on one side of the body occurs in strokes.

Which assessment data indicate to the nurse the client diagnosed with Legionnaries' disease is experiencing a complication? a. The client has an elevated body temperature. b. The client has less than 30 mL urine output an hour. c. The client has a decrease in body aches. d. The client has an elevated white blood cell count.

ANS: B

The client diagnosed with ALS asks the nurse, "I know this disease is going to kill me. What will happen to me in the end?" Which statement by the nurse would be most appropriate? a. "You are afraid of how you will die?" b. "Most people with ALS die of respiratory failure." c. "Don't talk like that. You have to stay positive." d. "ALS is not a killer. You can live a long life."

ANS: B About 50% of clients die within 2-5 years from respiratory failure, aspiration pneumonia, or another infectious process.

When obtaining a health history and physical assessment for a patient with possible multiple sclerosis (MS), the nurse should a. assess for the presence of chest pain. b. inquire about any urinary tract problems. c. inspect the skin for rashes or discoloration. d. question the patient about any increase in libido.

ANS: B Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.

The client is diagnosed with ALS, As the disease progresses, which intervention should the nurse implement? a. Discuss the need to be placed in a long-term care facility. b. Explain how to care for a sigmoid colostomy. c. Assist the client to prepare an advance directive. d. Teach the client how to use a motorized wheelchair.

ANS: C A client with ALS usually dies within 5 years. Therefore, the nurse should offer the client the opportunity to determine how he/she wants to die.

The nurse is caring for several clients on a medical unit. Which client should the nurse assess first? a. The client with ALS who is refusing to turn every two (2) hours. b. The client with abdominal pain who is complaining of nausea. c. The client with pneumonia who has a pulse oximeter reading of 90%. d. The client who is complaining about not receiving any pain mediciation.

ANS: C A pulse oximeter reading of less than 93% indicates that the client is experiencing hypoxemia, which is a life-threatening emergency. This client should be assessed first.

When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take? a. Check pupillary size. b. Monitor grip strength. c. Observe respiratory effort. d. Assess level of consciousness.

ANS: C Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.

Which assessment date would make the nurse suspect that the client has amyotrophic lateral sclerosis? a. History of a cold or gastrointestinal upset in the last month. b. Complaints of double vision and drooping eyelids. c. Fatigue, progressive muscle weakness, and twitching. d. Loss of sensation below the level of the umbilicus.

ANS: C Fatigue, progressive muscle weakness, and twitching are signs of ALS, a progressive neurological disease in which there is a loss of motor neurons. There is no cure, but recently a medication to slow the deterioration of the motor neurons has been found.

Which intervention should the nurse take with the client recently diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's disease)? a. Discuss a percutaneous gastrostomy tube. b. Explain how a fistula is accessed. c. Provide an advance directive. d. Refer to a physical therapist for leg braces.

ANS: C It is never too early to discuss advance directives with a client diagnosed with a terminal illness.

The male client is diagnosed with Guillain-Barre Syndrome (GBS) and is in the intensive care unit on a ventilator. Which cardiovascular rationale explains implementing passive range-of-motion (ROM) exercises? a. Passive ROM exercises will prevent contractures from developing. b. The client will feel better if he is able to exercise and stretch his muscles. c. ROM exercises will help alleviate the pain associated with GBS. d. They help to prevent DVTs by movement of the blood through the veins.

ANS: D

The client diagnosed with ALS is prescribed an antiglutamate, riluzole (Rilutek). Which instruction should the nurse discuss with the client? a. Take the medication with food. b. Do not eat green, leafy vegetables. c. Use SPF 30 when going out in the sun. d. Report any febrile illness.

ANS: D The medication can cause blood dyscrasias. Therefore, the client is monitored for liver function, blood count, blood chemistries, and alkaline phophatase. The client should report any febrile illness. This is the first medication developed to treat ALS.