J.B. is a 58-year-old retired postal worker who has been on your floor for several days receiving plasmapheresis every other day for myasthenia gravis (MG). About a year ago, J.B. started experiencing difficulty chewing and swallowing, diplopia, and slurring of speech, at which time he was placed on pyridostigmine (Mestinon). Before this admission he had been relatively stable. His medical history includes hypertension controlled with metoprolol (Lopressor) and glaucoma treated with timolol (ophthalmic preparation). Recently J.B. was diagnosed with a sinus infection and treated with ciprofloxacin (Cipro). On admission, J.B. was unable to bear any weight or take fluids through a straw. There have been periods of exacerbation and remission since admission. Current Vital Signs: Blood pressure 170/68 mm Hg Heart rate 118 beats/min Respiratory rate 32 breaths/min Temperature 101.8° F (38.8° C) Based on these vital signs, what is your immediate concern? Provide details on important assessment points for this patient. What other manifestations are associated with this disorder? Explain five priority nursing interventions (actions, not teaching) appropriate for J.B. List five teaching points you will provide to J.B. Explain the difference between a cholinergic crisis and myasthenic crisis, including the treatment for each crisis.

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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J.B. is a 58-year-old retired postal worker who has been on your floor for several days receiving plasmapheresis every other day for myasthenia gravis (MG). About a year ago, J.B. started experiencing difficulty chewing and swallowing, diplopia, and slurring of speech, at which time he was placed on pyridostigmine (Mestinon). Before this admission he had been relatively stable. His medical history includes hypertension controlled with metoprolol (Lopressor) and glaucoma treated with timolol (ophthalmic preparation). Recently J.B. was diagnosed with a sinus infection and treated with ciprofloxacin (Cipro). On admission, J.B. was unable to bear any weight or take fluids through a straw. There have been periods of exacerbation and remission since admission. Current Vital Signs: Blood pressure 170/68 mm Hg Heart rate 118 beats/min Respiratory rate 32 breaths/min Temperature 101.8° F (38.8° C) Based on these vital signs, what is your immediate concern? Provide details on important assessment points for this patient. What other manifestations are associated with this disorder? Explain five priority nursing interventions (actions, not teaching) appropriate for J.B. List five teaching points you will provide to J.B. Explain the difference between a cholinergic crisis and myasthenic crisis, including the treatment for each crisis.

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