Maternal Myasthenia Gravis

Maternal myasthenia gravis: The presence of myasthenia gravis in a pregnant woman.

Myasthenia gravis is an autoimmune neuromuscular disorder characterized by fatigue and exhaustion of muscles. It is caused by a mistaken immune response to the nicotinic acetylcholine receptors (AChR), which are found in junctions between muscles and the nervous system. The body produces antibodies that attack these AChR receptors, preventing signals from reaching the muscles. Proof that the anti-AChR antibodies are responsible for myasthenia comes from the effect these antibodies can have on the unborn and the newborn.

Maternal myasthenia gravis: During pregnancy in a woman with myasthenia, the anti-AChR antibodies can cross the placenta and block the function of the fetal form of AChR leading to fetal paralysis. Fetal and neonatal death is a common consequence. Babies who survive often have arthrogryposis multiplex congenita (nonprogressive congenital contractures) due to lack of fetal muscle movement before birth. Transient signs of MG are seen in 10-15% of babies born to MG mothers. These problems are potentially preventable if the mother is effectively treated during pregnancy.

Treatment: There is currently no cure for myasthenia gravis, but today at least 90 percent of patients with MG survive. A number of treatments are available that help, including steroids and other immunosuppressive medications and cholinergic medications.

Reference: Polizzi A, Huson SM, Vincent A. Teratogen Update: Maternal Myasthenia Gravis as a Cause of Congenital Arthrogryposis. Teratology 62:332-341, 2000.

Questions about risk factors for disease - Chest Pain

Risk factors for heart disease
  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Family history

Risk factors for pulmonary embolus (blood clot to the lung)

  • Prolonged inactivity such as bed rest, long car or airplane trips
  • Recent surgery
  • Fractures
  • Birth control pill use (particularly if the patient smokes cigarettes)
  • Cancer

Risk factors for aortic dissection
  • High blood pressure
  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • Polycystic kidney disease
  • Cocaine use
  • Pregnancy

Questions the doctor may ask about Chest Pain

Questions the doctor may ask about chest pain

  • When did the pain start?

  • What is the quality of the pain?

  • How long does the pain last?

  • Does the pain come and go?

  • What makes the pain better?

  • What makes the pain worse?

  • Does the pain radiate somewhere (move to another area of the body)?

  • Has there been any preceding illness?

  • Has there been any trauma?

  • Have there been similar episodes of pain in the past?

Physical examination helps refine the differential diagnosis for Chest Pain

Physical examination helps refine the differential diagnosis. While chest pain may be the initial complaint, often the whole body needs to be examined. Example components of the physical exam may include:

Vital signs

  • Blood pressure (BP), pulse rate (PR), respiratory rate (RR), temperature, and

  • Oxygen saturation (O2 sat)

Head and neck

  • Looking for neck vein distension or bulging

  • Listening over the carotid arteries for bruits (abnormal sounds) ormurmurs

Chest wall

  • Palpate for rib or muscle tenderness

  • Look for rashes

Lungs

  • Listen for abnormal lung sounds or decreased air entry

Heart

  • Listen for abnormal heart sounds, murmurs or rubs (a friction sound made by two rough surfaces rubbing against each other, which may be seen with inflammation of the heart lining, called pericarditis)

  • Listen for muffled heart tones

Abdomen

  • Palpate for tenderness or masses

  • Listen for bruits over the aorta

Extremities

  • Feel for pulses

Treatment for Malignant Mesothelioma

Treatment for Malignant Mesothelioma

Treatment for malignant mesothelioma has not been found, but the people affected by this disease still prefer to undergo treatment with a mixture of methods or participate in various clinical trials. Various kinds of mesotheliomatreatment techniques regularly performed with surgical procedures, drug therapy, and radiation therapy.

Although this treatment is most often found, you can find other treatment options that are now growing in popularity. Several treatment options, which are gene therapy, immunotherapy, and photodynamic therapy.

The different surgical procedures performed on patients with malignantmesothelioma there are 3 types of palliative surgical procedures, surgicalprocedures diagnostic, curative surgical procedure. Palliative surgery aimed at reducing the symptoms and eliminate all cancer cells. However, this type of operation is not recommended.

The purpose of curative surgery is to remove as much mesothelioma cancer, hoping this type of therapy to fully heal. Curative surgery is usually followed by chemotherapy or radiation therapy.

Diagnostic surgical approach intended to do with finding facts or not the existence of cancer in patients. This procedure is an addition that can help identify where the location of the cancer, if found, the diagnosis of mesothelioma is usually still in the form of non-invasive.

Chemotherapy drug given intravenously with the aim to destroy cancerous tissue.Mesothelioma Cancer cells grow very fast and chemotherapy would be more effective if given promptly.

Radiation therapy is done by comparing drug therapies, which aim to destroy cancerous tissue and limit the spread of cancer cells are much as possible. This is also called "ionizing radiation" and is usually used after surgery. The mechanism works with palliative care are also aimed to relieve pain caused by disease.

Photodynamic therapy is usually used if the cancer is malignant mesothelioma is still small and less effective for metastasis.Therapyi photodynamic cancer therapy requires intravenous drug that cancer cells will be killed due to certain vulnerable.

This gene treatment is still experimental d? N requires a person to be infected by an h? virus that will make a change genetically. The virus gets into the cause of mesothelioma cancer cell protein production. Some time after the virus infects a person who has changed genetically, will be given a chemotherapy drug that does not damage normal cells, but was able to kill cancer cells.

Immunotherapy is given under on the immune system of individuals trying to destroy cancer cells. With the Active Immunotherapy of individuals, malignantmesothelioma cells to be removed which is then used to produce vaccines. The person who injected the vaccine, will have an immune system capable of recognizing "malignant mesothelioma cell vaccine" as a hazardous substance, so that the cancer cell itself is known as hazardous substances.

Autism - Aspergers. What's The Difference?

by: Stephen Borgma

Asperger Syndrome is one of the autism spectrum disorders.

What are autism spectrum disorders? They are also called pervasive developmental disorders in the DSM-IV. These conditions are characterized by challenges/deficits of social interaction and communication.

Autism spectrum disorders begin in infancy or childhood. These conditions are not ‘cured’, as some might think. They are really just a different way of thinking and viewing the world. However, the challenges that arise in communication and social interaction should not be minimized, either.

According to Wikipedia,

ASD, in turn, is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as social deficits.[10] Of the other four ASD forms, autism is the most similar to AS in signs and likely causes but its diagnosis requires impaired communication and allows delay in cognitive development; Rett syndrome and childhood disintegrative disorder share several signs with autism but may have unrelated causes; and pervasive developmental disorder not otherwise specified (PDD-NOS) is diagnosed when the criteria for a more specific disorder are unmet.[11]

The Aspergers Autism Debate

Here is where the debate over the exact classification for Aspergers (AS) begins. The current classification of autism spectrum disorder, according to the researchers who are updating the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (coming out in May 20130, does not entirely reflect the true nature of autism spectrum disorders.

The plan is to eliminate the name of Aspergers Disorder, and put it under the umbrella of Autism Spectrum Disorders. There will be a focus on levels of severity, versus on the exact name of Aspergers.

This is a very controversial move, and researchers and doctors working on the manual still have not decided whether to call it a disorder or a syndrome.

(Personally, I like syndrome a whole lot better. While we don’t want to minimize the challenges that come with the autism spectrum, it’s too easy to miss all of the positive characteristics of the autism spectrum by calling it a disorder instead of a spectrum).

I hope this overview of the similarities and differences between Autism and Asperers was helpful.

Borderline Diabetic or Pre-Diabetic - Here's Your First Line of Defense

by: Curtis Bullock


Before you are diagnosed with Type 2 diabetes, you may be considered as a prediabetic. Prediabetes means that you have higher than normal blood sugar although not yet high enough to be considered as Type 2 diabetes. Being prediabetic simply means you have been given a "wake-up" call: you still can avoid diabetes and other diseases such as heart disease and stroke.

How do you know your are prediabetic?

When you see your doctor he normally orders blood tests such as:

fasting plasma glucose
fasting oral glucose tolerance
HbA1c

1. Fasting Plasma Glucose: Blood is drawn and tested after you've gone without food or drink for at least 8 hours. This test is usually the preferred test for diagnosing whether you have prediabetes or Type 2.

2. Fasting Oral Glucose Tolerance Test or Glucose Challenge: This test may be done right after a fasting test, or it may be done separately. You are given a glucose mixture to drink then wait for 1 or 2 hours when blood is drawn and your sugar level measured.

3. Hemoglobin A1C (HbA1c): This is one of the best tests to measure how your blood sugar is doing because a single blood test measures your blood sugar average over the previous 3 months.

Results of these tests indicates:

HbA1c... Normal 6.5%

Fasting Plasma Glucose... Normal 126mg/dL (7mmol/L)

Oral Glucose Tolerance Test... Normal 140mg/dL (7.8mmol/L)... Prediabetes 140 To 200mg/dL (7.8 to 11.1mmol/L)...Type 2 Diabetes >200mg/dL (11.1mmol/L)

Based on these results, as well as your:

genetics
age
weight
gender, and
other medical problems

your doctor will then make the decision whether you are prediabetic or not. Studies have supported the fact that prediabetics can prevent full-blown Type 2 diabetes by making changes in their lifestyle. These changes include weight control, regular exercise and a healthy diet.

Now, how do you start? Well, you don't have to have a gym membership or buy expensive exercise equipment. On a nice day, walk around the neighborhood... start small though, don't shock yourself. Start with 10 to 15 minutes per day. Remember, stop when you feel dizzy or experience chest pain.

Walking is not the only exercise you can do. Simple things like playing with your kids/grandkids or dancing the night away also count as exercise.

When it comes to your diet, it really is as simple as being aware of what you eat:

at the office cafeteria, there are usually vegetables and fruits served with each meal. Instead of reaching for that chocolate cake for dessert, try some apples or oranges instead
when eating out, branch out from your usual choices and scan the menu for healthier options like chicken or turkey. Try out that new salad too!
if you are cooking your own food, substitute regular oil with cold-pressed extra-virgin olive oil to help control your cholesterol
avoid adding additional salt or sugar to your dishes; instead try some herbs and spices
trim excess and visible fat and skin from your meats, also try grilling and broiling them instead of frying

Time to face the facts: there are a lot of changes to be made to your lifestyle. It's hard to adjust from a sedentary, eat-what-you-want lifestyle to an active, fruit and vegetable filled one. Making drastic changes is one thing; making them last is another. You would greatly benefit from making gradual small changes in your lifestyle rather than one big change.

Impaired Gas Exchange Nursing Diagnosis and Intervention for Pleural Effusion

Impaired Gas Exchange

Circumstances where an individual has decreased course of gas (O2 and CO2) that an actual or risk of lung alveoli and the vascular system.

Pleural Effusion is an accumulation of fluid in the pleural space. Pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatic system. Any condition that interferes with either secretion or drainage of this fluid leads to pleural effusion.


Nursing Diagnosis for Pleural Effusion


Impaired Gas Exchange related to alveolar – capillary membrane changes and respiratory fatigue secondary to Pleural Effusion

Goal :

Patient will verbalize understanding of the interventions given to improve patient’s condition.
Patient will demonstrate improved ventilation and adequate oxygenation of tissues AEB absence of symptoms of respiratory distress.

Nursing Inter­ventions and Rational :

Monitor and record vital signs
R/: To obtain baseline data
Auscultate breath sounds, note areas of decreased/adventitious breath sounds as well as fremitus
R/: To note for etiology precipitating factors that can lead to impaired gas exchange
Monitor respiratory rate, depth and rhythm
R/: To assess for rapid or shallow respiration that occur because of hypoxemia and stress
Provide supplemental oxygen at lowest concentration indicated by laboratory results and client symptoms/ situation
R/: To determine patients oxygenation status

Ineffective Breathing Pattern Nursing Diagnosis and Intervention for NCP Pleural Effusion

Pleural Effusion

Ineffective Breathing Pattern

Definition: The exchange of air inspiration and / or expiration inadequate.

Pleural Effusion is an accumulation of fluid in the pleural space. Pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatic system. Any condition that interferes with either secretion or drainage of this fluid leads to pleural effusion.


Nursing Diagnosis for Nursing Care Plan Pleural Effusion

Ineffective Breathing Pattern related to decreased lung volume capacity

As evidenced by :
  • tachypnea
  • presence of crackles on both lung fields and dyspnea

Goal :
  • patient will demonstrate appropriate coping behaviors and methods to improve breathing pattern.
  • patient would be able to apply techniques that would improve breathing pattern and be free from signs and symptoms of respiratory distress.

Nursing Intervention and Rational :
  • Assess breath sounds, respiratory rate, depth and rhythm
    R/: To note for respiratory abnormalities that may indicate early respiratory compromise and hypoxia

  • Assess breath sounds, respiratory rate, depth and rhythm
    R/: To obtain baseline data

  • Administer supplemental oxygen as ordered
    R/: To maximize oxygen available for cellular uptake

  • Assisst client in the use of relaxation technique
    R/: To provide relief of causative factors

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