Amiddle-aged client is being treated for myasthenia gravis with neostigmine. what change in the client’s health status would warrant immediate medical follow-up?
a)significant changes in mood and affectb)sudden muscle weaknessc)jaundiced)migraine-type symptoms

B. sudden muscle weakness

Explanation:

  Myasthenia gravis is an autoimmune disease in which communication between the nerves and muscles is affected, producing episodes of muscle weakness.

   The cholinergic properties of neostigmine are based on its inhibitory effect on  cholinesterase, which stabilizes acetylcholine, whose action is  enhanced and prolonged. At the system level  digestive and genitourinary, as well as other smooth muscle organs, neostigmine  causes contractions and increased peristalsis. Neostigmine  neutralizes blockage  neuromuscular disorders induced by curare myorelaxants and preparations of the same type (i.e., non-depolarizing) but   synergistically interacts with depolarizing myorelaxants.

  As with other cholinergics, overdosage with neostigmine may cause  cholinergic crisis characterized by marked muscle weakness (or increase of this symptom in myasthenics). If the condition is not identified, there is a risk of death due to respiratory muscle paralysis. Bradycardia, or  paradoxically, tachycardia may also occur.

exercising at a moderate intensity, and slowly increasing the duration.

    however, coronary heart disease , or chd, is actually a result of coronary artery disease, or cad, said edward a. fisher, m.d., ph.d., m.p.h., an american heart association volunteer who is the leon h. charney professor of cardiovascular medicine and also of the marc and ruti bell vascular biology and disease program at the nyu school of medicine.

  with coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. view an illustration of coronary arteries. this is also called ischemia. it may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot.

    the traditional risk factors for coronary artery disease are high ldl cholesterol, low hdl cholesterol, high blood pressure, family history, diabetes, smoking, being post-menopausal for women and being older than 45 for men, according to fisher. obesity may also be a risk factor.

    “coronary artery disease begins in childhood, so that by the teenage years, there is evidence that plaques that will stay with us for life are formed in most people,” said fisher, who is former editor of the american heart association journal, atvb. “preventive measures instituted early are thought to have greater lifetime benefits. healthy lifestyles will delay the progression of cad, and there is hope that cad can be regressed before it causes chd.”

  living a healthy lifestyle that incorporates good nutrition, weight management and getting plenty of physical activity can play a big role in avoiding cad.

    “coronary artery disease is preventable,” agreed johnny lee, m.d., president of new york heart associates, and an american heart association volunteer. “typical warning signs are chest pain, shortness of breath, palpitations and even fatigue.” if you feel any of these symptoms, don’t delay — call 9-1-1.