1. Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. 2. Ms. Fulton is a 38-year-old mother who was recently diagnosed with myasthenia gravis, a chronic disease of the neuromuscular system. Management of this disease process requires strict adherence to a medication regimen. The disease also affects ADLs for the patient and her family. Additionally, because myasthenia gravis is characterized by exacerbations that may require hospitalizations, Ms. Fulton has had to resign from her position as president of a marketing firm. She has remained as an employee of the same company, but now serves as a consultant with more flexible work hours.

Introduction:

This assignment focuses on two case studies of patients with different neurological conditions. The first case is Mr. Edwards, a 20-year-old male with paraplegia due to a car accident. He is admitted for the treatment of recurring pyelonephritis and surgical treatment of a urinary stricture. The second case is Ms. Fulton, a 38-year-old mother recently diagnosed with myasthenia gravis, a chronic disease that affects the neuromuscular system. This condition requires strict medication adherence and has forced her to make significant lifestyle changes.

Case Study 1: Mr. Edwards

Mr. Edwards, a 20-year-old male, is presented with recurring pyelonephritis and a urinary stricture. His paraplegia is attributed to a car accident that occurred when he was 16, leaving him paralyzed from the waist down. Upon admission to the hospital, Mr. Edwards arrived via ambulance, leaving his wheelchair and wheelchair pressure-relieving cushion at home.

Medical History:

According to the provided information, Mr. Edwards does not have a history of smoking, alcohol consumption, or illegal drug use. However, further details about his medical history, such as any previous hospitalizations or surgeries related to his paraplegia, are not provided. It is important to note that his paraplegia, as a consequence of the automobile accident, may have long-term implications for his overall health and well-being.

Diagnostic Evaluation:

As Mr. Edwards is admitted for the treatment of recurring pyelonephritis and a urinary stricture, further diagnostic evaluations may be required to assess the severity and etiology of these conditions. This may include laboratory tests, such as urinalysis and blood work, as well as imaging studies, such as a renal ultrasound or CT scan. Additionally, a urodynamic study may be necessary to evaluate bladder function and the impact of the urinary stricture on urinary flow.

Treatment Plan:

The treatment plan for Mr. Edwards will likely involve both medical and surgical interventions. Antibiotics will be prescribed to treat the recurring pyelonephritis, targeted at the most likely causative organisms. The surgical treatment of the urinary stricture may involve procedures such as urethral dilation or the placement of a stent to improve urinary flow. However, the specific surgical approach will depend on the severity and location of the stricture.

Nursing Considerations:

Given Mr. Edward’s paraplegia, the nursing team will need to address specific considerations to provide optimal care for him. This includes providing assistance with urinary and bowel management, as well as implementing appropriate pressure ulcer prevention measures. Given that Mr. Edwards did not bring his wheelchair and pressure-relieving cushion to the hospital, steps should be taken to ensure he has access to proper seating and pressure relief during his stay.

Case Study 2: Ms. Fulton

Ms. Fulton, a 38-year-old mother, has recently been diagnosed with myasthenia gravis, a chronic neuromuscular disease. This diagnosis requires her to strictly adhere to a medication regimen and make significant lifestyle changes due to the impact on her ability to perform activities of daily living (ADLs). As a result, Ms. Fulton has resigned from her position as the president of a marketing firm and now works as a consultant with more flexible hours.

Medical History:

Apart from the diagnosis of myasthenia gravis, further details about Ms. Fulton’s medical history are not provided. It would be valuable to know if there are any co-existing medical conditions or if there is a family history of autoimmune diseases, as these factors may have implications for the disease course and management. Additionally, information about any previous exacerbations or hospitalizations related to her condition would be relevant.

Management of Myasthenia Gravis:

The management of myasthenia gravis typically involves a multi-modal approach. The primary focus is on immunosuppressive therapy, aimed at reducing the immune system’s attack on the neuromuscular junction. Medications such as acetylcholinesterase inhibitors and immunosuppressants, such as corticosteroids or other immunomodulatory agents, may be prescribed. Regular follow-up appointments with a neurologist or a specialist in neuromuscular diseases are essential to monitor disease progression and adjust treatment as necessary.

Impact on Daily Living:

Myasthenia gravis can significantly impact an individual’s ability to perform ADLs. Weakness and fatigue in the muscles can make tasks such as dressing, eating, and even speaking challenging. Consequently, modifications to daily routines, adaptive aids, and assistive devices may be necessary to promote independence and maintain a good quality of life. It is recommended that Ms. Fulton consult with an occupational therapist or other healthcare professionals trained in rehabilitating patients with myasthenia gravis to develop strategies and techniques to maximize her functional abilities.

Career and Lifestyle Adjustments:

The nature of myasthenia gravis, characterized by recurrent exacerbations and the need for hospitalizations, has resulted in Ms. Fulton stepping down from her role as the president of a marketing firm. However, she has been able to continue working as a consultant with more flexibility in her schedule. This career adjustment allows her to manage her condition while maintaining employment and financial stability.

Conclusion:

These two case studies highlight the challenges faced by patients with different neurological conditions. Mr. Edwards, with paraplegia, requires medical and surgical interventions to address his recurring pyelonephritis and urinary stricture. Meanwhile, Ms. Fulton, with myasthenia gravis, must strictly adhere to medication regimens and make significant lifestyle changes. By understanding the unique features of these conditions, healthcare professionals can provide comprehensive care to ensure optimal outcomes for these patients.