Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic Therapy

Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyNeurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyA 23-year-old woman presents with complaints of muscle weakness in the face.DISCUSSIO QUESTION 1Review the following case study:Chief Complaint:A 23-year-old woman presents with complaints of muscle weakness in the face.History:The patient is a 23-year-old administrative assistant who complains of intermittent muscle weakness in her face that has been getting worse over the past 3 months. She also states that as she chews, her jaws feel tired. Swallowing has also become difficult. She reports episodes of double vision (diplopia), which seems to occur after reading for a few minutes in the late evening. With certain strenuous activities or after typing for long periods of time at work, she reports problems with bilateral arm weakness.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyPhysical Examination:Notable ptosis (drooping) of the eyelids after repeated blinking exercises. When asked to smile, she appears to be snarling. Reflexes and sensation are normal in both upper and lower extremities. There is considerable weakness of the arms noted bilaterally after exercise.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyORDER A PLAGIARISM-FREE PAPER HERECase Questions:Is the patient’s condition neurological, musculoskeletal, or both? Explain why and support your thoughts with evidence-based literature. What would be a possible neurologic or musculoskeletal condition causing the symptoms?Explain the pathophysiology behind the condition.What pharmacological agent(s) are commonly used to treat the disorder and how do the agent(s) alter the pathophysiology of the condition?What would be your educational plan for the patient? Include References and additional referenceLehne, R. A. (2015). Pharmacology for nursing care (9th ed.). St. Louis: Saunders/Elsevier. ISBN-13: 9780323321907McCance, K. L., Huether, S. E., Brashers, V.L., and Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis: Mosby Elsevier. ISBN-13: 9780323088541Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyDISCUSSION QUESTION 2Parkinson’s disease is a progressive neurodegenerative disorder. The current treatment options for the disorder have focused on symptom control. Research is now focusing on developing ways to modify the disease progression and possibly provide a cure. Investigate the current research on Parkinson’s disease treatments, including stem-cell research and the use of fetal tissue implants. Share your thoughts on the evolving therapies. What are the current controversies?Include References and additional referenceLehne, R. A. (2015). Pharmacology for nursing care (9th ed.). St. Louis: Saunders/Elsevier. ISBN-13: 9780323321907McCance, K. L., Huether, S. E., Brashers, V.L., and Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis: Mosby Elsevier. ISBN-13: 9780323088541Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyNeurological & Musculoskeletal SystemDiscussion Question 1According to the patient presentations highlighted in the case, the condition is both neurological and muscular in nature otherwise known as neuromuscular. In specific terms, the patient suffers from Myasthenia gravis, which according to Rashid et al. (2018), is a long-term disease condition that variedly presents muscle weakness that forms the principal complaint of the case study’s patient. Lil et al. (2017) postulates that the condition is both neurological and musculoskeletal and its main symptoms include muscle weaknesses, tired jaws, swallowing difficulties, double visions, bilateral arm weaknesses, and dropping of eyelids. These symptoms occur as a consequence of the blockage or destruction of nicotinic acetylcholine receptors by antibodies between the muscle and nerve junction. The fact that the body’s immune system attacks the muscles leads to the existence of the muscle weakness, which has been indicated as the patient’s chief complaint. However, the weakness is occasioned by the impact of neurological blockage as stated. Therefore, the prognosis of the condition is that it is long-term; also, it is both musculoskeletal and neurological.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyThe pathophysiology behind Myasthenia gravis is clearly illustrated in numerous literatures. In a normal person, acetylcholine is released from the neuromuscular junction’s motor nerve terminals in quanta. The released ACh then diffuses through the synaptic cleft and consequently bind to its receptors on the folded muscle membrane. This stimulates the motor nerves which release numerous discrete packages of ACh, which depolarize the muscle membrane through the end-plate region leading to muscle contraction (McCance et al., 2013). However, during the development of the condition, the post-synaptic muscle membrane becomes simplified and distorted due to the fact that it has lost its normal folded shape. This reduces the Ach-receptors concentration at the end-plate membrane of the muscle, paving way for attachment of antibodies. After the attachment, the ACh will undergo normal release processes but with reduced impact on the post-synaptic membrane. Consequently, the post-junctional membrane becomes less sensitive to the acetylcholine and the likelihood that nerve impulse will result in a muscle action potential reduces.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyMyasthenia gravis is primarily treated with cholinesterase inhibitors. These drugs interfere with the enzymatic hydrolysis of acetylcholine at the cholinergic synapses, which leads to prolonged action of the inhibitors due to accumulation of ACh at the membrane junction (Lehne, 2015). Further, patients suffering from Myasthenia gravis are given immunosuppressant drugs. As mentioned, the condition is autoimmune and itis precipitated by excessive production of T-lymphocytes and B-lymphocyte cells. The immunosuppressant drugs such as cyclosporine and mycophenolatemofetil (MMF) selectively bind to the receptors of those cells thereby reducing their productions.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyHowever, in addition to therapy, Myasthenia gravis patients need a complementary educational plan. In my educational plan, I would teach the patient benefits of taking enough rest and eliminating fatigue in their life. The patient will be allowed enough time to perform tasks. Family members and their significant other will be incorporated into the plan while I will make observations to make certain that the patient can undertake activities minus supervision. By allowing enough time, the patient’s energy will be preserved while their activity tolerance will be improved.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyDiscussion Question 2Research into treatment options for Parkinson’s diseases has made remarkable progress. These options, which include stem-cell research and fetal tissue implants, continue to evolve but there is consensus that they offer real promise in efforts to find cure for the condition. Importantly, the condition afflicts the brain and that is where the aforementioned research efforts have focused. In the continuing stem cell research, scientists are looking to leverage the capacity of stem cells to produce tissues. According to their prognosis, there is hope that they will ultimately find a way of turning the stem cells into specific kind of cells such as dopamine-producing neurons that can be utilized in the treatment of the disease condition. However, the stem cell treatment therapy has been mired in controversy ever since it was mooted. A section of scientists believe that it may produce risks involving involuntary movements (Lehne, 2015). In addition, ethical and moral questions regarding the procedure have been raised and continue to dominate debates regarding this therapy.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic TherapyMoreover, scientists are currently exploring the usage of fetal tissue implants with regard to the management of Parkinson’s condition. In this procedure, the possibility of implanting fetal cells into Parkinson patient’s brains so as to replace the cells that produce dopamine in the substantianigra is currently being explored and tested.Inasmuch as it promises some substantial results, the therapy is amongst the most controversial in the word. Like the stem cell therapy, studies have demonstrated that it produces too much dopamine within the brain, which in turn leads to involuntary movements also referred to as dyskinesia. However, the study has failed to circumvent the ethical and moral controversies that have followed the stem cell therapy. Therefore, whereas the two therapies offer promise in scientists’’ pursuit of Parkinson’s treatment alternatives, they still invite moral and ethical controversies that should be addressed.Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic Therapy  ReferencesLehne, R. A. (2015). Pharmacology for nursing care (9th ed.). St. Louis: Saunders/Elsevier. ISBN-13: 9780323321907Lili, W., Yun, Z., Maolin, H., Wang, L., Zhang, Y., & He, M. (2017).Clinical predictors for the prognosis of myasthenia gravis.BMC Neurology, 171-6.doi:10.1186/s12883-017-0857-7McCance, K. L., Huether, S. E., Brashers, V.L., and Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis: Mosby Elsevier. ISBN-13: 9780323088541Rashid, M., Babar, A., Khan, M. S., &Hussain, S. (2018). Myasthenia Gravis a Case Report and a Review of Literature.Isra Medical Journal, 10(1), 53-55. Neurological and Musculoskeletal System: Selected Pathophysiology and Pharmacologic Therapy