Patient and family education.
(2) Encourage patient to participate in physical therapy and an exercise
program to improve coordination and dexterity.
Emphasize importance of a daily exercise program.
(b) Instruct patient in postural exercises and walking techniques to
offset shuffling gait and tendency to lean forward.
Encourage warm baths and showers to help relax muscles and
(3) Instruct patient to establish a regular bowel routine with a high fiber diet
and plenty of fluids. Constipation is a problem due to muscle weakness, lack of
exercise, and drug effects.
(4) Eat a well-balanced diet. Nutritional problems develop from difficulty
(5) Encourage patient to be an active participant in his/her therapy and in
social and recreational events, as Parkinsonism tends to lead to withdrawal and
(6) Inform patient about American Parkinson's Disease Foundation for
patient education and group support.
2-36. MYASTHENIA GRAVIS
a. Definition. Myasthenia Gravis is an autoimmune disorder affecting the
neuromuscular transmission of impulses in the voluntary muscles of the body. In
normal individuals, transmission of impulses from the nerve to the motor end plate of
the muscle is accomplished by the transmitter substance acetylcholine.
(1) Acetylcholine is released at the nerve ending and moves to the muscle
end plate, causing muscle contraction.
(2) Acetylcholine is then broken down into acetate and choline by the
In myasthenia gravis, one of three physiological abnormalities may exist:
(a) There may be too much cholinesterase present, and acetylcholine
is destroyed too quickly.