REFERENCES MUST BE WITHIN 5 YEARS!  Case 1 You are working at a skilled nursing facility that cares for patients with ventilators. G.W. is your first patient with Guillain-Barre syndrome. G.W. Is a divorced, self-supporting 56-year-old woman from a small town who developed a URI after caring for her grandson who had the same. Three weeks later she developed weakness, numbness, and tingling in her feet that progressed up her body. Her physician recognized the seriousness of her condition and transferred her to a tertiary referral center. Within days she became totally paralyzed; she was trached and placed on mechanical ventilation. She spent 1 month in the neuro critical care unit and several months on the floor before being transferred to your facility. Her only in hospital complication was pneumonia, which has totally resolved. The physicians don’t know how long the paralysis will last. This patient is now going to be given Adrenergic drugs secondary to failing sympathetic stimulation: 1.     Enumerate signs and symptoms of failing sympathetic simulation to the following organs: a.     Heart b.     Lungs c.      Peripheral vasculature d.     Brain 2.     Based on the organs identified above and if the patient will be given adrenergic drugs, what would the therapeutic effect be (signs and symptoms)> example: if an alpha adrenergic will be given, its effect on the heart will be increase heart rate. 3.     Provide appropriate nursing care for our patient once the drug has been given and what are the possible adverse effects to watch out for? 4.     List three examples of adrenergic drugs and their mechanism of action in the: a.     Alpha receptor b.     Beta receptor 5.     Formulate a comprehensive education for your patient and their family when they are going to be maintained with these medications 6.     If an antiadrenergic will be provided for the above patient, what would be their mechanism of action and the reason they are being given? Case 2 You are working at a skilled nursing facility that cares for patients with ventilators. G.W. is your first patient with Guillain-Barre syndrome. G.W. Is a divorced, self-supporting 56-year-old woman from a small town who developed a URI after caring for her grandson who had the same. Three weeks later she developed weakness, numbness, and tingling in her feet that progressed up her body. Her physician recognized the seriousness of her condition and transferred her to a tertiary referral center. Within days she became totally paralyzed; she was trached and placed on mechanical ventilation. She spent 1 month in the neuro critical care unit and several months on the floor before being transferred to your facility. Her only in hospital complication was pneumonia, which has totally resolved. The physicians don’t know how long the paralysis will last. This patient is now going to be given Cholinergic drugs secondary to failing Parasympathetic stimulation: 1.     Enumerate signs and symptoms of failing Parasympathetic simulation to the following organs: a.     Heart b.     Lungs c.      Peripheral vasculature d.     Brain 2.     Based on the organs identified above and if the patient will be given cholinergic drugs, what would the therapeutic effect be (signs and symptoms)> example: if a cholinergic drug will be given, its effect in the heart will be decrease heart rate. 3.     Provide appropriate nursing care for our patient once the drug has been given and what are the possible adverse effects to watch out for? 4.     List three examples of cholinergic drugs and their mechanism of action in the: a.     Nicotinic receptor b.     Muscarinic receptor 5.     Formulate a comprehensive education for your patient and their family when they are going to be maintained with these medications when they go back to SNF 6.     If an anti-cholinergic will be provided for the above patient, what would be their mechanism of action and the reason they are being given? Case 3 T.S. is a 76-year-old widower being seen in your outpatient clinic for a medication refill for his Parkinson’s disease. He is a retired railroad engineer who derives great pleasure from collecting railroad memorabilia and taking daily walks with his dog around his neighborhood. T.S. was diagnosed with moderate (stage lll) Parkinson’s disease 2 years ago. He does not smoke cigarettes or drink alcohol. His PMH includes a femur fx at age 22, a cholecystectomy at age 47, and a transurethral resection of the prostate (TURP) at age 72. Medical management of the patient with Parkinson’s is usually directed toward control of symptoms with drug therapy, supportive therapy, physiotherapy, and possibly psychotherapy. Pharmacotherapy can be fairly complex in these patients because there are several types of antiparkinsonian drugs with different mechanisms of action. The physician works with the patient to achieve the most effective regimen and often involves trial-and-error periods.   1. Symptoms vary and are highly individualized. List eight symptoms associated with Parkinson’s and explain the pathophysiology of each of them 2. Why can’t we just give oral dopamine as replacement therapy? What medication do we give instead? 3. Levodopa is always given in combination with carbidopa. Why? 4. Other than the combination Carbi-Levo, what other medication can we give our patient to halt the progression of Parkinson (can be a mono therapy or in combination with Carbi-Levo), provide their mechanism of action as well. (At least three medications) 4. What are the medications that can be given to our patient to counteract the signs and symptoms brought about by Parkinson’s disease. 5. Enumerate nursing interventions to decrease the number or severity of side effects of antiparkinsonian medications?