Jenea admits a 24-year-old man with mania disease to an inpatient unit. She notes that the patient is irritable, has trouble sitting during the interview, and has a history of assault.

a. Identify appropriate responses the nurse can make to the patient. What interventions should be built into the care plan?

b. Identify and explain at least three long-term outcomes to consider when planning care.

This pedigree depicts the inheritance of the mitochondrial disease Leber hereditary optic neuropathy (LHON). Individual I-1 does not show any symptoms of$$\mathrm{LHON}$$, whereas her daughter and all three of her grandchildren are affected. Provide two explanations for this

Wilson’s disease leads to liver damage as well as joint inflammation, kidney failure, uncontrolled shaking, and psyhiatric disturbances in humans. These symptoms all result from an accumulation of copper in the body because of one of several point mutations in the coding region of a single type of membrane transporter protein that normally exports copper from liver cells. The Wilson’s disease gene (ATP7B) has been mapped to chromosome 13 (13q14.3) and is expressed primarily in the liver, kidney and placenta (membrane transporter protein that normally exports copper). 1 in 30,000 people worldwide are afflicted with Wilson’s disease. There are approximately 300 known alleles for Wilson’s disease. A newly discovered mutation H6532F causes a loss of function mutation and heterozygote individuals ARE NOT able to achieve adequate levels of functional protein.
1.What can you conclude about the Wilson disease H6532F allele? How many people worldwide has the ATP7B gene?

2.What is the maximum of number of alleles of the ATP7B gene can a human carry at a given locus?

Patient Profile

S.D., a 58-year-old African American male, was diagnosed with myasthenia gravis several years ago. He has been taking pyridostigmine and prednisone since then and has had few symptoms. Today, while visiting his daughter, he had a choking episode followed by the onset of severe weakness in his arms and legs along with respiratory distress. She drove him immediately to the emergency department.

Subjective Data

• Reports difficulty “getting enough air”
• Says food “got stuck in my throat”
• Having difficulty speaking clearly

Physical Examination

• Blood pressure 172/90, pulse 102, respirations 24 and shallow, temperature 99.9° F
• Oxygen saturation 91% on room air
• Symmetric muscle weakness involving all four limbs and jaw muscles
• One episode of bladder incontinence since arrival
• Tense and anxious
• Diaphoretic

Discussion Questions

1. Explain what is the pathophysiology of myasthenia gravis (MG) and what complication of myasthenia gravis is S.D. experiencing?
2. His daughter asks what may have caused her father to get worse. What would you tell her?

Maria has just met with Francesco, who has lived with a serious mental illness for most of his adult life. Francesco has lived with his parents for many years, but they are becoming elderly and frail and are having difficulty meeting Francesco’s needs.

Francesco’s sister Guiliana has been a long-time member of his care network and has suggested that Francesco move in with her and her husband, Bruce.

The other option is for Francesco to live independently. His parents have met many of his needs for decades and he is quite dependent upon them.

Francesco leans heavily on his sister for emotional and practical support and wants to move in with her. Bruce is less than happy about the idea.

Bruce has seen the way that his parents-in-law had their life dominated by their caring duties and already worries about the burden on Guiliana, particularly as Francesco ages.

Question: When facilitating support training or services to Francesco’s family, what are three factors that Maria should keep in mind?