Discharge And Home Healthcare Guidelines

Instruct the patient and family on the importance of rest and avoiding fatigue. Be alert to factors that can cause exacerbations, such as infection (an annual flu shot is suggested), surgery, pregnancy, exposure to extreme temperatures, and tonic and alcoholic drinks. Instruct the patient and family about drug actions and side effects, the indications for dosage alteration, and the selective use of atropine for any overdose. Stress the importance of taking the medication in a timely manner. It is advisable to time the dose 1 hour before meals for best chewing and swallowing. Explain the potential drug interactions (especially aminoglycosides and neuromuscular blocking

650 Myocardial Infarction agents, which include many pesticides). Encourage the patient to inform the dentist, ophthalmologist, and pharmacist of the myasthenic condition.

Instruct patients about the symptoms that require emergency treatment, and encourage them to locate a neurologist familiar with MG management for any follow-up needs. Suggest that they collect a packet of literature to take to the emergency department in case the available physician is unfamiliar with this disease. (The Physician's Handbook is available on request from the MG Foundation.)

Instruct patients to wear MG identification jewelry. Suggest having an "emergency code" to alert family if they are too weak to speak (such as ringing the phone twice and hanging up). Instruct the family about cardiopulmonary resuscitation techniques, how to perform the Heimlich maneuver, how to contact the rescue squad, and how to explain the route to the hospital. Make a referral to a vocational rehabilitation center if guidance for modifying the home or work environment, such as a raised seat and handrail for the toilet, would be beneficial.

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