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Cleansweep RN

Myasthenia Gravis comes from the Greek and Latin words meaning "grave muscular weakness." The most common form of MG is a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups. Myasthenia Gravis occurs in all races, both genders, and at any age. MG is not thought to be directly inherited nor is it contagious. It does occasionally occur in more than one member of the same family.

A. General information

  • Neuromuscular disorder in which there is a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction causing extreme muscle weakness
  • Auto immune disorder whereby antibodies destroy acetylcholine receptor sites on the post synaptic membrane of the neuromuscular junction.

B. Assessment findings

  • Diplopia, dysphagia
  • Extreme muscles weakness
  • Hoarseness and / weakening of voice
  • Mask-like facial expression
  • Ptosis
    a) Tensilon Test
    - IV injection of tensilon provides spontaneous relief of symptoms (lasts 5- 10 mins)
    b) Presence of anti-acetylcholine
    - Receptor antibodies in the serum
    c) Electromyography
    - Amplitude of evolved potentials decreases rapidly

C. Medical Management

  1. Surgery (thymectomy) - Surgical removal of thymus gland (involved in production of acetylcholine receptor antibody)
  2. Drug Therapy
    a) Anticholinesterase drugs : Ambenonium (Mytelase), Neostigmin (Prostigmin), Pyridostigmin (Mestinon)
    - Block action of cholinesterase and increase levels of acetylcholine at the neuromuscular junction.
    b) Corticosteroid drugs: Prednisone
    - Suppress autoimmune response
  3. Plasma exchange
    - Removes circulating acetylcholine receptor antibodies.

D. Nursing Management

  1. Administer Anti-cholinesterase drugs as ordered.
    > Give with milk and crackers to decrease GI upset.
    > Assess muscle strength and vital capacity before and after giving medications.
    > Avoid using morphine containing drugs and other strong sedatives (respiratory depressant effects), Quinidine, Procainimide, Neomycin, Streptomycin and other aminoglycosides (skeletal muscle effects).

  2. Promote optimal Nutrition
    > Give medication 30 minutes before meals.
    > Check gag and swallowing reflexes before feeding
    > Provide mechanical soft diet

  3. Monitor respiratory stats frequently
  4. Provide frequent rest periods
  5. Observe signs of myasthenic or cholinergic crisis.
    a) Myasthenic crisis
    > Severe generalized muscle weakness
    > Inability to swallow/speak or maintain respirations
    > Caused by physical/emotional, stress, infection and under medication

    b) Cholinergic crisis
    > Muscle weakness
    > Excessive salivation and sweating
    > Abdominal cramps
    > Nausea and vomiting
    > Diarrhea
    > Fasciculation
    > Caused of over medication of anti-cholinesterenase drugs

  6. Nursing care during crisis
    > Maintain tracheostomy/endotracheal tube with mechanical ventilation as indicated
    > Monitor ABG and vital capacities
    > Administer medication as ordered
    > Increase doses of anticholinesterenase during myasthenic crisis.
    > Discontinue anticholinesterenase drugs during cholinergic crisis until patient recovered.
    > Provide support and comfort

E. Patient Teachings

  • Use prescribed medications their side effects and signs of toxicity
  • Consult health professionals before taking any new medications
  • Plan activities during peak energy time and schedule frequent rest periods
  • Encourage to avoid fatigue, stress and avoid people with upper respiratory infections
  • Use eye patch for diplopia in alternate eye

Related Downloads:

Facts About Autoimmune Myasthenia Gravis for Patients and Families

Emergency Management of Myasthenia Gravis

Cleansweep RN
As part of commitment to help fellow Filipino Registered Nurses across the nation, Nurses’ Pad would like to inform the nursing community about the upcoming Trainings and Seminars for the month of November 2008.

November 4-5, 2008
Topic: ECG basic interpretation workshop
Venue: Edificio Enriqueta Building, N.S. Amoranto, corner D. Tuazon, Room 3D
Organizer: Critical Care Nurses Association of the Philippines.
Contact: 925 2401 loc. 3823

November 8, 2008
Topic: Cardiac Emergency & Closed System Suctioning
Venue: Edificio Enriqueta Building, N.S. Amoranto, corner D. Tuazon, Room 3D
Organizer: Critical Care Nurses Association of the Philippines.
Contact: 925 2401 loc. 3823

November 11, 2008
Topic: Lecture and Workshop on Building Competencies in Managing Surgical Instruments
Venue: Aesculap Academy, JMT Building, Ortigas Center, Pasig
Organizer: ORNAP and Aesculap Academy
Contact: +632 633-7284

November 14, 2008
Topic: IV Therapy Update: "Prevention of Nosocomial Intravascular Infection Related to IV Therapy"
Venue: Gov. Celestino Gallares Memorial Hospital, Tagbilaran City, Bohol
Organizer: Gov. Celestino Gallares Memorial Hospital
Contact: (038) 411-4831

November 14, 2008
Seminar on "Patient Safety in Surgery: A Nursing Challenge"
Venue: Kanhuraw Convention Hall. Tacloban City, Leyte
Organizer: Operating Room Nurses Association of the Philippines, Inc. Leyte Chapter
Contact: Ms. Ma. Victoria Cagnan at 053-327-1842 or 0919-6979002.

November 15, 2008
Liver Transplantation & Continuous Renal Replacement
Venue: Edificio Enriqueta Building, N.S. Amoranto, corner D. Tuazon, Room 3D
Organizer: Critical Care Nurses Association of the Philippines.
Contact: 925 2401 loc. 3823

November 22, 2008
Topic: Basic life support
Venue: Edificio Enriqueta Building, N.S. Amoranto, corner D. Tuazon, Room 3D
Organizer: Critical Care Nurses Association of the Philippines.
Contact: 925 2401 loc. 3823

** Schedules are subjected to change without prior notice.

For CCNAPI Trainings and Seminars:

For those who are interested to attend the training seminar and don’t hesitate to visit their office at 8th floor, Medical Arts Building , Philippine Heart Center, East Avenue, Quezon City, Philippines Mondays to Fridays 8AM to 5PM. For any questions, you may call the Secretariat Office at (02) 426-4394.Online application forms are available at their website. For online application, log on at CCNAPI’s website www.ccnapi.net.ph . CCNAPI Members are advised to present their Membership ID to avail discounts (strictly No ID No discounts), for Non CCNAPI members present any identification card upon registration. For those who want to become a member of CRITICAL CARE NURSES ASSOCIATION OF THE PHILIPPINES, INC. (CCNAPI). Please bring the following requirements: 1x1 ID Picture, PRC License/ Claim stub and Php 300 for membership fee.

Registration fees mode of Payment:

Pre-Registration: Php 300/topic for Member and Php 350/topic for Non-Member
On-site Registration: Php 400/topic for Member and Php 450/topic for Non-Member

For ECG training workshop:
Pre-Registration: Php 1500 for Member and Php 1700 for Non-Member
On-site Registration: Php 1700 for Member and Php 2000 for Non-Member

For BLS training workshop:
One day training includes:
Lecture on CPR - Pedia and Adult;
Use of AEDDemo on how to perform CPR and
the Use of AEDReturn Demo on Adult CPR and Written Exam

Deadline of Payments:
Pre-Registration: 2 weeks before the workshop
On-site Registration: on the day of registration (2 weeks onwards)


Cleansweep RN

As a nursing junior, a nursing cap (for females),pin (for males) and a lamp was given during the capping and candle lighting ceremony in honor of remembrance of Florence Nightingale, the pioneer of Nursing. The lamp is a symbol of lady who gave birth to modern nursing by her caring, compassionate, and concern for humanity. The lamp is a reminder of the art of caring and compassion a nursing student can make a difference in other’s lives. The lamp carried by Florence Nightingale served as an inspiration when nursing tasks seemed almost too heavy to carry.

Originally, nurses wore the practical white pleated cap and apron of a maid servant, signifying respectability, cleanliness and servitude. As the nursing profession gained recognition, nurses’ cap became less utilitarian and more symbolic, a badge of office and achievement, perched on top of the head.

The nurses’ cap dates back to early times when a woman’s humility and obedience were denoted by the veil she wore and her head. In the older times, the nurses’ cap was worn to cover their hair so as not to create disturbance during her ward work. The attempt to make a cap in every school different has resulted in some unique patterns. A nurses’ cap with her school pin and badge is one of her distinctive marks. Today, However in these times of challenging development, the nurses; cap should mean more than just a physical adornment on the head. The cap symbolizes responsibility. It also means acceptance the humility and the ability to work on any area assigned to him or her. It also symbolizes morality; hence the color white that is a nurse character must be one of the unimpeachable quality that she should be a model, a person to admire and to follow.

Lastly, nurses’ cap symbolizes duty and commitment, commitment not only to her self and to the immediate environs but rather commitment and a total skill; promotion of healthy people to create a healthy nation.

For the Romans, caduceus served as symbol of moral equilibrium and of good conduct. The wand represents the power; the two snakes wisdoms, the wings diligence; and the helmet is emblem of lofty thoughts. According to esoteric Buddhism, the wand of the caduceus corresponds to the access of the world and the serpents refers to the force called Kundalini, which in Jantrist teaching sleeps collide up at the base of the backbone thus a symbol evolutive power of pure energy. The two S – shapes of the serpents corresponds to illness and convalescence. In reality what defines caduceus is nature and meaning not so much of each individual element as of the composite whole.

In the caduceus balanced duality is twice stated: and the serpents and in the wings, there by emphasizing the supreme sates of strength and self control (and consequently of health) which can be achieved both on the lower plain of the instincts (symbolized by the serpents) and on the higher level of the spirit (represented by the wings).

Now is the beginning of life long commitment to learning. Nurses are patient advocate on therefore has an obligation to constantly add to each specialized body of knowledge and skills. Nursing is a professional occupation and professionalism requires a commitment to technical and clinical expertise. Nurses are in a unique position to belonging to a profession that combines science and technology with caring and a desire to improve public health.
Cleansweep RN

IVT Hub Admin Emmanuel Bañez (Noel R.N.) won first place in the essay writing competition during the 2nd PINOY Nurses Expo 2008: A Tribute to the Global Filipino Nurse held at the Megatrade Hall 3 of the SM Megamall in Mandaluyong City yesterday.

Emmanuel Bañez, a registered nurse from Bulacan was adjudged the first place winner in the Rotary International District 3830-sponsored essay writing competition which aims to deepen awareness on reduction of Child Mortality in the country. Bañez’s composition entry entitled “The Transcending Role of the Filipino Nurse” surpassed more than 100 essay entries sent in all over the country. Bañez was awarded with a cheque worth Php 30,000, a plaque of appreciation and gifts from exhibit sponsors. Other winners include Christine Roque (2nd place) and Judy May Lumaban (runner-up). The essay writing competition has provided the opportunity for thousands of Registered Nurses to contribute and to express to the nursing community their genuine thoughts and ideas on the topic, “The Role of Filipino Nurse in Reducing Child Mortality”. This theme was derived from Rotary International District’s current campaign for the community which is Child Mortality Reduction.

The competition was opened for nurse graduates or registered nurses from ages 21 and above nationwide. The winning entries will be published in next SCRUBS Magazine issue, one of the leading Health Care magazines in the country.

The essay writing contest was sponsored by the Rotary International District 3830 with the participation of Rotary Clubs of Alabang North, Las Piñas, Las Piñas North, Las Piñas West, Makati, Makati Bonifacio, Makati Buendia, Makati Central, Makati EDSA, Makati Forbes, Makati Greenbelt, Makati Legaspi, Makati Metro, Makati Nielsen, Makati Pasong Tamo, Makati Urdaneta, Muntinlupa Citycenter, Muntinlupa Filinvest, Muntinlupa North, Palanyag-Parañaque, Parañaque, Parañaque Lakambini, Parañaque Southeast, Rizal SW, Rizal West and Taguig West.

The Transcending Role of the Filipino Nurse
By Emmanuel Bañez

It is 5:15 in the morning; Tina grabs her trusty umbrella, bag and an ice box in what would look like an early morning day at the market. She’s heading off to a two-hour jeepney ride and another one-hour boat ride to the wetlands of Agusan.

As she arrives, Tina is welcomed by the Manobo elders who have already prepared a makeshift tent. The people gather with their half-awake children in tow. Tina opens her bag and arranges her sterile syringes and a bottle of cotton balls with alcohol. The children look in awe as she takes out an ampule from her ice box and prepares the vaccines. Like a soldier working in clockwork, Tina accomplishes the repetitive process of interviewing the mothers, administering vaccines, and documenting on the children’s immunization records. After that, Tina conducts a brief talk on sanitation and hygiene.

These are just some of the activities that Tina and other nurses (mostly, midwives) have been doing in the far-flung barangays of the Philippines. Their tasks may not be as complex as what hospital nurses do but their impact on the prevention of diseases among the children are of tremendous proportions.

In 2003, health survey showed that 40 of every 1,000 Filipino children suffer and die of complications from pneumonia, diarrhea, measles, tuberculosis, malaria and tetanus before they even reach their fifth birthday. These diseases have shattered their dreams forever.

Nurses should go beyond the curative and rehabilitative functions usually done in hospitals and look at the bigger perspective in promoting health for the Filipino children.

Nurses take on varied roles in the community. Aside from being health practitioners, they are teachers and advocates of health programs. The Expanded Program on Immunization which helps reduce child morbidity and mortality through immunization against tuberculosis, diphtheria, pertussis, tetanus, polio, and measles has been the core of the community nursing practice. Another is the Integrated Management of Childhood Illnesses which aims in preventing fatal complications from diarrhea, pneumonia, measles and dengue fever. Moreover, the importance of breastfeeding and prenatal care among mothers; and good nutrition are programs that nurses strive to impart in the community.

Nurses are catalysts to change as good hygiene practices and sanitation behaviors are promoted. Nurses bridges the community and the local government/private sector as improved access to toilets is pushed. With these activities, nurses surely help lower mortality and reduce malnutrition that continues to plague the Filipino children.

As Tina ends her tour of duty and bids goodbye, the children smile at her. She may be unaware of it but she has helped them move a step closer in achieving their dreams. Like Tina, the Filipino nurse is a soldier in the forefront of the war against the illnesses that threaten the dreams of every Filipino child. Working in the community may not be as financially rewarding but making dreams real for the Filipino children is a transcending role that is noble and worth emulating.

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