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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

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