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Myasthenia Gravis

The document describes a case of Myasthenia Gravis, a neuromuscular disease characterized by weakness and fatigue of voluntary muscles due to a defect in the transmission of nerve impulses at the neuromuscular junction, with signs and symptoms including difficulty swallowing, drooping eyelids, and respiratory impairment; pathophysiology involves decreased acetylcholine activity and treatment includes pyridostigmine to inhibit acetylcholinesterase and dexamethasone to decrease inflammation.

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657 views7 pages

Myasthenia Gravis

The document describes a case of Myasthenia Gravis, a neuromuscular disease characterized by weakness and fatigue of voluntary muscles due to a defect in the transmission of nerve impulses at the neuromuscular junction, with signs and symptoms including difficulty swallowing, drooping eyelids, and respiratory impairment; pathophysiology involves decreased acetylcholine activity and treatment includes pyridostigmine to inhibit acetylcholinesterase and dexamethasone to decrease inflammation.

Uploaded by

エド パジャロン
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Case# 6: Myasthenia Gravis

Myasthenia Gravis -A neuromuscular disease characterized by considerable weakness


and abnormal fatigue of the voluntary muscles
- A defect in the transmission of nerve impulses at the myoneural junction occurs.
- Causes include insufficient secretion of acetylcholine, excessive secretion of
cholinesterase, and unresponsiveness of the muscle fibers to acetylcholine.

Signs and Symptoms:


1. Weakness and fatigue
2. Difficulty chewing and swallowing
3. Dysphagia
4. Ptosis
5. Diplopia
6. Weak, hoarse voice
7. Difficulty breathing
8. Diminished breath sounds
9. Respiratory paralysis and failure
Pathophysiology

Decreased
Acetylcholine

Excessive secretion of Cholinesterase

Excessive Cholinesterase

Ineffective Transmission of nerve impulses

Muscle weakness and fatigue especially in respiratory muscles


Interpretation of Pathophysiology:
Chronic, progressive disorder characterized by decreased acetylcholine activity
in the synapses. This is due to insufficient acetylcholine secretion and excessive
secretion of cholinesterase, the enzyme that inactivates acetylcholine. This causes a
decrease in effective transmission of nerve impulses in the muscles, causing weakness
and fatigue, especially in respiratory muscles

Interpret DX results
AChR- To assist in confirming the diagnosis of myasthenia gravis (MG)
Examination Value Normal Limits Nursing
Responsibilities
Anti-acetylcholine 7.50 Less than 0.5 1. 1. Inform the
receptor antibodies nmol/L patient not to
(AChR) take
anything by
mouth for 8-
12 hours.
Rationale:
for accurate
result of the
test.
2. 2. Advise the
patient not to
take any
medication
prior to the
procedure
unless by
medical
direction.

Nursing Diagnoses:
1. Fatigue related to generalized weakness
2. Impaired Swallowing r/t neuromuscular impairment
3. Impaired physical Mobility r/t defective transmission of nerve impulses at the
neuromuscular junction
4. Imbalanced Nutrition: less than body requirements r/t difficulty eating and
swallowing
Nursing Care Plan:

Assessment Diagnosis Planning Intervention Rationale Evaluation


Impaired Short term: 1. If the client has 1. Feeding a client Short term:
Subjective: Swallowing r/t After 4-6 hours impaired who cannot After 4-6 hours
neuromuscular of nursing swallowing, do not adequately of nursing
“nahihirapan impairment interventions the feed orally until an swallow results interventions
akong lumunok patient will be appropriate in aspiration and the patient was
ng pagkain” as able to swallow diagnostic workup is possibly death be able to
verbalized by clear liquid diet completed. swallow clear
the patient. 2. Monitor client during 2. General liquid diet
oral feedings and aspiration
Objective: provide cueing as precautions Long Term:
PR: 76 Long Term: needed to ensure include: sit at 90 After 1 week of
RR: 17 After 1 week of client follows degrees for all nursing
BP: 124/82 nursing swallowing oral feedings; interventions
mmHg interventions the guidelines/aspiration take small the patient
Temp: 36.8 C patient will precautions bites/sips, slow demonstrated
O2 Sat: 98% demonstrate recommended by rate, no straws. effective
effective speech language swallowing
-Pregnant swallowing pathologist or without signs
-Looks tired without signs of dysphagia of aspiration.
-drooping aspiration. specialist.
eyelids 3. Work with the client 3. Clients who
-limitations in on swallowing received a high-
eye movements exercises intensity
of both eyes prescribed by the swallowing
when looking to dysphagia team. intervention
the right and to versus usual
the left. care or a low-
- AChR – 7.50 intensity
swallowing
intervention
were more likely
to return to a
normal diet and
recover
swallowing

Collaborative: Collaborative:

4. To manage 4. The dysphagia


impaired team can help
swallowing, use a the client learn to
dysphagia team swallow safely
composed of a and maintain a
rehabilitation nurse, good nutritional
speech pathologist, status
dietitian, physician,
and radiologist.

Dependent: Dependent:
5. Administer 5. Pyridostigmine is
Pyridostigmine as per a muscle
doctor’s order stimulant that
improve
dysphagia.
Drug Study

Generic Name Pyridostigmine


Trade/Brand name Mestinon
Dose/Route/Frequency 34mcg/Inhalation/PRN
Drug Classification Muscle stimulants
Mechanism of Action Inhibits acetylcholinesterase, blocking destruction of acetylcholine from
the parasympathetic and somatic efferent of nerves
Indication Pyridostigmine is used to treat the symptoms of myasthenia gravis. It is
also used in military personnel who have been exposed to nerve gas.

Contraindication You should not use pyridostigmine if you are allergic to it, or if you have
a bladder or bowel obstruction.
Side/Adverse effects Stop using pyridostigmine and call your doctor at once if you have any of
these serious side effects: extreme muscle weakness; loss of movement
in any part of body; weak or shallow breathing; slurred speech, vision
problems;
Nursing 1. Stop all other cholinergic before giving this drug
responsibilities 2. Monitor and document patient’s response after each dose.
Optimum dosage is difficult to judge
Generic Name Dexamethasone
Trade/Brand Name Decadron, Dexasone, Diodex, Hexadrol, Maxidex
Dosage/Route Frequency 0.7 mg-9 mg/day “oral”
Drug Classification classified as a corticosteroid (more precisely a glucocorticosteroid), and
has many uses in the treatment of cancer. One way that it works is to
decrease inflammation (swelling).
Mechanism Of Action . Anti-inflammatory effects are complex, but primarily via inhibition of
inflammatory cells and suppression of expression of inflammatory
mediators.
Indication to treat conditions such as arthritis, blood/hormone/immune system
disorders, allergic reactions, certain skin and eye conditions,
breathing problems, certain bowel disorders, and certain cancers. It
is also used as a test for an adrenal gland disorder (Cushing's
syndrome).
Contraindication peptic ulcers, osteoporosis, psychoses, infectious diseases (e.g.
herpes simplex, keratitis), diabetes and hypertension.
Side/Adverse Effect Stomach upset, headache, dizziness, menstrual changes, trouble
sleeping, increased appetite, or weight gain may occur. If any of
these effects persist or worsen, notify your doctor
or pharmacist promptly.
Nursing Responsibility  Do not use medication more than prescribed by the Doctors
 Report worsening condition pain, itching swelling
 Observe for signs adverse reaction
 Monitor blood pressure 2-3 times daily
 Before taking Dexamethasone, ask patient he or she allergic
to corticosteroid
DISCHARGE PLAN

 Medications:
corticosteroids dexamethasone, and pyridostigmine. Anticholinesterase medication helps improve energy and strength take your
medicine as directed.
 Exercise:
avoid strenuous exercise. Short walks spread out through the day will keep you fit without exhausting yourself.
 Diet:
Eat a healthy, balance diet
Eat moisten solid foods with gravy, sauce, broth, butter, mayonnaise, sour cream or yogurt. Choose chicken or fish instead of tougher
meats.
Foods rich in potassium include orange juice, bananas, potatoes, avocados and apricots.
 Health teaching:
Make regular follow up appointment with your health care provider.
Stay away from people who have colds or flu.
If you get double vision, talk to your doctor about wearing an eye patch.
Remove rugs and loose carpeting from the floor to help prevent falls.
Don’t drink alcohol. Alcohol can increase weakness.
Do one thing at a time.
Wash your hands often, keep them away to your face most germs are spread by hand-to-mouth contact.
Get plenty of rest. Plan your activities so that you have rest periods. It is better to go at a moderate pace with frequent rests than to
be so active that you tire out easily.

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