List, prioritize, discuss care for patients with either GB or MG to prevention complications and avoid pain.
 Create a quick concept map
Communication:
 Collaborate with speech-language
pathologist
 Instruct pt. to speak slowly and attempt to
lip read.
 Repeat what pt. says to check
 Other forms of communication can be used:
gestures, eye blinking, writing in notebook,
mobile devices, word, or picture boards.
Respiratory support
• Encourage pt. to breathe deeply and
cough. Teach assisted cough technique
• Get pharyngeal or nasopharyngeal
suctioning, oxygen equipment ready at
bedside.
• Collaborate with RT in providing chest
physiotherapy
• Be aware of pt. emotional response during
respiratory distress
• Monitor pt. drug response and pulmonary
congestion.
Drug therapy:
 Pt usually prescribed two types of drugs
anticholinesterase and
immunosuppressants.
 Give meds on time to maintain blood levels
 Immunosuppressants
• Usually used with corticosteroids or
rituximab
• IV immunoglobulins (IVGs) – used for
acute mngt. or for long term use
 Cholinesterase inhibitor drugs
(pyridostigmine)
• First line mngt. of MG.
• Expect day to day variation of dosage
depending on S/S
Nutrition:
• Collaborate with dietician, OT and SLP to
plan meals
• Assess pt. gag reflex and
chewing/swallowing ability
• Cut food into small pieces. Encourage pt.
to eat slow
• Monitor for choking, aspiration, or nasal
regurgitation
• Give high calorie snacks or supplements
• Keep HOB elevated during meals and after
meals.
• Thickened liquids should be considered to
avoid choking.
• Weigh pt. daily
• Monitor caloric intake, and serum
Preventing Complication/avoid pain prealbumin levels.
for MG patients: • Admin. Anticholinesterase 45-60 mins
before meals.
• Assess and maintain respiratory gas
exchange due to risk of respiratory
compromise, dysphagia, lung
infections.
• Promote mobility
• Administer drug therapy
• Plasmapheresis Plasmapheresis
• Assess pt. ADL’s – pt. may have self-
care deficits caused by generalized Removal of antibodies from plasma to reduce
weakness, fatigue. symptoms
• Determine pt. ability to communicate –
speech and facial muscle weakness  Used as short-term mngt. for
results in slurred and nasal speech exacerbation
• Improve nutrition – pt. with MG have  Pt. usually receives 3-4 treatments, 1-2
weakened muscles for chewing or days apart
swallowing.
Mobility:
• Assess pt. muscle strength. Aid if necessary
• Schedule tx, test, and activities early in the
day or during energy peaks.
• Plan rest periods with pt.
• Maintain skin integrity with repositioning,
and usage of pressure reducing devices.
• Collaborate with PT and OT
Real life scenario

I only encountered one patient with myasthenia gravis. The patient has difficulty swallowing and chewing so she was on aspiration precaution and I had
to help her eat. Most of her diet consist of soft and pureed foods with finely chopped veggies and meat. She was also weak and very unsteady, so she needed a
lot of assistance and was on fall risk. It does not help that she was having double vision as well. In addition, there was a noticeable droop on her eyelids and
mouth.