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Nursing Department

MAJOR CONCEPT
MAJOR CONCEPT

NEUROLOGIC

DIAGNOSIS DIAGNOSIS
MYASTHENIA GRAVIS

CASE SCENARIO

CASE SCENARIO
The patient is a 35-year-old woman who works as a librarian in a high school. She lives with her husband and dog in
a two-story house in the suburbs near the high school. The patient decided to try an outpatient physiotherapy clinic
for her increasing shoulder pain over the past 3 weeks. She also hopes to get some help with her generalized muscle
weakness and fatigue that is preventing her from completing her daily activities and work.

HX OF
HISTORY PRESENT
OF PRESENT ILLNESS ILLNESS

Student Name: Dela Cruz, Jesfel B. Intensive Practicum Prof. Marilen F. Pacis RM, RN, MAN Prof Basilio L. Bermas Jr. RN, MAN, EdD
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Nursing Department
Patient reported an aching pain in her right shoulder with occasional shooting pain when reaching too high overhead on
bookshelves. She reports having little to no pain at the beginning of the day, but it progressively gets worse and by her
lunch break she is unable to unload a full cart of books. After taking a 30-minute lunch break, her fatigue and pain improves,
and she prefers finishing the rest of her day with computer work. By the end of the day, she notices her vision becomes
slightly blurred and finds it worsens when driving home. Patient reports feeling frustrated with her exhaustion at the end of
the day and is unable to do her normal activities with her husband including cooking and walking the dog because of arm
weakness. Patient reports having a nap when she gets home from work and sleeping well through the night. No red flags
were detected.

FAMILY HISTORY
FAMILY HISTORY

Student Name: Dela Cruz, Jesfel B. Intensive Practicum Prof. Marilen F. Pacis RM, RN, MAN Prof Basilio L. Bermas Jr. RN, MAN, EdD
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Nursing Department

PATHOPHYSIOLOGY
PATHOPHYSIOLOGY & CONCEPT MAP & CONCEPT

**** DISEASE PROCESS AND/ OR HOW IT COMPLICATE THE INVOLVED SYSTEM. (MAY ADD ADDTL BOXES)

MYASTHENIA GRAVIS PATHOPHYSIOLOGY:

Myasthenia gravis is an autoimmune disease of the neuromuscular
junction (NMJ) caused by antibodies that attack components of the
postsynaptic membrane, impair neuromuscular transmission, and lead to
weakness and fatigue of skeletal muscle.
The normal neuromuscular junction releases acetylcholine (ACh) from the motor nerve terminal in discrete packages (quanta). The ACh quanta diffuse
across the synaptic cleft and bind to receptors on the folded muscle end-plate membrane. Stimulation of the motor nerve releases many ACh quanta that
depolarize the muscle end-plate region and then the muscle membrane causing muscle contraction. In acquired myasthenia gravis, the post-synaptic muscle
membrane is distorted and simplified, having lost its normal folded shape. The concentration of ACh receptors on the muscle end-plate membrane is
reduced, and antibodies are attached to the membrane. ACh is released normally, but its effect on the post-synaptic membrane is reduced. The post-
junctional membrane is less sensitive to applied ACh, and the probability that any nerve impulse will cause a muscle action potential is reduced.

RISK FACTORS CLINICAL MANIFESTATIONS DISEASE PROCESS

Men over 60 and women under 40 Weakness of the eye muscles Production of antibodies against components of
the neuromuscular junction maiinly the
acetylcholine receptor
Family history of autoimmune diseases Weakness in the arms, hands, fingers, legs, and
neck

Impaired speech Causing destruction and compromises the

transmission through muscle fibers

Diplopia

Student Name: Dela Cruz, Jesfel B. Intensive Practicum Prof. Marilen F. Pacis RM, RN, MAN Prof Basilio L. Bermas Jr. RN, MAN, EdD
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Nursing Department

NURSING CARE MAP NURSING CARE MA

CASE DIAGNOSIS NURSING DIAGNOSIS
NURSING INTERVENTIONS

Fatigue related to the disease process as

evidenced
- Evaluate the patient’s description of fatigue: severity, by patient’s
changes generalized
in severity over time,
weakness
aggregating factors, or alleviating factors.

NURSING
- Evaluate ASSESSMENT
the patient’s DESIRED
outlook for fatigue relief, eagerness OUTCOMES
to participate in strategies to
reduce fatigue, and level of family and social support.

- Restrict environmental stimuli, especially during planned times for rest and sleep.

- Encourage the patient to maintain a 24-hourShort

fatigue
termorgoal
activity log for at least 1 week.
Subjective data
- Aid the patient with developing a schedule for daily
After activity
8 hours of and rest.intervention,
nursing Emphasize the
importance
-n/a of frequent rest periods. patient will verbalize increased
energy and improved wellbeing.

COMMUNITY
NURSING RESOURCES
ALERTS
Objective data
Long term goal
(+) easy fatigability
After a Watch
week ofoutnursing
for drooping of one or both
intervention,
(+) blurry vision patienteyelids
Refer patient
will be(ptosis),
able toto develop
double
supportvision
groups,
a (diplopia),
health
which
promotion
may begroups,
horizontal
hospital,
or
schedule for daily activity and rest. vertical,
clinics,
and
improvesemergency
or resolveshotlines.
when one eye is
closed.

Student Name: Dela Cruz, Jesfel B. Intensive Practicum Prof. Marilen F. Pacis RM, RN, MAN Prof Basilio L. Bermas Jr. RN, MAN, EdD