WESLEYAN UNIVERSITY-PHILIPPINES

Mabini Extension, Cabanatuan City 3100 Nueva Ecija

COLLEGE OF NURSING
A.Y. 2022-2023

MYASTHENIA GRAVIS: A CASE PRESENTATION

A Case Presented to College of Nursing of Wesleyan University-Philippines

Submitted By: BSN 2-3 (GROUP 2)

In Partial Fulfillment of the Requirements for the NCM 104 (LEC) Community Health Nursing
Lecture

By:
Cuadra, Mica DR.
Cudal, Yvette Nicole
Daclag, Jasmin D.
Del Mundo, Angel Alexa
Diaz, Jianna Cailee D.
Dionisio, Ivan B.
Encarnacion, Gail
Engaran, Trisha Joyce
Estabillo, Geumi P.
Ferry, John Kenley Db.
BSN 2-3

December 5, 2022
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

TABLE OF CONTENTS

TITLE PAGE.................................................................................................................................

TABLE OF CONTENTS................................................................................................................

CASE OVERVIEW………………………………………….............................................................

PROBLEM CUES AND FAMILY NURSING DIAGNOSIS............................................................

DEFINITION………………………………......................................................................................

SYNONYMS………………............................................................................................................

CAUSATIVE AGENT…………………………………………………................................................

RISK FACTORS (MODIFIABLE).................................................................................................

RISK FACTORS (NON-MODIFIABLE) ......................................................................................

CLINICAL MANIFESTATIONS…................................................................................................

DIAGNOSTIC TESTS………….............................................................................................

PHATOPHYSIOLOGY………………..........................................................................................

OBJECTIVE OF MANAGEMENT……...................................................................................

MEDICATION MANAGEMENT.............................................................................................

SURGICAL MANAGEMENT......................................................................................................

COMPLICATIONS..................................................................................................................

SIGNS THAT THE ILLNESS IS UNDER CONTROL ACCORDING TO PATIENT.....................

PREVENTION.............................................................................................................................

DOH PROGRAM........................................................................................................................

REFERENCES.....................................................................................................................
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

INTRODUCTION TO THE CASE

CASE: This is a case of Family D. They are composed of 3 children with both parents
alive. Based on the conducted interview with the family, a member is diagnosed with an
illness referred to as Myasthenia Gravis. The 3 children have 3 to 4 years of age gaps,
the youngest child being 4 years old and the eldest being 10 years old.
PROBLEM IDENTIFIED: Family Member Diagnosed with Illness, Myasthenia Gravis as
a Health Deficit.
DATE IDENTIFIED: October 8, 2022
DATE EVALUATED: October 8, 2022

DEFINITION
A chronic autoimmune, neuromuscular disease that causes weakness in the skeletal
muscles that worsens after periods of activity and improves after periods of rest.
It affects breathing and moving parts of the body, including the arms and legs.
It is Latin and Greek in origin, meaning “grave, or serious, muscle weakness.”

SYNONYMS

 Autoimmune Disorder
 Neurological Disorder
 Disease of the neuromuscular junction

CAUSATIVE AGENT

 Caused by immunoglobulin (Ig)G1 and IgG3 antibodies to the

acetylcholine receptor (AChR).
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

RISK FACTORS (MODIFIEBLE)

 Emotional Stress and Excitement

 Some medications
 Fatigue
 Pregnancy and Delivery
 Menstrual Periods

RISK FACTORS (NON-MODIFIEBLE)

 Autoimmune reaction
 Age of 20-30y/o (FEMALE)
 Age of 60-70y/o (MALE)
 Abnormalities of the thymus gland
 Genes – having specific genetic markers called HLA-B8 or DR3
 Neonates with mothers who have abnormal antibodies – entered the baby’s body
via the placenta during pregnancy.

CLINICAL MANIFESTATIONS

MANIFESTATIONS TO LOOK OUT FOR

 weakness of the eye muscles (called ocular myasthenia)

 drooping of one or both eyelids (ptosis)
 blurred or double vision (diplopia)
 a change in facial expression
 difficulty swallowing
 shortness of breath
 impaired speech (dysarthria)
 weakness in the arms, hands, fingers, legs, and neck.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

MANIFESTATIONS THAT THE PATIENT EXPERIENCED

 ang pogi ni kenley

 oo

DIAGNOSTIC TEST

Neurological Exam

- This may include testing your reflexes, muscle strength, muscle tone, senses of
touch and sight, gait, posture, coordination, balance and mental skills. Impaired
eye movement or muscle weakness may prompt a doctor to evaluate further.

Blood Tests

- The main test for myasthenia gravis is a blood test to look for a type of antibody
(produced by the immune system) that stops signals from being sent between
the nerves and muscles. A test like the Anti-acetylcholine receptor antibody is a
great example.

Ice Test

- If you have a droopy eyelid, your doctor might place a bag filled with ice on your
eyelid. After two minutes, your doctor removes the bag and analyzes your droopy
eyelid for signs of improvement.

Edrophonium Test

- A short-acting drug called edrophonium chloride (Tensilon®) is given

intravenously. If weakness, especially in the eye muscles, briefly and temporarily
improves, it indicates you may have MG.

Nerve conduction studies

- A small electrical impulse is applied to a nerve resulting in muscle contraction.

Muscles in patients with MG fatigue easily and don’t bounce back from repeated
stimulation as well as those of a healthy person.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

Electromyography (EMG)

- A sterile needle electrode is inserted into a muscle that the patient gently
contracts or activates. Computer analysis of several recorded electrical signals in
that muscle may show abnormal neuromuscular transmission.

Imaging

- Computed tomography (CT) or magnetic resonance imaging (MRI) is often done

to identify an abnormal thymus gland or a thymus gland tumor (thymoma).

The patient was diagnosed through

- Wwww

PATHOPHYSIOLOGY

First Part of the diagram

 The autoimmune attack occurs when autoantibodies form against the nicotinic
acetylcholine receptors at the neuromuscular junction of skeletal muscles. The
antibodies are produced by the T cells from the thymus gland which primarily
attacks the receptors. When we say neuromuscular junction, our nerves and
muscle fibers meet, which is an essential synapse for muscle contraction and
movement. Synapse is the point where information is passed from 1 neuron to
another.
o ACTH is produced during presynaptic and nACHr is produced during
postsynaptic
o Normally, the ACTH binds with nACHr to produce muscle contraction, but
patients with Myasthenia gravis have abnormalities in terms of how they
bind or transmit certain signals. Here comes
 The impaired transmission takes place because the antibodies block, alter, or
destroy the receptors that ACTH was supposed to bind within the neuromuscular
junction.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

 Fewer receptors occur because of how the antibodies block the supposedly
binding of acetylcholine and the nicotinic receptors.
 If not enough ACTH and nACHr bind, it will not be enough to support muscle
contraction and will therefore lead to muscle weakness which is a number one
symptom and impact of Myasthenia gravis.

Further explanation of the impaired transmission

 Acetylcholine is released by the cholinergic fibers, in fact, are neurons.

 Immediately after ACTH is released, it will travel down or diffuse across the
synapse
 Since the antibodies already blocked or destroyed the nicotinic receptors, 
 Depolarization and muscle contraction don't occur and neuromuscular
transmission is a block
o What is the involvement of depolarization in this situation?
 Because the activation or the presence of the nAChR leads to the
flow of cations (sodium and calcium) that causes depolarization of
the muscle cell membrane. In turn, depolarization results in muscle
contractions.
 Neuromuscular blocking or disturbance results in muscle weakness/paralysis.

OBJECTIVE OF MANAGEMENT

1. Increase general muscle function

a. Moderate physical activity
b. The type and intensity of systematic training are adapted by the patient.

2. Intake of any of these medications to relieve signs and symptoms

a. Cholinesterase inhibitors
b. Corticosteroids
c. Immunosuppressants

3. Minimize the neuromuscular disease

a. Thymectomy (surgical)
b. Intravenous therapy
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

4. Dietary considerations

a. Eats during periods when patients have more strength.

- 5-6 smaller meals throughout the whole day rather than 3 larger meals.

b. A low-sodium, high-potassium diet may be advised to prevent fluid retention,

as well as supplements to maintain bone health.

- Vitamin D, Calcium, Astragalus, Creatine

MEDICATION MANAGEMENT

Pyridostigmine

 It can reduce muscle weakness, but the effect only lasts for a few hours so
the patient needs to take it several times a day
 Possible side effects include stomach cramps, diarrhea, muscle twitching,
and feeling sick.

Steroids

 If pyridostigmine does not help or only provides short-term relief, the

doctor may suggest taking steroid tablets such as prednisolone.
 It reduces the activity of the immune system (the body's natural defense
against illness and infection), to stop it from attacking the communication
system between the nerves and muscles.

Immunosuppressants

 An agent that decreases the body's immune responses.

 If steroids are not able to control the symptoms or need to take a high dose of
steroids, or steroids cause significant side effects, the doctor may suggest taking
a different medicine that reduces the activity of your immune systems, such as
azathioprine or mycophenolate.

 Side effects can include an increased risk of getting infections, feeling and being
sick, loss of appetite and tiredness.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

SURGICAL MANAGEMENT

Treatment for patients with thymomas, but is also taken into consideration for
those with myasthenia gravis who do not have Thymomas.

Thymectomy

 removal of the thymus gland

 can reduce patient’s need for medication and reduce the severity of MG

COMPLICATIONS

Caused by the disease and if the patient experienced it.

Myasthenic crisis

- A complication of myasthenia gravis that is life-threatening. This arises

whenever the respiratory muscles an individual employs become so poor
that one cannot breathe the air either into or out of the lungs. Due to the
respiratory muscles' weakening, respiratory failure happens, necessitating
mechanical ventilation.

Cholinergic crisis

- Once edrophonium is administered to the patient, a cholinergic crisis

occurs when such weakness does not resolve but rather worsens.
Edrophonium - anticholinesterase agent and injection used to help
diagnose myasthenia gravis and may help select the proper treatment. It
is also used to reverse the effects of certain muscle relaxants.

Heart Disease

- Heart muscle is a target for autoimmune inflammation in myasthenia

gravis. Symptoms overlap with myasthenia and may result in failure to
recognize cardiac involvement. People with MG are at risk of muscle
weakness spreading to their heart muscles.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

Thymoma

- The thymus gland is crucial to the immune system's functionality. The

thymus gland is frequently hyperactive, and excessively big, or MG
patients frequently have immune cell concentrations in their thymus gland
and it may develop or result in thymomas. These are tumors, which are
located on the thymus gland, and could or could not be cancerous.

SIGNS THAT THE ILLNESS IS UNDER CONTROL ACCORDING TO

THE PATIENT

Multidisciplinar Teams

- Presentations are communication tools that can be used as

demonstrations, lectures, speeches, reports, and more. It is mostly
presented before an audience.

Electronic Medical Records

- Presentations are communication tools that can be used as

demonstrations, lectures, speeches, reports, and more. It is mostly
presented before an audience.

24/7Support

- Presentations are communication tools that can be used as

demonstrations, lectures, speeches, reports, and more. It is mostly
presented before an audience.
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

PREVENTION

There is no way to prevent myasthenia gravis. However, if you have the condition, there
are steps you can take to prevent your symptoms from worsening, including:

 Reduce stress.
 Prevent infections.
 Avoid getting too hot or too cold
 Don’t overdo it
 Seek accommodations at work if necessary

DOH PROGRAM

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REFERENCES

Definition

- https://www.ninds.nih.gov/myasthenia-gravis-fact-sheet

Synonyms
- https://www.ninds.nih.gov/myasthenia-gravis-fact-sheet

Causative Agent

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926737/#!po=58.6957
 WESLEYAN UNIVERSITY-PHILIPPINES
Mabini Extension, Cabanatuan City 3100 Nueva Ecija
COLLEGE OF NURSING
A.Y. 2022-2023

Risk Factors (Modifiable)

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Risk Factors (Non-Modifiable)

- https://www.verywellhealth.com/myasthenia-gravis-causes-5112660
- https://www.saintjohnscancer.org/thoracic/conditions/myasthenia-gravis/

Clinical Manifestations

- https://www.ninds.nih.gov/myasthenia-gravis-fact-sheet

Medical Management

- https://www.nhs.uk/conditions/myasthenia-gravis/treatment/#:~:text=The
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- https://www.nhs.uk/conditions/myasthenia-gravis/treatment/#:~:text=The
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- https://www.nhs.uk/conditions/myasthenia-gravis/treatment/#:~:text=The
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