• Is an autoimmune disorder affecting the myoneural junction, is
characterized by varying degrees of weakness of the voluntary muscles • The thymus may give incorrect instructions to developing immune cells, ultimately resulting in autoimmunity and the production of the acetylcholine receptor antibodies. • The thymus is a specialized organ of the immune system. The only known function of the thymus is the production and "education" of T-lymphocytes(T cells), which are critical cells of the adaptive immune system • The thymus is composed of two identical lobes and is located anatomically in the anterior superior mediastinum in front of the heart and behind the sternum ETIOLOGY • Autoimmune disease • Thymoma
Women suffer at an earlier age (20-40) compared to men (60-70)
and are more affected Pathophysiology: • 1. Acetylcholine receptor antibodies interfere with impulse transmission • 2. Follows an unpredictable course of periodic exacerbations and remissions Clinical Manifestations of Myasthenia 1. Involves the ocular muscles Gravis a. diplopia – double vision b. ptosis – drooping of the eyelids 2. Bulbar symptoms – weakness of the muscles of the eyes , face and throat 3. Generalized weakness a. bland facial expression b. dysphonia c. decrease vital capacity • Difficulty in swallowing • Shortness of breath, Impaired speech, Weakness in the arms, hands, fingers, legs and neck • PURELY MOTOR WITH NO EFFECT ON SENSATION OR COORDINATION • • Risk Factors: • Age 20 to 40 • > Female gender • Male gender and age over 60 years • Family history for myasthenia gravis • Other autoimmune illness: Rheumatoid arthritis, and Lupus DIAGNOSTIC TESTS • 1. EMG • 2. TENSILON TEST (Edrophonium) • IV injection- provides spontaneous relief of symptoms ( last 5-10 mintutes)- positive • 3. CT scan • 4. Serum anti-AchReceptor antibodies A diagnosis can be confirmed in several ways:
• Acetylcholine Receptor Antibody – A blood test
for the abnormal antibodies can be performed to see if they are present. Approximately 85% of MG patients have this antibody and, when detected with elective of MG concentration the AChR antibody test is strongly indicative of MG. • Single Fiber EMG- studies can provide support for the diagnosis of MG when characteristic patterns are present. The single Fiber EMG and AChR antibody test are primary test used to confirm a clinical diagnosis of MG. • Anti- Musk Antibody Testing- a blood test for the remaining for the acetylcholine antibody. These patients have seronegative(SN) MG. about 40-70% of patients with SNMG test positive for the anti- Musk antibody. • Electromyography-(EMG) studies can provide support for the diagnosis of MG when characteristic pattern are present. MEDICAL THERAPY • Anticholinesterase drugs- • PYridostigmine ( mestinon) Neostigmine ( Prostigmin) • SHOULD BE GIVEN ON TIME • 30 MINS. BEFORE MEALS W/ MILK AND CRACKERS TO PREVENT CRISIS • Corticosteroids- suppress autoimmune response • Immunosuppresants • Plasmapheresis- remove circulating acetylcholine receptor antibodies • Thymectomy- removal of thymus gland Nursing Diagnosis for Myasthenia Gravis
• Ineffective Breathing Pattern related to respiratory muscle weakness.
• Impaired Physical Mobility related to weakness of voluntary muscles. • Risk for Aspiration related to the weakness of bulbar muscles. • Self-Care Deficit related to muscle weakness, general fatigue. • Imbalanced Nutrition: Less than Body Requirements related to dysphagia, intubation, or muscle paralysis. NURSING INTERVENTIONS • 1. Administer prescribed medication as scheduled • 2. Prevent problems with chewing and swallowing • 3. Promote respiratory function • 4. Encourage adjustments in lifestyle to prevent fatigue • 5.maximize functional abilities • 6. Prepare for complications like myasthenic crisis and cholinergic crisis • Cholinergic Crisis • caused by overmedication • Worsen with tensilon test • Antidote : atropine sulfate • Myasthenic crisis • Abrupt generalized muscle weakness • Caused by undermedication, physical, emotional stress, infection • Symptoms improved temporarily with tensilon test • 7. Prepare for complications like myasthenic crisis and cholinergic crisis • 8 . prevent problems associated with impaired vision resulting from ptosis of eyelids • 9. provide client teaching • 10. promote client and family coping