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Myasthenia Gravis Nursing Care PlanMyasthenia gravis literally means ‘grave muscle weakness’. It can affect muscles that control eye and eyelid movement, facial expression, chewing, swallowing and talking, the muscles in the arms, fingers, neck and legs and can cause unstable gait. The Care Plan sets out a clear explanation of the resident’s issue, and will guide the nurse or carer through the process of preparing a comprehensive, individual person centred Care Plan. Myasthenia Gravis Care Plan Features:Identifies the symptoms and issues experienced Details the comprehensive plan of care Identifies possible complications Digital DownloadsDelivery of your purchase Further Help
Myasthenia Gravis Nursing Care PlanMyasthenia gravis literally means ‘grave muscle weakness’. It can affect muscles that control eye and eyelid movement, facial expression, chewing, swallowing and talking, the muscles in the arms, fingers, neck and legs and can cause unstable gait. The Care Plan sets out a clear explanation of the resident’s issue, and will guide the nurse or carer through the process of preparing a comprehensive, individual person centred Care Plan. Myasthenia Gravis Care Plan Features:Identifies the symptoms and issues experienced Details the comprehensive plan of care Identifies possible complications Digital DownloadsDelivery of your purchase Further Help This NCLEX review will discuss myasthenia gravis. As a nursing student, you must be familiar with this neuro disease along with how to provide care to a patient experiencing this condition. Don’t forget to take the myasthenia gravis quiz. You will learn the following from this NCLEX review:
What is Myasthenia Gravis? It’s an autoimmune condition where the body attacks the receptors that allow for voluntary muscle control, which leads to muscle weakness. What voluntary muscles are involved? Neuromuscular Junction:
In myasthenia gravis the issue arises at the neuromuscular junction. This is the place where the motor neuron and muscle fiber meet and the neurotransmitter acetylcholine is released. At this junction are receptors on the muscle fiber called nicotinic acetylcholine receptors that become stimulated when acetylcholine is released and cause contraction of the muscle fiber. However, in myasthenia gravis the nicotinic acetylcholine receptors are being attacked by antibodies the immune system has created and are not working properly. These receptors can NOT access the release of acetylcholine and cause muscle contraction, so there is muscle weakness. The thymus gland (found anteriorly in the upper part of the chest behind the sternum in between the lungs) plays a very important role in our immune system health. It’s the creator of T-cells, which are super important for immune health by fighting viruses and bacteria. In children the thymus is large (remember it will produce most of the body’s T-cells by the time a person attains puberty). It should shrink by adulthood and then in older age be like a fatty tissue. But in people with myasthenia gravis, the thymus gland tends to stay large and develops tumors or collection of immune cells in the gland. It is thought that the thymus erroneously causes immune cells to produce antibodies that will attack receptor sites on these voluntary muscle neuromuscular junctions. Signs and Symptoms of Myasthenia Gravis**HALLMARK: muscle weakness becomes worse with activity (especially repetitive activity) but will improve after resting the muscle. Patients tend to notice symptoms in the eyes due to eye muscle weakness of the extraocular muscles or have problems with speaking (slurred) or swallowing….signs and symptoms vary among patients. “WEAKNESS” Weakness neck, face, arms/legs/hands Eyelid drooping…can be one eye or both (Ptosis) Appearance mask-like: no expression…looks very sleepy Keeps choking or gagging when eating (difficulty swallowing)…many muscles help with the swallowing process and have become weak No energy…very fatigued…gets worse throughout the day as muscles are used Extraocular muscle involvement leading to double vision…strabismus Slurred speech (voice may be hoarse and very soft) Short of breath (can extend to respiratory muscles) Complications of Myasthenia GravisMyasthenia gravis can go into remission where the patient doesn’t have signs and symptoms, but some patients can experience severe acute exacerbation with a complication called Myasthenic Crisis. This is where the disease is becoming worse and the patient may need intubation and mechanical ventilation to breathe. Risk factors for experiencing Myasthenic Crisis: improper dosage (not enough) of anticholinesterase meds to treat this condition, stress (physical…surgery or mental), and respiratory infection. That patient will have severe weakness of muscles that cause respiratory failure. How is it diagnosed?
IMPORTANT: What will happen if Edrophonium is given to a patient with myasthenia gravis or to a patient in myasthenic crisis? The patient’s signs and symptoms will temporarily improve. Hence, the test is positive. What will happen if Edrophonium is given to a patient with cholinergic crisis? The patient’s signs and symptoms will become worse….NO improvement. Hence, the test is negative.
Nursing Interventions & Medications for Myasthenia GravisMonitor respiratory status: effort of breathing, respiratory rate, oxygen saturation, does the patient feel like it’s hard to breathe? If hospitalized with exacerbation needs resuscitation equipment close by: suction etc. Monitor neuromuscular status:
Safety: at risk for injury….needs assistance at all times (remember the patient may have double vision (eye patch to help with this), arm and leg weakness) Speech pathologist will evaluate and recommend treatment based on findings. Patient may need or have a feeding tube and you will be managing this as the nurse. Monitor for aspiration, hob of greater than 30′ while eating Education about food because patient may have difficulty chewing and swallowing:
Educate about performing most of their activities early in the day when the patient will have the most energy. Help patient identify things that makes symptoms worst: menstrual cycle, sickness, stress, extreme temperatures Medications for Myasthenia Gravis:Anticholinesterase: “Pyridostigmine” …improves symptoms…there is no cure! How does the anticholinesterase medication work? Remember the substance we talked about earlier called acetylcholinesterase? This medication will prevent it from working. Therefore, there will NOT be the breakdown of acetylcholine. Therefore, more of it will be available at the neuromuscular junction site. This will help improve muscle strength. Patient should take 30 to 60 minutes before a meal to help increase muscle strength with swallowing and chewing. Monitor: Myasthenic crisis (from not enough medication) or cholinergic crisis (too much of the medication): ….both will have respiratory failure and severe muscle weakness but from different causes. Signs and Symptoms of Cholinergic Crisis: Think of the signs and symptoms experienced during cholinergic crisis similar to the parasympathetic nervous system being in overdrive:
Treatment: No anticholinesterase medications and atropine to reverse symptoms. Other drugs used to treat MG: corticosteroids and immunosuppressants Other treatments for MG:
References:
What are the nursing priorities for a patient with myasthenia gravis?Nursing Interventions & Medications for Myasthenia Gravis. smaller meals that are easy to chew foods… ... . try scheduling meals during peak time of medication (30 minutes to 1 hour before eating) so chewing and swallowing muscle will have the most access to acetylcholine.. Thicken liquids for swallowing.. What are the 5 components of nursing care plan?The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.
What are the 3 nursing interventions?There are typically three different categories for nursing interventions: independent, dependent and interdependent.
What are five nursing interventions?Common nursing interventions include:. Bedside care and assistance.. Administration of medication.. Postpartum support.. Feeding assistance.. Monitoring of vitals and recovery progress.. |
