Guide to Myasthenia Gravis| nursing care plan

Guide to Myasthenia Gravis

Who get it:

Myasthenia gravis occurs when your immune system - your immune system - triggers the immune system that interferes with your nerve signals. The result is that your muscles are weak. The usually does not go away, but your doctor can help you manage your symptoms. You may notice it in the eye muscles, but it can affect all the "skeletal" muscles, such as the ones that move your legs and arms or help you breathe.

Signs and symptoms

Signs: Your Eyes

Reduced eyes (ptosis), is the most common disease of myasthenia gravis. The disease causes small, delicate tissues around the eyes, making it difficult to keep them fully open. And you may find it difficult to control their movement and focus on things, causing blurring or double vision. One form of the disease, ocular myasthenia, is limited to the eye muscles.

Symptoms: Your Face and Neck

Myasthenia gravis usually affects the facial and throat muscles. That can create an appearance on your face that seems strange or unusual. For example, you may appear to be screaming when you try to smile. You may have trouble shaking your head or being aware of speech problems. Some people find it difficult to chew and swallow, which can lead to saliva, bath or diarrhea.

Symptoms: Respiratory problems

When myasthenia gravis tightens the muscles around your chest, you may find it difficult to breathe. Depression, infection, and certain medications can cause an emergency called a “myasthenic crisis,” in which you need help with specialized respiratory equipment. Talk to your doctor immediately if you notice problems with your breathing.

Symptoms: Weapons and Legs

If you have myasthenia gravis, how much muscle weakness you experience depends on your level of activity and things like stress, diet, and overall health. Occasionally, weakness in the arms and legs can make it difficult to lift objects, climb stairs, or even stand up. The way you walk may look different than normal. Relaxing is usually helpful.

Thymus Gland Problems

Some people with myasthenia gravis have a larger thymus gland than normal - the organ in your upper chest. It is part of your immune system. You may also find tumors in the thymus gland. It is usually harmless, but sometimes can lead to cancer.

Causes

Myasthenia gravis is an autoimmune disease, which means that your immune system attacks your tissues. Scientists believe that your genes play a key role, but they do not know which ones. Research is underway on this mysterious disease.

Why Your Condition Can Be So Bad

There are many things that can make your myasthenia gravis symptoms worse, such as:

1. Sickness
2. Depression or fatigue
3. Pregnancy or menstruation
4. Certain medications, such as beta blockers, quinidine gluconate, quinine, quinidine sulfate, phenytoin, other anesthesia drugs, and antibiotics

Diagnosis: examination

Your doctor will check your medical history and check your body. They will look at the tone, strength, and coordination of your muscles and eye movements. Because weakness is a common symptom in many different diseases, it can take a while - sometimes up to 2 years - before getting a full diagnosis. This is especially true in mild cases or when the weakness is limited to just a few muscles.

diagnosis: Testing

you can get an edrophonium test, where you get a cure for eye problems while your doctor sees how you are reacting. blood tests can detect high levels of certain antibodies. an energy boosting test shows how fast your muscles are. electromyography examines signals from nerves to muscles. ct scan or mris looks for a large or normal thymus gland. and a lung test can help help your doctor predict a myasthenic problem.

Treatment: Surgery

If there is one or more lesions in the thymus gland, your doctor may suggest surgery to remove the tumor or tissue. This often improves symptoms and reduces the need for medication. Surgery is often helpful even when there is no tissue. It can take as long as a few years to see results. The “open” surgery penetrates the inside of your chest bone (the thymus is behind it), but there are a few non-invasive options for some people.

Treatment: Medication

Your doctor may suggest that you take:

1. Anticholinesterase medications to improve the delivery of signals to your muscles.
2. Protective drugs help to improve muscle strength by reducing or stopping the production of harmful antibodies.

treatment: intravenous therapy (iv)

Additives add or remove blood and medication with a needle into your vein, usually on the arm. you often get them when the symptoms suddenly get worse. sometimes they help for up to a few months

1. Plasmapheresis removes plasma (a component of your blood) to eliminate harmful antibodies and replaces fine plasma
2. Intravenous immunoglobulin gives you a normal immune system to change how the immune system works
3. monoclonal antibodies are drugs that are sent in iv and are usually used only after the failure of other treatments..a..fail.

Who Get It

It is most common in women under 40 and men over 60, but you can get it at any time, including childhood. Although rare in children, there are cases in which a mother with myasthenia gravis may transmit antibodies to her baby (neonatal myasthenia).

Nursing care plan

Assessment

1. Weakness and fatigue
2. Difficulty chewing
3. Dysphagia
4. Ptosisptosis
5. Diplopia
6. Weak, hoarse voice
7. Difficulty breathing
8. Diminished breath sounds
9. Respiratory paralysis and failure

Primary Nursing Diagnosis

Ineffective airway clearance related to difficulty in swallowing and aspiration

Diagnostic Evaluation

Injection of edrophonium (Tensilon) is used to confirm the diagnosis (have atropine available for side effects). Improvement in muscle strength represents a positive test and usually confirms the diagnosis.

MRI may demonstrate an enlarged thymus gland.

Test includes serum analysis for acetylcholine receptor and electromyography (EMG) to measure electrical potential of muscle cells.

Holding your arms above your shoulders until they drop is one exercise that may be performed during the Tensilon test. In this test, the drug Tensilon is administered, and the response in the muscles are evaluated to help diagnose myasthenia gravis or to help differentiate between myasthenia gravis and other conditions.

Holding your arms above your shoulders until they drop is one exercise that may be performed during the Tensilon test. In this test, the drug Tensilon is administered, and the response in the muscles are evaluated to help diagnose myasthenia gravis or to help differentiate between myasthenia gravis and other conditions.

Medical Management

Management is directed at improving function through the administration of anticholinesterase medications and by reducing and removing circulating antibodies. Patients with MG are usually managed on an outpatient basis unless hospitalization is required for managing symptoms or complications.

Pharmacologic Highlights

Anticholinesterase drugs such as Pyridostigmine bromide (Mestinon), neostigmine bromide (Prostigmine); neostigmine methylsulfate can be given as a continuous infusion if the patient cannot take oral medication. Anticholinesterase drugs blocks the action of the enzyme anticholinesterase, thereby producing symptomatic improvement; atropine must be readily available to treat cholinergic side effects and medications must be administered on time, or the patient may be too weak or unable to swallow the drug.

Prednisone is used to suppresses the autoimmune activity of MG

Nonsteroidal immunosuppressants such as Azathioprine (Imuran), cyclophosphamide (Cytoxin) is used to suppress autoimmune activity when patients do not respond to prednisone; can produce extreme immunosuppression and toxic side effects

Nursing Interventions

1. Monitor respiratory status and ability to cough and deep breathe adequately.
2. Monitor for respiratory failure.
3. Maintain suctioning and emergency equipment at the bedside.
4. Monitor vital signs.
5. Monitor speech and swallowing abilities to prevent aspiration.
6. Encourage the client to sit up when eating.
7. Assess muscle status.
8. Instruct the client to conserve strength.
9. Plan short activities that coincide with times of maximal muscle strength.
10. Monitor for myasthenic and cholinergic crises.
11. Administer anticholinesterase medications as prescribed.
12. Instruct the client to avoid stress, infection, fatigue, and over-the counter medications.
13. Instruct the client to wear a Medic-Alert bracelet.
14. Inform the client about services from the Myasthenia Gravis Foundation.

Documentation Guidelines

Respiratory status: Rate, quality, depth, ease, breath sounds, arterial hemoglobin saturation with oxygen

Ability to chew, swallow, and speak (swallowing can be subjectively rated by the patient in anticipating ability to swallow food [0 =unable to swallow liquids to 5 = able to swallow regular diet]), food intake, daily weights

Muscle weakness and strength, speed and degree of fatigue, ability to perform activities of daily living, response to rest, and plans for modification of activity

Ptosis (can be rated by the nurse [0 = unable to open lid to 5 =uppermost edge of iris visible])

Discharge and Home Healthcare Guidelines

Instruct the patient and family on the importance of rest and avoiding fatigue. Be alert to factors that can cause exacerbations, such as infection (an annual flu shot is suggested), surgery, pregnancy, exposure to extreme temperatures, and tonic and alcoholic drinks. Instruct the patient and family about drug actions and side effects, the indications for dosage alteration, and the selective use of atropine for any overdose.

Stress the importance of taking the medication in a timely manner. It is advisable to time the dose 1 hour before meals for best chewing and swallowing. Explain the potential drug interactions (especially aminoglycosides and neuromuscular blocking agents, which include many pesticides). Encourage the patient to inform the dentist, ophthalmologist, and pharmacist of the myasthenic condition.

Instruct patients about the symptoms that require emergency treatment, and encourage them to locate a neurologist familiar with MG management for any follow-up needs. Suggest that they collect a packet of literature to take to the emergency department in case the available physician is unfamiliar with this disease. (The Physician’s Handbook is available on request from the MG Foundation.)

Instruct patients to wear MG identification jewelry. Suggest having an “emergency code” to alert family if they are too weak to speak (such as ringing the phone twice and hanging up).

Instruct the family about cardiopulmonary resuscitation techniques, how to perform the Heimlich maneuver, how to contact the rescue squad, and how to explain the route to the hospital.

Make a referral to a vocational rehabilitation center if guidance for modifying the home or work environment, such as a raised seat and handrail for the toilet, would be beneficial.