Martes, Oktubre 11, 2011

Myasthenia Gravis

MYASTHENIA GRAVIS (MG)

Chronic autoimmune neuromuscular disorder affecting the neurumuscular joint. It is purely a MOTOR Disorder with no effect on sensation or coordination. 


  •  characterized by fatigue and severe weakness of skeletal muscles.
  • occurs with remissions and exacerbations.
  • occurs more frequently in females, with onset between ages 20-30 
Manifestations:

  • Ptosis (drooping of eyelids), Diplopia (double vision)
  • weakness in mouth muscles resulting in dysarthria and dysplagia
  • weak voice, smile appears as snarl.
  • muscles are weak but DTRs are normal 
Complications:
       Pneumonia
       Myasthenic crisis
  • Sudden exacerbation of motor weakness putting client at risk for respiratory failure and aspiration
  • Manifestation: tachycardia, tachypnea, respiratory distress, dysphasia
      Cholinergic Crisis
  • Occurs with overdosage of medications (anticholinesterase drugs) used to treat MG
  • Develops GI symptoms, severe muscle weakness, vertigo and respiratory distress
Diagnostic Tests:
  • physical examination and history
  • Tensilon Test: edrophonium chloride administered and client with myasthenia will show significant improvement lasting 5mins.
  • EMG: reduced action potential
  • Antiacetylcholine receptor antibody serum levels; increased in 80% MG clients; used to follow course of treatment
  • Serum assay of circulating acetylcholine receptor antibodies
Medications:
  • Anticholinesterase medications [pyridostigmine bromide 'Mestinon']
  • Immunsuppression medications including glucocorticiods (cyclosporineor azathioprine 'Imuran')
Nursing Care:
  • Teaching interventions to deal with fatigue
  • Importance of following medication therapy 
Nursing Diagnosis:
  • Ineffective airway clearance
  • Impaired swallowing: plan to take medication to assist with chewing activity 

                   

 

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