Myasthenia Gravis

• 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