A chronic, progressive disorder characterized by decreased acetylcholine activity in the synapses. This is due to insufficient acetylcholine secretion and excessive secretion of cholinesterase, the enzyme that inactivates acetylcholine. This causes a decrease in the effective transmission of nerve impulses in the muscles, causing weakness and fatigue, especially in respiratory muscles.
MG is an autoimmune disorder that is often exacerbated by precipitating factors known as triggers. This includes stress, infection, hormone disturbances, trauma, and extreme temperatures.
Preserve functional ability, protect the airway, and prevent complications such as myasthenic crisis or cholinergic crisis.
Myasthenia Gravis (MG) Nursing Care Plan
- Double vision
- Ptosis (drooping eyelid)
- Abnormal ABG
- Diminished breath sounds or crackles due to atelectasis
- Vomiting, diarrhea
- Bronchial spasm
- Increased HR, RR, BP
- Hypoxia and cyanosis
- Bowel and Bladder incontinence
Nursing Interventions and Rationales
- Administer cholinesterase inhibitors (Physostigmine) and ensure proper dosing/timing
The goal is to have a net increase of acetylcholine activity at the nerve synapses. This should help improve the conduction of impulses within the muscles.
- Monitor respiratory status
Patients are at high risk for respiratory distress due to muscle weakness and dysphagia (aspiration)
Ptosis and weakness of eye muscles can cause dryness and irritation of the eyes. Provide eye drops or an eye patch as appropriate.
- Monitor feeding and ensure proper nutrition. Schedule meds 30-45 minutes before meals
Weakness and dysphagia make preparing and eating meals more and more difficult as the disease progresses. Scheduling meds 30-45 minutes before meals helps to minimize their symptoms as much as possible during meal times.
- Maintain suction and emergency equipment.
Because of the risk of respiratory depression – this is especially important to have at the bedside when administering a Tensilon test because it can send the patient into V-Fib or cardiac arrest, or can make the cholinergic crisis worse, leading to respiratory distress or respiratory arrest. Ensure the suction regulator is functioning and the ambu bag is available.
- Educate patient to identify and avoid triggers
This may include temperature extremes, stress, drugs, alcohol, infection, or caffeine. They should avoid any known triggers as much as possible.
- Educate the patient on s/s of cholinergic and myasthenic crisis to report to the provider.
Both cases can cause severe muscle weakness and respiratory depression. Early intervention to protect the patient’s airway is imperative.
- Cholinergic Crisis
- Withhold medication
- Administer antidote – anticholinergic medication
- Ventilatory support
- A cholinergic crisis can be caused by taking too much medication or can occur after a dose adjustment.
- Atropine may help, but isn’t always enough – patients often need ventilatory support until the medication is out of their system.
- Myasthenic Crisis
- Increase medication dose
- Ventilatory support
- Myasthenic crisis is caused by having too little medication and is essentially an exacerbation of the disease.
- Administer the missed dose or increase the dosage per provider orders. Patients often still require ventilatory support until the medication is at a therapeutic level again.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell