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 effective transmission of nerve impulses in the muscles, causing weakness and fatigue, especially in respiratory muscles.
MG is an autoimmune disorder which is often exacerbated by precipitating factors known as triggers. This includes stress, infection, hormone disturbances, trauma, and extreme temperatures.
Preserve functional ability, protect airway, and prevent complications such as myasthenic crisis or cholinergic crisis.
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)
Provide eye care
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 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 cholinergic crisis worse, leading to respiratory distress or respiratory arrest. Ensure suction regulator is functioning and 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 patient on s/s of cholinergic and myasthenic crisis to report to provider.
Both cases can cause severe muscle weakness and respiratory depression. Early intervention to protect the patient’s airway is imperative.
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