Myasthenia gravis

myasthenia gravis

1. Myasthenia Gravis By Ms. Snehal P atil

2. Neuro transmission:

3. Definition : It is a chronic autoimmune neuromuscular disease characterized by varying degree of weakness of skeletal muscles of the body. It is purely a motor disorder with no effects on sensation and co-ordination.

4. Etiology : Genetic Abnormality of thymus gland Thymic hyperplasia Women at earlier age (20-40 years) Men at older age (60-70 years)

5. Classification :

6. Pathophysiology :

7. Ocular symptoms: Ptosis Diplopia

8. Nystagmus Dysarthia Weakness of muscles of face and throat

9. Bland facial expression Dysphonia

10. Intercostal muscle weakness Generalized weakness

11. Diagnostic Test : Anticholinesterase test : normal value – 0.0 to 0.25 nmol /L Endrophonium chloride test: endrophonium chloride ( tensilon ) 2mg to 10 mg intravenously Repetative nerve stimulation test MRI for thymus gland enlargement

12. Medical management : Pharmacological therapy: Pyridostigmine bromide ( anticholinesterase medication) Immunosuppresive therapy Cytotoxic medications Azathioprine {T lymphocyte inhibitor} IVIG (Intravenous immune globulin)

13. Plasmapheresis :

14. Surgical Management : Thymectomy

15. Nursing management : Assessment – neurological examination - extent of respiratory involvement Assistance in activities of daily living Nutrition through eternal route Aspiration precautions Skin care Effective method of communication

16. Nursing diagnosis : Ineffective breathing pattern related to respiratory muscle weakness Ineffective airway clearance related to tracheal secretions Impaired physical mobility related to weakness of voluntary muscle Imbalanced nutrition less than body requirement related to dysphagia , intubation or muscle paralysis Risk for aspiration related to weakness of bulbar muscle

17. Self care deficit related to muscle weakness Risk for infection related to immunosupressive status or multiple invasive lines