myasthenia gravis ppt.pptx

It contain what is myasthenia gravis and anatomy and physiology of brain, definition ,incidence, classification, causes and risk factors, pathophysiology, sign symptoms, diagnosis, treatment, and managment.

1. MYASTHENIA GRAVIS Presented By – Harshika S. Tembhurne MSc. 1 st Year , SCON

2. Introduction Myasthenia gravis (MG) is the most common disorder affecting the neuromuscular junction (NMJ) of the skeletal muscles. The classic presentation is a fluctuating weakness that is more prominent in the afternoon. It usually involves muscles of the eyes, throat, and extremities.

3. Anatomy and physiology of Brain Cerebrum The largest and most obvious portion of the brain is the cerebrum, which is divided by a deep longitudinal fissure into two cerebral hemispheres.

4. Diencephalon The diencephalons is centrally located and is nearly surrounded by the cerebral hemispheres. It includes the thalamus, hypothalamus, and epithalamus.

5. Brain Stem The brain stem is the region between the diencephalons and the spinal cord. It consists of three parts: midbrain, pons, and medulla oblongata.

6. Cerebellum The cerebellum, the second largest portion of the brain, is located below the occipital lobes of the cerebrum.

7. Spinal Cord The spinal cord extends from the foramen magnum at the base of the skull to the level of the first lumbar vertebra.

8. Definition 1) Myasthenia gravis (MG) is a chronic disease characterised by fluctuating levels of muscle weakness. 2) A rare chronic autoimmune disease marked by muscular weakness without atrophy, and caused by a defect in the action of acetylcholine at neuromuscular junctions.  

9. Incidence It is uncommon, affecting only 15 per 100,000 individuals, and although it can be a very serious condition, 90 per cent of patients live a near-normal life while continuing medical treatment.  

10. Classification Class I: Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere Class II: Eye muscle weakness of any severity, mild weakness of other muscles Class IIa : Predominantly limb or axial muscles Class IIb: Predominantly bulbar and/or respiratory muscles Class III: Eye muscle weakness of any severity, moderate weakness of other muscles Class IIIa: Predominantly limb or axial muscles Class IIIb : Predominantly bulbar and/or respiratory muscles Class V: Intubation needed to maintain airway  

11. Causes and risk factors   It is an autoimmune disorder , in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction , inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions. Myasthenia is treated medically with cholinesterase inhibitors or immunosuppressants , and, in selected cases, thymectomy . Unknown Aging Factors

12. Pathophysiology

13. Signs and symptoms Muscle weakness caused by myasthenia gravis worsens as the affected muscle is used repeatedly. Although myasthenia gravis can affect any of the muscles that you control voluntarily, certain muscle groups are more commonly affected than others. Eye muscles Drooping of one or both eyelids (ptosis) Double vision (diplopia), which may be horizontal or vertical.

14. Face and throat muscles Altered speaking :- Your speech may be very soft or may sound nasal, depending upon which muscles have been affected. Difficulty swallowing :- You may choke very easily, which makes it difficult to eat, drink or take pills. In some cases, liquids you're trying to swallow may come out your nose. Problems chewing :-The muscles used for chewing may wear out halfway through a meal, particularly if you've been eating something hard to chew, such as steak. Limited facial expressions :- Family members may note that you've "lost your smile" if the muscles that control your facial expressions are affected.  

15. Neck and limb muscles Myasthenia gravis can cause weakness in your neck, arms and legs, but this usually happens in conjunction with muscle weakness in other parts of your body — such as your eyes, face or throat. The disorder usually affects arms more often than legs. However, if it affects your legs, you may waddle when you walk. If your neck is weak, it may be hard to hold your head erect.   Factors that can worsen myasthenia gravis Fatigue Illness Stress Extreme heat Some medications — such as beta blockers, calcium channel blockers, quinine and some antibiotics

16. Diagnostic evaluation Patient History . Physical especially Neurologic examination , Tests and diagnosis Edrophonium test Blood analysis Repetitive nerve stimulation Single- fiber electromyography (EMG) Imaging scans  

17. Treatment There is no cure for myasthenia gravis, but treatment can help relieve signs and symptoms — such as weakness of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and breathing. Medications Cholinesterase inhibitors Corticosteroids Immunosuppressants

18. Therapy Plasmapheresis This procedure uses a filtering process similar to dialysis. Blood is routed through a machine that removes the antibodies that are blocking transmission of signals from your nerve endings to your muscles' receptor sites. Intravenous immune globulin This therapy provides body with normal antibodies, which alters immune system response.

19. Surgery About 15 percent of the people who have myasthenia gravis have a tumor in their thymus, a gland under the breastbone that is involved with the immune system. need to have thymus removed. For people with myasthenia gravis who don't have a tumor in the thymus, it's unclear whether the potential benefit of removing the thymus outweighs the risks of surgery. Surgery is not recommended by most doctors if: Your symptoms are mild Your symptoms involve only your eyes You're older than 60 

20. Nursing Management   Pain Management : Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient Analgesic Administration: Use of pharmacologic agents to reduce or eliminate pain Environmental Management: Comfort: Manipulation of the patient’s surroundings for promotion of optimal comfort Anxiety Reduction: Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger Provision of a modified environment for the patient who is experiencing a chronic confusion state Calming Technique: Reducing anxiety in patient experiencing acute distress Delusion Management: Promoting the comfort, safety, and reality orientation of a patient experiencing false, fixed beliefs that have little or no basis in reality

21. Nursing diagnosis Acute pain Anxiety Disturbed thought processes Hyperthermia Imbalanced nutrition: Less than body requirements Impaired gas exchange Impaired physical mobility Risk for deficient fluid volume

22. Prognosis The prognosis of MG has improved significantly with the introduction of immunosuppressive therapy. The majority of patients become symptom free if they take adequate doses of steroids. However, most patients do have to remain on tablets for an indefinite period as the symptoms generally return if they stop the medication.

23. Complications   Myasthenic crisis Myasthenic crisis is a life-threatening condition, which occurs when the muscles that control breathing become too weak to do their jobs. Emergency treatment is needed to provide mechanical assistance with breathing. Medications and blood-filtering therapies help people recover from myasthenic crisis, so they can again breathe on their own.   Thymus tumors About 15 percent of the people who have myasthenia gravis have a tumor in their thymus, a gland under the breastbone that is involved with the immune system. Most of these tumors are noncancerous.  

24. Summary Myasthenia gravis is a disease that causes weakness in your voluntary muscles. These are the muscles that you control. For example, you may have weakness in the muscles for eye movement, facial expressions, and swallowing. You can also have weakness in other muscles. This weakness gets worse with activity, and better with rest. Myasthenia gravis is an  autoimmune disease . Your body's immune system makes antibodies that block or change some of the nerve signals to your muscles. This makes your muscles weaker. Other conditions can cause muscle weakness, so myasthenia gravis can be hard to diagnose. Tests used to make a diagnosis include blood, nerve, muscle, and  imaging tests .

25. CONCLUSION So, here we can conclude by saying that as brain is the regulating centre of the body and infection can lead to deadly complications. Hence, prompt treatment and wise decision on time is very important for the patient. So as a nurse we should anticipate in providing quality nursing care to a patient in the clinical practice.  

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