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Myasthenia Gravis 2
Myasthenia Gravis 2
of voluntary muscles, which often improves with rest and worsens with activity. The
condition is caused by an abnormal immune response.
CAUSE:
In myasthenia gravis, weakness occurs when the nerve impulse to initiate or sustain
movement does not adequately reach the muscle cells. This is caused when
immune cells target and attack the body's own cells (an autoimmune response
RISK FACTORS:
Blood tests
One test is for antibodies against the acetylcholine receptor. The test has a
reasonable sensitivity of 80–96%, but in MG limited to the eye muscles (ocular
myasthenia) the test may be negative in up to 50% of the cases.
Neurophysiology
TREATMENT
Medication
B cells
Plasma cells
Class I: Any eye Class II: Eye muscle weakness of Class III: Eye muscle Class IV: Eye muscle
any severity, mild weakness of
Class V:
muscle weakness, weakness of any severity, weakness of any severity,
other muscles moderate weakness of other severe weakness of other
Intubation
possible ptosis, muscles muscles needed to
no other evidence maintain airway
Class IIa: Predominantly limb or
of muscle weakness axial muscles Class IIIa: Predominantly Class IVa: Predominantly
elsewhere limb or axial muscles limb or axial muscles
Class IIb: Predominantly bulbar
and/or respiratory muscles Class IIIb: Predominantly Class IVb: Predominantly
bulbar and/or respiratory bulbar and/or respiratory
muscles muscles.
NURSING DIAGNOSIS:
Assist to a sitting position with head slightly flexed, shoulders relaxed, and kneed flexed.
- Lying flat causes the abdominal organs to shift toward the chest, crowding the lungs and making it
more difficult to breath.
Encourage her to take a deep breath, hold for 2 seconds, and cough 2 or 3 times in succession
- Controlled coughing is accomplished by the closure of the glottis and explosive expulsion of air from
the lungs by the work of abdominal and chest muscles.
- Adequate fluid intake enhances liquefaction of pulmonary secretions and facilitates expectoration of
mucus.
Provided progressive mobilization by maintaining head of bed at least 30 degree angle and assisted the client slowly
from lying to sitting position.
- Prolonged bed rest can cause a sudden drop in blood pressure (orthostatic hypotension) as blood
returns to peripheral circulation.
- Frequent stimulation of the patient increases brain activity and ICP. Clustering care activities in a short
period of time also increases ICP.
Perform passive ROM at least three to four times daily. Exercises are done slowly to allow the muscles time to relax,
and support the extremity above and below the joint to prevent strain on joints and tissues. Stop when the pain and
resistance is met.
- A voluntary muscle will lose tone and strength and becomes shortened from reduced range of motion
or lack of exercise.
- The upright position facilitates the gravitational flow of food or fluid through the alimentary tract. If the head of
the bed cannot be elevated because of the patient’s condition, use a right side-lying position after feedings to
facilitate passage of stomach contents into the duodenum.
Position patient at 90-degree angle, whether in bed or in a chair or wheelchair. Use cushions or pillows to maintain position
- Proper positioning of patients with swallowing difficulties is of primary importance during feeding or eating.
Offer foods with consistency that patient can swallow. Use thickening agents as appropriate. Cut foods into small pieces
- Semisolid foods like pudding and hot cereal are most easily swallowed. Liquids and thin foods like creamed soups
are most difficult for patients with dysphagia.
Encourage patient to chew thoroughly and eat slowly during meals. Instruct patient not to talk while eating