Myasthenia Gravis

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Author:
japanice27
ID:
306262
Filename:
Myasthenia Gravis
Updated:
2015-08-11 01:00:52
Tags:
myastheniagravis neurologicdisorder
Folders:
neuro
Description:
review about myasthenia gravsis
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  1. Myasthenia Gravis
    • -a neuromuscular disease characterized by weakness and abnormal fatigue of the voluntary muscles.
    • -(+)defect in the transmission of nerve impulses at the myoneural junction occurs.
  2. Causes of MG:
    • -insufficient secretion of acetylcholine.
    • -excessive secretion of cholinesterase.
    • -unresponsiveness of the muscle fibers to the acetylcholine.
  3. Assessment of MG:
    • ~weakness and fatigue
    • ~diff chewing and swallowing
    • ~ptosis, diplopia
    • ~weak, hoarse voice
    • ~DOB
    • ~diminished breath sound
    • ~resp paralysis and failure
  4. Intervention for MG:
    • >MONITOR: RR and status, ability to cough; resp failure
    • -deep breath accurately
    • -maintain SUCTIONING and EMERGENCY equipment @ bedside
    • >MONITOR: speech and ability to swallow (px aspiration)
    • -SIT UP when eating
    • >assess muscle status
    • -conserve strength (plan short activities)
    • >WOF: myathenia crisis and cholinergic crisis
    • >AVOID: stress, infection and OTC meds
  5. Antimyasthenic meds: anticholinesterase meds
    • -relieve muscle weakness by BLOCKING Act breakdown at the neuromuscular junction.
    • -used to tx or dx MG or to distinguish CC frm MC.
    • -MEDS: ambenonium chloride (mytelase), endrophonium chloride (tensilon), neostigmine bromide (prostigmin), pyridostigmine (mestinon)

    • INT:
    • ~assess neuromuscular status (reflex, muscle strength and gait)
    • ~WOF s/sx of med overdose (CC) or underdose (MC)
    • ~take meds on time to maintain therapeutic blood level, thus px weakness
    • ~take meds with SMALL amount of food (px GIT sx)
    • ~eat 45-60 mins after taking meds to decrease risk of aspiration
    • ~lifelong therapy
  6. Myasthenia crisis:
    • -an acute exacerbation of the disease
    • >CAUSE: rapid, unrecognized progression of the disease, inadequate amt of meds, fatigue or stress

    • S/SX:
    • ↥ PR, RR and BP
    • Dyspnea, anoxia and cyanosis
    • ↧ UO
    • (-)cough and swallow reflex
  7. INT for Myasthenic crisis:
    • WOF s/sx.
    • ↥ anticholinesterase meds
  8. Cholinergic crisis:
    • -results in depolarization of the motor end plates.
    • >CAUSE: overmedication with anticholinesterase.

    • S/SX:
    • (+)abdominal cramps
    • N&V,diarrhea
    • blurred vision
    • pallor
    • facial muscle twitching
    • hypotension
    • pupillary miosis

  9. INT for Cholinergic crises:
    • !WITHHOLD anticholinesterase meds
    • ANTIDOTE: atropine sulate

    *have atropine sulfate available when performing TENSILON TEST.
  10. Endrophonium test: tensilon test
    • -used to dx MG and used to differentiate MC and CC.
    • -@ risk for: ventricular fibrillation and cardiac arrest.

    • TO DX MG:
    • -(+) pt shows improvement in muscle strength after administration (muscle tone: 30-60 sec; muscle improvement lasts: 4-5mins)
    • -(-) pt shows NO improvement in muscle strength, and strength may deteriorate after injection.

    • TO DIFF CRISIS:
    • >MG: strength IMPROVES, pt needs more meds.
    • >CC: weakness is more severe, the pt is overmedicated; give atropine sulfate (antidote)

    • -given IV
    • -can CAUSE: bronchospasm, laryngospasm, hypotension, bradycardia and cardiac arrest
    • -ATROPINE SULFATE-antidote for overdose
  11. N/I for MG:
    • -conserve energy
    • -rest before meals
    • -sit upright during meals
    • -soft foods with gravy or sauce; (+) choking-pureed foods with a pudding like consistency.
    • -suction available @ home
    • -tape eyes for short intervals and instill artificial tears
    • -AVOID factors that exacerbate sx: emotional stress, infections (resp), vigorous physical activity, some meds, and high environmental temp.

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