Homeostasis: Myasthenia Gravis

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by:

a positive edrophonium (Tensilon) test

Myasthenia gravis occurs when antibodies attack which receptor sites?

acetylcholine

myasthenia gravis occurs when antibodies attack...

acetylcholine receptors at the neuromuscular junction

ice test for myasthenia gravis is best used for patients with...

cardiac disorders

Which meal option would be the most appropriate for a patient diagnosed with myasthenia gravis?

clam chowder with mashed potatoes - soft foods in gravy or sauces can be swallowed more easily

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication?

increased muscle strength

A nurse caring for a client in myasthenic crisis identifies a priority concern as:

maintenance of airway and respiration

The client is diagnosed with myasthenia gravis, a condition in which antibodies block, alter, or destroy the receptors for acetylcholine. What symptom would the nurse expect this client to display?

muscle dysfunction

when antibodies attack acetylcholine receptors at the neuromuscular junction, it leads to...

muscle weakness - antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction resulting in voluntary muscle weakness that escalates with continues activity

Upon assessment of a client with myasthenia gravis, the nurse observes drooping of the upper eyelids. This finding is known as:

ptosis

A nurse is planning the care of a 28-year-old client hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client?

In the morning, with frequent rest periods

A nurse is caring for a client with myasthenia gravis. The client is having difficulty forming words and his tone is nasal. Which of the following is an effective communication strategy for this client?

Repeat what the client has said to verify the meaning

A client with a diagnosis of myasthenia gravis underwent a mastectomy. The surgery was a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which priority measure should the care team initiate immediately?

Respiratory support and protection of the client's airway

The 38-year-old client with a recent history of varied neuromuscular symptoms has just been administered edrophonium. The client immediately demonstrates significantly increased muscle strength. How should the nurse best interpret this finding?

The client likely has myasthenia gravis

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose?

The muscles will become fatigued and the patient will not be able to chew food or swallow pills

thymectomy

complete removal of thymus gland (thymus located behind sternum) - used for patients with myasthenia gravis

A 67-year-old client diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors?

Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait

Which patient below is most at risk for developing a cholinergic crisis?

a patient with myasthenia gravis who reports taking too much of their anticholinesterase medication - cholinergic crisis is caused by overmedication with cholinesterase inhibitors and is rare

In myasthenia gravis (MG), there is a decrease in the number of receptor sites of which neurotransmitter?

acetylcholine

A nurse is educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. Where would the nurse state it is located?

behind the sternum in between the lungs

cholinergic crisis

caused by overmedicating with pyridostigmine (rare)

myasthenia crisis

commonly caused by respiratory infection OR not taking medication

pyridostigmine (ACTH inhibitor)

first line of therapy for myasthenia gravis - blocks ACTH enzyme which increases ACh receptors

The nurse is educating a client with myasthenia gravis about medications. The nurse is sure to include which of the following?

medications must be taken on time

A home health nurse is providing care to a patient diagnosed with myasthenia gravis. Today the nurse plans on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?

morning

tensilon IV injection for myasthenia gravis

should improve muscle function

A client has been newly diagnosed with myasthenia gravis. What education should the nurse provide the client and family?

the signs and symptoms of a medication overdose

myasthenia gravis medical management: IV therapy

therapeutic plasma exchange

A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapheresis and explains this in which of the following statements?

Antibodies are removed from the plasma

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

Edrophonium (Tensilon)

A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?

It stimulates the parasympathetic nervous system

bulbar weakness

can't talk, swallow

ptosis

drooping

The neurologist is conducting a Tensilon test (edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of edrophonium would confirm a diagnosis of myasthenia gravis?

the patient experiences improved muscle strength - 30 seconds after injection, facial muscle weakness and ptosis should resolve for about 5 min, which represents a positive test and usually confirms diagnosis

The nurse is preparing a patient for an endoscopic procedure that will use a nondepolarizing neuromuscular junction (NMJ) blocking agent. Which condition in the patient's history will require a change in anesthetic medication?

Myasthenia gravis

A patient diagnosed with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take pyridostigmine. At what time should the nurse administer this medication so the patient will have the maximum benefit of this medication?

as soon as possible - onset of action 35-45 min; duration 3-6 hours, therefore peak action around 90 min

A nurse is teaching a group of patients diagnosed with myasthenia gravis about treatment options. Which of the following is not a treatment option for this condition?

cholinesterase medications

myasthenia crisis treatment

pyridostigmine

therapeutic plasma exchange

removal of blood plasma to filter antibodies - used for patients with myasthenia gravis

A client being treated for myasthenia gravis is receiving neostigmine. When the client's pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia?

atropine

A nurse is preparing to help a neurologist conduct a Tensilon test. Which antidote should the nurse have on hand in case of an emergency?

atropine - reverses potential side effects such as bradycardia, systole, bronchoconstriction, sweating, and cramping

Today you are caring for James, a 47-year-old man who suffers from myasthenia gravis. He has periods of great weakness and is unable to do the things for his family that he would like to. He says to you, "I am not worth much these days". Knowing that sometimes patients focus on things they cannot do, which of the following statements by you might be helpful?

"What are some of the things you do well?"

myasthenia gravis diagnostics

- ACTH test (tensilon IV injection which should improve muscle function) - ice test (best used for patients with cardiac disorders) - ACTH blood test (definitive confirmation) - repetitive nerve stimulation EMG MRI

myasthenia crisis assessment

- airway/respiratory support (may need intubation or NG tube) - ABGs, serum electrolytes, I&O, daily weight

A nurse observing a client receiving treatment with pyridostigmine for myasthenia gravis notices the client clenching the jaw, salivating excessively, and experiencing muscle weakness, rigidity, and spasm. The nurse interprets these as indicating which of the following?

cholinergic crisis

ACTH blood test for myasthenia gravis is...

definitive confirmation

diplopia

double vision

medication for reversal of pyridostigmine (ACTH inhibitor) for myasthenia gravis

atropine

The nurse is providing education to a client who has been recently diagnosed with myasthenia gravis. During teaching, the nurse would describe it as what type of disorder?

autoimmune

myasthenia gravis

autoimmune (motor) disorder affecting neuromuscular function

myasthenia crisis contraindications/interactions

avoid SEDATIVES - worsens hypoxia

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by...

a positive edrophonium test

myasthenia gravis medical management: surgical

thymectomy

putting ice on ptosis

you'll see an immediate change

pyridostigmine (ACTH inhibitor) adverse effects

- bradycardia - cardiac arrest - hypotension - bronchospasm - anticholinergic effects

myasthenia gravis clinical manifestations

- involves ocular muscles (diplopia and ptosis) - facial and throat muscle weakness (dysphagia, dysphonia, generalized weakness, respiratory failure

myasthenia gravis nursing interventions

- minimize stress - avoid high environmental temperatures - medication management

pyridostigmine (ACTH inhibitor) patient teaching

- must take on time (before meals) - wear a medical alert bracelet

myasthenia gravis complications

- myasthenia crisis - cholinergic crisis

myasthenia gravis medical management: pharmacological

- pyridostigmine (ACTH inhibitor) - intravenous immunoglobulin/IVIG (immunomodulator)

what signs and symptoms can present in myasthenia gravis?

- respiratory failure - diplopia - ptosis - slurred speech - mask-like appearance of looking sleepy - difficulty swallowing

cholinergic crisis s/s

- severe muscle weakness - respiratory and bulbar weakness

myasthenia crisis s/s

- severe muscle weakness - respiratory and bulbar weakness

Intravenous immunoglobulin (IVIG) for myasthenia gravis

- the infused antibodies will, for a time, dilute the abnormal host antibodies that are causing the disease - presence of large amounts of IgG will also suppress the production of host IgG (including, hopefully, the disease causing antibodies)

A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem?

Myasthenia gravis

myasthenia gravis medical management

NO CURE - reduce circulating antibodies