myasthenia gravis

Select all the signs and symptoms associated with cholinergic crisis:* A. Miosis B. Dry mouth C. Blurred vision D. Constipation E. Muscle fasciculation F. Diarrhea and abdominal cramping G. Respiratory failure

A. Miosis C. Blurred vision E. Muscle fasciculation F. Diarrhea and abdominal cramping G. Respiratory failure

A patient is experiencing unexplained muscle weakness and respiratory failure. The neurologist conducts a Tensilon test to differentiate between myasthenic crisis or cholinergic crisis. During the test the patient experiences improved muscle strength. Based on this finding the patient has:* A. Myasthenic Crisis B. Cholinergic Crisis C. Neither

A. Myasthenic Crisis

You are teaching your patient diagnosed with myasthenia gravis about treatments. Which of the following statements, if made by the patient indicates the need for further teaching? A) Plasmapheresis is way to reduce symptoms but will need to be done every day B) A thymectomy is a removal of my thymus gland and will show some immediate relieving of my symptoms C) Corticosteroids can be used for short periods of time to help improve my symptoms, but it isn't good for long periods of time D) I need to take my Mestinon four times a day at the same time each day

B) A thymectomy is a removal of my thymus gland and will show some immediate relieving of my symptoms Answer: B. A thymectomy may help reduce symptoms, but the effects may not be seen for many months after surgery. Plasmapheresis is the removal of antibodies from blood plasma. It must be done daily for a period of time. Corticosteroids are mostly used for short periods of time unless the patient is experiencing ocular complications. Pyridostigmine bromide (Mestinon) is divided into several doses and should be taken at the same time daily.

While assisting with a Tensilon test you will have what antidote on hand?* A. Narcan B. Atropine C. Flumazenil D. Glucagon

B. Atropine

The patient with myasthenia gravis arrives to the clinic and states that he is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 Temp 100.0 R 19 O2 97%. What is the nursing priority?A) Prepare the patient for intubation. He is about to go into a myasthenic crisis. B) Perform teaching on medication side effects C) Assess for signs of infection D) Further assess for other thymectomy complications

C) Assess for signs of infection Answer: C. Although the GI symptoms is a common side effect of medicaitons, it is important to follow up on the high temperature and assess for sings of infection. An infection can often exacerbate a Myasthenic crisis and should be carefully monitored for. There is no evidence that this person is about to have a myasthenic crisis and intubation should only be done if the patient is experiencing respiratory failure. There is no evidence that this patient has had a thymectomy.

Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse's priority intervention is to: A. Administer the medication exactly on time B. Administer the medication with food or mild C. Evaluate the clients muscle strength hourly after medication D. Evaluate the clients emotional side effects between doses

C. Evaluate the clients muscle strength hourly after medication

diagnosis of myasthenia gravis

CT, lab, EMG, Tensilon test

The patient with myasthenia gravis is complaining about dealing with muscle weakness. Which of the following could the nurse do for this patient? A) Administer antispasmodic medication B) Teach the patient to do physical exercise for several hours each day to help strengthen muscles C) Teach the patient it is important to avoid all forms of physical activity whenever possible D) Help the patient form a plan to take medications on time

D) Help the patient form a plan to take medications on time Answer: D. Taking medications at the same time each day will help reduce the exacerbation of muscle weakness. Antispasmodic medications are not indicated for this patient. Exercising for that much time each day will worsen muscle weakness and fatigue and is not feasible. The patient does not need to avoid all forms of physical activity. They need to time out physical activity with peaks of the medication in order to conserve energy.

Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to: A. Change her diet order from soft foods to clear liquids B. Place an emergency tracheostomy set in her room C. Assess her respiratory status before and after meals D. Coordinate her meal schedule with the peak effect of her medication, Mestinon

D. Coordinate her meal schedule with the peak effect of her medication, Mestinon

The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? A. Visual disturbances, including diplopia B. Ascending paralysis and loss of motor function C. Cogwheel rigidity and loss of coordination D. Progressive weakness that is worse at the days end

D. Progressive weakness that is worse at the days end

what to assess in your myasthenia gravis patient

energy level swallow breathing

Causes of Myasthenia Gravis

enlarged thymus, hyperthyroidism, possibly genetic, pregnancy, medications

What does pyridostigmine bromide do?

inhibits the destruction of Ach by cholinesterase thereby making it more available

cholinergic crisis is caused by

overmedication of anticholinesterase medication

when to take anticholinesterase

prior to meals for strength

signs and symptoms of myasthenia gravis

ptosis, diplopia, chewing , swallowing difficulties, weak voice (dysphonia), generalized weakness

. __________________ happens due to excessive stimulation of the receptors at the neuromuscular junction by acetylcholine, which eventually leads to muscle weakness and respiratory failure.* A. Myasthenic crisis B. Cholinergic crisis

B. Cholinergic crisis

_________________ happens due to minimal to no stimulation of the receptors at the neuromuscular junction site by acetylcholine because there is damage to the receptor sites, which leads to muscle weakness and respiratory failure.* A. Myasthenic crisis B. Cholinergic crisis

A. Myasthenic crisis

The most significant initial nursing observations that need to be made about a client with myasthenia include: A. Ability to chew and speak distinctly B. Degree of anxiety about her diagnosis C. Ability to smile an to close her eyelids D. Respiratory exchange and ability to swallow

A. Ability to chew and speak distinctly

Select all the signs and symptoms associated with a myasthenic crisis:* A. Pupil dilation B. Muscle fasciculation C. Miosis D. Bowel and bladder incontinence E. Negative gag or cough reflex F. Respiratory failure G. Bradycardia

A. Pupil dilation D. Bowel and bladder incontinence E. Negative gag or cough reflex F. Respiratory failure

A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by: A.Blocking the action of cholinesterase B.Accelerating transmission along neural swaths C.Replacing deficient neurotransmitters D.Stimulating the cerebral cortex

A.Blocking the action of cholinesterase

The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: A.Prostigmine (neostigmine) B.Atropine (atropine sulfate) C.Didronel (etidronate) D.Tensilon (edrophonium)

A.Prostigmine (neostigmine)

During a Tensilon test the patient has worsening of muscle weakness. The nurse anticipates that the physician will give the following order?* A. Administer Atropine along with an anticholinesterase medication. B. Administer Atropine and hold any further doses of Pyridostigmine. C. Administer Pyridostigmine and hold Atropine. D. Administer Edrophonium along with Atropine.

B. Administer Atropine and hold any further doses of Pyridostigmine.

Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: A.Inhibits the breakdown of acetylcholine at the neuromuscular junction. B.Decreases the production of autoantibodies that attack the acetylcholine receptors. C.Promotes the removal of antibodies that impair the transmission of impulses D.Stimulates the production of acetylcholine at the neuromuscular junction.

B.Decreases the production of autoantibodies that attack the acetylcholine receptors. Steroids decrease the body's immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to: A. Develop a teaching plan B. Facilitate psychologic adjustment C. Maintain the present muscle strength D. Prepare for the appearance of myasthenic crisis

C. Maintain the present muscle strength

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: A. Getting too little exercise B. Taking excess medication C. Omitting doses of medication D. Increasing intake of fatty foods

C. Omitting doses of medication

Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces: A. Brief exaggeration of symptoms B. Prolonged symptomatic improvement C. Rapid but brief symptomatic improvement D. Symptomatic improvement of just the ptosis

C. Rapid but brief symptomatic improvement

The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time? A.Reschedule patient's physical therapy. B.Recheck vital signs in 1 hour. C.Notify the physician immediately. D.Administer an acetaminophen suppository.

C.Notify the physician immediately. The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient's respiratory status. The patient may need incubation and mechanical ventilation. The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. This patient's vital signs need to be re-checked sooner than 1 hour. Rescheduling the physical therapy can be delegated to the unit clerk and is not urgent. Focus: Prioritization

You're patient is recovering from a myasthenic crisis and you are providing education to the patient about the causes of this condition. Which statement by the patient demonstrates they understood the teaching about how to prevent this condition?* A. "I will make sure I don't take too much of my anticholinesterase medication because it can lead to this condition." B. "I will avoid milk products while taking Pyridostigmine because it increases the chances of toxicity." C. "I will avoid taking over-the-counter supplements that contain aconite." D. "I will avoid people who are sick with respiratory infections and be sure not to miss my scheduled doses of Pyridostigmine."

D. "I will avoid people who are sick with respiratory infections and be sure not to miss my scheduled doses of Pyridostigmine."

You're examining a patient's health history and find that the patient experienced a cholinergic crisis last year. As the nurse you know that the most common cause of a cholinergic crisis is?* A. Over usage of adrenergic blocker medications B. Stress C. Respiratory infections D. Overmedication of an anticholinesterase medication

D. Overmedication of an anticholinesterase medication

cholinergic crisis S/S

SLUDGE S: Salivation L: Lacrimation (tears) U: Urination D: Defecation G: Gastric Upset E: Emesis hypotension, bradycardia respiratory failure

a client with myasthenia gravis has been prescribed to take pyridostigmine (Mestinon). What health teaching will the nurse include related to this drug? selected all that apply a. "watch for signs and symptoms of myasthenia crisis" b. "take the drug about an hour before eating a meal" c. "take the same dose of medication every day" d. "take the drug with food to prevent nausea" e. "do not take sedatives or sleeping pills while on this drug"

a. "watch for signs and symptoms of myasthenia crisis" b. "take the drug about an hour before eating a meal" c. "take the same dose of medication every day" e. "do not take sedatives or sleeping pills while on this drug"

when caring for a client with myasthenia gravis which of these nursing activities may be safely delegated to a nursing assistant? select all that apply a. feeding dinner to the client b. teaching the family about drug therapy c. assisting with client communication d. consulting with the physical therapist e. assisting with ambulation f. recording food and fluid intake

a. feeding dinner to the client c. assisting with client communication e. assisting with ambulation f. recording food and fluid intake

what is the pathophysiology of myasthenia gravis

autoimmune disorder affecting the neuromuscular junction causing muscle weakness

myasthenic crisis

severe generalized muscle weakness with respiratory and bulbar weakness tachycardia, HTN, respiratory failure

medical management of myasthenia gravis

~ Anticholinesterase medication ~ Pyridostigmine bromide (Mestinon) = First line!! ~ Immunosuppressive agents ~ -cytoxin - Corticosteroids -IVIG -Plasmapheresis -Thymectomy