myasthenia gravis Flashcards
myasthenia gravis is low in?
acetylcholine or ACH
a neuromuscular disorder characterized by failure of transmission of nerve impulses at the myoneural junction
myasthenia gravis
MG is what type of disorder
autoimmune disorder
there is a decreased number of what?
functioning acetylcholine receptor sites
age for young women in MG
20-30
age in older men for MG
60-70
start of symptoms
Mind to Ground
Descending weakness
Patho
cytotoxin - production of b-cells - blocks the nicotinic receptor
clinical manifestations
muscle weakness associated with activity - relieved by rest
early morning, full of energy ang ptx with MG but in tye evening, may weakness na
fatigue
impaired speech
ptosis (di magalaw ang eyelids)
diplopia (double vision)
strabismus (duling)
snarl-mask like facial expression
dysphagia (diff in swallowing)
drooling
descending weakness
triangular-shaped muscle located in each upper eyelid. The primary function is elevation and retraction of the upper eyelid
levator palpebrae superioris
diagnostic test
tensilon test (edrophonium test) - temporarily increases muscle strength
administer through iv 2 mg muna bago 8 mg
results in tensilon test
if positive, patient shows surge of energy and muscle strength but returns after 3-5 minutes
if negative - no changes and has muscle weakness (cholinergic crisis, to rule out MG)
means to destroy
anticholinesterase
first priority
safety in airway
(asssess gag reflex: muscle weakness - cannot swallow properly - aspiration)
positive result in tensilon test
ptx shows surge of energy and muscle strength but returns after 3-5 minutes
negative tensilon test
muscle weakness
no changes in energy
what drug is taken during tensilon test
edrophonium
nursing mgmt
assess airway -ability to chew and swallow, cold water to contract muscles in tongue, possible blockage: asthma, foreign object
assess breathing
promote rest through cluster activity (isang bagsakan para mabilis mapagod si ptx)
prevent client from falls
avoid exposure to infections
start meal with cold beverage to contract muscle of the throat
administer medication on time to prevent constipation
administer meds 20-30 mins before meals
pharmacological mgmt
acetylchonlinesterase inhibitor/anticholinesterase
- neostigmine (prostigmin) MESTONIN
- ambenomium
drug mechanism of action
prevents breakdown of ACH ths helps in neuromuscular impulse
caused by undermedication
myasthenia crisis
myasthenia crisis manifestation
elevated HR and BP
severe respiratory distress
cyanosis
absent swallow reflex
bowel and bladder incontinence
severe weakness
management for myasthenia crisis
increase the dose of edrophonium or mestinon and ready for mech vent
caused by overmedication
cholinergic crisis
manifestations of cholinergic crisis
diarrhea
polyuria
blurred vision
increased salivation
dysphagia
blurred vision
increased salivation
severe weakness
management for cholinergic crisis
provide mech vent
discontinue drug until it decreases
provide 1mg of atropine sulfate
normal value of ach and dopamine
high ACH,high dopamine
for antiinflammatory effects and to suppress production of antibodies
glucocorticoids/corticosteroids
to prevent gastrointestinal upset due to glucocorticoids
antacids
removal of the thymus gland that possibly causes the autoimmune response since 25% of patients with MG was found with thymons
surgical intervention for MG
Thymectomy
antidote for acetylcholine
atropine sulfate
