Neuromuscular

Question 1

Pathophysiology of MG

Answer 1

Neuromuscular disorder

Issues with transmission of impulses at the post-synaptic neuromuscular junction

Question 2

Autoimmune involvement with MG

Answer 2

Involves antibody-mediated disruption of Acetylcholine receptors

Question 3

Possible cause of MG?

Answer 3

Thymus tumors often associated with MG

Question 4

Occurrence of MG

Answer 4

more commonly women/men

Women 30, men 40/50

Question 5

What relation to activity does MG have?

Answer 5

Increased muscle weakness with activity, relieved with rest

Question 6

What medication is used to treat MG since it is progressive not curable

Answer 6

anticholinergic

Question 7

Subjective assessments

Answer 7

Muscle fatigue- increased with use, improves with rest
Dysphagia
diplopia-double vision 
dysarthria- difficulty speaking
Dyspnea

Question 8

Objective assessments

Answer 8

Ptosis of eyelid- Early sign
Myasthenic smile- snarling/ nasal smile
Strabismus- cross-eyed
Voice weakness
Articulation problem- w/ continued conversation
Muscle strength decreases with use C/O resp failure, bowel bladder incontinence

Question 9

What is the thymus responsible for1

Answer 9

Produces T lymphocytes

Question 10

How is MG dx

Answer 10

Tension test

Question 11

What is given for the tension test?

Answer 11

IV edrophonium
muscle weakness is relieved for +/- 5 mins for positive
Worse for negative results

Question 12

Electrophysiologic tests

Answer 12

Decrease in action potential amplitude in 60%

Question 13

AchR serum Antibody titer

Answer 13

Sensitivity 90% in generalized

Ocular 50%

Question 14

Medical management

Answer 14

Anticholinesterases
Pyridostigmine- mestinon PO
Neostigmine- Prostigmin IV

Immunosuppressants- corticosteroids

Question 15

What is the antidote for anticholinesterase

Answer 15

Atropine

Question 16

Surgery?

Answer 16

Thymectomy d/ tumor- may cause remission

Question 17

Myasthenic crisis

Answer 17

R/T medication- too little too late

Question 18

Onset of Myasthenic crisis

Answer 18

Abrupt, sever, generalized muscle weakness

Inability to speak, swallow, or maintain RESP!!

Question 19

Cause of myasthenic crisis?

Answer 19

under medication!

infection, stress (physical or emotional)

Question 20

Test for Myasthenic crisis

Answer 20

IV edrophonium

Symptoms will improve +/- 5 mins (positive tensilon test)

Question 21

Nursing considerations for myasthenic crisis

Answer 21

increase medication drugs as rxd by prescriber

Question 22

Cholinergic crisis

Answer 22

r/t Medication- too much or taken too soon

Question 23

Symptoms of cholinergic crisis

Answer 23

excessive salivating, sweating, urinary incontinence, hyperperistalsis (N/V/D)
Bronchorrhea, wheezing
bradycardia
Miosis
Muscle fasciculations & weakness
Anxious, agitated

Question 24

Test for cholinergic crisis

Answer 24

Iv edrophonium, if muscle symptoms get worse +/- 5 mins= Negative tensilon test
Keep antidote atropine and emergency equipment on hand

Question 25

What is necessary at bedside

Answer 25

trach kit, endotrach kit- ventilation may be necessary