RN Student: Myasthenia Gravis

It is a chronic autoimmune, in which autoantibody attack Acetycholine receptors. Therefore nerves fail to give skeletal muscle contraction. The Thymus gland is often abnormal and Hyperthoidism is also associated. This disease affect women more, and onset at 20-30 yrs old.

MG affects the MOTOR system such as muscle weakness, poor posture, ptosis, weak/incomplete eye closure, Diplopia, Respiratory compromise, Loss of Bowel/Bladder conrol, Fatigue, Dysphagia/Dysarthria.
It also affects the SENSORY: Parethesia, Decreased smell and taste, and muscle ache.

1. EMG
2. CXR/CT for Thymus gland
3. Thyroid function test
4. Lab shows Acetylcholine antibodies increased
5. Tensilon Testing

It is a test used to confirm MG. Tensilon is an anticholeresterase inhibitor injection. In MG pts, Tensilon injection will cause a marked improvement of muscle tone for 4-5 minutes.

V. Fib and Cardiac Arrest

Atropine should always be ready when use of Tensilon.

1. Cholineresterase inhibitors drugs: Pyrigdostigmine (Mestinon, Regonal), Neostigmine (Prostigmine)
2. Immunosuppressants
3. Plasmapheresis
4. Thymectomy

Give medication ON TIME! At least an hour or two before activities, meals, etc.

Avoid giving Morphine or sedatives because it cause more muscle weakness and comprise breathing.

1. Myasthenic Crisis, which is being undermedicated with anthicholeresterase inhibitor. 2. Cholinergic Crisis, which is being overmedicated with anticholineresterase inhibihor.

So whether u give little or too much anthicholineresterase inhibitor will cause crisis.

Give Tensilon to improve the symptoms,

Give anticholinergic (Atropine) to reduce the symptoms.