Myasthenia gravis nursing NCLEX review on symptoms, treatment, pathophysiology, nursing interventions, and pharmacology. This review will also discuss myasthenic crisis vs. cholinergic crisis and the Tensilon test (Edrophonium).
What is myasthenia gravis? It is an autoimmune condition where the body attacks the receptors that allow for voluntary muscle control, which leads to muscle weakness.
In myasthenia gravis, the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system. This limits the amount of acetylcholine that can transmit to the receptor leading to muscle weakness. In addition, the thymus gland plays a role in myasthenia gravis in that it may create the antibodies that attack the nicotinic receptors.
Symptoms of myasthenia gravis include: weakness of the neck, face, arms/legs, eye drooping (ptosis), mask-like appearance that looks sleepy, recurrent gagging or choking while eating (difficulty swallowing), strabismus, slurred speech.
Treatment for myasthenia gravis includes: anticholinesterase medications (Pyridostigmine) which will make more acetylcholine available at the receptor site to increase muscle strength. Also, corticosteroids or immune suppressors can be ordered. In addition, a thymectomy (removal of the thymus gland) can be performed along with plasmapheresis with IV immunoglobulin therapy.
A tenslion test can be performed to diagnosed myasthenia gravis or differentiate between myasthenic crisis vs. cholinergic crisis. During this test signs and symptoms will improve after the administration of Edrophonium if myasthenia gravis or myasthenic gravis is present, but worsen if cholinergic crisis is present.
CORRECTION: At 14:58, when I discuss Edrophonium (the Tensilon Test) it should say that Edrophonium is a acetylcholinesterase inhibitor (which is a cholinesterase inhibitor) NOT ANTIcholinesterase.
Nursing interventions for myasthenia gravis include: monitoring airway, assessing neuromuscular status, monitoring for aspiration, education about food and activities, following speech pathologist recommendations etc.
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