blood

1. MYASTHENIA GRAVIS
DEPARTMENT
OF
MEDICAL SURGICAL NURSING
Smt. Radhikabai Meghe Memorial College
of
Nursing

2. Learning Objectives
At the end of the class, students are able to
• define Myasthenia Gravis
• Explain the pathophysiology of Myasthenia
Gravis.
• Enlist the clinical manifestation of
myasthenia gravis.
• Describe the diagnostic evaluation of it
• Discuss the management of myasthenia
gravis.

3. DEFINITION :
MYASTHENIA GRAVIS Myasthenia gravis (MG) is
a rare autoimmune disease.
It is a disorder of neuromuscular function
thought to be due to the presence of antibodies
to acetylcholine receptors at the neuromuscular
junction .

4. PATHOPHYSIOLOGY
• a chemical impulse precipitates the release of
acetylcholine
• from vesicles on the nerve terminal at the
myoneural
• junction.

5. • The acetylcholine attaches to receptor sites on
the motor end plate, stimulating muscle
contraction.
• Continuous binding of acetylcholine to the
receptor site is required for muscular
contraction to be sustained.

6. • In myasthenia gravis, autoantibodies directed at
the acetylcholine receptor sites impair
transmission of impulse across the myoneural
junction.

7. CLINICAL MANIFESTATION
• Diplopia (double vision)
• ptosis (drooping of the eyelids)
• Weakness
• Generalized weakness
• dysphonia (voice impairment)
• Weakness of the facial muscles

8. Assessment and Diagnostic Findings
• An anticholinesterase test is used to diagnose
myasthenia gravis.
• Edrophonium chloride (Tensilon) is injected
intravenously, 2 mg at a time to a total of 10 mg.

9. • This immediate improvement in muscle
strength after administration of this agent
represents a positive test and usually confirms
the diagnosis.

10. • The thymus gland, which is a site of
acetylcholine receptor antibody production, is
enlarged in myasthenia gravis.

11. Management
PHARMACOLOGIC THERAPY
• pyridostigmine bromide
• neostigmine bromide (Prostigmin)
• immunosuppressive therapy
• Corticosteroids suppress the patient’s immune
response.

12. • Medications such as azathioprine (Imuran),
cyclophosphamide (Cytoxan), and
cyclosporine reduce the circulating
antiacetylcholinereceptor antibody titers.

13. PLASMAPHERESIS
Plasma exchange (plasmapheresis) is a
technique used to treat exacerbations

14. SURGICAL MANAGEMENT
• Thymectomy (surgical removal of the thymus
gland) can produce antigen-specific
immunosuppression

15. Nursing Management
• Educational topics for outpatient self-care
include medication management, energy
conservation, strategies to help with ocular
manifestations, and prevention and
management of complications.

16. • Medication management, Understanding the
action of the medications and taking them on
schedule is emphasized.
• The patient is also taught srategies to conserve
energy

17. Summary
• So far we have discussed about Definition,
Pathophysiology, clinical manifestation,
diagnostic evaluation and management of
Myasthenia Gravis.

18. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

19. Thank You