myasthenia gravis ppt

8/13/2019 Myasthenia Gravis ppt

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PATHOPHYSIOLOGY


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Age

Predisposing Factor

Incidence of Myasthenia Gravisoccurs between ages 15-35 for

women. (Porth p.1131)

Our patient is 29 years old.

Gender

HereditaryA person born into family withhistory of certain autoimmune

disease is at risk of developing

such autoimmune disease.(www.emedicine.com)

Myasthenia Gravis is three times

more common in women than men.(Porth, p1131)


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Precipitating Factor

Poor environmentPoor house/ office

Ventilationcrowded environment

Location

StressOccupation

Constant exposure to dustor chemical substances can

weaken the immune systemof every individual that

lead to infection.(www.emedicine.com)

Stress can weaken the immune system.According to psychoneuroimmunology, they

found consistent stress-related increases innumbers of total white blood cell, as well asdecreases in the numbers of helper T cells,suppressor T cells, and cytotoxic T cells, Bcell, and natural killer T cells.

(www.emedicine.com)


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Predisposing FactorPrecipitating Factor

Abnormal DNA mutation

Production of abnormalT-Cells

Difference in the variableRegion of antibodies

Decrease # of T-cell

Alteration of the T-cells function


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Abnormal Antibodies

Unable to recognize Self-antigen

Attacking the AcetylcholineReceptor Sites

Inhibit musclespecific Protein

MuSK

Malformations ofNeuromuscular

Junction

Destruction of AcetylcholineReceptor Sites

Decreased PatencyOf NeuromuscularJunction

Decrease # of functioningAcetylcholine Receptors site


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Myasthenia Gravis

S/sxExpressionless faceNasal timbrePtosis

DiplopiaDysphagiaDysarthriaDysphoniaWeakness of all Extremities


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A blood test for the remaining 15% of seronegative (SN) MG patients, thosewho have tested negative for the acetylcholine antibody, 40-70% testpositive for the anti-MuSK antibody. The remaining patients have anunidentified antibody causing their MG.

Anti-MuSK Antibody testing

Nursing DiagnosisFatigue r/t generalized muscle weakness 2 MG.

Independent Action:

Schedule/ organize activitiesAssist pt. with ADLs These can minimize energy expenditure and prevent injury with activities


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Collaborative:

Pyridostismine bromide 65mg/ tab, 1 tab t.i.d. Pyridostigmine is used to improve muscle strength in patients

with a certain muscle disease (myasthenia gravis). It works by

preventing the breakdown of a certain natural substance

(acetylcholine) in your body. Acetylcholine is needed for normal

muscle function.

Azathioprine 50mg tab O.D.

An immunosuppressive medication that decreases the actions of

the bodysimmune system. Drugs that suppress the immune system

are used in patients with myasthenia gravis because MG is an

autoimmune disorder that results from the production of abnormal

antibodies.


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Prednisone 20mg, 1 tab q 12

Prednisone is a corticosteroid hormone (glucocorticoid). It decreases your

immune system's response to various diseases to reduce symptoms such asswelling and allergic-type reactions. It is used to treat conditions such as

arthritis, blood disorders, breathing problems, certain cancers, eye problems,

immune system diseases, and skin diseases.

S/sx

Inability to expectoraterespiratory muscle weakness

Disruption of mechanical

defense

Invasion of microorganism innasal


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S/Sx:CoughCrackles

Diagnostic Test

Jan. 5 - Increased WBC-Neutrophils- 90 x10g/lLymphocytes- 4x10g/l

Jan. 9- ETA/ GSCS result

14-16x10g/l

The culture result reveals that the specific type

of bacteria called Acinetobacter baumaanii issusceptible to certain types of antibiotics such as:

Amikacin, Ampi/Sulbactam, Ceftaxidine,

Ciprofloxacin, Gentamicin, Ticarcillin and Tobramycin;

hence, effective in killing these types of microorganisms.


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Nursing Diagnosis

Ineffective airway clearance r/t retainedtracheobronchial secretions 2 MG, CAP

Independent Action:

Suction secretion ,prn It mechanically clears airway in pt. who is unable

to do so because of ineffective cough.Assist pt. in performing Deep breathing exercises Deep breathing facilitates maximum expansionof the lung areas.

Collaborative

Sultamicilline 150mg, 1 tab. B.i.d.Acinetobacter baumaanii is susceptible toSultamicilline


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From MG

If treated:MedicationsLaboratoriesSurgeriesHealth Teachings

If treated

Activation of immune system

Release of Endotoxin andexotoxins

If complaint If not compliant Inflammation of the Lungsparenchyma

PNEUMONIAFurther distraction of

Acetylcholine Receptorsites

Lessen the S/sx

Colonization of microorganism

Invasion of microorganism in

the lungs


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Nursing Diagnosis

Risk for Aspiration r/t muscle weakness 2 MG

Independent Action:

Assess Gag reflex Pt. with weak gag reflex is at risk for aspiration

Keep pt. upright for 30-60 min. after meals

The upright position facilitates the gravitational flow offood or fluid through the alimentary tract and reduces therisk of aspiration.

Keep suction equipment at bedside and suction necessary.

This is necessary to maintain patent airway.

Collaborative:Monitor ABG and pulse oximeter pulling of secretions leads to pneumonia which will lead tomore aggressive interventions.


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From MG

If treated:MedicationsLaboratoriesSurgeriesHealth Teachings

If treated

Activation of immune system

Release of Endotoxin andexotoxins

If complaint If not compliant Inflammation of the Lungsparenchyma

PNEUMONIAFurther distraction of

Acetylcholine Receptorsites

Lessen the S/sx

Colonization of microorganism

Invasion of microorganism in

the lungs


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Criteria Poor(1)

Fair

(2)

Good

(3)

Justification

a. Duration of illness Our patient has been diagnosed withMyasthenia Gravis for more than a yearnow. She has been admitted for a few

times due to the complications led by her

illness.

b. Onset of Illness During the first few weeks upon the onsetof symptoms, the patient continuedworking as a clerk. She only sought for

medical intervention when she can no

longer bear the symptoms she felt.

c. Precipitating

Factors With the precipitating factors, our patient

has poor prognosis since her age bracket

falls in middle adulthood (29 years old).

Considering also that she is a female and

such disease is common in their gender.


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d. Willingness to takeMedications

Our patient was able to comply with hermedications as evidenced by taking in her

medicine on time and having sufficient

financial resources to sustain her

medications.

e. Age Myasthenia Gravis commonly affects youngadult women, usually those under the age of

40. Since our patient is 29 years old, she has

a poor prognosis when age is considered.

f. Environment Our patient lives in a stressful environment.Stress can trigger the remission of

symptoms

g. Family Support The patientsfamily is supportive. They arealways there when she needs them.

Score: 2+2+1+3+1+1+3= 13/7=1.85 (poor - fair)


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Based on the data, our patient got an average score of

1.85 in 7 criteria which means poor to fair prognosis.

In addition, both fair and good prognosis got 2 criteria

while the precipitating factors, age, and environment got a score

of 1 or poor prognosis. With this data, our patient is more

susceptible for the recurrence of the disease. If this will not becorrected, this will lead to poor prognosis.

If the patient is compliant with the treatment, she will

have a significant improvement in her muscle weakness and

can expect to live a normal life. If some factors such as stress

Will be encountered then there is possible recurrence.

myasthenia gravis ppt

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