Nursing Care Plan Interventions For Myasthenia Gravis

Myasthenia Gravis is an autoimmune disorder of the neuromuscular junction. This condition is characterized by fluctuating weakness of the skeletal muscle group that worsens with use and improves with rest. The classic sign of Myasthenia Gravis is the fluctuating weakness of the skeletal muscle

Developing Nursing Care Plan Interventions For Myasthenia Gravis

Introduction

Myasthenia gravis is a chronic autoimmune illness that causes muscle weakness and exhaustion by affecting the neuromuscular junction. Various muscles, including those needed for breathing, swallowing, and speaking, might be affected by the illness. There are several therapy options that can help manage symptoms and improve quality of life.

Myasthenia Gravis Pathophysiology

Myasthenia gravis (MG) is an autoimmune disorder where the body’s immune system attacks the acetylcholine receptors (AChRs) on muscle cells, causing muscle weakness and fatigue. The destruction of AChRs leads to a reduction in the number of functioning receptors, which results in weakened muscle contractions. Treatment options aim to increase the number of functioning AChRs, improve nerve transmission to the muscles, and suppress the immune system’s attack on AChRs and MuSK.

Myasthenia Gravis Causes and risk factors

The exact causes of MG are still unknown, but it is thought to be related to genetic predisposition, environmental triggers, and immunological factors.

Myasthenia Gravis Symptoms

The hallmark symptom of MG is muscle weakness, which typically worsens with use and improves with rest. Some of the most common symptoms of MG include:

  1. Diplopia (double vision): This occurs when the muscles that control eye movement are affected by MG, causing the eyes to point in different directions.
  2. Ptosis (drooping eyelids): MG can cause weakness in the muscles that control the eyelids, resulting in one or both eyelids drooping.
  3. Dysarthria (difficulty speaking): MG can cause weakness in the muscles that control the tongue, lips, and throat, resulting in difficulty speaking clearly.
  4. Dysphagia (difficulty swallowing): MG can cause weakness in the muscles involved in swallowing, making it difficult to swallow food and liquids.
  5. Weakness in the limbs: MG can cause weakness in the arms and legs, making it difficult to perform tasks that require strength, such as lifting objects or climbing stairs.
  6. Fatigue: MG can cause a general feeling of fatigue, even after minimal physical activity.
  7. Shortness of breath: In severe cases, MG can affect the muscles involved in breathing, making it difficult to breathe.

As a nurse, you play an important role in assisting patients with myasthenia gravis in managing their symptoms and achieving their treatment objectives. This post will go over a nursing care plan for myasthenia gravis that focuses on symptom management and quality of life.

Nursing Care Plan Interventions For Myasthenia Gravis

Nursing Care Plan for Myasthenia Gravis: Managing Symptoms and Improving Quality of Life

The first step in creating a nursing care plan for myasthenia gravis is to assess the patient’s condition. This involves gathering information about the patient’s symptoms, medical history, medications, and lifestyle. You should also evaluate the patient’s ability to perform activities of daily living (ADLs) and their overall physical and emotional well-being.

Nursing Diagnosis for Myasthenia Gravis

  • Ineffective airway clearance related to disease process, Weak oropharyngeal muscle contraction decreased ability to cough and swallow
  • Risk for infection related to disease process weak oropharyngeal muscle contraction, depressed gag reflex
  • Fatigue related to the disease process and muscle weakness
  • Interrupted family process related to the crisis of dealing with the diagnosis
  • Impaired physical mobility related to the defective transmission of nerve impulses at the neuromuscular junction
  • Imbalanced nutrition: Less than body requirements related to difficulty eating and swallowing
  • Impaired swallowing related to neuromuscular impairment
  • Risk for caregiver role strain: Risk factors: severity of illness of the client, overwhelming needs of the client

I) Ineffective airway clearance related to disease process, Weak oropharyngeal muscle contraction decreased ability to cough and swallow

Evidenced by

1) absent or ineffective cough
2) adventitious breath sound
3) altered respiratory rhythm
4)rapid, shallow breathing
5) cyanosis
6) difficulty verbalizing and nasal flaring

Outcome
The patient will demonstrate effective coughing, clear breath sounds, and a clear airway without respiratory distress symptoms.
The patient will verbalize one strategy to maintain airway strength and support

Assessment

1) Assess the respiratory rate, rhythm, and lung sound
Alterations in respiratory rate and rhythm are present when there is an attempt to compensate for ineffective airway clearance and breathing. Diminished lung sounds or the presence of adventitious lung sounds can indicate a blocked airway
2) Evaluate and monitor ABG values
Alteration in ABG levels indicates worsening respiratory failure
3)Have the patient perform the single-breath sound test
This test has the patient inhale a maximal breath and then count out count as long as they can before taking another breath. The ability to count to 50 indicates normal breathing. A count of fewer than 15 signals respiratory weakness

Nursing Interventions

1) Monitor the patient’s ability to swallow or cough
The pulmonary symptom of Myasthenia Gravis is muscle weakness, it is important to monitor the patient’s ability to swallow or cough. This can help determine the progression of the disease and the need for additional interventions to protect the patient’s airway.
2)Suction secretions as needed
Suctioning secretions helps patients with Myasthenia Gravis, who are unable to cough or swallow
3) Elevate the head of the bed
Elevating the head of the bed improves lung expansion and makes breathing easier
4) Educate on myasthenia gravis crisis
MG crisis occurs when the respiratory muscles weakness and results in respiratory failure. This can be life-threatening and requires emergency medical attention. Educate the client to seek assistance if they notice dyspnea, accessory muscle use, and a weak cough
5) Refer for pulmonary function test
PFTs can assist in diagnosing Myasthenia Gravis as well as monitoring the progression of the disease. Not all patients will experience respiratory muscle involvement, but routine assessment can help prevent a crisis or other complications

II) Risk for infection related to disease process weak oropharyngeal muscle contraction, depressed gag reflex

Evidenced by

Signs and symptoms do not evidence a risk diagnosis as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms

Outcome
The patient will maintain a patent airway and demonstrate clear breath sounds. The patient will demonstrate strategies to safety swallow

Assessment

1) Assess the patient’s ability to swallow and cough
Assessing the patient’s swallow and gag reflexes is necessary to reduce the risk of aspiration and maintain clear airways
2) Auscultate breath sounds
Breath sound asses the patient’s pulmonary status. Coarse crackles are often heard during auscultation with aspiration

Nursing Intervention

  1. Assist the patient to a sitting position when eating and drinking.
    (Keeping the patient in an upright position while eating and drinking and for 30 minutes following meals.
    2)Consider the use of feeding tubes
    (In severe cases of Myasthenia Gravis, an NG feeding tube may be required for dysphagia until the client recovers from their Myasthenia Gravis flare.
    3) Administer the medication as indicated(medications like pyridostigmine are prescribed to help alleviate symptoms of Myasthenia Gravis
    4) Adjust the eating routine
    Educate the patient to eat when they have optimal muscle strength. Take time to chew, and focus on smaller meals. Choosing softer foods will require less chewing.
    5)Consult with speech therapy
    A speech therapist can perform a swallowing assessment and determine foods that are safe or unsafe to eat. They can also work with the client on strengthening their mouth and throat muscles.

III) Fatigue related to the disease process and muscle weakness

Evidenced by

Decreased gait or velocity
Difficulty maintaining usual physical activity
Ptosis
Diplopia
Weak facial expressions
Expresses tiredness and weakness
Inadequate role performance
Lethargy

Outcome

The patient will demonstrate an increased activity level and participate in desired activities
The patient will participate in supportive therapy to improve fatigue and muscle strength.

Assessment

1) Assess the patient’s severity and frequency of fatigue
(Assessing fatigue frequency and severity can help formulate the most appropriate treatment plan for the patient. Fatigue can lead to falls, injuries, and poor quality of life if not properly evaluated
2) Assess the patient’s ability to perform ADLs
This will help determine the degree of assistance that the patient will require in performing self-care and other activities of daily living.
3) Perform a neurological evaluation
The nurse should perform a neurological assessment to determine fatigue of the eyes, face, and reflexes

Intervention

1) Encourage the patient to perform activities as tolerated

Allowing the patients to perform activities of daily living with an adequate rest period in between will promote a sense of comfort and independence
2) Asses the patients identifying MG triggers
A patient can prevent an MG flare by understanding their triggers. Common triggers include illness or infection, inadequate sleep, some medication, extreme temperature, menstruation alcohol, and stress.
3) Refer the patient to appropriate therapies
Physical therapy and occupational therapy can assist with motor strength exercises and recommended strategies and equipment to assist with ADLs
4) Prepare for IVIG therapy
Intravenous immunoglobulin is a transfused blood product that is believed to destroy damaged antibodies through healthy donor antibodies. A nurse can administer the transfusion in a hospital or at the patient’s home. This treatment can be given in an MG crisis, prevent impending crisis, or as a treatment to stabilize the patient prior to surgery
5) Prepare for surgery
For some patients, the thymus gland itself or a tumor in the thymus gland(thymoma) may contribute to MG. In an attempt to reduce symptoms, and in some cases cure patients, a thymectomy is performed.

IV) Interrupted family process related to the crisis of dealing with the diagnosis:

Nursing Interventions:

Provide emotional support to the family members.
Encourage family members to express their feelings and concerns.
Facilitate communication between family members and the healthcare team.
Educate family members about the client’s condition and treatment options.
Encourage family members to participate in the client’s care.

Outcome:

Family members express their feelings and concerns.
Family members demonstrate effective coping mechanisms.
Family members are able to communicate effectively with the healthcare team.
Family members are able to make informed decisions regarding the client’s care.

Evaluation:

Family members report feeling more informed and supported.
Family members are able to communicate effectively with the healthcare team.
Family members demonstrate effective coping mechanisms.


V) Impaired physical mobility related to the defective transmission of nerve impulses at the neuromuscular junction:

Nursing Interventions:

Assist client with mobility, as needed.
Encourage the client to perform range-of-motion exercises.
Provide assistive devices, as needed.
Educate the client on safe transfer techniques.
Collaborate with physical therapy for additional interventions.

Objectives:

The client demonstrates an increased ability to move affected limbs.
The client is able to perform range-of-motion exercises independently.
The client is able to transfer safely.

Evaluation:

The client demonstrates increased ability to move affected limbs.
The client is able to perform range-of-motion exercises independently.
The client is able to transfer safely.


VI) Imbalanced nutrition: Less than body requirements related to difficulty eating and swallowing:

Interventions:

Assist client with meals, as needed.
Provide small, frequent meals.
Collaborate with speech therapy for evaluation and interventions.
Encourage the client to maintain an upright position during meals.
Monitor the client’s weight.

Objectives:

The client maintains adequate weight.
The client is able to eat and swallow without difficulty.
The client demonstrates an understanding of dietary modifications.

Evaluation:

The client maintains adequate weight.
The client is able to eat and swallow without difficulty.
The client demonstrates an understanding of dietary modifications.
Impaired swallowing related to neuromuscular impairment:

Interventions:

Collaborate with speech therapy for evaluation and interventions.
Assist client with meals, as needed.
Encourage the client to maintain an upright position during meals.
Provide thickened liquids and pureed foods, as needed.
Monitor for signs of aspiration.

Objectives:

The client is able to eat and swallow without difficulty.
The client demonstrates an understanding of dietary modifications.
The client does not demonstrate signs of aspiration.

Evaluation:

The client is able to eat and swallow without difficulty.
The client demonstrates an understanding of dietary modifications.
The client does not demonstrate signs of aspiration.

Risk for caregiver role strain: Risk factors: severity of illness of the client, overwhelming needs of the client:

Interventions:

Provide emotional support to the caregiver.
Encourage caregivers to express their feelings and concerns.
Provide education regarding the client’s condition and treatment options.
Collaborate with social work for additional support resources.
Encourage the caregiver to take breaks and engage in self-care activities.

Objectives:

The caregiver demonstrates effective coping mechanisms.
The caregiver is able to manage their own stress.
The caregiver is able to make informed decisions regarding the client’s care.

Evaluation:

The caregiver reports feeling more informed and supported.
The caregiver demonstrates effective coping mechanisms.
The Caregiver is able to manage their own stress.

Myasthenia Gravis Medications

Pharmacological management aims to improve the transmission of nerve impulses to the muscles and/or suppress the immune system’s attack on acetylcholine receptors (AChRs). Medications commonly used in MG include:

  1. Cholinesterase inhibitors: These drugs help to increase the amount of acetylcholine available at the neuromuscular junction, improving nerve impulse transmission. Examples include pyridostigmine and neostigmine.
  2. Immunosuppressants: These drugs work to suppress the immune system’s attack on AChRs. Examples include corticosteroids, azathioprine, mycophenolate mofetil, and cyclosporine.
  3. Intravenous immunoglobulin (IVIG): This treatment involves infusing high doses of immunoglobulin proteins into the bloodstream to block the antibodies that attack AChRs.
  4. Biologic therapies: These are newer drugs that target specific components of the immune system that are involved in the attack on AChRs. Examples include rituximab and eculizumab.

Myasthenia Gravis Surgery

Surgical management may be considered for patients who do not respond to pharmacological treatments or who have thymomas (tumors of the thymus gland). Thymectomy, which is the surgical removal of the thymus gland, has been shown to be effective in improving symptoms and reducing the need for medication in many patients with MG.

FAQs:

Q: What exactly is myasthenia gravis?
A: Myasthenia gravis is a chronic autoimmune illness that causes muscle weakness and exhaustion by affecting the neuromuscular junction.

Q: What are the signs and symptoms of myasthenia gravis?
A: Myasthenia gravis symptoms include muscle weakness, tiredness, difficulty breathing, difficulty swallowing, and double vision.

Q: What is the treatment for myasthenia gravis?
A: Medications such as cholinesterase inhibitors and immunosuppressants, as well as plasmapheresis or thymectomy surgery, may be used to treat myasthenia gravis.

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