Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide speaking. Antibodies attack the acetylcholine receptors in the neuromuscular junctions and reduce muscle strength while causing fatigue. This disease is most common between the ages of 20 to 30 and can be triggered by stress, infections (especially viral), heat, and fatigue. Some people who suffer from MG may experience spontaneous remission of the disease with rest and proper treatment. There are some, however, that experience a significant health decline. Signs and symptoms of myasthenia gravis: • Diaphragmatic weakness (respiratory depression) • Weakness of the extremities • Vocal weakness • Eyelid weakness/ptosis/diplopia • Facial weakness/mask-like expression • Hypotension • Incontinence • Nausea • Vomiting • Decreased or absent cough reflex • Blurry vision • Dysphagia Nursing assessment for myasthenia gravis: • Head to toe general assessment o Check respiratory effort, pattern, and breath sounds o Neurological assessment o Check swallowing; important to check this in the morning as swallowing and chewing can be weaker in the evening o Inquire about family assistance, community support, home health for assistance with ADLs, housekeeping, bills, shopping, and trips to the doctor • Review laboratory reports: o Tensilon testing (tensilon): An IV injection of edrophonium chloride, an anticholinesterase, is given to check if muscle weakness improves. If the patient is in cholinergic crisis, tensilon will worsen the symptoms and not improve them. o EMG: Nerve conduction studies are done to check the nerves to the hand muscles. This test will show muscle fatigue. o Eye test: Testing for ptosis. Have the patient look upward and hold the gaze upward for three minutes. This will cause the eyelids to droop and then close on theirown. Nursing diagnosis for myasthenia gravis: • Ineffective breathing pattern related to diaphragmatic weakness • Altered nutrition less than body requirements related to chewing/swallowing dysfunction • Activity intolerance related to muscle weakness and fatigue • Impaired verbal communication related to speaking muscle dysfunction • Knowledge deficit related to disease process, care management, feeding, and ADL assistance

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