Case Study 66 Myasthenia Gravis (also called MG)
Case Study 66 Myasthenia Gravis. A weakness and rapid fatigue of muscles under voluntary control. The condition is caused by a breakdown in communication between nerves and muscles.
11/18/23, 7:53 AM Case Study 66 Myasthenia Gravis (also called MG)
Case Study 66 Myasthenia Gravis
J.B. is a 58-year-old retired postal worker who has been on your floor for several days receiving
plasma- pheresis every other day for myasthenia gravis (MG). About a year ago, J.B. started
experiencing difficulty chewing and swallowing, diplopia, and slurring of speech, at which time
he was placed on pyridostigmine (Mestinon). Before this admission he had been relatively stable.
His medical history includes hypertension controlled with metoprolol (Lopressor) and glaucoma
treated with timolol (ophthalmic preparation). Recently J.B. was diagnosed with a sinus infection
and treated with ciprofloxacin (Cipro). On admission, J.B. was unable to bear any weight or take
fluids through a straw. There have been periods of exacerbation and remission since admission.
VITAL SIGNS
Blood pressure 170/68 mm Hg
Heart rate 118 beats/min
Respiratory rate 32 breaths/min
Temperature 101.8 ⁰ F (38.8 C)
1. You note that the nursing assistive personnel (NAP) has just entered these vital signs
into J.B.'s record. What is your immediate concern and why?
The respiratory rate is almost double of what it should be.
2. What action do you need to take based on this concern?
Assessing O2 saturation and applying oxygen.
3. What other assessment findings would support this complication being present?
Increased heart rate
4. What medical treatment do you anticipate for J.B.?
Anticholinesterase such as pyridostigmine, corticosteroids like prednisone, immunosuppressive
therapy such as azathioprine or cycloporine, plasmapheresis
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, 11/18/23, 7:53 AM Case Study 66 Myasthenia Gravis (also called MG)
5. What is your nursing priority at this time?
Patient safety and respiratory status
6. Based on this priority, what nursing interventions do you need to perform?
Due to the patient being in a myasthenic crisis he needs to receive edrophonium immediately,
patient should be placed in. ICU for continuous monitoring of respiratory status, patient may
need breathing assistance via ventilator, give patient fluids and nutritional support as needed.
7. Which actions do you need to implement to administer edrophonium (Tensilon) safely?
Select all that apply.
a. Have intravenous (IV) atropine sulfate readily available.
b. Monitor for changes in level of consciousness.
c. Place J.B. on continuous cardiac monitoring.
d. Initiate precautions to prevent excessive bleeding.
e. Administer a prophylactic antiemetic before injection.
8. What is the difference between a cholinergic crisis and myasthenic crisis?
Cholinergic crisis is too much medication and myasthenic crisis is to little medication.
Myasthenic crisis is like fight or flight with increased HR, RR, BP, difficulty breathing and
swallowing, absent cough reflex, anoxia, and cyanosis. Cholinergic crisis is like rest or digest
with abdominal cramps, N/V/D, excessive pulmonary secretions.
9. J.B.'s wife asks you, “What may have caused my husband to get worse, and why does he
keep having these episodes?” What explanation should you give her?
Your husband’s medication was not enough for him causing him to be in a myasthenic crisis.
With some time we will be able to figure out the correct dosage of medications that is best for
your husband.
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