Myasthenia Gravis Nursing Assessment and Treatment | Nursing Lecture
The video is an instructional nursing lecture that walks students through the pathophysiology, critical nursing assessments, and treatment interventions for Myasthenia Gravis (MG). It emphasizes the hallmark of MG—muscle weakness that worsens with activity and improves with rest—and repeatedly ties each assessment and intervention back to this underlying mechanism. Key assessment points include safety (vision, strabismus, swallowing, gag reflex), airway protection, respiratory monitoring, and the Tensilon (edrophonium) test to confirm diagnosis and differentiate myasthenic versus cholinergic crisis. Treatment discussions cover anticholinesterase medications, monitoring for cholinergic crisis and using atropine as an antidote, plasmapheresis, and thymectomy, while highlighting the importance of timing meals, energy conservation, trigger avoidance, and medication reconciliation. Throughout, the presenter stresses critical‑thinking strategies for exam preparation, provides a free study checklist, and promotes the Nursing SOS membership for further support.
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In this video, we are walking through the nursing assessment and treatment for myasthenia gravis. Now, of course, we will not stop there. We are also going to walk through the critical thinking behind it all. So you're not just memorizing these random nursing assessments and nursing interventions that you will need to know for your nursing school exam, but you actually will know how to critically think through it all and know why you are doing it. Because let's be real, my friend, when was the last time your nursing school exam tested you on memorization? Yeah. Never. Right? It just doesn't work that way. They are going to test you on how well you apply the information that you're learning and how well you critically think about it. So I'm going to give you the critical thinking points that you need to know so that you can learn how to critically think. An ace, your nursing school exam. And of course, I have a free cheat sheet for you to help you learn these things faster in nursing school. So be sure to stay until the end of the video and I will let you know where you can get that. Now hit that subscribe button and click the notification bell and let's dive in. Now, before we dive into the nursing assessments and the treatment for myasthenia gravis, let's review the pathophysiology real quick so we have a solid foundation for our critical thinking. Like we've talked talked about in this video, when you think myasthenia gravis, the first thing that should come to your mind is muscle weakness. Now, myasthenia gravis is a neurological condition that prevents muscles from contracting like they should. What's happening here is that the patient's immune system is attacking that connection between neurons and muscles. Now, the neurons and the muscles cannot talk to each other, and then the neurons can't tell the muscles to contract. So when the immune system attacks like this, the muscles aren't able to contract like they should. So now that we understand the pathophysiology of what's happening here, remember, it's that muscle weakness. You've got to understand the pathophysiology first before you can understand the nursing assessment and the treatment and the critical thinking behind it all. So now that we know the patho, let's dive into what we will be assessing for as the nurse, and then the treatment and nursing interventions for. For myasthenia gravis, of course, we will not stop there. Oh, no, friend, we won't just give you a list of nursing assessments and interventions. To do that would not be helpful for you. We're going to dive deeper and connect it all back to why we are doing those assessments and the treatments, connecting it all back to the pathophysiology of myasthenia gravis so that you can critically think about it. Now, remember that the hallmark sign of this condition is muscle weakness that gets worse with activity, but then it gets better with rest. Now that's the key thing to know here. And all of the signs and symptoms are related to a lack of muscle contraction and muscle weakness. So keep this in mind as we go through our nursing assessment. So with this muscle weakness, one of the main things that you want to assess for with your patient would be safety concerns. Assess their vision and if they are having strabismus with double vision now, assess their ability to swallow and their gag reflex, which are needed to help them protect and maintain their airway. Right. It's important to make sure that the muscles that they use to protect and maintain their airway are not affected. And if they are affected, then the timing of meals is very important, like having them eat earlier on in the day before those muscles become tired. Now, you'll also need to assess their respiratory effort and monitor their respiratory muscles for involvement. Now, the respiratory muscles can become involved quickly as more and more of that acetylcholine is naturally broken down throughout the day. Now, this leaves less and less of it to bind to any open nicotinic acetylcholine receptors, so the respiratory muscles will be less able to contract. Now remember, back to the pathophysiology. The neurons and the muscles can all talk to each other as well. And the neurons can't tell the muscles to contract. So when the immune system attacks like this, the muscles aren't able to contract like they should. And it gets worse with activity and worse throughout the day and then better with rest. So the nursing is assessment is going to focus on muscle weakness and safety. Now, another important factor to assess is if the patient does in fact have myasthenia gravis. Now, in order to assess this, a neuro, neurologist, I almost can say that a neurologist will do what's called a tensilon test. Now, a tensilon test is going to be given to determine if the muscle weakness is caused by myasthenia gravis. This test is performed by giving the patient an injection of tensalon. Now, the medication, tensalon, or enderphone acutemium is an acetylcholinesterase inhibitor and it prevents the natural breakdown of acetylcholine. Now, by preventing acetylcholine from being naturally broken down, it keeps more of it present at that neuromuscular junction, the nmj, and then helps flood the receptors and increase the chances of acetylcholine binding to any receptors that aren't yet blocked by autoantibodies. Now, if there is an improvement in muscle contraction and a lack of weakness, then the test is positive for myasthenia gravis. Now, this test is usually used in combination with other hallmark signs and symptoms like ptosis or drooped eyelids, a lack of facial expression, and difficulty swallowing. Now, you also want to assess if the patient is in a myasthenic crisis. Now, this means that the respiratory muscles are quickly weakening or they are already weakened, which can lead to respiratory failure. Now, this test is done by giving tensilon as well. Now, if you give them the tensilon and they temporarily become better, then they are in a myasthenic crisis and they will need more medication to help them improve. If they become worse when you give them tensilon, then they are in a cholinergic crisis. Now, this means that the neuromuscular junction was already saturated with acetylcholine, and now acetylcholine is present due to that tensalon. Now, this is caused by the patient receiving too much of their treatment medications for myasthenia gravis. Now, if a patient is in a cholinergic crisis and is given tensilon, they can decline quickly. So it's important to have emergency supplies very readily available before administering it. Atropine is the antidote to tensalon and will reverse it. So it should be administered if the patient is in a cholinergic crisis. So those are the key nursing assessments that you'll need to do for a patient with myasthenia gravis. Now, again, relating it all back to that pathophysiology and the why behind why we are doing those assessments. Now, the neurons and the muscles, like we said, they can't talk to each other and the neurons can't tell the muscles to contract, so the muscles aren't able to contract like they should, and then that can cause muscle weakness. Now, let's talk about the nursing interventions and the treatment that you might do for for a patient with myasthenia gravis. Now, don't worry, we will again walk through the critical thinking components for why we do each intervention. So let's dive in. Now, since their muscles aren't contracting like they should they may have muscle weakness. So they are at a big risk for safety concerns with basic activities of daily living. Now, the biggest component when taking care of patients with myasthenia gravis is is safety. Right? Safety. The biggest concern is the muscles of the respiratory system failing if they are unable to contract. So make sure to have emergency equipment and suctioning equipment ready at the bedside at all times and assist during intubation if necessary. Like we said, safety. Huge thing. Now, a key thing to remember is that weakness tends to worsen throughout the day as more and more acetylcholine is blocked and then naturally broken down over time. Now, the muscles can't contract without acetylcholine to tell them to. So since acetylcholine can't bind to the receptors, there's nothing there to tell the muscles to contract. Now again, remember that the hallmark sign of this condition is that muscle weakness gets worse with activity, but gets better with rest. Now that's the key thing to know here. And all of these interventions are related to a lack of muscle contraction and muscle weakness. So keep that in mind when you take your nursing school exam. Simple tasks such as swallowing and eating food can become a challenge, especially as the meal progresses or as the day goes on. And then keep the head of the bed elevated to help facilitate swallowing and monitor their food consumption. And encourage small bites and larger meals earlier in the day when the muscles are more capable of contracting. And then assist them with tasks that might be difficult if they are having trouble sleeping, seeing or experiencing double vision. And make sure that they are safe, of course, when ambulating, and assist them when needed. Now, you might also want to set up their personal belongings where they can see and reach them pretty easily. And you'll want to educate the patient on maximizing their energy when they have most of it, like after times of rest, especially in the morning. And then help them organize their most high energy demand activities in the morning, as well as eating larger meals early earlier in the day. Now this will allow their muscles to contract more during those times since there's more acetylcholine present to help stimulate those receptors and help the muscles contract. Now, help your patient identify and minimize triggers that increase symptoms such as illness, stress, hot temperatures and heat, and hormonal changes such as during menstrual cycles. Then minimizing these or preparing for them can help the patient manage their symptoms and know what to expect. Expect. Now, it's also super important to encourage your patient to rest. With rest, those muscle contractions can improve. Now, rest will allow more acetylcholine to build up at that neuromuscular junction and allow it to flood more of the receptors, helping the muscles to contract. Now again, think back to the pathophysiology and the why behind our interventions, the nursing interventions. Now, that hallmark sign of this condition is that muscle weakness gets worse with activity, but gets better with rest. Now, you may also need to work with the healthcare team to audit the patient's medications, both prescribed medications and over the counter medications. Now, there are many medications that interact with common meds that are given and prescribed for myasthenia gravis. And many medications may make their muscle weakness worse. So it's important that they talk with their doctor before they take any other medications. Now, the main treatment is anticholinesterase medications which blocks the breakdown of acetylcholine, making it more available at that neuromuscular junction site and then therefore increases muscle contraction. Now, with anticholinesterase, you have to watch out for that cholinergic crisis, which can happen when they receive too much of the medication. Now signs of this would be bradycardia, pupil constriction, bronchoconstriction, respiratory failure, increase muco production and saliva, GI upset and incontinence. Now, atropine is the antidote to anticholinesterase medications, so that may be given if the patient becomes over medicated. Now sometimes patients have relief from plasmapheresis, which removes the antibodies that are attacking the neuromuscular junction receptors, but this only works for a few months. They may also remove the thymus gland, which may improve symptoms too. But there is no true cure, just management of the symptoms. So those are the key nursing assessments that you'll do for a patient with myasthenia gravis, along with the nursing interventions and treatment for it. Now remember that the hallmark sign of this condition is the muscle weakness that gets worse with activity but then gets better with rest. So remember that for your nursing school exam. Then the key thing to remember, safety is your number one priority. Your first concern should be to make sure that their respiratory system isn't compromised and that they are breathing well. And because of this muscle weakness that happens, and all of the nursing assessments and the treatments and nursing interventions are related to that lack of muscle contraction and the muscle weakness. So again, keep that in mind when you take your exam and make sure to download the free nursing school study checklist that we have for you that walks you through step by step, how to study in nursing school. The study process to follow and how to critically think faster. Now it's also filled with other great study tips to help you pass. Now the link is in the description below for you to get that and if you're struggling with med surg and learning all of these disorders and everything in nursing school, be sure to check out the step by step videos that we have for you inside the Nursing SOS Membership community. My friend, you do not have to figure everything out alone anymore. I am here to hold your hand every step of the way. Now the link is in the description for you to check out all of the details. And if you like this video, make sure to hit that like button. Leave a comment below, let me know that you loved it, share it with your friends. And of course click that subscribe button and hit the notification bell so you never miss a video. And click on one of these videos right over here so you can keep rocking nursing school and go become the nurse that God created only you to be. And I'll see you next time on the Nursing School show. Take care my friend. Bye bye.
