Medical Surgical Myasthenia Gravis MG #1

Question

The evening nursing is caring for a client with a new onset of myasthenia gravis. The nurse expects to find which of the following assessment observations?

Answers

  1. Hand tremors when lifting a gallon of milk.
    • Rationale:

      This answer is not correct because while tremors when lifting the weight of a gallon of liquid may not be a cardinal sign, even though tremors may occur with profound weakness, that may occur while using muscles for small low weight tasks. Vision and speech impairments are some of the first noticeable symptoms.

  2. Stronger hand grips and steadier gait
    • Rationale:

      This answer is not correct because with the fatigue associated with MG, strong hand grips and steady gait is not expected. Vision and speech impairments are some of the first noticeable symptoms.

  3. Pain and tingling to extremities
    • Rationale:

      This answer is not correct because MG is a weakness in the voluntary skeletal muscles and does not cause nerve compression which can result in numbness and tingling to extremities. Vision and speech impairments are some of the first noticeable symptoms.

  4. Blurred vision and unclear speech patterns
    • Rationale:

      This answer is correct because vision and speech impairments are some of the first noticeable symptoms. Blurred vision and unclear speech patterns are common symptoms associated with MG. Eye muscle weakness can cause misalignment in the eyes resulting in double vision. Weakness of the palate and/or tongue causes slurred speech or unclear speech.

Overview

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease that causes weakness in skeletal muscles including those that control breathing and eye movement. Vision changes, difficulty swallowing, breathing, ptosis, speech, and peripheral weakness are symptoms, and may worsen as the day progresses.

Explanation

Learning Outcomes

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease that causes weakness in skeletal muscles including those that control breathing and eye movement. Symptoms of MG may worsen as the day progresses. The transmission between where nerve cells bridge with muscles is impaired in clients with MG. Antibodies block, alter, or destroy receptors for acetylcholine at the neuromuscular junction which prevents muscular contraction. This ultimately results in voluntary muscle weakness, causing fatigue, diplopia, facial paralysis, dysphagia or ptosis. Treatment includes cholinesterase inhibitors which increase communication between the nerve cells and muscles and immunosuppressant drugs such as corticosteroids to suppress the body’s immune response. The last option is intravenous immunoglobulin therapy (IVIG) where the client receives normal antibodies to help strengthen the immune system.

Test Taking Tip

MG affects skeletal muscles which affect many areas besides the obvious arm and leg muscles. Remember that weakness in skeletal muscles also affects muscles of the eyes, tongue, and mouth.

Video Rationale