{
  "name": "Myasthenia Gravis",
  "slug": "myasthenia-gravis",
  "url": "https://nursingplex.com/care-plans/myasthenia-gravis",
  "category": "Neurological",
  "summary": "Fluctuating muscle weakness; medication timing, crisis recognition and energy pacing.",
  "nursing_diagnoses": [
    "Ineffective breathing pattern",
    "Impaired swallowing",
    "Fatigue"
  ],
  "overview": [
    "Myasthenia gravis is an autoimmune disorder in which antibodies destroy acetylcholine receptors at the neuromuscular junction. Fewer functioning receptors means the muscle fails progressively with repeated use, which produces the disease's signature: weakness that worsens with activity and improves with rest.",
    "Ocular symptoms — ptosis and diplopia — usually come first. Bulbar involvement brings dysphagia, dysarthria, chewing fatigue and a nasal voice, and generalized disease adds proximal limb and respiratory muscle weakness. Symptoms are typically mildest in the morning and worst by evening.",
    "The two crises must be distinguished. Myasthenic crisis is severe weakness with respiratory failure from undermedication, infection or stress. Cholinergic crisis results from excess anticholinesterase medication and adds SLUDGE symptoms — salivation, lacrimation, urination, defecation, GI cramping and emesis — with pinpoint pupils. Both present as respiratory failure, and both require immediate airway support."
  ],
  "key_facts": [
    {
      "label": "Hallmark",
      "text": "Fatigable weakness — worse with repeated use and at the end of the day, better with rest."
    },
    {
      "label": "Medication timing",
      "text": "Give pyridostigmine 30–60 minutes before meals so chewing and swallowing are strongest."
    },
    {
      "label": "Myasthenic crisis",
      "text": "Undermedication or infection: severe weakness, respiratory failure, often with tachycardia and dry secretions."
    },
    {
      "label": "Cholinergic crisis",
      "text": "Overmedication: weakness plus SLUDGE symptoms, excessive secretions, fasciculations and miosis."
    },
    {
      "label": "Drugs to avoid",
      "text": "Aminoglycosides, fluoroquinolones, beta blockers, magnesium and neuromuscular blocking agents worsen weakness."
    },
    {
      "label": "Thymus link",
      "text": "Thymectomy can improve or remit disease in many patients, especially with thymoma."
    }
  ],
  "nursing_priorities": [
    "Protect the airway and monitor respiratory function.",
    "Prevent aspiration during eating and drinking.",
    "Time medications precisely around activity and meals.",
    "Conserve energy and pace activity.",
    "Recognize crisis early and avoid precipitating drugs.",
    "Support long-term self-management."
  ],
  "assessment": {
    "subjective": [
      "Pattern of weakness over the day and its response to rest",
      "Double vision, drooping eyelids, difficulty chewing or swallowing",
      "Shortness of breath, weak cough or voice change",
      "Medication schedule, missed doses and recent illness or new drugs",
      "Emotional stress, which commonly precipitates exacerbation"
    ],
    "objective": [
      "Vital capacity, negative inspiratory force, respiratory rate and cough strength",
      "Ptosis and diplopia, worsened by sustained upward gaze",
      "Swallowing safety, gag reflex, speech clarity and nasal quality",
      "Proximal muscle strength before and after repetitive movement",
      "Pupil size, secretions, bowel sounds and fasciculations when crisis is suspected",
      "Acetylcholine receptor antibody titers, ice pack test and edrophonium testing when performed"
    ],
    "related_factors": [
      "Autoantibody destruction of acetylcholine receptors",
      "Infection, surgery, pregnancy, heat and emotional stress",
      "Undermedication or overmedication with anticholinesterase drugs",
      "Contraindicated medications impairing neuromuscular transmission"
    ]
  },
  "goals": [
    "The client will maintain effective ventilation with vital capacity above the ordered threshold.",
    "The client will swallow safely without aspiration.",
    "The client will take medication on an exact schedule and describe the reason for the timing.",
    "The client will pace activity and report reduced fatigue.",
    "The client will identify the signs of both crises and the drugs to avoid."
  ],
  "interventions": [
    {
      "title": "Airway and aspiration prevention",
      "points": [
        "Monitor vital capacity and negative inspiratory force at intervals and keep suction and intubation equipment nearby.",
        "Assess swallowing before every meal; hold oral intake if bulbar weakness is significant.",
        "Position upright at 90 degrees for eating and for 30 minutes afterward.",
        "Provide soft, easily chewed foods, small bites and rest breaks during meals; schedule the largest meal when strength peaks."
      ]
    },
    {
      "title": "Medication management",
      "points": [
        "Administer pyridostigmine exactly on time, 30–60 minutes before meals, and never delay doses.",
        "Monitor for cholinergic excess: cramping, diarrhea, excess saliva, sweating, small pupils and fasciculations.",
        "Administer immunosuppressants, corticosteroids, IVIG or plasmapheresis as ordered and monitor for infection.",
        "Screen every new prescription against the list of drugs that worsen myasthenia and flag them with the prescriber."
      ]
    },
    {
      "title": "Energy conservation",
      "points": [
        "Cluster care and plan demanding activities for the morning and after doses.",
        "Alternate activity with scheduled rest and encourage sitting for tasks.",
        "Avoid heat exposure, infection and emotional stress, which worsen weakness.",
        "Provide eye patching alternately for diplopia and artificial tears if eyelid closure is incomplete."
      ]
    },
    {
      "title": "Crisis recognition and response",
      "points": [
        "Assess pupils and secretions to help differentiate cholinergic from myasthenic crisis.",
        "Prepare for intubation and mechanical ventilation in either crisis; airway comes before diagnosis.",
        "Have atropine available for cholinergic crisis and be prepared to hold anticholinesterase therapy per order.",
        "Treat infection promptly and avoid contraindicated antibiotics."
      ]
    }
  ],
  "patient_teaching": [
    "Take medication at exactly the same times daily and set alarms; timing is the treatment.",
    "Eat the main meal when strength is highest and sit upright while eating.",
    "Carry a medical alert card listing the diagnosis and drugs to avoid, and show it to every prescriber and dentist.",
    "Avoid crowds during respiratory illness season and get recommended vaccinations.",
    "Report increasing weakness, difficulty swallowing or breathing immediately.",
    "Plan rest periods into the day and avoid extremes of heat and exertion."
  ]
}