NCLEX Review & Nursing School

– Neuromuscular disease: weakness and fatigue of the voluntary muscles.

– Is usually due to insufficient amount of Acetycholine.

CAUSES:

– An autoimmune response

– Inadequate release of Ach.

ASSESSMENT

• WEAKNESS AND FATIGUE
• DIFFICULTY CHEWING
• DYSPHAGIA, PTOSIS
• DIFFICULTY BREATHING (RESPIRATORY)

Diagnostics:

Tensilon Test

– used for diagnosing Myasthenia Gravis.

– used to defferntiate cholinergic crisis from myasthenic crisis.

How the test is done:

An IV injection of edrophonium or neostigmine causes some quick relief of muscle weakness.

Cholinesterase Inhibitor is used for Myasthenia Gravis

– Cholinesterase Inhibitor can intensify transmission at muscarinic and neuromuscular junctions.

Atropine- antidote for cholinergic crisis.

TREATMENT:

Cholinergic Medications (Anticholinesterase.

• Neostigmine (Prostigmin)
• Pyridostigmine (Mestinon)

Side effects of Medications:

• – increase GI motilioty
• – bradycardia
• –  increased salivation

* Pay attention to the patient and monitor for

1. Cholinergic Crisis (Drug Overdose)
2. Myasthenic Crisis (Undermedication)

Differentiation between the two:

1. Cholinergic Crisis– usually develops about an hour before the administration of the drug.

       * Atropine is the antidote.

Symptoms can include:

• dysphagia
• dyspnea
• respiratory and muscle weakness2

    2. Myasthenic Crisis= Increase the anticholinesterase dose.