This document discusses the pharmacological, surgical, dietary, and nursing management of myasthenia gravis. Pharmacological treatments include immunosuppressants like azathioprine to prevent organ rejection, corticosteroids like prednisone to suppress the immune system, and cholinesterase inhibitors like pyridostigmine as first-line therapy. Plasmapheresis removes antibodies against blood proteins before transplantation. Surgical management may include thymectomy. Dietary management focuses on reducing protein and dairy intake while increasing fruits, vegetables, and foods high in potassium. Nursing care addresses ineffective breathing, impaired communication and mobility, risk of aspiration, and disturbed sensory perception. Potential complications include myasthenic crisis requiring ventilation and

1. BY –
SHUBHRIMA KHAN

10. Cont..

14. Pharmacological Management
• Immunosuppressive Therapy: Azathioprine used to prevent organ rejection in
people with organ transplantation
• Corticosteroid: to suppress the immune system. To decreases production of
autoantibody. Prednisone used to suppress immune system and decreases
inflammation in condition such as asthma, COPD
• Cholinesterase Inhibitors: First line of therapy
– Neostigmine bromide (Pyridostigmine)
– Edrophonium chloride (Tensilon)
• Immunoglobulin therapy: helps to decrease the immune systems attack on the
nervous system.

15. Plasmapheresis
• A process by which plasma is seperated from formed elements of
blood , plasma is discarded and RBC electrolyte are returned to the
clients.
• Antibodies against blood proteins can lead to rejection after a blood
incompatible transplant.
• Plasmapheresis before transplant removes the antibodies against the
donor blood type from the recipient, so they can not attack.

16. Surgical Management
• Thymectomy: surgical removal of thymus gland

17. Dietary management
• Reduce protein intake to 10 percent of total calories; replace animal protein
as much as possible with plant protein
• Eliminate milk and milk products (substitute other calcium sources).
• Eat more fruits and vegetables (make sure that they are organically grown).
• Eat plenty of food rich in potassium such as tomatoes, orange, bananas,
broccoli etc.
• Eliminate polyunsaturated vegetable oils and all foods (such as deep-fried
foods) that might contain trans-fatty acids. Use extra-virgin olive oil.
• Take ginger or turmeric capsule.

18. Nursing management
• Ineffective breathing pattern related to intercoastal muscle weakness
• Impaired verbal communication related to weakness of the larynx ,lips,
mouth, pharynx and jaw
• Impaired physical mobility related to voluntary muscle weakness
• Risk for aspiration related to weakness of the bulbar muscles
• Disturbed sensory perception related to ptosis and decreased eye
movements.

19. Complications
Myasthenic Crisis
• Under medication
• Increased HR/BP/RR Bowel and bladder incontinence
• Decreased urine output
• Absent cough and swallow reflex
• May need mechanical ventilation
• Temporary improvement of symptoms with administration of Tensilon

20. Complications
Cholinergic Crisis
• Overmedication
• Decreased BP
• Diarrhea
• Blurred vision
• Pallor, Facial muscle twitching
• Constriction of pupils
• Tensilon has no effect. Symptoms improve with administration of
anticholinergics (Atropine)