LESSON PLAN

ON
MYASTHENIA GRAVIS
 BASELINE DATA

NAME OF THE TEACHER : MS. G. KIRANMAI

COURSE : B.SC NURSING

NAME OF THE TOPIC : MYASTHENIA GRAVIS

SUBJECT : ADULT HEALTH NURSING II

UNIT : VI

TIME : 45 MIN

VENUE : IV SEMESTER B.SC CLASS ROOM

METHOD OF TEACHING : LECTURE CUM DISCUSSION

A.V AIDS : POWER POINT, BLACK BOARD, CHARTS,

FLASH CARDS

PREVIOUS KNOWLEDGE OF THE TOPIC : YES

 OBJECTIVES
GENERAL OBJECTIVES:

At the end of the session, the students will gain in-depth knowledge regarding Myasthenia Gravis -
definition, anatomy and physiology of neuromuscular system, causes, clinical manifestations, diagnostic
evaluation, medical and the nursing management of a patient with myasthenia gravis in a hospital setting.

SPECIFIC OBJECTIVES:

At the end of the class, the students will be able to:

 Review anatomy and physiology of neuromuscular system.

 Define myasthenia gravis.

 To understand the causes of myasthenia gravis.

 To describe the pathophysiology of myasthenia gravis.

 Discuss the clinical manifestations of myasthenia gravis.

 Describe the diagnostic evaluation of myasthenia gravis.

 List out the nursing diagnosis & Describe the Medical and nursing management of myasthenia gravis.
S.NO TIME OBJECTI TOPIC TEACHER LEARNER AV- EVALUATION
ACTIVITY ACTIVITY AIDS
VE
1. 1min To INTRODUCTION: Lecture Listens Board What do you
introduce Myasthenia gravis is an auto immune disorder, method attentively mean by auto
the topic and it is neuromuscular disease that leads to immunity?
weakness of the skeletal muscles. The disease can
affect at any age but more common in women
after 40 years and men older than 60 years.

Lecture Listens Define the

2. 1min To define DEFINITION: method attentively LCD term MG?
the term Myasthenia gravis can be defined as “an auto
myastheni immune disorder, and it is neuro muscular
a gravis disease,” That affects the communication between
nerves and muscles, leading to muscle weakness
and fatigue.
Lecture Students What do you
method are actively mean by
3. 3min To review NEURO MUSCULAR JUNCTION: listening& acetyl
the i. To Communicate with each other It is noting the cholinesterase
anatomy specialised region called synapses. At points ?
and most synapses is more gap is called
physiolog Synaptic Cleft Separates the two cells. The
y of neuro past cell communicates with the second
&muscula cell by releasing a chemical called
r system neurotransmitter.
ii. The particular type of synapses formed
between a motor and neuron and a
skeleton muscle fibre is called the
neuromuscular junction.
iii. In Motor Neurons, the digital tip of each
axon terminal extends into cluster of
synaptic end bulbs, that contain many
 membranes enclosed sacs called synaptic
vesicles.
iv. Inside each synaptic vesicles, the
thousands of neurotransmitters molecules.
v. The neurotransmitters releases at the
neuromuscular junction isacetylcholine. It
contains the region of the muscle fibre,
plasma membrane that is adjacent to axon
terminal is called motor and plate.
vi. It contains acetyl choline receptors. The
term neuromuscular junction includes all
motor neurons, axon terminals with their
synaptic end bulbs, plus the motor and
plate of the muscle fibres, which typically Lecture Students Chalk What do you
contains 30 to 40 million of acetyl choline cum are actively and mean by
discussion listening& board Thymoma?
receptors.
method noting the
To list points
4. 3min down the
causes of
myastheni CAUSES:
a gravis *Autoimmune disorder: Most cases of myasthenia
gravis is due to an autoimmune response. The
immune system produces antibodies that
interferes with the transmission of nerve signals to
muscles, leading to weakness.

*Thymus abnormalities: The Thymus is located in

the upper chest. thymus abnormalities are
common in people with myasthenia gravis. And
may trigger the production of antibiotics
associated with this condition.

*Congenital factors: some causes are congenital,

 meaning they are present at the birth.

*Maternal antibodies: In rare cases, a mother may

pass antibodies to children during pregnancy,
leading to myasthenia gravis.

*Thymus: People with myasthenia gravis have a

higher chance of having cancer in the
thymus(thymoma).
Lecture Students chart What do you
*Thyroid dysfunction: Both under active and cum are actively mean by
overactive thyroid function, can contribute to discussion listening& MuSK?
muscle weakness. method noting the
points
Myasthenia gravis is not preventable, but
5. 3min To classify avoiding the triggers like emotional stress,
the MG. extreme temperatures, infections and certain
medications can help to manage the symptoms.

CLASSIFICATION:
Myasthenia gravy is broadly classified is as
follows:

 Early onset myasthenia gravis: Age at

onset less than 50years (Thymic
hyperplasia) usually seen in females.

 Late onset myasthenia gravis: Age at onset

more than 50 years (Thymicatrophy)
mainly seen in males .

 Thymoma associated with myasthenia

gravies:
  10 to 15 % Myasthenia gravis with anti-
MUSK antibodies.

 MG with anti MuSK antibodies.

 Ocular myasthenia gravis(oMR):

Symptoms only affecting extra ocular
muscles.

 Myasthenia gravis with no detectable

AchR and muscle specific tyrosine
kinaseMuSKa ntibodies

Lecture Students Power What is

6. 2min To o Myasthenia graves Is a weakness of cum are actively Point neuromuscula
illustrate skeletal muscles. discussion listening&a r junction?
pathophysi method. nswering
the
ology of o It is caused by an abnormality at the
questions?
myastheni neuromuscular junction that partially
a Gravis blocks contraction.

o Recall that motor neurons stimulate

skeletal muscle fibres to contract by
releasing acetylcholine (Ach).

o Myasthenia gravis is an autoimmune

disease caused by antibodies directed
against acetylcholine receptors and
binders.
o The attachment of acetylcholine as the
disease progresses, more and more
acetylcholine receptors are affected. The
 muscle becomes increasingly weaker and
may eventually cease to function.

7. 2min To learn Diagnosis: Lecture Students Board What is

about cum are actively MRI ?
diagnostic o Physical Examination: discussion listening&
evaluation Your healthcare provider method noting the
points
of will assess your symptoms,
myastheni medical history, and
a gravis. perform a physical exam.
o Neurological
Examination: This includes
checking reflexes, muscle
weakness, and testing
sensation and motor
functions.
o Repetitive Nerve
Stimulation Test: Small
electrical pulses are used to
assess nerve-to-muscle
signaling.
o Antibody Test: A blood
test checks for antibodies
associated with MG.
o Imaging: CT or MRI scans
may be done to rule out
thymus gland
abnormalities.
o Edrophonium (Tensilon)
Test: A drug is
administered intravenously
to observe muscle
 movements.

8. 5min To Myasthenia gravis (MG) is a neuromuscular Lecture Students Power What do you
describe disorder that affects voluntary muscles, causing cum are actively Point mean by
about weakness and fatigue. The common symptoms discussion listening& myasthenia
clinical associated with MG: method answering crisis?
the
manifestat
questions?
ions of 1. Muscle Weakness: MG primarily causes
myastheni muscle weakness, especially in muscles
a gravis. under voluntary control. This weakness
worsens with exercise and as the day
progresses.
2. Eye Problems: Many people with MG
experience drooping eyelids (ptosis) and
double vision due to weakness in the eye
muscles.
3. Difficulty Speaking and Swallowing:
Weakness in facial muscles can lead to
problems with speaking, swallowing
(which may cause choking), and chewing.
4. Weakness in Limbs: MG can affect limb
muscles, leading to weakness in the arms
and legs.
5. Thymus-Related Issues: Abnormal
enlargement or tumors of the thymus
gland are associated with MG. Thymomas
(cancer of the thymus) occur more
frequently in people with MG.
6. Myasthenic Crisis: If untreated, MG can
lead to a life-threatening condition called Lecture Students Board What do you
myasthenic crisis, affecting the muscles cum are actively mean by
involved in breathing.. discussion listening& plasmapheres
9. 5min method answering is?
To Medical management: the
describe questions?
about Medications (such as immune suppressants and
medical cholinesterase inhibitors) can help manage
manageme symptoms.
nt of
myastheni 1. Medications:
a gravis. o Pyridostigmine: This drug
improves signaling between nerve
cells and muscles.
o Immuno suppressants (e.g.,
prednisolone, triamcinolone,
methylprednisolone): These
minimize abnormal immune
responses.
2. Procedures:
o Thymectomy: Surgical removal of
an enlarged thymus gland to
relieve symptoms.
o Plasma exchange: Removes
antibodies from plasma to reduce
excess antibodies.
3. Dietary considerations:
o To reduce fatigue from chewing,
moisten solid foods with gravy,
sauce, or yogurt.
o Choose chicken or fish over
tougher meats.
o Avoid dry, crumbly foods like
crackers and nuts.
10. 5min To list out 1. Monitor respiratory status and Lecture Students Board What are the
the ability to cough and deep cum are actively nursing
nursing breathe adequately. discussion listening& interventions
interventio 2. Monitor for respiratory failure. method answering for
the myasthenia
ns. 3. Maintain suctioning and
questions? gravis?
emergency equipment at the
bedside.
4. Monitor vital signs.
5. Monitor speech and
swallowing abilities to prevent
aspiration.
6. Encourage the client to sit up
when eating.
7. Assess muscle status.
8. Instruct the client to conserve
strength.
9. Plan short activities that
coincide with times of
maximal muscle strength.
10. Monitor for myasthenic and
cholinergic crises.
11. Administer
anticholinesterase
medications as prescribed.
12. Instruct the client to avoid
stress, infection, fatigue, and
over-the counter medications.
13. Instruct the client to wear a
Medic-Alert bracelet.
14. Inform the client about
services from the Myasthenia
Gravis Foundation.
 SUMMARY:
11.
So far, we have discussed regarding myasthenia
gravis-definition,types,
pathophysiology,diagnostic evaluation, clinical
manifestations, medical and nursing management.
CONCLUSION:
By this lesson plan, I gained some knowledge
12. regarding burns and the nursing care of a patient
with myasthenia gravis.
ASSIGNMENT:
Write down the nursing management for a
patient with myasthenia gravis?

13.
BIBLIOGRAPHY:
*Joyce M Black, H.Hawks, A.M.Keene, Clinical
management for positive outcomes,6th edition,V-2
,page no—.
14.
*Tortara Grabowski, Principals of Anatomy and
Physiology,8th edition, page no 265--353.
*R.S.Satoskar, S.D .Bhandarkar, S.S. Ainapure,
Pharmocology and Pharmocotherapeutics,revised
16th edition,V-1.
EVALUATION TOOL

1. What is myasthenia gravis?

a) Skeletal disorder b) Muscular disorder
c) Autoimmune disorder d) None
2. Myasthenia gravis is common in ages?
a) Males above 60 years b) Females 40 above
d) none d) both a&b
3. What are the types of myasthenia gravis?
a) Acute MG b) Chronic MG
c)Both d) early onset MG, late onset MG, ocular MG.
4. What are the complications of Myasthenia gravis?
 a) Bleeding b) Infection
c) Renal failure d) Myasthenia crisis
5. Ptosis means?
a) Drooping of eye lids b) Loss of eyebrows
c)Drooping of tongue d) Loss of hair
BLANKS :
1. Thymectomy means ______________.
2. Plasmapheresis means ______________.
3. Dysphagia means _____________.
4. Thymoma means ______________.
5. Tensilon test means_______________.
KEY

Multiple choice questions BLANKS:

1.c 1.Surgical removal of Thymus gland.

2.b 2.Removes antibodies from plasma to reduce excess antibodies.

3.d 3. Difficulty in swallowing.

4.d 4. Cancer of Thymus gland.

5.a 5. A drug is administered intravenously to observe muscle movements.