(b) There may be too little acetylcholine released from the nerve fiber,
resulting in inadequate depolarization of the motor end plate.
The motor end plate is not sensitive to the action of acetylcholine.
b. Signs and Symptoms.
Diplopia (double vision).
Ptosis (dropping of one or both eyelids).
(3) Abnormal muscle weakness; characteristically worse after effort and
improved by rest.
Sleepy, mask-like facial expression with difficulty smiling.
Speech weakness (high-pitched nasal voice).
Choking, aspiration of food.
c. Medical and Nursing Management.
(1) Primary drug therapy (anticholinesterase drugs to enhance the action of
acetylcholine at the myoneural junction).
(a) Drug must be given exactly on time to control symptoms.
(b) After initial medication adjustments are made, patient learns to take
his medication according to his/her needs.
Patient needs explicit instructions regarding medications.
Reasons for timing.
(d) Symptoms of overdosage and actions to take should crisis occur.
(3) Have mealtimes coincide with peak effect of anticholinergics, when
ability to swallow is best.
Obtain medic alert bracelet signifying that patient has myasthenia gravis.