Anda di halaman 1dari 19

Miastenia Gravis

Miastenia gravis
 adalah suatu kelainan autoimun yang
ditandai oleh suatu kelemahan abnormal
dan progresif pada otot rangka yang
dipergunakan secara terus-menerus dan
disertai dengan kelelahan saat
beraktivitas.
 Penyakit ini timbul karena adanya
gangguan dari synaptic transmission atau
pada neuromuscular junction.
Etiologi :
 Acquired autoimmune.
 Transient neonatal caused by the passive
transfer of maternal anti-AChR antibodies
 Drug induced: D-penicillamine,
aminoglycosides, quinine, procainamide,
and calcium channel blockers.
 Congenital myasthenic syndromes (AChR
deficiency, slow channel syndrome, and
fast channel syndrome)
Tanda dan Gejala
 Kelemahan yang berfluktuasi pada otot rangka
akan meningkat apabila sedang beraktivitas.
 Penderita akan merasa ototnya sangat lemah
pada siang hari dan akan berkurang apabila
penderita beristirahat.
 Kelemahan pada otot ekstraokular atau ptosis.
 Ptosis yang merupakan salah satu gejala sering
menjadi keluhan utama penderita miastenia
gravis, ini disebabkan oleh kelumpuhan dari
nervus okulomotorius.
 Walaupun otot levator palpebra jelas lumpuh,
namun ada kalanya otot-otot okular masih
bergerak normal.
 kelemahan dari otot masseter sehingga
mulut penderita sukar untuk ditutup.
 Kelemahan otot bulbar juga sering terjadi,
diikuti dengan kelemahan pada fleksi dan
ekstensi kepala.
 Selain itu dapat pula timbul kesukaran
menelan dan berbicara akibat kelemahan
dari otot faring, lidah, pallatum molle, dan
laring sehingga dari pallatum molle
menimbulkan suara sengau.
 Kelemahan otot-otot pernapasan yang
dapat menyebabkan gagal napas akut
Pathofisiology :
Mekanisme imunogenik
memegang peranan yang sangat
penting pada patofisiologi
miastenia gravis : autoimun tiroiditis,
sistemik lupus eritematosus, arthritis
rheumatoid.
Antibodi pada reseptor nikotinik
asetilkolin merupakan penyebab
utama kelemahan otot
 Ikatan antibodi reseptor asetilkolin
pada reseptor asetilkolin
mengakibatkan terhalangnya
transmisi neuromuskular melalui
beberapa cara: ikatan silang
reseptor asetilkolin terhadap
antibodi anti-reseptor asetilkolin
dan mengurangi jumlah reseptor
asetilkolin neuromuscular junction
dengan cara menghancurkan
sambungan ikatan pada membran
post sinaptik
Miastenia gravis dapat dikatakan
sebagai “penyakit terkait sel B”,
dimana antibodi yang merupakan
produk dari sel B justru melawan
reseptor asetilkolin.
Peranan sel T pada patogenesis
miastenia gravis mulai semakin
menonjol.Walaupun mekanisme
pasti tentang
Diagnostik
 Uji Tensilon (edrophonium chloride)
 Uji Prostigmin (neostigmin)
 Uji Kinin
 Laboratorium : Antistriated muscle (anti-
SM) antibody, Anti-muscle-specific kinase
(MuSK) antibodies, Antistriational
antibodies, Anti-asetilkolin reseptor
antibodi
 Elektrodiagnostik : Single-fiber
Electromyography (SFEMG), Repetitive
Nerve Stimulation (RNS)
PENATALAKSANAAN
 Plasma Exchange (PE)
 Intravena Immunoglobulin (IVIG)
 Intravena Metilprednisolone(IVMp)
 Kortikosteroid
 Azathioprine (analog purin)
 Cyclophosphamide (CPM)
 Timektomi (Surgical Care)
Diagnosa Keperawatan :
1. Impaired gas exchange related to
respiratory muscle weakness
2. Ineffective airway clearance related to
difficulty in swallowing and aspiration
3. Self-care deficit related to muscle
weakness, general fatigue
4. Imbalanced Nutrition Less Than Body
Requirements related to dysphagia,
intubation, or muscle paralysis.
Impaired gas exchange related to
respiratory muscle weakness
Purpose:
Patient will maintain adequate gas exchange.
Interventions:
a. Approach to the client, with communication
alternatives, if the client is using a ventilator.
b. Note the oxygenation saturation, with oximetry,
especially with activity
c. Measure respiratory parameters regularly.
d. Collaboration with physicians to anticholinergic
medication.
e. Sucktion as required anticholinergic drugs increased
bronchial secretion).
Ineffective airway clearance related to
difficulty in swallowing and aspiration
 Monitor respiratory status and ability to cough and deep breathe
adequately.
 Maintain suctioning and emergency equipment at the bedside.
 Monitor speech and swallowing abilities to prevent aspiration.
 Encourage the client to sit up when eating.
 Assess muscle status.
 Instruct the client to conserve strength.
 Plan short activities that coincide with times of maximal muscle
strength.
 Monitor for myasthenic and cholinergic crises.
 Administer anticholinesterase medications as prescribed.
 Instruct the client to avoid stress, infection, fatigue, and over-the
counter medications.
 Instruct the client to wear a Medic-Alert bracelet.
 Inform the client about services from the Myasthenia Gravis
Foundation.
Self-care deficit related to muscle
weakness, general fatigue:
Patients will be able to do at least 25% of
the activities themselves and dress up.
Interventions:
1. Create maintenance schedule to the
interval.
2. Give the patient a break in between
events.
3. Perform self-care for the patient during a
very excessive muscle weakness or include
family.
4. Demonstrate energy saving techniques
Imbalanced Nutrition Less Than Body Requirements related to
dysphagia, intubation, or muscle paralysis.

Purpose:
Caloric intake will be adequate to meet the metabolic needs
Interventions
a. Assess reflex cough reflex and swallowing disorders
before administration by mouth
b. Stop feeding by mouth if the patient is unable to cope
with oral secretions or if the cough reflex swallowing
disorders or depressed.
c. Replace the hose and give small meals eaten per-
interval if there dysfagia.
d. Record intake and output.
e. Perform nutritional consultation to evaluate calories.
f. Measure the patient's body weight every day. ads
Thank You