Myasthenic Marge — Myasthenia Gravis & Myasthenic Crisis
Ptosis and diplopia worsen with use — watch for crisis when swallowing and breathing fail
Marge's eyelids droop more by dinnertime, and her voice grows softer with every sentence. Tonight, halfway through her soup, she suddenly cannot swallow and her breathing sounds shallow.
Marge's body attacks its own acetylcholine receptors, so her muscles fatigue with repeated use and recover with rest. Ptosis and diplopia worsen through the day; chewing, swallowing and even breathing can weaken. A myasthenic crisis — severe respiratory muscle weakness — is a true emergency, and the Tensilon test distinguishes it from cholinergic crisis caused by too much medication.
Read Myasthenic Marge's full story →The story arc
The setup
Marge notices her eyelids sag by afternoon and her jaw tires halfway through a meal, but mornings feel almost normal.
The turn
Double vision appears when she reads for more than a few minutes, and her voice grows nasal and weak by the end of a phone call.
The crisis
Marge suddenly cannot swallow her soup, her voice fades to a whisper, and her respirations become shallow and rapid with a falling vital capacity.
The save
The nurse keeps suction and intubation equipment at the bedside, monitors vital capacity and negative inspiratory force closely, and the provider orders a Tensilon (edrophonium) test to distinguish myasthenic crisis from cholinergic crisis before adjusting medication.
NCLEX study section — Myasthenia Gravis & Myasthenic Crisis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.