Page 2027 - Saunders Comprehensive Review For NCLEX-RN

deep-breathe adequately.
2. Monitor for respiratory failure.
3. Maintain suctioning and 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 MedicAlert bracelet.
14. Inform the client about services from the Myasthenia
Gravis Foundation.
D. Anticholinesterase medications: Increase levels of acetylcholine at
the myoneural junction (see Chapter 59)

E. Myasthenic crisis

1. Description
a. An acute exacerbation of the disease
b. The crisis is caused by a rapid,
unrecognized progression of the
disease, inadequate amount of
medication, infection, fatigue, or stress.
2. Assessment
a. Increased pulse, respirations, and blood
pressure
b. Dyspnea, anoxia, and cyanosis
c. Bowel and bladder incontinence
d. Decreased urine output
e. Absent cough and swallow reflex
3. Interventions
a. Assess for signs of myasthenic crisis.
b. Increase anticholinesterase medication,
as prescribed.

F. Cholinergic crisis

1. Description
a. Results in depolarization of the motor
end plates
b. The crisis is caused by overmedication

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