The nurse is caring for a patient who has myasthenia gravis (MG) ...

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The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon). The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing. What action will the nurse perform next?
 
  a. Contact the provider to request an order for atropine sulfate.
  b. Contact the provider to request an order for edrophonium chloride (Tensilon).
  c. Report signs of cholinergic crisis to the provider.
  d. Report signs of myasthenic crisis to the provider.

Question 2

The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours.
 
  The patient's last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?
  a. Assess the patient for signs of ptosis.
  b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
  c. Obtain an order for atropine sulfate.
  d. Request an order for an extra dose of pyridostigmine.

[nathang24]

Answer to Question 1

ANS: B
Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia. Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor. When given, if the symptoms are alleviated, the cause is myasthenic crisis; if symptoms worsen, it is cholinergic crisis. Since patients can have similar symptoms, the nurse cannot report one or the other to the provider without more information.

Answer to Question 2

ANS: C
Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.

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TYSM

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