A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:
A. Getting too little exercise.
B. Taking excess medication.
C. Omitting doses of medication.
D. Increasing intake of fatty foods.
Correct Answer: C. Omitting doses of medication.
Myasthenic crisis often is caused by under medication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Myasthenic crisis is a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation.
Option A: The most common precipitant is infection. One series documented infection in 38% of patients presenting with myasthenic crisis; most commonly, the infection was bacterial pneumonia followed by a bacterial or viral upper respiratory infection. Other antecedent factors include exposure to temperature extremes, pain, sleep deprivation, and physical or emotional stress.
Option B: Cholinergic crisis (the opposite problem) is caused by excess medication and responds to withholding of medications. Patients taking an excess of acetylcholinesterase inhibitors may precipitate a cholinergic crisis characterized by both muscarinic and nicotinic toxicity. Although cholinergic crisis is an important consideration in the evaluation of the patient in myasthenic crisis, it is uncommon.
Option D: Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger a myasthenic crisis. Other precipitants include aspiration pneumonitis, surgery, pregnancy, perimenstrual state, certain medications (see below), and tapering of immune-modulating medications.
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