The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crisis. The nurse tells the client that this is most effectively done by:
A. Eating large, well-balanced meals.
B. Doing muscle-strengthening exercises.
C. Doing all chores early in the day while less fatigued.
D. Taking medications on time to maintain therapeutic blood levels.
Correct Answer: D. Taking medications on time to maintain therapeutic blood levels
Taking medications correctly to maintain blood levels that are not too low or too high is important. The complication of myasthenia gravis includes myasthenic crisis, usually secondary to infections, stress, or acute illnesses. Patients are advised to take their medications as directed and to avoid taking new medicines without checking with the medical provider.
Option A: Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress. It is important to stress the value of avoiding precipitants like infections, excessive exertion, emotional stress, worsening of chronic medical illnesses, and drugs (aminoglycosides, fluoroquinolones, beta-blockers).
Option B: Muscle-strengthening exercises are not helpful and can fatigue the client. Patients should also be educated about various complications and advised to seek medical care as early as possible. Wearing a medical identification bracelet that shows they have myasthenia gravis is also recommended. Health promotive measures to prevent infections like handwashing and yearly flu vaccine should be emphasized.
Option C: Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. The nurses encourage the patients to follow preventive measures like handwashing, smoking cessation, and age-appropriate vaccinations. These can prevent infections that could trigger a myasthenic attack.
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