While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition?
A. The client may be less sensitive to the effects of a neuromuscular blocking agent.
B. Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
C. Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
D. Pancuronium and succinylcholine both require cautious administration.
Correct Answer: D. Pancuronium and succinylcholine both require cautious administration.
The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Patients on NMDA are usually in the intensive care unit. Monitoring of patients on NMDA includes pulse oximetry for oxygen saturation, continuous end-tidal C02. The rise in the level of carbon dioxide might show the development of malignant hyperthermia.
Option A: Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent. Succinylcholine administration correlates to a significant rise in the serum potassium. Therefore, it is recommended to avoid use of succinylcholine in patients with chronic renal disease, burn patients, patients with crush injuries, and rhabdomyolysis. Elevated potassium level can lead to fatal arrhythmia.
Option B: Succinylcholine is also associated with bradycardia especially in the pediatric population. The stimulation of the nicotinic receptor activates a muscarinic receptor that produces bradycardia. The effect can be blunted by administering atropine or glycopyrrolate.
Option C: Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis. When an electric impulse transmits along the motor neuron, it causes the release of acetylcholine (ACh) from the presynaptic membrane which travels across the synaptic cleft and acts on the nicotinic receptors on the postsynaptic membrane, causing muscle contraction.
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