A nurse is caring for a client with myasthenia gravis who is experiencing increased dyspnea and decreased oxygen saturation levels. Which of the following interventions should the nurse prioritize to improve this client's respiratory status?

Rationale:

A. Complete avoidance of activity can lead to muscle atrophy, joint stiffness, decreased endurance, and worsening fatigue. While rest is important during flare-ups, total inactivity is detrimental to overall function and quality of life.

B. Extended rest alone does not address fatigue or loss of joint mobility. Excessive inactivity can contribute to deconditioning, increased stiffness, and diminished independence.

C. Moderate, low-impact exercise such as walking, swimming, or gentle range-of-motion exercises has been shown to reduce fatigue, improve muscle strength, enhance joint mobility, and increase energy levels in patients with rheumatoid arthritis. This intervention supports independence in daily activities and overall quality of life. Exercise should be tailored to the patient’s tolerance and combined with periods of rest during flare-ups.

D. While proper nutrition is important, increasing caloric intake alone will not reduce fatigue or improve joint function. Focus should be on a balanced diet that supports overall health, rather than excessive calories, which could lead to weight gain and additional joint stress.

Rationale:

A. While it is important to review the patient’s medications to avoid drug interactions (e.g., with cholinergic or anticholinergic drugs), this is not the primary assessment to evaluate Tensilon’s effectiveness in diagnosing myasthenia gravis.

B. Respiratory status is critical to monitor due to the risk of respiratory compromise in myasthenia gravis or during a cholinergic crisis. However, prior to administering Tensilon for diagnostic purposes, the primary goal is to assess neuromuscular response, not respiratory function, although baseline respiratory assessment is part of overall safety.

C. Monitoring vital signs is necessary because edrophonium can cause bradycardia or hypotension, but these parameters do not measure the diagnostic effectiveness of the medication.

D. Tensilon works by temporarily inhibiting acetylcholinesterase, increasing acetylcholine at the neuromuscular junction. The diagnostic response is evaluated by observing improvement in muscle strength and endurance, typically in areas such as ptosis, facial muscles, or grip strength. Comparing pre- and post-administration muscle performance allows the nurse and provider to determine whether the patient has myasthenia gravis.