Myasthenia gravis is causing a patient to have respiratory muscle weakness. He has a vital capac-ity of 5 mL/kg and is unable to cough effectively. What therapy would you recommend to help prevent pulmonary complications?
a. Incentive spirometry
b. Deep-breathing exercises
c. Positive expiratory pressure
d. Intermittent positive-pressure breathing
ANS: D
The patient's vital capacity of 5 mL/kg is a contraindication for the use of incentive spirometry, and coupled with the fact that he is unable to cough effectively, this makes the use of deep-breathing exercises inappropriate. The patient's respiratory weakness plus the fact that there is no mention of excessive sputum make positive expiratory pressure therapy inappropriate. In-termittent positive-pressure breathing is appropriate because of the patient's low vital capacity and inability to cough effectively.
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