The nurse is caring for a 49-year-old patient, who has been receiving bethanechol (Duvoid) for 1 week. The patient develops progressive muscle weakness and respiratory difficulty. Edrophonium is ordered and injected and the patient's symptoms worsen
How would the nurse interpret this response? A) Myasthenic crisis
B) Cholinergic crisis
C) Anaphylactic reaction
D) Pulmonary edema
B
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The patient with a cholinergic crisis presents with progressive muscle weakness and respiratory difficulty because the accumulation of acetylcholine at the cholinergic receptor site leads to reduced impulse transmission and muscle weakness. This is a crisis when the respiratory muscles are involved. Myasthenic crisis and cholinergic crisis display similar clinical pictures. The drug edrophonium can be used as a diagnostic agent to distinguish the two conditions. If the patient improves immediately after the edrophonium injection, the problem is a myasthenic crisis, which is improved by administration of the cholinergic drug. If the patient gets worse, the problem is probably a cholinergic crisis, so withdrawal of the patient's cholinergic drug along with intense medical support is indicated. The situation does not depict an anaphylactic reaction or pulmonary edema.
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