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The respiratory assessment of a 44-year-old female patient diagnosed with myasthenia gravis shows:

- Vital capacity: 475 mL
- Maximum inspiratory pressure (MIP): 18 cm H₂O

The patient is 5 feet 6 inches tall and weighs 188 lb. The most recent ABG on a 2 L/min nasal cannula is:

- pH: 7.32
- PaCO₂: 49 mm Hg
- PaO₂: 77 mm Hg
- SaO₂: 95%
- HCO₃: 24 mEq/L

What is the most appropriate recommendation for this patient?

a. 50% air entrainment mask
b. Continuous positive airway pressure
c. Noninvasive positive pressure ventilation
d. Intubation and mechanical ventilation

Answer :

Final answer:

The most appropriate recommendation for a 44-year-old female patient diagnosed with myasthenia gravis, with reduced respiratory muscle strength and function, and ABG results indicating respiratory acidosis with hypoxemia, is noninvasive positive pressure ventilation.

Explanation:

Myasthenia gravis is a chronic autoimmune neuromuscular disease that affects the muscles responsible for breathing. In this case, the respiratory assessment of a 44-year-old female patient diagnosed with myasthenia gravis shows a vital capacity of 475 mL and a maximum inspiratory pressure (MIP) of 18 cm H₂O. These measurements indicate reduced respiratory muscle strength and function.

The patient's ABG results on a 2 L/min nasal cannula show a pH of 7.32, PaCO₂ of 49 mm Hg, PaO₂ of 77 mm Hg, SaO₂ of 95%, and HCO₃ of 24 mEq/L. These values suggest respiratory acidosis with hypoxemia.

Based on the respiratory assessment findings and ABG results, the most appropriate recommendation for this patient is noninvasive positive pressure ventilation (option c). Noninvasive positive pressure ventilation (NPPV) provides ventilatory support without the need for intubation and mechanical ventilation. It helps improve ventilation and oxygenation by delivering positive pressure to the airways during inspiration, assisting the patient's weakened respiratory muscles.

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