A nurse is caring for a client with myasthenia gravis who is experiencing a myasthenic crisis. Which nursing action should be the highest priority?

Upon recognizing signs of myasthenic crisis (dyspnea, tachypnea, weak cough, inability to clear secretions), immediately assess the airway, breathing, and circulation. The highest priority is evaluating respiratory rate, depth, oxygen saturation, and the patient's ability to protect their airway. Maintain a patent airway using positioning, suctioning, or adjuncts as needed while continuously monitoring for impending respiratory arrest.

Notify the provider and prepare for emergency airway management. Have endotracheal intubation equipment and a bag-valve-mask device at the bedside. Non-invasive positive pressure ventilation (BiPAP) may be used temporarily, but progressive hypercapnia or hypoxia necessitates definitive airway control and mechanical ventilation. Serial monitoring of negative inspiratory force (NIF) and vital capacity (VC) guides the timing of intubation.

Administer prescribed anticholinesterase inhibitors (e.g., pyridostigmine) as ordered, but never delay airway intervention for medication administration. Plasmapheresis or intravenous immunoglobulin (IVIG) are first-line immunomodulatory treatments to rapidly reverse the crisis. Corticosteroids may be initiated with caution due to potential transient worsening of weakness.

Monitor for complications such as aspiration pneumonia, atelectasis, and deep vein thrombosis. Implement strict aspiration precautions, including frequent oral suctioning and keeping the head of bed elevated. Provide meticulous eye care if the patient has ptosis or impaired lid closure. Once stabilized, collaborate with respiratory therapy and physical therapy for gradual weaning and rehabilitation.