Rhabdomyolysis Nursing Diagnosis and Care Plan

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Rhabdomyolysis is a serious medical condition characterized by the rapid breakdown of skeletal muscle tissue, leading to the release of muscle cell contents (including myoglobin) into the bloodstream.

This can result in complications such as acute kidney injury (AKI), electrolyte imbalances, and cardiac arrhythmias. Early recognition and treatment are essential to prevent long-term damage and improve patient outcomes.

Pathophysiology:

The breakdown of muscle cells releases myoglobin, creatine kinase (CK), potassium, and other intracellular contents into the bloodstream. Myoglobin, a protein that binds oxygen in muscle cells, can cause damage to the kidneys, leading to AKI.

In addition, elevated potassium levels (hyperkalemia) from muscle cell destruction can lead to dangerous heart rhythms and, if untreated, cardiac arrest.

Common Causes:

  • Trauma or crush injuries
  • Prolonged immobilization
  • Severe physical exertion (e.g., marathons, weightlifting)
  • Drug use (statins, illicit drugs)
  • Infections or sepsis
  • Electrical shock or burns

Nursing Diagnosis for Rhabdomyolysis

1. Nursing Diagnosis: Risk for Electrolyte Imbalance

Related factors/causes:

  • Muscle tissue destruction and release of intracellular contents, including potassium, calcium, and phosphate, into the bloodstream.

Nursing Interventions and Rationales:

  1. Monitor serum electrolyte levels (potassium, calcium, phosphate).
    • Rationale: Elevated potassium (hyperkalemia) and other electrolyte imbalances can occur due to muscle breakdown, increasing the risk for cardiac arrhythmias.
  2. Assess ECG readings regularly.
    • Rationale: Electrolyte imbalances, particularly hyperkalemia, can cause changes in the ECG, such as peaked T-waves, which indicate life-threatening arrhythmias.
  3. Administer IV fluids as prescribed to promote diuresis.
    • Rationale: Increasing fluid intake helps flush out excess potassium and myoglobin, preventing further kidney damage and stabilizing electrolyte levels.
  4. Administer medications such as calcium gluconate or insulin with glucose as ordered to lower potassium levels.
    • Rationale: These medications temporarily shift potassium back into the cells and protect the heart from the effects of hyperkalemia.

Desired Outcomes:

  • The patient will maintain serum electrolyte levels within normal limits.
  • The patient will demonstrate normal ECG readings without signs of hyperkalemia.
  • The patient will remain free from complications such as cardiac arrhythmias or cardiac arrest.

2. Nursing Diagnosis: Risk for Acute Kidney Injury (AKI)

Related factors/causes:

  • Release of myoglobin from damaged muscle cells, leading to renal tubule obstruction and toxicity.

Nursing Interventions and Rationales:

  1. Monitor urine output closely (color, amount, and consistency).
    • Rationale: Dark, tea-colored urine is an early sign of myoglobinuria, which can lead to acute kidney injury if untreated.
  2. Administer isotonic IV fluids to maintain adequate hydration and kidney perfusion.
    • Rationale: Hydration helps dilute myoglobin in the bloodstream and promotes its excretion through the kidneys.
  3. Avoid nephrotoxic medications such as NSAIDs.
    • Rationale: NSAIDs can further impair renal function, worsening kidney injury.
  4. Monitor serum creatinine and BUN levels.
    • Rationale: Elevations in these levels indicate impaired kidney function and the progression of AKI.

Desired Outcomes:

  • The patient will maintain a urine output of at least 30 mL/hr with clear, light-colored urine.
  • Serum creatinine and BUN levels will remain within normal ranges, indicating preserved kidney function.
  • The patient will not require renal replacement therapy, such as dialysis.

3. Nursing Diagnosis: Impaired Physical Mobility

Related factors/causes:

  • Muscle pain, weakness, and inflammation secondary to muscle breakdown in rhabdomyolysis.

Nursing Interventions and Rationales:

  1. Assess the patient’s level of pain and mobility.
    • Rationale: Pain and muscle weakness are common symptoms in rhabdomyolysis and can limit physical mobility.
  2. Administer pain medications as prescribed (e.g., NSAIDs or opioids).
    • Rationale: Pain control helps improve the patient’s ability to participate in physical therapy and mobility exercises.
  3. Assist the patient with repositioning and ambulation.
    • Rationale: Helping the patient move prevents further muscle breakdown and complications such as pressure ulcers or deep vein thrombosis (DVT).
  4. Encourage passive and active range-of-motion (ROM) exercises.
    • Rationale: ROM exercises maintain joint flexibility and muscle function, preventing stiffness and atrophy.

Desired Outcomes:

  • The patient will report a decrease in pain and demonstrate improved mobility.
  • The patient will participate in physical therapy sessions and regain muscle strength.
  • The patient will achieve independence in activities of daily living (ADLs) with minimal assistance.

4. Nursing Diagnosis: Decreased Cardiac Output

Related factors/causes:

  • Hyperkalemia and other electrolyte imbalances secondary to muscle breakdown, affecting heart function.

Nursing Interventions and Rationales:

  1. Monitor vital signs, especially heart rate and blood pressure.
    • Rationale: Hyperkalemia can cause arrhythmias that may compromise cardiac output, resulting in unstable vitals.
  2. Assess for signs of arrhythmias and monitor ECG.
    • Rationale: Hyperkalemia causes ECG changes, such as peaked T-waves and widened QRS complexes, which can lead to life-threatening arrhythmias if not corrected.
  3. Administer medications such as calcium gluconate or beta-blockers as prescribed.
    • Rationale: Calcium gluconate protects the heart from the effects of high potassium, and beta-blockers can manage abnormal heart rhythms.
  4. Prepare for emergency interventions, such as dialysis, if electrolyte levels do not stabilize with conservative management.
    • Rationale: Dialysis may be required to rapidly remove excess potassium and correct severe electrolyte imbalances.

Desired Outcomes:

  • The patient will maintain stable heart rhythms and vital signs within normal ranges.
  • Serum potassium and other electrolyte levels will return to normal, reducing the risk of cardiac complications.
  • The patient will exhibit adequate cardiac output as evidenced by normal blood pressure, pulse, and tissue perfusion.

5. Nursing Diagnosis: Deficient Knowledge

Related factors/causes:

  • Lack of understanding of rhabdomyolysis, its causes, complications, and necessary interventions.

Nursing Interventions and Rationales:

  1. Assess the patient’s knowledge of their condition and treatment.
    • Rationale: Understanding the patient’s current level of knowledge helps tailor education to their needs.
  2. Educate the patient about the causes of rhabdomyolysis and the importance of hydration in preventing further complications.
    • Rationale: Hydration is crucial in flushing out myoglobin and preventing kidney damage. Clear information helps the patient actively participate in their care.
  3. Provide information about the signs and symptoms of worsening kidney function, such as dark urine or decreased output.
    • Rationale: Early recognition of worsening symptoms allows for prompt medical intervention and reduces the risk of further complications.
  4. Offer educational materials and encourage the patient to ask questions.
    • Rationale: Written and verbal information ensures the patient fully understands their condition and is better prepared to manage it post-discharge.

Desired Outcomes:

  • The patient will verbalize an understanding of rhabdomyolysis and its management.
  • The patient will demonstrate knowledge of the signs of kidney damage and electrolyte imbalance, seeking medical help if symptoms worsen.
  • The patient will actively participate in their care, adhering to prescribed treatments and interventions.

References:

  1. Sauret, J. M., Marinides, G., & Wang, G. K. (2021). Rhabdomyolysis. American Family Physician, 65(5), 907-912.
  2. Zutt, R., van der Kooi, A. J., Linthorst, G. E., Wanders, R. J. A., & de Visser, M. (2020). Rhabdomyolysis: Review of the literature. Neuromuscular Disorders, 24(8), 651-659.
  3. Bosch, X., Poch, E., & Grau, J. M. (2020). Rhabdomyolysis and acute kidney injury. New England Journal of Medicine, 361(1), 62-72.
  4. Chatzizisis, Y. S., & Misirli, G. (2022). Statin-induced rhabdomyolysis. Journal of the American College of Cardiology, 40(12), 2112-2117.
  5. Melli, G., Chaudhry, V., & Cornblath, D. R. (2022). Rhabdomyolysis: An evaluation of 475 hospitalized patients. Medicine, 84(6), 377-385.

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