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Case Presentation: Rhabdomyolysis

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shirley Frias

on 1 July 2015

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Transcript of Case Presentation: Rhabdomyolysis

Case Presentation by:
Shirley M. Frias

NUR273
Summer 2015
Rhabdomyolysis
Case scenario:
A 44 y/o female was received from the ED with the c/c of leg cramps, nausea and anuria. V/s are: BP 187/95, Pulse 66, respiration 18, SpO2 99%, pain 8/10. She have a history of McArcdle syndrome, musculoskeletal disease, neurological disease and migraine. Past surgical history of tumor biopsies, C-section, hysterectomy and placement of mediport to the left chest. Upon assessment, the patient reports constant pain of both legs. Caps refill is <2sec, skin normal in color, skin temperature is warm, distal sensation is intact and muscle tone normal. No signs of infection, trauma and swelling.
Diagnostic procedures:
Blood and urine tests
CT or MRI
Biopsy
Blood vessel
K+
Hyperkalemia
K+
K+
K+
K+
K+
K+
K+
Cardiac arrhythmia / Cardiac arrest
Creatine Kinase
Phosphate
Sulfate
Urate
Metabolic Acidosis
Myoglubin
Tea or
Coca-cola - colored urine
Na+
Ca+
H2O
Muscle swelling
Kidney damage
Na+ in serum results to brain swelling and AMS
Injured Muscle
Causes:
severe trauma,
burns,
heatstroke,
seizures,
metabolic derangements,
viral infections,
alcohol,
medications such as statins and amphetamines,
genetic defects of lipid and carbohydrate metabolism and
intense exertion
Compartment Syndrome
Lab values
Treatment:
Fluids
Dialysis
Blood transfusion
Fasciotomy

Administer aggressive I.V. fluids to help minimize damage to the kidneys.
Monitor I’s and O’s
Monitor kidney function tests, electrolyte levels, and daily weight
Auscultate breath sounds and monitor for signs of pulmonary edema
Notify MD immediately if the client has dark or decreased urine

Nursing Intervention:

GOAL: Early diagnosis and rapid treatment.
Patient Outcome:

With good hydration and rest, there is a good prognosis.
NCLEX Questions!
1. A patient who takes a Statin is admitted with a diagnosis of Rhabdomyolysis. Which of the following nursing diagnoses probably would be most appropriate for this patient?

A. Noncompliance, related to drug regimen
B. Altered nutrition, less than body requirements
C. Pain, related to drug-induced myopathy
D. Deficit knowledge, related to need for altered lifestyle


C. Pain, related to drug-induced myopathy

Rationale:
Statins can cause muscle injury, resulting in symptoms such as weakness, soreness, and pain. Rhabdomyolysis is a medical condition in which muscle tissue becomes extremely inflamed, resulting in breakdown of muscle.

Reference: http://wps.prenhall.com/chet_holland_coreconcepts_2/46/11781/3016167.cw/content/index.html


2. The nurse is caring for a patient with a skeletal muscle disorder. The nurse reviews the patient’s lab results and expects which creatinine phosphokinase isoenzyme to be elevated?

A. BB
B. MB
C. MK
D. MM

D. MM

Rationale:
Creatinine Phosphokinase, or creatinine kinase (CK) is an enzyme that is released from tissue after injury. CK-MM is expressed during skeletal muscle disease. CK-BB is expressed in the brain, CK-MB is reflective of cardiac muscle damage, CK-MK does not exist.

Reference: NCLEX RN Mastery App (Musculoskeletal)



A. Betadine soaked dressings
B. Silver-based, hydrocolloid dressing
C. Sterile saline soaked dressings
D. Vaseline gauze with bacitracin

C. Sterile saline soaked dressings

Rationale:
Fasciotomy sites are left open in the immediate postoperative period to allow assessment of tissue viability and pressure release. Sterile saline soaked gauze are used to allow frequent wound assessment. After 24 to 48 hours, negative pressure wound therapy can be used.

Reference: NCLEX RN Mastery App (Musculoskeletal)


B. 24 hours

Rationale:
Keeping the site elevated for 24 hours will reduce edema and discomfort. Elevating for less than 24 hours may cause additional edema.

Reference: NCLEX RN Mastery App (Musculoskeletal)

4. When caring for a patient after a muscle biopsy, the nurse should keep the site elevated for:

A.12 hours
B. 24 hours
C. 6 hours
D. 8 hours

A.Slow the infusion
B. Explain that the pain will subside after the first few exchanges
C. Stop the infusion
D. Decrease the amount to be infused

B. Explain that the pain will subside after the first few exchanges

Rationale:
Pain during the inflow of dialysate is common during the first few exchanges because of peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment.

Reference: Saunders comprehensive review 5th ed. (pg. 886)


3. The nurse is caring for a patient that underwent a fasciotomy for the treatment of Rhabdomyolysis. Which type of dressing should the nurse prepare to cover the site?
5. A client newly diagnosed with renal failure after rhabdomyolysis has just been started on peritoneal dialysis. During the infusion of the dialysate, the client complains of abdominal pain. Which action by the nurse is appropriate?
Hooorayyy!!!!
(26-192)
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