Nursing Care Plan for Rhabdomyolysis

Pathophysiology

Essentially, skeletal muscle is destroyed (for various reasons) and their intracellular contents (in particular myoglobin) leak into the bloodstream. The kidneys can’t handle this large amount of myoglobin and it can damage them, and in some cases (roughly 30-40% of patients with this develop acute renal failure) can cause kidney failure.

Etiology

Quite a few things can cause this. One that has been discussed more frequently recently is due to the increase in people engaging in high-intensity workouts (like CrossFit). This causes intense muscle breakdown, which can result in this condition. Trauma can also be a cause, as well as conditions of genetic origin, seizures, metabolic issues, temp-regulating issues, and many medications.  A few medications that can cause this to occur include statins, diuretics, aspirin overdose (salicylate toxicity), recreational drugs like cocaine and amphetamines, and narcotics.

Desired Outcome

Rhabdomyolysis Nursing Care Plan

Subjective Data:

  • Muscle pain*
  • Generalized weakness*
  • Nausea
  • Tender muscles

Objective Data:

  • Dark urine*
  • Vomiting
  • Fever
  • Edema
  • Skin changes (may even look like necrosis)
  • Tense muscles

Nursing Interventions and Rationales

  1. Ensure fluid resuscitation
    • “Expansion of extracellular volume is the cornerstone of treatment and must be initiated as soon as possible.” (Source)

  2. Record I&O
    • The amount of urine output, or lack thereof, may dictate various treatment regimens. Patients may need dialysis if oliguria is present.

  3. Insert Foley and prevent infection
    • Enables nurse to closely and accurately monitor urine output, foley is a source of infection and must be cared for diligently

  4. Monitor labs
    • Labs can and will dictate treatment regimens, especially because symptoms can vary widely. CK, serum and urine pH, bicarb, and electrolytes to name a few

  5. Correct electrolytes per orders
    • Electrolyte imbalances are common (K, Ca, P are of particular importance)

  6. Monitor for compartment syndrome
    • If significant muscle injury occurred, compartment syndrome is a risk. Muscle injury is typical due to decreased perfusion.

  7. Discharge education r/t diet, activity level/prevention
    • Diet changes can prevent this in the future when there is a metabolic cause, patients who are active athletes need to ensure they are hydrated appropriately and use caution with intense exercise, and note if they’re experiencing heat stroke. If a medication was noted to cause this, it and alternatives should be evaluated with the prescriber. Prevention is key!


References

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