Nursing Care and Pathophysiology for Rhabdomyolysis

When the muscle cells break down, everything inside the cell is leaded into the bloodstream. Let’s pretend this is a patient’s leg and they went to a really extreme spinning class and severely overworked their leg muscles. This is a picture of a muscle cell inside of the leg. Creatinine kinase, myoglobin, potassium, and phosphorus are all components within the cell, so when that cell is destroyed, they will all leak out into the bloodstream.

So, after the muscle cells break down and the components are leaked into the bloodstream, those components are going to affect the rest of the body. The kidneys are going to be affected the most because the myoglobin blocks the renal tubules making it hard for them to get oxygen from blood. They will eventually die without treatment and renal failure will occur. The patient may have low urine output or none at all. The brain is affected as well because of the toxins in the blood reaching the brain causing confusion. The electrolyte imbalance from the cellular leakage can lead to irregular heart rhythms. The biggest complication and end result of rhabdo is organ failure.

The patient with rhabdo is going to present with weakness, swelling, dark colored urine, low or no urine output, and confusion. It depends on what caused the rhabdo, for example a patient like in this picture that over exerted themselves in exercise will have a lot of pain and swelling in their legs. A patient that was lying in one spot for a long period of time may just be super confused. This is why it is important to assess our patients thoroughly.

We will be monitoring our patients lab values, which will show increased CK, myoglobin, potassium, and phosphorus. The normal ranges will depend on the policies of the organization that your are working in, however here are some guidelines for normal ranges to go off of. Potassium is usually around 3.5 to 5. Phosphorus is 2.5 to 4.5. Creatinine kinase levels vary from 22 to 198, and myoglobin levels may be zero, or up to 85. Here is our patient in rhabdo with a foley catheter and an I & O sheet  so that we may monitor their output to ensure their kidney function is improving with treatment. The patient may be put on continuous cardiac monitoring telemetry to watch for arrhythmias. And of course, we want to assess the patient’s pain level and try to keep them comfortable.

So we want to keep our patient’s kidneys working. We will administer normal saline IV infusions to flush the kidneys. Diuretics may be given to reduce any swelling in the body and to increase their urine output. Dialysis may be necessary to clean toxins from the blood if the kidneys are failing to do so. It’s important that we let our patients rest their muscles to prevent any further injury.

You will want to let your patient know to keep an eye on their urine color and amount, and to start activity slowly and increase over time. They should seek help right away after any trauma that occurs to their body. If your patient is an elder, help them to plan for future fall incidents. They might have a family member check on them daily, a cell phone they keep in their pocket at all times, or even a life alert button that they can press if they fall. This could prevent them from lying in a spot for many days. Patients that use drugs should be advised to stop to prevent further damage to their body.

Our priority nursing concepts for rhabdomyolysis are elimination, cellular regulation, and fluid and electrolyte balance.