Lesson Objectives for Rhabdomyolysis

• Understanding Rhabdomyolysis:
  • Define rhabdomyolysis as a medical condition characterized by the breakdown of skeletal muscle tissue, leading to the release of muscle cell contents into the bloodstream.
• Identifying Causes and Risk Factors:
  • Explore the common causes and risk factors associated with rhabdomyolysis, including traumatic injuries, muscle overexertion, crush injuries, certain medications, and underlying medical conditions.
• Recognizing Clinical Manifestations:
  • Identify the signs and symptoms of rhabdomyolysis, such as muscle pain, weakness, dark urine (myoglobinuria), and potential complications like kidney injury. Understand the importance of early recognition for prompt intervention.
• Diagnostic Approaches:
  • Learn about the diagnostic methods used to confirm rhabdomyolysis, including blood tests to assess creatine kinase levels, urine myoglobin tests, and imaging studies. Understand the significance of these assessments in determining the extent of muscle damage.
• Management and Nursing Interventions:
  • Explore the principles of managing rhabdomyolysis, including fluid resuscitation, electrolyte monitoring, and addressing the underlying cause. Understand the role of nursing interventions in monitoring and supporting patients with rhabdomyolysis.

Pathophysiology of Rhabdomyolysis

• Muscle Injury:
  • Rhabdomyolysis begins with muscle injury, often due to trauma, excessive exercise, crush injuries, or conditions leading to muscle breakdown. The integrity of muscle cell membranes is compromised.
• Release of Intracellular Contents:
  • The damaged muscle cells release intracellular contents into the bloodstream, including myoglobin, creatine kinase (CK), potassium, and other cellular components.
• Myoglobinuria:
  • Myoglobin, a protein found in muscle cells, is released and filtered by the kidneys. In high concentrations, myoglobin can overwhelm the renal filtration capacity, leading to myoglobinuria (dark-colored urine).
• Renal Implications:
  • Myoglobinuria and the release of other cellular components can cause acute kidney injury (AKI). Myoglobin can precipitate in renal tubules, contributing to renal dysfunction and further complications.
• Systemic Effects:
  • The release of potassium from damaged cells can lead to hyperkalemia, and the systemic inflammatory response may contribute to a cascade of events, including fluid shifts and electrolyte imbalances.

Etiology of Rhabdomyolysis

• Physical Trauma:
  • Severe physical trauma, such as crush injuries, accidents, or prolonged immobilization, can result in muscle damage and the release of intracellular contents.
• Excessive Exercise:
  • Intense and prolonged physical activity, especially in individuals unaccustomed to such exertion, can lead to muscle breakdown and rhabdomyolysis.
• Drug-Induced:
  • Certain medications, such as statins, antipsychotics, and illicit substances like cocaine or amphetamines, may contribute to muscle injury and rhabdomyolysis.
• Infections and Inflammatory Conditions:
  • Infections, especially viral myositis, and inflammatory conditions like autoimmune myopathies can trigger rhabdomyolysis.
• Metabolic and Genetic Factors:
  • Metabolic disorders (e.g., metabolic myopathies) and genetic factors affecting muscle structure or function can predispose individuals to rhabdomyolysis.

Desired Outcome for Rhabdomyolysis

• Normalization of Creatine Kinase (CK) Levels:
  • Achieve a gradual decrease and eventual normalization of CK levels, indicating resolution of muscle breakdown and reduced risk of further complications.
• Prevention of Acute Kidney Injury (AKI):
  • Prevent the development or progression of AKI by promoting adequate hydration, monitoring renal function, and promptly addressing any signs of renal impairment.
• Pain Management:
  • Alleviate and manage muscle pain and discomfort through appropriate pain management strategies, contributing to improved patient comfort and mobility.
• Fluid and Electrolyte Balance:
  • Restore and maintain fluid and electrolyte balance, preventing complications such as electrolyte imbalances, hyperkalemia, and fluid shifts.
• Prevention of Recurrence:
  • Implement measures to prevent the recurrence of rhabdomyolysis by addressing underlying causes, educating the patient on risk factors, and promoting a balanced approach to physical activity.

Rhabdomyolysis Nursing Care Plan

Nursing Interventions and Rationales

Evaluation for Rhabdomyolysis

• Creatine Kinase Levels:
  • Evaluate the trend of CK levels over time. A decreasing trend indicates resolution of muscle breakdown, and normalization suggests successful management.
• Renal Function:
  • Assess renal function through monitoring of serum creatinine, blood urea nitrogen (BUN), and urine output. Stabilization or improvement in renal function indicates successful prevention or management of acute kidney injury.
• Pain Relief:
  • Evaluate the effectiveness of pain management interventions by assessing the patient’s reported pain levels. Adequate pain relief contributes to improved patient comfort and mobility.
• Fluid and Electrolyte Balance:
  • Monitor fluid balance and electrolyte levels. Normalization of electrolyte imbalances and maintenance of adequate hydration signify successful fluid resuscitation and management.
• Prevention of Recurrence:
  • Assess the patient’s understanding of preventive measures and lifestyle modifications to avoid recurrence. Education and adherence to recommendations contribute to long-term prevention.

References

• https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis
• https://www.cdc.gov/niosh/topics/rhabdo/default.html