Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.

Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.

This study guide is about muscular dystrophy, diagnosis of muscular dystrophy, treatment of muscular dystrophy, and  3 muscular dystrophy nursing care plan examples. It can be referred to in the creation of nursing care plans for muscular dystrophy.

Muscular Dystrophy

What is muscular dystrophy?

Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.
Muscular Dystrophy

Muscular dystrophy is a medical condition wherein the muscles of the body are compromised, resulting in the degeneration of muscle fibers.

There are different types of muscular dystrophy, but all share the same characteristics:

1. It is inherited;

2. It is non-inflammatory;

3. It is progressive; and

4. Absence of central or peripheral nerve abnormality.

What are the signs and symptoms of muscular dystrophy?

Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.
signs and symptoms of muscular dystrophy

The clinical manifestations of muscular dystrophy vary according to each type and are listed below:

A. Duchenne type – most common form; more common in boys

  • Falls frequently
  • Difficulty in moving from a lying or sitting position
  • Difficulty in running and/or jumping
  • Uneven gait (wadding)
  • Walking on toes
  • Enlarged calf muscles
  • Muscle pain and stiffness
  • Learning challenges
  • Delayed growth

B. Becker type

  • Signs and symptoms are milder than the Duchenne type
  • Progresses more slowly when compared to Duchenne type
  • Generally occurs in the teenage years but may occur in the mid-’20s or later.

C. Other types of Muscular dystrophy

  • Myotonic – characterized by the inability to relax muscles after contractions. Patients with this type often have long, thin faces, drooping eyelids, and elongated, swan-like necks. This type usually starts in the face and neck muscles.
  • Facioscapulohumeral (FSHD) – Muscle weakness starts in the face, shoulders, and hips. Patients with this type oftentimes have their shoulder blades flared out, like wings, when arms are raised. This type begins in teens but can start during childhood or later in life.
  • Congenital – This type affects both genders and is present at birth. It may progress rapidly or slowly.
  • Limb-girdle – The usually affected area starts at the hip and shoulder muscles. Patients usually have difficulty lifting the front part of their foot, thereby tripping often. Onset is during childhood or during the teenage years.

What are the causes and risk factors of muscular dystrophy?

The musculoskeletal system is composed of the skeleton, muscles, and other connective tissues (i.e. tendons, cartilage, ligaments, joints, etc.) that have a function to bind and support the body, thereby allowing for motion. It also serves as protection for the vital parts of the body. When the muscle fibers degenerate, muscular dystrophy occurs.

The cause of Muscular dystrophy lies in the genetic material responsible for the development of specific muscle proteins of the body. This genetic abnormality compromises dystrophin production, the protein protecting the muscle fibers, thereby contributing to the development of the condition.

Muscular dystrophy is classified according to the involved phenotype, pathology, and hereditary patterns. These patterns include sex-linked, autosomal recessive, and autosomal dominant muscular dystrophy. Muscular dystrophy occurs in both the male and female sexes, in all age groups and races. However, the Duchenne type is most common in boys. Familial history of muscular dystrophy predisposes patients to develop the disease and to pass it along in the genetic family tree.

What will happen if muscular dystrophy is left untreated?

If the condition is left untreated and controlled, progressive muscle-weakening may result to:

  1. Functional problems. Some patients eventually will require the use of a wheelchair due to progressive muscle weakness. Challenges in using arms are also experienced by patients with muscular dystrophy.
  2. Contractures. Shortening of muscles or tendons around joints called contractures occur, thereby further limiting the range of motion
  3. Breathing problems. Weakened muscles of the chest will compromise breathing. Patients would initially utilize assistive breathing devices at night to address the symptom.
  4. Scoliosis. Weakened muscles of the chest compromise spine support.
  5. Heart problems. Muscles of the heart are weakened, thereby limiting its contraction capacity.
  6. Swallowing issues. Peristalsis is compromised due to altered musculature of the throat and esophagus.

Diagnosis of Muscular Dystrophy

How do you diagnose muscular dystrophy?

Diagnosing Muscular dystrophy involves the following techniques and procedures.

  1. Laboratory studies
  2. Creatine phosphokinase (CPK) – most specific test. Elevated results correlate with muscular dystrophy
  3. Transaminase, Lactate dehydrogenase, and aldolase levels – may be elevated in muscular dystrophy but not reliable. Can be altered due to liver dysfunction.
  4. Multiplex polymerase chain reaction assay (PCR) – may be useful for it detects deletion of the dystrophin gene by up to 98%.
  5. Imaging studies
  6. Ultrasonography – noninvasive technique used for screening patients with muscular dystrophy by observing for deteriorating muscle tissue
  7. Electromyography (EMG) – involves needle insertion to the muscle to assess for electrical activity
  8. Other tests
  9. Electrocardiography (ECG) – expected to have right ventricle abnormalities, tall R waves, deep Q waves, and inverted T waves, thereby prompting for cardiac management
  10. Pulmonary function tests (PFTs) – together with arterial blood gas (ABG) sampling, and hematologic workup will allow for assessment of pulmonary function.
  11. Muscle biopsy – Biopsy allows for sampling and microscopic assessment of cellular structures to differentiate Muscular dystrophy from other conditions.

Treatment of Muscular Dystrophy

What are the best treatments for Duchenne muscular dystrophy?

Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.
Treatment of Muscular Dystrophy

There is no cure for Muscular dystrophy. However, the goal of care is to mitigate and control the debilitating effects of the condition. The therapies that can be given include:

  1. Medical Therapy. Medication involves the use of the following drugs:
  2. Corticosteroids – delay cellular damage of muscular dystrophy to the degenerating muscle cells
  3. Morpholino Antisense Oligomers (Biologic agents) – increase dystrophin levels which are otherwise depressed in patients with Muscular dystrophy.
  4. Gene Therapy. This procedure involves the introduction of healthy, immature myoblasts to the patient’s body, wherein they bind with the diseased muscle, thereby strengthening the muscle tissues.
  5. Surgical Therapy. The goal of surgical intervention is to correct deformities, thereby allowing the patient to be ambulatory for as long as surgically possible. These include the following but are not limited to:
  6. use of prosthesis
  7. fracture management
  8. soft-tissue or bone surgeries
  9. Non-operative measures. These entail the use of assistive ambulatory devices (e.g. wheelchair), gait and posture training, physical therapy, etc.

 3 Muscular Dystrophy Nursing Care Plan Examples

What are some of the available nursing care plans for muscular dystrophy?

Nursing Care Plan 1

Nursing diagnosis: Impaired physical mobility related to weakness of muscles secondary to muscular dystrophy as evidenced generalized weakness, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness

Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.

Interventions Rationales
Assess the patient’s level of functional mobility and ability to perform ADLs. To assist in creating an accurate diagnosis and monitor the effectiveness of treatment and therapy.
Assist the patient during exercises and when performing activities of daily living. To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and important things like phones and eyeglasses are easy to reach. To maintain patient safety and reduce the risk of falls.
Encourage the patient to perform a range of motion (ROM) exercises in all extremities. To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.
Refer to the physiotherapy and occupational therapy team. To provide specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Nursing Care Plan 2

Nursing Diagnosis: Fatigue related to muscle weakness secondary to muscular dystrophy as evidenced by generalized weakness, irritability, and verbalization of overwhelming tiredness

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.

Interventions Rationales
Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try. To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep.    Encourage enough rest and sleep and provide comfort measures. To help the patient balance his/her physical activity and rest periods.   To reserve energy levels and provide optimal comfort and relaxation.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room. To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to the physiotherapy/occupational therapy team as required. To provide more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.

Nursing Care Plan 3

Nursing Diagnosis: Risk for Ineffective Breathing Pattern secondary to muscular dystrophy

Desired Outcome: The patient will maintain an effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minute, oxygen saturation within the target range, and verbalizing ease of breathing.

Interventions Rationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. To assist in creating an accurate diagnosis and monitor the effectiveness of medical treatment.
If oxygen levels drop, administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. To increase the oxygen level and achieve an SpO2 value within the target range.
Administer the prescribed medications. Bronchodilators: To dilate or relax the muscles on the airways. Steroids: To reduce the inflammation in the lungs. Cholinesterase inhibitors: To improve muscle strength and contractility by enhancing the communication between the nerves and muscles.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position. Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Educate the patient about proper breathing techniques such as pursed-lip breathing, deep breathing exercises, and diaphragmatic breathing. To help the patient improve his/her lung function.

Other nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

Muscular Dystrophy, Diagnosis of Muscular Dystrophy, Treatment of Muscular Dystrophy, and  3 Muscular Dystrophy Nursing Care Plan Examples.

 

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