Muscular Dystrophy Nursing Diagnosis and Nursing Care Plan

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:

• It is inherited;
• It is non-inflammatory;
• It is progressive; and
• Absence of central or peripheral nerve abnormality.

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-20’s or later.

C. Other types of Muscular dystrophy

• Mytonic – characterized by the inability to relax muscles after contractions. Patients with this type often have long, thin faces, drooped 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 usual 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 teenage years.

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 on 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 developing the disease and to passing it along in the genetic family tree.

Complications of Muscular Dystrophy

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

1. Functional problems. Some patients eventually will require use of wheelchair due to the 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 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

Diagnosing Muscular dystrophy involves the following techniques and procedures.

1. Laboratory studies
2. Creatine phosphokinase (CPK) – most specific test. Elevated results correlates with muscular dystrophy
3. Transaminase, Lactate dehydrogenase and aldolase levels – maybe elevated in muscular dystrophy but not reliable. Can be altered due to liver dysfunction.
4. Multiplex polymerase chain reaction assay (PCR) – maybe useful for it detects deletion of the dystropin 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

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

Medical Therapy. Medication involves the use of the following drugs:

• Corticosteroids – delay cellular damage of muscular dystrophy to the degenerating muscle cells
• Morpholino Antisense Oligomers (Biologic agents) – increase dystrophin levels which are otherwise depressed in patients with Muscular dystrophy.
• 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.

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:

• use of prosthesis
• fracture management
• soft-tissue or bone surgeries

Non-operative measures. These entail the use of assistive ambulatory devices (e.g. wheelchair), gait and posture training, physical therapy, etc.

Nursing Diagnosis for Muscular Dystrophy

Nursing Care Plan for Muscular Dystrophy 1

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.

Nursing Interventions for Muscular Dystrophy	Rationales
Assess the patient’s level of functional mobility and ability to perform ADLs.	To assist in creating an accurate diagnosis and monitor 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 that important things like phone and eyeglasses are easy to reach.	To maintain patient safety and reduce the risk of falls.
Encourage the patient to perform 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 a specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.

Nursing Care Plan for Muscular Dystrophy 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 demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Nursing Interventions for Muscular Dystrophy	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 physiotherapy / occupational therapy team as required.	To provide a 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 for Muscular Dystrophy 3

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

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

Nursing Interventions for Muscular Dystrophy	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 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 and 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.

Nursing Care Plan for Muscular Dystrophy 4

Risk for Falls

Nursing Diagnosis: Risk for Falls related to compromised muscles of the body and the degeneration of muscle fibers secondary to muscular dystrophy.

Desired Outcomes:

• The patient will express understanding about the use of different safety measures that will prevent falls.
• The patient and the caregivers will implement strategies that may help increase the patient’s safety even at home.

Nursing Interventions for Muscular Dystrophy	Rationale
1. Check for any circumstances that will increase the patient’s risk of falls. Check for any alteration in the patient’s physical condition as well as the patient’s cognitive status.	Determining the degree of fall risk of the patient by assessing the intrinsic and extrinsic factors will help the nurse in planning care for the patient with fall risk.
2. Ask the patient if he or she has a previous history of falls.	Patients with a previous history of falls for the last 6 months are more likely to experience repeat falls.
3. Evaluate the alterations in the patient’s mental status.	A person who is disoriented and has impaired awareness may experience falls. The patient’s safety may be jeopardized due to confusion and impaired judgment.
4. Evaluate the age-related physical changes of the patient.	Age and development may affect the ability of the patient to protect himself or herself from falls. A person of older age may have weak muscles because of decreased muscle strength, flexibility, and endurance. Patients of old age may also experience reduced vision, reduced color perception, change in the center of gravity, unsteady gait, reduced muscle strength, and delayed response that increases the incidence of injuries and falls.
5. Check for the patient’s sensory perception deficits.	A person’s sensory perception of environmental stimulants is important in maintaining safety. Impairment of the vision and hearing may limit the patient’s ability to perceive hazards in the patient’s surroundings. A patient with visual problems should be provided a well-lit room to avoid injuries and falls.
6. Check if the patient is using mobility assistive devices.	Improper use, selection, and maintenance of the mobility aids such as canes, walkers, and wheelchairs may increase the patient’s energy expenditure and joint damage which may increase the patient’s risk for falls.
7. Evaluate and check the patient’s medication that he or she is currently taking.	Older adults usually take various medications because of multiple chronic conditions that will increase the patient’s risk of falls. These medications are antihypertensive agents, diuretics, and antidepressants.
8. Evaluate and check the patient’s environment for the presence of environmental hazards.	The patient’s surroundings may increase the risk for falls such as unfamiliar furniture and equipment that is placed in a certain area of the hospital or home. The nurse should assess the patient’s environment at home, workplace, and the community for any environmental hazards that may increase the patient’s risk of falls.
9. Make an individualized care plan for preventing falls. Make sure to provide a plan of care that focuses on the patient’s unique needs.	For planning nursing care for patients who are at risk of falls, it is important to avoid relying too much on universal fall precautions because every individual has different needs. An Individualized fall prevention program is important and the nurse should use a multifaceted approach.
10. Put the patient’s things that he or she usually uses within easy reach.	Objects that are too far may need to require the patient to reach out or ambulate unnecessarily which may potentially be a hazard and may contribute to falls.
11. Place the bed of the patient in a possible lowest position and always secure that patient’s side rails as needed.	Placing the bed closer to the floor and securing the side rails reduces the risk of falls and serious injuries
12. Instruct the patient and the patient’s family about the proper ways to ambulate at home, which includes safety measures such as having handrails in the bathroom.	The family of the patient must be taught about the proper ways of ambulating to reduce the risk of falls during ambulation in a home setting.

Nursing Care Plan for Muscular Dystrophy 5

Risk for Injury

Nursing Diagnosis: Risk for Injury related to impaired sensory and cognitive function, inadequate nutritional source, improper use of assistive devices, and lack of knowledge about the environmental hazards secondary to muscular dystrophy.

Desired Outcomes:

• The patient will be able to determine the factors that increase his or her risk for injury and will be able to show behaviors to avoid injury after the nursing interventions and treatment.
• The patient will be able to remain free of injuries after the interventions and health teachings.

Nursing Interventions for Muscular Dystrophy	Rationale
1. Evaluate the patient’s age, developmental change, health status, lifestyle, compromised communication, mobility, sensory-perceptual impairment, cognitive awareness, and ability to make decisions that will increase the risk for injury.	Determining these factors will help the nurse to know the patient’s ability to keep him or her safe. The nurse should carefully assess these factors before formulating a plan of care. Changes in these factors will increase the patient’s risk of injury.
2.  Check for the patient’s ability or capacity to ambulate and identify the risk of a patient for falls.	Changes in the patient’s mobility due to muscle weakness, paralysis, poor balance, and the patient’s lack of coordination will increase the risk of falls and injury.
3.. Do a proper safety assessment in the patient’s home or care setting.	The nurse should do an environmental risk assessment and determine the presence of objects that can potentially harm or injure the patient. Therefore objects that can harm the patient should be removed.
4. Assist the patient when sitting and standing up and limit the use of wheelchairs except for transportation as needed.	The patient may fall when they are left in a wheelchair because the patient may stand up without locking the wheels of the wheelchair or removing the footrest. A patient that uses a wheelchair has limited ability to move.
5. Assist the patient when using assistive devices such as pillows, gait belts, and slider boards during transfer.	The nurse and the patient may have a possible risk of injury when transferring the patient. Assistive devices will help the nurse with the mobility problems of the patient. Using assistive devices, the nurse will be able to safely transfer the patient to the bed or chair. Assistive devices are used for patients with deficits to balance and strength
6. Maintain and observe proper body mechanics before doing any procedure.	Maintaining proper body mechanics will reduce the risk of muscle and bone injury and will help in promoting proper body movement. This will also help in facilitating mobility without causing muscle strain to the patient’s body.
7. Coordinate with a physical therapist or occupational therapist to help the patient increase mobility and perform activities of daily living.	The safety of the patient is achieved through collaborative efforts by both individuals that will provide direct or indirect care to the patient and the healthcare system.
8. Instruct the patient about the safety ambulation at home including the safety measures such as grab bars or handlebars in the patient’s bathroom.	Safety at home should be maintained by the nurse and the caregivers. The nurse should discuss the importance of safety with the clients and the caregivers. Home safety should always be considered when making decisions when planning patient care.
9. Instruct and advise the patient to use non-slip, well-fitting footwear, and encourage the patient to ask for assistance if needed.	Non-slip well-fitting footwear will help reduce the risk of falls and injury. Teaching the patient and the caregiver about the modification of the home environment is important in the promotion of functional and independent living of the patient and to prevent injury.
10. Provide alternatives that can be used to prevent injuries and falls.	Alarm systems such as ankle or wrist bracelets, alarms for bed or wheelchairs, close monitoring of the patient, and keeping the bed in a low position will help in reducing the risk of injury.

Nursing Care Plan for Muscular Dystrophy 6

Risk for Ineffective Airway Clearance

Nursing Diagnosis: Risk for ineffective airway clearance related to respiratory muscle failure and impaired gas exchange secondary to muscular dystrophy.

Desired Outcomes:

• The patient will be able to keep clear and open airways after the interventions as evidenced by normal breath sounds, and normal depth of respiration.
• The patient will show increased air exchange after the interventions.
• The patient will express knowledge on how to identify and avoid factors that may inhibit effective airway clearance.

Nursing Interventions for Muscular Dystrophy	Rationale
1. Check for the patient’s airway patency and auscultate the patient’s lungs for the presence of adventitious breath sounds such as the absence of breath sounds, wheezing, and crackles. Check for the presence of the sputum, such as the quality, color, amount, and consistency.	The presence of abnormal breath sounds may indicate ineffective airway clearance and may indicate the possible presence of mucus and secretions on the patient’s airways. The unusual appearance of the patient’s secretion may be due to an infection or other conditions.
2. Check for any fluctuations in the patient’s heart rate, blood pressure, and temperature.	The patient’s heartbeat, blood pressure, and temperature may be affected because of increased work of breathing. The presence of fever may be a sign of infection or an inflammatory process.
3. Instruct the patient about the following: Proper optimal positioning or sitting position Using pillow or hand splints when coughingUsing of abdominal muscles for a more forceful coughUsing quad and huff techniquesUsing incentive spirometryExplain the importance of ambulation and frequent change of position	To promote effective coughing, it is important to maintain a proper sitting position and splinting of the abdomen that will also increase the abdominal pressure and upward diaphragmatic movement. Instructing the patient to ambulate with assistance as needed will promote lung expansion, mobilize secretions, and will lessen atelectasis.
4. Place the patient in an upright position as tolerated and regularly check the patient’s position to avoid sliding down in the bed.	Placing the patient in an upright position will help to limit abdominal contents from pushing upward and will help in inhibiting lung expansion and will help improve air exchange.
5. Instruct the patient to drink at least 3 liters per day as tolerated and if not contraindicated.	Increasing the fluid intake will help minimize mucosal drying and will maximize the actions of the ciliary to move the secretions.
6. Provide medications as prescribed by the physician such as antibiotics, mucolytic agents, bronchodilators, and expectorants. The nurse should note the effectiveness and side effects of the medications.	Medications may be used to manage specific problems that will help in promoting clear airway secretions and will also help in decreasing airway resistance.
7. Maintain a pace of activities, especially for patients with reduced energy such as muscular dystrophy. Always maintain planned rest periods and promote energy-conservation methods.	Ineffective coughing may be due to the patient’s fatigue. Enough energy is needed to have effective coughing and may consume an extra effort for the patient.
8. Encourage the patient to verbalize and express feelings to decrease anxiety.	An increase in oxygen demand happens when the patient is experiencing anxiety and can potentiate respiratory distress.
9. Refer the patient to a respiratory therapist that will help with chest physiotherapy and nebulizer management if needed.	Chest physiotherapy is needed for postural drainage and chest percussion to mobilize secretions from the smaller airways of the lungs that cannot be eliminated through coughing and suctioning.
10. Check for the arterial blood gases and use a pulse oximeter to monitor the patient’s oxygenation and to assess for respiratory fatigue.	The patient’s oxygenation should be maintained and monitored through pulse oximetry. Any alterations in ABG levels may result in increased pulmonary secretions and respiratory fatigue in the patient.
11. Instruct the patient about the proper ways of coughing and breathing such as taking a deep breath, holding for 2 seconds, and coughing twice or thrice in succession.	Proper breathing and coughing is the convenient way to remove secretions. The nurse should assist the patient while doing the activity. Proper deep breathing will help in promoting oxygenation before doing controlled coughing.

More Nursing Diagnosis for Muscular Dystrophy

• Activity Intolerance
• Deficient Knowledge

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.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

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

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