Treatments for Myopathy
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Discussion of treatments for Myopathy:
Treatments for myopathy vary depending on the type.
Supportive and symptomatic treatment may be the only treatment available
or necessary in some cases. Treatment for other forms may include drug
therapy, such as immunosuppressives, physical therapy, bracing, and
surgery.
(Source: excerpt from
NINDS Myopathy Information Page: NINDS)
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Muscle Weakness – Distal:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Acute demyelinating disorders (GBS, CIDP)
–Often respond to intravenous gamma-globulin
-
Medication/chemotherapy-induced neuropathies
–Often improved after cessation of the offending medication
–Response is time-dependent; may take up to months
-
Toxic exposures
–Often difficult to detect, unless resulting from acute overdose
-
Metabolic neuropathies are treated supportively
-
Braces often assist with foot drop for both acquired and congenital neuropathies
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Muscle Weakness – Proximal:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Combination of physical therapy, bracing, and orthopedic surgical interventions can help patients maintain functional motor skills
-
Duchenne muscular dystrophy
–Oral prednisone to increase and sustain muscle strength
-
Endocrine myopathies
–Treating the underlying endocrine disease corrects the myopathy and weakness
-
Dermatomyositis
–Oral prednisone
–If resistant to oral steroids, immunosuppression with high-dose intravenous steroids, methotrexate, cyclophosphamide or intravenous immunoglobulins
-
Transverse myelitis
–Treat with high-dose intravenous steroids
-
Myasthenia gravis
–Acetylcholinesterase inhibitors (pyridostigmine), immunosuppression, and thymectomy
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Muscle flaccidity [Muscle hypotonicity]:
Emergency Interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient’s muscle flaccidity results from trauma, make sure his cervical spine has been stabilized. Quickly determine his respiratory status. If you note signs and symptoms of respiratory insufficiency — dyspnea, shallow respirations, nasal flaring, cyanosis, and decreased oxygen saturation — administer oxygen by nasal cannula or mask. Intubation and mechanical ventilation may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Muscle spasms [Muscle cramps]:
Emergency Interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet, quickly attempt to elicit Chvostek’s and Trousseau’s signs. If these signs are present, suspect hypocalcemia. Evaluate respiratory function, watching for the development of laryngospasm; provide supplemental oxygen as necessary, and prepare to intubate the patient and provide mechanical ventilation. Draw blood for calcium and electrolyte levels and arterial blood gas analysis, and insert an I.V. line for administration of a calcium supplement. Monitor the patient’s cardiac status, and prepare to begin resuscitation if necessary.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
After palpating abdominal rigidity, quickly take the patient’s vital signs. Even though the patient may not appear gravely ill or have markedly abnormal vital signs, abdominal rigidity calls for emergency interventions.
Prepare to administer oxygen and to insert an I.V. line for fluid and blood replacement. The patient may require drugs to support blood pressure. Also prepare him for catheterization, and monitor intake and output.
A nasogastric tube may have to be inserted to relieve abdominal distention. Because emergency surgery may be necessary, the patient should be prepared for laboratory tests and X-rays.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Accessory muscle use:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient displays increased accessory muscle use, immediately look for signs of acute respiratory distress. These include a decreased level of consciousness, shortness of breath when speaking, tachypnea, intercostal and sternal retractions, cyanosis, adventitious breath sounds (such as wheezing or stridor), diaphoresis, nasal flaring, and extreme apprehension or agitation. Quickly auscultate for abnormal, diminished, or absent breath sounds. Check for airway obstruction and, if detected, attempt to restore airway patency. Insert an airway or intubate the patient. Then begin suctioning and manual or mechanical ventilation. Assess oxygen saturation using pulse oximetry, if available. Administer oxygen; if the patient has chronic obstructive pulmonary disease (COPD), use only a low flow rate for mild COPD exacerbations. You may need to use a high flow rate initially, but be attentive to the patient’s respiratory drive. Giving a patient with COPD too much oxygen may decrease his respiratory drive. An I.V. line may be required.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Muscle flaccidity [Muscle hypotonicity]:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s muscle flaccidity results from trauma, make sure his cervical spine has been stabilized. Quickly determine his respiratory status. If you note signs and symptoms of respiratory insufficiency—dyspnea, shallow respirations, nasal flaring, cyanosis, and decreased oxygen saturation—administer oxygen by nasal cannula or mask. Intubation and mechanical ventilation may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Muscle spasms [Muscle cramps]:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet, quickly attempt to elicit Chvostek’s and Trousseau’s signs. If these signs are present, suspect hypocalcemia. Evaluate respiratory function, watching for the development of laryngospasm; provide supplemental oxygen as necessary, and prepare to intubate the patient and provide mechanical ventilation. Draw blood for calcium and electrolyte levels and arterial blood gas analysis, and insert an I.V. line for administration of a calcium supplement. Monitor cardiac status, and prepare to begin resuscitation if necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
After palpating abdominal rigidity, quickly take the patient’s vital signs. Even though the patient may not appear gravely ill or have markedly abnormal vital signs, abdominal rigidity calls for emergency interventions.
Prepare to administer oxygen and to insert an I.V. line for fluid and blood replacement. The patient may require drugs to support blood pressure. Also prepare him for catheterization, and monitor intake and output.
A nasogastric tube may have to be inserted to relieve abdominal distention. Because emergency surgery may be necessary, prepare the patient for laboratory tests and X-rays.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Accessory muscle use:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient displays increased accessory muscle use, immediately look for signs of acute respiratory distress. These include decreased level of consciousness, shortness of breath when speaking, tachypnea, intercostal and sternal retractions, cyanosis, external breath sounds (such as wheezing or stridor), diaphoresis, nasal flaring, and extreme apprehension or agitation. Quickly auscultate for abnormal, diminished, or absent breath sounds. Check for airway obstruction and, if detected, attempt to restore airway patency. Insert an airway or intubate the patient. Then begin suctioning and manual or mechanical ventilation. Assess oxygen saturation using pulse oximetry, if available. Administer oxygen; if the patient has chronic obstructive pulmonary disease (COPD), use only a low flow rate for mild COPD exacerbations. You may need to use a high flow rate initially, but be attentive to the patient’s respiratory drive. Giving too much oxygen may decrease the patient’s respiratory drive. An I.V. line may be required.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Muscle spasms:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Depending on the cause, help alleviate your patient’s spasms by slowly stretching the affected muscle in the direction opposite the contraction. If necessary, administer a mild analgesic.
Administer antibiotics and an anticoagulant, as appropriate. Prepare the patient for diagnostic tests, such as electrocardiography, endocardiography, echocardiography, and angiography. Diagnostic studies may include serum calcium, sodium and carbon dioxide levels, thyroid function tests, and blood flow studies or arteriography.
Because a cardiac abnormality is frightening to the patient and family, provide emotional support.
Patient teaching
Explain the use of prophylactic antibiotics. Also explain the signs and symptoms the patient should report immediately. Provide information on the importance of follow-up care and monitoring.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Muscle weakness:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient how to safely use assistive devices. Make sure he understands the importance of frequent position changes to reduce the risk of pressure ulcer formation. Encourage him to plan frequent rest periods throughout the day.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Accessory muscle use:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient displays increased accessory muscle use, immediately look for signs of acute respiratory distress, including decreased level of consciousness, shortness of breath when speaking, tachypnea, intercostal and sternal retractions, cyanosis, external breath sounds (such as wheezing or stridor), diaphoresis, nasal flaring, and extreme apprehension or agitation. Quickly auscultate for abnormal, diminished, or absent breath sounds. Check for airway obstruction and, if detected, attempt to restore airway patency. Insert an airway or intubate the patient. Then begin suctioning and manual or mechanical ventilation. Assess oxygen saturation using pulse oximetry if available. Then administer oxygen. You may need to use a high flow rate initially, but be attentive to the patient’s respiratory drive (too much oxygen may decrease respiratory drive). If the patient has chronic obstructive pulmonary disease (COPD), use only a low flow rate for mild COPD exacerbations. An I.V. line also may be required.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Muscle spasms:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet, quickly attempt to elicit Chvostek’s and Trousseau’s signs. If these signs are present, suspect hypocalcemia. Evaluate respiratory function, watching for the development of laryngospasm. Provide supplemental oxygen as necessary, and prepare to intubate the patient and provide mechanical ventilation. Draw blood for calcium and electrolyte levels and arterial blood gas analysis, and insert an I.V. line for administration of a calcium supplement. Monitor cardiac status, and prepare to begin resuscitation, if necessary.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Muscle spasticity:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Muscle flaccidity [Muscle hypotonicity]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Provide regular, systematic, passive ROM exercises to preserve joint mobility and increase circulation.
▪ Reposition the patient every 2 hours to protect him from skin breakdown.
▪ Pad bony prominences and other pressure points.
▪ Treat isolated flaccidity by supporting the affected limb with a sling or splint.
▪ Consult a physical therapist and an occupational therapist to formulate a personalized therapy regimen and foster independence.
▪ Prepare the patient for diagnostic tests, such as cranial and spinal X-rays, computed tomography scans, and electromyography.
Patient teaching
▪ Teach the patient how to use assistive devices.
▪ Review the prescribed exercise regimen.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle weakness:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Provide assistive devices as necessary.
▪ Protect the patient from injury.
▪ If sensory loss occurs, guard against pressure ulcer formation and thermal injury.
▪ With chronic weakness, provide ROM exercises or splint limbs as necessary.
▪ Allow for adequate rest periods.
▪ Administer pain medications as needed.
▪ Prepare the patient for blood tests, muscle biopsy, electromyography, nerve conduction studies, and X-rays or computed tomography scans.
Patient teaching
▪ Teach the patient how to use assistive devices as necessary.
▪ Explain the importance of frequent position changes and rest periods.
▪ Explain the cause of muscle weakness and the treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle spasms [Muscle cramps]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Help alleviate muscle spasms by slowly stretching the affected muscle in the direction opposite the contraction.
▪ If necessary, administer a mild analgesic.
▪ Prepare the patient for diagnostic studies, such as serum calcium, sodium and carbon dioxide levels, thyroid function tests, and blood flow studies or arteriography.
Patient teaching
▪ Discuss measures for pain relief.
▪ Teach the patient how to use assistive devices, if appropriate.
▪ Teach about dietary changes that may help to decrease muscle spasms.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient closely for signs of shock.
▪ Place the patient in a position of comfort.
▪ Administer analgesics, as ordered, and evaluate their effect.
▪ Withhold food and fluids.
▪ Administer an I.V. antibiotic as ordered if emergency surgery is required.
▪ Prepare the patient for diagnostic tests which may include blood, urine, and stool studies; chest and abdominal X-rays, computed tomography, magnetic resonance imaging, gastroscopy, and colonoscopy.
Patient teaching
▪ Explain diagnostic tests or surgery the patient will need.
▪ Tell the patient about any food or fluid restrictions.
▪ Show him how to position himself for comfort.
▪ Explain the underlying disorder and treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle spasticity [Muscle hypertonicity]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, which may include electromyography, muscle biopsy, or intracranial or spinal magnetic resonance imaging or computed tomography.
▪ Administer pain medication and an antispasmodic, as ordered.
▪ Perform passive range-of-motion exercises, splinting, traction, and application of heat to help relieve spasms and prevent contractures.
▪ Maintain a calm, quiet environment to help relieve muscle spasms and prevent recurrence, and encourage bed rest.
▪ In cases of prolonged, uncontrollable muscle spasticity, as with spastic paralysis, prepare the patient for nerve blocks or surgical transection to provide permanent relief, as indicated.
Patient teaching
▪ Teach the patient to use assistive devices as needed.
▪ Help the patient to identify ways to maintain independence.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Accessory muscle use:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ If the patient is alert, elevate the head of the bed to make his breathing as easy as possible.
▪ Encourage him to get plenty of rest.
▪ Reinforce the importance of drinking plenty of fluids to liquefy secretions.
▪ Administer oxygen, as ordered.
▪ Prepare the patient for such tests as PFTs, chest X-rays, lung scans, arterial blood gas analysis, complete blood count, and sputum culture.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Explain how smoking endangers the patient's health, and refer him to an organized program to stop smoking.
▪ Teach him the signs and symptoms of infection, when to report them, and about prevention.
▪ Explain the purpose of prescribed drugs, such as bronchodilators and mucolytics, and make sure he knows their dosage, schedule, and how to administer them.
▪ Teach the patient relaxation techniques to reduce his apprehension and improve breathing.
▪ Provide instruction on pursed-lip breathing for patients with chronic lung disorders.
▪ Teach the patient coughing and deep- breathing exercises to help keep airways clear.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Muscle atrophy [Muscle wasting]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Help the patient maintain muscle length by encouraging him to perform frequent, active ROM exercises.
▪ If he can't actively move a joint, provide active assistive or passive exercises, and apply splints or braces to maintain muscle length.
▪ If you find resistance to full extension during exercise, consult the physical therapist.
▪ Use heat, pain medication, or relaxation techniques to relax resistant muscles.
▪ Prepare the patient for electromyography, nerve conduction studies, muscle biopsy, and X-rays or computed tomography scans.
Patient teaching
▪ Teach the patient to use necessary assistive devices properly to ensure his safety and prevent falls.
▪ Discuss safety measures that that patient should follow.
▪ Teach exercises that the patient can perform at home and increase in intensity as his muscle strength improves.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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