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Rhabdomyolysis, which may account for 25% of all cases of acute renal failure, results from injury to skeletal muscle causing the release of myoglobin into the urine. This case study presents history and physical findings, nursing diagnoses, interventions, and research findings related to the disorder and its treatment.
Objectives
This educational activity is designed for nurses and other health care professionals who care for and educate patients regarding rhabdomyolysis. The multiple choice examination that follows is designed to test your achievement of the following educational objectives. After studying this offering, you will be able to:
1. Describe the pathophysiology of rhabdomyolysis.
2. Explain the process by which rhabdomyolysis can cause acute renal failure.
3. Identify laboratory and diagnostic studies used in assessing rhabdomyolysis.
4. Explain the rationale for interventions used in treating rhabdomydomyolysis.
On Tuesday afternoon, Mr. Daniels, a 48-year-old man with a history of excessive alcohol intake, is brought by ambulance to the emergency department. The manager at his apartment house called 911 after finding him unresponsive. Per a history obtained during a previous admission, the nurse notes that he usually consumes about a fifth of whiskey daily. The manager comments that the last time he saw Mr. Daniels was on Saturday evening when he seemed depressed and was drinking even more heavily than usual. His neighbors asked the manager to check on him because they had not seen him outside his apartment since Saturday.
The paramedics found him unresponsive but still breathing. There was a strong odor of urine. His clothes were slightly damp but not wet with urine. By his position on the floor it appeared that he may have had a seizure. There was a large amount of dried blood on his left forehead and face. An IV was started and he was transported to the hospital.
A CT scan is negative for a subdural hematoma, but a chest x-ray demonstrates right lower lobe infiltrate, probably due to aspiration. His mucous membranes are dry and his skin turgor is poor (tenting). His admitting labs are very remarkable: sodium (Na) = 150 mEq/l; potassium (IK) = 6.4 mEq/l; calcium (Ca) = 6.8 mg/100 ml; phosphorus (P) = 6.0 mg/dl; albumin = 2.2 Gm/100 ml; blood urea nitrogen (BUN) =...