Considerations for Care of Neuromuscular Impairment

Key points

1. Physical nursing priorities

   Nursing considerations for patients with neuromuscular impairment include physical needs such as maintaining respiratory function, promoting mobility, managing pain, ensuring optimal nutrition, and monitoring elimination and skin integrity.

2. Respiratory muscle weakness

   The muscle weakness that occurs with neuromuscular disorders eventually affects the diaphragm and intercostal muscles, resulting in impaired breathing.

3. Secretion aspiration risk

   With weak muscles, it may be difficult for the patient to cough effectively and keep the airway clear of secretions. If secretions cannot be cleared, the patient is at high risk for aspiration and subsequent aspiration pneumonia, which can be life-threatening.

4. Tracheostomy and ventilator care

   For patients with tracheostomies, it is important for the nurse to provide “trach” care as ordered to keep the airway clear and prevent infection. Additionally, the nurse should have familiarity with the ventilator settings and be able to intervene appropriately for various alarms.

5. Effects of immobility

   Regardless of the cause, immobility can cause degradation of cardiovascular, respiratory, gastrointestinal, and musculoskeletal functioning. Promoting mobility can prevent these complications from occurring.

6. Benefits of mobilization

   Studies have shown several benefits of mobilization, including less delirium, pain, urinary discomfort, urinary tract infection, fatigue, deep vein thrombosis (DVT), skin breakdown, and pneumonia, as well as an improved ability to void (Alaparthi et al., 2020)..

7. Pain medication safety

   It is important for the nurse to be familiar with analgesic medications, especially their potential side effects before administering them. For example, overuse of opioids can lead to constipation, which can cause more pain for a patient experiencing muscle weakness from a neuromuscular disorder.

8. Nutritional vulnerability

   Monitoring nutritional status is important for all patients but is especially important for patients with neuromuscular disorders. These patients experience severe muscle weakness, which can be exacerbated by malnourished states.

9. Dysphagia nutrition collaboration

   It is important for the nurse to collaborate effectively with the care team, including dieticians and speech therapists, to ensure the patient is receiving appropriate nutrition, especially if they are experiencing dysphagia.

10. Incontinence complication prevention

    In more severe cases where the patient cannot manage the incontinence themselves, it is important for the nurse to check the patient frequently to ensure they are clean and dry to help prevent skin breakdown or the development of a urinary tract infection.

11. Skin breakdown risk

    Patients with neuromuscular disorders often spend extended periods of time in bed or sitting in wheelchairs because they have muscle weakness, making it difficult or impossible to ambulate. These periods of immobility increase their risk of skin breakdown and pressure injuries.

12. Bedridden care and falls

    For patients who are bedridden, the nurse should elevate the head of the bed to 30 to 45 degrees, unless medically contraindicated, and turn and reposition the patient every two hours. Furthermore, the nurse should perform hourly rounding to check on the patient’s needs and prevent falls.

13. Emotional support and coping

    These disorders can be debilitating, which can negatively affect the patient’s quality of life and result in depression or anxiety. To improve this, the nurse should provide support for both the patient and their family members and teach effective coping strategies.

14. Early intervention education

    The nurse should emphasize the importance of early intervention services and explain how these therapies can help promote optimal development, improve functional abilities, and enhance quality of life.