A 4-year-old boy is diagnosed with Duchenne muscular dystrophy. Which nursing teaching is most appropriate to reinforce for this child's parents?

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11ecbb05_cae5_05d3_b433_732d4d4561b5_MD0009_00 Duchenne muscular dystrophy (DMD) is the most common form of childhood MD. The condition is X-linked recessive (ie, carried by females and affects males) and is due to lack of a protein called dystrophin needed for muscle stabilization. Disease onset is age 2-5 years. Muscles of the proximal lower extremities and pelvis are affected first. Calf muscles hypertrophy (pseudohypertrophy) initially in response to proximal muscle weakness and are later replaced by fat and connective tissue. The Gower sign involves the use of one's hands to rise from a squat or from a chair to compensate for proximal muscle weakness. There is no effective cure. Most children are wheelchair bound by adolescence and die by age 20-30 from respiratory failure. It is important to avoid floor clutter (eg, throw rugs) and prevent falls/injury (Option C). (Option A) Iron deficiency is not related to MD. Diet should be assessed to ensure adequate fluid, whole grains, fruits, and vegetables to maintain bowel function to reduce the risk for constipation from immobility. (Option B) Clients are encouraged to participate in regular gentle recreation-based exercises and swimming to avoid disuse muscle atrophy and social isolation. Overexertion such as weight lifting is not recommended due to the risk of muscle injury. (Option D) Skeletal muscle relaxants such as baclofen (along with benzodiazepines) are used in cerebral palsy to control spasticity and seizures. Cerebral palsy is characterized by abnormal muscle tone and lack of coordination with spasticity. MD is characterized by weak muscles from the muscle tissue being replaced by connective tissue. Educational objective: MD is the replacement of muscle fibers with connective tissue, resulting in lower-extremity weakness. It is important to eliminate floor clutter to prevent injury. Clients are encouraged to participate in regular gentle recreation-based exercises and swimming to avoid disuse muscle atrophy and social isolation.

A 4-Year-Old Boy Is Diagnosed with Duchenne Muscular Dystrophy