Faulkner State Community College; Division of Nursing

NUR 201
Clinical Paperwork Data Sheet

Student Name_____________________________________ Clinical Week_____________

Date ______________ Client Initials___________ Age ____________ Admission Date __________________

Instructor_____________________________________ Clinical Area _________________________________

Medical Diagnosis and Pathophysiology: (Be sure to list signs and symptoms). Please indicate your
source of information.

Inclusion body myositis (IBM) is an inflammatory muscle disease characterized by progressive muscle
weakness and wasting. Inclusion-body myositis, or IBM for short, is found in more men than women. Signs
of IBM usually start after age 50. A small number of IBM cases may be hereditary. IBM is thought to be an
autoimmune disease, meaning the bodys immune system, which normally fights infections and viruses,
does not stop fighting once the infection or virus is gone. The immune system then attacks the bodys own
normal, healthy tissue through inflammation.

The onset of muscle weakness in IBM is generally gradual (over months or years). Falling and tripping are
usually the first noticeable symptoms. For some patients the disorder begins with weakness in the hands
causing difficulty with gripping, pinching, and buttoning. The disease affects both the proximal and distal
muscles. There may be weakness of the wrist and finger muscles and atrophy of the quadriceps muscles in
the legs. Atrophy or shrinking of the forearms is also characteristic. Trouble swallowing, or dysphagia, is a
common problem for IBM patients. Weakness of face muscles is sometimes seen. Patient has total
paralysis of his limbs due to the progression of his IBM. He is confined to bed and unable to participate in
any ADLs.
There is no standard course of treatment for IBM. The disease is unresponsive to corticosteroids and
immunosuppressive drugs. Some evidence suggests that IV immunoglobulin may have a slight, but short
lasting, beneficial effect in a small number of cases. Physical therapy may be helpful in maintaining
mobility. Other therapy is symptomatic and supportive

www.ninds.nih.gov/disorders/inclusion_body_myositis/inclusion_body_myositis.htm

www.myositis.org/about_myositis/inclusion-body_myositis.cfm

List and prioritize any secondary diagnosis that has been identified for your client (Based on your patient's
problems).

1. Respiratory Arrest

2. A Fib of rapid Ventricular Response

3. DVT Right Popliteal Vein

4. Hypertension

5. Jaundice

6. UTI

7. Electrolyte Imbalance

8. Diabetes Mellitus Type II