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Course: Pediatric Nursing

Topic: Nursing care of child with

Neuromuscular Disorders Part IV (Dermatomyositis)

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Module Goals

Learners will be able to:

Identify risk factors associated with and/or causes of dermatomyositis in children.
Identify common signs and symptoms of dermatomyositis.
Discuss the medical treatment and management of dermatomyositis.
Explain the role of the nurse in caring for children with dermatomyositis.

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Juvenile Dermatomyositis (JDM)

A rare but complex and potentially life-threatening autoimmune disease of childhood, primarily affecting proximal muscles and skin.
In the UK, incidence is approximately 3.2 per million children per year.
Three times more common in girls than boys.
Mean age of onset is 7 years.

Martin & Wedderburn, 2012

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Critical Thinking Question

Juvenile Dermatomyositis (JDM) is autoimmune disease of childhood, primarily affecting proximal muscles and skin and more common in:

Boys
Girls

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Causes

Exact cause is not yet known
Associated with abnormalities of immune system
Having a viral infection or cancer may compromise immune system and lead to development of dermatomyositis

University of Rochester, 2022

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Signs and Symptoms

Symptoms often first appear in children between ages 5 and 10 years
Appear slowly over time
Weakness especially in muscles around neck, shoulders, and hips
Skin rash around certain areas:

Eyelids, knuckles, finger joints, and elsewhere

University of Rochester, 2022

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Signs and Symptoms

Others Symptoms include:

Fever
Lack of energy (fatigue)
Malaise
Muscle pain, soreness and wasting
Irritable mood
Trouble swallowing
Weight loss
Joint pain and inflammation
Calcium deposits under skin (calcinosis)
Mouth ulcers

University of Rochester, 2022

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Critical Thinking Question

A child is suspected case of Juvenile Dermatomyositis (JDM).

What are the signs and symptoms a nurse would expect to see in the child? (Select all that apply)

Weakness in muscle around neck
Skin rash around eyelids
Fever
Difficulty swallowing

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Diagnosis

Medical history
Physical examination
Blood tests:

Assess presence of antibodies, muscle enzymes, and signs of inflammation

MRI:

To determine inflammation

Electromyogram (EMG):

An electrical test that may be done to find nerve or muscle damage

Muscle and skin biopsy

University of Rochester, 2022

Contact info: info@nursesinternational.org

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Management

No cure but symptoms can be managed
Treatments may include:

Medicines:

Treats inflammation and skin symptoms

Physical and occupational therapy:

Improve muscle function and strength

Sunscreen:

Helps to prevent more irritation or damage to skin

Nutrition:

Supports body during the disease

University of Rochester, 2022

Contact info: info@nursesinternational.org

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Complications

Mobility issues due to joint contractures
Some children may have chronic symptoms:

Pain, muscle weakness
Deposits of calcium in skin
Delayed growth
Damage to bones, joints, lungs, or other internal organs

University of Rochester, 2022

Contact info: info@nursesinternational.org

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Nurses Role

Physical examination
Assess for signs and symptoms
Support oxygenation and ventilation
Encourage physical therapy and occupational therapy
Assisting child with orthoses
Encourage use of sunscreen to protect against ultraviolet rays
Medication administration
Psychological support

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

There is no cure but symptoms can be managed for Juvenile Dermatomyositis (JDM).

True
False

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References:

Martin, N., Li, C. K., & Wedderburn, L. R. (2012). Juvenile dermatomyositis: new insights and new treatment strategies. Therapeutic advances in musculoskeletal disease, 4(1), 41–50. https://doi.org/10.1177/1759720X11424460

University of Rochester. (2022). Juvenile Dermatomyositis. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p01714

Wint, C. (2022). Dermatomyositis: What Is It?. https://www.healthline.com/health/dermatomyositis

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