Musculoskeletal SystemMIDTERMS

9.
BURSAE
Musculoskeletal System - Presentation Transcript

1. 2. MUSCULO-SKELETAL SYSTEM Nurse Licensure Examination Review pinoynursing.webkotoh.com Review of Anatomy and Physiology
Sac containing fluid that are located around the joints to prevent friction
10. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
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The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints The primary function of which is to produce skeletal movements
The nurse usually evaluates this small part of the over-all assessment and concentrates on the patients posture, body symmetry, gait and muscle and joint function
Muscles
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Three types of muscles exist in the body 1. Skeletal Muscles Voluntary and striated 2. Cardiac muscles Involuntary and striated 3. Smooth/Visceral muscles
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1. HISTORY 2. Physical Examination Perform a head to toe assessment Nurses need to inspect and palpate The special procedure is the assessment of joint and muscle movement Usually, a tape measure and a protractor are the only instruments
Involuntary and NON-striated
TENDONS
12. ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM
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Bands of fibrous connective tissue that tie bones to muscles
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Gait Posture Muscular palpation Joint palpation Range of motion Muscle strength
LIGAMENTS
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Strong, dense and flexible bands of fibrous tissue connecting bones to another bone
BONES
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7. Variously classified according to shape, location and size Functions 1. Locomotion
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2. Protection
LABORATORY PROCEDURES 1. BONE MARROW ASPIRATION
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3. Support and lever

4. Blood production 5. Mineral deposition
Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia Usual site is the sternum and iliac crest Pre-test : Consent Intratest : Needle puncture may be painful Post-test : maintain pressure dressing and watch out for bleeding
JOINTS

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The part of the Skeleton where two or more bones are connected
CARTILAGES
A dense connective tissue that consists of fibers embedded in a strong gel-like substance
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LABORATORY PROCEDURES 2. Arthroscopy A direct visualization of the joint cavity Pre-test : consent, explanation of procedure, NPO Intra-test : Sedative, Anesthesia, incision will be made Post-test : maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort
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1. Assess patients perception of pain 2. Instruct patient alternative pain management like meditation, heat and cold application, TENS and guided imagery
20. Nursing Management
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PAIN 3. Administer analgesics as prescribed Usually NSAIDS Meperidine can be given for severe pain 4. Assess the effectiveness of pain measures
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LABORATORY PROCEDURES 3. BONE SCAN Imaging study with the use of a contrast radioactive material Pre-test : Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated Intra-test : IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning Post-test : Increase fluid intake to flush out radioactive material
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IMPAIRED PHYSICAL MOBILITY 1. Instruct patient to perform range of motion exercises, either passive or active 2. Provide support in ambulation with assistive devices 3. Turn and change position every 2 hours 4. Encourage mobility for a short period and provide positive reinforcements for small accomplishments
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SELF-CARE DEFICITS 1. Assess functional levels of the patient 2. Provide support for feeding problems Place patient in Fowlers position Provide assistive device and supervise mealtime Offer finger foods that can be handled by patient Keep suction equipment ready
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LABORATORY PROCEDURES 4. DXA- Dual-energy XRAY absorptiometry Assesses bone density to diagnose osteoporosis Uses LOW dose radiation to measure bone density Painless procedure, non-invasive, no special preparation Advise to remove jewelry
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SELF-CARE DEFICITS 3. Assist patient with difficulty bathing and hygiene Assist with bath only when patient has difficulty Provide ample time for patient to finish activity
18. Common musculoskeletal problems The Nursing Management 19. Nursing Management of common musculo-skeletal problems
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PAIN These can be related to joint inflammation, traction, surgical intervention
24. Musculoskeletal Modalities
Traction
Cast
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Long arm Short arm Spica
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Traction A method of fracture immobilization by applying equipments to align bone fragments Used for immobilization, bone alignment and relief of muscle spasm
34. Casting Materials
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Skeletal traction 27. Traction
Plaster of Paris Drying takes 1-3 days If dry, it is SHINY, WHITE, hard and resistant Fiberglass
26. Traction
Skin traction

Lightweight and dries in 20-30 minutes Water resistant
Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities
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CAST: General Nursing Care 1. Allow the cast to dry (usually 24-72 hours) 2. Handle a wet cast with the PALMS not the fingertips 3. Keep the casted extremity ELEVATED using a pillow 4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast
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Traction: General principles 1. ALWAYS ensure that the weights hang freely and do not touch the floor 2. NEVER remove the weights 3. Maintain proper body alignment 4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot
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Traction: General principles 5. Observe and prevent foot drop Provide foot plate 6. Observe for DVT, skin irritation and breakdown 7. Provide pin care for clients in skeletal tractionuse of hydrogen peroxide
CAST: General Nursing Care 5. Petal the edges of the cast to prevent crumbling of the edges 6. Examine the skin for pressure areas and Regularly check the pulses and skin
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CAST: General Nursing Care 7. Instruct the patient not to place sticks or small objects inside the cast 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses
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CAST Immobilizing tool made of plaster of Paris or fiberglass Provides immobilization of the fracture
38. Common Musculoskeletal conditions Nursing management 39. METABOLIC BONE DISORDERS
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Osteoporosis A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure
CAST: types
40. METABOLIC BONE DISORDERS
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2. Hormone replacement therapy 3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST 4. Moderate weight bearing exercises 5. Management of fractures
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Osteoporosis: Pathophysiology Normal homeostatic bone turnover is altered rate of bone RESORPTION is greater than bone FORMATION reduction in total bone mass reduction in bone mineral density prone to FRACTURE
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46. METABOLIC DISORDER
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Osteoporosis: TYPES 1. Primary Osteoporosis- advanced age, postmenopausal 2. Secondary osteoporosis- Steroid overuse, Renal failure
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Osteoporosis Nursing Interventions 1. Promote understanding of osteoporosis and the treatment regimen Provide adequate dietary supplement of calcium and vitamin D Instruct to employ a regular program of moderate exercises and physical activity Manage the constipating side-effect of calcium supplements
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RISK factors for the development of Osteoporosis 1. Sedentary lifestyle 2. Age 3. Diet- caffeine, alcohol, low Ca and Vit D 4. Post-menopausal 5. Genetics- caucasian and asian 6. Immobility
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Osteoporosis Nursing Interventions Take calcium supplements with meals Take alendronate with an EMPTY stomach with water Instruct on intake of Hormonal replacement
43. METABOLIC DISORDER 48. METABOLIC DISORDER
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ASSESSMENT FINDINGS
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1. Low stature
Osteoporosis Nursing Interventions 2. Relieve the pain Instruct the patient to rest on a firm mattress Suggest that knee flexion will cause relaxation of back muscles Heat application may provide comfort Encourage good posture and body mechanics Instruct to avoid twisting and heavy lifting
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2. Fracture
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Femur
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3. Bone pain
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LABORATORY FINDINGS 1. DEXA-scan Provides information about bone mineral density T-score is at least 2.5 SD below the young adult mean value 2. X-ray studies
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Medical management of Osteoporosis 1. Diet therapy with calcium and Vitamin D
Osteoporosis Nursing Interventions 3. Improve bowel elimination Constipation is a problem of calcium supplements and immobility Advise intake of HIGH fiber diet and increased fluids
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Osteoporosis Nursing Interventions 4. Prevent injury Instruct to use isometric exercise to strengthen the trunk muscles AVOID sudden jarring, bending and strenuous lifting Provide a safe environment
57. JRA
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Nursing Management During acute attack: SPLINT the joints NEUTRAL positioning Warm or cold packs
51. Juvenile rheumatoid Arthritis
58. DEGENERATIVE JOINT DISEASE
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Definition: AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause SYSTEMIC chronic disorder of connective tissue Diagnosed BEFORE age 16 years old
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OSTEOARTHRITIS The most common form of degenerative joint disorder
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OSTEOARTHRITIS Chronic, NON-systemic disorder of joints
52. Juvenile rheumatoid Arthritis
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PATHOPHYSIOLOGY : unknown Affected by stress, climate and genetics Common in girls 2-5 and 9-12 y.o.
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OSTEOARTHRITIS: Pathophysiology Injury, genetic, Previous joint damage, Obesity , Advanced age Stimulate the chondrocytes to release chemicals chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening
53. Juvenile rheumatoid Arthritis Poor prognosis Very Good prognosis Anorexia, anemia, fatigue Five or more joints Less than 4 joints Five or more joints Weight Bearing joints IRIDOCYCLITIS Salmon-pink rash Morning joint stiffness and fever MILD joint pain and swelling FEVER PolyarticularPauci-articular Systemic JRA 54. JRA
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OSTEOARTHRITIS: Risk factors 1. Increased age 2. Obesity 3. Repetitive use of joints with previous joint damage 4. Anatomical deformity 5. genetic susceptibility
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Symptoms may decrease as child enters adulthood With periods of remissions and exacerbations
55. JRA
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Medical Management ASPIRIN and NSAIDs- mainstay treatment Slow-acting anti-rheumatic drugs Corticosteroids
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OSTEOARTHRITIS: Assessment findings 1. Joint pain 2. Joint stiffness 3. Functional joint impairment limitation The joint involvement is ASYMMETRICAL This is not systemic, there is no FEVER, no severe swelling Atrophy of unused muscles Usual joint are the WEIGHT bearing joints
56. JRA
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Nursing Management Encourage normal performance of daily activities Assist child in ROM exercises Administer medications Encourage social and emotional development

Administer prescribed analgesics Application of heat modalities. ICE PACKS may be used in the early acute stage!!! Plan daily activities when pain is less severe Pain meds before exercising
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OSTEOARTHRITIS: Assessment findings 1. Joint pain Caused by Inflamed synovium Stretching of the joint capsule Irritation of nerve endings
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OSTEOARTHRITIS: Nursing Interventions 2. Advise patient to reduce weight
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OSTEOARTHRITIS: Assessment findings 2. Stiffness
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Aerobic exercise Walking 3. Administer prescribed medications
commonly occurs in the morning after awakening Lasts only for less than 30 minutes DECREASES with movement Crepitation may be elicited
NSAIDS
69. Rheumatoid arthritis
A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more women (ages 35-45) than men
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OSTEOARTHRITIS: Diagnostic findings 1. X-ray Narrowing of joint space Loss of cartilage Osteophytes 2. Blood tests will show no evidence of systemic inflammation and are not useful
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FACTORS: Genetic Auto-immune connective tissue disorders Fatigue, emotional stress, cold, infection
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Pathophysiology Immune reaction in the synovium attracts neutrophils releases enzymes breakdown of collagen irritates the synovial lining causing synovial inflammation edema and pannus formation and joint erosions and swelling
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OSTEOARTHRITIS: Medical management 1. Weight reduction 2. Use of splinting devices to support joints
72. Rheumatoid arthritis 3. Occupational and physical therapy
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4. Pharmacologic management
ASSESSMENT FINDINGS 1. PAIN 2. Joint swelling and stiffness- SYMMETRICAL, Bilateral 3. Warmth, erythema and lack of function 4. Fever , weight loss, anemia , fatigue 5. Palpation of join reveals spongy tissue 6. Hesitancy in joint movement
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Use of PARACETAMOL, NSAIDS
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Use of Glucosamine and chondroitin Topical analgesics Intra-articular steroids to decrease inflam
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OSTEOARTHRITIS: Nursing Interventions 1. Provide relief of PAIN
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ASSESSMENT FINDINGS Joint involvement is SYMMETRICAL and BILATERAL Characteristically beginning in the hands, wrist and feet Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement, diminishes as the day progresses
Can damage the kidney and causes bone marrow depression
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Nursing MANAGEMENT 1. Relieve pain and discomfort USE splints to immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE DEFORMITY Administer prescribed medications Suggest application of COLD packs during the acute phase of pain, then HEAT application as the inflammation subsides
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ASSESSMENT FINDINGS
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Joints are swollen and warm Painful when moved
79. Rheumatoid arthritis Deformities are common in the hands and feet causing misalignment Rheumatoid nodules may be found in the subcutaneous tissues
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Nursing MANAGEMENT 2. Decrease patient fatigue Schedule activity when pain is less severe Provide adequate periods of rests 3. Promote restorative sleep
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Diagnostic test
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1. X-ray Shows bony erosion
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2. Blood studies reveal (+) rheumatoid factor, elevated ESR and CRP and ANTI-nuclear antibody 3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory proteins
Nursing Management 4. Increase patient mobility Advise proper posture and body mechanics Support joint in functional position Advise ACTIVE ROME
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MEDICAL MANAGEMENT 1. Therapeutic dose of NSAIDS and Aspirin to reduce inflammation 2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid 3. For advanced cases- arthroplasty, synovectomy 4. Nutritional therapy
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Nursing Management 5. Provide Diet therapy Patients experience anorexia, nausea and weight loss Regular diet with caloric restrictions because steroids may increase appetite Supplements of vitamins, iron and PROTEIN
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MEDICAL MANAGEMENT GOLD THERAPY: IM or Oral preparation Takes several months (3-6) before effects can be seen
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6. Increase Mobility and prevent deformity: Lie FLAT on a firm mattress Lie PRONE several times to prevent HIP FLEXION contracture Use one pillow under the head because of risk of dorsal kyphosis
NO Pillow under the joints because this promotes flexion contractures
For acute attack
91. Gouty arthritis 83. Hot versus Cold ACUTE ATTACK After acute attack Use to control inflammation and pain Use to RELIEVE joint stiffness, pain and muscle spasm Cold HOT 84. Gouty arthritis
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Nursing Intervention 1. Provide a diet with LOW purine Avoid Organ meats, aged and processed foods STRICT dietary restriction is NOT necessary 2. Encourage an increased fluid intake (2-3L/day) to prevent stone formation 3. Instruct the patient to avoid alcohol 4. Provide alkaline ash diet to increase urinary pH 5. Provide bed rest during early attack of gout
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A systemic disease caused by deposition of uric acid crystals in the joint and body tissues CAUSES: 1. Primary gout- disorder of Purine metabolism
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2. Secondary gout- excessive uric acid in the blood like leukemia
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92. Gouty arthritis
87. Gouty arthritis
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Nursing Intervention 6. Position the affected extremity in mild flexion 7. Administer anti-gout medication and analgesics
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ASSESSMENT FINDINGS 1. Severe pain in the involved joints, initially the big toe 2. Swelling and inflammation of the joint 3. TOPHI- yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty appearance 4. PODAGRA
93. Fracture
A break in the continuity of the bone and is defined according to its type and extent
94. Fracture
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Severe mechanical Stress to bone bone fracture Direct Blows Crushing forces Sudden twisting motion Extreme muscle contraction
88. Gouty arthritis
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ASSESSMENT FINDINGS 5. Fever, malaise 6. Body weakness and headache 7. Renal stones
95. Fracture
89. Gouty arthritis
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TYPES OF FRACTURE 1. Complete fracture Involves a break across the entire crosssection 2. Incomplete fracture The break occurs through only a part of the cross-section
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DIAGNOSTIC TEST Elevated levels of uric acid in the blood Uric acid stones in the kidney
90. Gouty arthritis
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Medical management 1. Allupurinol- take it WITH FOOD
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Rash signifies allergic reaction
97. Fracture
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TYPES OF FRACTURE 1. Closed fracture
2. Colchicine
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The fracture that does not cause a break in the skin 2. Open fracture
104. Fracture
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The fracture that involves a break in the skin
ASSESSMENT FINDINGS 4. Crepitus A grating sensation produced when the bone fragments rub each other
99. Fracture
105. Fracture
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TYPES OF FRACTURE 1. Comminuted fracture A fracture that involves production of several bone fragments 2. Simple fracture
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DIAGNOSTIC TEST X-ray
106. Fracture
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A fracture that involves break of bone into two parts or one
EMERGENCY MANAGEMENT OF FRACTURE 1. Immobilize any suspected fracture 2. Support the extremity above and below when moving the affected part from a vehicle 3. Suggested temporary splints- hard board, stick, rolled sheets 4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest
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100. Fracture
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ASSESSMENT FINDINGS 1. Pain or tenderness over the involved area 2. Loss of function 3. Deformity 4. Shortening 5. Crepitus 6. Swelling and discoloration
107. Fracture
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EMERGENCY MANAGEMENT OF FRACTURE 5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination 6. DO NOT attempt to reduce the facture
101. Fracture
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ASSESSMENT FINDINGS 1. Pain
108. Fracture
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Continuous and increases in severity Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone
MEDICAL MANAGEMENT 1. Reduction of fracture either open or closed, Immobilization and Restoration of function 2. Antibiotics, Muscle relaxants and Pain medications
102. Fracture
109. Fracture
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ASSESSMENT FINDINGS
General Nursing MANAGEMENT For CLOSED FRACTURE 1. Assist in reduction and immobilization 2. Administer pain medication and muscle relaxants 3. teach patient to care for the cast 4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain
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2. Loss of function
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Abnormal movement and pain can result to this manifestation
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103. Fracture
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ASSESSMENT FINDINGS 3. Deformity Displacement, angulations or rotation of the fragments Causes deformity
110. Fracture
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General Nursing MANAGEMENT For OPEN FRACTURE 1. Prevent wound and bone infection Administer prescribed antibiotics Administer tetanus prophylaxis Assist in serial wound debridement 2. Elevate the extremity to prevent edema formation
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2. tachycardia 3. Chest pain 4. Crackles, wheezes and cough 5. Petechial rashes over the chest, axilla and hard palate
115. Fracture
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3. Administer care of traction and cast
FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 1. Support the respiratory function Respiratory failure is the most common cause of death Administer O2 in high concentration Prepare for possible intubation and ventilator support
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111. Fracture
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FRACTURE COMPLICATIONS Early 1. Shock 2. Fat embolism 3. Compartment syndrome 4. Infection 5. DVT
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116. Fracture
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FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 2. Administer drugs Corticosteroids Dopamine Morphine
112. Fracture
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FRACTURE COMPLICATIONS Late 1. Delayed union 2. Avascular necrosis 3. Delayed reaction to fixation devices 4. Complex regional syndrome
117. Fracture
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FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 3. Institute preventive measures Immediate immobilization of fracture Minimal fracture manipulation Adequate support for fractured bone during turning and positioning Maintain adequate hydration and electrolyte balance
113. Fracture
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FRACTURE COMPLICATIONS: Fat Embolism Occurs usually in fractures of the long bones Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs
118. Fracture
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Early complication: Compartment syndrome A complication that develops when tissue perfusion in the muscles is less than required for tissue viability
114. Fracture
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FRACTURE COMPLICATIONS: Fat Embolism Onset is rapid, within 24-72 hours ASSESSMENT FINDINGS 1. Sudden dyspnea and respiratory distress
119. Fracture
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Early complication: Compartment syndrome ASSESSMENT FINDINGS
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1. Pain- Deep, throbbing and UNRELIEVED pain by opiods Pain is due to reduction in the size of the muscle compartment by tight cast Pain is due to increased mass in the compartment by edema, swelling or hemorrhage
124. End of Musculoskeletal

1. 2.
Musculoskeletal System Part 2 Presentation Transcript
Below the knee amputaion Nursing Intervention
120. Fracture
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Early complication: Compartment syndrome ASSESSMENT FINDINGS 2. Paresthesia- burning or tingling sensation
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Preoperative Offer support/encouragement Discuss:
3. Numbness

4. Motor weakness 5. Pulselessness, impaired capillary refill time and cyanotic skin
Rehabilitation program & use of prosthesis Upper extremity exercise such as push ups in bed Crutch walking Amputation dressing/cast Phantom limb sensation as a normal occurrence Observe stump dressing for signs of hemorrhage and mark outside of dressing so rate of bleeding can be assessed (tourniquet at bedside)

121. Fracture
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Early complication: Compartment syndrome Medical and Nursing management 1. Assess frequently the neurovascular status of the casted extremity 2. Elevate the extremity above the level of the heart 3. Assist in cast removal and FASCIOTOMY 3.
122. Strains
Post-operative Care
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Excessive stretching of a muscle or tendon Nursing management 1. Immobilize affected part
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Prevent edema Raise extremity with pillow support for first 24 h Prevent hip/knee contractures
2. Apply cold packs initially, then heat packs

3. Limit joint activity 4. Administer NSAIDs and muscle relaxants
Avoid letting patient sit in chair with hips flexed for long periods of time Have patient assume prone position several times a day and position hip on extension Avoid elevation of stump after 24 hrs For BKA: hip & knee exercises For AKA: hip exercises Pain medication as ordered (phantom limb pain) Ensure that stump bandages fit tightly and are applied properly to enhance prosthesis fitting
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123. Sprains
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Excessive stretching of the LIGAMENTS Nursing management 1. Immobilize extremity and advise rest 2. Apply cold packs initially then heat packs
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3. Compression bandage may be applied to relieve edema 4. Assist in cast application 5. Administer NSAIDS 2.
Inflammatory Disorders of the Musculoskeletal System
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Rheumatoid arthritis chronic systemic inflammatory disease
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destruction of connective tissue and synovial membrane within the joints weakens and leads to dislocation of the joint and permanent deformity Risk Factors exposure to infectious agents fatigue
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Pharmacotherapy
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Gold compounds Injectable form: sodium thiomalate, aurothioglucose; given IM once a week; takes 3-6 months to become effective Oral form: auranofin- smaller doses are effective; diarrhea is a common side effect Corticosteroids Intra-articular injections
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stress
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Rheumatoid Arthritis 7.
Rheumatoid Arthritis
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Signs and Symptoms
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Morning stiffness
Treatment Surgical Procedures: synovectomy, arthrotomy, arthrodesis, arthroplasty Nursing Management Advised bed rest during acute pain Passive ROM exercise of joints Splint painful joints Heat & Cold application Advised warm bath in the morning Protect from infection Advised well-balanced diet
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Fatigue Weight loss Joints are warm, tender, and swollen Swan neck deformity-late Diagnostic Studies X-ray Elevated WBC, platelet count, ESR*, and positive RF Treatment
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No cure for RA 8. Arthrotomy Arthrodesis Arthroplasty Osteoarthritis (Degenerative Joint Disease) 9.
Swan neck deformity Rheumatoid Arthritis Pharmacotherapy
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Progressive degeneration of the joints as a result of wear and tear affects weight-bearing joints and joints that receive the greatest stress, such as the knees, toes, and lower spine .
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Aspirin- mainstay of treatment, has both analgesic and anti-inflammatory effects Nonsteroidal anti-inflammatory drugs (NSAIDs): Indomethacin (Indocin) Phenylbutazone (Butazoldin) Ibuprofen (Motrin) Fenoprofen (Nalfon) Naproxen (Naprosyn) Sulindac (Clinoril) I mmunosuppressives : Methotrexate Gold Standard for RA treatment Teratogenic
10. Osteoarthritis
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Risk Factors aging (>50 yr) rheumatoid arthritis arteriosclerosis obesity trauma family history Signs and Symptoms Dull, aching pain,* tender joints
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fatigability, malaise crepitus cold intolerance* joint enlargement
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Promote comfort: reduce pain, spasms, inflammation, swelling Heat to reduce muscle spasm Cold to reduce swelling and pain Prevent contractures: exercise, bed rest on firm mattress, splints to maintain proper alignment Weight reduction Isometric and postural exercises Nursing Diagnosis Pain related to friction of bones in joints Risk for injury related to fatigue Impaired physical mobility related to stiff, limited movement
presence of Heberdens nodes or Bouchards nodes weight loss
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11. Medications
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Aspirin inhibits cyclooxygenase enzyme, diminishes the formation of prostaglandins anti-inflammatory, analgesic, antipyretic action
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inhibit platelet aggregation in cardiac disorders Adverse effects Epigastric distress, nausea, and vomiting In toxic doses, can cause respiratory depression Hypersensitivity Reyes syndrome Ibuprofen use for chronic treatment of rheumatoid and osteoarthritis less GI effects than aspirin Adverse effects dyspepsia to bleeding headache, tinnitus and dizziness
14. Gouty Arthritis
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Metabolic disorder that develops as a result of prolonged hyperuricemia Caused by problems in synthesizing purines or by poor renal excretion of uric acid. Acute onset, typically nocturnal and usually monarticular, often involving the first metatarsophalangeal joint Risk Factors Men Age (>50 years) Genetic/familial tendency
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15. Gouty Arthritis
12. Medications
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Signs and Symptoms extreme pain swelling erythema of the involved joints fever Tophi Laboratory Findings elevated serum uric acid (>7.0 mg/dl)* urinary uric acid elevated ESR and WBC crystals of sodium urate aspirated from a tophus confirms the diagnosis*
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Indomethacin inhibits cyclooxygenase enzyme more potent than aspirin as an anti-inflammatory agent Adverse effects: nausea, vomiting, anorexia, diarrhea headache, dizziness, vertigo, light-headedness, and mental confusion Hypersensitivity reaction
13. Osteoarthritis
Nursing Intervention
16. Treatment
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Staphylococcus aureus is the most common pathogen. Other organisms include Proteus, Pseudomonas and E. Coli
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Allopurinol - a purine analog - reduces the production of uric acid by competitively inhibiting uric acid biosynthesis which are catalyzed by xanthine oxidase. Effective in the treatment of primary hyperuricemia of gout and hyperuricemia secondary to other conditions (malignancies). Adverse effects : hypersensitivity reactions, nausea and diarrhea Colchicine
19. Osteomyeliti s
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Risk Factors poorly nourished, elderly or obese impaired immune systems chronic illnesses long term corticosteroid therapy Clinical Manifestation area appears warm, swollen and extremely painful systemic manifestations (fever, chills, tachycardia) Diagnostic Studies X-ray Bone Scan Blood and wound culture
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Effective for acute attacks
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Anti-inflammatory activity alleviating pain within 12 hours Adverse effects : nausea, vomiting, abdominal pain, diarrhea, agranulocytosis, aplastic anemia, alopecia Probenecid/Sulfinpyrazone uricosuric agents increases the renal excretion of uric acid Sulfinpyrazone used as a preventive agent. Adverse effects: nausea, rash & constipation
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Promote comfort Immobilized affected bone by maintaining splinting. Elevate affected leg Administer analgesics as needed. Control infectious process Apply warm, wet soaks 20 min. several times a day. Administer antibiotics as prescribed. Use aseptic technique when dressing the wound. Encourage participation in ADL within the physical limitations of the patient.
17. Nursing Implementation
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Maintain a fluid intake of at least 2000 to 3000 ml a day to avoid kidney stone. Avoid foods high in purine such as wine, alcohol, organ meats, sardines, salmon, anchovies, shellfish and gravy. Take medication with food.
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Have a yearly eye examination because visual changes can occur from prolonged use of allopurinol Caution client not to take aspirin with these medication because it may trigger a gout attack and may cause an elevated uric acid levels. Encourage rest and immobilize the inflamed joints during acute attacks Avoid excessive alcohol intake
21. Osteoporosis
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Notify physician if rash, sore throat, fever or bleeding develops.
reduction of total bone mass change in bone structure, which increases susceptibility to fracture bone becomes porous, brittle, and fragile
22. Risk Factors
18. Osteomyelitis
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Menopause aging
Infection of the bone
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long term corticosteroid therapy high caffeine intake smoking high alcohol intake sedentary lifestyle or immobility insufficient calcium intake or absorption
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Relieving pain Improving bowel elimination Preventing injury Nursing Activities Encourage use of assistive devices when gait is unstable Protect from injury (side rails, walker) Encourage active/passive ROM Promote pain relief Encourage good posture and body mechanics
hereditary predisposition
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coexisting medical conditions (hyperparathyroidism, hyperthyroidism)
o o
23. Osteoporosis
o o o o o o o o o o o o
Clinical Findings loss of height fractures of the wrist, vertebral column and hip lower back pain kyphosis
26. Bone Tumors
o o o o
Osteosarcoma Most common primary bone tumor Occurs between 10-25 years of age, with Paget's disease and exposure to radiation Exhibits a moth-eaten pattern of bone destruction. Most common sites: metaphysis of long bones especially the distal femur, proximal tibia and proximal humerus
Respiratory impairment
o
Diagnostic Findings X-rays Dual-energy x-ray absorptiometry (DEXA) Serum calcium Serum phosphatase Urine calcium excretion
27. Osteosarcoma
o o o o o o o o o o
Clinical Manifestation local signs pain ( dull, aching and intermittent in nature), swelling, limitation of motion palpable mass near the end of a long bone systemic symptoms: malaise, anorexia, and weight loss Diagnostic Findings Biopsy- confirms the diagnosis X-ray MRI Bone Scan Increase alkaline phosphatase
24. Medical Management
o o o o
Pharmacologic Therapy Hormone replacement therapy Alendronate (Fosamax) Calcitonin- plasma levels of Ca, deposition of Ca in the bone
o o o o o o
Prevention Adequate dietary or supplemental calcium Regular weight bearing exercise Modification of lifestyle Calcium with vitamin D supplements Administer HRT, as prescribed
28. Medical Management
o o o
Radiation Chemotherapy Surgical management amputation
o
limb salvage procedures Prognosis: poor prognosis (rapid growth rate)
33. Dysplasia of the Hip
condition in which the head of the femur is improperly seated in the acetabulum, or hip socket, of the pelvis. Congenital or develop after birth
o o o o o
Promote understanding of the disease process and treatment regimen Promote pain relief
34. Assessment
o
Prevent pathologic fracture Assess for potential complications (infection, complications of immobility). Encourage exercise as soon as possible (1st or 2nd post-op day)
Neonates: laxity of the ligaments around the hip, allowing the femoral head to be displaced from the acetabulum upon manipulation. Implementation: Splinting of the hips with Pavlik harness to maintain flexion and abduction and external rotation (neonatal period)
o o
30. Total Hip Replacement
a plastic surgery that involves removal of the head of the femur followed by placement of a prosthetic implant
Pavlik harness 35. Assessment
o o
Infants Asymmetry of the gluteal and thigh skin folds when the child is placed prone and the legs are extended against the examining table. Limited range of motion in the affected hip. Asymmetric abduction of the affected hip when the child is placed supine with the knees and hips flexed. apparent short femur on the affected side
o o o o o o o
Teach client how to use crutches Teach client mechanics of transferring. Discuss importance of turning and positioning postop. Place affected leg in an abducted position and straight alignment following surgery Prevent hip flexion of more than 90 degrees. Apply support stockings
o o o
36. Congenital Hip Dysplasia
o o
Advise client to avoid external/internal rotation of affected extremity for 6 months to 1 year after surgery Instruct client to avoid excessive bending, heavy lifting, jogging, jumping Encourage intake of foods rich in Vitamin C, protein, and iron. Administer prescribed medications.
Implementation Traction and/or surgery to release muscles and tendons Following surgery, positioning and immobilization in a spica cast until healing is achieved.
o o o
37. Assessment
o o
The walking child minimal to pronounced variation in gait with lurching toward the affected side; positive Trendelenburg sign Positive Barlow or Ortolanis maneuver
Metallic implant 32. Complications
o o o o o o
Infection Hemorrhage Thrombophlebitis
Ortolanis maneuver Barlow maneuver 38. Scoliosis
o o
Pulmonary embolism
Lateral curvature of the spine Surgical and nonsurgical interventions are employed The type of treatment depends on the degree of curvature, the age of the child, and the amount of growth that is anticipated.
o
Prosthesis dislocation Prosthesis loosening
39. Assessment
o o o
Position as ordered Lower spinal surgery- flat Cervical spine surgery: slight elevation of head of bed Proper body alignment- cervical spinal surgery: avoid flexion of neck and apply cervical collar
o o o o o o o
visible curve fails to straighten when the child bends forward and hangs arms down toward feet. asymmetry of hip height pelvic obliquity inequalities of shoulder height
43. Laminectomy: Postoperative Care scapular prominence
o
rib prominence and rib humps severe cases, cardiopulmonary and digestive function may be affected because of compression or displacement of internal organs.
Avoid:
o o
Acute hip flexion (bending, stooping, crossing the legs Prolonged sitting/standing Running, jogging, horseback riding Back- strengthening exercises Prone position Walk in seawater Lie in side- lying with hip flexion
40. Nursing Intervention
o o o o o o o
Monitor progression of the curvature Prepare the child and parents for the use of a brace if prescribed Worn from 23 hours a day Inspect the skin for signs of redness or breakdown Keep the skin clean and dry, avoiding lotions and powders Advise the child to wear soft nonirritating clothing under the brace Scoliosis screening: 8 years old* 44.
45. Laminectomy: Postoperative Care
o
Patient teaching and Discharge Planning Wound care Good posture and proper body mechanics Activity level as ordered Recognition and reporting of complications such as wound infection, sensory or motor deficits
41. Nursing Implementation
o o o o o o
Prepare the child and parents for surgery if prescribed. Postoperative maintain proper alignment; avoid twisting movements logroll the child when turning, to maintain alignment instruct in activity restrictions instruct the child to roll from a side-lying position to a sitting position, and assist with ambulation
42. Laminectomy
o o o o
Surgical incision of part of posterior arch of vertebrae and removal of protruded disc Nursing Intervention Preoperative Teach patient log rolling and use of bedpan Postoperative

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Musculoskeletal System - Presentation Transcript

10. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

11. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

Involuntary and NON-striated

12. ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM

Bands of fibrous connective tissue that tie bones to muscles

13. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

LABORATORY PROCEDURES 1. BONE MARROW ASPIRATION

14. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

20. Nursing Management

15. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

21. Nursing Management

22. Nursing Management

16. ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

23. Nursing Management

PAIN These can be related to joint inflammation, traction, surgical intervention

24. Musculoskeletal Modalities

Long arm Short arm Spica

25. Nursing Management

34. Casting Materials

Lightweight and dries in 20-30 minutes Water resistant

35. Nursing Management

36. Nursing Management

31. Nursing Management

37. Nursing Management

32. Nursing Management

40. METABOLIC BONE DISORDERS

41. METABOLIC BONE DISORDERS

46. METABOLIC DISORDER

42. METABOLIC BONE DISORDERS

47. METABOLIC DISORDER

43. METABOLIC DISORDER 48. METABOLIC DISORDER

44. METABOLIC DISORDER

49. METABOLIC DISORDER

45. METABOLIC DISORDER

50. METABOLIC DISORDER

51. Juvenile rheumatoid Arthritis

58. DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS The most common form of degenerative joint disorder

59. DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS Chronic, NON-systemic disorder of joints

52. Juvenile rheumatoid Arthritis

60. DEGENERATIVE JOINT DISEASE

61. DEGENERATIVE JOINT DISEASE

62. DEGENERATIVE JOINT DISEASE

63. DEGENERATIVE JOINT DISEASE

68. DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Nursing Interventions 2. Advise patient to reduce weight

OSTEOARTHRITIS: Assessment findings 2. Stiffness

Aerobic exercise Walking 3. Administer prescribed medications

69. Rheumatoid arthritis

65. DEGENERATIVE JOINT DISEASE

70. Rheumatoid arthritis

71. Rheumatoid arthritis

66. DEGENERATIVE JOINT DISEASE

72. Rheumatoid arthritis 3. Occupational and physical therapy

67. DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Nursing Interventions 1. Provide relief of PAIN

73. Rheumatoid arthritis

Can damage the kidney and causes bone marrow depression

78. Rheumatoid arthritis

74. Rheumatoid arthritis