Care of Patients with Musculoskeletal Problems Flashcards
Chronic metabolic disease in which bone loss causes decreased density and possible fracture - lack Ca in bone
Spine, hip, and wrist are most often at risk
Can be classified as generalized or regional
Generalized
Regional
Osteoporosis
decreased bone mass - bone weak
Chronic metabolic disease in which bone loss causes decreased density and possible fracture - lack Ca in bone - Osteoporosis
Postmenopausal women: decreased estrogen levels - estrogen helps move Ca in
Men in their seventh or eighth decade of life: decreasing levels of testosterone which builds bone
Generalized: Primary - Osteoporosis
Results from other medical conditions - lack ability get Ca into bone
Generalized: Secondary - Osteoporosis
Occurs when a limb is immobilized related to a fracture, injury, or paralysis - not moving Ca in bone
Immobility for longer than 8-12 weeks can result in this type of osteoporosis
Regional - Osteoporosis
Older age in both genders and all races
Parental history of osteoporosis, especially mother
History of low-trauma fracture after age 50
Low body weight - not much weight bearing on bones
Chronic low calcium and/or vitamin D intake
Estrogen or androgen (male) deficiency
Current smoking
High alcohol intake
Carbonation beverages or high phosphate levels
Lack of physical exercise or prolonged immobility
Osteoporosis risk factors
Excessive caffeine in the diet can cause calcium loss in the urine and carbonated beverages - high phosphate in them
A diet lacking enough calcium and vitamin D stimulates the parathyroid gland to produce parathyroid hormone which triggers the release of calcium from the bony matrix - not enough Ca tells release PTH which tells bone release Ca from bones
Activated vitamin D is needed for calcium uptake in the body - need sunlight activate vit D
Malabsorption of nutrients in GI tract contributes to low serum calcium levels
People not exposed to sunlight may be at higher risk because they do not receive adequate vitamin D for the metabolism of calcium
Calcium loss occurs at a more rapid rate when phosphorus intake is high
People drinking large amounts of carbonated beverages each day (over 40 ounces) are at high risk for calcium loss
Protein deficiency may reduce bone density, but excessive protein intake may increase calcium loss in the urine
Osteoporosis etiology
Build strong bones as a young person - activities
Decrease modifiable risk factors
Osteoporosis: teaching prevention
Build strong bones as a young person - activities
Decrease modifiable risk factors
Osteoporosis: teaching prevention
Especially young women - automatically bone loss starts after age 30
Build strong bones as a young person - activities - Osteoporosis: teaching prevention
Include dietary calcium: Dairy products and dark green, leafy vegetables
Importance of sun exposure - activated vit D
Adequate vitamin D in the diet or a supplement
Limit amount of carbonated beverages per day and caffeine in diet
Low alcohol
Exercise - huge: Weight bearing exercises (ex. Walking - gold standard) - good
Decrease modifiable risk factors - Osteoporosis: teaching prevention
Physical assessment
Lab
Imaging
Osteoporosis: assessment
Kyphosis
Reports of “getting shorter” - breakdown bony matrix in vertebra and will lose height
Pain
Assess for fractures (pain, swelling, misalignment) - high risk; unexplained fractures investigate
Physical assessment
No definitive lab test confirms the diagnosis of primary osteoporosis
Serum calcium and vitamin D3 levels annually for all women and men older than 50 who are at high risk for the disease
Lab
Dual x-ray absorptiometry (DXA or DEXA)
Xray Measures bone mineral density
Best tool available for a definitive diagnosis
Imaging
Nutrition therapy - HUGE
Exercise
Lifestyle changes
Drug therapy
Osteoporosis: interventions
Fruits and vegetables
Low-fat dairy and protein sources - increase Ca and sunlight
Increased fiber
Moderation of alcohol and caffeine
Decrease carbonation
Nutrition therapy - HUGE
Walking 30 minutes 3 to 5 times a week is the most effective - weight bearing exercise
Exercise
Avoid tobacco
Hazard-free environment to decrease risk for falls - safety precaution because high risk for fracture
Lifestyle changes
Calcium and vitamin D supplements
Stim osteoblasts
Bisphosphonates
Estrogen agonist/antagonists
Calcitonin
Drug therapy
Slows bone resorption by binding with crystal elements in bone and causes Ca stay in bone
Commonly taken
Ex. Alendronate (Fosamax); risedronate (Actonel); ibandronate (Boniva)
Severe esophagitis
Take early in the morning, 8 oz. of water, sit upright for 30-60 min - can cause reflux irritation
Bisphosphonates
Ex. raloxifene (Evista)
Inhibits bone resorption (breakdown of bones)
Stimulates osteoblast activity and inhibits PTH (parathyroid hormone)
Keeps Ca in bones
Estrogen agonist/antagonists
Inhibits bone resorption (breakdown of bones) - keeps Ca in bone
Calcitonin
Most common arthritis
Major cause of disability among adults older than 60
Also called osteoarthrosis or degenerative joint disease (DJD)
Progressive deterioration and loss of cartilage in one or more joints - looking at joints not bones
Causes:
Osteoarthritis
Combination of many factors: aging, genetic, obesity (more wear and tear on joints), joint injury, occupation
More females affected 2:1
Causes: - Osteoarthritis
History
Disease pattern:
Physical assessment/Key Features:
Osteoarthritis: assessment
Typ Unilateral, single joint
Affects weight-bearing joints and hands (frequent use), spine
Non-systemic - indiv joints
Disease pattern:
Chronic joint pain and stiffness
Herbeden’s Nodes (in joints of hand)
Physical assessment/Key Features:
Psychosocial assessment: - hard be in pain
Imaging: - BIG; diagnosis
Lab findings:
Osteoarthritis: assessment
Cannot do things independent or do ADLs
Constant, chronic pain
Inability to care for oneself
Depression and anxiety
Altered body image
Decreased self-esteem
Psychosocial assessment: - hard be in pain
X-rays
MRI
CT
Imaging: - BIG; diagnosis
Normal or slightly elevated ESR
Slightly elevated C-reactive protein (CRP)
Inflammatory markers
Lab findings:
Chronic pain related to cartilage deterioration
Decreased mobility related to joint pain and muscle atrophy
Osteoarthritis: planning/nursing diagnosis: Priority problems:
Pain control that is acceptable to the patient
Moves and functions in his or her own environment independently with or without assistive devices - as mobile and functional as possible
Osteoarthritis: planning/nursing diagnosis: Expected outcomes:
Tylenol drug of choice
Topical drug applications lidocaine 5% patch (Lidoderm)
NSAIDs
Cortisone injections - stop-gap things; not control pain with PO meds; tiding to get joint replacement as late in life as possible
Muscle relaxants
Osteoarthritis: treatments/interventions: Drug therapy:
Not a primary inflammatory disorder
Tylenol drug of choice
May apply for 12 hours each day
Relieve pain and right on area where pain is
Topical drug applications lidocaine 5% patch (Lidoderm)
CBC, kidney, liver function tests are obtained for baseline
From tylenol to here
If inflammation gets worse
Ex. celecoxib (Celebrex); ibuprofen
NSAIDs
Rest, balanced with exercise - active as can be but rest joints
Joint positioning
Heat or cold applications - good thing
Weight control (to decrease stress on joints) - first things do
Osteoarthritis: treatment/interventions: Nonpharmacologic:
Most common procedure is total joint arthroplasty
Hip and knee joints are most commonly replaced
Osteoarthritis: treatment/interventions: Surgery:
Active infection
Advanced osteoarthritis
Rapidly progressive inflammation; age
Osteoarthritis: treatment/interventions: Contraindications to surgery:
Dislocation:
Infection:
Venous thromboembolism:
Bleeding and hypotension:
Neurovascular compromise:
Scar tissue formation (total knee arthroplasty):
Total joint arthroplasty: complications and nursing interventions
Position correctly
Hip: keep leg slightly abducted and prevent hip flexion beyond 90 degrees - lot precautions taken - keep hips in joint
Assess for pain, rotation, and extremity shortening - out of joint
Dislocation:
Use aseptic technique for wound care and emptying of drains
Take out joint if infection
Culture drainage fluid, if needed
Monitor temperature
Report excessive inflammation or drainage
Infection:
Highest risk for DVT
Use of sequential compression devices and/or compression hose
Teach leg exercises,
Encourage fluid intake,
Observe for signs of thrombosis (redness, swelling, or pain);
Administer anticoagulant as prescribed,
Do not massage legs if already have DVT
Venous thromboembolism:
VS at least every 4 hours
Observe patient for bleeding
Fluid volume lost in OR so always keep an eye of vitals
Assist with slow position changes
Bleeding and hypotension:
Check and document color, temperature, distal pulses, capillary refill, movement, and sensation
Compare the operative leg with the nonoperative leg
Neurovascular compromise:
Continuous passive motion (CPM) machine
Keeps the knee in motion
Formation of scar tissue can decrease knee mobility and increase postoperative pain - passive movement
Slowly increase angle and mobility as pat improves
Scar tissue formation (total knee arthroplasty):
