Musculoskeletal Disorders Flashcards
Health Assessment
- Chief complaint, onset, duration and manifestations
- Effects on function – ADL’s
- Precipitatingfactors
- Pain – 5th vital sign
- Inspect and palpate bones/ joints deformity, tenderness, swelling, warmth and ROM
- Gait, posture, sitting, ability to walk
- Muscle strength
Diagnostic Tests
- Xray
- CT
- MRI
- Bone density
- Bone Scan
- Arthroscopy & arthrocentesis
- Blood Work: Calcium, phosphate, alkaline phosphate, Uric acid, RF
Preventing Trauma
Prevention is key Teach importance of using safety equipment Older client - At highest risk for falls - Safety in the home
Soft Tissue Trauma: Nursing Care, Assessment
- Mechanism of injury
- Protective devices
- Pain assessment
- Inspection for redness, swelling, deformity
- Range of motion
- Palpation for warmth, tenderness, crepitus
Soft Tissue Trauma: Nursing Care; Decrease Swelling and Pain (PRICE)
To decrease swelling and pain - PRICE • Protect • Rest • Ice • Compression • Elevation - Heat after several days - NSAIDs • Impaired physical mobility
Soft Tissue Trauma: Nursing Care, Teaching
- Promote comfort
- Prevent further injury
- Allow healing
Joint Trauma: Nursing Care
• Assessment of pain,neuromuscular status • Traction to maintain alignment • Implement care to prevent complications of immobility • Teaching - Immobilization recommendations - Skin care - Pain control - Rehabilitation exercises
Dislocations
- Manual traction to reduce dislocation
- Narcotics
- Musclerelaxants
- Conscious sedation to control pain and manipulate the joint back into place
Fractures: Nursing Care
• Needs prompt treatment • Goal of treatment: - Anatomic realignment of bone fragments (reduction) - Immobilization to maintain alignment Restoration of normal function
Fractures: Emergency Care
- Immobilize before moving client
- Joint above and below
- Check pulse, colour, movement, sensation before splinting
- Sterile dressing for open wounds
Nursing Management: Nursing Assessment
Brief history of the accident
Mechanism of injury
Special emphasis focused on assessment of the region distal to the site of injury
Fractures: Nursing Care, Assessment; Neurovascular
Pain Pulses Sensation Skin color Temperature Motion Edema Motor Function
Collaborative Care: Fracture Reduction; Closed Reduction, Open Reduction
Closed reduction
Non‐surgical, manual realignment casts
Open reduction
Correction of bone alignment through a surgical incision
Casts
- Rigid device to immobilize bones and promote healing
- Plaster or fiber glass
- Joints above and below fracture
- Type of cast depends on type of fracture
Collaborative Care: Fracture Immobilization; Traction
Application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction
Prevent or reduce pain and muscle spasm Immobilization
Reduction
Treat a pathological condition
Prevent deformity
Traction
- Manual
- Skin
- Skeletal
- Straight
- Balanced suspension
Collaborative Care: Fracture Immobilization; Internal/ External Fixation
Internal Fixation
- ORIF
- Pins, plates, intramedullary rods, and screws
- Surgically inserted at the time of realignment
External fixation
- Metallic device composed of pins that are inserted into the bone and attached to external rods
Fractures: Other Interventions
- Analgesics
- NSAIDs
- Parenteral pain medications
- Stool softeners
- Anti‐ulcerdrugs
- Electrical bone stimulation
Fractures: Nursing Care
• Pain • Impaired Mobility • Risk for Ineffective Tissue Perfusion • Evaluate effectiveness - Pain control - Safety and mobility - Tissue perfusion
Fractures: Teaching, Risk for Falls
Teaching - Care at home - Safety assessment - Ambulation with Assistive devices • Risk for falls - Fall prevention - High risk for hip fractures • Decreased bone mass and muscle strength • Slowed reflexes • Medications affecting cognition and balance • Osteoporosis
Hip Fracture
• Break in the femur at the head, neck, or trochanter regions
- Intracapsular
- Extracapsular
• Pain, shortening, and external rotation of the affected lower extremity
Hip Fracture
- Buck’s traction
- ORIF
- Arthroplasty
- Total hip replacement
Hip Fracture Nursing Care
- Hip precautions
- Abductor pillow
- Isometric exercises
- Physical therapy
- Hip chair
- TED stockings and anticoagulants
- Skin integrity
Hip Fractures: Nursing Diagnosis
- Pain
- Impaired Physical Mobility
- Impaired Skin Integrity
Amputation: Nursing Care; Goals/ Nursing Diagnosis
Goals: - Physiological healing with no associated complications Pain relief - Achieve maximal rehabilitation potential Nursing Diagnosis: - Pain - Risk for Infection - Risk for Dysfunctional Grieving - Disturbed Body Image - Impaired Physical Mobility
Nursing Care: Amputaiton
- Assess pain
- Strategies for acute and chronic pain
- Drug and non‐drug interventions for pain
- Assistive devices
- Rest periods
- Emotional support
Amputation: Phantom Pain
Splint and support
Reposition
Encourage distraction, meditation, deep breathing and relaxation exercises
Amputation: Risk for Infection
Protect from contamination
Give antibiotics
Teach stump wrapping
Elevated WBC
Collaborative Care: Drug Therapy; Amputation
Muscle relaxant
Tetanus‐diphtheria toxoid or immunoglobulin
Bone‐penetrating antibiotic
- Cephalosporin
Amputation: Teaching
- Knowledge to care for needs
- Home management
Osteomyelitis Collaborative Care
• Vigorous and prolonged IV antibiotic therapy is the treatment of choice for acute osteomyelitis, as long as bone ischemia has not yet occurred
Collaborative Care: Antibiotics
– penicillin – cephalexin (Keflex) – cefazolin (Ancef) – cefoxitin (Mefoxin) – gentamicin (Garamycin) – tobramycin (Nebcin)
Collaborative Care: Antibiotics; Osteomyelitis
– Oral fluoroquinolone (ciprofloxacin [Cipro]) for 6‐8 weeks may be prescribed for chronic osteomyelitis or as a follow‐up of IV therapy
– Response to drug therapy is monitored through bone scans and ESR tests
Collaborative Care: Surgical Treatment; Osteomyelitis
– Removal of the poorly vascularized tissue and dead bone
– Antibiotic‐impregnated polymethymethacrylate bead chains may be implanted at this time to aid in combating the infection
Collaborative Care: Surgical Treatment; Osteomyelitis
– After debridement the wound may be closed, and a suction irrigation system is inserted
– Intermittent or constant irrigation of the affected bone with antibiotics may also be initiated
– Protection of the limb or surgical site with casts or braces is frequently done
Collaborative Care: Osteomyelitis
- Hyperbaric oxygen therapy of 100% oxygen may be administered in chronic osteomyelitis
- Orthopedic devices may need to be removed
- Myocutaneous flaps or skin and bone grafting may be necessary if destruction is extensive
Nursing Assessment: Subjective Data; Osteomyelitis
Past health history – Bone trauma, open fracture, wounds, infections Medications – Use of analgesics or antibiotics Surgery or other treatment – Bone surgery – IV drug abuse
Nursing Assessment: Subjective Data; Osteomyelitis
Health perception – IV drug abuse, malaise Nutritional‐metabolic – Anorexia, weight loss, chills Activity‐exercise – Weakness, paralysis, muscle spasms around affected bone
Nursing Assessment: Subjective Data; Osteomyelitis
Cognitive‐perceptual
– Local tenderness over affected area
Coping‐stress tolerance
– Irritability, withdrawal, dependency, anger
Nursing Assessment: Objective Data; Osteomyelitis
- Restlessness
- High, spiking temperature
- Diaphoresis
- Erythema, warmth, edema at infected bone
- Restricted movement
- Wound drainage
- Spontaneous fractures
Nursing Assessment: Objective Data; Osteomyelitis Possible Findings
- Leukocytosis
- Positive blood and/or wound cultures
- Elevated ESR
- Presence of sequestrum and involucrum
Osteomyelitis: Nursing Diagnoses
- Acute pain
- Impaired physical mobility
- Ineffective therapeutic regimen management
Osteomyelitis: Planning; Overall goals
– Satisfactory pain and fever control
– No complications
– Cooperation with treatment plan
– Maintenance of a positive outlook on the outcome of the disease
Osteomyelitis: Nursing Implementation; Acute Intervention
• Immobilization indicated to decrease pain
• Avoid excessive manipulation
• Pain assessment and intervention
– NSAIDs
– Narcotic analgesics
– Muscle relaxants
– Non‐pharmacological approaches to pain (e.g., relaxation breathing) should be encouraged by the nurse
Osteomyelitis: Nursing Implementation; Acute Intervention
• Wound management
– removal of devitalized tissue
– maintaining a moist wound balance
• Bed rest in the early stages for an acute infection
• Good body alignment and frequent position changes
Osteoporosis Nursing Management: Overall goals
Maintain or improve joint function
Use joint protection measures
Achieve independence of self‐care
Use pharmacological strategies to manage pain
Osteoporosis: Collaborative Care; Good/ Poor sources of calcium
• Good sources of calcium – Milk and milk products – Green leafy vegetables – Seafood – Almonds – Hazelnuts • Poor sources of calcium – Eggs – Beef – Poultry – Pork – Apple – Banana – Potato
Osteoporosis: Collaborative Care
- Supplemental vitamin D may be recommended
- Exercise should be encouraged to build up and maintain bone mass
- Clients should be instructed to quit smoking or cut down on alcohol intake to decrease losing bone mass
Osteoporosis: Collaborative Care; Drug Therapy
Estrogen replacement after menopause
Calcitonin
Bisphosphonates
Osteoarthritis: Collaborative Care; Goals
- Pain and inflammation management
- Prevent disability
- Maintain and improve joint function
Osteoarthritis: Nursing Management; Assessment
- Type, location, severity, frequency, and duration of joint pain and stiffness
- Pain‐relieving practices
Osteoarthritis: Collaborative Care
- Heat and cold applications
- Nutritional therapy and exercise
- Complementary and alternative therapies
Osteoarthritis: Collaborative Care
Rest and joint protection
Rest during any periods of acute inflammation
Immobilization not to exceed one week Health Promotion
• Elimination of modifiable risk factors
Rheumatoid Arthritis: Nursing Management; Nursing Diagnoses
- Acute and chronic pain
- Disturbed sleep pattern
- Impaired physical mobility
- Self‐care deficits
- Imbalanced nutrition: less than body requirements
- Chronic low self‐esteem
Rheumatoid Arthritis: Nursing Management; Goals
– Reduction of inflammation
– Management of pain
– Maintenance of joint function and prevention or correction of joint deformity with minimal loss of functional ability of the affected joints
– Participate in planning and carrying out the therapeutic regimen
– Maintain a positive self‐image
– Perform self‐care to maximum amount possible
Rheumatoid Arthritis: Collaborative Care; PT/ OT
Care of the client with RA – Drug therapy and education Physical therapy – Joint motion and muscle strength Occupational therapy – Upper extremity function – Assistive devices and strategies
RA: Collaborative Care; Drug Therapy
• Cornerstone of RA treatment
• Disease‐modifying anti‐rheumatic drugs (DMARDs)
– Potential to lessen the permanent effects of RA
RA: Collaborative Care; Drug Therapy
Based on the severity of symptoms Salicylates NSAIDs Non‐opioid analgesics Opioid analgesics Corticosteroids Immunosuppressants Antibiotics
RA: Collaborative Care; Nutritional Therapy
• Balanced nutrition is important
• Weight loss may result
– From loss of appetite
– Inability to shop for and prepare foods
• Corticosteroids or immobility may result in
unwanted weight gain
• Exercise reduces stress on arthritic joints
• Weight slowly adjusts to normal several months after cessation of therapy
RA: Ambulatory and Home Care; Rest, Body Alignment
• Body alignment – Firmmattress – Bedboard • Positions of extension – Avoid positions of flexion • Lying prone for half an hour twice daily • Light weight splints – Rest inflamed joints and prevent deformity • Skin care • Range‐of‐motion exercises
RA: Ambulatory and Home Care; Heat and Cold Therapy
• Help relieve stiffness, pain, and muscle spasm
• Cold (≤10 to 15 minutes at a time)
– Beneficial during periods of disease exacerbation
• Moist heat (≤20 minutes at a time)
– Relief of chronic stiffness
RA: Ambulatory and Home Care; Exercise
- Gentle range‐of‐motion exercises are done daily to keep joints functional
- Emphasize that usual daily activities do not provide adequate exercise to maintain joint function
- During acute inflammation, exercise should be limited to 1 to 2 repetitions
RA: Ambulatory and Home Care; Joint Protection
• Energy conservation • Work simplification techniques – Work should be done in short periods – Schedule rest breaks – Spread work throughout the week • Time‐saving joint protection devices
Gout: Assessment, Interventions
• Assessment
– Pain, joint swelling, tophi, uric acid stones, fever, and a history of trauma, injury, or surgery
• Interventions
– Acute Pain
– Impaired Physical Mobility
– Altered Urinary Elimination
– Ineffective Therapeutic Regimen Management
Gout: Nursing Interventions
– Asymptomatic hyperuricemia requires no medical treatment
– NSAID alone or with colchicine for acute gouty arthritis
– For subsequent attacks: indomethacin, corticosteroids, and corticotrophin
– Avoid foods high in purines
