1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

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1 Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 43 Caring for Clients with Musculoskeletal Disorders Scoliosis Diagnosed in adolescence More common in girls Idiopathic Scoliosis 1

2 Scoliosis X-rays show lateral curvature and rotation of the spine Severe scoliosis results in: Back pain Dyspnea Anorexia Crowding of internal organs Kyphosos Structural changes from multiple causes Hunchback Impaired mobility Potential respiratory yp problems if severe Kyphosis 2

3 Scoliosis/Kyphosis Diagnosis by x-rays Physical exam Symmetry of shoulders, scapulae, waist creases, length of arms Prominence of scapula or hip when bending over Thoracic rounding or lumbar swayback Risk for Injury Potential for skin breakdown from braces Osteoporosis Porous Bones Fragile bones with risk of fractures 80% are women over the age of 60 Cause unclear Osteoporosis Risk Factors Cannot be Changed Age Female Family history Endocrine disorders Can be Changed Calcium deficiency Estrogen deficiency Smoking Excess alcohol Sedentary lifestyle Medications 3

4 Osteoporosis Reduced bone mass Imbalance of bone growth and maintenance Peak bone mass at age 35 Formation does not keep pp pace with resorption, resulting in loss of bone mass Osteoporosis Type I Postmenopausal women ages Caused by estrogen deficiency Type II Men and women over age 70 Slow development Calcium deficiency Osteoporosis Focus is on stopping or slowing process Relieving symptoms Preventing complications Bone density measurement 4

recommendations TABLE 43-1 NIH Recommended Daily Calcium Intake.

5 Osteoporosis Calcium Vital in prevention Adequate intake may slow process Calcium needs change over lifetime NIH calcium intake recommendations TABLE 43-1 NIH Recommended Daily Calcium Intake. Medications Calcium supplements Hormone replacement Other drugs Osteoporosis 5

6 Osteoporosis Nursing Care Risk for Injury Imbalanced Nutrition: Less than Body Requirements Pain Osteoporosis Teaching Prevention Calcium intake in diet Physical activity Hormone replacement tth therapy Smoking Fall prevention Osteomalacia Adult rickets Inadequate mineralization of bone Insufficient amounts of calcium or phosphate No mineralization of bone matrix Bone unable to bear weight Results in deformities and pathologic fractures Cause is lack of vitamin D 6

7 Paget s Disease Increase of osteoclasts Osteoblasts are stimulated but produce soft and poorly mineralized bone Prone to fracture Cause unknown Osteomalacia/Paget s Disease Replace vitamin D Calcium and phosphate supplements Biphosphonates and calcitonin drugs Osteomyelitis Infection in the bone Staphylococcus aureus Any age Older adults at risk Pth Pathogens enter the bone from an open wound Spread to the bone from local tissue 7

Osteomyelitis Pathogens lodge and multiply Cause

to contain the infection, but release enzymes that destroy

the infection to spread Spreads along the surface

8 Osteomyelitis Pathogens lodge and multiply Cause inflammatory and immune system response Phagocytes attempt to contain the infection, but release enzymes that destroy bone tissue Canals in the marrow cavity of the bone allow the infection to spread Spreads along the surface Disruption of blood supply leads to necrosis Osteomyelitis Osteomyelitis 8

9 Osteomyelitis Early diagnosis and antibiotic therapy WBC Blood and tissue cultures MRI Bone scan Medications intravenously Surgery Cultures Debridement Osteomyelitis Nursing Care Pain Hyperthermia Impaired Physical Mobility Teaching Medications and wound management Rest and limited weight bearing Good nutrition Bone Tumors Benign or malignant Primary Adolescents Metastatic Adults Originates from tumors of the prostate, breast, kidney, thyroid, and lung 9

10 Primary Bone Tumors Classification Bone osteogenicosteogenic Cartilage chondrogenic Collagen collagenic Bone marrow myelogenicmyelogenic Primary tumors cause bone breakdown Bone Tumors Malignant tumors Invade and destroy adjacent bone tissue Benign tumors Symmetric controlled growth Weakening bone structure Risk for fractures Bone Tumors Diagnostic Tests X-rays CT scan and MRI Biopsy Serum alkaline phosphatase p RBC Serum calcium 10

11 Bone Tumors - Treatment Chemotherapy Radiation therapy Surgery Bone Tumors Nursing Care Pain Impaired Physical Mobility Disturbed Body Image Anticipatory Grieving Bone Tumors Nursing Care Teaching Disease Potential consequences Treatment options Home environment needs Wound care Activity and weight restrictions Resources 11

12 Common Foot Disorders Hallux valgus Hammertoe Hallux Valgus Bunion Enlargement and lateral displacement of great toe Due to chronic pressure against the great toe Heredity Pointed-toe toe shoes or high heels Metatarsophalangeal (MTP) joint enlarged Callus develops Hammertoe Flexion of the proximal interphalangeal joint with hyperextension of the MTP and distal interphalangeal joints Affects any toe Causes painful corns to develop 12

13 Foot Disorders Corrective shoes and orthotic devices Analgesics and corticosteroids Surgery Nursing Care Pain Risk for Infection Arthritis Inflammation of a joint Localized Osteoarthritis Systemic Rheumatoid arthritis Systemic lupus erythematosus Osteoarthritis Degenerative joint disease with progressive loss of joint cartilage Most common type Leading cause of disability in older adults Equal in men and women 13

14 Osteoarthritis Risk factors Age Repetitive joint use and trauma Heredity Obesity Congenital and acquired defects Osteoarthritis Entire joint affected Cartilage loses strength and elasticity and erodes and ulcerates Underlying bone exposed Cartilage-coated osteophytes (bony outgrowths) Osteoarthritis Manifestations and complications Inflammation in the joint Pain Decrease in joint range of motion Enlarged dj joints Herniated disk 14

Osteoarthritis History Physical and x-ray examination Weight reduction and exercise Heat for local pain relief Medications Surgery Arthroscopy Arthroplasty Reconstruction

15 Osteoarthritis History Physical and x-ray examination Weight reduction and exercise Heat for local pain relief Medications Surgery Arthroscopy Arthroplasty Reconstruction or replacement of the joint Total joint replacement Hip, knee, shoulder, elbow, ankle, wrist, joints of finger and toes Infection is major problem Total hip replacement. 15

diagnosis Chronic Pain Impaired Physical Mobility Self-Care Deficit Osteoarthritis Nursing

16 Total knee replacement. Osteoarthritis Nursing Care Assessment focuses on effects of the disease and ADLs Nursing diagnosis Chronic Pain Impaired Physical Mobility Self-Care Deficit Osteoarthritis Nursing Care Teaching Environmental safety Use of assistive devices to maintain independence Medications Activity and weight bearing Signs and symptoms of infection 16

Rheumatoid Arthritis Chronic systemic inflammatory disorder of the joints More women than men Ages 30 50 Multiple

bind with IgG to form immune complexes Complement activated and WBCs attracted to the area Cells phagocytize

17 Rheumatoid Arthritis Chronic systemic inflammatory disorder of the joints More women than men Ages Multiple joints Remission and exacerbations Rheumatoid Arthritis Autoimmune response Autoantibodies (rheumatoid factors) bind with IgG to form immune complexes Complement activated and WBCs attracted to the area Cells phagocytize immune complexes and also destroy the joint Figure Joint inflammation and destruction in rheumatoid arthritis. 17

(Source: Custom Medical Stock Photos, Inc.

18 Rheumatoid Arthritis Systemic symptoms Fatigue Anorexia Weight loss Aching and stiffness Destruction of joints and immobility Figure Typical hand deformities associated with rheumatoid arthritis. (Source: Custom Medical Stock Photos, Inc.) Rheumatoid Arthritis Diagnosis History and physical exam Rheumatoid factors Erythrocyte sedimentation rate Synovial lfl fluid aspirate X-rays Rest and exercise 18

19 Rheumatoid Arthritis - Treatment Medications Aspirin and NSAIDs Steroids Drugs to modify the autoimmune response Surgery Relieve pain and repair or replace joints Arthrodesis (joint fusion) Rheumatoid Arthritis - Treatment Plasmapheresis Total lympoid radiation Rheumatoid Arthritis Nursing Care Assessment focuses on progress of disease and effect on functional abilities Nursing diagnoses Pain Fatigue Ineffective Role Performance Disturbed Body Image 19

20 Rheumatoid Arthritis Nursing Care Teaching Disease and systemic effects Rest and exercise Medications Assistive devices Safety Systemic Lupus Erythematosus (SLE) Chronic inflammatory connective tissue disorder affecting multiple systems Mild to severe, even fatal More women than men Common and severe in African ancestry Cause unknown SLE Autoantibodies target normal cells Deposit immune complexes in the connective tissue of Blood vessels Lymphatic vessels Kidneys Musculoskeletal system Brain 20

mild and chronic Remissions and exacerbations Risk for infections Figure 43-8.

21 SLE Heart Lung GI tract Skin Peritoneum SLE Manifestations Mimic rheumatoid arthritis Fever Skin manifestations (butterfly rash) Photosensitivity Course is mild and chronic Remissions and exacerbations Risk for infections Figure The butterfly rash of systemic lupus erythematosus. (Source: Photo Reseachers, Inc.) 21

22 SLE Diagnostic Tests Antinuclear antibodies Anti-DNA C-reactive protein ESR Urinalysis Renal function tests SLE - Treatment Medications Aspirin and NSAIDs Antimalarial drugs Corticosteorids Other therapies Sunscreen End-stage renal disease treatment SLE Nursing Care Similar to arthritis patients Nursing diagnoses Impaired Skin Integrity Ineffective Protection 22

23 SLE Nursing Care Teaching Disease Psychosocial issues Skin care Exposure to infection Treatment plan Gout Metabolic disorder Accumulation of urate crystals in joints Men more than women Primary yg gout Genetic disorder Secondary gout Other causes or drugs Gout Imbalance of uric acid Joints become red, hot, swollen, and painful Frequent site is great toe 23

24 Gout Treatment focus NSAIDs Indocin Aspirin Nursing care Acute pain Teaching Disease signs and symptoms Medications Lyme Disease Inflammatory disorder caused by spirochete Borrelia burgdorferi Spread by ticks Seen in children and adults More common in Northeast, upper Midwest, and Pacific Coast Lyme Disease Enters skin at site of tick bite Incubation 30 days Lesion erythema erythema migrans Spread through lymph or blood to other sites Flat, slightly raised red lesion 24

25 Lyme Disease Systemic symptoms Fatigue Malaise Fever Muscle pain Secondary skin lesions and musculoskeletal symptoms Other chronic manifestions Lyme Disease Treatment NSAIDs and aspirin Nursing care Educational to prevent infection Ankylosing Spondylitis Chronic inflammatory arthritis of the spine Pain and progressive stiffening Insidious Pain worse at night with morning stiffness Intermittent or persistent bouts of low back pain Treatment NSAIDs to relieve pain and stiffness Supportive care and education 25

26 Fibromyalgia Fibrositis Common rheumatic syndrome of musculoskeletal pain, stiffness, and tenderness Women over the age of 50 Cause unknown Fibromyalgia Chronic achy muscle pain and tenderness at trigger points Systemic effects May resolve spontaneously or become chronic and recurrent Supportive treatment and care Low Back Pain Acute or chronic low back pain due to strains in muscles and tendons of the back Lumbar or lumbosacral or sacroiliac areas Degenerative disk disease or herniated vertebral disks 26

27 Five types of pain Local Referred Pain of spinal origin Radicular Muscle spasm Low Back Pain Diagnosis H&P X-rays, CT scan, MRI Low Back Pain Treatment Rest Ice packs Exercise Diathermy TENS NSAIDs and analgesics Low Back Pain 27

28 Low Back Pain Nursing Care Ineffective Health Maintenance Pain Teaching Safe lifting, bending, and turning Body mechanics, posture, sleeping on a firm mattress, chairs with good support Muscular Dystrophy Inherited muscle disease of progressive degeneration and wasting Most common form Duchenne s muscular dystrophy Inherited sex-linked recessive disorder d Mother to male children One out of 3,500 live male births Muscular Dystrophy Muscle fiber atrophy, necrosis, regeneration, and fibrosis lead to progressive weakness of voluntary muscle No cure Care focused on preserving and promoting mobility 28

CHAPTER 6 MUSCULOSKELETAL SYSTEM DISEASES, DISORDERS, AND DIAGNOSTIC TERMS. Ms. Doshi

CHAPTER 6 MUSCULOSKELETAL SYSTEM DISEASES, DISORDERS, AND DIAGNOSTIC TERMS Ms. Doshi Worksheet 1 pp 154-156 Review Exercises Infections Disease cellulitis myocellulitis osteitis osteomyelitis osteochondritis