Table 61-5: Normal Physical Assessment of the Musculoskeletal System, p Table 61-1: Gerontologic Assessment Differences, p1451
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1 Unit II: Activity and Rest Needs- Musculoskeletal System Los Angeles Harbor College Associate Degree Nursing Program Description: After appropriate study and practice, the nursing student will be able to plan and give care to adult patients in an acute hospital setting to meet identified needs; with special emphasis on activity and rest needs due to pain, soft tissue injuries, fractures, bone tumors, amputations, osteomyelitis, osteoporosis, Paget s disease, osteomalacia, lower back pain, common hand and foot disorders and connective tissue disorders. The Roy Adaptation Model and the Nursing Process will be integrated to provide a nursing framework for providing nursing care to patients with adaptation problems relating to activity and rest needs. Estimated time of achievement: Two weeks Objectives: Course Content Learning Activities QSEN Concepts Section 11: Problems Related to Chapter 61: Assessment of Movement and Coordination Musculoskeletal System, pages (Chapters 61-64) Select significant subjective and objective data related to the musculoskeletal system. 2. Select appropriate techniques to use in the physical assessment of the musculoskeletal system. 3. Determine abnormal findings of a physical assessment of the musculoskeletal system. 4. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the musculoskeletal system. Table 61-2: Health History Musculoskeletal System, p.1452 Table 61-5: Normal Physical Assessment of the Musculoskeletal System, p Table 61-6: Assessment Abnormalities Musculoskeletal System, p Table 61-1: Gerontologic Assessment Differences, p1451 Table 61-7: Diagnostic Studies Musculoskeletal System, p : Standard x- ray, Diskogram, Computed tomography (CT) scan, 1 Case Study Patient Introduction, p Subjective Data, p Objective Data: Physical Examination, p Diagnostic Studies, p Online Student Resources: s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Patient- Centered Care Gerontologic Considerations: Effects of Aging on Musculoskeletal System, p Genetic Risk Alert, p Table 61-1: Gerontologic Assessment Differences, p Table 61-2: Health History: Musculoskeletal System, p Teamwork and Collaboration Discussion Role- Relationship Pattern, p Quality Improvement Focused Assessment: Musculoskeletal System, p Safety Genetic Risk Alert, p. 1453
2 5. Differentiate among the etiology, pathophysiology, clinical manifestations, nursing management, and interprofessional care of soft tissue injuries, including strains, sprains, dislocations, subluxations, anterior cruciate ligament, types of fractures, and amputations. 6. Relate the sequential events involved in fracture healing and explain common complications associated with a fracture and fracture healing. 7. Compare closed reduction, cast immobilization, open reduction, and traction in terms of purpose, nursing management, and complications. 8. Describe the types of joint replacement surgery for arthritis and prioritize the preoperative and postoperative management of joint replacement surgery. Myelogram with or without CT, MRI. Bone Mineral Density (BMD) Measurements: Dual energy x- ray absorptiometry (DXA), Radioisotope Studies: Bone scan. Mineral Metabolism: Alkaline phosphate, Calcium, Phosphorus. Serologic Studies: Rheumatoid factor (RF), Uric acid, C- reactive protein (CRP). Markers of muscle injury: Creatine kinase (CK). Invasive Procedures: Arthrocentesis, Arthroscopy, Electromyogram (EMG). Miscellaneous: Duplex venous Doppler Sprains & Strains Fractures Complications of Fx s Hip Fracture Amputation Table 62-4: Manifestations of Fracture, p Table 62-5: Complications of Fracture Healing, p Table 62-10: Problems Associated with Musculoskeletal Injuries, p Table 62-3: Emergency Management Acute Soft Tissue Injury, p Table 62-6: Interprofessional Care, p Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery, pages (Sprains & Strains, Fractures, Fracture Complications, Hip Fracture, Amputation) Case Study Periprosthetic Hip Fracture and Revision Arthoplasty, p Online Student Resources: s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Patient- Centered Care Gerontologic Considerations: Hip Fracture, p Gerontologic Considerations: Amputation, p Table 62-1: Patient & Caregiver Teaching: Prevention of Musculoskeletal Problems in Older Adults, p Table 62-9: Patient & Caregiver Teaching Guide: Cast Care, p Table 62-11: Patient & Caregiver Teaching: Hip Replacement, p Table 62-14: Patient & Caregiver Teaching: Following Lower Extremity Amputation, p Teamwork and Collaboration Ambulatory Care, pp. 1464, 1477, 1484, 1490 Nursing and Interprofessional Management, pp. 1465, 1466, 1467, 2
3 Table 62-7: Emergency Management Fractured Extremity, p Table 62-8: Nursing Assessment Fracture, p Table 62-13: Interprofessional Care Amputation, p Table 62-9: Patient & Caregiver Teaching Cast Care, p Table 62-11: Patient & Caregiver Teaching Hip Replacement, p Table 62-14: Patient & Caregiver Teaching Following Lower Extremity Amputation, p Teamwork & Collaboration: Caring for the Patient With a Cast or Traction, p Evidence- Based Practice Evidence- Based Practice: Translating Research Into Practice Do Physical Activity Exercises Decrease Sport Injuries?, p Safety Discussion Health Promotion, pp. 1463, 1475, 1488 Safety Alert, pp. 1462,1480 Table 62-3: Emergency Management: Acute Soft Tissue Injury, p Table 62-7: Emergency Management: Fractured Extremity, p Informatics/Nursing Judgment Informatics in Practice: Web- Based Knee and Hip Replacement Community, p Describe the etiology, pathophysiology, clinical manifestations, nursing management, interprofessional care, including surgical therapy, and nursing management of osteoporosis, osteomyelitis, and acute/chronic low back pain (including intervertebral disc disease). Osteoporosis Osteomyelitis Acute/Chronic Low Back Pain Table 63-2: Nursing Assessment - Osteomyelitis, p Table 63-5: Nursing Assessment Low back pain, p Table 63-7: Chapter 63: Musculoskeletal Problems, pages Case Study Metastatic Bone Tumor/Pathologic Fracture, p Teamwork and Collaboration/Professional Identity Discussion Muscular Dystrophy, p Online Student Resources: Patient- Centered Care Genetic Link, p Gerontologic Considerations: Foot Problems, p Gerontologic Considerations: Metabolic Bone Diseases, p Table 63-6: Patient & Caregiver Teaching: Low Back Problems, p Table 63-10: Patient & Caregiver Teaching: Neck Exercises, p Genetics in Clinical Practice: Duchenne and Becker Muscular Dystrophy (MD), p
4 Manifestations of Lumbar Disc Herniation, p Table 63-12: Risk Factors for Osteoporosis, p Table 63-8: Interprofessional Care Intervertebral Disc Disease, p s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Cultural & Ethnic Health Disparities: Osteoporosis, p Gender Differences: Osteoporosis, p Safety Drug Alerts, pp. 1498, 1513 Safety Alert, pp. 1502, 1514 Table 63-12: Risk Factors for Osteoporosis, p Table 63-13: Interprofessional Care Osteoporosis, p Table 63-6: Patient & Caregiver Teaching Low Back Problems, p Compare and contrast the sequence of events leading to joint destruction in osteoarthritis and rheumatoid arthritis. 11. Differentiate among the etiology, pathophysiology, clinical manifestations, nursing management and interprofessional care, including surgical therapy of osteoarthritis, rheumatoid arthritis, gout, and systemic Lupus Erythematosus (SLE). Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout Systemic Lupus Erythematosus (SLE) Table 64-5: Stages of Rheumatoid Arthritis, p Table 64-6: Comparison of Rheumatoid Arthritis and Osteoarthritis, p Table 64-7: Diagnostic Criteria for Rheumatoid Arthritis, p Table 64-9: Nursing Assessment Rheumatoid Arthritis, p Chapter 64: Arthritis and Connective Tissue Diseases, pages Case Study Rheumatoid Arthritis, p Managing Multiple Patients, p Online Student Resources: s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Patient- Centered Care Genetic Link, p Gerontologic Considerations: Arthritis, p Table 64-4: Patient & Caregiver Teaching: Joint Protection and Energy Conservation, p Table 64-10: Patient & Caregiver Teaching: Protection of Small Joints, p Table 64-13: Patient & Caregiver Teaching: Prevention and Early Treatment of Lyme Disease, p Table 64-17: Patient & Caregiver Teaching: Systemic Lupus Erythematosus, p Gender Differences: Osteoarthritis (OA), p
5 Table 64-14: Diagnostic Criteria for Systemic Lupus Erythematosus, p Table 64-16: Nursing Assessment Systemic Lupus Erythematosus, p Table 64-2: Interprofessional Care - Osteoarthritis, p Table 64-8: Interprofessional Care - Rheumatoid Arthritis, p Table 64-12: Interprofessional Care - Gout, p Table 64-15: Interprofessional Care - Systemic Lupus Erythematosus, p Table 64-10: Patient & Caregiver Teaching Protection of Small Joints, p Table 64-17: Patient & Caregiver Teaching Systemic Lupus Erythematosus, p Diagnostic & Laboratory Exams Gender Differences: Gout, p Cultural & Ethnic Health Disparities: Arthritis and Connective Tissue Disorders, p Genetics in Clinical Practice: Ankylosing Spondylitis, p Teamwork and Collaboration Ambulatory Care, pp. 1524, 1531, 1542 Interprofessional Care, pp. 1519, 1528, 1533, 1537, 1540, 1543, 1547 Nutritional Therapy, pp. 1529, 1534 Nursing Management: Fibromyalgia, p Myofascial Pain Syndrome, p Evidence- Based Practice Table 64-5: Stages of Rheumatoid Arthritis, p Table 64-7: Diagnostic Criteria for Rheumatoid Arthritis, p Table 64-13: Patient & Caregiver Teaching: Prevention and Early Treatment of Lyme Disease, p Table 64-14: Diagnostic Criteria For Systemic Lupus Erythematosus, p Complementary & Alternative Therapies: Acupuncture, p Complementary & Alternative Therapies: Glucosamine and Chondroitin, p Safety Drug Alerts, pp. 1529,
6 Drug Therapy List Chapter 62 Chapter 63 Chapter 64 Non- steroidal anti- inflammatory drugs (NSAIDs) Antibiotic therapy cefazolin, vancomycin Analgesics nonopioid/opioid morphine, hydromorphone (Dilaudid) Muscle relaxants cyclobenzaprine (Flexeril), methocarbamal (Robaxin) Stool softeners/laxatives Docusate sodium (Colace), polyethylene glycol (Miralax) Anticoagulants warfarin (Coumadin) Low- molecular weight heparin enoxaparin (Lovenox), dalteparin (Fragmin) Factor Xa inhibitor fondaparinux (Arixtra), rivaroxaban (Xarelto), apixaban (Elquis) Antibiotic therapy cephalexin, cefazolin, cefoxitin, gentamicin, tobramycin, penicillin, vancomycin, ciprofloxacin (Cipro) Non- steroidal anti- inflammatory drugs (NSAIDs) Corticosteroid oral/epidural injections prednisone Analgesics nonopioid/opioid morphine, hydromorphone (Dilaudid) Muscle relaxants cyclobenzaprine (Flexeril), methocarbamal (Robaxin) Stool softeners/laxatives Docusate sodium (Colace), polyethylene glycol (Miralax) Antidepressants Duloxetine (Cymbalta) Antiseizure Gabapentin (Neurontin) Biphosphonates Analgesics nonopioid acetaminophen (Tylenol) Salicylates aspirin Non- steroidal anti- inflammatory drugs (NSAIDs) ibuprofen (Advil), naproxen (Aleve), indomethacin (Indocin), meloxicam (Mobic), celecoxib (Celebrex) Antibiotics doxycycline (Vibramycin), Topical analgesics capsaicin cream, diclofenac sodium (Volatren gel) Corticosteroids intraarticular injections methylprednisolone acetate (Depo- Medrol), triamcinolone (Aristospan) Corticosteroids systemic hydrocortisone (Solu- Cortef), methylprednisolone (Solu- Medrol), dexamethasone, prednisone, triamcinolone 6
7 Tetanus and diphtheria prophylaxis alendronate (Fosamax) Selective estrogen receptor modulator raloxifene (Evista) Antigout colchicine (Colcrys), allopurinol (Zyloprim), febuxostat (Uloric), Disease- modifying antirheumatic drugs (DMARDs) methotrexate (Trexall), sulfasalazine (Azulfidine) Gold compounds parenteral: gold sodium thiomalate aurothioglucose; oral: auranofin (Ridaura) Antimalarial Hydroxychloroquine (Plaquenil) Immunosuppressants azathioprine (Imuran), mofetil (Cellcept) JAK (Janus Kinase) inhibitor tofacitinib (Xeljanz) Biologic Response Modifiers (Biologics, Immunotherapy) Tumor necrosis factor inhibitors infliximab (Remicade), adalimumab (Humira) Interleukin- 1 receptor antagonist anakinra (Kineret) 7
8 Interleukin- 6 receptor antagonist tocilizumab (Actemra) T cell activation inhibitor abatacept (Orencia) B cell depleting agent rituximab (Rituxan) Topical immunomodulators Tacrolimus (Prograf) 8
9 9
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